Blood work and Natesto

[BigBeard411]

My first visit to a doctor, where blood was taken in a fasted state at about 1pm, resulted in the following:

Prolactin at 20.1 ng/mL (Ref 4-15.2)

Estradiol at 24.7 pg/mL (Ref 7.6-42.6)

LH at 4.9 mIU/mL (Ref 1.7-8.6)

Testosterone at 291 ng/dL (Ref 264-916)

Free Test Direct at 15.7 pg/mL (Ref at 8.7-25.1)

Albumin 4.5 g/dL

This doctor prescribed me Natesto nasal testosterone gel, 3x per day. I had all the classical symptoms of low T and felt better immediately (within 20 minutes) after taking this. Worst symptoms were brain fog, fatigue poor motivation/focus, and running out of energy very easily. Libido was ok, not great but not very bad.

Brain fog/fatigue dissipated within 20 minutes of my dosing with Natesto. Motivation and energy skyrocketed - i finally felt normal after feeling like crap for 5+ years, and attributing that simply to "getting old".
I have been working out for 12 years consistently, and within the last 2-3 years have been gaining a lot of fat, strength stagnated, and a few months ago even my strength began to decrease.

I had in the past considered i may have low T due to the symptoms i have been experiencing, but I had put that thought aside as I am pretty well built from the years of training.

I went to another doctor to look into my above normal prolactin, and to get a 2nd opinion, as i am 35, working 5x per week - I was hoping TRT would be transient for me, and building a family is very important to me. Natesto was recommended as it preserves fertility, according to my doctor.

This other doctor had me stop taking my TRT for 2 weeks and retest my hormone levels. I was on Natesto for 2 weeks prior to this. I felt pretty crappy for 2 days after stopping, then went back to feeling ok, but not as good as when i was using Natesto.

From this 2nd doctor and different (in-house) lab, i received the following results, where my blood was taken at 8am:

Prolactin 14.2 (ref 2.5-17.4)

Total testosterone: 433 ng/dL (ref 249-836)

Free test: 10.52 ng/dL (ref 1.8 - 21)

LH 2.9 miu/mL (ref 1.2-10.6)

FSH 2.3 miu/mL (ref 1.4-18.2)

SHBG 26.52 nmol/L (ref 10-57)

Albumin 4 g/dL (ref 3.4-5.0)


So it seems like my prolactin normalized. My testosterone was much higher than the last time i got checked...is it possible this is because of the Natesto, even though i stopped for 2 weeks?

What would you guys do in my situation? Get off TRT? Stay on for 6-12 months? One of the issues i had was i gained about 40 pounds of fat over 5 years, even though i eat less and workout, though intensity has faded over the years due to lack of energy and fatigue prior to TRT (all of that is gone now). I was thinking of staying on Natesto to help with my energy levels, to lose some fat that i gained over the years (despite being consistent in working out), and then seeing how I feel once i stop TRT.

I have not spoken to this 2nd doctor yet, but I assume she would tell me not to continue taking TRT. Logically, if all my symptoms went away after starting, wouldn't the conclusion be I am suffering from Low-T symptoms, despite being in the normal range now? There is also no way i can know if this new test level would have dropped further if i had stopped Natesto for a few months as opposed to 2 weeks, though the half life of Natesto is quite short.

 

[Willyt]

Very interesting. Your follow-up blood test looked similar to my experience. I too was surprised that nasal gel appears to bump up the natural production baseline for some guys. Nobody seems to how long the baseline stays elevated after you discontinue the Natesto. You could retest in 1-2 months to find out.

It sounds like you had better subjective results than I did though. Were you on Natesto only for two weeks? As you may know already, there is a bit of a honeymoon period with TRT - some of it physiological but also a placebo effect

 

[cegranger]

Very interesting. Your follow-up blood test looked similar to my experience. I too was surprised that nasal gel appears to bump up the natural production baseline for some guys. Nobody seems to how long the baseline stays elevated after you discontinue the Natesto. You could retest in 1-2 months to find out.

