Better with high free T or total T or both?

[TheMiko1976]

Hi all.

Was wondering which is more "important". Free testosterone or total.

I had my annual bloodwork done required by my provider in November of last year. Total testosterone was 1100 ng/dl. Free test was 20.8 pg/mL. E2 was 34 pg/mL. SHBG was 36 nmol/L. I was injecting IM.

I switched about a month ago to SuQ injections, same as HCG, into belly fat. The reason was to get better control of hematocrit.

Today my total T is 497, free T is 111.3 pg/mL.

So, which is more desirable? I feel about the same, except my libido has decreased a bit. My performance in the gym has increased, though and I'm carrying less water weight, and it shows.

My Protocol is the following: 140mg of testosterone cypionate. Injection frequency is daily, 20mg or .10mL.
HCG is 220mg per week, broken up into daily injections Also.

Any thoughts would be appreciated.

 

[Systemlord]

Was wondering which is more "important". Free testosterone or total.

Free T and it’s metabolites, estrogen and DHT drives all of the benefits of TRT, Total T is less important, unless you lack the accurate testing methods for testing Free T, such as the equilibrium dialysis method which you can calculate the Free T using the Total T and SHBG.

Today my total T is 497, free T is 111.3 pg/mL.

Total T is a function of SHBG, the higher the SHBG, the higher the Total T independent of the Free T.

The Free T is the only thing you should concern yourself with. I’m unable to give you any advice on your Free T values since you didn’t provide the reference ranges which differ depending upon which lab company you use.

I feel about the same, except my libido has decreased a bit. My performance in the gym has increased, though and I'm carrying less water weight, and it shows.

You were probably dealing with fluid retention. Testosterone increases various other hormones that tell the kidneys to hold onto more sodium and sodium carries water.

I think you lowered your dose too much, as your Total T dropped by a little more than 50%, you should probably increase it a little bit.

HCG is 220mg per week

HCG dosing in measured in international units or IU, not mg.

 

[TheMiko1976]

Free T drives all of the benefits of TRT, Total T is less important, unless you lack the accurate testing methods for testing Free T, such as the equilibrium dialysis method which you can calculate the Free T using the Total T and SHBG.

Total T is a function of SHBG, the higher the SHBG, the higher the Total T independent of the Free T.

The Free T is the only thing you should concern yourself with. I’m unable to give you any advice on your Free T values since you didn’t provide the reference ranges which differ depending upon which lab company you use.



You were probably dealing with fluid retention. Testosterone increases various other hormones that tell the kidneys to hold onto more sodium and sodium carries water.

I think you lowered your dose too much, as your Total T dropped by a little more than 50%, you should probably increase it a little bit.


HCG dosing in measured in units or IU, not mg.

 

[Systemlord]

I switched about a month ago to SuQ injections

This amounts to a dosage change, so 4 to 6 weeks to steady blood levels. As of right now, your hormone levels are in flux, similar to when you first started TRT.

SQ can be a reason for lower hormone levels at the same dosage after switching from IM to SQ.

 

[TheMiko1976]

My dose is still 140mg per week, just injected SubQ now

 

[Systemlord]

My dose is still 140mg per week, just injected SubQ now

You would’ve got the same effect, lower fluid retention if you just lowered your dose and continued injecting IM.

SQ is overrated in my opinion.

I would inject 120 mg IM and if that doesn’t provide the results you’re looking for then 100 mg IM.

 

[TheMiko1976]

Would the lower total T help to control hematocrit? Or is it a combination of the 2?

 

[Systemlord]

Would the lower total T help to control hematocrit? Or is it a combination of the 2?

Testosterone drives secondary erythrocytosis, injections affects it more than any other delivery system. The oral testosterone undecanoate, Jatenzo, Orlando and Kyzatrex in the clinical trials, secondary erythrocytosis was a non-issue.

When you go to a place at high altitude, men not on TRT, testosterone spikes, hemoglobin and hematocrit increases causing secondary erythrocytosis.

I don't recall seeing any labs with hemoglobin and hematocrit values and normal ranges.

 

[TheMiko1976]

I've heard this also. But I like to play it safe and keep things withing range, or as close as possible

 

[FunkOdyssey]

Total testosterone was 1100 ng/dl. Free test was 20.8 pg/mL. E2 was 34 pg/mL. SHBG was 36 nmol/L. I was injecting IM.

I switched about a month ago to SuQ injections
Today my total T is 497, free T is 111.3 pg/mL.

Any thoughts would be appreciated.

