Dosage protocol and lab test change help

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rayrock1

Member
My blood results from 100mg Test Cyp only ,once weekly injections, after one month time, tested on trough day was as follows, this was from my Dr's own in house lab;


Dr's in house lab results;


Hemocrit 50.4 range; [40-54]


Total T 524 [193-740 ng/dl]


Free T 7.9 [2.9-20.7 ng/dl]


Bioavailable T 231 [15-575 ng/dl]


Estradiol 15 [11-43 pg/ml ]


SHGB 47 [19-76 nmol/l]


At this Dr visit, I complained of achy testicles, so my Dr put my on HCG, 500iu/week, split into 2 injections. I also complained of feeling a slump after the first 3 days had passed, on the once injection per week schedule, so he also increased my test dosage to 120 mg/week and suggested to also split the dose as well, into 2 injections per week e3.5d.


On the following month, I returned to the Dr. I told him that I split the dosage on the Test as he recommended but left the dosage per week the same ,at the 100 mg, and initiated the 500 iu HCG as he suggested. I did not want to change to many variables and figured he would retest to see where things were with the dosage split at e3.5d and the HCG addition.

The Dr. did not want to retest, as he said, nothing in the Test dosage had changed. I told him my Testicles were still an issue and I still felt a slump the day before and day of my injection day. He suggested to increase my HCG to 700iu/week and my Test Cyp. to 140 mg/week, still injecting e3.5d.

I decided to modify his suggestions once again, bad patient I quess, to increase the HCG to only 600iu/week and my Test Cyp to 120 mg/week injecting e3.5d, and try it for another month before increasing to the dosages he recommended. At this months end, the lab results were as follows from a different lab, Quest Lab

Quest Labs;

Hemocrit 50.3 range; [38-50]

Total T 1296 [250-827 ng/dl ]

Free T 132 [46-224 pg/ml ]

Bioavailable T 300 [110-575 ng/dl ]

Estradiol [35384-7] 57 [0-29 pg/ml]

SHGB 55 [10-50 nmol/l ]

Can these values actually be possible? His in house lab had my values so much lower, while Test Cyp level was only changed 20 percent. Also I read, that dosages of HCG below 700 iu per week had minimal impact on Testosterone levels? is this not the case? Does Quest lab calculate testosterone and estradiol levels differently some how?

While waiting for the blood test results, I went ahead and increased my dosage of HCG and Test Cyp to what the Dr recommended as I was still getting a slight testicle ache and still had the slump feeling on the day before my injection, thinking he was probably right, and should have done so all along, not imagining my total Testosterone level would come back from the new lab, to be at 1200 plus already.

Ironically, after doing so, [700 iu HCG and 140mg Test], I had the best week since I started TRT treatment. I feel more calm, great libido and more leveled out. Can't imagine what my blood levels will be at these dosages............................ Any suggestions? Thank you for your help.
 
Last edited:
Defy Medical TRT clinic doctor

Westin

Active Member
You won’t really know where you stand after a dosage adjustment for 6 to 8 weeks. TC has a long halflfe. If you keep making quick adjustments without waiting you will never get dialed in. It takes time, no way to shortcut it. I have been adjusting for a year and a half. It’s better now, but you need to wait it out before your body and numbers adjust, or you’ll be playing this game forever.
 

madman

Super Moderator
My blood results from 100mg Test Cyp only ,once weekly injections, after one month time, tested on trough day was as follows, this was from my Dr's own in house lab;


Dr's in house lab results;


Hemocrit 50.4 range; [40-54]


Total T 524 [193-740 ng/dl]


Free T 7.9 [2.9-20.7 ng/dl]


Bioavailable T 231 [15-575 ng/dl]


Estradiol 15 [11-43 pg/ml ]


SHGB 47 [19-76 nmol/l]


At this Dr visit, I complained of achy testicles, so my Dr put my on HCG, 500iu/week, split into 2 injections. I also complained of feeling a slump after the first 3 days had passed, on the once injection per week schedule, so he also increased my test dosage to 120 mg/week and suggested to also split the dose as well, into 2 injections per week e3.5d.


