Advice on blood test results?

[Jonny2023]

Hi, I'm looking to get some advice about my recent blood test! I started trt about a month ago after testing 14nmol with symptoms. Also tested 9nmol a few months back showing low T again. Also done a test which said 18nmol with nhs which tells me it's not always low but decided to give trt a go because it was low consistently. Symptoms like fatigue, poor sleep, bad muscle pain, poor recovery, low libido, lack of morning erections etc... These things wouldn't be there 100% of the time but are becoming pretty regular. I started TRT about 5 weeks ago and done the first blood test after a month. My dose has been 0.15ml of sustanon twice a week and 500iu of hcg twice a week. I made the mistake of doing the blood test after injecting. The dr mentioned in an email to do test before injection but I forgot about this and results were as followed from an Optimale blood test.
FSH 0.3iu LH 0.3iu Oestradiol 116pmol Free T 2.321nmol Total T 88.70nmol (wtf?) SHBG 42nmol Prolactin 138mu
I'm confused about the high testosterone on 0.15ml twice a week. Even after a blood test why would it be this high on 80mg a week? I feel like the levels would have maybe slightly gone up! Doctor said he couldn't interpret the result so I've to do another test. Some slight improvements with symptoms. The past month has been periods feeling benefits and periods not feeling much. Sleep has been better but the muscle pain has been bad recently and been feeling a bit shitty. Just wondering mainly why the T is sky high on a low dose with hcg? I thought even at a peak levels could maybe reach higher end of the reference range!
Any advice appreciated! Not an expert on this stuff. Mainly surface level knowledge from reading studies, watching videos and reading stuff on places like reddit.

 

[Systemlord]

Free T 2.321nmol Total T 88.70nmol (wtf?) I'm confused about the high testosterone on 0.15ml twice a week. Even after a blood test why would it be this high on 80mg a week?

Biotin supplements cause falsely elevated hormone values. Another possibility is lab error or you’re injecting more than you think you are.

 

[Jonny2023]

Biotin supplements cause falsely elevated hormone values. Another possibility is you’re injecting more than you think you are.

Only take a multivitamin! Can't see that being the cause of the high reading!

 

[Systemlord]

Only take a multivitamin! Can't see that being the cause of the high reading!

If it has biotin in it, then yes. Personally, I don’t like multivitamins because it’s a cookie-cutter approach. You may only need some of the vitamins in the multivitamin and not necessarily the others.

 

[Jonny2023]

If it has biotin in it, then yes. Personally, I don’t like multivitamins because it’s a cookie-cutter approach. You may only need some of the vitamins in the multivitamin and not necessarily the others.

Been taking the same multivitanin for years! Have tested for low t a few times! I don't thinks that's the issue but thanks for your response!

 

[Jonny2023]

Biotin supplements cause falsely elevated hormone values. Another possibility is lab error or you’re injecting more than you think you are.

I think it may be a lab error! Definitely 0.15ml of a 1ml syringe!

 

[Jonny2023]

Got blood results back and levels on 0.15ml sustanon twice a week were

OESTRADIOL
41 - 159 R
136
pmol/L
TESTOSTERONE
8.64 - 29 R
19.8
nmol/L
FREE TESTOSTERONE - CALC.
0.2 - 0.62 R
0.385

Asked for a dosage increase to 150mg a week.

 

[madman]

Got blood results back and levels on 0.15ml sustanon twice a week were

OESTRADIOL
41 - 159 R
136
pmol/L
TESTOSTERONE
8.64 - 29 R
19.8
nmol/L
FREE TESTOSTERONE - CALC.
0.2 - 0.62 R
0.385

Asked for a dosage increase to 150mg a week.

You are hitting a descent trough TT 571 ng/dL.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

You SHBG was highish 42 nmol/L on your previous lab work.

Using cFTV with a trough TT 571 ng/dL, SHBG 42 nmol/L and Albumin 4.3 g/dL (default) than your trough FT would be 10.6 ng/dL.

