62 Year Old Male - Latest Blood Work - Comments Please

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jacb

Active Member
Please find attached my latest Blood Work.

The PDF also shows my starting Base Line Tests taken two years ago.

I was on 110mg Test Cyp' (2 x 55mg) IM Per week and 500IU hCG (2 x 250IU) when I visited the UK in early 2021 ... Little did I know that Covid 19 would prevent me from returning home for eight months. During my stay I ran out of hCG and was not able to access tests under UK lock down. I had little option other than to revert to Testosterone Cypionate only ... but at what mg?
I elected to try 150mr per week (2 x 75mg IM) of "British Dragon" Testosterone Cypionate. These are the results of 3 Months 15 days on that protocol. The blood was drawn in the trough (ie just before next T injection was scheduled)..

Prior to my UK trip I had tried to have a Phlebotomy / Venesection for elevated HCT reasons but had failed to find a way of getting it done in NZ. Blood donation was not an option because I lived for more than 6 Months in the UK between 1980/1996 and NZ are still worried about vCJD.

When I returned to the UK I tried to donate blood and was accepted ... but they were not able to complete the procedure due to my "veins not being suitable". (small ?).

Net result ... Phlebotomy / Venesection is not an option for me.

I was WELL hydrated. 3 Litres+ per day for at least four days prior to the test blood being drawn.

I believe my Testosterone is now too high ... but that begs the question of what target value to aim for? I think 800 pmol/L is a sensible target .... But that it depends on ones SHBG, Albumin and Free Testosterone. Free testosterone seems to be the driving factor for ones Total Testosterone Target - can anyone elaborate on the Free/Total ratio issue now that I have actual figures.

I also believe that my E2 is too high ... But again Nelson has being saying that it is a ratio (testosterone/E2) and yes it is a large number, but if the ratio is OK then, so is a large number. E2 will go up with T. Thoughts please?

SHBG (what is a normal range) ... am I high/low/normal? Slight change from my base value (might be test error range issue).

All in all I feel fine but I have put on quite a bit of weight (fat) unexpectedly since changing protocol and yes some of it is on my chest (Gyno?). However I do not have any nipple issue (enlargement/tenderness etc).

I would like to go back on hCG primarily because of: Penile sensitivity (big change). I would like to keep some ITT activity if possible and I don't much care for the Testicular atrophy mono Test/Cyp brings or the reduced ejaculate.

Wow a lot there .... Appreciate any thoughts

Regards
 

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Defy Medical TRT clinic doctor

madman

Super Moderator
Please find attached my latest Blood Work.

The PDF also shows my starting Base Line Tests taken two years ago.

I was on 110mg Test Cyp' (2 x 65mg) IM Per week and 500IU hCG (2 x 250IU) when I visited the UK in early 2021 ... Little did I know that Covid 19 would prevent me from returning home for eight months. During my stay I ran out of hCG and was not able to access tests under UK lock down. I had little option other than to revert to Testosterone Cypionate only ... but at what mg?
I elected to try 150mr per week (2 x 75mg IM) of "British Dragon" Testosterone Cypionate. These are the results of 3 Months 15 days on that protocol. The blood was drawn in the trough (ie just before next T injection was scheduled)..

Prior to my UK trip I had tried to have a Phlebotomy / Venesection for elevated HCT reasons but had failed to find a way of getting it done in NZ. Blood donation was not an option because I lived for more than 6 Months in the UK between 1980/1996 and NZ are still worried about vCJD.

When I returned to the UK I tried to donate blood and was accepted ... but they were not able to complete the procedure due to my "veins not being suitable". (small ?).

Net result ... Phlebotomy / Venesection is not an option for me.

I was WELL hydrated. 3 Litres+ per day for at least four days prior to the test blood being drawn.

