Bumping up T and testing SHBG

ReillyJ · May 30, 2018

I asked for advice on my husband and how often to give his T dose and you all gave me good advice on splitting his dose to 3 x a week instead of 2 x like we had been doing. He's on the standard 400 mg a month but his FREE T has consistently tested low and his Total has been in the 500's in a trough.

It had been suggested he might have high SHBG (he has non alcoholic liver cirrhosis) and he's 69 and been on TRT since last October.

We did notice better results with the 3 x a week (IM) dosage (better libido, a bit increase of energy) so that is good but his doc just OK'd an increase of 50% in his RX, i don't know what that's going to be until i pick up his RX but i want to order a SHBG test.

Is there a time requirement of when to test like there is for T (for example before a shot)? I think i'll have all three tests taken.

Also with this new dosage, should i just keep on the 3 x a week shots? We honestly don't want to do SubQ and would want to stick to IM (he gets it in the glutes currently) and he doesn't mind doing it more frequently if it's suggested here.

His last Estradiol test was in January and it was normal...i know dosage increases come with their own complications and i obviously want to avoid that, i imagine he might be converting into other hormones esp. with his liver and probably needed the 3 x a week instead of 2 x.

Thanks all for your help, so greatly appreciated

Susie

Vince · May 30, 2018

When changing your protocol you need to wait at least 6 weeks before doing labs. Then do your lab as normal before you inject on injection day.

FeelingLost · May 30, 2018

Hi Susie, You can pretty much have his SHGB tested at any time. Fasting is not even required.
If you just want that one test checkout Nelsons service. SHGB only for 68 bucks.
https://www.discountedlabs.com/sex-hormone-binding-globulin-shbg

Knowing that value will help determine how frequest you should be injecting.

A 50% increase is a lot. Even if the doc says OK I would increase the dose slowly. If you are doing 100mg/wk now just go up to 120/wk and see where his E2 goes in 40 days and see how he is feeling. A slightly high E2 is probably a good thing for his age it will help keep his bones strong and joins lubricated.
Many have E2 and prolactin issues on doses over 100mg/wk.

hth

ReillyJ · May 30, 2018

Vince said:
When changing your protocol you need to wait at least 6 weeks before doing labs. Then do your lab as normal before you inject on injection day.

Thanks, yes i just figured this out! At least the tests are ordered (so insurance will cover most of it) and we'll retest in 6wks.

I'm also wondering if we should go ahead and test his SHGB right NOW, since it's never been tested..but like i said he just got his first dosage increase...

ReillyJ · May 30, 2018

FeelingLost said:
Hi Susie, You can pretty much have his SHGB tested at any time. Fasting is not even required.
If you just want that one test checkout Nelsons service. SHGB only for 68 bucks.
https://www.discountedlabs.com/sex-hormone-binding-globulin-shbg

Knowing that value will help determine how frequest you should be injecting.

A 50% increase is a lot. Even if the doc says OK I would increase the dose slowly. If you are doing 100mg/wk now just go up to 120/wk and see where his E2 goes in 40 days and see how he is feeling. A slightly high E2 is probably a good thing for his age it will help keep his bones strong and joins lubricated.
Many have E2 and prolactin issues on doses over 100mg/wk.

hth

Thank you. Well i went ahead and gave him his first shot which will be .25 ml 3 x weekly.... idk maybe we should just see in 6 weeks how he does on this?

FeelingLost · May 30, 2018

ReillyJ said:
Thank you. Well i went ahead and gave him his first shot which will be .25 ml 3 x weekly.... idk maybe we should just see in 6 weeks how he does on this?

Hi Susie, This is what 150mg/wk for 2 months did to my TT and FT I required an AI (.125mg anastrozole) with every shot, I injected M/W/F to keep my E2 in range. I also had to donate blood every 56 days to keep my blood (HCT) from thickening raising my blood pressure.

ReillyJ · May 30, 2018

FeelingLost said:
Hi Susie, This is what 150mg/wk for 2 months did to my TT and FT I required an AI (.125mg anastrozole) with every shot, I injected M/W/F to keep my E2 in range. I also had to donate blood every 56 days to keep my blood (HCT) from thickening raising my blood pressure.

