Advice on Lab Results

[mgsnell]

I have been a reader of this forum for some months now and recently got back my labs after being on trt for 3 months the results are as follows and done by Quest Labs and drawn at 8:30 am the day of an injection but before injecting;

Estradiol Ultrasensitive LC/MS/MS range < 29 pg/mL Actual 65 pg/mL
DHT LC/MS/MS range 16-79 ng/dL Actual 152 ng/dL
Hematocrit range 38.5 - 50.0% Actual 48.8%
Hemoglobin range 13.2 - 17.1 g/dL Actual 16.6 g/dL
DHEA Sulfate range 24-244 mcg/dL Actual 115 mcg/dL
Prolactin range 2.0 * 18.0 ng/dL Actual 9.2 ng/dL
PSA range <4.0 ng/mL Actual 3.6 ng/mL
SHBG range 22-77 nmol/L Actual 67nmol/L
Total Testosterone 250-1100 ng/dL Actual 1771 ng/dL
Free Testosterone range 35.0-155.0 pg/mL Actual 224.2 pg/mL

The regime used to get these numbers was weekly injections of 0.5mg Testosterone Cyponate 200 mg/mL along with 0.125 mg anastrozole the day after injection.

It is apparent by the labs that Total Testosterone is way too high as is DHT. The new protocol I was given is now inject 0.1mg three times a week (M,W,F) and HCG 250 iu twice a week. Doctor would also like me to take 400mg of DIM daily, but I question if this will lower my Estradiol as I am currently experiencing ED symptoms. It may be worth noting that for the first 2 months I experienced daily morning wood, starting the last week of July that ended and now even with Viagra it is difficult to maintain an erection. I am understanding that by lowering the Total Testosterone numbers will also bring down DHT and Free Testosterone as well if that is the case then it would appear that at this point I need to focus on the Estradiol numbers. I haven't started HCG yet and perhaps it would be better to hold off and get total testosterone and estradiol controlled then add HCG. Any insight/advice will be greatly appreciated as I have been thru 3 different doctors each with different protocalls which didn't work including time on clomid over the past 2 years.

Marvin

 

[Vince]

When you say you were injecting 0. 5 mg once a week. Do you mean a hundred mg once a week?

When levels of testosterone increase, more of it is converted into DHT and estrogen.

 

[Vince Carter]

IS DHT is not a problem when it's elevated and shouldn't be lowered but I'd still cut the dose a bit to have the Free T come down closer to the lab range. That's all I'd do at this point, your SHBG is rather high and IMHO a M/W/F injection protocol would be contraindicated.

 

[MarkM]

IS DHT is not a problem when it's elevated and shouldn't be lowered but I'd still cut the dose a bit to have the Free T come down closer to the lab range. That's all I'd do at this point, your SHBG is rather high and IMHO a M/W/F injection protocol would be contraindicated.

Hi Marvin,

Welcome to the forum. I agree with Vince Carter. With an SHBG as high as yours going to a M-W-F protocol is not recommended. I think I would drop down the dose to 75 mg in one injection per week. Stay on that dose for a minimum of 6 weeks, preferably 8 weeks, and then retest.

I would hold off on the HCG until you get bring everything inline. If you throw HCG into the mix now it will be hard to tell if you made any progress or not and it will just cloud things.

How do your new labs compare against your pre-TRT labs?

 

[mgsnell]

When you say you were injecting 0. 5 mg once a week. Do you mean a hundred mg once a week?

When levels of testosterone increase, more of it is converted into DHT and estrogen.

Yes 0.5 cc results in 100mg once a week. I should have said 0.5cc instead of 0.5mg's sorry

 

[mgsnell]

Hi Marvin,

Welcome to the forum. I agree with Vince Carter. With an SHBG as high as yours going to a M-W-F protocol is not recommended. I think I would drop down the dose to 75 mg in one injection per week. Stay on that dose for a minimum of 6 weeks, preferably 8 weeks, and then retest.