I believe my Testosterone is now too high ... but that begs the question of what target value to aim for? I think 800 pmol/L is a sensible target .... But that it depends on ones SHBG, Albumin and Free Testosterone. Free testosterone seems to be the driving factor for ones Total Testosterone Target - can anyone elaborate on the Free/Total ratio issue now that I have actual figures.

I also believe that my E2 is too high ... But again Nelson has being saying that it is a ratio (testosterone/E2) and yes it is a large number, but if the ratio is OK then, so is a large number. E2 will go up with T. Thoughts please?

SHBG (what is a normal range) ... am I high/low/normal? Slight change from my base value (might be test error range issue).

All in all I feel fine but I have put on quite a bit of weight (fat) unexpectedly since changing protocol and yes some of it is on my chest (Gyno?). However I do not have any nipple issue (enlargement/tenderness etc).

I would like to go back on hCG primarily because of: Penile sensitivity (big change). I would like to keep some ITT activity if possible and I don't much care for the Testicular atrophy mono Test/Cyp brings or the reduced ejaculate.

Wow a lot there .... Appreciate any thoughts

Regards

You are injecting 150mg T/week (75 mg every 3.5 days).

As you can clearly see you are hitting a high-end trough TT 1098 ng/dL but more importantly with an SHBG 26 nmol/L your trough FT would be absurdly high.

Normal SHBG would be 30-35 nmol/L.

CFTZ (TruT) would have your trough FT level 41.27 ng/dL.

Keep in mind that your peak TT, FT, and estradiol will be higher.

FT 5-10 ng/dL is considered low.

FT 16-31 ng/dL (top-end) is healthy.

Most men will do well with FT 20-30 ng/dL.

Some may choose/feel better running higher levels.

Comes down to the individual.

Most struggling with sides are running to high an FT level.

Excess FT levels can result in acne/oily skin (genetically prone), accelerated balding (genetically prone), drive down HDL, increased RBCs/hemoglobin/hematocrit (common), overstimulation of the CNS (common), bloating/water retention due to androgens effects on the retention of electrolytes (common).

Let alone many end up trying to manage estradiol with the use of an aromatase inhibitor.

Some of the side effects are due to testosterone metabolites estradiol/DHT.

Easy to see that your RBCs/hemoglobin/hematocrit let alone estradiol is elevated due to running a very high trough FT.

You easily have room to lower your overall weekly dose and bring down your FT level which will have a big impact on driving down your RBCs/hemoglobin/hematocrit and estradiol let alone may end up feeling better overall minus any sides.

If one truly feels good overall, blood markers were healthy, minus any sides then I would say leave it be.

You could easily still hit a healthy high-end FT running a TT 800ng/dL.

Even then keep in mind that depending on your protocol (dose of T/injection frequency) there can be a significant difference in peak--->trough.

Too many get caught up on running absurdly high FT levels let alone at trough!
 

Vince

Super Moderator
It would be interesting to see what your A1C is at. Are you taking any meds like metformin? Also, are you supplementing with vitamin D3? Personally, I think the best supplement for anyone is magnesium.

Another thought I have. Does melatonin help lower or stabilize? HCT.

Injecting 500 IU of HCG and 50 mg of testosterone twice a week would be a good starting protocol.
 

jacb

Active Member
You are injecting 150mg T/week (75 mg every 3.5 days).

As you can clearly see you are hitting a high-end trough TT 1098 ng/dL but more importantly with an SHBG 26 nmol/L your trough FT would be absurdly high.

Normal SHBG would be 30-35 nmol/L.

CFTZ (TruT) would have your trough FT level 41.27 ng/dL.

Keep in mind that your peak TT, FT, and estradiol will be higher.

FT 5-10 ng/dL is considered low.

FT 16-31 ng/dL (top-end) is healthy.

Most men will do well with FT 20-30 ng/dL.

Some may choose/feel better running higher levels.

Comes down to the individual.

Most struggling with sides are running to high an FT level.

