My endocrinologist has been the one Rx'ing test cypionate to me. I've ranged from where he started me on at 140mg weekly and down to 100mg weekly.
I've had quarterly check-ins with the endocrinologist and my blood work has always decent but i've had the normal side effects. High hematocrit, low libido etc. Doctor told me to drop my dose down to 100mg when he saw my hematocrit. In March of this year I saw a urologist to get the snip as two kids is a plenty. I chatted with the urologist briefly during consult about being on TRT and i briefly mentioned the libido stuff to him and the blood work etc and he said it just sounded like high e2. I went back to the urologist back in June for a consult to see if he would take over TRT care which he was fine with. He ordered a labs and told me to up my dose of testosterone back to 140 mg. He also prescribed Aromasin at 25mg twice a week even before he saw my labs. That little tidbit sort of through me off. I waited till my bloodwork came back and my estrogen was 39 , testosterone was 798 and free t was 20. Still high blood markers etc. These labs were taking in day prior to my once a week shot.
What method (direct, cFTV, Equilibrium Dialysis) was used to test your FT?
Always post method used/reference ranges.
You would need to have your FT tested using an accurate assay the gold standard Equilibrium Dialysis to know where it truly sits especially in cases of altered SHBG.
Where does your SHBG sit?
Where did your RBCs, hemoglobin and hematocrit sit pre-therapy and where do they sit as of now?
You stated that you were hitting a TT 798 ng/dL and more importantly FT 20 ng/dL the day before your next once weekly shot 140 mg TC/week.
This would be 24 hrs before you hit true trough (lowest point) before your next injection which would be 7 days post-injection which means that your true trough TT/FT will be a little lower.
Even then if you end up hitting true trough FT 15-18 ng/dL injecting once weekly then your peak TT and more importantly FT (8-12 hrs) post-injection/levels during the first 2-3 days will be much higher.
Nothing to fret over if you were feeling well overall and not experiencing any sides but unfortunately you were and are struggling with elevated hematocrit.
Mind you we have no idea where it truly sits as you never posted critical blood markers RBCs, hemoglobin and hematocrit.
Keep in mind It is a given that running too high a steady-state let alone trough FT level will. drive up your hematocrit.
Top it off the big difference between peak--->trough when injecting once weekly will also play a role.
Injecting more frequently which will clip the peak--->trough will help but you still need to be mindful of how high a trough/steady-state FT level you are running.
There is a drastic difference between one hitting a high-end/high trough FT injecting daily vs twice-weekly vs once weekly!
With all that being said seeing as you stated that you have OSA than this can easily contribute to elevating your hematocrit so chances are if you get this under control than your hematocrit will come down some.
Unless you have it under control which seems unlikely since you are not sleeping well.
Again post your pre-TTH RBCs hemoglobin and hematocrit and where they sit as of now.
Members stated post #4:
Sure you want to keep an eye on things like hematocrit, but the increase usually doesn’t increase beyond the initial small bump people see at the beginning of treatment. In other words, if it had increased a few points in the first 3 months there’s no reason to think it would continue to increase over time. It’s just your body adjusting to its new environment.
This is false and the guy it out to lunch!
After all the years on this forum he clearly still has no clue!
Hematocrit will increase within the first month of starting TTh and will take anywhere from 6-9 months and in some cases up to a year to reach peak levels.
It does not stabilize 3 months in this is COMPLETE BULLS**T!
Same applies to tweaking a protocol and increasing your dose the hematocrit will be driven up further and it will in no way stabilize 3 months in!
Tread lightly on who you take advice from on here!
On your current protocol injecting 140 mg T once weekly you would be hitting a very high peak FT and would still be hitting a healthy trough FT 15+ ng/dL and this is 7 days post-injection!
Again not a bad thing if one feels good overall, blood markers are healthy and they are not experiencing any slides.
The downfall for many injecting once weekly is that there will be a big difference between the peak--->trough and blood levels will not be as stable throughout the week which. can easily have a negative impact on mood, energy, libido and erectile function for some.
Even then there are many men who do well injecting once weekly as long as they are running a sensible weekly dose.
Some will fare much better splitting their dose and injecting more frequently throughout the week which will clip the peak--->trough and result in more stable blood levels throughout the week.
Many can lower their weekly dose and still easily achieve a healthy trough FT.