On the following month, I returned to the Dr. I told him that I split the dosage on the Test as he recommended but left the dosage per week the same ,at the 100 mg, and initiated the 500 iu HCG as he suggested. I did not want to change to many variables and figured he would retest to see where things were with the dosage split at e3.5d and the HCG addition.

The Dr. did not want to retest, as he said, nothing in the Test dosage had changed. I told him my Testicles were still an issue and I still felt a slump the day before and day of my injection day. He suggested to increase my HCG to 700iu/week and my Test Cyp. to 140 mg/week, still injecting e3.5d.

I decided to modify his suggestions once again, bad patient I quess, to increase the HCG to only 600iu/week and my Test Cyp to 120 mg/week injecting e3.5d, and try it for another month before increasing to the dosages he recommended. At this months end, the lab results were as follows from a different lab, Quest Lab

Quest Labs;

Hemocrit 50.3 range; [38-50]

Total T 1296 [250-827 ng/dl ]

Free T 132 [46-224 pg/ml ]

Bioavailable T 300 [110-575 ng/dl ]

Estradiol [35384-7] 57 [0-29 pg/ml]

SHGB 55 [10-50 nmol/l ]

Can these values actually be possible? His in house lab had my values so much lower, while Test Cyp level was only changed 20 percent. Also I read, that dosages of HCG below 700 iu per week had minimal impact on Testosterone levels? is this not the case? Does Quest lab calculate testosterone and estradiol levels differently some how?

While waiting for the blood test results, I went ahead and increased my dosage of HCG and Test Cyp to what the Dr recommended as I was still getting a slight testicle ache and still had the slump feeling on the day before my injection, thinking he was probably right, and should have done so all along, not imagining my total Testosterone level would come back from the new lab, to be at 1200 plus already.

Ironically, after doing so, [700 iu HCG and 140mg Test], I had the best week since I started TRT treatment. I feel more calm, great libido and more leveled out. Can't imagine what my blood levels will be at these dosages............................ Any suggestions? Thank you for your help.


This is a complete mess!

If anything after starting when you had blood work done on the once-weekly 100 mg/week protocol although your trough TT 524 ng/dl which may very well seem sub-par let alone not high enough to achieve a healthy FT as your levels are still too low the main issue is you did not use an accurate assay so we have no idea where your FT truly sits.

You need to have it tested using the most accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration.


At this Dr visit, I complained of achy testicles, so my Dr put my on HCG, 500iu/week, split into 2 injections. I also complained of feeling a slump after the first 3 days had passed, on the once injection per week schedule, so he also increased my test dosage to 120 mg/week and suggested to also split the dose as well, into 2 injections per week e3.5d

As you can clearly see the downfall of injecting higher doses of T once-weekly is that not only will there be a significant difference between peak--->trough levels (high post-injection and elevated within the first few days only to be much lower come weeks end) but blood levels will not be as stable throughout the week which can result in a yo-yo effect on energy/mood/libido/erectile function/recovery.

Switching to twice weekly and splitting the overall weekly dose 100 mg (50 mg every 3.5 days) would have been a sensible move but your doctor not only added hCG but increased your T dose when you would have most likely achieved better trough TT/FT levels leaving the dose as is 100 mg/week (50 mg every 3.5 days).


On the following month, I returned to the Dr. I told him that I split the dosage on the Test as he recommended but left the dosage per week the same ,at the 100 mg, and initiated the 500 iu HCG as he suggested. I did not want to change to many variables and figured he would retest to see where things were with the dosage split at e3.5d and the HCG addition.

The Dr. did not want to retest, as he said, nothing in the Test dosage had changed. I told him my Testicles were still an issue and I still felt a slump the day before and day of my injection day. He suggested to increase my HCG to 700iu/week and my Test Cyp. to 140 mg/week, still injecting e3.5d.


