6 mo. into TRT and level dropped with increase in freqency of injections. Stumped.

sting · Mar 26, 2017

Going on 58yrs. old and started TRT therapy aprox. 6 mo. ago. I'm stumped and want to understand what happened before going back to the urologist with my questions. Been reading, but this is all too new to me. All help is appreciated.

Started with just Test. cyp. 100mg. every 14 days. (no hcg or anything else.) Dr. had me go to 6 days 100mg. about 2 mo. ago. and recent testosterone level dropped from 391ng./dl. to now 336ng./dl. since.

I did donate blood the day before lab (3/18/17) work because of high hematocrit level from my primary care physician lab work weeks prior to this.

As of 3/19/17 Dose 100mg. average every 6 days.
Testosterone 336 ng/dL 250 - 1100 ng/dL
Free Testosterone 74.2 pg/mL 46.0 - 224.0 pg/mL
Testosterone, Bioavailable 159.0 ng/dL 110.0 - 575.0 ng/dL
Sex Hormone Binding Globulin 15 nmol/L 22 - 77 nmol/L
Albumin, Serum 4.7 g/dL 3.6 - 5.1 g/dL
TSH 0.75 uIU/ML 0.35 - 4.9 uIU/ML
CBC as of 3/19/17
WBC 16.9 K/UL 4.0 - 11.0 K/UL
RBC 5.65 M/UL 4.40 - 5.60 M/UL
HGB 17.1 G/DL 13.5 - 17.5 G/DL
HCT 49.7 % 40.0 - 51.0 %
MCV 88 FL 80 - 97 FL
MCH 30.3 PG 27.0 - 33.0 PG
MCHC 34.4 G/DL 32.0 - 36.0 G/DL
Platelet 188 K/UL 150 - 400 K/UL
RBC Dist Width 13.2 % 12.0 - 14.5 %

Labs into therapy as of 10/27/16

Testosterone 391 ng/dL 250 - 1100 ng/
Free Testosterone 75.2 pg/mL 46.0 - 224.0 pg/mL
Testosterone, Bioavailable 164.4 ng/dL 110.0 - 575.0 ng/dL
Sex Hormone Binding Globulin 19 nmol/L 22 - 77 nmol/L
Albumin, Serum 4.8 g/dL 3.6 - 5.1 g/dL
Estradiol 17 PG/ML 11 - 44 PG/ML
CBC
WBC 8.0 K/UL 4.0 - 11.0 K/UL
RBC 5.41 M/UL 4.40 - 5.60 M/UL
HGB 16.2 G/DL 13.5 - 17.5 G/DL
HCT 47.5 % 40.0 - 51.0 %
MCV 88 FL 80 - 97 FL
MCH 29.9 PG 27.0 - 33.0 PG
MCHC 34.1 G/DL 32.0 - 36.0 G/DL
Platelet 165 K/UL 150 - 400 K/UL
RBC Dist Width 13.2 % 12.0 - 14.5 %

CSI007 · Mar 26, 2017

I can tell you right now that it's a pretty horrible protocol. 100mg once every 2 weeks likely would keep your levels very low. Even 100mg once per week (in my experience doing 50mg twice a week) might not be enough T. Are you testing in the trof? Immediately before your next injection?

CoastWatcher · Mar 26, 2017

sting said:
Going on 58yrs. old and started TRT therapy aprox. 6 mo. ago. I'm stumped and want to understand what happened before going back to the urologist with my questions. Been reading, but this is all too new to me. All help is appreciated.

Started with just Test. cyp. 100mg. every 14 days. (no hcg or anything else.) Dr. had me go to 6 days 100mg. about 2 mo. ago. and recent testosterone level dropped from 391ng./dl. to now 336ng./dl. since.

I did donate blood the day before lab (3/18/17) work because of high hematocrit level from my primary care physician lab work weeks prior to this.

As of 3/19/17 Dose 100mg. average every 6 days.
Testosterone 336 ng/dL 250 - 1100 ng/dL
Free Testosterone 74.2 pg/mL 46.0 - 224.0 pg/mL
Testosterone, Bioavailable 159.0 ng/dL 110.0 - 575.0 ng/dL
Sex Hormone Binding Globulin 15 nmol/L 22 - 77 nmol/L
Albumin, Serum 4.7 g/dL 3.6 - 5.1 g/dL
TSH 0.75 uIU/ML 0.35 - 4.9 uIU/ML
CBC as of 3/19/17
WBC 16.9 K/UL 4.0 - 11.0 K/UL
RBC 5.65 M/UL 4.40 - 5.60 M/UL
HGB 17.1 G/DL 13.5 - 17.5 G/DL
HCT 49.7 % 40.0 - 51.0 %
MCV 88 FL 80 - 97 FL
MCH 30.3 PG 27.0 - 33.0 PG
MCHC 34.4 G/DL 32.0 - 36.0 G/DL
Platelet 188 K/UL 150 - 400 K/UL
RBC Dist Width 13.2 % 12.0 - 14.5 %