Some may have an easier time controlling elevated hematocrit let alone estradiol mind you many can still struggle with elevated hematocrit or high estradiol even when injecting daily if they end up running to high a steady-sate/trough FT even with a minimal difference in peak--->trough.
Trial and error is key here.
Now when it comes to a common theme on the forums let alone so called men's health forums struggling with low libido let alone ED (short/long-term).
Every time you increase the dose and drive up FT there will be a mini-honeymoon period where it's common for one to experience an increase in libido and erections, euphoric type feeling due to T levels rising, increased dopamine/AR activity as hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE).
During this transition period (first 4-6 weeks) the body is trying to adjust.
Unfortunately this is short-lived and temporary as once blood levels have stabilized (4-6 weeks TC/TE) the body will eventually adapt (over the next few months) to its new set-point and the increased libido and erections, euphoric type feeling will eventually wane more what we call into the norm.
This mini-honeymoon period is common when starting testosterone therapy or tweaking your protocol (increasing dose of T).
Also keep in mind some may even end up struggling with libido/erectile function in the long-run when running to high a trough/steady-state FT due to hammering the S**T out of dopamine!
Again running too high a trough/steady-state FT can be just as bad in many ways as running too low a FT especially when it comes to libido and erectile function.
For some it can even have a negative effect on mood and sleep as T has a tonic effect on the CNS and can easily make one feel amped up, agitated/irritable.
The body was never meant to be jacked up on T 24/7 let alone running around with FT levels at trough well beyond their genetic natty set-point.
When it comes to how great you felt the first 2-3 months in you most likely jumped the gun here!
Although you stated that you felt great the first 2-3 months in especially when it comes to libido it does not mean that it would have lasted. as even though you most likely made it through the initial honeymoon period and the body would have had a. chance to adapt 12 weeks in it does not mean that the way you felt overall would have lasted long-term as it is common for libido to eventually wane. back into what we call the norm compared to the big improvements seen for many when first starting therapy or increasing the T dose when tweaking a protocol.
Some may get lucky and maintain this longer than others but in most cases libido will tend to wane back over time to what we call the norm as in healthy for you.
Bad move trying to chase the honeymoon let alone the feeling you get when first starting or tweaking a protocol (increasing dose of T).
Much more to the story when it comes to testosterones impact on libido/erectile function!
As I have stressed numerous times on the forum having a healthy FT is only one piece of the puzzle as libido let alone ED are multifactorial.
Getting quality sleep, minimizing stress (physical/mental), following a healthy diet, exercising/staying active, improving overall vascular health will have a far bigger impact than jacking up your trough FT!
Have realistic expectations especially when it comes to libido and erectile function!
The most important things you can do when it comes to TRT are following a healthy diet, getting enough exercise (cardiovascular/weight bearing), maintaining a healthy weight, quality sleep and managing stress.
Your high level of stress let alone lack of quality sleep can easily put a hamper on libido.
Yes for some men elevated estradiol can have a negative impact.
Some men are what we call high-aromatizes especially if you are carrying a lot of adipose but even then lean men can still be high aromatizers!
Need to be mindful when it comes to the use of an AI as some may. fare better using micro-doses but for most they are not needed especially if you do not drive your trough/staed-state FT too high!
We need to tread lightly when trying to manipulate testosterone metabolites estradiol and DHT as they are needed in healthy amounts and are critical to our overall health.
Estradiol and DHT are needed in healthy amounts to experience the full spectrum of testosterone's beneficial effects on mood, energy, libido, erectile function, cardiovascular health, brain, bones, tendons, immune system, body composition, and recovery.
I would ditch the AI and if you want to stay on your current dose and tough it out longer than 3 months to see if you feel better overall but highly unlikely you are going to get back to where you were and it is not going to improve your elevated hematocrit.
You need to address the sleep apnea if you are still struggling let alone may need to look into what may be a more sensible protocol (dose of T/injection frequency).
Do what you feel is best for you and if anything before even attempting to tweak your protocol it would be wise to find out where your true trough FT (lowest point) before your next injection try sits and in order for such you would need to make sure you have it tested using an accurate assay (ED).
Would also be a smart move finding out where your SHBG sits.