It sounds like you had better subjective results than I did though. Were you on Natesto only for two weeks? As you may know already, there is a bit of a honeymoon period with TRT - some of it physiological but also a placebo effect.

It seems likely that his most recent test level is higher simply because blood was drawn in the morning instead of afternoon. I wouldn’t assume it has anything to do with the nasal gel. Maybe I’m thinking about this wrong though.

 

[madman]

My first visit to a doctor, where blood was taken in a fasted state at about 1pm, resulted in the following:

Prolactin at 20.1 ng/mL (Ref 4-15.2)

Estradiol at 24.7 pg/mL (Ref 7.6-42.6)

LH at 4.9 mIU/mL (Ref 1.7-8.6)

Testosterone at 291 ng/dL (Ref 264-916)

Free Test Direct at 15.7 pg/mL (Ref at 8.7-25.1)

Albumin 4.5 g/dL

This doctor prescribed me Natesto nasal testosterone gel, 3x per day. I had all the classical symptoms of low T and felt better immediately (within 20 minutes) after taking this. Worst symptoms were brain fog, fatigue poor motivation/focus, and running out of energy very easily. Libido was ok, not great but not very bad.

Brain fog/fatigue dissipated within 20 minutes of my dosing with Natesto. Motivation and energy skyrocketed - i finally felt normal after feeling like crap for 5+ years, and attributing that simply to "getting old".
I have been working out for 12 years consistently, and within the last 2-3 years have been gaining a lot of fat, strength stagnated, and a few months ago even my strength began to decrease.

I had in the past considered i may have low T due to the symptoms i have been experiencing, but I had put that thought aside as I am pretty well built from the years of training.

I went to another doctor to look into my above normal prolactin, and to get a 2nd opinion, as i am 35, working 5x per week - I was hoping TRT would be transient for me, and building a family is very important to me. Natesto was recommended as it preserves fertility, according to my doctor.

This other doctor had me stop taking my TRT for 2 weeks and retest my hormone levels. I was on Natesto for 2 weeks prior to this. I felt pretty crappy for 2 days after stopping, then went back to feeling ok, but not as good as when i was using Natesto.

From this 2nd doctor and different (in-house) lab, i received the following results, where my blood was taken at 8am:

Prolactin 14.2 (ref 2.5-17.4)

Total testosterone: 433 ng/dL (ref 249-836)

Free test: 10.52 ng/dL (ref 1.8 - 21)

LH 2.9 miu/mL (ref 1.2-10.6)

FSH 2.3 miu/mL (ref 1.4-18.2)

SHBG 26.52 nmol/L (ref 10-57)

Albumin 4 g/dL (ref 3.4-5.0)


So it seems like my prolactin normalized. My testosterone was much higher than the last time i got checked...is it possible this is because of the Natesto, even though i stopped for 2 weeks?

What would you guys do in my situation? Get off TRT? Stay on for 6-12 months? One of the issues i had was i gained about 40 pounds of fat over 5 years, even though i eat less and workout, though intensity has faded over the years due to lack of energy and fatigue prior to TRT (all of that is gone now). I was thinking of staying on Natesto to help with my energy levels, to lose some fat that i gained over the years (despite being consistent in working out), and then seeing how I feel once i stop TRT.

I have not spoken to this 2nd doctor yet, but I assume she would tell me not to continue taking TRT. Logically, if all my symptoms went away after starting, wouldn't the conclusion be I am suffering from Low-T symptoms, despite being in the normal range now? There is also no way i can know if this new test level would have dropped further if i had stopped Natesto for a few months as opposed to 2 weeks, though the half life of Natesto is quite short.

Nothing to do with the Natesto as there is no buildup/steady-state achieved due to its fast-acting nature.

In/out of your system quick!

Natesto would be considered the least suppressive to the HPTA due to the short-lived peaks/significant trough times between doses.

