Target Free T Levels

[Fortunate]

Gentlemen,

My free T (details below) is in the middle of normal range per Quest. But, I feel really sluggish and I am working on figuring out (a) why? and, (b) how to treat it?

I am trying to get a sense of where most guys feel "optimal" relative to their free T. I know there are a myriad of factors to consider (thus the contents of much of this forum), but for now, I am focusing on free T.

I have searched for a while and can't find a thread that specifically focuses on what free T levels guys are targeting and where they feel best. If this thread exists, please excuse my inadequate search capabilities! If not, feel free to share any correlation you have found between free T and how you feel.

I realize there are tons of discussions on simply how to measure free T, which may make this conversation harder. My lab results don't indicate how the numbers were derived and I'm not 100% sure how they were ordered, but the lab was Quest.

Recent Quest labs:

• Total T 921 ng/dL (250-827)
• Albumin 4.2 g/dL (3.6-5.1)
• SHBG 32 nmol/L (10-50)
• Free T 150.1 pg/mL (46-224)
• Bioavailable T 289.1 mg/dL (110-575)
• Estradiol, Ultrasensitive Pending

Background:

• These are fasting, first thing in the morning levels 1 day after 50mg Xyosted (so, peak levels)
• I had been on 50mg Xyosted every 4-5 days for about three weeks prior to labs
• I (I think regrettably) took 0.125mg of anastrazole several times around the time I injected
• I have generally been on hCG throughout most of my TRT life, but have been mostly off it in the last 5 weeks, with a few doses here and there (but not for several weeks prior to these labs)

I currently feel really, really tired. Mood is lowish. Libido poor. I have a suspicion the culprit may be the one missing lab (E2) and will report back when I get it. I suspect I bottomed out my E2.

That said, assuming my E2 comes back looking appropriate, I may consider trying to manipulate my TRT to manipulate my free T. The problem is, I am not sure if I should push it up or down. In general, I have follow the "less is more" principal. But, I have been supraphysiologic and have never felt this tired before. Generally, when I am really supra, I feel anxious, but not tired. By the way, hemoglobin is normal (I am not anemic).

On the other hand, I am in the middle of the normal range for free T, so I wouldn't expect to feel this kind of fatigue.

Cutting to the chase: if there is a way to compare apples to apples between labs and techniques, where do you like your free T? Where do you feel best relative to your free T?

Edit: for what it’s worth, I felt pretty darn good the day I got my labs and the following day. To confound matters, I happened to inject hCG right after getting those labs and the following day. I have no idea if it was the testosterone levels that were elevated from the hCG or some type of direct effect of hCG that made me feel good those two days, but by the third day of hCG, I felt like the hCG was a little too much, so I backed off. The point I’m making is that I felt good despite my total testosterone levels being as high as it was.

 

[FunkOdyssey]

I currently feel really, really tired. Mood is lowish. Libido poor. I have a suspicion the culprit may be the one missing lab (E2) and will report back when I get it. I suspect I bottomed out my E2.

How long have you been feeling this way? Did you feel better back when you were taking hCG regularly? Your T and E2 would have dropped significantly since stopping. What symptoms led you to use anastrozole?

 

[Fortunate]

How long have you been feeling this way? Did you feel better back when you were taking hCG regularly? Your T and E2 would have dropped significantly since stopping. What symptoms led you to use anastrozole?

If there is one thing I have learned it's that TRT is an exercise in patience. I don't typically post over such a small timeframe. The reason I did this time is the level of fatigue I have felt for the length of time (about 9 days) is unusual for me. The other reason is that I have generally under treated myself with Natesto and hCG, so I am not as familiar with high free T levels.

Rough timeline: started Xyosted (which is enanthate) 50mg about every 4-5 days four weeks ago. Most of the time, no hCG. I used the anastrazole to address mild anxiety and low grade headache around the time I injected. About 9 days ago, I started feeling the fatigue, which was kinda overwhelming. I assumed I "crashed" my E2, which is why I started the hCG again (an attempt to bump up E2 a bit).

I felt better on the hCG for the first two days. By day three of hCG, I started to feel bad (hard to describe), so I stopped.

It will be interesting to see what my E2 looks like. If it's the culprit, I suppose it can be either way too high or way too low, which is crazy. If I had to bet, I'd bet too low.

I will definitely post once I get it. Meanwhile, I am genuinely curious what free T levels guys are aiming for (I totally understand free T is only one part of a very large puzzle).

