Pre-Defy consult lab work

[Spetzal]

These labs are from 02/06/23, taken five days after injecting a weekly dose of 200mg test enanthate IM. I understand the dose is too high, and no need to discuss that. I temporarily stopped TRT after that injection, pending the Defy consult. Too many things out of control symptom-wise. Too many mistakes on various people‘s parts, including my own.

Im not familiar with most of these labs except the free and total t, and have been reading info on this forum but still need general assistance as to how everything connects. I need to ask Defy intelligent questions and understand. I left out the cbc and cmp, as they were all normal except elevated rbc, hematocrit, and hemoglobin…and those have been dealt with.

43 years old
FSH <0.7 (1.6-8.0)
LH <0.2 (1.5-9.3)
Iron, Total 60 (50-180)
Iron Binding Capacity 420. (250-425)
Ferritin 24 (38-380)
%Saturation 14 (20-48)
Estradiol, Ultrasensitive 73 (less than or equal to 29)
DHEA-Sulfate 27 (61-442)
Testosterone, Free (Dialysis) 360.9 (35.0-155.0)
Testosterone, Total, MS 1237 (250-1100)
IGF-1 324 (52-328)
TSH 1.10 (0.40-4.50)
PSA 0.27 (less than or equal to 4.00)
SHBG 15 (10-50)

symptoms ive been experiencing are severely dry skin, poor sleep, moodiness/irritability, very erratic libido. I understand this to be estrogen related.

 

[Spetzal]

is it correct to say that due to very low SHBG, most of injected test dpesnt get bound up and just hangs loose?

 

[Systemlord]

Ferritin 24 (38-380)
%Saturation 14 (20-48)

These two tests are the cause of at least 50% of your symptoms.

symptoms ive been experiencing are severely dry skin, poor sleep, moodiness/irritability, very erratic libido. I understand this to be estrogen related.

I started TRT with iron saturation at 14% and iron at the very bottom of the ranges and doctors said nothing. I struggle to get symptom relief. TRT doesn’t work very well when iron is low, because there are so many metabolic abnormalities with low iron.

It’s looking like you’ll require iron supplementation on TRT.

 

[Systemlord]

I understand this to be estrogen related.

Estrogen always seems to be the first scapegoat.

Why can’t your symptoms also be related to excessive testosterone?

 

[Blackhawk]

elevated rbc, hematocrit, and hemoglobin…and those have been dealt with.
Estradiol, Ultrasensitive 73 (less than or equal to 29)
Testosterone, Free (Dialysis) 360.9 (35.0-155.0)
Testosterone, Total, MS 1237 (250-1100)

I understand the dose is too high, and no need to discuss that.

You have already posted the right answer to your query.

Without further explanation, I have to question "those have been dealt with". With low ferritin you are in a bad place to manage the hematocrit problem.

Raising ferritin FAST (a how-to, not a question)

Hi all, I started TRT in 2001 and have been giving blood over the years and have always had issues with recovering my ferritin. Long story short, I got tired of waiting for others to do the research, so I did it myself, created a protocol, hired a hematologist in May 2021 who thought it could...

www.excelmale.com

 

[Spetzal]

These two tests are the cause of at least 50% of your symptoms.

I started TRT with iron saturation at 14% and iron at the very bottom of the ranges and doctors said nothing. I struggle to get symptom relief. TRT doesn’t work very well when iron is low, because there are so many metabolic abnormalities with low iron.

It’s looking like you’ll require iron supplementation on TRT.

I suspended TRT pending the consult. recent updated cbc shows hematocrit at 49 and hemoglobin at 17.1

imdont know what my current iron levels are, and i havent been taking any supplements for it. Ill be drawing a iron panel and ferritin later this week.

 

[Spetzal]

Estrogen always seems to be the first scapegoat.

Why can’t your symptoms also be related to excessive testosterone?

I cqnt dispute your assertion. Im making a conclusion (or assumption) based on allegedly known common high estrogen symptoms. The anastrazole prescribed substantially improved my mood, but i suspended that also pending Defy consult.

 

[Spetzal]

In terms of NOT rapidly raising hematocrit by imcreasing iron

You have already posted the right answer to your query.

Without further explanation, I have to question "those have been dealt with". With low ferritin you are in a bad place to manage the hematocrit problem.

Raising ferritin FAST (a how-to, not a question)

Hi all, I started TRT in 2001 and have been giving blood over the years and have always had issues with recovering my ferritin. Long story short, I got tired of waiting for others to do the research, so I did it myself, created a protocol, hired a hematologist in May 2021 who thought it could...

www.excelmale.com

”dealt with” meaning h&h lowered to 49 and 17.1, respectively, and the rest is for Defy……i did not mean to imply the situation had been corrected

 

[Spetzal]

Am appreciating the participation on this thread. systemlord, your observation on the iron issue and your experience with that prob was helpful.

i can read some of the excellent articles here and understand that “lab a” has this effect and “lab b” has that effect….where im struggling is connecting the dots Between those two labs. Things like dhea, shbg, igf, etc

if ive missed a comprehensive resource explaining the interdynamics, please link that

i want to see, at a beginners level, what Defy is going to see When they look at these labs. this way ill be up to speed better when i talk to them and theyre explaining things

 

[Blackhawk]

In terms of NOT rapidly raising hematocrit by imcreasing iron

Read that article. This is not an iron is iron is iron subject.

