Blood Test Results - What to Make of Um

[Drug350]

There shouldn’t be one number for everyone! I have heard of men with Free T midrange and symptomatic, go on TRT and get their Free T over 20 and symptoms disappear.

Are you taking 237 MG's of testosterone twice a week (237 MG's twice daily ???) for a total of 474 MG's OR 237 MG's of testosterone per week split between 2 injections ??? I assume the latter. 474 MG's a week would be considered extremely high and in the realm of "performance enhancing".

 

[sammmy]

Systemlord is on oral testosterone pills - very low % is absorbed so the daily dose is 40 times of the daily injectable T.

Have your doctor check cortisol too or do it yourself - 4 point saliva test during the day. Low cortisol (adrenal fatigue) can cause symptoms similar to yours.

 

[Blackhawk]

Krikey, Drug350, I would be utterly confused in your place with these responses. There are some very knowledgeable members contributing to this thread, much more knowledgeable than I am, but you are not getting a comprehensive tutorial here to guide your protocol, clear input about dealing with your doctor (or seeking another... there are warning signs), or understanding of TRT as a whole, rather this has already turned into bickering over side issues and a heap of personal anecdote.

Do not heed individual anecdotes except as single data points of things which work for someone else. It is folly for you to chase someone else's protocol, but is reasonable to take them into consideration after you have established your own baseline from sticking with a common starting protocol for the needed 6-8 weeks, getting labs and adjusting.

spacemonkey's outlook is based on his own case. It is not good advice for all. The more is better outlook often leads to many more problems than it solves.

Systemlord has been through the wringer to get to his current protocol, because the stuff that does commonly work didn't for him. It is individualized based on his own idiosyncratic case. His protocol is not something to chase.

The CAG repeat issue is at work in all of us, but not pertinent to you starting TRT. You really don't need to worry about that at this time.

Let's just focus on the basics:

Most doctors do not understand TRT beyond the archaic protocols on the prescribing information for testosterone. Your doctor obviously does not know how to manage hypogonadism properly. It will be hit or miss whether you will do OK on what you have been prescribed, and there is high likelihood of a miss.

Your symptoms are important and your response to therapy needs to be taken into account. TRT is not adequately managed by adhering to arbitrary numbers like 300-700. That is utter nonsense. "Governmental standards"? No.

Labs: It looks like you have gotten a pretty good array. For more info, Nelson's Discounted labs website has tons of info. It is linked above under "lab tests" in the menu bar.

Your doctor is focusing on total T to decide on your future, but generally, free T is a better marker for having enough useful T in your system. Testing for free T is fickle. The Free T direct lab test remains a standard, but it isn't a good one. Much better: Total T LC/MS/MS and free T equilibrium dialysis or ultrafiltration... or read about free T calculators. There is disagreement over vermeulen vs Tru-T calculators.

SHBG is another controversial topic. It can be useful in determining dose frequency. The general guideline is men with higher SHBG do better with less frequent dosing, but despite that, once again, it needs to be personalized. My SHBG is high and I do better on at least every other day dosing, or daily.

100mg/week is not a bad starting place. for some it is perfect, for others not enough, for others too much. I started on 150/week it was way too much. I have subsequently reduced dose repeatedly over 5 years and now an on an unusual protocol of two esters daily at 56mg/week, and my lab results are higher than your doctor would allow. So that's great for me, but your doctor would shut me down with this protocol that actually works, because I am above 700 TT, but lower and my free T would be too low. Your doctor's limitations would harm me. (BTW, again, what works for me means nothing in respect to what ends up working for you!)

It has been mentioned that once a week dosing isn't good. For some men it's fine, but typically that schedule results in a high peak and low trough weekly, and some men do terribly with that symptomatic swing. It is nothing like normal endogenous hormone metabolism. Common customized dosing schedules for injected testosterone are 1/week, 2x/week, every 3 days, every 2 days, daily. The more frequently you dose, the more level the amount in your blood stream/the less peaks and troughs. For better mimicry of daily fluctuation some of us use some or all T proprionate which is faster acting and faster to be used up. This is generally not a good thing to start with though.

