Blood Work Questions

[Malang Sob]

Hi,

I want to see if there is anyone on here who can give me an honest opinion.

I feel like a million bucks. Been on TRT for almost two months. However, I am going about this on my own as my PCM denied me TRT due to adequate levels. As a result I have some questions that i hope people can answer.

Question
-How do I reduce SHBG and increase Free T? Do I even need to tinker?
-Is my estradiol too high? Especially given my total T? I know the paper says yes but I am experiencing no ill effects that I can tell. Should I still work to reduce?

Regimen
I micro dose test cyp 16mg/d or 112 mg/wk.
I saw something stating that reducing injection frequency can drive down SHBG and increase free test. Is this valid?

Any opinions are appreciated.

Thank you very much.

 

[madman]

Hi,

I want to see if there is anyone on here who can give me an honest opinion.

I feel like a million bucks. Been on TRT for almost two months. However, I am going about this on my own as my PCM denied me TRT due to adequate levels. As a result I have some questions that i hope people can answer.

Question
-How do I reduce SHBG and increase Free T? Do I even need to tinker?
-Is my estradiol too high? Especially given my total T? I know the paper says yes but I am experiencing no ill effects that I can tell. Should I still work to reduce?

Regimen
I micro dose test cyp 16mg/d or 112 mg/wk.
I saw something stating that reducing injection frequency can drive down SHBG and increase free test. Is this valid?

View attachment 42081

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Any opinions are appreciated.

Thank you very much.

Forget getting caught up in trying to lower SHBG.

Increasing your TT will drive up your FT.

Increasing your FT will incease your estradiol.

Larger doses injected less frequently would have a bigger impact on driving down SHBG.

Even than not everyone will see a big drop in SHBG when using therapeutic doses of T.

My SHBG has barely budged during the 7 years I have been on TTh and I inject 150 mg T/week split into twice-weely injections (every 3.5 days).

I run a high-end trough FT.

Keep in mind that 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.

Unfortunately, you had your FT tested using the known to be inaccurate direct immunoassay.

You need to have your FT tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration, especially in cases of altered SHBG to know where it truly sits.

If you do not have access to such assays, highly doubtful if you live in the US then you would need to use/rely upon the linear law-of-mass action cFTV.

It is available online for free.

Plug in your TT, SHBG, and Albumin to see where your FT sits.

With a whopping TT 1487 ng/dL, high SHBG 57 nmol/L, and Albumin 4.3 g/dL (default) your FT 28.9 ng/dL would be high.

As you can see with a whopping TT of almost 1500 ng/dL even with a high SHBG of 57 nmol/L your FT is high!

Keep in mind as of now cFTV tends to overestimate sligtly when copared against a standardized Equilibrium Dialysis assay.

So although your FT level may very well be a little lower ifyou had it tested using the most accurate assay (ED) it would still be on the high-end/high.

You are missing critical blood markers RBCs, hemoglobin, and hematocrit which need to be done when using exogenous T.

This is important and needs to be addressed.

Keep in mind that when starting TTh or tweaking a protocol (increasing dose of T) hematocrit will increase within the first month and will take 6-9 months and in some cases a year to reach peak levels.

Where your levels sit 6-8 weeks let alone 3 months in is not where they will end up 6-9 months from now.

If you feel good overall, minus any sides, and your blood markers are healthy then stick with it for the time being!

If shit goes south down the road then you easily have room to bring down your FT level if need be.

Keep in mind you are only 8 weeks in and you need to give it more time to truly gauge how you feel.

Many fail to realize that when first starting TTh let alone tweaking a protocol (increasing dose of T) hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE) and it is common to experience ups/downs during the transition as the body is trying to adjust.

More importantly, once blood levels have stabilized (4-6 weeks) it will still take time (a few more months) for the body to adapt to its new set-point and this is the critical time when one needs to gauge how they truly feel overall regarding relief/improvement of low-symptoms and overall well-being.

Every protocol needs to be given 12 weeks before claiming whether it was a success or failure.

Patience is key.

 

[Malang Sob]

Forget getting caught up in trying to lower SHBG.

Increasing your TT will drive up your FT.

Increasing your FT will incease your estradiol.

Larger doses injected less frequently would have a bigger impact on driving down SHBG.