I would hold off on the HCG until you get bring everything inline. If you throw HCG into the mix now it will be hard to tell if you made any progress or not and it will just cloud things.

How do your new labs compare against your pre-TRT labs?

Unfortunately, I do not have pre TRT labs the last labs where while I was on clomid at 25mg every day. So on 5/18/2018 E2 was 27pg/mL, Total Testosterone was 987 ng/dL, Free Testosterone was 100pg/ml and SHBG was 59 nmo/L. My Urologist is at least working with me as most of the recommendations regarding what test to have done adding HCG etc were listened to and accepted. My last Dr and Endo had me on an injection protocal of 200mg of testosterone cyp every 2 weeks and needless to say I had major E2 issues like crying while watching cartoons and he would not listen to my complaints or consider my suggestions even though I brought in peer reviewed articles from the Journal of Endocronology.

I would appreciate it if you could check my math if I was to do 75mg once a week by my math that would be 0.375 cc's correct considering my testosterone cyp is 200mg/mL

 

[Systemlord]

Unfortunately, I do not have pre TRT labs the last labs where while I was on clomid at 25mg every day. So on 5/18/2018 E2 was 27pg/mL, Total Testosterone was 987 ng/dL, Free Testosterone was 100pg/ml and SHBG was 59 nmo/L. My Urologist is at least working with me as most of the recommendations regarding what test to have done adding HCG etc were listened to and accepted. My last Dr and Endo had me on an injection protocal of 200mg of testosterone cyp every 2 weeks and needless to say I had major E2 issues like crying while watching cartoons and he would not listen to my complaints or consider my suggestions even though I brought in peer reviewed articles from the Journal of Endocronology.

That's because your last doctor is inexperienced and doesn't do TRT on a regular basis and it shows. Your doctor was just following outdated guidelines are had no real knowledge to call his own which is why he didn't listen you your concerns or the studies.

Any doctor putting a guy on a 200mg every two week protocol is just getting his feet wet as it pertains to replacing a guys hormones, zero experience which is why he stuck to what the guidelines stat because he's scared of the unknown.

 

[MarkM]

..................I would appreciate it if you could check my math if I was to do 75mg once a week by my math that would be 0.375 cc's correct considering my testosterone cyp is 200mg/mL

That is correct.

 

[mgsnell]

Any thoughts on E2 should I maintain the 0.125 mg once a week, stop it until I get testosterone under control or increase it. My intuition is to not mess with it right now, change to the reduced dosage of 0.375cc once a week do labs in 8 weeks and go from there. Hopefully during this time my E2 will drop to a level where I can at least maintain an erection for my sake and the wife.

 

[MarkM]

Your E2 is technically on the high side but your testosterone is high and as your T goes, so does your E. It's best to change one thing at a time and when all is said and done you might need a little AI. Plus there is no real harm in the small amount, 0.125 mg a week, you are taking. I think your intuition is right Marvin.

 

[MarkM]

Marvin I just noticed your PSA was 3.6 on your labs. Is that a normal PSA result for you? Did the doctor give you a digital exam prior to the blood draw?

 

[mgsnell]

I noted that to my last PSA reading in may of this year was 2.0 so I am wondering if this 1.6 increase is due to the increase of testosterone and conversely DHT. I have noticed that my urination stream is weaker than it was several weeks ago and wonder about BHP. I did have a prostrate exam about a year ago by this Urologist and at that time all was good and my PSA was 1.6. I am guessing that this increase is due to the testosterone, DHT being high. The doctor didn't seem too concerned when I asked and my next visit isn't until 6 months from now. In the mean time in about 8 weeks I will pay out of pocket to get my estradiol, PSA and total and free testosterone as well as SHBG done and should have a better idea of how things are going

 

[MarkM]

I really don’t think its the testosterone or DHT that has raised it. It could be just a lab error which happens a lot more than you think it would. I would just get it checked again in 8 weeks like you are planning to do.

 

[Systemlord]

Don't be overly concerned with serum DHT levels, the level of DHT in your tissues is different from that level in the circulating in the blood.