Excess FT levels can result in acne/oily skin (genetically prone), accelerated balding (genetically prone), drive down HDL, increased RBCs/hemoglobin/hematocrit (common), overstimulation of the CNS (common), bloating/water retention due to androgens effects on the retention of electrolytes (common).

Let alone many end up trying to manage estradiol with the use of an aromatase inhibitor.

Some of the side effects are due to testosterone metabolites estradiol/DHT.

Easy to see that your RBCs/hemoglobin/hematocrit let alone estradiol is elevated due to running a very high trough FT.

You easily have room to lower your overall weekly dose and bring down your FT level which will have a big impact on driving down your RBCs/hemoglobin/hematocrit and estradiol let alone may end up feeling better overall minus any sides.

If one truly feels good overall, blood markers were healthy, minus any sides then I would say leave it be.

You could easily still hit a healthy high-end FT running a TT 800ng/dL.

Even then keep in mind that depending on your protocol (dose of T/injection frequency) there can be a significant difference in peak--->trough.

Too many get caught up on running absurdly high FT levels let alone at trough!
Thank you Madman

Most men will do well with FT 20-30 ng/dL.
Noted

Excess FT levels can result in acne/oily skin (genetically prone), accelerated balding (genetically prone), drive down HDL, increased RBCs/hemoglobin/hematocrit (common), overstimulation of the CNS (common), bloating/water retention due to androgens effects on the retention of electrolytes (common).

Fortunately, I haven’t suffered from oily Skin. Accelerated balding .. I was already follicly challenged. HCT etc is an issue ...

Let alone many end up trying to manage estradiol with the use of an aromatase inhibitor.

I really don’t want to go down the AI route, too many horror stories.

Easy to see that your RBCs/hemoglobin/hematocrit let alone estradiol is elevated due to running a very high trough FT.

Yes the Total Testosterone etc has to come down. I ran my same SHBG and Albumin numbers through the CFTZ (TruT) free Testosterone Calculator and played with my Total Testosterone levels until it gave a Free Testosterone value of 30 ng/dL. It equates to approximately 800ng/dL in my case assuming the SHBG and Albumin numbers don’t change as my protocol does – I fear this is a vain hope, but you have to start somewhere.

Attached is a little more history that shows only Total Testosterone and HCT immediately prior to a Blood test. Not a full set of data but based on these past data points, I plan to try either:

90mg T' C' (2 x 45mg) & 1000 IU hCG (2 x 500IU) Per Week (If I can get some hCG)

or

110mg T' C' (2 x 55mg) Per Week

For a minimum of three months and then retest.

One thing I have noticed is that all hCG is not the same. In my small user experience I would say that Ovidac IU’s are much less "potent" than the supposedly equivalent Pregnyl IU’s. This of course also effects the outcome of any tests.

Thanks again
 

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  • Total T and HCT Prior to Test.pdf
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jacb

Active Member
It would be interesting to see what your A1C is at. Are you taking any meds like metformin? Also, are you supplementing with vitamin D3? Personally, I think the best supplement for anyone is magnesium.

Another thought I have. Does melatonin help lower or stabilize? HCT.

Injecting 500 IU of HCG and 50 mg of testosterone twice a week would be a good starting protocol.
Hi Vince, thank you for your reply.

I am taking no medications at the moment, but until three months ago I was taking supplements. List attached.

D3 was on the list. I don't believe that Magnesium was.

I have never been tested for A1c - I will try and find out if Northland Pathology - NZ, offers the test.

Melatonin and I didn't get on .... Tried slow release etc but just couldn't get used to it. Haven't even tried to use it for over eighteen months ... It would be nice to sleep longer .. perhaps I should try again. No idea about its effects on HCT.

I have tried quite a variety of different protocols (some due to supply issues - Covid 19 related etc) and now have some good data about what my body responds to. Attached is a basic Total T / HCG data set.

