Bumping up T and testing SHBG

Blackhawk · Jun 4, 2018

FeelingLost said:
Your research is correct with a high SHGB less injections are better and can really bring down ones SHGB.

Please provide references for this information.

This idea is common discussion on this forum, but I have searched and never found any documentation, and discussed this with Dr Saya 2 weeks ago. Unless there was something miscommunicated between us, he denied this as true.

I believe this interpretation came because high SHBG guys can do fine on less frequent injections, and somehow this got misconstrued as high SHBG need less frequent injections. Apparently there is no documented reason they can or should not inject more frequently.

To overcome high SHBG and get free T higher they need larger dosing relative to low SHBG guys. That does not mean less frequent, just more T.

Then there are those who kind of break that mold, like me. I just had SHBG tested at 48.1 with free T in good range and we have lowered my T dose to 84mg per week

The other aspect for Reilly is that her husband felt better when increasing injection frequency..

ReillyJ · Jun 4, 2018

Blackhawk said:
Please provide references for this information.

This idea is common on this forum, but I have never seen any documentation, and discussed this with Dr Saya 2 weeks ago. Unless there was something miscommunicated between us, he denied this as true.

I believe this interpretation came because high SHBG guys can do fine on less frequent injections, but apparently there is no other reason they can or should not inject more frequently.

To overcome high SHBG and get free T higher they need larger dosing relative to low SHBG guys. That does not mean less frequent, just more T.

Then there are those who kind of break that mold, like me. I have SHBG 46 and am down to taking 84mg per week with free T in good range.

The other aspect for Reilly is that her husband felt better when increasing injection frequency..

This would be interesting, BlackHawk, especially since your doctor disagreed w/the less frequent injecting protocol.

I don't know what the forum will say about my husbands #'s but maybe it will just be a dosage increase is what he really needs and i'll probably keep the 3x/wk injecting so as to possibly (if this is correct) minimize E2 conversion. I surmise probably his difficulty lies in his age and the fact that he has mild non alcohol liver cirrhosis...

Blackhawk · Jun 4, 2018

Reilly,

I am still unsure, which is why I ask for references, but I've looked for and asked repeatedly for references on this issue and gotten none.

Regarding making changes, in my case the doctor also wanted make only one change at a time, so we reduced dosage rather than going more frequently, but he was fine with either. My needs and the reason for my change is different than your husbands. I need lower dosing to reduce hematocrit, hemoglobin and E2.

Completely your's (and his choice), but this idea is that it is easier to attribute causation to changes that are only done one at a time and reassessed after reaching the next new steady state.

ReillyJ · Jun 4, 2018

Blackhawk said:
Reilly,

I am still unsure, which is why I ask for references, but I've looked for and asked repeatedly for references on this issue and gotten none.

Regarding making changes, in my case the doctor also wanted make only one change at a time, so we reduced dosage rather than going more frequently, but he was fine with either. My needs and the reason for my change is different than your husbands. I need lower dosing to reduce hematocrit, hemoglobin and E2.

Completely your's (and his choice), but this idea is that it is easier to attribute causation to changes that are only done one at a time and reassessed after reaching the next new steady state.

This makes sense which is why i'm keeping the 3/wk injection since it doesn't seem that his SHBG is excessively high and that is what we've been doing for a while. I think i will do the dosage increase the doctor suggested and sit on it for a month and then get tested again and more importantly, how he feels in the next month.

Blackhawk · Jun 4, 2018

Give it at least 6 weeks. The half life of T cyp requires 40 days to reach steady state.

madman · Jun 4, 2018

ReillyJ said:
This makes sense which is why i'm keeping the 3/wk injection since it doesn't seem that his SHBG is excessively high and that is what we've been doing for a while. I think i will do the dosage increase the doctor suggested and sit on it for a month and then get tested again and more importantly, how he feels in the next month.

Thought you were getting his shbg tested?

In your earlier post 1:26 pm what are the exact lab ranges for total t and free t on the new lab work and are those labs on the 125mg/week (split M/W/F) that he just started 2 weeks ago?

If those are the new numbers you just posted was his dose not just recently increased 2 weeks ago as it takes 6 weeks for blood levels to stabilize and if one changes protocol whether lowering/increasing dose.....6 weeks on the new dose is needed before bloods are done.

madman · Jun 4, 2018

Blackhawk said:
Please provide references for this information.

