1st labs after switching from cream. Need some advice dialing in dosage. (UPDATED)

[Midage55]

I recently switched to injections from cream. I'm 55 years old and workout 5 to 6 days a week. Bodyfat is 12%. I've been using testosterone cream for about 7 years but recently hasn't been working as well (no libido, take 2 naps a day, tired most of the time). I've always had high SHBG. My doctor (not a TRT specialist) prescribed testosterone cypionate 200mg every two weeks which I did not do and instead have been injecting 50mg Monday morning and Thursday evening (100mg/week).

The first attachment is my labs on cream. The second attachment is my 6 week labs on injections. If I input my numbers in the testosterone "Calculator", it shows Free T 21.6 ng/dl at 1.59% and Bioavailable T 540 ng/dl (39.8%).
Labs were taken before Monday morning injection.

My energy has been better but seems to come and go, I have no libido and have recently been getting sore nipples. I am not on an AI.

Any advice on dosage changes and frequency of injections would be appreciated. I'm thinking maybe try 40mg twice a week to hopefully bring E2 down a little. Wish Free T
percentage was better.




Thanks!

 

[Vince Carter]

40mg sounds like a good change, your Free T on the lab sheet is almost double the lab range, I might suggest 45mg and not 40 and not take such a big swing at the dose change. With your Free T so high it too indicates Free E could in play and that's not shown in the sensitive LC/MS/MS testing.

 

[Midage55]

40mg sounds like a good change, your Free T on the lab sheet is almost double the lab range, I might suggest 45mg and not 40 and not take such a big swing at the dose change. With your Free T so high it too indicates Free E could in play and that's not shown in the sensitive LC/MS/MS testing.

Vince, I will try 45mg twice a week as you suggest and retest in 6 to 8 weeks. I'll see about maybe testing Free E next time if I can afford it. Hopefully my E2 also drops slightly from the change in dose so nipple soreness goes away so I don't have to use an AI.

Thanks for your help!!!

 

[Vince]

With shbg at 66.9 your testosterone is too high, did you do Labs on injection day before you inject it?

 

[Midage55]

With shbg at 66.9 your testosterone is too high, did you do Labs on injection day before you inject it?

Yes. I had blood labwork done then went home and did an injection.

 

[Vince]

Yes. I had blood labwork done then went home and did an injection.

For having testosterone at 1356, your estrogen is not high at all. I wonder what would happen if you injected 90 mg once a week. If you inject once a week it should help lower your shbg, I think it's worth a try anyways. Is your HCT in a good range.

 

[Midage55]

For having testosterone at 1356, your estrogen is not high at all. I wonder what would happen if you injected 90 mg once a week. If you inject once a week it should help lower your shbg, I think it's worth a try anyways. Is your HCT in a good range.

Hmm. I'll have to decide what to do on that for my next shot on Monday. I'm all for lowering my shbg. I didn't have my HCT done this time and am planning on getting a complete panel the next time in 6 to 8 weeks. Three months ago while on cream my HCT was 42.

 

[Vince]

When I increase my testosterone dose, everything increases including shbg and of course when I lower my dose, everything follows. Just for the heck of it I'll give you my protocol and labs. Trt is so different for everyone.

My protocol is 16 mg of testosterone cypionate daily, 500 iu of HCG twice a week, 25 mg of DHEA, 10mg of pregnenolone and no AI.

Testosterone serum 1117 ng/dL range 264 - 916
Free T 30.3 pg/mL range 6.6 - 18.1
DHEA - Sulfate 347.3 range 48.9 - 344.2
Estradiol, Sensitive 29.5 range 8.0 - 35.0
SHBG 48.8 range 19.3 - 76.4
HCT 47.9 range 37.5 - 51.0

 

[Midage55]

When I increase my testosterone dose, everything increases including shbg and of course when I lower my dose, everything follows. Just for the heck of it I'll give you my protocol and labs. Trt is so different for everyone.

My protocol is 16 mg of testosterone cypionate daily, 500 iu of HCG twice a week, 25 mg of DHEA, 10mg of pregnenolone and no AI.