I now plan to try 90mg T' C' (2 x 45mg) & 1000 IU hCG (2 x 500IU) Per Week (If I can locate some hCG)

or

110mg T' C' (2 x 55mg) Per Week.

How quickly does e2 reduce if you take away the artificial testosterone stimulus? I really don't want to go down the AI route if I don't have to.


Thanks again

PS: I looked into the test and it is available but only if requested by a GP Details
 

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  • Total T and HCT Prior to Test.pdf
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  • Supliments.pdf
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Vince

Super Moderator
Always do Labs on injection day before you inject. Wait at least 6 to 12 weeks after protocol change, when getting labs. It takes that long for levels get stable. Skip the workout before labs. Working out increases hct.
 

jacb

Active Member
Thanks again Vince but I do understand the need to do the labs the day before you inject … referred to as the trough in my first blood test results (# 1 above).

I also understand the need to wait about three months for a new protocol to stabilise. However when I tried HCG Mono Therapy it was quite obvious it wasn’t producing the desired results (based on how I felt, Dr’s advice etc) and the cost/availability of HCG in NZ became a very real factor. Hence the early test, which showed 50% low on the target total T’.

I am not regularly working out at the moment …. Life style has been demanding with a lot of travel/stress etc. Yes a workout might help the stress .. but at the moment I don’t need the increased HCT. Reduce the T‘ first I think.

The point of my last post was to show that 50mg a week of T’ won’t cut it in my case …. Whilst 150mg a week is over the top. Looking at the data it is also possible the see the effect hCG has on my metabolism in HCT terms … it would appears to be minimal. It seems that T’ has a considerable effect on my HCT values.

So if 110mb T‘ per week turns out to be about right for me, what would the equivalent protocol be with HCG be in Total Testosterone and HCT terms?

My guess (based on the simplified data set and memory of previously how I felt) would seem to suggest 90mg per week of Test’ Cyp’ and 1000 IU of hCT Should be worth trying for three months. I would divide the weekly does into two injection per week.

Yes I would like to use hCH but supply is an issue based on the country I live in and which brand name of hCG is reliable/available from the likes of ReliableRX. It seems that Pregnyl and Corion are not available and Ovidac is less effective that the other brands based on similar IU values. Any HCG brand name recommendations?
 
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Vince

Super Moderator
Up to this point, I'm still getting my HCG from empower pharmacy. Which is no longer producing it. I have enough for over a year and then I must find a new source. I had to donate blood for 2 years before my HCT stabilized. Now I haven't donated blood for over 5 years. I'll show you my last labs and protocol.
 

Vince

Super Moderator
 

Nelson Vergel

Founder, ExcelMale.com
90mg T' C' (2 x 45mg) & 1000 IU hCG (2 x 500IU) Per Week (If I can get some hCG)

or

110mg T' C' (2 x 55mg) Per Week

For a minimum of three months and then retest.
I think @madman has given you good input.

I agree with your lower T dosage as madman pointed out.

There is no need to worry about an AI.

Were you able to locate hCG from countries around NZ?

Sorry that you are still dealing with barriers to blood donations but at least your hematocrit is 54. This number can fall under 52 after a few months on lower TRT doses. I would just take a baby aspirin a day. I am assuming that your blood pressure is good.
Since you have never donated, your ferritin is higher than what it is for most of us. Not a bad thing to have.

Your liver and kidney functions are good.

Are you able to import melatonin gummy bears? They work really well as they allow for faster absorption even after dinner.

I would just follow @madman's advice which you seem to have already started to do.
 

jacb

Active Member
Hi Vince

You are doing well.

I made up the attached table, in the result format you used for ease of comparison ... PDF attached.

I have the following questions regarding your information:
  • How do you take Pregnenolone and why? How frequently do you take it?
  • How do you take DHEA and why? How frequently do you take it?
  • How is the Free testosterone percentage calculation done as shown in your results? Can you get to 3.57% ?
 

