3 Month Labs - Unsure What to Make of It

[JYD21]

3 months in. I started at 40mg MWF. Felt good, nothing crazy good or bad. Short-lived decent honeymoon. My provider is very conservative.

June 2022 - All CBC, Lipids, Thyroid, PSA, DHEA, Prolactin were good.
TESTOSTERONE, TOTAL, MALES (ADULT), IA 441 250-827 ng/dL IG
SEX HORMONE BINDING GLOBULIN 32 10-50 nmol/L IG
TESTOSTERONE, FREE 62.1 46.0-224.0 pg/mL
TESTOSTERONE,BIOAVAILABLE 114.1 110.0-575.0 ng/dL

We did 6 week Labs and I requested more accurate labs. Results below. My HCT was 50, so my provider told me to dump blood, so I did. Knowing what I know now, I would not have done that.
TESTOSTERONE, TOTAL, MS 996 250-1100 ng/dL
TESTOSTERONE, FREE 166 H 35.0-155.0 pg/mL
ESTRADIOL,ULTRASENSITIVE, LC/MS 51 H < OR = 29 pg/mL EZ

Sept 2022 - All CBC, Lipids, Thyroid, PSA, DHEA, Prolactin were still good.
SEX HORMONE BINDING IG GLOBULIN 31 10-50 nmol/L
TESTOSTERONE, TOTAL, MS 1068 250-1100 ng/dL
TESTOSTERONE, FREE 229.4 H 35.0-155.0 pg/mL
ESTRADIOL,ULTRASENSITIVE, LC/MS 55 H < OR = 29 pg/mL
RED BLOOD CELL COUNT 5.82 H 4.20-5.80
HEMOGLOBIN 17.4 H 13.2-17.1 g/dL
HEMATOCRIT 50.9 H 38.5-50.0 %
IRON, TOTAL 208 H 50-180 mcg/dL
IRON BINDING CAPACITY 455 H 2 50-425 mcg/dL (calc)
% SATURATION 46 20-48 % (calc)
FERRITIN 20 L 38-380 ng/mL

My provider freaked out at my E2 and H/H RBCs and Iron. He suggested I dump blood again, but I pointed out my Ferritin.

Mind you, since he wasn't ordering the tests I wanted when I wanted, I had to go to DLabs and get my own tests. So in a 6-week period, I drew blood 3 times, including the donation. I'm sure that crushed my Ferritin a bit, plus just started TRT which can do naturally as well as raise the H/H.

He suggested I lower my dose. I respect his conservatism, and he's a personal friend, but I am also considering finding a new clinic/doc/provider that is a bit more up-to-date on current research .i.e TT/E2 ratio, H/H numbers starting out, etc. etc.

A lot of lessons learned from here and a few other forums. Frankly, I was educating my provider a bit on some things. This site has been great.

How do I feel? Pretty good. Nothing crazy, but I was not crazy low when I started as you can see above. But I am slowly feeling a bit better. My best benefit so far is my look and gym results. Libido has come and gone, still. But I believe that has a lot to do with my stress levels and mindset as well.

Open to any feedback. Thank you.

 

[Vince]

I think your labs are good. Your HCT is somewhat high, make sure you drink lots of water before your labs. Even though you're fasting, you can drink water right up to the blood draw. You may want to consider fish oil and baby aspirin. It helps your blood flow through arteries.

One of my co-workers brings a gallon of water to work with him everyday and drinks it while he's working. I would consider that in your case.

 

[Systemlord]

My HCT was 50, so my provider told me to dump blood, so I did.

Insane, truely unbelievable to force a donation for an HCT at 50.9%!

 

[Systemlord]

He suggested I dump blood again, but I pointed out my Ferritin.

Not only is your provider conservative, but it's also incompetent.

 

[mikeb29]

Its pretty clear your dose is way too high

 

[Systemlord]

Its pretty clear your dose is way too high

So what his provider should have recommended was lowering the dosage and not a blood donation.

His provider is acting on fear and a lack of knowledge on how to manage men on replacement therapy.

Any provider freaking out over on E2 at 55 clearly is in over their head.

 

[sammmy]

Don't take aspirin on regular basis, unless you have to. Studies show intestinal mucosal damage even from the smallest chronic doses of aspirin. That applies to all NSAIDS. Only people that have no other options should take them.

 

[JYD21]

I think your labs are good. Your HCT is somewhat high, make sure you drink lots of water before your labs. Even though you're fasting, you can drink water right up to the blood draw. You may want to consider fish oil and baby aspirin. It helps your blood flow through arteries.