Thanks for that...

What were your labs on 100 mg a wk? H's is in the 500's and his free T3 is always very low.... i absolutely do feel he needs an increase but will ponder what you've said.. maybe others can weigh in but yes i will think carefully about this

madman · May 30, 2018

ReillyJ said:
I asked for advice on my husband and how often to give his T dose and you all gave me good advice on splitting his dose to 3 x a week instead of 2 x like we had been doing. He's on the standard 400 mg a month but his FREE T has consistently tested low and his Total has been in the 500's in a trough.

It had been suggested he might have high SHBG (he has non alcoholic liver cirrhosis) and he's 69 and been on TRT since last October.

We did notice better results with the 3 x a week (IM) dosage (better libido, a bit increase of energy) so that is good but his doc just OK'd an increase of 50% in his RX, i don't know what that's going to be until i pick up his RX but i want to order a SHBG test.

Is there a time requirement of when to test like there is for T (for example before a shot)? I think i'll have all three tests taken.

Also with this new dosage, should i just keep on the 3 x a week shots? We honestly don't want to do SubQ and would want to stick to IM (he gets it in the glutes currently) and he doesn't mind doing it more frequently if it's suggested here.

His last Estradiol test was in January and it was normal...i know dosage increases come with their own complications and i obviously want to avoid that, i imagine he might be converting into other hormones esp. with his liver and probably needed the 3 x a week instead of 2 x.

Thanks all for your help, so greatly appreciated

Susie

It is critical to know his shbg.

What were his pre-trt hemoglobin/hematocrit levels?

Going from 100--->150mg test/week is a large jump and may very well result in high e2 let alone make sure you are ready for his hemoglobin/hematocrit to increase as when one starts trt or increases dose of testosterone when making a protocol adjustment hemoglobin/hematocrit will increase within the first 3 months and can take up to 9-12 months to reach peak levels.

Do understand that him being almost 70 that older men are usually more sensitive to the effects of testosterone.

You stated that on his current protocol of 100mg/week split into (3 injections/week) that his free t is still low and his total t trough is in the 500s.

Do you have labs to post with the ranges, especially including CBC (complete blood count) as knowing where his hemo/hemato is on the current protocol let alone e2.

If it turns out from lab work that his shbg is high than 3 weekly injections are not needed and injecting every 3.5 days would be better.

ReillyJ · May 30, 2018

Thanks for your response!

I will get him in and get his SHBG tested, even though i just gave him his new dosage.... it has never been tested, needless to say we fired his Endo as he wouldn't even test E2, we had that tested ourselves and it was fine..this was 4 months into TRT at 100/wk.

His Hemo/Hematocrit is fine, actually somewhat low and has always tested that way, he has non alcoholic liver cirrhosis and is slightly anemic (long story) so his doctor isn't worried there.

I do think, even though i just gave him the first dosage increase, that i will do the 125/wk instead for 6 weeks and see what happens.

Right now our schedule is Wed morn/Fri night/Sun night and what i noticed after moving to that from 2x a week is a bit more energy and libido. Reason for the request in increase is Free T is pretty darn low even after 8 months on TRT.

Going to do .2 ml 3 x weekly instead of the .25....

madman · May 30, 2018

ReillyJ said:
Thanks for your response!

I will get him in and get his SHBG tested, even though i just gave him his new dosage.... it has never been tested, needless to say we fired his Endo as he wouldn't even test E2, we had that tested ourselves and it was fine..this was 4 months into TRT at 100/wk.

His Hemo/Hematocrit is fine, actually somewhat low and has always tested that way, he has non alcoholic liver cirrhosis and is slightly anemic (long story) so his doctor isn't worried there.

I do think, even though i just gave him the first dosage increase, that i will do the 125/wk instead for 6 weeks and see what happens.

Right now our schedule is Wed morn/Fri night/Sun night and what i noticed after moving to that from 2x a week is a bit more energy and libido. Reason for the request in increase is Free T is pretty darn low even after 8 months on TRT.

