New to TRT. Received first labs. Concerned and need help.

[trtguy8]

Male. Mid 50’s.

Symptoms prior to TRT: excessive fatigue, no energy, brain fog, difficulty concentrating, depression, anxiety, low libido, loss of muscle mass, reduced strength.

Prior to TRT, my total testosterone was 460. I know that may sound high to start TRT but I have been searching for a solution to my symptoms for a long time. My doctors have ruled out Vitamin D, B12, Folate, Anemia, infections, liver, kidney, hydration, thyroid, Iron, etc. Even at 460, I needed to see if TRT could help. I started with a low dose, waited 3 months, did my labs, and here I am.

I started TRT 3 months ago - testosterone cypionate 50mg, 2 IM injections per week (every 3 1/2 days). Total of 100mg per week.

Improvement with libido, muscle mass, and strength. No noticeable improvement with any other symptoms (which were my main goal). No noticed side effects (no water retention, acne, hair loss, etc).

Recent labwork taken at the trough of testosterone (3 1/2 days after last injection):

Labcorp

Albumin 4.8 g/dL 3.8-4.9

Hematocrit 48.1 % 37.5-51.0

eGFR 84 mL/min/1.73 >59

Testosterone, Total 676 ng/dL 264-916

Testosterone,Free 31.91 ng/dL 5.00-21.00

% Free Testosterone 4.72 % 1.50-4.20

Estradiol, Sensitive 23.1 pg/ml 8.0-35.0


Lipids, Thyroid, PSA, CMP, CBC, Urinalysis, & Vit D - all came back within normal ranges. Normal blood pressure.


Other:
Workout 5-6 days a week
Eat healthy, high protein diet
Low sugar
Drink lots of water
Sleep 7-8 hours/night
Lean, muscular body


Questions:

Should I be worried that my Free and % Free Testosterone are so high and outside the normal range? Does that mean I should reduce my dosage immediately?

I thought Free Testosterone at such high levels would greatly increase my energy and drive. Since it hasn't, does that tend to indicate TRT may not be much help with my symptoms?

Why would my Total Testosterone only go up slightly while my Free shot up drastically? My previous Free Test was about 10. It's now almost 32. My previous Free % was 2.3. It's now 4.7. That's at 100mg/week of test cyp. Is that big of an increase at a low dose a bad sign?

Any ideas why I am not seeing improvement with all my other symptoms? Too soon? Give it more time? Should I adjust my dose of testosterone cypionate?


I am just looking for some guidance. This is all new to me. My main goal for trying TRT was to improve my quality of life. I'm not trying to get huge in the gym. I just want to be healthy with energy and focus (like I was in my younger days.) And, I want to do it in a healthy, sustainable way.

Any help is GREATLY appreciated!! Thank you!

 

[WhiteMale]

SHBG? You're over range FT at 3.5days in a trough would indicate that you have low SHBG. I like to think for a low SHBG guy, if you have testing please tell us a number, can tend to be less tolerant to Estrogen which just means that 23.1 could be too high, for you.

% and ratios don't matter.

You do need more time.

 

[Cataceous]

While percent free testosterone is not a very useful number in general, that figure of 2.3% is suggesting that your pre-TRT free testosterone was around 11 ng/dL. Is this correct? If that was obtained by equilibrium dialysis then it's not a particularly low number.

Your current high free testosterone along with your modest total testosterone suggest that your SHBG is low. It could have been low originally, but testosterone and other androgens can suppress its production and drive it down.

Bear in mind that with twice-weekly injections peak serum levels can be 50-60% higher than trough values. This is likely putting your free testosterone at more than double the top of the normal range. Even if your blood work is not currently revealing any problems with these high levels, that can change over time. Furthermore, some risks accumulate over long periods, meaning that some men may pay a price for maintaining even modestly high levels for too long.