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jacb

Active Member
Thank you Nelson - I appreciate your input.

I agree with your lower T dosage as madman pointed out.
OK

There is no need to worry about an AI.
How fast does Estradiol reduce with a changed Testosterone Protocol? Is there a half life issue? I note that when I did a genuine "Sensitive Estradiol Test" as part of my Base Line Blood work, it was 38.8 pg/mL even when my total T was 354.5 ng/dL.

I cant see how with my metabolism and a current target of TT 800 ng/dL I am going to get me back into a normal e2 range without some sort of AI or other changes. Can you shed a little light on this thought process?

Were you able to locate hCG from countries around NZ?
Yes and No ... It is available to be shipped. But not all available imported hCG brands are as good as each other ... IE Pregnyl and Corion seemed very good, Whilst Ovidac works, but the IU factor seems weaker (you need more for the same result). There are many brands so which brand do you buy? we need a user poll ... just look at ReliableRx for the large number of hCG brands available.

The second part of the issue is the need for a MedSafe form to be signed by your GP in NZ. Some GP's will sign and some wont. It would seem that now that Testosterone Cypionate and Pregnyl (hCG) are no longer available to be prescribed in NZ, it might be seen as a reasonable request to ask for signature and save the tax payer money whilst allowing treatment to continue.... but it depends on your GP.

Sorry that you are still dealing with barriers to blood donations but at least your haematocrit is 54. Take a baby aspirin a day.
Will do.

I am assuming that your blood pressure is good.
Not so good .. It is starting to get high and the GP is commenting on it and asking if I would like some medication for it? What is the best way to approach this whilst on TRT?

Since you have never donated, your ferritin is higher than what it is for most of us. Not a bad thing to have.
You might be looking at my base line number which was 428 ug/L. The current value is 212 ug/L which seems to be mid range 20-450 Ug/L?

Your liver and kidney functions are good.
Noted - Thanks

Are you able to import melatonin gummy bears? They work really well as they allow for faster absorption even after dinner.
Melatonin is a restricted product here in NZ .. So I don't see much hope there.

I would follow @madman's advice which you seem to have already started to do.
Will do ... Now on 110mg (2 x 55mg) IM and will take a small aspirin daily. I talk with my medical contacts re the addition of hCG for the reasons stated in #1 above.

What do you think about Vince's suggestion that I look into an A1c blood Test?

Rgds
 
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Vince

Super Moderator

I supplement with dhea and Pregnenolone before bed. I use pure brand for both.
 

jacb

Active Member
Thanks


I supplement with dhea and Pregnenolone before bed. I use pure brand for both.
 

jacb

Active Member
Vince you say that you are injecting your Test' Cyp' daily SubQ. I found a link posted by Nelson that says that one way to lower HCT is to:

"Switch from Intramuscular Injections to Lower Dose Subcutaneous Testosterone Injections. Two hundred thirty-two men took part in a University of California study. Baseline levels were recorded for all men in each of the four measurement areas, and then again at 6-12 weeks post-treatment. The results showed that men who underwent subcutaneous testosterone (SubQ) injections had a 14% greater increase in total testosterone levels compared to the testosterone level of intramuscular testosterone injection (IM) patients. SubQ patients also had a 41% lower hematocrit post-therapy than IM patients and 26.5% lower estradiol levels. For both groups of men, there were no elevated levels of PSA".​

I did try SubQ once in my stomach area using a 27g x 1/2" needle .... I found it much less comfortable than using IM in my shoulder with the same combination. You are injecting 16mg of Test' Cyp' daily. What site do you inject into and what size needle do you use?
 
