Confused by new results

[lcvl]

Hi everybody,

Long story short: physically active, very lean, healthy 43yo man who's 7 months into TRT. Started out with plenty of wrong advice by unqualified professionals until I found a not so bad endo who at least is willing to experiment with multiple self administered test injections per week at different dosages to see how my body reacted.

My TRT journey started in march 2015. In june 2015, after 6 weeks of 150mg of Test divided in three weekly shots (M W F) these were my results:

- Total Test: NOT ANALYZED
- Free Test: 18.60 pg/mL (3.64-19.30)
- 17beta Estradiol: 55 pg/mL (<56)
- SHBG: 39.3 nmol/L (13.5-71.4)
- Prolactine: 8.1 ng/mL (3.5-19.4)
- Cortisol: 10.80 (3.70-19.40)
- Hematocrite: 48.30% (40-55)
- Cholesterol: 243 mg/dL (130-220)
- HDL Cholesterol: 82 mg/dL (>35)
- LDL Cholesterol: 145 mg/dL (<150)

At that point, after several weeks of 150mg Test per week I was starting to feel less energy and some high E2 symptoms were slowly appearing (mostly water retention, some acne, etc.)

Decided to gradually lower my dosage over the course of the summer, down to 100mg a week (2 x 50mg injections, on Monday and Thursday).

During the five weeks on the new 50mgx2 protocol I've basically felt fine, not great, but pretty much OK. OK energy, OK libido, still some ED and no spontaneous/night time erections. The overall feeling I got was that 100mg of Test a week was barely enough for me to get by and function properly, with very little margin to play with. Actually the one day I had to delay my injection by 8 hours I paid for it with the two following days of lethargy/fatigue and other very clear low T symptoms.

What's confusing is that the new blood results (Oct 2015) show a completely different scenario.

- Total Test: 14,99 ng/mL (1,66-8,11)
- Free test: NOT ANALYZED
- 17beta Estradiol: 46,0 pg/mL (<56,0)
- SHBG: 40,3 nmol/L (13,5-71,4)
- Prolactine: 10,0 ng/mL (3,5-19,4)
- Cortisol: NOT ANALYZED
- Hematocrite: 46,60 % (40,00-55,00)
- Cholesterol: 228 mg/dL (130-220)
- HDL Cholesterol: 78 mg/dL (>35)
- LDL Cholesterol: 136 mg/dL (<150)

Before seeing these results I was planning on increasing my dosage to 120mg per week (still divided into 2 injections), but looking at the new total T values I'm really confused about what to do.

I'll see the endo later this week and see what she thinks.

Any suggestion/idea is welcome.

 

[ERO]

Your Free T is likely lower on your second set of blood work, which could account for how you feel. Do you know if the E2 test was the regular or the ultra sensitive? Your e2 is likely fine, but anytime you have a doc doesn't understand TRT and doesn't use the ultra sensitive test, it is a red flag that getting a new doc would be a good idea if possible. You see, asking her about these results when she is not a TRT expert is most likely going to give you bad answers and send you off in the wrong direction.

Your SHBG is mid-range so you would do fine injecting every 3.5 days - no specific need to do it more often in your case. Going to 120 a week (split into two 60 mg doses, say Monday Morning and Thursday evening) would be a logical next step. Getting an ultra sensitive E2 test would be good as well, just to baseline if nothing else. Adding in HCG may help you feel better as well.

If you are not bound by insurance, I would call Defy Medical - many of use use them with great results - they truly know what they are doing.

 

[lcvl]

I live in Spain. Ultra sensitive E2 test is not available here.
I just called the labs and it looks like they forgot about Free T on the latest tests. Hopefully they'll be able to retrieve the info using the same blood samples and will let me know. I'll update the results here as well.

 

[Gene Devine]

I concur with ERO and his recommendation on moving to 120 mg weekly injected twice weekly Monday AM and Thursday PM.

Your Estradiol is probably overstated here since this was not the "sensitive" lab; have you noticed any of the classic symptoms of elevated level now?

In all honesty, your labs are pretty good.

Please tell me your taking HCG to make up for the loss of LH!!!

 

[lcvl]

TRT protocols here in Spain (and in most European countries as well, from what I've seen) don't use HCG or AI. Just Test injections. Not ideal, but it could be worse after all. I consider myself quite lucky being able to self administer my medication, choosing injection frequency and administration method (insulin syringe with 31g needles).

Haven't had any high E2 symptoms for the past couple months, while I was gradually lowering my dosage (from 150 to 100mg weekly).

I'll talk to the endo and see what she thinks. An increase to 120mg (60+60) seems hard to justify considering my total T is so high. Hopefully I'll get my Free T results tomorrow.

Thanks for the help!

 

[ERO]

Your Free T # is far more important than your Total T #.

 

[Vettester Chris]

Yep, agree with ERO and Gene. HCG and AI's are there too, just need to seek them out a bit.