You will likely experience a "honeymoon period" as your T rises and your body adapts, and then feel a let down as things normalize at the new level.

It takes time for the level to build, based on the half life of the drug. 6-8 weeks is generally considered an OK amount of time to retest labs, but it takes longer for your body to completely adjust to the new levels. For me it takes 2-3 months to feel stable at the new level after changes.

If things go well, typically you will feel good, stronger, more confident and stable with dose increases. If things don't go well, it can be the opposite.

When lowering dose, you can have dreadful withdrawal including weakness, aches and pains, mental let down anxiety and depression. Some men experience these much more than others. Or in some cases, lowering dose may make you feel better!

There are common side effects:

Injecting testosterone shuts down your own testicular production of T. And it inhibits other aspects of the hormonal pathway functions of the body. It helps to understand steroidal hormone pathways to gain an understanding.

The shut down can cause testicular shrinkage, pain and sometimes problems with the testicles retracting painfully. HCG is often used to help this.

Troubles with estradiol are pretty common. There is extreme controversy over what E2 levels are OK or not. Some choose to add an aromatase inhibitor if symptomatic from high E2. Aromatase inhibitors are incredibly strong and can cause estrogen to crash. This is very bad. Having too litle is generally more dangerous for the long term than some excess. Some men do seemingly fine with high levels, but the is not complete data on men with long term high E2 because of taking exogenous T.

It commonly also affects pregnenelone and DHEA, which also can be replaced with supplementation. HCG can also help again.

Also can be changes with DHEA, Prolactin, progestone, neurotransmitters etc...

Testosterone inhibits hepcidin (produced in your liver) which in an inhibitor that keeps your red blood cell production from running rampant. Too many RBCs (erythrocytosis) result in high hematocrit and hemoglobin. The RBCs are essentially solid material in your blood. Hematocrit is a measurement of the percent of RBC solids. When you have too much solid material, your blood gets thick and viscous. I don't care the nonsense that people spew about this to justify suraphysiological abuse of testosterone, this is bad for you. It causes wear and tear on the endothelium of your arteries, high blood pressure and range of other symptoms especially with exercise/exertion. The short term treatment for erythrocytosis is phlebotomy (removing blood), but that depletes ferritin. You can end up with low ferritin (Low iron stores) from too many phlebotomies. These are super common issues for men taking T injections, and super common because so many men are put on too much from the get go.

Taking testosterone can both alleviate, but also cause sexual issues like erectile dysfunction, and loss of libido.

OK, enough for now I am sure I have missed some things, but I hope you have a better overview.

Personally if i were you I would find another doctor. This may be no small task, especially if you are stuck on the insurance game. Many of us decide to pay out of pocket for better care. Defy Medical is an easy answer. Many of us including our host Nelson are Defy patients.

Oh, and I'd say pay particularly good attention to MadMan and Cataceous.

EDIT/ADDENDUM: Injections, some men do very well on Subcutaneous injections, some do not, There is ongoing tension on this forum over this issue and it is just stupid. Do what works for you.

Many of us use smaller length and gauge insulin syringes. The carrier oil of your testosterone may make a difference. Cottonseed oil is thicker/more viscous that grapeseed oil. I am on the tiny end of things and use a 30g 5/16" syringe for tiny daily doses subQ in grapeseed oil.

Probably more common, 1/2" 29 or 27g, 27g will make cottonseed oil easier to draw... as will warming the vial. I warm my vial in warm water or against my body before drawing.

For those that do not do well on SubQ, many still get away with 1/2" needles and shallow intramuscular injections in deltoid or ventral glutes. Some masochists insist on deep intramuscular using 5/8" to 1.25" needles. Again, you will need to find what works for you.

 

[Systemlord]

my levels, at 180mg total per week (mon-wed-fr) are: total 754ng/dl free: 22.6ng/dl
reading wed before injection

You’re like a LaFerrari V12, you get bad gas mileage!

this is quite a difference, with my SHBG ultra low (11). most people tell me i should be higher.

You should only focus on the FT, the TT matters much less.

 

[Systemlord]

Systemlord is on oral testosterone pills - very low % is absorbed so the daily dose is 40 times of the daily injectable T.

