switched to ED protocol with same dose and FT dropped??

[Gianluca]

Current protocol is 26mg daily, .13ml T-CYP. Free Test come back at 50 ng/dl Labcorp, but my doc explained the assay they used is incorrect, and since my SHBG at 11, albumin at 5, he calculated a true FT of about 22, TT came back at 615. I wanted to run the test again, this time with Quest Lab, FT came back at 221 pg/ml, TT at 850 here, pretty much in line with what my doc said.

Unusually lower than suppose to. I just switched two months ago from .3ml 3 x week to ED with basically same weekly dose. With 3 x week inj, FT would always came back between 24 and 30, depending if I was on Thyroid or not, drawing blood prior next injection, TT between 600 and 1000, again depending on Thyroid. I was expecting a FT above 30 here for sure, as past history on .13ml daily showed a FT of 34.

My sex drive is fine, libido could be better but no complains, same with erections. Only thing I complain is my sleep, and perhaps often being restless, nervous, impatient. I actually thought my FT would be coming back too high on ED protocol, and therefore the negative symptoms.

thoughts? perhaps the pharmacy made a compounding mistake? I have been using Empower pharmacy for sometime and trust them. I do IM injections, delt and quads with insulin syringe 29G 1/2 inch, I'm pretty lean

 

[Cataceous]

Are you comparing free testosterone results from the same assay by the same lab? If not it's a fruitless exercise; different methods for determining free T are not directly comparable. The best you can do is see where each measurement falls relative to its respective reference range. In addition, the standard direct free T tests are too inaccurate to use, leaving equilibrium dialysis or ultrafiltration. The free T calculators are usable even if imperfect, but ideally the source T, SHBG and albumin should still be measured with the same assays by the same lab.

Was your albumin previously this high? A value of 5 g/dL can drop free testosterone by 10-15% compared to a more typical 4.3 g/dL.

 

[madman]

Current protocol is 26mg daily, .13ml T-CYP. Free Test come back at 50 ng/dl Labcorp, but my doc explained the assay they used is incorrect, and since my SHBG at 11, albumin at 5, he calculated a true FT of about 22, TT came back at 615. I wanted to run the test again, this time with Quest Lab, FT came back at 221 pg/ml, TT at 850 here, pretty much in line with what my doc said.

Unusually lower than suppose to. I just switched two months ago from .3ml 3 x week to ED with basically same weekly dose. With 3 x week inj, FT would always came back between 24 and 30, depending if I was on Thyroid or not, drawing blood prior next injection, TT between 600 and 1000, again depending on Thyroid. I was expecting a FT above 30 here for sure, as past history on .13ml daily showed a FT of 34.

My sex drive is fine, libido could be better but no complains, same with erections. Only thing I complain is my sleep, and perhaps often being restless, nervous, impatient. I actually thought my FT would be coming back too high on ED protocol, and therefore the negative symptoms.

thoughts? perhaps the pharmacy made a compounding mistake? I have been using Empower pharmacy for sometime and trust them. I do IM injections, delt and quads with insulin syringe 29G 1/2 inch, I'm pretty lean.

but my doc explained the assay they used is incorrect

How can this even happen?

You are not a newbie.

Whether getting bloodwork on your own or through your doctor it is your responsibility to make sure that the correct assays (most accurate) are used.

You have been on here long enough to know that when comparing results it is critical to that the same lab, same assay (most accurate) TT/e2 (LC/MS-MS), and FT (Equilibrium Dialysis or Ultrafiltration) is used let alone always testing at the trough on the exact same protocol (dose T/injection frequency).

Otherwise, you are just wasting your time!

 

[Gianluca]

Are you comparing free testosterone results from the same assay by the same lab? If not it's a fruitless exercise; different methods for determining free T are not directly comparable. The best you can do is see where each measurement falls relative to its respective reference range. In addition, the standard direct free T tests are too inaccurate to use, leaving equilibrium dialysis or ultrafiltration. The free T calculators are usable even if imperfect, but ideally the source T, SHBG and albumin should still be measured with the same assays by the same lab.

Was your albumin previously this high? A value of 5 g/dL can drop free testosterone by 10-15% compared to a more typical 4.3 g/dL.

Hi Cartaceous, I just checked my albumin for the past 3 years and it seats always between 4.9 and 5 (labcorp). I generally buy labs from Defy, and quiet honestly never pay attention to the different assays, just trust them they order the proper test. I know I learned E2 must be LC/MS. Looking back to previous FT results, there is always a "direct" FT, not quiet sure what the assay is. This time my FT at 50 it was not "direct", Dr Saya pointed that out immediately. So TT 615 ng/dl, albumin 5 g/dl and SHBG 11,2 nmol/L = FT of 18.1 ng/dl

 

[Gianluca]

but my doc explained the assay they used is incorrect

How can this even happen?

You are not a newbie.

Whether getting bloodwork on your own or through your doctor it is your responsibility to make sure that the correct assays (most accurate) are used.

You have been on here long enough to know that when comparing results it is critical to that the same lab, same assay (most accurate) TT/e2 (LC/MS-MS), and FT (Equilibrium Dialysis or Ultrafiltration) is used let alone always testing at the trough on the exact same protocol (dose T/injection frequency).

Otherwise, you are just wasting your time!