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Testosterone might not do as much for your libido as people think it does. Here's what this hormone does and doesn't do for your sex drive.
www.yahoo.com
As an expert on andrology and sexual dysfunctions, urologist Andrew Y. Sun, M.D., sees plenty of patients who’re struggling with low libido. And most are pretty sure they already know why: They must have low testosterone levels. Even if it turns out they don’t, “most of them still strongly believe that increasing their testosterone levels will improve their libido,” says Sun, who practices at Urology Partners of North Texas.
Sun’s...
Introduction Androgens play a crucial role in the development and maintenance of: Male reproductive and sexual functions Body composition Erythropoiesis
www.thebloodproject.com
Introduction
- Androgens play a crucial role in the development and maintenance of:
- Male reproductive and sexual functions
- Body composition
- Erythropoiesis
- Muscle and bone health
- Cognitive function
- Testosterone falls progressively with age and a significant percentage of men over the age of 60 years have serum testosterone levels that are below the lower limits of young...
Key Takeaways
*Testosterone has a dose-dependent stimulating effect on erythropoiesis
*Erythrocytosis is the most common dose-limiting effect of testosterone therapy
*The mechanism by which testosterone increases the Hct/Hb is not clear but may involve changes in the levels of hepcidin, erythropoietin and/or estradiol
*Erythrocytosis tends to occur in the first 6 months of treatment, peaks within the first year of therapy and normalizes 3-12 months after discontinuation of treatment
*There is no compelling evidence that testosterone therapy or testosterone therapy-associated erythrocytosis are associated with increased risk of cardiovascular events or venous thromboembolism
*However, clinical practice guidelines generally recommend intervention if hematocrit of ≥54% while taking testosterone therapy; interventions include stopping testosterone therapy altogether, changing the dose or route of administration or instituting a phlebotomy regimen
Diagnosis and Management of Obstructive Sleep Apnea A Review (2020)
Daniel J. Gottlieb, MD, MPH; Naresh M. Punjabi, MD, PhD
IMPORTANCE Obstructive sleep apnea (OSA) affects 17% of women and 34% of men in the US and has a similar prevalence in other countries. This review provides an update on the diagnosis and treatment of OSA.
OBSERVATIONS The most common presenting symptom of OSA is excessive sleepiness, although this symptom is reported by as few as 15% to 50% of people with OSA in the general population. OSA is associated with a 2- to 3-fold...
*hematocrit of ≥54% appears to be consistent threshold to discontinuing or reducing treatment utilized by major urologic governing bodies, while the evidence for this specific cutoff is lacking
*There is no compelling evidence that testosterone therapy or testosterone therapy-associated erythrocytosis are associated with increased risk of cardiovascular events or venous thromboembolism
*However, clinical practice guidelines generally recommend intervention if hematocrit of ≥54% while taking testosterone therapy; interventions include stopping testosterone therapy altogether, changing the dose or route of administration or instituting a phlebotomy regimen
Fig 1: Change in hematocrit at 12, 48, 72 and 96 months in men receiving testosterone therapy vs. untreated men.5
* Hematocrit levels show significant increase (+4% at month 96) in men receiving TTh. This increase occurred during the first 48 months, as illustrated in figure 1. Final assessment (month 96) resulted mean hematocrit was 49% (range 47-51%). No subject had hematocrit above 52%. No change in hematocrit noted so far in men not receiving TTh.
* The present study showed that increased hematocrit (up to 52% at final...
* Hematocrit levels show significant increase (+4% at month 96) in men receiving TTh. This increase occurred during the first 48 months, as illustrated in figure 1. Final assessment (month 96) resulted mean hematocrit was 49% (range 47-51%). No subject had hematocrit above 52%. No change in hematocrit noted so far in men not receiving TTh.
* The present study showed that increased hematocrit (up to 52% at final assessment) was independently associated with reduced mortality [5]. This confirms the current clinical guidelines recommendation of using 54% as a threshold for change in management of men receiving testosterone therapy (e.g. dose reduction or therapeutic phlebotomy) [11-15]. It should be kept in mind that dehydration can cause a temporary elevation in hematocrit [16] and therefore a high hematocrit reading should be confirmed in a second blood test, ensuring the patient is in a well hydrated state, before action is taken.
* This study has a limitation as registry design. Furthermore, the sample is relatively small. Large scale, placebo-controlled studies with large cohort over prudential period is needed to robustly confirm these results