If he is slightly anemic than an increase in hemo/hemato will be beneficial but as far as your injection protocol I would stick with it for now but once you know his shbg than decide if a change is needed as if it truly is high 3 injections per week are not needed.

ReillyJ · May 30, 2018

madman said:
If he is slightly anemic than an increase in hemo/hemato will be beneficial but as far as your injection protocol I would stick with it for now but once you know his shbg than decide if a change is needed as if it truly is high 3 injections per week are not needed.

I'll get him to go in to the lab today, very interested to see what the result is, i am going with what you all are advising and trying 125/wk instead of 150/wk you all have never steered me wrong and i appreciate the help. Better to go slow and at least it is an increase!

Susie

Vince Carter · May 30, 2018

ReillyJ said:
Thanks for that...

What were your labs on 100 mg a wk? H's is in the 500's and his free T3 is always very low.... i absolutely do feel he needs an increase but will ponder what you've said.. maybe others can weigh in but yes i will think carefully about this

The posting of those labs has nothing to do with anything at all. None of this is at all linear and nothing can be equated to how one guy will respond on X dosage.

FeelingLost · May 30, 2018

ReillyJ said:
Thanks for that...

What were your labs on 100 mg a wk? H's is in the 500's and his free T3 is always very low.... i absolutely do feel he needs an increase but will ponder what you've said.. maybe others can weigh in but yes i will think carefully about this

Hi Susie, I posted my lab page just as an example of how high ones TT and FT can go on 150/wk. To try and convince you to start with a lower dose. You can always raise it later. I went too high, 150 to be exact, and I hated it.
If your husbands free t is super low even with 100mg/wk there is a very good chance he will have a high SHGB high being above average.
Mine is not @ 24.2 so I convert a ton of T to free T. Free T is the part he feels.

My numbers were very low when I dropped back to .16(32mg) M/W/F 96mg/wk
I then increased it to .20(40mg) M/W/F 120mg/wk and I feel much better. Blood draws in 2 more weeks.
But I did have to start taking my AI again. One(.125) Thursday and one Sat.
I was experiencing waves of emotions which from past blood tests and feeling I know is E2 over 40ng/dL.

As Madman stated we really need that SHGB number to give you the best advice to consider.
I'm betting it is high like over 50 I hope you will post the number when you get it.

ReillyJ · May 30, 2018

FeelingLost said:
Hi Susie, I posted my lab page just as an example of how high ones TT and FT can go on 150/wk. To try and convince you to start with a lower dose. You can always raise it later. I went too high, 150 to be exact, and I hated it.
If your husbands free t is super low even with 100mg/wk there is a very good chance he will have a high SHGB high being above average.
Mine is not @ 24.2 so I convert a ton of T to free T. Free T is the part he feels.

My numbers were very low when I dropped back to .16(32mg) M/W/F 96mg/wk
I then increased it to .20(40mg) M/W/F 120mg/wk and I feel much better. Blood draws in 2 more weeks.
But I did have to start taking my AI again. One(.125) Thursday and one Sat.
I was experiencing waves of emotions which from past blood tests and feeling I know is E2 over 40ng/dL.

As Madman stated we really need that SHGB number to give you the best advice to consider.
I'm betting it is high like over 50 I hope you will post the number when you get it.

Thank you, FeelingLost

OK now from extensive reading, it seems that at least one of the ways to treat high SHBG (IF that's what he has and i am betting...) is with TRT and less frequent injecting like..once a week (this from search results on this forum) so that would be very interesting to do, a little nerve wracking as everything that has been drilled into my brain since having him start on this (i'm the one researching as much as i can, to help him) is more frequent injections = better results.

He's also on all the supplemental protocol such as D (although how much is being absorbed may be in question, he's taking 5,000 IU-we live in the PAC NW), Zinc, Magnesium, etc. and he's on liver support. Hopefully by tomorrow we'll have the results, if not..by Friday for sure and of course i'll post.

Doc also has Total and Free T tests ordered but i'm going to hold off on those since he's just done the first dosage change.