Keep in mind it may very well be lower.

As you should know your peak TT, FT and estradiol will be higher.

You would need to have it tested using what would be considered the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration to know where it truly sits.

If you do not have access to such than you would need to use/rely upon the linear law-of-mass action cFTV.

You definitely have room to bring up your FT if need be.

Definitely would not jump from 75--->150 mg/week.

Way too big of a jump doubling your dose and you will most likely overshoot!

Any time you increase the dose you are going to be driving up your TT, FT, estradiol and hematocrit.

You are missing critical blood markers RBCs, hemoglobin and hematocrit.

Did you even get a full thyroid panel before hopping on TRT?

 

[Jonny2023]

You are hitting a descent trough TT 571 ng/dL.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

You SHBG was highish 42 nmol/L on your previous lab work.

Using cFTV with a trough TT 571 ng/dL, SHBG 42 nmol/L and Albumin 4.3 g/dL (default) than your trough FT would be 10.6 ng/dL.

Keep in mind it may very well be lower.

As you should know your peak TT, FT and estradiol will be higher.

You would need to have it tested using what would be considered the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration to know where it truly sits.

If you do not have access to such than you would need to use/rely upon the linear law-of-mass action cFTV.

You definitely have room to bring up your FT if need be.

Definitely would not jump from 75--->150 mg/week.

Way too big of a jump doubling your dose and you will most likely overshoot!

Any time you increase the dose you are going to be driving up your TT, FT, estradiol and hematocrit.

You are missing critical blood markers RBCs, hemoglobin and hematocrit.

Did you even get a full thyroid panel before hopping on TRT?

Hemoglobin 144gl
Hematocrit 0.450ll

Thyroid just after new year was
THS 0.65mul
Free T4 20.2

 

[Jonny2023]

Doctor seems reluctant to go above 0.20ml sustanon twice a week stating 'any more is likely to tip you into supraphysiological levels' Thinking of coming off as I feel I could have a better chance improving health and wellbeing with prioritising my own production. Libido is pretty low atm as well on trt. Was better off playing about with supplements like ecdysterone and tongkat ali! Some pros like stable mood and sleep but not much with libido. Energy is stable as well but not great. What do people think? Should I stay on or come off?

 

[madman]

Doctor seems reluctant to go above 0.20ml sustanon twice a week stating 'any more is likely to tip you into supraphysiological levels' Thinking of coming off as I feel I could have a better chance improving health and wellbeing with prioritising my own production. Libido is pretty low atm as well on trt. Was better off playing about with supplements like ecdysterone and tongkat ali! Some pros like stable mood and sleep but not much with libido. Energy is stable as well but not great. What do people think? Should I stay on or come off?

Again you have room to try bringing up your FT if need be.

Going from .15mL (15 units) --->.20mL (20 units) twice weekly is a decent jump.

75--->100 mg/week will give you a nice bump in TT, FT, and estradiol.

Of course, it will drive up your hematocrit further but your levels are still in range.

Would definitely give it a go before throwing in the towel.

 

[Jonny2023]

Again you have room to try bringing up your FT if need be.

Going from .15mL (15 units) --->.20mL (20 units) twice weekly is a decent jump.

75--->100 mg/week will give you a nice bump in TT, FT, and estradiol.

Of course, it will drive up your hematocrit further but your levels are still in range.

Would definitely give it a go before throwing in the towel.

Ok! Thanks for the advice! Is an extra 0.10ml weekly as much as 25mg? I didn't think it was that much!

 

[Jonny2023]

Again you have room to try bringing up your FT if need be.

Going from .15mL (15 units) --->.20mL (20 units) twice weekly is a decent jump.

75--->100 mg/week will give you a nice bump in TT, FT, and estradiol.

Of course, it will drive up your hematocrit further but your levels are still in range.

Would definitely give it a go before throwing in the towel.

