Here is my basic panel I do twice a year.
Done in trough at 3.5 days
View attachment 54769View attachment 54770
Been on test cyp for 5 years.
.25 twice a week equals .5 a week for total of 100mg
I see my free is low and the dont match any online calculators.
Shbg seems high.
I am decent shape and eat well at 49 years old.
Sleep like shit and always have,go to bed at 930 on average and get up at 430 but toss and turn a lot and pee twice at least.
My biggest issue is fatigue and just no energy.
High stress personality with three teens.
I have a huge appetite and eat very clean and tried everything over the years as far as keto,carnivore,high carbs etc.
No change.
What can i do?I just need more energy for as disciplined as I am .
Lower shbg some how,up my test more to get the free to hopefully rise?
Thanks for any advice
I am decent shape and eat well at 49 years old.
Sleep like shit and always have,go to bed at 930 on average and get up at 430 but toss and turn a lot and pee twice at least.
My biggest issue is fatigue and just no energy.
High stress personality with three teens.
I have a huge appetite and eat very clean and tried everything over the years as far as keto,carnivore,high carbs etc.
No change.
What can i do?I just need more energy for as disciplined as I am .
Lack of quality sleep is a big red flag here!
Lack of sleep let alone a high stress personality is going to have a negative impact on cortisol.
Too many expect testosterone to be the end all be all when in fact having healthy adrenals/thyroid is critical let alone ones lifestyle (diet, sleep, exercise) will have a huge impact on how one feels overall physically/mentally regardless of having healthy T levels.
If you have dysfunctional thyroid/adrenals it can have a negative impact on the overall effectiveness of T-therapy as having healthy T levels is only one piece of the puzzle.
This is the panel you had done through Quest.
testdirectory.questdiagnostics.com
Would not even consider bumping up your dose until you see where your trough FT true sits!
Your TT was not even tested using the most accurate assays (LC/MS-MS) as the standard IA was used.
More importantly your FT was calculated but Quest uses a modified Vermeulen method.
Keep in mind as of now the go to calculated method is the linear law-of-mass action Vermeulen (cFTV) which is considered the most accurate as it has been validated against a standardized ED assay which is the gold standard testing method for free testosterone.
Yes it tends to overestimate slightly but will still give a good approximation.
If we calculated your FT using the go to Vermeulen method with a high trough TT 1033 ng/dL, higher-end SHBG 43 nmol/L and Albumin 4.7 g//dL then your trough FT 20.5 ng/dL would be very healthy as in high-end!
You would be hitting a healthy trough FT 20.5 ng/dL and this is 3.5 days post-injection which means your peak TT and more importantly FT and estradiol will be higher.
Your SHBG is in the low 40s but not really high and you are hitting a high trough TT.
Remember what I have stated numerous times on here when it comes to testing the most critical fraction free testosterone you would need to have it tested using the most accurate assay the gold standard Equilibrium Dialysis in order to know where it truly sits especially in cases of altered SHBG.
Since your Quest trough calculated FT is 12.7 ng/dL and your cFTV 20.5 ng/dL is much higher then your best bet if you want to put your mind at peace here is to retest your FT using the most accurate assay ED.
Then you will know where it truly sits and decide if there truly is a need to address the FT.
Chances are cFTV is on point here but ED would be the only way to truly know especially when you have altered SHBG.
FT <5 ng/dL would be considerd low.
FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.
FT 10-15 ng/dL would be healthy.
FT 20-25 ng/dL would be high-end/high.
If it turns out that your trough FT is closer to 12.7 ng/dL then you would easily have room to bring it up further.
You can easily pay out of pocket and use Nelson's
discounted labs which would be the most cost effective option or if insurance covers the test then you can use Labcorp, Quest or Mayo clinic as they all offer the ED assay.
Labcorp test details for Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences)
www.labcorp.com