Regardless of whether dosing 2-3 times daily, there is a short-lived peak Tmax 40-60 min (t1/2 ~1h) with long trough times 6-8 hrs between doses.

The reason your testosterone is higher on your most recent labs (2nd) is that you had it tested in the early am when your levels will be at peak (highest) during the 24 hr circadian rhythm.

Hopefully, you also fasted otherwise your levels would have been higher.

Critical that blood work is done in a fasted state in the early am as we want to test at the peak.

Top it off that if you strength train then I would strongly recommend taking a week off so you are well rested/recovered as excess stress whether (mental/physical), let alone lack of quality sleep can hammer down T levels!

The sad fact of the matter is your TT 433 ng/dL at the peak is far from anything to brag about and more importantly, your FT would be sub-par.

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.

Always best to have blood work done twice over the course of a few weeks in the early am/fasted and take a week off from the gym if you strength train.


*Do not make a diagnosis of AD (androgen deficiency) based on a single T measurement or only on T level




post #9

Testosterone Blood Test Results - Time of Day?

I have taken two blood tests over the last two weeks with very different results. I appreciate levels fluctuate all the time from day, week, month and clearly hourly, so getting a consistent results is almost impossible. I was very surprised at the difference in levels! Test 1 - taken at...

www.excelmale.com

 

[BigBeard411]

Nothing to do with the Natesto as there is no buildup/steady-state achieved due to its fast-acting nature.

In/out of your system quick!

Natesto would be considered the least suppressive to the HPTA due to the short-lived peaks/significant trough times between doses.

Regardless of whether dosing 2-3 times daily, there is a short-lived peak Tmax 40-60 min (t1/2 ~1h) with long trough times 6-8 hrs between doses.

The reason your testosterone is higher on your most recent labs (2nd) is that you had it tested in the early am when your levels will be at peak (highest) during the 24 hr circadian rhythm.

Hopefully, you also fasted otherwise your levels would have been higher.

Critical that blood work is done in a fasted state in the early am as we want to test at the peak.

Top it off that if you strength train then I would strongly recommend taking a week off so you are well rested/recovered as excess stress whether (mental/physical), let alone lack of quality sleep can hammer down T levels!

The sad fact of the matter is your TT 433 ng/dL at the peak is far from anything to brag about and more importantly, your FT would be sub-par.

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.

Always best to have blood work done twice over the course of a few weeks in the early am/fasted and take a week off from the gym if you strength train.


*Do not make a diagnosis of AD (androgen deficiency) based on a single T measurement or only on T level




post #9

Testosterone Blood Test Results - Time of Day?

I have taken two blood tests over the last two weeks with very different results. I appreciate levels fluctuate all the time from day, week, month and clearly hourly, so getting a consistent results is almost impossible. I was very surprised at the difference in levels! Test 1 - taken at...

www.excelmale.com

Thanks for the input, to all of you.
Yes, Natesto has a very short half life so it seems unlikely the natural boost in test is due to that. I was on it for 2 weeks, then had to go off for 2 weeks for the retest by the 2nd doctor. I went back to a low energy/easily fatigued state during that time. I went to the gym a single day during the 2-week off period and had to leave after 20 minutes because i just could not do it. I am now on it and I feel normal again for someone my age (35). I would not call it a honey moon, but it simply feels great feeling normal, especially after suffering for years.

Yes, the 2nd test was at 8am at the theoretical peak at the fasted state. It seems strange that compared to the afternoon, it is over 50% higher. Regardless, it is still a very poor level and I am indeed symptomatic without it. Even my libido and erection strength improved in such a short time. My reasoning is that if i was truly not hypogonadal, I would not see any of these benefits with typical TRT.

I am just disappointed since I am young for TRT, despite having worked out for a large part of my life and been healthy. Part of me feels like the only other choice is to feel like crap for the rest of my life - possibly getting worse with age.

what would be the average free test for someone in my age group? I probably have close to half of total test.

