TRT 3 years in - Labs higher on same old dosing

[Plainview]

I’ve been on TRT for 3 years now. Played the game with a reluctant and partially educated dr to end up taking 120mg a week in split doses. I worked up to this dose after 100mg every 2 weeks, 80mg, and 100mg a week. 120mg a week ended up being a good max dosage for me as I need no AI and push upper boundaries in all T labs and keep my E2 in check. My dr. Has me do labs 2x a year and for the last year or so I’ve been seeing my T values go up. When I was working my way up to my max dose 80mg had always put my total T around 520, 100mg put me at 720mg and 120 put me around 940 range for these 250-1100. Within the last year I’ve been seeing these values go up on the same dosages. Just this week i did labs and my dr. Only wanted to test total T for some reason. Roughly 100mg a week had me at 1042 TT 300-890. I should have mentioned all previous tests were by the lc ms/ms method. Range 250-1100. I’m confused what could be changing in my body that these values are increasing on the same amount of T. I do supplement with a multivitamin, grapeseed, turmeric, co q10, DIM with calcium d-glucate, rez-v, l-Theanine, 7-keto and ZMA at night. I’m wondering if the zinc supplemention through the multi and ZMA could be causing the increase in T values. Thought one of the prominent TRT Dr’s used zinc on low with low doses of TRT for this reason. If anyone has any input, I’d like to hear it. Thanks in advance.

 

[fifty]

Nothing is changing. Testing just sucks.

 

[Cataceous]

If the test results are correct and the timing and apparent doses are well matched then other possibilities for inconsistent measurements include incorrect drug testosterone concentrations, increasing SHBG, and a reduced metabolic clearance rate independent of SHBG—possibly related to liver function.

 

[Plainview]

Well to bring this thread full circle I received an unexpected phone call from my Dr.’s office this past monday and They called to tell me my testosterone labs came back normal. So I logged on to the portal and it appears my Dr. Ran two sets of labs for T. An immunoassay as well as an LC MS/MS comprehensive for T. I think he was only gonna run the immunoassay until the nurse came in to draw blood and I started asking her about which T test he ordered so she drew a plain red top just incase. This result was exactly what I would have expected.

total t 971 250-1100
Free T 144 46-224
Bioavailable 316 110-575
SHBG 34 10-50
Albumin 4.8 3.6-5.1

seems the consensus is that the lc ms/ms is the standard for testing T and the immunoassay can overestimate T. If anyone has any influence with their Dr or a say in their treatment, then I would never let them use the immunoassay method for a T lab. Of course most know that doesn’t tell the whole story anyway. So in the end my dr. Agreed to allow me to stay on my previous dose of 120mg a week rather than cut me back to 60mg every 5 days which only amounts to 84mg a week.
My next puzzle is the fact that my SHBG went up from what has always been 15-22 to 34. Don’t know if this is good bad or otherwise but I know my free T at peak would be pretty high even at 100-120mg a week when it was lower. Now it’s just a little above the middle which theoretically could call for a dose increase if anything. I was briefly looking to see what could have changed that and it appears through one paper I found that rezveratrol can increase SHBG. Guess that results in smoother more consistent Free T levels. I would think that would be a desired effect.