Thoughts on my most recent bloodwork? IS my E2 too high?

Arcane

Member
Just got my bloodwork back for 30 mg eod been on this protocol for about 3 months

TESTOSTERONE, TOTAL: 1257 ng/DL (250-827)
TESTOSTERONE, FREE: 226.6 pg/mL (46-224)
ESTRADIOL,ULTRASENSITIVE: 61 pg.mL (< or = 29)
SHBG: 30 n/Mol (10-50)


I feel pretty good, but Ive been breaking out like crazy since bumping up my dose. any suggestions?
 

madman

Super Moderator
Just got my bloodwork back for 30 mg eod been on this protocol for about 3 months

TESTOSTERONE, TOTAL: 1257 ng/DL (250-827)
TESTOSTERONE, FREE: 226.6 pg/mL (46-224)
ESTRADIOL,ULTRASENSITIVE: 61 pg.mL (< or = 29)
SHBG: 30 n/Mol (10-50)


I feel pretty good, but Ive been breaking out like crazy since bumping up my dose. any suggestions?

With a trough, TT 1257, ng/dL, and SHBG 30 nmol/L your FT is going to be through the roof let alone your e2.

Why you are wasting your time testing your FT using the piss poor direct immunoassay is beyond me.

As you very well know the only way to know where your FT truly sits is to have it tested using an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration.

You easily have room to lower your dose slightly and bring down your FT.

Put money on it that if you had tested your FT using an accurate assay (ED or UF) you would see how high it really is.

High FT can cause acne in the genetically prone.

Bet you will feel just as good running a lower trough TT/FT.
 

madman

Super Moderator
Go out of your way to use the most accurate assay for estradiol (LC/MS-MS) yet skimp out on the most critical.....free testosterone!

You are either playing stupid or in denial that your trough FT is going to be absurdly high.

Sit back and take a good look where Vince's FT level sits.

His TT is not much higher than what you are hitting yet his SHBG is almost 48.2 nmol/L.....who knew!

 

Arcane

Member
With a trough, TT 1257, ng/dL, and SHBG 30 nmol/L your FT is going to be through the roof let alone your e2.

Why you are wasting your time testing your FT using the piss poor direct immunoassay is beyond me.

As you very well know the only way to know where your FT truly sits is to have it tested using an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration.

You easily have room to lower your dose slightly and bring down your FT.

Put money on it that if you had tested your FT using an accurate assay (ED or UF) you would see how high it really is.

High FT can cause acne in the genetically prone.

Bet you will feel just as good running a lower trough TT/FT.
Ive used the Dialysis earlier this month it was
167.0 pg/mL (35-155)
 

Arcane

Member
Go out of your way to use the most accurate assay for estradiol (LC/MS-MS) yet skimp out on the most critical.....free testosterone!

You are either playing stupid or in denial that your trough FT is going to be absurdly high.

Sit back and take a good look where Vince's FT level sits.

His TT is not much higher than what you are hitting yet his SHBG is almost 48.2 nmol/L.....who knew!

Vinces Free T values are read in ng/dL. You can easily convert my pg/mL Values to that on the same ref range: 22 ng/dL
 

madman

Super Moderator
Vinces Free T values are read in ng/dL. You can easily convert my pg/mL Values to that on the same ref range: 22 ng/dL

Same assay FT (Equilibrium Ultrafiltration).....different labs (Quest vs Labcorp) let alone reference ranges/units based on the particular assay used.

No way you are only hitting a FT 22 ng/dL with a TT 1257 ng/dL and SHBG 30 nmol/L.

Vince is running a TT 1319 ng/dL (not much higher than yours) with an SHBG 48.2 nmol/L (much higher than yours) and is hitting an absurd FT of 48 ng/dL.

Testosterone, Serum 1319 ng/dL range 264-916
Free Testosterone 47.9 ng/dL range 5.00-21.00
% Free Testosterone 3.57 range 1.50-4.20
DHEA-Sulfate 449.0 H ug/dL range 30.9-295.6 (age adjusted)
Estradiol, Sensitive 24.0 pg/mL range 8.0-35.0
Sex Horm Binding Glob, Serum 48.2 nmol/L range 19.3-76.4
Hematocrit 46.8 % range 37.5-51.0
Hemoglobin 16.0 g/dL range 13.0-17.7
Albumin 4.2 g/dL range 3.8-4.8



Like I stated numerous times before on the forum pointless to try comparing different assays let alone the same assays (even when converting) from 2 different labs (Quest vs Labcorp).