Lastly, the clinical diagnosis for hypogonadism seems arbitrary, as it takes value into account prior to symptoms, and compares values according to a range as opposed to a healthy average. It also makes no sense how i can dwindle in an out of that medically defined hypogonadal state. I do notice i feel best early in the morning, which is why i work out very early, and then the rest of the day is typically a horrible drag where I have to force myself to do anything and am constantly stressed and irritated.

Would you continue TRT if you were in my shoes? Would injections have shut me down after 2 weeks of taking them?

 

[Systemlord]

Would you continue TRT if you were in my shoes

Choose quality of life, which makes you feel better, off or on TRT?

 

[madman]

Thanks for the input, to all of you.
Yes, Natesto has a very short half life so it seems unlikely the natural boost in test is due to that. I was on it for 2 weeks, then had to go off for 2 weeks for the retest by the 2nd doctor. I went back to a low energy/easily fatigued state during that time. I went to the gym a single day during the 2-week off period and had to leave after 20 minutes because i just could not do it. I am now on it and I feel normal again for someone my age (35). I would not call it a honey moon, but it simply feels great feeling normal, especially after suffering for years.

Yes, the 2nd test was at 8am at the theoretical peak at the fasted state. It seems strange that compared to the afternoon, it is over 50% higher. Regardless, it is still a very poor level and I am indeed symptomatic without it. Even my libido and erection strength improved in such a short time. My reasoning is that if i was truly not hypogonadal, I would not see any of these benefits with typical TRT.

I am just disappointed since I am young for TRT, despite having worked out for a large part of my life and been healthy. Part of me feels like the only other choice is to feel like crap for the rest of my life - possibly getting worse with age.

what would be the average free test for someone in my age group? I probably have close to half of total test.

Lastly, the clinical diagnosis for hypogonadism seems arbitrary, as it takes value into account prior to symptoms, and compares values according to a range as opposed to a healthy average. It also makes no sense how i can dwindle in an out of that medically defined hypogonadal state. I do notice i feel best early in the morning, which is why i work out very early, and then the rest of the day is typically a horrible drag where I have to force myself to do anything and am constantly stressed and irritated.

Would you continue TRT if you were in my shoes? Would injections have shut me down after 2 weeks of taking them?

-Yes, the 2nd test was at 8am at the theoretical peak at the fasted state. It seems strange that compared to the afternoon, it is over 50% higher.


It is a known fact that testosterone levels of healthy young men peak in the early am.

FIG. 1. Hourly serum testosterone levels (mean ± SEM) in normal young (n = 17) and old (n = 12) men. Blood samples were obtained using an indwelling peripheral venous cannula, which allowed free movement and normal sleep. *, P < 0.05; **, P < 0.01 (significance levels of the differences between young and old men at each time point). The absence of an asterisk denotes that there was no significant difference at that time point.

Fig. 1 Cosinor-derived circadian rhythmometry (CHRONOLAB) for serum (a), total testosterone (b), bioavailable testosterone (c), free testosterone (d) SHBG in young (dotted lines) and elderly (solid lines) men. The arrows (dotted = young: solid = elderly) indicate the time of acrophase. PHASE represents the time in degrees 360° = 24 h).




That is why blood work needs to be done in the early am as we want to test at the peak.

Your first doctor was out to lunch!

Even then you would be better off testing twice over a few weeks using the same lab/same assays (most accurate).

-what would be the average free test for someone in my age group? I probably have close to half of total test.

Have no clue where your T levels sat in your prime late teens/the early 20s.

Even then would not be too surprised if you were only hitting a TT 600 ng/dL in your prime!