HI Madman, I generally buy my test through Defy, and my bad I have been around long enough, but never pay attention to lab assay too much, as I trust Defy having the correct one, I did learned E2 must be LC/MS for sure. Still, if I look at my TT 615 ng/dl, albumin 5 g/dl and SHBG 11,2 nmol/L, my FT come back at 18.1 ng/dl, based on this calculator Free & Bioavailable Testosterone calculator

Again, this is too low based on past history with same or similar protocol, where if I only look at TT it was just higher with similar SHBG and Albumin, dose and frequency.

I only Test though LabCorp with Defy, but because the "wrong" assay, I decided to try Quest. Quest is a different lab, with different ranges, assay. But again, TT and FT unusually low based on past history. I was considering an absorption issue, a compounding mistake from pharmacy, or not sure is even possible that my body started to metabolize Testosterones at a higher rate for some reason

 

[madman]

HI Madman, I generally buy my test through Defy, and my bad I have been around long enough, but never pay attention to lab assay too much, as I trust Defy having the correct one, I did learned E2 must be LC/MS for sure. Still, if I look at my TT 615 ng/dl, albumin 5 g/dl and SHBG 11,2 nmol/L, my FT come back at 18.1 ng/dl, based on this calculator Free & Bioavailable Testosterone calculator

Again, this is too low based on past history with same or similar protocol, where if I only look at TT it was just higher with similar SHBG and Albumin, dose and frequency.

I only Test though LabCorp with Defy, but because the "wrong" assay, I decided to try Quest. Quest is a different lab, with different ranges, assay. But again, TT and FT unusually low based on past history. I was considering an absorption issue, a compounding mistake from pharmacy, or not sure is even possible that my body started to metabolize Testosterones at a higher rate for some reason

If you have always been using the direct immunoassay for FT then so be it and stick with it but even then you need to make sure when comparing results that you are using the same lab/assay.

I would not rely on the direct immunoassay for FT and if you want to know where it truly sits then you would need to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best) and again testing using the same lab/same assay.

Keep in mind that it would be more sensible to test more than once if results are suspect as yes there can be lab errors even when using the most accurate assays but it would be far from common.

Nothing but pure confusion when one is using different labs let alone different assays when trying to compare lab results.

To top it all off when it comes to the reference ranges for measured or calculated FT they vary between different labs, and as of now, there is no standardization let alone a harmonized reference range.

Efforts are underway to standardize the procedures for FT and to generate harmonized reference ranges.



* This filthy s**t show will be coming to an end soon enough!

 

[Gianluca]

If you have always been using the direct immunoassay for FT then so be it and stick with it but even then you need to make sure when comparing results that you are using the same lab/assay.

I would not rely on the direct immunoassay for FT and if you want to know where it truly sits then you would need to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best) and again testing using the same lab/same assay.

Keep in mind that it would be more sensible to test more than once if results are suspect as yes there can be lab errors even when using the most accurate assays but it would be far from common.

Nothing but pure confusion when one is using different labs let alone different assays when trying to compare lab results.

To top it all off when it comes to the reference ranges for measured or calculated FT they vary between different labs, and as of now, there is no standardization let alone a harmonized reference range.

Efforts are underway to standardize the procedures for FT and to generate harmonized reference ranges.
* This filthy s**t show will be coming to an end soon enough!

since Quest lab seems to be using Dialysis for FT, and you mention you preferer this method, yet I have never used this before and wouldn't know how to compare it. Now, I know we are not treating numbers but subjective feelings, my result came back at 221.7 pg/ml scale is 35 / 155, how do you see that? too high? or just just at low end of what most people need to feel better? to my understanding most people feel their best with a FT perhaps between 20 to 35, what is the scale based on this assay where majority of people feel their best at?

 

[madman]

since Quest lab seems to be using Dialysis for FT, and you mention you preferer this method, yet I have never used this before and wouldn't know how to compare it. Now, I know we are not treating numbers but subjective feelings, my result came back at 221.7 pg/ml scale is 35 / 155, how do you see that? too high? or just just at low end of what most people need to feel better? to my understanding most people feel their best with a FT perhaps between 20 to 35, what is the scale based on this assay where majority of people feel their best at?

I see no issues with where your FT level sits and if you feel well overall and blood markers are healthy then that is what truly matters.

Even then if your FT level came back double the top end and you felt great let alone blood markers were healthy I would still see no issue!

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

Labcorp test details for Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences)

www.labcorp.com

Prefer the reference range used by Labcorp FT (Equilibrium Dialysis) 52-280 pg/mL.

Regardless as I stated earlier when it comes to the reference ranges for measured or calculated FT they vary between different labs, and as of now, there is no standardization let alone a harmonized reference range.

Efforts are underway to standardize the procedures for FT and to generate harmonized reference ranges.

The sooner this happens the better as there is much confusion when it comes to testing FT.

FT 16-31 ng/dL would be considered healthy.

Most men do well with FT in the 20-30 ng/dL range or slightly higher.

Many tend to aim for the higher end

Some men can run higher-end FT levels with no issues whereas others may struggle as it comes down to the individual.

Believe it or not, some men may feel good with a FT 16 ng/dL.

Need to find what is best for you and as you very well know symptom relief is what truly matters.

We also need to keep in mind that many get caught up in the more T is better mentality and end up running absurdly high trough TT/FT levels thinking they need to achieve such to experience the beneficial effects of testosterone.

Many of these same individuals end up struggling on a protocol especially when trying to chase that so-called optimal.

Too many ends up having unrealistic expectations when it comes to trt and gets caught up in searching for that raging libido let alone expect that being on trt or running absurdly high T levels will have them running around with tons of energy, stellar mood, raging libido, titanium erections 24/7!

Pipe dreams.