First labs since starting TRT - very surprised by results!

[Goel]

The protocol needs to be consistent (dose T/injection frequency) for 6 weeks before any blood work is done.

I understand that. I believe he's just looking to either confirm or rule out that labwork from last week. He is doing estradiol this time along with ferritin.

 

[madman]

I understand that. I believe he's just looking to either confirm or rule out that labwork from last week. He is doing estradiol this time along with ferritin.

This could only be done if you were still on the 100mg/week injections and would need to be done at trough (7 days after your last 100 mg/week injection) to have any relevance as you already switched over to 50 mg every 3.5 days.

If he wanted to confirm or rule out your previous labs (the one you posted from 6 weeks in on the 100mg/week protocol) then blood work would have needed to be done 7 days after your last 100 mg/week injection before you switched over to injecting 50 mg every 3.5 days.

Your last set of labs was done at the true trough (7 days post-injection) and it was tested using one of the most accurate assays Equilibrium Ultrafiltration.

In order for him to rule out a lab error which I doubt than he would need to test blood again at the true trough (7 days post-injection) after your last 100mg/week injection before you switched over to the new protocol (50 mg every 3.5 days) and you would need to test TT/FT using the lab and same assays.

If anything TT/FT should be tested using the most accurate assay (LC-MS/MS) and FT (Equilibrium Dialysis or Ultrafiltration) and in your case on your last set of labs FT was tested using Equilibrium Ultrafiltration.

 

[madman]

I asked about SHBG and he pointed to the %FT result at 4.67 (1.5 - 4.2) and said that because that's calculated with SHBG he could infer that SHBG was good.

Once/week I could tell where my peaks/troughs were and I was starting to drag a bit the couple days before I was due again. So my thought was by splitting to twice/week I'd flatten the cycle a bit and if that was still not enough go to every other day. I'm not fond of the idea of every day injections but wouldn't rule it out.

This would be expected when injecting once weekly as levels will peak (8-12 hr) post-injection and be elevated the first few days only to be followed by much lower levels come weeks end which can have a negative impact on energy/mood/libido/erectile function/recovery.

In your case, trough FT levels were still through the roof 7 days post-injection so your levels are still very robust come weeks end before your next injection which would mean that the down and out feeling you were experiencing would most likely be due to the extreme fluctuation in your peak--->trough levels as your peak TT/FT/e2 levels will be much higher post-injection/days following.

Injecting 50 mg every 3.5 days (keeping overall weekly dose @100 mg/week) will most likely still allow you to achieve a healthy FT level as not only will you be clipping the peak--->trough but your blood levels will be more stable throughout the week.

The only way you will know where your trough TT/FT/e2 levels truly sit is to stay consistent with your new protocol (dose T/injection frequency) and once levels have stabilized (4-6 weeks) then get blood work done.

Again forget worrying about where your trough TT will end up on such protocol as FT is what you want to pay attention to let alone SHBG, estradiol.

Testing needs to be done using accurate assays for TT (LC-MS/MS), FT (Equilibrium Dialysis or Ultrafiltration), and estradiol (LC-MS/MS).

Your doctor used #2 on your last set of labs.

Any of the 3 below will suffice.

Everyone on trt should be using these assays to test Free Testosterone!




1 500726: Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences) | LabCorp

2 081786: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone | LabCorp

3 Testosterone, Total and Free (NO Upper Limit) plus Hematocrit

 

[Goel]

I finally got the results back from the confirmation draws my doctor pulled. I had to insist on the E and SHBG tests. The first draw was 3.5 days after a 50mg injection

TT = 763 (264 - 916)
FT = 25.48 (5.0 - 21.0)
Estradiol = 17.8 (8.0 - 35.0)
SHBG = 29.7 (19.3 - 76.4)

Went home that evening and injected 50mg and returned for another draw the following day

TT = 796
FT = 33.91
Estradiol = 17.8
SHBG = 29.7

During the phone consult that follows below I mentioned that I understand it takes about a day for the body to seperate the TestCyp from the oil carrier and begin absorbing it. It was ~16 hrs between injection and 2nd draw, was that enough to warrant the draw so soon? "yes"...