 

[Cataceous]

That looks to be Quest's calculated free testosterone, though it doesn't appear to correspond at all to the Vermeulen method. The latter puts out a figure for you of 22.7 ng/dL, which is at the top of the normal reference range for healthy younger men. I get good results at about 15 ng/dL for my daily peak, which is near the mean.

 

[FunkOdyssey]

Systemlord reminds us to check iron/ferritin too:

Brain fog

Brain fog Been on trt for 8 months. Had my dose increased to 180 a week and recently lowered to 160, not relevant. Started at 100mg and have been trending up to achieve upper range of normal free test. Have had brain fog for probably 4-5 months, feels like I’m always chronically tired even...

www.excelmale.com

 

[FunkOdyssey]

As far as target free T levels, I don't have the experience to tell you what I prefer but there are a couple different levels I think are reasonable to try. One is a modestly above average level for healthy young men: 15-20 ng/dL. The second is the very top of the physiological range and extending slightly into the supraphysiological: 25-30 ng/dL.

There are people who try the higher levels and complain of side effects, ED, and etc and only see resolution of symptoms at the lower level. There also seem to be many guys that don't resolve their low T symptoms until they reach the higher level. Interestingly, different online communities seem to self-sort and gravitate towards different levels -- that lower range seems popular here versus Facebook groups where higher ranges dominate.

If you're going to be on TRT (or TOT) for life, I don't think you should decide where to be based solely on the argumentation of either side. I think the decision should be informed by direct experience. Having determined what the benefits are for you personally will take some mystery out of the risk/benefit analysis.

So what does that mean for you with your calculated 22.7 ng/dL free? I think there's a good chance that going lower makes you feel better and there's also a good chance that going higher makes you feel better. Unfortunately there's only one way to find out.

 

[Fortunate]

As far as target free T levels, I don't have the experience to tell you what I prefer but there are a couple different levels I think are reasonable to try. One is a modestly above average level for healthy young men: 15-20 ng/dL. The second is the very top of the physiological range and extending slightly into the supraphysiological: 25-30 ng/dL.

There are people who try the higher levels and complain of side effects, ED, and etc and only see resolution of symptoms at the lower level. There also seem to be many guys that don't resolve their low T symptoms until they reach the higher level. Interestingly, different online communities seem to self-sort and gravitate towards different levels -- that lower range seems popular here versus Facebook groups where higher ranges dominate.

If you're going to be on TRT (or TOT) for life, I don't think you should decide where to be based solely on the argumentation of either side. I think the decision should be informed by direct experience. Having determined what the benefits are for you personally will take some mystery out of the risk/benefit analysis.

These are excellent thoughts, and I agree that the crowd does seem to self select. I also realize that discussing one small variable without considering all the other hormones, lab parameters and life factors that can affect how we feel is a massive oversimplification of the matter. That said, I was surprised to find very little discussion on free T as it relates to symptom relief, which may have more to do with my search capabilities than anything! I am aware of the TOT crowd, but am more interested in where the guard rails are for this crowd.

I think successful protocols can vary widely among individuals, and like you said, you will only discover one with direct experience. I am willing to pursue a protocol as long as it is close to what other reasonable people are doing (for, example I tried a propionate/enanthate blend per @Cataceous's recommendations a few times). So, I use a combination of accepted medical guidance along with anecdotal information, and often the latter is more helpful than the former in the world of TRT.

My posts here are mostly centered on my central theme: I struggle with TRT, yet need it. I have been on TRT for about 8 years and have tried a number of protocols to find one that provides benefit without unacceptable side effects. When I run into trouble, I usually revert back to the least disruptive protocol: Natesto. But, I find myself feeling under treated on it. Someone once referred to it as "hypogonadal+", which may be a good description. I have less experience running a protocol that puts me in a high or supraphysiologic range, although I have been there briefly before. Which brings me to this discussion. I am trying to figure out which direction I can and/or need to push.

The numbers you reference are actually very helpful. While I work through my current detour, I prefer to make sure I stay in the lane where most people drive.

 

[Belekas]

As I understand your nutrition, training and recovery all on point if you solely looking at blood tests and how you feel?

 

[Fortunate]

As I understand your nutrition, training and recovery all on point if you solely looking at blood tests and how you feel?

Yes. I eat a relatively high fat, moderate protein and low carb diet. I’m not perfect, but fairly adherent to it. I do it for migraine prevention, and it seems to work. I eat minimally processed foods.

I am not an overzealous gym rat, but I do exercise 4 to 6 days a week. I keep my sleep relatively consistent.

Again, lab values, particularly one single lab value, is an over simplication of all the things at play, but my most recent bout of fatigue is unusual and that’s why am isolating lab values for the time being.