Unfortunately as of now, there is no standardization let alone harmonization reference range for free testosterone.
 

madman

Super Moderator
post# 9/10/11/12
 

madman

Super Moderator
This sums it up nicely!



Total testosterone, which can be measured with high accuracy using LC-MS/MS assays in CDC-certified laboratories, and free testosterone are highly correlated, and it is only in individuals with altered binding-protein concentrations that the associations begin to diverge. For the time being, we, therefore, suggest continuing to follow the Endocrine Society’s guidelines to measure total testosterone level and, in circumstances of suspected alterations in SHBG and albumin concentrations and/or binding, checking free testosterone level by equilibrium dialysis. Efforts are underway to standardize the procedures for free testosterone measurement and to generate harmonized reference ranges. Until that time, clinicians should be aware that inaccuracies in free testosterone measurements and calculations and poorly defined reference ranges can increase the risk of misclassification in the diagnosis of androgen disorders.
 

madman

Super Moderator
Vinces Free T values are read in ng/dL. You can easily convert my pg/mL Values to that on the same ref range: 22 ng/dL

Even when using the cFTV your trough FT 34 ng/dL is very high!
Screenshot (4134).png



The newer cFTZ your trough FT 46 ng/dL is absurdly high!
Screenshot (4150).png






Like I stated earlier your trough FT level is very high as in much higher than 22 ng/dL.
 
Last edited:

madman

Super Moderator
Just got my bloodwork back for 30 mg eod been on this protocol for about 3 months

TESTOSTERONE, TOTAL: 1257 ng/DL (250-827)
TESTOSTERONE, FREE: 226.6 pg/mL (46-224)
ESTRADIOL,ULTRASENSITIVE: 61 pg.mL (< or = 29)
SHBG: 30 n/Mol (10-50)


I feel pretty good, but Ive been breaking out like crazy since bumping up my dose. any suggestions?

If you feel PRETTY good overall let alone blood markers are healthy (hemoglobin/hematocrit) and can tolerate dealing with the acne sides than leave it be.....just do not kid yourself into thinking that your trough FT levels are not high!

No brainer here.
 

Arcane

Member
What healthy young male is banging out a TT of almost 1300 ng/dL with an SHBG 30 nmol/L?
In Vince's thread you linked me to his Total T is 1300 ng/dL and his Free Test was double the top of the reference range.

meanwhile this was your response

"If you feel great overall and blood markers remain healthy then this is gold!"

I swear you have some weird vendetta against me lol
 

madman

Super Moderator
In Vince's thread you linked me to his Total T is 1300 ng/dL and his Free Test was double the top of the reference range.

meanwhile this was your response

"If you feel great overall and blood markers remain healthy then this is gold!"

I swear you have some weird vendetta against me lol

Again he has no sides let alone blood markers remain healthy.....and yes he would most likely feel just as well running much lower levels!

Unfortunately many are caught up in the more T is better mentality.

In many cases, those same individuals struggling on a protocol are running way too high a trough FT level.

Like I said if you feel PRETTY good overall let alone blood markers are healthy (hemoglobin/hematocrit) and can tolerate dealing with the acne sides then leave it be.....just do not kid yourself into thinking that your trough FT levels are not high!

Do what you feel is best for you.
 

Match

Member
Eu me sinto muito bem, mas tenho estourado como um louco desde que aumentei minha dose. alguma sugestão?
O que quis dizer com "estourado como louco"? Nao deveria reduzir dose TRT em face do que disseram, TT, TF bem alto nem sempre pode ser tão vantojoso???
 

Zibernet

Active Member
With a trough, TT 1257, ng/dL, and SHBG 30 nmol/L your FT is going to be through the roof let alone your e2.

Why you are wasting your time testing your FT using the piss poor direct immunoassay is beyond me.