One of my co-workers brings a gallon of water to work with him everyday and drinks it while he's working. I would consider that in your case.

Thanks, @Vince . Yup. I'm learning to drink more water for sure. Pissing clearer now. Will continue to hydrate with water and electrolytes. I also do take fish oil, but not everyday, so perhaps I could do that more consistently. Diet during the week is in check, but girlfiend and I do like cheat meals over the week. I don't drink. I do occasionally have a vape or cigarette on a weekend social, but that has to stop now.

So what his provider should have recommended was lowering the dosage and not a blood donation.

His provider is acting on fear and a lack of knowledge on how to manage men on replacement therapy.

Any provider freaking out over on E2 at 55 clearly is in over their head.

@Systemlord - Thanks for the feedback and I agree. Not up to date. He's been on TRT himself for years, due to AAS use when younger. He pins 200mg once a week and he had gyno surgery, so he's admits his personal bias, and to his credit, also admits he needs to learn through his patients a bit, but that's not helping me feel confident.

I need a doc or clinic that is really on the up and up. So I am currently looking for a new clinic/provider.

Its pretty clear your dose is way too high

Yeah, I was thinking that. What do you base that on most, @mikeb29 ?

These labs were 48 hours after injecting, so I wonder what they would look like if I was pinning twice a week instead of MWF and did labs 72 hours after, say, a Monday injection.

Don't take aspirin on regular basis, unless you have to. Studies show intestinal mucosal damage even from the smallest chronic doses of aspirin. That applies to all NSAIDS. Only people that have no other options should take them.

Gotcha. Thanks for the feedback and insight.

 

[Vince]

Don't take aspirin on regular basis, unless you have to. Studies show intestinal mucosal damage even from the smallest chronic doses of aspirin. That applies to all NSAIDS. Only people that have no other options should take them.

You're right, I just looked it up. Thanks for the updated information.

 

[mikeb29]

Thanks, @Vince . Yup. I'm learning to drink more water for sure. Pissing clearer now. Will continue to hydrate with water and electrolytes. I also do take fish oil, but not everyday, so perhaps I could do that more consistently. Diet during the week is in check, but girlfiend and I do like cheat meals over the week. I don't drink. I do occasionally have a vape or cigarette on a weekend social, but that has to stop now.


@Systemlord - Thanks for the feedback and I agree. Not up to date. He's been on TRT himself for years, due to AAS use when younger. He pins 200mg once a week and he had gyno surgery, so he's admits his personal bias, and to his credit, also admits he needs to learn through his patients a bit, but that's not helping me feel confident.

I need a doc or clinic that is really on the up and up. So I am currently looking for a new clinic/provider.


Yeah, I was thinking that. What do you base that on most, @mikeb29 ?

These labs were 48 hours after injecting, so I wonder what they would look like if I was pinning twice a week instead of MWF and did labs 72 hours after, say, a Monday injection.


Gotcha. Thanks for the feedback and insight.

Free T being way over-range plus the other values causing concern. They wouldn't be a problem if the dose was lowered. You need a new provider, the fact they couldn't identify this is beyond incompetence.

 

[JYD21]

Free T being way over-range plus the other values causing concern. They wouldn't be a problem if the dose was lowered. You need a new provider, the fact they couldn't identify this is beyond incompetence.

Thanks, @mikeb29

I am currently looking for other, more up to date, providers (Defy, Matrix, and some local folks are contenders).

My current provider did suggest lowering the dose or increasing the frequency but did not give me any guidelines for either. So I come here for information and assistance until I can start with my new one.

Since my provider was not clear on any direction, do you, or anyone, have a suggestion on how where to go next? These latest labs are from pinning 36mg MWF for a total of 108 weekly. I go by the marks on my 1mg syringe.

Should I
A) move from MWF to EOD and keep the dose or reduce the dose to say, 28mg EOD for a total of 98mg weekly or even lower?

B) stay on MWF and drop the dose to 32mg (96mg weekly) or even 28mg (84mg weekly)?

C) What are yours, or others', thoughts on lowering the dose, but moving from MWF to Twice weekly injections? I understand conventional wisdom would say go to more frequent to help reduce some of these numbers, but some guys reported a drop in numbers when they tested 3.5+ days at their trough vs 24-48 hours, but I realize also that is very dependent on the person.

Any guidance is appreciated.

 

[mikeb29]

Thanks, @mikeb29

I am currently looking for other, more up to date, providers (Defy, Matrix, and some local folks are contenders).