Labs into therapy as of 10/27/16

Testosterone 391 ng/dL 250 - 1100 ng/
Free Testosterone 75.2 pg/mL 46.0 - 224.0 pg/mL
Testosterone, Bioavailable 164.4 ng/dL 110.0 - 575.0 ng/dL
Sex Hormone Binding Globulin 19 nmol/L 22 - 77 nmol/L
Albumin, Serum 4.8 g/dL 3.6 - 5.1 g/dL
Estradiol 17 PG/ML 11 - 44 PG/ML
CBC
WBC 8.0 K/UL 4.0 - 11.0 K/UL
RBC 5.41 M/UL 4.40 - 5.60 M/UL
HGB 16.2 G/DL 13.5 - 17.5 G/DL
HCT 47.5 % 40.0 - 51.0 %
MCV 88 FL 80 - 97 FL
MCH 29.9 PG 27.0 - 33.0 PG
MCHC 34.1 G/DL 32.0 - 36.0 G/DL
Platelet 165 K/UL 150 - 400 K/UL
RBC Dist Width 13.2 % 12.0 - 14.5 %

With your very low SHBG, you are clearing testosterone quickly and should move to multiple, smaller injections per week. You are measuring your estradiol with the wrong test - you want to capture that value with the sensitive, LC, MS/MS, assay. You should determine if HCG ought to be part of your protocol, or at least have a discussion with your doctor so you can make an informed decision about it. Finally, I ask you to consider finding better medical care. Your doctor has no understanding, I would suggest, of the role SHBG plays in the design of a successful protocol, nor does he order the correct e2 test.

You deserve better care.

Vince Carter · Mar 26, 2017

100% correct on the SHBG value...thanks CW

ERO · Mar 26, 2017

If your urologist thinks this is a good protocol (and he does, or he would not have put you on it) that is a huge red flag that tells you to find a new TRT doctor. He doesn't use the proper E2 test, he thinks 100 mg every 2 weeks is going to help, he doesn't understand how SHBG levels factor into TRT, etc...The difference between your T levels of 391 to 336 on the two tests are the least of your problems. Both indicate a "Low T" state due to your horrible protocol. Better TRT docs get their guys to the upper quartile of the normal range. Typically 750 to 1000 in rough numbers.

sting · Mar 26, 2017

CSI007 said:
I can tell you right now that it's a pretty horrible protocol. 100mg once every 2 weeks likely would keep your levels very low. Even 100mg once per week (in my experience doing 50mg twice a week) might not be enough T. Are you testing in the trof? Immediately before your next injection?

Yes it was tested Immediately before . Going to ask him to up the dose.

sting · Mar 26, 2017

ERO said:
If your urologist thinks this is a good protocol (and he does, or he would not have put you on it) that is a huge red flag that tells you to find a new TRT doctor. He doesn't use the proper E2 test, he thinks 100 mg every 2 weeks is going to help, he doesn't understand how SHBG levels factor into TRT, etc...The difference between your T levels of 391 to 336 on the two tests are the least of your problems. Both indicate a "Low T" state due to your horrible protocol. Better TRT docs get their guys to the upper quartile of the normal range. Typically 750 to 1000 in rough numbers.

I went thru 4 docs in 2 years and none would prescribe testosterone with levels in the low 300's.
I've been on 100mg every 6 days now. Don't understand why the test level came in lower compared to the 14 days protocol.

CSI007 · Mar 26, 2017

sting said:
Yes it was tested Immediately before . Going to ask him to up the dose.

Before you just start throwing darts at a dart board....Maybe have a look at my thread and where I am today.

https://www.excelmale.com/forum/showthread.php?8911-My-journey-so-far-with-low-testosterone

You might be best served on the same dose but at more frequent intervals. I'm not sure if that is going to get me where I need to be (every other day from twice a week) yet or not. But I am feeling pretty good right now. Certainly better then I did when I was every 3.5 days. And I did not increase my dosage. I actually decreased it slightly because of the EOD protocol. In the end, I may need to adjust up but I wont know until I test again in a few weeks.

Increasing dosage can bring about other unwanted side effects. As I was told here, best to take a conservative approach and see how things play out.

CSI007 · Mar 26, 2017

sting said:
I went thru 4 docs in 2 years and none would prescribe testosterone with levels in the low 300's.
I've been on 100mg every 6 days now. Don't understand why the test level came in lower compared to the 14 days protocol.