As you very well know the only way to know where your FT truly sits is to have it tested using an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration.

You easily have room to lower your dose slightly and bring down your FT.

Put money on it that if you had tested your FT using an accurate assay (ED or UF) you would see how high it really is.

High FT can cause acne in the genetically prone.

Bet you will feel just as good running a lower trough TT/FT.

Is SHBG reliably measured in most labs ?

Or like FT it requires a special method ?
 

madman

Super Moderator
Is SHBG reliably measured in most labs ?

Or like FT it requires a special method ?

As of now, there is no gold standard for measuring SHBG.

The most common methodology used is Electrochemiluminescence immunoassay (ECLIA).

Depending on the lab different immunoassay platforms are used such as Abbott Architect, Roche, Beckman, and Siemens

Keep in mind that there can be significant differences in SHBG results produced by different analyzers.


*The effects of using different testosterone assays on the estimated CFT have been studied in detail, and reference measurement procedures and standard reference materials are available for testosterone to enable traceability of routine laboratory methods to higher-order reference methods and materials. This has had some success in standardizing testosterone measurement across laboratories, although not all manufacturers of commercial assays have been involved and further improvement is still required. However, only limited attempts have been made to standardize other components of the CFT equations, such as SHBG.



When it comes to free testosterone the most accurate assays would be the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

As of now, there is no standardization let alone harmonized reference range for FT which is in the works as we speak.

The same can be said for SHBG.





post #2

10:50-16:10

(11:46-12:00) As part of our testosterone work, we are interested in SHBG. We are working very hard right now on a free testosterone method (reference method) and are making good progress on that one.
Screenshot (5535).png






Standardization and harmonized programs in development
PTH, Thyroid function tests (Free and total T4 and TSH), Free testosterone, Binding proteins
1624513043693.png
 

Zibernet

Active Member
As of now, there is no gold standard for measuring SHBG.

The most common methodology used is Electrochemiluminescence immunoassay (ECLIA).

Depending on the lab different immunoassay platforms are used such as Abbott Architect, Roche, Beckman, and Siemens

Keep in mind that there can be significant differences in SHBG results produced by different analyzers.


*The effects of using different testosterone assays on the estimated CFT have been studied in detail, and reference measurement procedures and standard reference materials are available for testosterone to enable traceability of routine laboratory methods to higher-order reference methods and materials. This has had some success in standardizing testosterone measurement across laboratories, although not all manufacturers of commercial assays have been involved and further improvement is still required. However, only limited attempts have been made to standardize other components of the CFT equations, such as SHBG.



When it comes to free testosterone the most accurate assays would be the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

As of now, there is no standardization let alone harmonized reference range for FT which is in the works as we speak.

The same can be said for SHBG.





post #2

10:50-16:10

(11:46-12:00) As part of our testosterone work, we are interested in SHBG. We are working very hard right now on a free testosterone method (reference method) and are making good progress on that one.
View attachment 15092





Standardization and harmonized programs in development
PTH, Thyroid function tests (Free and total T4 and TSH), Free testosterone, Binding proteins
View attachment 15089

You recently showed a screenshot from a website that you use to calculate FT by inputting TT, SHBG and Albumin.

Is that FT calculation method as accurate as the most reliable methods for direct FT calculations?
 

UCFguy01

Active Member
Just got my bloodwork back for 30 mg eod been on this protocol for about 3 months

TESTOSTERONE, TOTAL: 1257 ng/DL (250-827)
TESTOSTERONE, FREE: 226.6 pg/mL (46-224)
ESTRADIOL,ULTRASENSITIVE: 61 pg.mL (< or = 29)
SHBG: 30 n/Mol (10-50)


I feel pretty good, but Ive been breaking out like crazy since bumping up my dose. any suggestions?
Looks perfect to me.....especially if you're feeling good. The high T levels make some breakout but not others. Just depends
 

madman

Super Moderator
You recently showed a screenshot from a website that you use to calculate FT by inputting TT, SHBG and Albumin.

Is that FT calculation method as accurate as the most reliable methods for direct FT calculations?