That would be 474 mg daily! This would be a full blown cycle if we were taking about cypionate.

 

[wannabefan]

Would seem your issue is high prolactin levels causing you to feel not so terrific. Thyroid as mentioned and benign issues in the pituitary should be ruled out. I don’t see DHT but assume it’s in the tank as well as DHEA-S. I’d want to go further upstream before starting T, and get fullest picture.

 

[AMPS]

I'm 54 yrs young, in good shape, 6'0" / 195 pounds, eat healthy. I've felt run down for several years now, lack of drive, energy, ED issue's, poor sleep (waking up many times all night long) and poor focus, but I'm an engineer for BNSF Railway (USA) and am on call 24/7/365 days a year with 2 hour call. I work an average of 250 hours each month, with no set sleep or work schedule, so I figured it was my job causing most of my issue's. My primary care physician ran blood work as part of my annual physical. Here's my numbers and the normal range alongside:

Total Testosterone = 169 NGDL (200 - 800 NGDL = norm range)
Free Testosterone = 3.1 NGDL (3.1 - 12.8 NGDL = norm range)
Bioavailable Testosterone = 72.6 NGDL (71.7 - 300.0 = norm range)
SHBG = 34 NMOL (13 - 74 NMOL = norm range)
TSH Sensitive w/Reflex = 2.64 uiU ( .030 - 4.50 uiU = norm range)
Prolactin = 14.6 ng/ml (3.5 - 19.4 ng/ml = norm range)
LH = 3 mlU/ml (1.0 - 12 mlU/ml = norm range)
FSH = 4 mlU/ml (1.0 - 12 mlU/ml = norm range)
Estradiol = 21 pg/ml (11 - 44 pg/ml = norm range)
PSA = .05 ng/ml (0.0 - 4.0 ng/ml = norm range)
HCT (hematocrit) = 44% (38.8 - 50.0 % = norm range)


She said my testosterone levels were low and referred me to a Urologist and Sexual Health Doctor within the hospital system. The Urologist ran my bloods 3 more times, first thing in the morning, and each time they came back nearly identical to the first set of numbers above. There were additional blood tests for cholesterol, AIC, etc... I can post too if needed. Based on my numbers above, she recommended starting me on 100 MG's Testosterone Cypionate once a week with bloods drawn again in 8 - 10 weeks. Because all the blood tests came back with a total testosterone below normal range of 200 NGDL, insurance will cover my TRT for life. This is not a "TRT Clinic" or "Wellness Center" so the goal is to get me in the middle of the US Government recommended levels of 400 - 700 NGDL. She stated this several times so she won't allow me to go higher, like 700 + NGDL. I'm not very familiar with all of the above numbers, but most seem in range, except for total testosterone. Does anything stand out besides the low totals ??? With these numbers and the way I've been feeling, would you recommend going on TRT as she's suggested, and does 100 MG's weekly sound right ??? I probably would choose twice weekly injections vs once a week or EOW. Any opinions or advice would be greatly appreciated. Thank you in advance to anyone who takes their time to answer my questions. I greatly appreciate your advice and opinions.

If your doctor did a CBC your hematocrit levels should be there what is that number?

 

[Drug350]

If your doctor did a CBC your hematocrit levels should be there what is that number?

Under "Hematocrit" it shows HCT = 44. 7% with their normal range being 38.8% - 50.0%
Under "Hemoglobin" it shows Hemoglobin = 15.6 g/dl with their normal range being 13.5 - 17.5 g/dl
Does this tell you anything ??? Is my "Prolactin" number on the high side ??? From doing past cycles with of 19 Nor's, mostly Trenbolone and Deca, I had issues with my Prolactin and would have to take Cabergoline. I'm week 5 on 100 MG's weekly of Testosterone Cypionate (1 shot) and my nipples starting hurting about 2 weeks ago. I hit my chest on the wall and wanted to scream. I'm going to try twice weekly shots once I get my new blood work back next week and see my Urologist. I know it probably would help splitting the overall weekly dose from a single shot, into two doses instead. I know I aromatize easily too. I always had issues with gyno from doing gear and plan on getting gyno surgery in March and have my entire glands removed.