Read my thread. You will see that I had an initial bump up (a lot higher then yours) but then it began to decrease as time went on.

CSI007 · Mar 26, 2017

One more thing. You should really talk to your (or a future) doctor about HCG. It has wonderful benefits for men on T.

sting · Mar 26, 2017

CSI007 said:
One more thing. You should really talk to your (or a future) doctor about HCG. It has wonderful benefits for men on T.

I plan on having a good conversation with him once I pick up some good info. here. I will read your thread, thank you!

sting · Mar 26, 2017

CoastWatcher said:
With your very low SHBG, you are clearing testosterone quickly and should move to multiple, smaller injections per week. You are measuring your estradiol with the wrong test - you want to capture that value with the sensitive, LC, MS/MS, assay. You should determine if HCG ought to be part of your protocol, or at least have a discussion with your doctor so you can make an informed decision about it. Finally, I ask you to consider finding better medical care. Your doctor has no understanding, I would suggest, of the role SHBG plays in the design of a successful protocol, nor does he order the correct e2 test.

You deserve better care.

Please define the testosterone clearing quickly. Thanks

CSI007 · Mar 26, 2017

sting said:
Please define the testosterone clearing quickly. Thanks

Your body uses it up more quickly then someone else.

For instance,

Person A after a week of 100mg T could have a serum T level of 750.

Person B after a week of 100mb T could have a serum T level of 350.

Person B is "using" or passing it through there system quicker then Person A

ERO · Mar 26, 2017

Guys with low SHBG (generally) clear T very quickly from their system - that means that if they inject once a week or even twice a week, their T level may drop so fast between doses that they still don't feel good and their levels are bouncing from low to high(er) all of the time. I am a low SHBG guy and I am one of many here that injects a small amount of T daily with an insulin syringe to maintain a stable T level.

sting · Mar 26, 2017

ERO said:
Guys with low SHBG (generally) clear T very quickly from their system - that means that if they inject once a week or even twice a week, their T level may drop so fast between doses that they still don't feel good and their levels are bouncing from low to high(er) all of the time. I am a low SHBG guy and I am one of many here that injects a small amount of T daily with an insulin syringe to maintain a stable T level.

Been weight training in the gym for 35 yrs. I train 5 days a week and eat a high protein diet . 5'7 200lbs.
Would this cause it to clear quickly??? Thanks for your help.

madman · Mar 26, 2017

sting said:
Been weight training in the gym for 35 yrs. I train 5 days a week and eat a high protein diet . 5'7 200lbs.
Would this cause it to clear quickly??? Thanks for your help.

It should make no difference ( training/high protein ). Hepatic clearance can account for
50-65% of metabolic clearance rate of testosterone and muscle mass may be a large contributor to the extra hepatic clearance of testosterone.

https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2006-0822

https://www.ncbi.nlm.nih.gov/books/NBK279000/

Vince Carter · Mar 27, 2017

sting said:
Been weight training in the gym for 35 yrs. I train 5 days a week and eat a high protein diet . 5'7 200lbs.
Would this cause it to clear quickly??? Thanks for your help.

SHBG is what causes T to "clear" quickly, not weights/gym or anything else.

sting · Mar 27, 2017

ERO said:
Guys with low SHBG (generally) clear T very quickly from their system - that means that if they inject once a week or even twice a week, their T level may drop so fast between doses that they still don't feel good and their levels are bouncing from low to high(er) all of the time. I am a low SHBG guy and I am one of many here that injects a small amount of T daily with an insulin syringe to maintain a stable T level.

Injecting more frequently as yourself, does your level ever go up to the level of the person who does not need to inject frequently?

sting · Mar 27, 2017

Vince Carter said:
SHBG is what causes T to "clear" quickly, not weights/gym or anything else.

Having it to clear quickly, would it still raise hematocrit as it does with me with a small dose? I've had it as high as 52.3%

sting · Mar 28, 2017

CoastWatcher said:
With your very low SHBG, you are clearing testosterone quickly and should move to multiple, smaller injections per week. You are measuring your estradiol with the wrong test - you want to capture that value with the sensitive, LC, MS/MS, assay. You should determine if HCG ought to be part of your protocol, or at least have a discussion with your doctor so you can make an informed decision about it. Finally, I ask you to consider finding better medical care. Your doctor has no understanding, I would suggest, of the role SHBG plays in the design of a successful protocol, nor does he order the correct e2 test.

You deserve better care.

In this scenario, Instead of the 100mg. every 6 days. Would and increase of 100mg. twice weekly show an increase in my SHGB? Then would the increase in SHGB allow my testosterone levels to increase as well? Thanks.

6 mo. into TRT and level dropped with increase in freqency of injections. Stumped.

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