 

[Fortunate]

By the way, for anyone not already bored reading this thread, i’m going to put my money on estrogen. I’m still waiting for my sensitive test to come back, but I suspect I crashed it. Will post when I get it!

 

[tareload]

That looks to be Quest's calculated free testosterone, though it doesn't appear to correspond at all to the Vermeulen method.

Behold, Quest has done us a solid with the modified Vermeulen equation:

Testosterone Testing

www.questdiagnostics.com

Might be nice to give the details on their site.

 

[tareload]

I am aware of the TOT crowd, but am more interested in where the guard rails are for this crowd.

more like ropes made with biodegradable polymer

What is TRT and What is NOT TRT

Danny gets a little introspective here at 2:45: Was that an eye roll? fT of 80-150 ng/dl (LMFAO) and he starts to get a little concerned. Good job Danny, great to know you start to worry about limits of human physiology at some point. You even mentioned to go do some bloodwork...

forums.t-nation.com

But hey, it takes all kinds.

And excellent thread BTW @Fortunate. I think part of the issue you raise is there is no standardized range for fT and we are still waiting on what an accurate measurement of fT actually is. Hard to characterize and calibrate in a quantitative fashion when you don't have standardized measurement system. Most still struggling between RIA, calculated/equations of various forms, tru-T, ED, UF, phase of the moon, etc. I kinda do this stuff for an actual living and scratch my head at what dudes and ladies must be going through trying to make their way through the maze.

 

[FunkOdyssey]

And excellent thread BTW @Fortunate. I think part of the issue you raise is there is no standardized range for fT and we are still waiting on what an accurate measurement of fT actually is. Hard to characterize when you don't have standardized measurement system. Most still struggling between RIA, calculated/equations of various forms, tru-T, ED, UF, phase of the moon, etc. I kinda do this stuff for an actual living and scratch my head at what dudes and ladies must be going through trying to make their way through the maze.

The ranges I was suggesting are based on the Vermuelen calculated values. Even if you measure free T directly with equilibrium dialysis, I think it still makes sense to determine your Vermeulen free T. So many men have been using it for so many years that it gives you a good basis for comparison. In most cases, when you hear broad statements made like "men usually feel good between X-X ng/dL", those levels are Vermeulen values. I would call it the de facto standard.

 

[Systemlord]

Systemlord reminds us to check iron/ferritin too:

Brain fog

Brain fog Been on trt for 8 months. Had my dose increased to 180 a week and recently lowered to 160, not relevant. Started at 100mg and have been trending up to achieve upper range of normal free test. Have had brain fog for probably 4-5 months, feels like I’m always chronically tired even...

www.excelmale.com

Yes, TRT crushes my iron, ferritin within 2 months without supplementation, stopping TRT see's them both rise quickly without supplementation.

 

[Fortunate]

Yes, TRT crushes my iron, ferritin within 2 months without supplementation, stopping TRT see's them both rise quickly without supplementation.

@Systemlord, I have read about your iron struggles. Does your doc think it's TRT related, too? Do you see any change in your hemoglobin or hematocrit along with iron changes?

 

[FunkOdyssey]

Yes, TRT crushes my iron, ferritin within 2 months without supplementation, stopping TRT see's them both rise quickly without supplementation.

This is interesting because TRT decreases hepcidin which should increase iron absorption from the diet. Maybe on TRT you are turning iron into hemoglobin faster than you can absorb it so that the net effect on iron status is negative? What does your daily iron intake (from food) look like?

 

[Systemlord]

Does your doc think it's TRT related, too?

More so than my diabetes, because when I stop TRT after iron, ferritin were low, both would rise quickly without iron supplementation. This happened on two separate occasions when starting, stopping TRT which is why my endo recommended iron supplementation.

Now that I get phlebotomized monthly, it's even more important.

What does your daily iron intake (from food) look like?

140 mg iron daily (5 capsules), but I have to split it up into three separate dosages because of absorption issues related to diabetes.

Lately though I have been getting signs I may need to reduce it since I'm making solid improvements in my diabetes control. After I take my 5th capsule, I get very sweaty and hot.

 

[Fortunate]

The reason I started this thread was because I was experiencing crushing fatigue and was trying to figure why I had it and what I could do to reverse it (thus, the question of how high I can/should push my fT).

The fatigue was significant and prolonged - I am not used to feeling that tired for so long. I was really confident that I "crashed" my E2, as I had been taking 0.125mg of anastrazole around the time of each injection for about three weeks. So, I got labs, posted above, but didn't have my ultrasensitive estradiol, until today, and I wanted to post feedback.....