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Vince

Super Moderator
Vince you say that you are injecting your Test' Cyp' daily SubQ. I found a link posted by Nelson that says that one way to lower HCT is to:

"Switch from Intramuscular Injections to Lower Dose Subcutaneous Testosterone Injections. Two hundred thirty-two men took part in a University of California study. Baseline levels were recorded for all men in each of the four measurement areas, and then again at 6-12 weeks post-treatment. The results showed that men who underwent subcutaneous testosterone (SubQ) injections had a 14% greater increase in total testosterone levels compared to the testosterone level of intramuscular testosterone injection (IM) patients. SubQ patients also had a 41% lower hematocrit post-therapy than IM patients and 26.5% lower estradiol levels. For both groups of men, there were no elevated levels of PSA".​

I did try SubQ once in my stomach area using a 27g x 1/2" needle .... I found it much less comfortable using IM in my shoulder with the same combination. You are injecting 16mg of Test' Cyp' daily. What site do you inject into and what size needle do you use?
I inject with a 29 g 1/2-in syringe for both testosterone and HCG. I rotate my VG, love handles and shoulders. It's working great for me. Yes sub q apparently helps lower hct for some.
 

Nelson Vergel

Founder, ExcelMale.com
I cant see how with my metabolism and a current target of TT 800 ng/dL I am going to get me back into a normal e2 range without some sort of AI or other changes. Can you shed a little light on this thought process?
The "normal" range of estradiol does not apply in men on TRT with higher total T levels. This study showed how the body adjusts how much estradiol to produce to compensate for the higher T. Guys worry way too much.



I am assuming that your blood pressure is good.
Not so good .. It is starting to get high and the GP is commenting on it and asking if I would like some medication for it? What is the best way to approach this whilst on TRT?
Losartan is good, it does not kill erections, and may have a lowering effect on hematocrit


Since you have never donated, your ferritin is higher than what it is for most of us. Not a bad thing to have.
You might be looking at my base line number which was 428 ug/L. The current value is 212 ug/L which seems to be mid range 20-450 Ug/L?
Lucky you. Most of us live with ferritin under 50
 

jacb

Active Member
Thanks Nelson

You say "The "normal" range of estradiol does not apply in men on TRT with higher total T levels. This study showed how the body adjusts how much estradiol to produce to compensate for the higher T."

"How to Predict Estradiol and DHT at Different Testosterone Doses".

You/the article makes the point that it is the ratio between Total Testosterone and Estradiol that we should primarily be concerned about, not the absolute pg/mL value. It goes without saying that more Testosterone we have, the greater the amount of Estadiol we will have because of the aromatase process.

The article also says that the efficiency of the aromatase process changes as we age and this is shown in a range of graphs. So it is now possible to accurately predict Estradiol and DHT values if we know the Total Testosterone and the age of the man.

Like you, I made a small spread sheet up with the given data. I then input my measured values to see how closely my actual data matches the predictions.

I see that in my case I make somewhere between 20/25% more E2 than the predicted value. At the moment I am reducing my weekly dose of Test Cyp to 110mg per week with the hope that my TT levels will stabilize around 800 pmol/L and a Free T value of 30 ng/dL. I will retest in three months time.

Acording to the calculated E2 prediction (considering my age and TT of 800 pmol/L) the E2 will be 48.7 pg/mL.

My question for you is how far from the target values are "acceptable" before considering Ai intervention? The same question stands for the TT/E2 ratio etc.

I predict that at TT of 800 pmol/L my E2 will be approximately 48.7 + 23% (based on my test records to date) = 58.4 pg.mL If I am correct would that be something you would be concerned about for a 62 year old man with a TT of 800 pmol/L, concerned enough to intervein with Ai?


Of course I will do nothing until I have the test results in three Months time.

Regards

E2 Prediction.JPG




.
 

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jacb

Active Member
Losartan is good, it does not kill erections, and may have a lowering effect on hematocrit


I previously knew nothing about of Losartan, but having looked at your link, if I am pushed into taking a BP Lowing Medicine by my GP, I will certainly suggest this one as a possible candidate.

It seems that it is available in NZ according to the Pharmac.co.nz listing.
 
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