FeelingLost · May 30, 2018

ReillyJ said:
Thank you, FeelingLost

OK now from extensive reading, it seems that at least one of the ways to treat high SHBG (IF that's what he has and i am betting...) is with TRT and less frequent injecting like..once a week (this from search results on this forum) so that would be very interesting to do, a little nerve wracking as everything that has been drilled into my brain since having him start on this (i'm the one researching as much as i can, to help him) is more frequent injections = better results.

He's also on all the supplemental protocol such as D (although how much is being absorbed may be in question, he's taking 5,000 IU-we live in the PAC NW), Zinc, Magnesium, etc. and he's on liver support. Hopefully by tomorrow we'll have the results, if not..by Friday for sure and of course i'll post.

Doc also has Total and Free T tests ordered but i'm going to hold off on those since he's just done the first dosage change.

I hope your husband knows how much effort you are doing on his behalf. I applaud you.
Your research is correct with a high SHGB less injections are better and can really bring down ones SHGB. But please don't try that until you have the SHGB number. There are side effects( HAHA there is always side effects for everything in this dam TRT game) when doing one big T shot and that is E2 can spike. With a big T shot between 24 and 48 hours his system will be flooded with T and the body will start converting all that extra T to E.

FeelingLost · May 30, 2018

Some on this forum will say the only way to know if ones E2 is too high is a sens E2 blood test.
I am telling you there are other ways.

It's more like a cars engine idiot light. You know the engine has overheated you don't know the engines temp.
If you are not taking an AI and you increase your T cyp dose your E2 will only go up. By how much is the only question.

this technique is not as accurate as a blood test but you will know if E2 is higher than normal and possible too high. He will learn what this feels like as well.

Post T shot 24-48 hours T peaks. E follows so 48-72 hours later get him alone talk about something sensitive not too sensitive you both start crying the topic need to be something right on the edge and if he is overwhelmed you will know his E2 is too high. You don't have to trick him you can tell him what you are doing.

I do this test on myself with music videos. I listen and watch these when my E2 is perfect via blood tests and when I feel something is wrong.

Here is an example of how I test my E2. You two will have to find something that works for you.

for max effect use headphones.

ReillyJ · May 31, 2018

Oh no... yes another thing to worry about and that's why we started at twice weekly because i knew about the E2 conversion. I won't do anything until tests come back tomorrow and i may just stick with twice weekly i think, depending on what tests say. That's the last thing he needs is to be overcome with emotion. As a female, obviously i know what that is like and while they are useful and serve a purpose, i don't care for those feelings at all... I also am familiar with that song!! Well, i will be posting the SHBG hopefully tomorrow.

Maybe it will be in the correct range and just the bump up of T will be what he needs....

ReillyJ · Jun 4, 2018

Test result in

OK so we got his result in and the number isn't too bad:

Standard range: 22-77 nmol
His result: 55 nmol.

This is shooting 3 x a week. We are going to go ahead and bump it up to the 150/wk.

For reference, his last Total and Free T numbers were:

mid March: Total : 513. Free: 34.2 (below normal) reference range begins at 35.0

This was on 100/wk 2x. We bumped it up to shooting 3x a week at least a month or so ago with seemingly better results.

So now, what would the consensus be with 2 or 3x a week at 150? Don't want it to convert to E2, especially.

Thanks
Susie

Vince · Jun 4, 2018

I probably would inject 75 mg twice a week, but injecting 50 mg three times a week should still be okay. I know sometimes we tend to overthink things.

ReillyJ · Jun 4, 2018

Vince said:
I probably would inject 75 mg twice a week, but injecting 50 mg three times a week should still be okay. I know sometimes we tend to overthink things.

Overthink boy isn't that the truth!! I'm just trying to do the best i can to figure this out and help him but the rest is up to his body. I DO know that one way of raising Free T is upping the dosage so he was on the minimum dose, maybe this is what he needs. I'll have to think about how often to inject... don't want E2 to rise and thank you so much for responding.

Bumping up T and testing SHBG

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