My current provider did suggest lowering the dose or increasing the frequency but did not give me any guidelines for either. So I come here for information and assistance until I can start with my new one.

Since my provider was not clear on any direction, do you, or anyone, have a suggestion on how where to go next? These latest labs are from pinning 36mg MWF for a total of 108 weekly. I go by the marks on my 1mg syringe.

Should I
A) move from MWF to EOD and keep the dose or reduce the dose to say, 28mg EOD for a total of 98mg weekly or even lower?

B) stay on MWF and drop the dose to 32mg (96mg weekly) or even 28mg (84mg weekly)?

C) What are yours, or others', thoughts on lowering the dose, but moving from MWF to Twice weekly injections? I understand conventional wisdom would say go to more frequent to help reduce some of these numbers, but some guys reported a drop in numbers when they tested 3.5+ days at their trough vs 24-48 hours, but I realize also that is very dependent on the person.

Any guidance is appreciated.

Change one variable at a time. Id start with dosage.

 

[JYD21]

Change one variable at a time. Id start with dosage.

Thanks. By how much would you suggest?

 

[mikeb29]

If it were me Id go down to 25mg three times a week and let my values settle and take it from there

 

[JYD21]

I'm exactly two weeks into lowering my dosage since I started this post, but I don't feel better. I actually feel like I'm a little more sluggish and still no libido to speak of.

I'll hold steady for the next few weeks until my appointment with a new, more knowledgeable, provider on Nov. 4th.

I am trying to be patient and am hopeful my new provider can point me in the right direction.

I admit I got bad advice all around from the start and this frustrates me, but I'm learning from it as well.

 

[CaptianCurious]

Did you ever bring your ferritin up? The sluggishness could just be due to that.

 

[Blackhawk]

Should I
A) move from MWF to EOD and keep the dose or reduce the dose to say, 28mg EOD for a total of 98mg weekly or even lower?

B) stay on MWF and drop the dose to 32mg (96mg weekly) or even 28mg (84mg weekly)?

C) What are yours, or others', thoughts on lowering the dose, but moving from MWF to Twice weekly injections? I understand conventional wisdom would say go to more frequent to help reduce some of these numbers, but some guys reported a drop in numbers when they tested 3.5+ days at their trough vs 24-48 hours, but I realize also that is very dependent on the person.

Any guidance is appreciated.

The difference between MWF and EOD is not that significant. I personally prefer the evenness of EOD, and did that for years. You may be fine on 98 or 84 weekly. I have done both and remained above "normal range" TT with both, and top end of range for Free T. It brought my HCT down well. I continued to lower even further and have been just fine, with comparably robust lab results for these kinds of doses. Only one way to find out.

Know that you may feel like crap during lowering phases. For me it takes 2-3 months to fully adjust to LOWER doses.

 

[JYD21]

Did you ever bring your ferritin up? The sluggishness could just be due to that.

Not sure yet. I won't test for another week, Nov. 9th, which would bring me to 8 weeks since I last tested.

I'm seeing a new (and better) doctor this Friday and hope to get dialed in better. He's got great feedback.

The difference between MWF and EOD is not that significant. I personally prefer the evenness of EOD, and did that for years. You may be fine on 98 or 84 weekly. I have done both and remained above "normal range" TT with both, and top end of range for Free T. It brought my HCT down well. I continued to lower even further and have been just fine, with comparably robust lab results for these kinds of doses. Only one way to find out.

Know that you may feel like crap during lowering phases. For me it takes 2-3 months to fully adjust to LOWER doses.

Are you still doing EOD? And where are you today: 98 or 84 weekly or lower? Though being top of the range on those doses, did one 'feel' better?

I'll be 2 months on a lower dose next week; see how we go. I still hear from folks that my dose is too low, though. 96mg weekly: 32/32/32 MWF.

 

[Blackhawk]

Are you still doing EOD? And where are you today: 98 or 84 weekly or lower? Though being top of the range on those doses, did one 'feel' better?

I'll be 2 months on a lower dose next week; see how we go. I still hear from folks that my dose is too low, though. 96mg weekly: 32/32/32 MWF.

The simple answer is I did well on T cyp down to 70mg/week/20mg EOD SubQ. My labs remained robust.

The complicated answer for where I am now, a T cyp/prop blend about equivalent to 8mg/day T cyp, 6mg/day pure T sans ester weight, or 56/42mg/week: Daily T cyp/prop results . I am doing well on this.