This idea is common discussion on this forum, but I have searched and never found any documentation, and discussed this with Dr Saya 2 weeks ago. Unless there was something miscommunicated between us, he denied this as true.

I believe this interpretation came because high SHBG guys can do fine on less frequent injections, and somehow this got misconstrued as high SHBG need less frequent injections. Apparently there is no documented reason they can or should not inject more frequently.

To overcome high SHBG and get free T higher they need larger dosing relative to low SHBG guys. That does not mean less frequent, just more T.

Then there are those who kind of break that mold, like me. I just had SHBG tested at 48.1 with free T in good range and we have lowered my T dose to 84mg per week

The other aspect for Reilly is that her husband felt better when increasing injection frequency..

High doses of androgens will usually lower shbg so it is not necessarily the less injection frequency as in order to use a high dose of testosterone PER injection than one would be injecting less frequently.

madman · Jun 4, 2018

The most effective way to lower shbg is adding a low dose c-17 alpha alkylated oral steroid such as stanozolol (winstrol) or oxandrolone (anavar) due to the effects these orals have on the liver where shbg is produced.

There are some trt doctors who prescribe low doses with testosterone injections in patients with high shbg issues.

ReillyJ · Jun 4, 2018

madman said:
Thought you were getting his shbg tested?

In your earlier post 1:26 pm what are the exact lab ranges for total t and free t on the new lab work and are those labs on the 125mg/week (split M/W/F) that he just started 2 weeks ago?

If those are the new numbers you just posted was his dose not just recently increased 2 weeks ago as it takes 6 weeks for blood levels to stabilize and if one changes protocol whether lowering/increasing dose.....6 weeks on the new dose is needed before bloods are done.

No, he started TRT 100/wk last October and has been on that steady dose. The last labs were in March that i posted and other labs (don't have them) have shown low FREE T.

Just got his lab back on SHBG and posted it (55). Just last week we increased his dosage (rx'd) to 150/wk and do know that labs shouldn't be done until about 6 weeks.

1Draw · Jun 4, 2018

Susie has your husband ever had a full thyroid panel? Low thyroid levels can mimic low T levels. I ask that because you mentioned his T3 is always very low. Here is a great website and recommended test which are T4 T3 RT3 and antibodies. Pay close attention to RT3 which most doctors don’t test

https://www.restartmed.com/thyroid-symptoms-men/

It’s not always low testerone!

madman · Jun 4, 2018

ReillyJ said:
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

The range for shbg 22-77 nmol/L than the mean is 49.5 (mid-normal) so 55 is slightly above mid-normal shbg range.

Twice weekly injections (every 3.5 days) would suffice and you can stick with the 3 times weekly but your frequency times should be planned out properly.

As an example (M/W/F) protocol would be Monday injection at 7am, Wednesday at 3pm and than Friday at 11pm so you have 56 hrs between injections to be consistent.....otherwise I would stick to a twice weekly protocol which is easier time wise to follow as an example Monday injection at 7am, Thursday at 7pm.

Do understand that even though his free t is still low going from 100-150mg/week is a large increase in testosterone but it is your call.

Personally I would try 120-140mg/week.

Even though his free t is low one does not necessarily need to have free t levels in the high/normal physiological range as many can do well with mid-normal free t levels.

madman · Jun 4, 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.

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

Your 3 times weekly injection protocol is completely wrong....I did not catch this before but if you are injecting him Wednesday morning/Friday night/Sun night than your time between injections is not consistent and you only have 48 hrs between the Friday night to Sunday night injections.

When using a 3 times/week injection protocol as an example M/W/F than Monday injection 7am, Wednesday injection 3pm and Friday injection 11pm so you have 56 hrs between each injection as oppose to the inconsistent times you have with the protocol you are using.

The idea with any protocol whether daily, EOD, M/W/F, twice weekly (every 3.5 days) or once weekly is consistency with the time between injections to get an accurate trough reading when doing lab work.

FeelingLost · Jun 4, 2018

Blackhawk said:
Reilly,

I am still unsure, which is why I ask for references, but I've looked for and asked repeatedly for references on this issue and gotten none.

