Advice for TRT Lab results

[Cali965]

Hello again, after not being happy with my primary care Dr for trt I managed to see an endinocrologist and started trt again after a few months break in between. My endinocrologist started me on Xyosted 50mg twice a week (100mg total weekly) and it’s been just over 3 months now and I have my lab results. The following, besides the testosterone level were out of range:

Testosterone, Total, MS = 925 (Reference Range: 250-1100 ng/dL)
Testosterone Free (Dialysis) = 0.4 (Reference Range: 35.0-155.0)
Dihydrotestosterone, LC/MS/MS = 87 (Reference Range: 12-65 ng/dL)
Red Blood Cell Count = 6.60 (Reference Range: 4.20-5.80 Million/uL)
Hemoglobin = 19.3 (Reference Range: 13.2-17.1 g/dL)
Hematocratic = 57.1 (Reference Range: 38.5-50.0)
Estradiol, Ultrasensitive, LC/MS = 92 (Reference Range: < OR = 29 pg/mL)
LDL-Cholesterol = 121 (Reference range: <100)
Non HDL Cholesterol = 145 (Reference Range: <130 mg/dL)
Vitamin D,25-OH,Total,IA = 7 (Reference Range: 30-100 ng/mL)

Dr is addressing these results by:

1. High Red Blood Cell Count, Hemoglobin, Hematocratic = Referral to Hematology for Phlebotomy
2. High Estradiol = Prescribed Letrozole 2.5mg 1x daily
3. High LDL-Cholesterol & Non HDL Cholesterol = Nothing except more exercise for the moment.
4. Low Vitamin D,25-OH,Total,IA = Take Vitamin D3 5000 1x daily

He is lowering the Testosterone frequency/dosage to injecting Xyosted 50mg 2 x 1 week and then 1x 50mg the 2nd week and continue alternating each week until next labs which will be in early December. He is including SHBG test in the next lab work.

I haven’t felt any different so far while on trt as far as mood, motivation etc or noticed any changes in my body, I know that takes some time and changes to the trt.
I’m not sure if alternating between 100mg and 50mg each week is the best idea…..your thoughts or alternative?
Are the steps my Dr is taking to address the labs ok?
Any other recommendations?

 

[sammmy]

Your stated free testosterone seems to be a typo.

Your testosterone dose needs to be decreased, best is to inject the same amount each time, not crazy alternating scheme. If Xyosted is fixed dose, that means going for generic.

Decreasing the T dose so that your through value is in the middle of the normal range, most probably will make the Letrozole unnecessary. It doesn't make sense to inject too much T and then treat the resulting high estrogen with an aromatase inhibitor, which has side effects on its own.

 

[Systemlord]

He is lowering the Testosterone frequency/dosage to injecting Xyosted 50mg 2 x 1 week and then 1x 50mg the 2nd week and continue alternating each week until next labs which will be in early December.

This is dumb, this is way out in left field. You’ll have good hormone levels one week, low the next. This would be no different from the brain-dead ancient, 200 mg every two weeks, no, wait, actually it’s worse.

That’s basically 150 mg every 2 weeks!

Why not just lower your dosage to 70 mg weekly, or 35 mg twice weekly and get a phlebotomy?

Oh wait, you can’t, because Xyosted comes in fixed dosing amounts. Now you see firsthand why Xyosted has limitations in dialing in on TRT.

Treating the high estrogen with medication, and the adjustment of the dosage seems redundant and is an unacceptable risk to benefit ratio.

Any other recommendations?

Find another doctor asap! No seriously!

 

[Cali965]

Your stated free testosterone seems to be a typo.

Your testosterone dose needs to be decreased, best is to inject the same amount each time, not crazy alternating scheme. If Xyosted is fixed dose, that means going for generic.

Decreasing the T dose so that your through value is in the middle of the normal range, most probably will make the Letrozole unnecessary. It doesn't make sense to inject too much T and then treat the resulting high estrogen with an aromatase inhibitor, which has side effects on its own.

Free Testosterone level from the lab work is 0.4
Not sure if it's an error in the lab work as it is way too low and never that low previously

 

[Cali965]

Xyosted is available in 50, 75 & 100 injections.
So, would be injecting 75mg weekly be better instead of taking 2x 50mg weekly ......I was doing 2x weekly as from my research and questions it is better to keep T levels fluctuating too much?
I won't start the Letrozole for the moment and see what the lower dosage with the phlebotomy does.

 

[Systemlord]

I was doing 2x weekly as from my research and questions it is better to keep T levels fluctuating too much?

Protocols that spike, your testosterone high tend to see higher rates of erythrocytosis, especially 200 mg every two weeks! So, go to the other end of the spectrum, more frequent dosing, smaller doses, smaller spikes.

This is something @Vince was able to do, and was the reason why he no longer has to get blood donations.

 

[Cali965]

Protocols that spike, your testosterone high tend to see higher rates of erythrocytosis, especially 200 mg every two weeks! So, go to the other end of the spectrum, more frequent dosing, smaller doses, smaller spikes.

This is something @Vince was able to do, and was the reason why he no longer has to get blood donations.

If I stick with Xyosted then the only options are:

1. Switch to 75mg auto-injector once weekly
2. Inject 1x 50mg 3 time in 2 weeks……what days would I inject?

 

[24xx23xy]

Hi,

2 weeks = 14 days, make it 15 days, easier to calculate, 3 times = every 5 days. When was your last 200 mg injection? 5 days after last injection, which side? I can make a chart for you using MS Excel.

 

[Vince]

Protocols that spike, your testosterone high tend to see higher rates of erythrocytosis, especially 200 mg every two weeks! So, go to the other end of the spectrum, more frequent dosing, smaller doses, smaller spikes.

This is something @Vince was able to do, and was the reason why he no longer has to get blood donations.

I'll give you my protocol and latest labs.

Vince's Labs for October 2023

I haven't changed my protocol, 16 mg of testosterone cypionate daily, 500 iu of hcg twice weekly and no AI. Pregnenolone 10 mg and 25 mg of DHEA. My last injection before labs, about 28 1/2 hrs. Labs are from LabCorp. Testosterone, Serum 1417 ng/dL range 264-916 Free Testosterone 47.8 ng/dL...

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