Look over the thread posted below.

post #31/33

Microdosing Enanthate

Slightly being defined as past the upper quartile but not double the norm. A TT of 1,200 ng/dL would be considered to be slightly supraphyiological. I will take myself as an example of why treating how a patient feels is as important if not more than maintaining physiological testosterone...

www.excelmale.com

A Validated Age-Related Normative Model for Male Total Testosterone Shows Increasing Variance but No Decline after Age 40 Years (2014)


Discussion

Using data-driven modeling and analysis, we have derived a normative model of total testosterone throughout the lifespan. We have shown that in the average healthy male testosterone is low in pre-puberty, rises from age 11, and peaks at age 19 at 15.4 (7.2– 31.1) nmol/L [mean (2.5–97.5 percentile)]. Thereafter TT falls slightly to age 40 years to 13.0 (6.6–25.3) nmol/L. We find no evidence to support a progressive decline in testosterone in middle-aged and older men, sometimes termed the ‘andropause’, as TT does not fall significantly in the average man after the age of 40 years. Our analyses show that the 95% prediction limit increases from 18.7 nmol/L at age 40 years to 24.5 nmol/L at age 88 years. This increase in variation with increasing age demonstrates that reference ranges for TT that do not take chronological age into account are inappropriate for the assessment of an individual’s testosterone levels.




*Our model is derived from data from multiple sources of the measurement of TT in over 10,000 healthy males aged between 3 and 101 years. This is both a strength and weakness of the study. The strength is that modeling power is increased by the provision of large numbers of data points for a wide range of ages: it has been previously shown that models that include both prepubertal, pubertal, and adult ages can be used to derive important insights for a restricted age range [47]. The weakness is the approximate heterogeneity of the values obtained from diverse sources, especially as assay conversion factors were used that have known high correlation but are nevertheless inexact. This includes studies that involve convenience samples (e.g. primary care and outpatient attendees) as well as those that involve population-derived cohorts. Further limitations of our approach are that insufficient data were found to model accurately neonatal ages and that we had to exclude potentially useful studies that used in-house assays which lack standardization and harmonization, and for which no conversion formula has been published [48]. Ten of the thirteen studies used as data sources (Table 1) excluded subjects taking medication that could affect the endocrine system, but three studies [5,6,49] (combined n = 2,371 of 10,097) do not have equivalently explicit inclusion criteria. We can therefore not rule out the possibility that a small number of subjects were on medication that increased their TT levels.




Figure 4. The validated model. Our dataset (n = 10,098) of observed total testosterone for ages 3–88 years, split into normative ranges determined by mean predicted values (blue line) and one (red), two (blue), three (green), and four (purple) standard deviations higher and lower than the predicted values. doi:10.1371/journal.pone.0109346.g004

Figure 5. The validated model in centiles. Normative ranges for the model of total testosterone from ages 3–88 years. In the average case (red line) total testosterone remains constant for age .40. However, the variance in normative ranges increases for these ages, with 1st to 99th centile ranges of 5.6–27.6 nmol/L at age 35 years and 4.1–33.1 nmol/L at age 88 years. doi:10.1371/journal.pone.0109346.g005

-Would you continue TRT if you were in my shoes? Would injections have shut me down after 2 weeks of taking them?

From this 2nd doctor and different (in-house) lab, i received the following results, where my blood was taken at 8am:

Prolactin 14.2 (ref 2.5-17.4)

Total testosterone: 433 ng/dL (ref 249-836)

Free test: 10.52 ng/dL (ref 1.8 - 21)

LH 2.9 miu/mL (ref 1.2-10.6)

FSH 2.3 miu/mL (ref 1.4-18.2)

SHBG 26.52 nmol/L (ref 10-57)

Albumin 4 g/dL (ref 3.4-5.0)




As I stated previously.

The sad fact of the matter is your TT 433 ng/dL at the peak is far from anything to brag about and more importantly, your FT would be sub-par.

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.

Regarding injections, the full shutdown of the hpta does not happen immediately.

It can take anywhere from 2-6 weeks depending on the dose used.

High doses of T (beyond therapeutic) will result in a much quicker shutdown of the hpta.