Regarding making changes, in my case the doctor also wanted make only one change at a time, so we reduced dosage rather than going more frequently, but he was fine with either. My needs and the reason for my change is different than your husbands. I need lower dosing to reduce hematocrit, hemoglobin and E2.

Completely your's (and his choice), but this idea is that it is easier to attribute causation to changes that are only done one at a time and reassessed after reaching the next new steady state.

Hi Blackhawk I have no studies I can give you to justify this theory. But there have been many members over the last year and a half posting blood work and when they had high SHGB they would move to 1 no more than 2 shots a week and the very next blood test their shgb was always, I repeat always, lower and that gave them a higher Free T for the same dose.

Guys with low SHGB doing 1 shot or even 1 shot every two week have also posted bloods and when they increased there injection frequency not weekly dose the shgb went up. This is not as important unless your SHGB is 10.

FeelingLost · Jun 4, 2018

ReillyJ said:
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

ReillyJ said:
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.

Hi Susie, I guessed right his SHGB is high. 55 is not mid scale it is high.
IMO there is no reason to do 3 shots a week 2 is fine. My SHGB is 24.2 and I do 3 shots.

E2 is going to go up no matter the shot frequency.
More T in the body makes more E2 the question will be how much and can he deal with it with out taking an AI.
Ask him often how he is feeling. 24 hours after the shot his T will be peaking and 48-72 his E2 will peak.
If his E2 goes too high he will lose his libido and ED could develop. That may or may not be an issue but it is a symptom of high E2.

ReillyJ · Jun 4, 2018

1Draw said:
Susie has your husband ever had a full thyroid panel? Low thyroid levels can mimic low T levels. I ask that because you mentioned his T3 is always very low. Here is a great website and recommended test which are T4 T3 RT3 and antibodies. Pay close attention to RT3 which most doctors don’t test

https://www.restartmed.com/thyroid-symptoms-men/

Oh sorry, i mean Free Testosterone is always very low. He is on NDT (Nature-Throid) and has been since initiating TRT therapy

It’s not always low testerone!

Oh sorry, i mean Free Testosterone is always very low and Total usually tests out in the high 500's. He is on NDT (Nature-Throid) and has been since initiating TRT therapy

Also if you guys really think i should go to twice weekly then i will defer to you and do that as you obviously have more experience than i do, of course i cannot control every aspect nor how his body is going to respond and given he has other health issues....

If i were to give 125/week in 2 divided injections, i have a 1 ml syringe...what would the dose be? (right now i am totally brain fatigued after an awful day)

He just had a shot last night so our schedule will be i guess.. Sunday night and Wednesday morning if anyone wants to help me with that, much appreciated. I guess i just didn't want his E2 to rise but that sounds like it could, anyway. I will also stick with 125/wk if you all really think that is wise instead of what his doc rx'd (150/wk).

Susie

madman · Jun 4, 2018

FeelingLost said:
Hi Susie, I guessed right his SHGB is high. 55 is not mid scale it is high.
IMO there is no reason to do 3 shots a week 2 is fine. My SHGB is 24.2 and I do 3 shots.

E2 is going to go up no matter the shot frequency.
More T in the body makes more E2 the question will be how much and can he deal with it with out taking an AI.
Ask him often how he is feeling. 24 hours after the shot his T will be peaking and 48-72 his E2 will peak.
If his E2 goes too high he will lose his libido and ED could develop. That may or may not be an issue but it is a symptom of high E2.

The lab range for shbg is 22-77 nmol/L so the mean (mid-normal) is 49.5 and he is 55 which is not high it is just above mid-normal.

Regardless the injection protocol she is using M/W/F is wrong as the time between his injections is not consistent just as I explained to you before when you were injecting the way you were using M/W/F.

FeelingLost · Jun 4, 2018

madman said:
The lab range for shbg is 22-77 nmol/L so the mean (mid-normal) is 49.5 and he is 55 which is not high it is just above mid-normal.

Regardless the injection protocol she is using M/W/F is wrong as the time between his injections is not consistent just as I explained to you before when you were injecting the way you were using M/W/F.