The method is all about raising FERRITIN.

FERRITIN is about stored iron, which is depleted via phlebotomy. Ferritin is not the form used for erythrocytosis.

Serum iron is about what is available for use in erythropoesis.

 

[Spetzal]

It was interesting to note that during january, the hair i rapidly lost on my lower legs and top of head suddenly started coming back….slow, but definitely noticable. I recall reading that testosterone and dht are the main things involved with that. Illhave to ask about that. what? No more bald guy? Dare i hope? Probably not, lol

 

[Spetzal]

Read that article. The method is all about raising ferritin without increasing serum iron without raising hematocrit.

Ferritin is about stored iron, which you deplete via phlebotomy. Ferritin is not the form used for erythrocytosis.

Serum iron is about what is available for use in erythropoesis.

Yes, i understand and thank you for the link. I ran across it earlier this month. I will discuss that method with defy.

 

[Cataceous]

is it correct to say that due to very low SHBG, most of injected test dpesnt get bound up and just hangs loose?

No, that older line of thought is being challenged. Newer thinking is that SHBG has little effect on free testosterone in normal situations. Instead, free testosterone is driven proportionally by the testosterone production rate or dose rate, at least at steady state. Fluctuations in SHBG are more directly reflected in total testosterone. In your case total testosterone of 1,237 ng/dL is on the low side considering the extremely high free testosterone. This is the result of having low SHBG. SHBG might be thought of as a storage reservoir for testosterone. A small reservoir means less testosterone can be stored at one time, thus total testosterone is lower. Free testosterone is akin to the flow rates into and out of the reservoir. The rates are independent of the size of the reservoir, except transiently during size changes.

 

[Spetzal]

No, that older line of thought is being challenged. Newer thinking is that SHBG has little effect on free testosterone in normal situations. Instead, free testosterone is driven proportionally by the testosterone production rate or dose rate, at least at steady state. Fluctuations in SHBG are more directly reflected in total testosterone. In your case total testosterone of 1,237 ng/dL is on the low side considering the extremely high free testosterone. This is the result of having low SHBG. SHBG might be thought of as a storage reservoir for testosterone. A small reservoir means less testosterone can be stored at one time, thus total testosterone is lower. Free testosterone is akin to the flow rates into and out of the reservoir. The rates are independent of the size of the reservoir, except transiently during size changes.

In terms of my situation then, my takeaway from your words is “less injected test is desirable”. I realize thats a very broad statement, and there are other factors in play that im ignorant of. For context, a once weekly IM inj of 100mg test cyp was known to consistently produce a total t of 592-ish and a free t of 136-ish. this left me feeling on edge and somewhat irritable. I have no idea what estradiol or any of these other factors were doing because no one ever tested or discussed them. Prescribers just kept saying “maybe you should inject a higher dose”, which ive resisted until these labs….and look where it got me *wry look*

is it correct to say that my low shbg results in high availability of test for metabolism, and it just rapidly converts to estradiol due to my fat belly? Im diabetic and currently at 264 lbs and 6 ft tall

 

[Spetzal]

Interesting thread….

How can one increase SHBG when it is too low?

 

[Cataceous]

In terms of my situation then, my takeaway from your words is “less injected test is desirable”. I realize thats a very broad statement, and there are other factors in play that im ignorant of. For context, a once weekly IM inj of 100mg test cyp was known to consistently produce a total t of 592-ish and a free t of 136-ish. this left me feeling on edge and somewhat irritable. I have no idea what estradiol or any of these other factors were doing because no one ever tested or discussed them. Prescribers just kept saying “maybe you should inject a higher dose”, which ive resisted until these labs….and look where it got me *wry look*
...

I'm always in favor of exploring a range of physiological testosterone doses before heading higher. Better late than never. The problem is that dose reductions are sometimes unpleasant for a prolonged period. It's still worth it, but it's more mentally challenging than following a low-and-slow dosing strategy from the beginning. If the testosterone doses are reasonably spread out then the physiological range is covered by roughly 40-110 mg testosterone cypionate per week. This makes 100 mg per week a pretty high-end dose, contrary to popular perception. Taking testosterone cypionate in one dose per week typically causes large swings in serum levels. If you measured that 592 ng/dL at trough then you could have a peak at around 1,200-1,500 ng/dL. Such variation is not natural and probably leads to poor results for more than a few men on TRT. I list some anecdotes here where guys describe getting better results after pushing through with dose reductions.

I have a lot of good things to say about Defy Medical, and I'm a patient as well. But I do think they tend to prescribe more testosterone than necessary. It's good to go in knowing what's physiological so you can push back against higher doses.

...
is it correct to say that my low shbg results in high availability of test for metabolism, and it just rapidly converts to estradiol due to my fat belly? Im diabetic and currently at 264 lbs and 6 ft tall

No, that's the same misconception. Consider this: if you inject 10 mg of testosterone cypionate per day then you're getting 7 mg of testosterone daily. At steady state you must metabolize 7 mg of testosterone daily, regardless of what your SHBG is doing. Low SHBG does not lead to more free testosterone and enhanced metabolism.

That said, low SHBG is associated with some bad things, and it may still have some negative effects on androgen signaling, independent of free testosterone.