Please help me read my first post-TRT test results

[otus]

Hi everyone.

So, my urologist ordered the first follow-up blood tests four weeks into TRT. I took those tests yesterday, prior to my weekly injection of 100mg. I have a follow-up appointment with him at the end of this week where I intend to tell him that the only changes I've felt after four weeks are that I'm sleeping very soundly, and that by the time I get to the final 24 hours before injection, I am feeling droopy-eyed and craving naps.

When I look at these numbers, it looks to me like my initial dose of 100mg is too low, and my drowsiness on Day 7 leads me to think I probably need to pin twice a week. But I have zero experience and would really value the input of this forum.

Here are my numbers before->after

PSA:
1.43->1.39

HGB:
15.4->14.4

HCT:
47.6->43.1

ESTRADIOL
19.6->31.8

TOTAL TEST:
438->461

SHBG:
49.03->28.7

Not sure how to compare these last two numbers, as it doesn't seem like they did the same type of blood test:

-First test showed "Free Test" at 6.99 (range 5.97-19.30) and "Testosterone, Bioavailable" at 163.8 (range 140-453)
-Second test showed "Calc Free Testosterone" at 103.5 (range 47.0-244.0)

I would like to go into my appointment as informed as possible. My doc seems pretty good, but I don't yet assume he is as up to date on protocols as some of you.

Thanks in advance.

 

[Belekas]

The less you stress about it the better you will become IME. 3-4 weeks is nothing, give it a bit more time and listen to your doctor what he says. Also measurement units would be good next time you post blood markers fwiw. Remember theres a possibility that most men that are posting on these forums are outliers and they either need smaller or bigger dose to feel symptom resolution or have other issues not hormone related. 100mg is a great dose to start IMO just don't change 2 variables at once or you will struggle and get anxious trying to riddle it all out if that makes sense

 

[otus]

The less you stress about it the better you will become IME. 3-4 weeks is nothing, give it a bit more time and listen to your doctor what he says. Also measurement units would be good next time you post blood markers fwiw. Remember theres a possibility that most men that are posting on these forums are outliers and they either need smaller or bigger dose to feel symptom resolution or have other issues not hormone related. 100mg is a great dose to start IMO just don't change 2 variables at once or you will struggle and get anxious trying to riddle it all out if that makes sense

I'm not stressed - just trying to figure out what the labs mean.

I have feel no different than pre-TRT and my numbers don't appear to have moved much. I know it's early, but what does this lab result say?

 

[Cataceous]

...
When I look at these numbers, it looks to me like my initial dose of 100mg is too low, and my drowsiness on Day 7 leads me to think I probably need to pin twice a week. ...

100 mg per week of testosterone cypionate is on average giving you 10 mg of testosterone per day. The normal natural production range is 3-9 mg, with 6-7 being average for healthy young men. Therefore, your overall dose is likely excessive. You hint at the problem: by injecting only once a week you have a large variation in serum testosterone. You've measured a trough value of 461 ng/dL. Even this puts you in the lower end of the healthy normal range for free testosterone, which is substantially better than pre-TRT—the drop in SHBG mutes the rise in total testosterone, but it's free that matters. Meanwhile, your peak testosterone in the day or so following each injection is likely between two and three times higher, i.e. around 1,000-1,500 ng/dL, which is excessive and could in time lead to side effects. So yes, do consider injecting more often. I think you should also try a little lower dose, e.g. 40 mg twice a week. Best guess is that your average total testosterone on 100 mg TC/week is 800-900 ng/dL. I think for initial evaluation it's better to target 600-700 ng/dL, assuming SHBG around 30 nMol/L.

Once your levels are reasonable then you need to give it time:

Onset of effects of testosterone treatment and time span until maximum effects are achieved

Testosterone has a spectrum of effects on the male organism. This review attempts to determine, from published studies, the time-course of the effects induced by testosterone replacement therapy from their first manifestation until maximum effects are ...

www.ncbi.nlm.nih.gov

 

[otus]

Thanks for the feedback. I'll post an update after my Friday in-person.

 

[madman]

Hi everyone.

So, my urologist ordered the first follow-up blood tests four weeks into TRT. I took those tests yesterday, prior to my weekly injection of 100mg. I have a follow-up appointment with him at the end of this week where I intend to tell him that the only changes I've felt after four weeks are that I'm sleeping very soundly, and that by the time I get to the final 24 hours before injection, I am feeling droopy-eyed and craving naps.

When I look at these numbers, it looks to me like my initial dose of 100mg is too low, and my drowsiness on Day 7 leads me to think I probably need to pin twice a week. But I have zero experience and would really value the input of this forum.

Here are my numbers before->after

PSA:
1.43->1.39

HGB:
15.4->14.4

HCT:
47.6->43.1

ESTRADIOL
19.6->31.8

TOTAL TEST:
438->461

SHBG:
49.03->28.7

Not sure how to compare these last two numbers, as it doesn't seem like they did the same type of blood test:

-First test showed "Free Test" at 6.99 (range 5.97-19.30) and "Testosterone, Bioavailable" at 163.8 (range 140-453)
-Second test showed "Calc Free Testosterone" at 103.5 (range 47.0-244.0)

I would like to go into my appointment as informed as possible. My doc seems pretty good, but I don't yet assume he is as up to date on protocols as some of you.