Convinced the level was going to be undetectable or something, I opened my labs and my estradiol is (drumroll....) 39 (normal is <29)!

Wow, was I surprised! Crashed E2 could not explain my conundrum. And, while some are really sensitive to even slightly elevated E2, I really doubt that a level of 39 could be the culprit of all this fatigue (although, I suppose it's still possible - but is at the bottom of my list). A day or two before getting the labs back, I started thinking about other possible culprits (I am not anemic and I have no reason to have a brand new thyroid disorder), and my next choice was nebivolol (Bystolic).

Beta blockers are known to cause fatigue, depression, sluggish thinking, etc. I switched from propranolol to nebivolol for this very reason. It didn't occur to me that this could be nebivolol because I had been on it for a while in the past and restarted it a full three weeks prior to the onset of the fatigue. That said, I happened to request brand name Bystolic over generic nebivolol because I didn't think the generic was as effective. My fatigue started about two weeks after that!

Two nights ago, I dropped my nebivolol dose from 5mg to 2.5mg. Yesterday, I still had some fatigue, but it was significantly less than usual. As of now, I am pretty convinced the Bystolic was the issue all along, which really surprised me. I plan to continue at the lower dose and watch. If the issues persist, I will try to wean off it altogether, which is a bummer, because I do appreciate the benefits.

It's funny, while on TRT, we (or, at least I) tend to get so focused on hormones and how they are impacting every aspect of our lives. This little story is a reminder to me that hormones are neither the source of nor are they the solution to all my woes.

As an aside, it is interesting that my E2 was high despite using anastrazole on a fairly regular basis. I still doubt high E2 is the issue and plan to ignore it for the time being while I see how things go on the lower dose of nebivolol.

I will post more as I learn more.

 

[FunkOdyssey]

The reason I started this thread was because I was experiencing crushing fatigue and was trying to figure why I had it and what I could do to reverse it (thus, the question of how high I can/should push my fT).

The fatigue was significant and prolonged - I am not used to feeling that tired for so long. I was really confident that I "crashed" my E2, as I had been taking 0.125mg of anastrazole around the time of each injection for about three weeks. So, I got labs, posted above, but didn't have my ultrasensitive estradiol, until today, and I wanted to post feedback.....

Convinced the level was going to be undetectable or something, I opened my labs and my estradiol is (drumroll....) 39 (normal is <29)!

Wow, was I surprised! Crashed E2 could not explain my conundrum. And, while some are really sensitive to even slightly elevated E2, I really doubt that a level of 39 could be the culprit of all this fatigue (although, I suppose it's still possible - but is at the bottom of my list). A day or two before getting the labs back, I started thinking about other possible culprits (I am not anemic and I have no reason to have a brand new thyroid disorder), and my next choice was nebivolol (Bystolic).

Beta blockers are known to cause fatigue, depression, sluggish thinking, etc. I switched from propranolol to nebivolol for this very reason. It didn't occur to me that this could be nebivolol because I had been on it for a while in the past and restarted it a full three weeks prior to the onset of the fatigue. That said, I happened to request brand name Bystolic over generic nebivolol because I didn't think the generic was as effective. My fatigue started about two weeks after that!

Two nights ago, I dropped my nebivolol dose from 5mg to 2.5mg. Yesterday, I still had some fatigue, but it was significantly less than usual. As of now, I am pretty convinced the Bystolic was the issue all along, which really surprised me. I plan to continue at the lower dose and watch. If the issues persist, I will try to wean off it altogether, which is a bummer, because I do appreciate the benefits.

It's funny, while on TRT, we (or, at least I) tend to get so focused on hormones and how they are impacting every aspect of our lives. This little story is a reminder to me that hormones are neither the source of nor are they the solution to all my woes.

As an aside, it is interesting that my E2 was high despite using anastrazole on a fairly regular basis. I still doubt high E2 is the issue and plan to ignore it for the time being while I see how things go on the lower dose of nebivolol.

I will post more as I learn more.

TLDR: He comes in here with fatigue, thinks it has something to do with E2, and neglects to mention he's on a beta-blocker! Good lesson for us all about blaming everything on hormones. Thanks Fortunate.

 

[Fortunate]

J

TLDR: He comes in here with fatigue, thinks it has something to do with E2, and neglects to mention he's on a beta-blocker! Good lesson for us all about blaming everything on hormones. Thanks Fortunate.

In fairness to my neglect to mention this is that I have been on this beta blocker before. I think it was the brand name vs. generic that made the difference, which surprised me.