There's this pervasive myth that 100 mg of testosterone cypionate per week is a low dose. It's not. Top-of-range natural production is equivalent to more like 90 mg TC per week. Typical production in healthy young men is equivalent to 50-70 mg TC per week. Thus you are taking more testosterone than almost any man could make naturally and yet perceive it to be low. There is no evidence that such supraphysiological dosing is better for overall health, and plenty to the contrary. Testosterone has this complex interplay with at least a couple of dozen other hormones. Going too high with testosterone almost certainly creates imbalances. My main objection though is that in starting so high you have never experienced physiological levels. I think it's important to experiment with various modest doses before pushing the limits.

Unfortunately, dose decreases are usually harder than dose increases. It's something to be aware of if you do decide to experiment with lower doses. You need to give the new dose a few months before making a final evaluation. Another option is switching to a fast-acting form of testosterone. The nasal gels are the best known of these. These are useful because the relatively short periods of high testosterone give benefits without causing the side effects of longer exposure.

Regrettably, testosterone is no cure-all. If you didn't have hypogonadism to begin with then TRT may do more harm than good. However, you do have some indications that testosterone is helping. Thus I think it would be worthwhile to continue experimenting with TRT, either with lower doses or with fast-acting testosterone. Something else to look into is things that raise dopamine activity. There are various supplements you can try, as well as drugs such as selegiline. How do you respond to stimulants like caffeine? I'm wondering if you have any hints about what lessens your remaining symptoms.

 

[trtguy8]

SHBG? You're over range FT at 3.5days in a trough would indicate that you have low SHBG. I like to think for a low SHBG guy, if you have testing please tell us a number, can tend to be less tolerant to Estrogen which just means that 23.1 could be too high, for you.

% and ratios don't matter.

You do need more time.

I did not get SHBG tested this time unfortunately.

The last time I tested SHBG was 4 years ago (no TRT). It was 21.9 nmol/L.

 

[trtguy8]

While percent free testosterone is not a very useful number in general, that figure of 2.3% is suggesting that your pre-TRT free testosterone was around 11 ng/dL. Is this correct? If that was obtained by equilibrium dialysis then it's not a particularly low number.

Your current high free testosterone along with your modest total testosterone suggest that your SHBG is low. It could have been low originally, but testosterone and other androgens can suppress its production and drive it down.

Bear in mind that with twice-weekly injections peak serum levels can be 50-60% higher than trough values. This is likely putting your free testosterone at more than double the top of the normal range. Even if your blood work is not currently revealing any problems with these high levels, that can change over time. Furthermore, some risks accumulate over long periods, meaning that some men may pay a price for maintaining even modestly high levels for too long.

There's this pervasive myth that 100 mg of testosterone cypionate per week is a low dose. It's not. Top-of-range natural production is equivalent to more like 90 mg TC per week. Typical production in healthy young men is equivalent to 50-70 mg TC per week. Thus you are taking more testosterone than almost any man could make naturally and yet perceive it to be low. There is no evidence that such supraphysiological dosing is better for overall health, and plenty to the contrary. Testosterone has this complex interplay with at least a couple of dozen other hormones. Going too high with testosterone almost certainly creates imbalances. My main objection though is that in starting so high you have never experienced physiological levels. I think it's important to experiment with various modest doses before pushing the limits.

Regrettably, testosterone is no cure-all. If you didn't have hypogonadism to begin with then TRT may do more harm than good. However, you do have some indications that testosterone is helping. Thus I think it would be worthwhile to continue experimenting with TRT, either with lower doses or with fast-acting testosterone. Something else to look into is things that raise dopamine activity. There are various supplements you can try, as well as drugs such as selegiline. How do you respond to stimulants like caffeine? I'm wondering if you have any hints about what lessens your remaining symptoms.

Yes, my pre TRT free testosterone was 10 ng/ml.

Both replies suggest I may have low SHBG. Is that bad?

I was under the assumption 100mg/week was low. Thank you for your feedback. Maybe I need to titrate downward and watch symptoms and redo bloodwork in 3 months?

I drink coffee daily. Caffeine helps wake me up and feel better. I just can't take too much or I feel jittery and ultimately tired. I have also been prescribed Modafinil over the years. I don't take it often, but it wakes me up and does give me some energy. I just try not to use it too often.