Even than not everyone will see a big drop in SHBG when using therapeutic doses of T.

My SHBG has barely budged during the 7 years I have been on TTh and I inject 150 mg T/week split into twice-weely injections (every 3.5 days).

I run a high-end trough FT.

Keep in mind that 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.

Unfortunately, you had your FT tested using the known to be inaccurate direct immunoassay.

You need to have your FT tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration, especially in cases of altered SHBG to know where it truly sits.

If you do not have access to such assays, highly doubtful if you live in the US then you would need to use/rely upon the linear law-of-mass action cFTV.

It is available online for free.

Plug in your TT, SHBG, and Albumin to see where your FT sits.

With a whopping TT 1487 ng/dL, high SHBG 57 nmol/L, and Albumin 4.3 g/dL (default) your FT 28.9 ng/dL would be high.

As you can see with a whopping TT of almost 1500 ng/dL even with a high SHBG of 57 nmol/L your FT is high!

View attachment 42089

Keep in mind as of now cFTV tends to overestimate sligtly when copared against a standardized Equilibrium Dialysis assay.

So although your FT level may very well be a little lower ifyou had it tested using the most accurate assay (ED) it would still be on the high-end/high.

You are missing critical blood markers RBCs, hemoglobin, and hematocrit which need to be done when using exogenous T.

This is important and needs to be addressed.

Keep in mind that when starting TTh or tweaking a protocol (increasing dose of T) hematocrit will increase within the first month and will take 6-9 months and in some cases a year to reach peak levels.

Where your levels sit 6-8 weeks let alone 3 months in is not where they will end up 6-9 months from now.

If you feel good overall, minus any sides, and your blood markers are healthy then stick with it for the time being!

If shit goes south down the road then you easily have room to bring down your FT level if need be.

Keep in mind you are only 8 weeks in and you need to give it more time to truly gauge how you feel.

Many fail to realize that when first starting TTh let alone tweaking a protocol (increasing dose of T) hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE) and it is common to experience ups/downs during the transition as the body is trying to adjust.

More importantly, once blood levels have stabilized (4-6 weeks) it will still take time (a few more months) for the body to adapt to its new set-point and this is the critical time when one needs to gauge how they truly feel overall regarding relief/improvement of low-symptoms and overall well-being.

Every protocol needs to be given 12 weeks before claiming whether it was a success or failure.

Patience is key.

Awesome response.

Yeah man. I just wanted to make sure that my numbers are not crazy.

I see 'HIGH' on a lab report and I'm like oh crap. I'm just winging this.

It doesn't seem like I'm that far off though.

My RBC (4.68) WBC (5.9) Hematocrit (43.5) and Hemoglobin (14.7) are within limits.

Well, according to the lab report scale.

Yes, as of right now I feel great but like you said it's only 8 weeks in on a very long road.

I really appreciate you takin that time man.


Thank You Madman!

 

[Systemlord]

My RBC (4.68) WBC (5.9) Hematocrit (43.5) and Hemoglobin (14.7) are within limits.

Even if your hematocrit and hemoglobin were not within limits, there’s no medical literature that says high hematocrit is harmful.

A high lab value doesn’t always mean that it’s bad.

A slight elevation in hematocrit may be more beneficial as the human vascular system can transport oxygen more efficiently with higher than normal hematocrit levels, then with normal levels.

 

[FunkOdyssey]

How do I reduce SHBG and increase Free T? Do I even need to tinker?

You increase your dose if you want to increase free T. You don't need to modify your SHBG. Ignore your SHBG. You are hitting around 29 ng/dL calculated free T so you have plenty. I wouldn't change anything if you are feeling good.

-Is my estradiol too high? Especially given my total T? I know the paper says yes but I am experiencing no ill effects that I can tell. Should I still work to reduce?

No, your E2 is not too high. It is actually low given your high T, and your high SHBG, which will result in a lower free E2. I would not modify your E2, or anything else for that matter, if you are feeling good.

 

[Malang Sob]

You increase your dose if you want to increase free T. You don't need to modify your SHBG. Ignore your SHBG. You are hitting around 29 ng/dL calculated free T so you have plenty. I wouldn't change anything if you are feeling good.