Testosterone serum 1117 ng/dL range 264 - 916
Free T 30.3 pg/mL range 6.6 - 18.1
DHEA - Sulfate 347.3 range 48.9 - 344.2
Estradiol, Sensitive 29.5 range 8.0 - 35.0
SHBG 48.8 range 19.3 - 76.4
HCT 47.9 range 37.5 - 51.0

Great numbers Vince! Thanks for sharing. I'll bookmark this page. Hopefully I can get my SHBG down some although I'm normally on the high side. I'm having slight tenderness in the nipples even though I am only just on the upper normal range of E2. I'm currently on vacation and only brought enough syringes for 2 small doses so I think I may try 40-45mg twice a week to hopefully keep the E2 down then in 6-8 weeks see how things go with the labs. Your right in TRT is different for everyone. Too bad TRT isn't cookie cutter.

Thanks again for your input!

 

[Vince]

Great numbers Vince! Thanks for sharing. I'll bookmark this page. Hopefully I can get my SHBG down some although I'm normally on the high side. I'm having slight tenderness in the nipples even though I am only just on the upper normal range of E2. I'm currently on vacation and only brought enough syringes for 2 small doses so I think I may try 40-45mg twice a week to hopefully keep the E2 down then in 6-8 weeks see how things go with the labs. Your right in TRT is different for everyone. Too bad TRT isn't cookie cutter.

Thanks again for your input!

Most men on trt even if their estrogen is in a range get some nipple sensitivity. It's just part of the game.

 

[Midage55]

Most men on trt even if their estrogen is in a range get some nipple sensitivity. It's just part of the game.

Good to Know. Thanks!

 

[Midage55]

UPDATE: 6 weeks later... Something strange is going on. I lowered my dosage of 50mg twice a week down to 42mg twice a week and Total T, E2 sensitive, and SHBG actually increased. Free T dropped. Labs are attached. Using the Free and Bioavailable T calculator shows Free T at 24.9 ng/dl (1.36%) and bioavailable T 648 ng/dl (35.4%) using my latest labs.

I still have E2 issues (nipple sensitivity and puffiness, get teary at dog and cat commercials and started to get a lump under one of my nipples). HCT looks good. I'm seeing the doctor on Wednesday. I'm thinking I need an AI and possibly tamoxifen for the short term to hopefully resolve the lump issue and maybe lowering my T dosage or maybe just use once a week injections because of my high SHBG. I don't want to make too many changes in variables at one time though. Thoughts?

 

[Vince]

Are you sure you only injecting 42 mg of testosterone twice a week and did you do labs an injection day before you inject.

Total testosterone 1828

 

[Cataceous]

I can't account for the SHBG changing, but in the case of the other numbers, here's a possibility—not sure how likely: your SHBG is so high that it has effectively doubled the half life of your T cypionate. So if the effective half life is more like 15 days, then your stabilization period is more like 75 days. When you tested previously you had not reached steady state, and were still accumulating testosterone. Likewise, your current lab results are not fully reflecting the dose reduction.

I would also double-check the volume/concentration you're injecting. I thought I was an over-responder getting 1,300 ng/dL from 100 mg per week. But this much greater...

 

[Midage55]

Are you sure you only injecting 42 mg of testosterone twice a week and did you do labs an injection day before you inject.

Total testosterone 1828

I was initially thinking the same thing and double checked the dosage. Labs were drawn in the morning and then I did my injection right afterwards.

 

[Midage55]

I can't account for the SHBG changing, but in the case of the other numbers, here's a possibility—not sure how likely: your SHBG is so high that it has effectively doubled the half life of your T cypionate. So if the effective half life is more like 15 days, then your stabilization period is more like 75 days. When you tested previously you had not reached steady state, and were still accumulating testosterone. Likewise, your current lab results are not fully reflecting the dose reduction.

I would also double-check the volume/concentration you're injecting. I thought I was an over-responder getting 1,300 ng/dL from 100 mg per week. But this much greater...

Good analysis and reasoning. I double checked everything. One thought on my high SHBG is that I exercise pretty hard every day. I know sometimes exercise increases SHBG but to increase it over 20 points is crazy...