Thanks in advance.

The downfall of injecting once weekly is that there will be a big difference in the peak--->trough let alone blood levels will not be as stable throughout the week which can easily have a negative impact on energy/mood/libido/erectile function/recovery.

Peak T levels will be very high (8-12 hrs) post-injection/during the first few days only to be followed by much lower levels come week's end (trough).

Mind you many men will have absurdly high peak levels let alone fairly high trough levels come week's end due to high-dose protocols as many of the dime-a-dozen T-mills have everyone jacked up on 200 mg T/week from the get-go.

Although your TT 461 ng/dL may seem low you need to keep in mind that bloodwork was done at trough (lowest point).

Would be a given that your peak TT, FT, and estradiol levels will be very high.

Keep in mind that although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

You would most likely fare better splitting up your weekly dose of 100 mg T and injecting twice weekly (50 mg T every 3.5 days).

This will clip the peak---> trough and result in more stable blood levels throughout the week let alone you should easily hit a descent trough TT/FT level.

Keep in mind when using exogenous esterified T it will take 4-6 weeks for blood levels to stabilize (using TC/TE) due to the ester's half-life.

Most would have blood work done 6 weeks in testing at the true trough (lowest point).

Although you can test at 4 weeks keep in mind that your levels will be slightly higher if you tested at 6.

No big deal.

Would not even waste my time checking bioavailable T and if you want to know where your FT level truly sits then you would need to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration

Again would not even compare your pre-trt #s to your current trt #s as you tested at the trough which means your peak TT, FT, and estradiol levels will be much higher let alone you drove your highish SHBG 49.03 nmol/L down to 28.7 nmol/L.

You would be much better off splitting your dose and injecting it twice weekly.

I would just stick with your current dose and inject 50 mg T every 3.5 days.

As you should know you will need to wait another 4-6 weeks for blood levels to stabilize before blood work is done.

Always test at the true trough using the most accurate assays TT/estradiol (LC-MS/MS) and FT (Equilibrium Dialysis or Ultrafiltration).




My reply from previous threads:

Whether using TC or TE it takes 4-6 weeks for blood levels to stabilize due to the ester's half-life.

It is common for many to experience ups/downs during the weeks leading up to this as hormones are in flux and the body is trying to adjust to the increasing T levels.

Once blood levels have stabilized blood work needs to be done so you can see where your trough TT, FT, and estradiol sit let alone other important blood markers such as RBCs/hemoglobin/hematocrit.

Even once blood levels have stabilized it will take time for the body to adapt to the new set-point and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-t symptoms.

The first 4-6 weeks can be very misleading!

Critical to let everything settle.

Need to give the protocol 12 weeks before claiming it was a success or failure.

The only way your dose should be increased 6 weeks in is if your trough FT level is too low and you are still suffering from low-t symptoms.

 

[otus]

Update: Doc upped me to 160mg/week, now divided into two doses.

 

[Cataceous]

Update: Doc upped me to 160mg/week, now divided into two doses.

Why does he think it's advisable for somebody new to TRT to take such a high dose? If he thinks it's justified by that trough measurement then he is not competent. You should spend many months evaluating physiological doses before venturing where no natural man has been.

 

[otus]

Why does he think it's advisable for somebody new to TRT to take such a high dose? If he thinks it's justified by that trough measurement then he is not competent. You should spend many months evaluating physiological doses before venturing where no natural man has been.

Not feeling any side effects. I know plenty of guys on 160/week, doesn’t seem that crazy.

 

[otus]

Would like to follow up on this because I get so many mixed messages and I’m just trying to do the right thing.

I read a lot that a good doctor will treat the symptoms and the patient and not be obsessed with the numbers. But I’m reading here that when I go back with zero changes and the doctor makes a change he should stick to the numbers.

I also read a lot that 100mg/week is a small conservative dose and most doctors don’t know enough to start higher. But now I’m being told 160/week is “such a high dose.”

Really confused.

 

[Cataceous]

...
I read a lot that a good doctor will treat the symptoms and the patient and not be obsessed with the numbers. ...

The problem here is that your doctor isn't even allowing time for symptoms to resolve before raising your dose to well above what's physiological. This initial blood test should be used to titrate the dose such that your levels are physiological throughout the dose cycle. Splitting the dose to twice weekly is a step in the right direction. However, what your doctor doesn't seem to understand is that your average total testosterone level may be around 800 ng/dL on 100 mg TC per week. A 60% dose increase could put your average level over 1,200 ng/dL. This is approaching double what I believe should be targeted by those in the early stages of TRT. A better strategy goes by the moniker "low and slow". This means you start with modest, or even seemingly low doses, and only increase the dose if symptoms of hypogonadism persist after a reasonable evaluation period. Starting too high can lead to unnecessary side effects, and lowering the dose is often uncomfortable for a long enough period that many give up. Below are some anecdotes from those who discovered that dosing lower is better.

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www.excelmale.com

Anyone combine injections and cream? How do you feel?

Interesting anecdote. I’m curious what what your SHBG and current protocol are? @JoeMatts im curious for this as well

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