Also what would your thoughts be of adding supplements like tongkat ali or ecdysterone on top of trt and hcg! These supplements seem to help with libido! I also noticed ecdysterone helped libido and massively increased semem volume! Not sure what caused this but thinking it could be worth trying as noticed a reduction in semen volume since starting trt. My friend also noticed this effect from ecdysterone! Wonder if this effect would still be there on trt?

 

[Systemlord]

Thinking of coming off as I feel I could have a better chance improving health and wellbeing with prioritising my own production.

This isn’t reality. Your problem is you have no patience. You expect instant results and when you don’t gets results, it’s time to throw in the towel after less than 2 months.

Now all this talk about throwing supplements at the problem.

Symptoms like fatigue, poor sleep, bad muscle pain, poor recovery, low libido, lack of morning erections etc...

This is a disease state.

These supplements seem to help with libido!

This product is not intended to diagnose, treat, cure, or prevent any disease.

 

[Jonny2023]

This isn’t reality. Your problem is you have no patience. You expect instant results and when you don’t gets results, it’s time to throw in the towel after less than 2 months.

Now all this talk about throwing supplements at the problem.

This is a disease state.

This product is not intended to diagnose, treat, cure, or prevent any disease.

You could have a point! I'll give the dosage increase a go and give it some more time! Noticed some improvements but nothing much with libido or morning wood! Usually morning wood is a good sign that things are optimised!

 

[Systemlord]

Noticed some improvements but nothing much with libido or morning wood!

Excellent progress in such a short time, it took my 7 years to get to this point! No joke, treatment failure over 5-6 years until recently. My avatar has all the countless threads on my struggles.

 

[Systemlord]

Onset of effects of testosterone treatment and time span until maximum effects are achieved

Testosterone has a spectrum of effects on the male organism. This review attempts to determine, from published studies, the time-course of the effects induced by testosterone replacement therapy from their first manifestation until maximum effects are ...

www.ncbi.nlm.nih.gov

Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, with no further increments expected beyond. Changes in erections/ejaculations may require up to 6 months. Effects on quality of life manifest within 3–4 weeks, but maximum benefits take longer. Effects on depressive mood become detectable after 3–6 weeks with a maximum after 18–30 weeks. Effects on erythropoiesis are evident at 3 months, peaking at 9–12 months. Prostate-specific antigen and volume rise, marginally, plateauing at 12 months; further increase should be related to aging rather than therapy. Effects on lipids appear after 4 weeks, maximal after 6–12 months. Insulin sensitivity may improve within few days, but effects on glycemic control become evident only after 3–12 months. Changes in fat mass, lean body mass, and muscle strength occur within 12–16 weeks, stabilize at 6–12 months, but can marginally continue over years. Effects on inflammation occur within 3–12 weeks. Effects on bone are detectable already after 6 months while continuing at least for 3 years.

Conclusion​

The time-course of the spectrum of effects of testosterone shows considerable variation, probably related to pharmacodynamics of the testosterone preparation. Genomic and non-genomic effects, androgen receptor polymorphism and intracellular steroid metabolism further contribute to such diversity.

 

[Jonny2023]

Excellent progress in such a short time, it took my 7 years to get to this point! No joke, treatment failure over 5-6 years until recently. My avatar has all the countless threads on my struggles.

Seem to always notice a quick increase with libido from supplements but doesn't last long but is good while it lasts!

 

[Jonny2023]

Excellent progress in such a short time, it took my 7 years to get to this point! No joke, treatment failure over 5-6 years until recently. My avatar has all the countless threads on my struggles.

Seems like a long time! What were your levels like before treatment?

 

[Systemlord]

Seems like a long time! What were your levels like before treatment?

You’ll get no argument from me. The half-life of Test has to be very short for TRT to work. Jatenzo has a 6 hour half-life, requiring twice daily dosing.

Compared to your 259 ng/dL, mine was 91 and 120 ng/dL.