Bad move on your doctors part even though T dose was left the same 100 mg/week (50 mg every 3.5 days) the injection frequency was changed which will have a big impact on your peak--->trough levels and blood work should have been done to see where your trough TT/FT/e2 let alone hemoglobin/hematocrit sit on such.

No bloodwork and having ABSOLUTELY no idea where your TT/FT/e2 levels sit he turns around and increase your dose from 100mg/week (50 mg every 3.5 days) to 140mg/week (70mg every 3.5 days) which is a large jump 40 mg/week and top it off with the fact that he also ups your hCG dose.

Increasing the overall weekly T dose by 20 mg can have a big impact on bumping up TT/FT/e2 levels yet he bumped you up by 40 mg which is a big increase.


I decided to modify his suggestions once again, bad patient I quess, to increase the HCG to only 600iu/week and my Test Cyp to 120 mg/week injecting e3.5d, and try it for another month before increasing to the dosages he recommended. At this months end, the lab results were as follows from a different lab, Quest Lab

Quest Labs;

Hemocrit 50.3 range; [38-50]

Total T 1296 [250-827 ng/dl ]

Free T 132 [46-224 pg/ml ]

Bioavailable T 300 [110-575 ng/dl ]

Estradiol [35384-7] 57 [0-29 pg/ml]

SHGB 55 [10-50 nmol/l ]





You then take it in your own hands and decided to go from 100mg/week (50 mg every 3.5 days) to 120 mg/week (60 mg every 3.5 days) and slightly lower your hCG dose.

Not surprised to say the least that at the trough on the higher dose T 120 mg/week (60 mg every 3.5 days) + hCG that you are now hitting a much higher trough TT and although FT is only in the mid-range you had it tested using an inaccurate method (calculated).

Seeing as you are hitting a trough TT 1296 ng/dL even with a higher SHBG of 55 nmol/L than I bet your FT level would have been much higher if you would have had it tested using an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration.

Imagine how much higher your levels would have been if you took your doctor's piss poor advice and jumped up from 100 mg/week to 140 mg/week.
 
Last edited:

rayrock1

Member
Thank you for your input and detailed response.
I did not know that I had to test the free Testosterone level with the Equilibrium Dialysis.How did you know the Free T test was the calculated version?
I agree the protocol is all over the place and it was a major misstep not doing the blood test earlier. Do you think it was the testosterone dosage increase of 20 mg or the 600 iu of HCG that had the most impact of my TT?
Thank you both for taking the time to help.
 

madman

Super Moderator
Thank you for your input and detailed response.
I did not know that I had to test the free Testosterone level with the Equilibrium Dialysis.How did you know the Free T test was the calculated version?
I agree the protocol is all over the place and it was a major misstep not doing the blood test earlier. Do you think it was the testosterone dosage increase of 20 mg or the 600 iu of HCG that had the most impact of my TT?
Thank you both for taking the time to help.


The reference range and your TT was not even tested using the most accurate assay LC/MS-MS.

  • Testosterone, Total, Males (Adult), Immunoassay
  • Albumin
  • Sex Hormone Binding Globulin (SHBG)
  • Testosterone, Free and Bioavailable (calculated)


These are the tests you want to have done as they are the most accurate assays when it comes to TT/FT.

Nelsons discountedlabs.com:

1600407130195.png



Everyone on trt should be using this!

Blood work is critical let alone testing using an accurate assay.
 

rayrock1

Member
Thank you for pointing this out. I thought the e2 was the special test needed only, now I know e2 and TT and Free T. My doctor was only concerned about the bioavailable testosterone level. I asked him about my free T levels and he said that the bioavailable is above 190 then its sufficient. Not to worry about free T. Have you heard of this before? Is bioavailable and free T equivalent for evaluation purposes?
 

Systemlord

Member
Upon starting TRT I had testicle aching that went away after a short while. The reason for the dull ache is your testicles are starving for LH (Luteinizing Hormone) which TRT almost completely shuts down.

The Total and Free T measurement is what should be tested using the testing methods madman has mentioned, end of story.
 
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