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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Advice/help for high shbg guy
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<blockquote data-quote="madman" data-source="post: 207399" data-attributes="member: 13851"><p>A full thyroid panel includes much more than just TSH.</p><p></p><p>Hematocrit of 56 is very high and I would look into this as most would not recommend starting trt when hematocrit is >52%.</p><p></p><p>When using exogenous T RBCs/hemoglobin/hematocrit will increase within the 1st month and can take up to 9-12 months to reach peak levels.</p><p></p><p>T formulation, the dose of T, genetics (polymorphism of the AR), age all play a role in the impact a trt protocol will have on blood markers (RBCs/hemoglobin/hematocrit).</p><p></p><p>Other factors such as sleep apnea, smoking can have a negative impact on hematocrit.</p><p></p><p></p><p><em><strong>*<em><strong>Men with significant erythrocytosis (hematocrit >52%), severe untreated obstructive sleep apnea, or untreated severe congestive heart failure should not be started on treatment with TTh without prior resolution of the co-morbid condition.</strong></em></strong></em></p><p><em><strong></strong></em></p><p><em><strong></strong></em></p><p><em><strong>-Some authors recommend that TTh be discontinued if hematocrit is >54%, which may be reasonable while baseline hematocrit level >50% is a relative contraindication for starting testosterone therapy. <u>However, these recommendations are based on assumptions – the clinical significance of a hematocrit >54% is unknown</u>. </strong>The meta-analysis by FernandezBalsells [208] showed that, despite a higher incidence of elevated hematocrit, no clinical adverse effects were reported. Results of earlier studies (MEDLINE database search from 1966 to 2004) showed that, despite TTh-treated men being nearly four times as likely to have hematocrit >50% compared with placebo-treated men (OR ¼ 3.69, 95% CI, 1.82–7.51), the frequency of cardiovascular events, sleep apnea or death was not significantly different between the two groups. Hematocrit elevations were reported in 43.8% of patients administered intramuscular T enanthate injections and in 15.4% of patients administered transdermal T treatment [222]. The lack of increase in cardiovascular events with elevated hematocrit may be due to the fact that T acts as a vasodilator and has anti-atherosclerotic effects [223]. In addition, testosterone is able to decrease plasma concentrations of procoagulatory substances such as fibrinogen and PAI-1 as well as Factor XII [224]<strong> Isolated hematocrit elevations can be the result of insufficient fluid intake on a hot day. <u>Only repeated measures of hematocrit >54% should be followed by concomitant administration of aspirin, bleeding, therapeutic phlebotomy, and/or discontinuation of TTh until hematocrit declines below 54%. After normalization of hematocrit levels, TTh can be continued with a reduced dosage</u></strong></em></p><p><em><strong></strong></em></p><p><em><strong>-Periodic hematological assessment is, however, indicated, i.e. before TTh, then 3–4 months and 12 months in the first year of treatment, and annually thereafter. <u>Although it is not yet clear what upper limit of hematocrit level is clinically desirable, dose adjustments may be necessary to keep hematocrit below 52–54%</u></strong></em></p><p></p><p></p><p></p><p></p><p>Adrenals- 4 point cortisol test.</p><p></p><p>Yes, you can purchase TT (LC/MS-MS)/FT (Equilibrium Dialysis or Ultrafiltration) through PMD.</p><p></p><p>Or better yet through Nelson's Discountedlabs.com</p><p></p><p></p><p><strong>1. Total Testosterone (LC/MS- No Upper Limit) and Free Testosterone</strong> <strong>(Equilibrium Dialysis)</strong></p><p>[URL unfurl="true"]https://www.discountedlabs.com/hematocrit-total-and-free-testosterone-1500-ng-dl[/URL]</p><p></p><p><strong>2. Total Testosterone (LC/MS- No Upper Limit) and Free Testosterone</strong> <strong>(Equilibrium Ultrafiltration)</strong></p><p>[URL unfurl="true"]https://www.discountedlabs.com/testosterone-free-dialysis-and-total-ls-ms-ms[/URL]</p></blockquote><p></p>
[QUOTE="madman, post: 207399, member: 13851"] A full thyroid panel includes much more than just TSH. Hematocrit of 56 is very high and I would look into this as most would not recommend starting trt when hematocrit is >52%. When using exogenous T RBCs/hemoglobin/hematocrit will increase within the 1st month and can take up to 9-12 months to reach peak levels. T formulation, the dose of T, genetics (polymorphism of the AR), age all play a role in the impact a trt protocol will have on blood markers (RBCs/hemoglobin/hematocrit). Other factors such as sleep apnea, smoking can have a negative impact on hematocrit. [I][B]*[I][B]Men with significant erythrocytosis (hematocrit >52%), severe untreated obstructive sleep apnea, or untreated severe congestive heart failure should not be started on treatment with TTh without prior resolution of the co-morbid condition.[/B][/I] -Some authors recommend that TTh be discontinued if hematocrit is >54%, which may be reasonable while baseline hematocrit level >50% is a relative contraindication for starting testosterone therapy. [U]However, these recommendations are based on assumptions – the clinical significance of a hematocrit >54% is unknown[/U]. [/B]The meta-analysis by FernandezBalsells [208] showed that, despite a higher incidence of elevated hematocrit, no clinical adverse effects were reported. Results of earlier studies (MEDLINE database search from 1966 to 2004) showed that, despite TTh-treated men being nearly four times as likely to have hematocrit >50% compared with placebo-treated men (OR ¼ 3.69, 95% CI, 1.82–7.51), the frequency of cardiovascular events, sleep apnea or death was not significantly different between the two groups. Hematocrit elevations were reported in 43.8% of patients administered intramuscular T enanthate injections and in 15.4% of patients administered transdermal T treatment [222]. The lack of increase in cardiovascular events with elevated hematocrit may be due to the fact that T acts as a vasodilator and has anti-atherosclerotic effects [223]. In addition, testosterone is able to decrease plasma concentrations of procoagulatory substances such as fibrinogen and PAI-1 as well as Factor XII [224][B] Isolated hematocrit elevations can be the result of insufficient fluid intake on a hot day. [U]Only repeated measures of hematocrit >54% should be followed by concomitant administration of aspirin, bleeding, therapeutic phlebotomy, and/or discontinuation of TTh until hematocrit declines below 54%. After normalization of hematocrit levels, TTh can be continued with a reduced dosage[/U] -Periodic hematological assessment is, however, indicated, i.e. before TTh, then 3–4 months and 12 months in the first year of treatment, and annually thereafter. [U]Although it is not yet clear what upper limit of hematocrit level is clinically desirable, dose adjustments may be necessary to keep hematocrit below 52–54%[/U][/B][/I] Adrenals- 4 point cortisol test. Yes, you can purchase TT (LC/MS-MS)/FT (Equilibrium Dialysis or Ultrafiltration) through PMD. Or better yet through Nelson's Discountedlabs.com [B]1. Total Testosterone (LC/MS- No Upper Limit) and Free Testosterone[/B] [B](Equilibrium Dialysis)[/B] [URL unfurl="true"]https://www.discountedlabs.com/hematocrit-total-and-free-testosterone-1500-ng-dl[/URL] [B]2. Total Testosterone (LC/MS- No Upper Limit) and Free Testosterone[/B] [B](Equilibrium Ultrafiltration)[/B] [URL unfurl="true"]https://www.discountedlabs.com/testosterone-free-dialysis-and-total-ls-ms-ms[/URL] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
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Advice/help for high shbg guy
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