No, your E2 is not too high. It is actually low given your high T, and your high SHBG, which will result in a lower free E2. I would not modify your E2, or anything else for that matter, if you are feeling good.

Thank you so much.

 

[Malang Sob]

Oh guys, one more thing.

I noticed my blood glucose was high..ish (108).

I am on a Keto diet so my intake of carbs is ~50g/day, or less.

My question is, I supplement with Niacin (500Mg/d).

I read somewhere that B3 (Niacin) may spike blood glucose...like really high.

Like diabetes high.

Could that be the culprit?

Thanks in advance again.

 

[FunkOdyssey]

My question is, I supplement with Niacin (500Mg/d).

I read somewhere that B3 (Niacin) may spike blood glucose...like really high.

That may be the culprit. You don't want to take niacin anyway:

Excess niacin causes blood vessel inflammation and cardiovascular disease

They are finally realizing that anything promoting blood vessel inflammation, in this case excess niacin metabolites, can lead to cardiovascular disease. It's not the cholesterol. https://consultqd.clevelandclinic.org/link-discovered-between-excess-niacin-and-cardiovascular-disease

www.excelmale.com

 

[t_spacemonkey]

Oh guys, one more thing.

I noticed my blood glucose was high..ish (108).

I am on a Keto diet so my intake of carbs is ~50g/day, or less.

My question is, I supplement with Niacin (500Mg/d).

I read somewhere that B3 (Niacin) may spike blood glucose...like really high.

Like diabetes high.

Could that be the culprit?

Thanks in advance again.

my glucose on keto ran higher. 100 fasted. when i stopped keto (doing carnivore/fruit now) my fasting glucose is around 80. not a keto fan any longer. my a1c did not change however. my fasting insulin with this new approach is 5, so metabolically speaking this is good

 

[Vince]

Magnesium will help increase your free testosterone. Even with higher levels of SHPG. I'll show you a copy of my labs. I do supplement with magnesium.

Vince's Labs for October 2023

I haven't changed my protocol, 16 mg of testosterone cypionate daily, 500 iu of hcg twice weekly and no AI. Pregnenolone 10 mg and 25 mg of DHEA. My last injection before labs, about 28 1/2 hrs. Labs are from LabCorp. Testosterone, Serum 1417 ng/dL range 264-916 Free Testosterone 47.8 ng/dL...

www.excelmale.com

 

[Malang Sob]

That may be the culprit. You don't want to take niacin anyway:

Excess niacin causes blood vessel inflammation and cardiovascular disease

They are finally realizing that anything promoting blood vessel inflammation, in this case excess niacin metabolites, can lead to cardiovascular disease. It's not the cholesterol. https://consultqd.clevelandclinic.org/link-discovered-between-excess-niacin-and-cardiovascular-disease

www.excelmale.com

Jeeze...that's not good.

Well, i guess it's no more of that for me....that sucks dude.

I really liked that Niacin flush...almost addictive...haha!

 

[Malang Sob]

my glucose on keto ran higher. 100 fasted. when i stopped keto (doing carnivore/fruit now) my fasting glucose is around 80. not a keto fan any longer. my a1c did not change however. my fasting insulin with this new approach is 5, so metabolically speaking this is good

I'm gonna have to research the diff.

All these frickin diets man.

I just dont wanna be a buffalo butt.

Can't win fer losin I guess.

Thanks.

 

[Systemlord]

Jeeze...that's not good.

Well, i guess it's no more of that for me....that sucks dude.

I really liked that Niacin flush...almost addictive...haha!

This is a case where being overly proactive can lead to serious health problems. If you're not deficient, and can get plentily through diet, leave it alone.

 

[jtierney001]

Jeeze...that's not good.

Well, i guess it's no more of that for me....that sucks dude.

I really liked that Niacin flush...almost addictive...haha!

I take 3 grams a day and have been using Niacin for 25 years. I enjoy the flush, it relaxes me, creates better hardons--they're gonna have to come up w/ more a couple biomarkers to dissuade me from the benefits I FEEL immediately.

 

[sammmy]

I am surprised that at such a relatively high TRT dose, the RBC, Hemoglobin, and Hematocrit are not higher?

I think 8 weeks on such TRT is enough time for these parameters to rise.

Could it be the lack of carbs?