He also wanted to recheck my Ferritin.
Results now = 72 (30 - 400)
Previous results when last tested 2 yrs ago = 179 (same ref range)

That seems like a fairly big drop in Ferritin to me but he wasn't the least bit concerned. As I understand it low Ferritin levels can present many of the same symptoms as low T.

I just spoke with Doc about the lab results. He said my labs were great - but I don't feel that way. He said I could either continue on as-is and re-evaluate in January but he'd rather see me cut my dosage from 100mg/week to 100mg every 10 days. You're kidding, right ??

I said that confused me - I was feeling marginally better but cutting my dose seems like going backward. He repeatedly pointed to the labs and said my TT was that of a 27 yr old. This is very odd because this is the same doctor who, when I started with him, said he likes to go on how I FEEL more than labs and he'd like to see me at 800-1200 or so. Now he's changed his song and saying he doesn't want to see me go above 900 or so peak. When I pointed that out to him, he said well there are other clinics in town who'll take you to 1600 or 2000 or more but not me. I understand that, and I'm not looking for that - I just want to feel better.

In the end, we agreed to continue with 100mg/week split in half at 3.5 days and recheck in January. But I'm rapidly losing confidence in this doctor.

 

[Goel]

add: Hematocrit levels from a recent CBC panel 46.8 (41.5 - 53.8)

 

[Systemlord]

I just spoke with Doc about the lab results. He said my labs were great

While your Total T and Free T are elevated, your estrogen in relation to Total and Free T is disproportionately low, you want it higher and I think that might be why you don't quite feel dialed in.

 

[Goel]

While your Total T and Free T are elevated, your estrogen in relation to Total and Free T is disproportionately low, you want it higher and I think that might be why you don't quite feel dialed in.

That sounds odd (not disagreeing though) since so many have to fight against that. I mean, it seems odd to NEED to increase my estradiol. So how do I get there - increase my dosage and shorten the frequency? I'm not taking an AI.

 

[Gman86]

Iron and ferritin are extremely misunderstood by most. Check out Morley Robbins, he explains it the best that I’ve found to date. Here’s a really good video where he goes over iron and ferritin, if I remember correctly. Have u had an iron panel done?

 

[Goel]

Iron and ferritin are extremely misunderstood by most. Check out Morley Robbins, he explains it the best that I’ve found to date. Here’s a really good video where he goes over iron and ferritin, if I remember correctly. Have u had an iron panel done?

Thanks I'll check that out when I can give it 2hrs uninterrupted.

No iron panel, just ferritin.

 

[Systemlord]

That sounds odd (not disagreeing though) since so many have to fight against that. I mean, it seems odd to NEED to increase my estradiol. So how do I get there - increase my dosage and shorten the frequency? I'm not taking an AI.

Well I have seen guys diagnosed with osteoporosis with estrogen a few points lower than yours and have minor to moderate erection problems at these levels. Your estrogen is not in the healthy range.

I have seen guys with higher natural T and low estrogen, they report symptoms and it's usually an aromatase deficiency which decreases the conversion rate of T->E2.

I don't understand where you are getting the idea that so many have fought against increasing estrogen into a healthy range. Estrogen is an important male hormone.

 

[Goel]

Well I have seen guys diagnosed with osteoporosis with estrogen a few points lower than yours and have minor to moderate erection problems at these levels. Your estrogen is not in the healthy range.

I have seen guys with higher natural T and low estrogen, they report symptoms and it's usually an aromatase deficiency which decreases the conversion rate of T->E2.

I don't understand where you are getting the idea that so many have fought against increasing estrogen into a healthy range. Estrogen is an important male hormone.

I'm not disputing a word of that, just expressing my (perhaps faulty) impression that many on TRT seem concerned about or guard against their estrogen increasing beyond healthy range and I evidently don't have that "problem".

But it seems that I do need to increase my estrogen - how should I do that in conjunction with TRT? Clearly if I were on an AI then I'd stop, but I'm not on one. I also don't want to sabotage my increased T levels