My thoughts: you are now getting about half the value from each vial of testosterone after your switch to SC injections. The reduced absorption you are seeing with SC is relatively common in real life, despite little evidence of this effect in published clinical trials. It happened to me as well.

I would suggest you return to IM injections and lower your dosage in order to save money and stop wasting testosterone.

 

[Systemlord]

I've heard this also. But I like to play it safe and keep things withing range, or as close as possible

It's not that simple. Normal ranges can differ depending on the lab company. There's hematocrit ranges, 49, 50, 51 and 52%. If you're at 50.5%, and lab range is 50%, go to a different lab company with a 52% cut off and now you're in range.

 

[TheMiko1976]

My thoughts: you are now getting about half the value from each vial of testosterone after your switch to SC injections. The reduced absorption you are seeing with SC is relatively common in real life, despite little evidence of this effect in published clinical trials. It happened to me as well.

I would suggest you return to IM injections and lower your dosage in order to save money and stop wasting testosterone.

Definitely a thought. Just curious why/how my free T would rise nearly 5x or more in such a short time. I've heard this is a benefit to SubQ

 

[FunkOdyssey]

Definitely a thought. Just curious why/how my free T would rise nearly 5x or more in such a short time. I've heard this is a benefit to SubQ

Your free T dropped by about half when you switched to SC, just like your total T dropped by more than half. The first free T measurement you have looks like a LabCorp direct free T test which is both notoriously inaccurate and the units are off by a decimal place. It roughly corresponds to either 20 ng/dl or 200 pg/ml.

The better measurement to use with your first total T and SHBG values is the vermeulen calculation for free T which indicates you had 26 ng/dl free T. The 111 pg/ml free T you have now translates to 11 ng/dl. Your values for both free and total T have dropped precipitously since you switched to SC.

 

[TheMiko1976]

Your free T dropped by about half when you switched to SC, just like your total T dropped by more than half. The first free T measurement you have looks like a LabCorp direct free T test which is both notoriously inaccurate and the units are off by a decimal place. It roughly corresponds to either 20 ng/dl or 200 pg/ml.

The better measurement to use with your first total T and SHBG values is the vermeulen calculation for free T which indicates you had 26 ng/dl free T. The 111 pg/ml free T you have now translates to 11 ng/dl. Your values for both free and total T have dropped precipitously since you switched to SC.

Interesting. Looks like I'm going back to IM. That said, my labs from November were from my doctors office. Seems they use the Labcorp scale.

You'd think they have this standardized by now.

Thanks for that clarification.

 

[TheMiko1976]

Your free T dropped by about half when you switched to SC, just like your total T dropped by more than half. The first free T measurement you have looks like a LabCorp direct free T test which is both notoriously inaccurate and the units are off by a decimal place. It roughly corresponds to either 20 ng/dl or 200 pg/ml.

The better measurement to use with your first total T and SHBG values is the vermeulen calculation for free T which indicates you had 26 ng/dl free T. The 111 pg/ml free T you have now translates to 11 ng/dl. Your values for both free and total T have dropped precipitously since you switched to SC.

This kept me up all night lol. But I'm grateful for your help. So, how's a guy supposed to get an accurate account regarding T levels? Is there a specific test? Also makes me wonder about the accuracy of other lab results. It's quite frustrating.

As an anecdote, I was misdiagnosed with polycythemia vera about 6 years ago. The genetic test came back false-positive for the genetic mutation. The doctor never ordered a bone marrow biopsy which he should have. Went for a second opinion. Second blood test was negative for the mutation and the biopsy was negative too.

 

[Seagal]

Hi all.

Was wondering which is more "important". Free testosterone or total.

I had my annual bloodwork done required by my provider in November of last year. Total testosterone was 1100 ng/dl. Free test was 20.8 pg/mL. E2 was 34 pg/mL. SHBG was 36 nmol/L. I was injecting IM.

I switched about a month ago to SuQ injections, same as HCG, into belly fat. The reason was to get better control of hematocrit.

Today my total T is 497, free T is 111.3 pg/mL.

So, which is more desirable? I feel about the same, except my libido has decreased a bit. My performance in the gym has increased, though and I'm carrying less water weight, and it shows.

My Protocol is the following: 140mg of testosterone cypionate. Injection frequency is daily, 20mg or .10mL.
HCG is 220mg per week, broken up into daily injections Also.

Any thoughts would be appreciated.