Hello everyone,

First off, the number bits:
- TT: 480 (240-870)
- FT: 10 (8-40)
- e2: 15 (11-44)

After 2 months taking a B-vitamin complex:
- TT: 860 (240-870)
- FT: 11 (8-40)

- e2: 15 (11-44)


Hard to believe you achieved a significant bump in T from the simple addition of b-vitamins!

Unfortunately, you have no idea where your SHBG sits let alone FT as you never had it tested using an accurate assay.

I would not rely on the piss poor direct immunoassay let alone outdated calculated methods especially in cases of altered SHBG

Although the newer cFTZ algorithm (TruT) should give fairly consistent results I would prefer to rely on direct testing using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration especially in cases of altered SHBG.

The EAM (cFTZ) appears to be an accurate and testable model for calculating free testosterone levels, but this model needs further validation in large populations.

This will be a part of the ongoing phase II.

As I am patiently waiting on the completion of Phase II for the TruT (cFTZ) Algorithm let alone standardization and harmonized reference ranges for Free testosterone which is in the works as we speak.


The new dynamic model leads to the reconsideration of several dogmas related to testosterone's binding to SHBG and has important physiologic and clinical implications.

*First, the fraction of circulating testosterone that is free is substantially greater (2.9±0.4%)
than has been generally assumed (% cFTV 1.5±0.4%).

*Second, percent FT is not significantly related to total testosterone over a wide range of total testosterone concentrations. However, the percent FT declines as SHBG concentrations increase, although it does not decline as precipitously as predicted by Vermeulen's model. Due to the allostery between the two binding sites, SHBG is able to regulate FT levels in a much larger dynamic range.



Key points:

EAM (cFTZ) SHBG: T binding

*
Intra-dimer complex allostery suggests that SHBG can regulate FT fraction over a wide range of total testosterone concentrations without getting saturated.

*Indeed, it was found that percent FT calculated using the new model changed very modestly over a wide range of total testosterone concentrations.


*Due to the allostery between the two binding sites, SHBG is able to regulate FT levels in a much larger dynamic range.
 

Zibernet

Active Member

Hello everyone,

First off, the number bits:
- TT: 480 (240-870)
- FT: 10 (8-40)
- e2: 15 (11-44)

After 2 months taking a B-vitamin complex:
- TT: 860 (240-870)
- FT: 11 (8-40)

- e2: 15 (11-44)


Hard to believe you achieved a significant bump in T from the simple addition of b-vitamins!

Unfortunately, you have no idea where your SHBG sits let alone FT as you never had it tested using an accurate assay.

I would not rely on the piss poor direct immunoassay let alone outdated calculated methods especially in cases of altered SHBG

Although the cFTZ (TruT) should give fairly consistent results I would prefer to rely on direct testing using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration especially in cases of altered SHBG.

The EAM (cFTZ) appears to be an accurate and testable model for calculating free testosterone levels, but this model needs further validation in large populations.

This will be a part of the ongoing phase II.

As I am patiently waiting on the completion of Phase II for the TruT (cFTZ) Algorithm let alone standardization and harmonized reference ranges for Free testosterone which is in the works as we speak.


The new dynamic model leads to the reconsideration of several dogmas related to testosterone's binding to SHBG and has important physiologic and clinical implications.

*First, the fraction of circulating testosterone that is free is substantially greater (2.9±0.4%)
than has been generally assumed (% cFTV 1.5±0.4%).

*Second, percent FT is not significantly related to total testosterone over a wide range of total testosterone concentrations. However, the percent FT declines as SHBG concentrations increase, although it does not decline as precipitously as predicted by Vermeulen's model. Due to the allostery between the two binding sites, SHBG is able to regulate FT levels in a much larger dynamic range.



Key points:

EAM (cFTZ) SHBG: T binding

*
Intra-dimer complex allostery suggests that SHBG can regulate FT fraction over a wide range of total testosterone concentrations without getting saturated.

*Indeed, it was found that percent FT calculated using the new model changed very modestly over a wide range of total testosterone concentrations.


*Due to the allostery between the two binding sites, SHBG is able to regulate FT levels in a much larger dynamic range.

So, TT, SHBG and Albumin are a reliable way to measure FT if one doesn't have access to dialysis and whatnot?
 

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