I agree Madman,
Most of the guys who have reported a 55 SHGB always has a low Free T
55 might just be slightly over mid range but its a FT killer.

madman · Jun 4, 2018

ReillyJ said:
Oh sorry, i mean Free Testosterone is always very low and Total usually tests out in the high 500's. He is on NDT (Nature-Throid) and has been since initiating TRT therapy

Also if you guys really think i should go to twice weekly then i will defer to you and do that as you obviously have more experience than i do, of course i cannot control every aspect nor how his body is going to respond and given he has other health issues....

If i were to give 125/week in 2 divided injections, i have a 1 ml syringe...what would the dose be? (right now i am totally brain fatigued after an awful day)

He just had a shot last night so our schedule will be i guess.. Sunday night and Wednesday morning if anyone wants to help me with that, much appreciated. I guess i just didn't want his E2 to rise but that sounds like it could, anyway. I will also stick with 125/wk if you all really think that is wise instead of what his doc rx'd (150/wk).

Susie

Twice weekly (every 3.5 days) will be easier to be consistent regarding injection times.

If you are going to stick with Sunday night 7pm (not sure what time you injected last night) than Thursday morning at 7am would be the next injection as injecting every 3.5 days is 84hrs between injections.

As far as dose if he was scripted 150mg/week by his doctor than you should follow it and that would be 75mg every 3.5 days (84hrs).

So if the strength of his testosterone is 200mg/ml than if you are using a 1ml (1cc) syringe than .375ml would be 75mg.

You may be slightly over/under depending on how you eye the line on the barrel.

Increasing dose slowly is always better but even though we suggested earlier to try a lower dose than 150mg/week you should follow your doctors orders or at least get in touch with him and let him know you would prefer using a lower dose than what he recommended.

madman · Jun 4, 2018

ReillyJ said:
Oh sorry, i mean Free Testosterone is always very low and Total usually tests out in the high 500's. He is on NDT (Nature-Throid) and has been since initiating TRT therapy

Also if you guys really think i should go to twice weekly then i will defer to you and do that as you obviously have more experience than i do, of course i cannot control every aspect nor how his body is going to respond and given he has other health issues....

If i were to give 125/week in 2 divided injections, i have a 1 ml syringe...what would the dose be? (right now i am totally brain fatigued after an awful day)

He just had a shot last night so our schedule will be i guess.. Sunday night and Wednesday morning if anyone wants to help me with that, much appreciated. I guess i just didn't want his E2 to rise but that sounds like it could, anyway. I will also stick with 125/wk if you all really think that is wise instead of what his doc rx'd (150/wk).

Susie

http://health.prenhall.com/olsen/pdf/Olsen_ch7.pdf

ReillyJ · Jun 4, 2018

madman said:
Twice weekly (every 3.5 days) will be easier to be consistent regarding injection times.

If you are going to stick with Sunday night 7pm (not sure what time you injected last night) than Thursday morning at 7am would be the next injection as injecting every 3.5 days is 84hrs between injections.

As far as dose if he was scripted 150mg/week by his doctor than you should follow it and that would be 75mg every 3.5 days (84hrs).

So if the strength of his testosterone is 200mg/ml than if you are using a 1ml (1cc) syringe than .375ml would be 75mg.

You may be slightly over/under depending on how you eye the line on the barrel.

Increasing dose slowly is always better but even though we suggested earlier to try a lower dose than 150mg/week you should follow your doctors orders or at least get in touch with him and let him know you would prefer using a lower dose than what he recommended.

Thank you, madman.

You all don't know how much i appreciate the help.

Well we inject late because we aren't morning people. Last injection was Sunday at midnight, so next injection will be Thursday at noon, correct? Then repeat....

I don't think his doctor would mind either way what dosage. I was the one who asked him for an increase as i DO think he needs one and we wanted to see how he did after 6 weeks and then adjust. Seeing how he is mid/slightly over SHBG, then it sounds like he would do better going back to 2/wk.

I am still in a quandry whether to go with 125 or 150/wk. I had one guy who's same age, etc. say he went that route with no problems at all but YES everyone is different. I suppose i could look at it this way: If 125/wk isn't sufficient for him, we will know in 6 wks. But part of us wants to charge full steam ahead if indeed he would do better with 150. I think maybe i'll just go slower and we'll wait it out.

Bumping up T and testing SHBG

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