Did you do the IM injections also daily?
I feel my SC injected oil for about week under the skin (until it's absorbed into circulation, I guess). Thus I think that there is about one week stretch in blood level response compared to IM and therefore it might take much longer to achieve 'stable/peak' blood levels compared to IM. That is my opinion to explain part of the huge discrepancy (50%) between IM and SC after one month. Do you also had E2 measured?
Why did you do daily SC injections? Compared to IM one can reduce frequency because of the slower release of the oil into circulation.

 

[TheMiko1976]

Did you do the IM injections also daily?
I feel my SC injected oil for about week under the skin (until it's absorbed into circulation, I guess). Thus I think that there is about one week stretch in blood level response compared to IM and therefore it might take much longer to achieve 'stable/peak' blood levels compared to IM. That is my opinion to explain part of the huge discrepancy (50%) between IM and SC after one month. Do you also had E2 measured?
Why did you do daily SC injections? Compared to IM one can reduce frequency because of the slower release of the oil into circulation.

Yes I've always done daily injections. I switched from IM as a way to hopefully slow the rise in hematocrit etc. I heard that was possible that way. I knew there would be a drop in testosterone, bit not by that degree. Back to IM as of this morning.

I had my E2 measures in November of last year and it was on the high side but in range.

 

[FunkOdyssey]

This kept me up all night lol. But I'm grateful for your help. So, how's a guy supposed to get an accurate account regarding T levels? Is there a specific test? Also makes me wonder about the accuracy of other lab results. It's quite frustrating.

There is no direct measurement for free T that is 100% accurate 100% of the time (at least not readily available yet). The most consistently reliable measurement at this time is actually the Vermeulen calculation. With each lab test for Total T, you will want to make sure you get your SHBG tested as well, which can be combined with the albumin value from your metabolic panel to calculate your free T:

Free & Bioavailable Testosterone calculator

 

[Systemlord]

Total T measurements can be plus or minus 70 ng/dL, and so this can be problematic for those requiring two seperate lab tests <300 to qualify for TRT.

Sadly the doctors are aware of the limitations in lab testing and have to follow guidelines to the letter!

 

[GTSILVER]

Hi all.

Was wondering which is more "important". Free testosterone or total.

I had my annual bloodwork done required by my provider in November of last year. Total testosterone was 1100 ng/dl. Free test was 20.8 pg/mL. E2 was 34 pg/mL. SHBG was 36 nmol/L. I was injecting IM.

I switched about a month ago to SuQ injections, same as HCG, into belly fat. The reason was to get better control of hematocrit.

Today my total T is 497, free T is 111.3 pg/mL.

So, which is more desirable? I feel about the same, except my libido has decreased a bit. My performance in the gym has increased, though and I'm carrying less water weight, and it shows.

My Protocol is the following: 140mg of testosterone cypionate. Injection frequency is daily, 20mg or .10mL.
HCG is 220mg per week, broken up into daily injections Also.

Any thoughts would be appreciated.

Free Testosterone is what your body actually uses because it isn’t already “bound” to other things. Total Testosterone and Free Testostetone don’t have an actual reliable ratio to refer too. In other words, a very high Total reading doesn’t automatically provide a high Free Testosterone reading. However, it’s alway important not to exceed what’s normally recognized as the maximum level of Total Testosterone to take for your body, for example, 1500 or above is not sustainable and can cause unwanted side effects!
Personally, I started TRT over 23 years ago at age 56 due to HYPOGONADISM. I am now age 69. If I don’t utilize TRT my Total Teststosterone goes down to levels between 20-90. In essence, this makes me “medically castrated!” Even worse, I have been seriously debilitated for about 30 years from CFS, CHRONIC FATIGUE SYNDROME, FM, FIBROMYALGIA and CI, CHIARI MALFORMATION.
Utilizing TRT measurably increases my normal wellbeing. If I am not utilizing TRT, my entire life falls apart reduced to total bedrest, home confinement with an increase in the severity of all my disability related symptoms.
It’s a life saver for me.
Regardless of the different levels we’ve tried on my Total Testosterone, (we aim to be at about a consistent 750-800), my levels of Free Testosterone are still lower than normal and frankly don’t change much for me unless I am off of TRT completely.
You need to try different types of Testosterone in varying amounts and delivery systems to see what works best for you. There is no type of “T” or type of delivery system that works best for everybody or most people.
With some time and patience, you’ll find what works best for you. It’s also important to have some fair and realistic expectations.
TRT won’t solve all of your medical or physical woes but if used apparently, can provide a considerable improvement in your overall health and well-being.
Best wishes and good luck,
Philip Snowdon