 

[lcvl]

The products are available on the market, yes, but they don't get prescribed by uros/endos for TRT use. Unless you're suggesting I try to seek them out illegally (not interested).

In any case, it looks like I'm primary, so why would I use HCG?
No signs of high E2 at the moment, so no need for AI either, right?

 

[lcvl]

Your Free T # is far more important than your Total T #.

I know... Hopefully they'll send that result today via email.

My guess, based on how I feel, is that I need very high Total T values to get a decent Free T reading.

 

[lcvl]

Just got the final results.
Even more puzzled... How's possible that my free T went up after decreasing my weekly dose from 150mg to 100mg?

Not that I'm complaining... I think these numbers look great on paper, it's just that I don't think they match 100% how I feel/what I'm experiencing.
I feel fine, but definitely not great, and still dealing with some ED/absence of spontaneous erections issues.

JUNE 2015
After 6 weeks of 150mg a week (3x50mg shallow IM)

- Total Test: NOT ANALYZED
- Free Test: 18.60 pg/mL (3.64-19.30)
- 17beta Estradiol: 55 pg/mL (<56)
- SHBG: 39.3 nmol/L (13.5-71.4)
- Prolactine: 8.1 ng/mL (3.5-19.4)
- Cortisol: 10.80 (3.70-19.40)
- Hematocrite: 48.30% (40-55)
- Cholesterol: 243 mg/dL (130-220)
- HDL Cholesterol: 82 mg/dL (>35)
- LDL Cholesterol: 145 mg/dL (<150)

OCTOBER 2015
After 6 weeks of 100mg a week (2x50mg shallow IM)

- Total Test: 14,99 ng/mL (1,66-8,11)
- Free test: 19,10 pg/mL (3,64-19,30)
- 17beta Estradiol: 46,0 pg/mL (<56,0)
- SHBG: 40,3 nmol/L (13,5-71,4)
- Prolactine: 10,0 ng/mL (3,5-19,4)
- Cortisol: NOT ANALYZED
- Hematocrite: 46,60 % (40,00-55,00)
- Cholesterol: 228 mg/dL (130-220)
- HDL Cholesterol: 78 mg/dL (>35)
- LDL Cholesterol: 136 mg/dL (<150)

 

[Nelson Vergel]

18.60 is the same as 19.10, really. Those two numbers are pretty much the same considering variability in blood testing, time of day relative to injection, etc.

Yes, it is interesting. Too bad you did not have total T analyzed in June.

 

[lcvl]

18.60 is the same as 19.10, really. Those two numbers are pretty much the same considering variability in blood testing, time of day relative to injection, etc.

Yes, it is interesting. Too bad you did not have total T analyzed in June.

I know, too bad. It might have provided a more clear reading of my whole situation.

So, under this scenario, with very high Tot T and free T values at just 100mg a week but still experiencing some issues (I would rate my energy levels a 7.5/10, libido 7/10, sexual function 6/10) what would you guys do?

I was thinking that maybe I could try lowering my weekly dose a bit more, maybe down to 90mg or even 80mg a week and see what happens.

I've read that some people feel way better on TRT at slightly lower Tot T/Free T values, injecting just 60, 70 or 80mg a week.

Thanks!

 

[lcvl]

My Test readings (different lab) before starting TRT:
February 2015
- Total Test: 6.60 ng/mL (2.4-8.3)
- Free Test: 6.60 pg/mL (6.60-30 for 40-59 y.o. men)
- LH: 3.5 Ul/L (1.5-8)
- FSH: 2.4 Ul/L (1-15)
- Prolactin: 7.7 (2.1-17.7)
- Cortisol: 19.7 (5-25)

After 6 weeks of 150mg a week (3x50mg shallow IM)
JUNE 2015
- Total Test: NOT ANALYZED
- Free Test: 18.60 pg/mL (3.64-19.30)
- 17beta Estradiol: 55 pg/mL (<56)
- SHBG: 39.3 nmol/L (13.5-71.4)
- Prolactine: 8.1 ng/mL (3.5-19.4)
- Cortisol: 10.80 (3.70-19.40)
- Hematocrite: 48.30% (40-55)
- Cholesterol: 243 mg/dL (130-220)
- HDL Cholesterol: 82 mg/dL (>35)
- LDL Cholesterol: 145 mg/dL (<150)

After 6 weeks of 100mg a week (2x50mg shallow IM)
OCTOBER 2015
- Total Test: 14,99 ng/mL (1,66-8,11)
- Free test: 19,10 pg/mL (3,64-19,30)
- 17beta Estradiol: 46,0 pg/mL (<56,0)
- SHBG: 40,3 nmol/L (13,5-71,4)
- Prolactine: 10,0 ng/mL (3,5-19,4)
- Cortisol: NOT ANALYZED
- Hematocrite: 46,60 % (40,00-55,00)
- Cholesterol: 228 mg/dL (130-220)
- HDL Cholesterol: 78 mg/dL (>35)
- LDL Cholesterol: 136 mg/dL (<150)