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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Considering starting TRT. My blood work is attached.
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<blockquote data-quote="madman" data-source="post: 267691" data-attributes="member: 13851"><p><strong><em> I have some Low-T symptoms most notably brain fog, no drive, ED, and no libido.</em></strong> <strong><em>I believe some of this may be due to me not getting quality sleep.</em></strong></p><p><strong><em></em></strong></p><p><strong><em>So recently I've had blood work done 3 times in the past 3 months and my total T has been between 630 and 680 with my free-t being around 13. I'm 46 years old so I believe the Total-T is a decent number.</em></strong></p><p></p><p>Although having healthy free testosterone levels is critical lack of quality sleep, excess stress (physical/mental), and poor diet can easily hammer down libido/have a negative effect on erections, and cause a lack of drive/motivation/fatigue.</p><p></p><p>Dysfunction thyroid/adrenals can easily mimic low-T symptoms.</p><p></p><p>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.</p><p></p><p>On your most recent labs, you are hitting a robust TT 682 ng/dL and although your SHBG is high (not very high), based on the known to be inaccurate direct FT immunoassay your FT level is not low.</p><p></p><p>Something that many lack the understanding of is just because one has high/highish SHBG it is not a given that they have low/bottom-end FT as again it depends on where your TT sits.</p><p></p><p>Unfortunately, you never had your FT tested using an accurate assay.</p><p></p><p>The only way to know where your FT level truly sits is to have it tested using what is considered the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration.</p><p></p><p>This is critical, especially in cases of altered SHBG.</p><p></p><p>Even then we can easily calculate your FT by taking your TT, SHBG, and Albumin.</p><p></p><p>The most commonly used is the linear law-of-mass action cFTV.</p><p></p><p>With a robust TT 682 ng/dL, high SHBG 51.7 nmol/L, and Albumin 4.6 g/dL your FT would be 11 ng/dL which is far from low although it is under where a healthy young male would be at peak which is around 13-14 ng/dL.</p><p></p><p></p><p>[URL unfurl="true"]https://www.issam.ch/freetesto.htm[/URL]</p><p>[ATTACH=full]38235[/ATTACH]</p><p></p><p>Also, keep in mind as of now cFTV tends to overestimate when compared against the gold standard Equilibrium Dialysis so your FT may very well be somewhat lower but it still would not be low/bottom-end.</p><p></p><p>The shit kicker here is if you retested it using the gold standard Equilibrium Dialysis although it may be somewhat lower doubtful it would be really low but it may be in what we call the grey zone for you as in sub-par which can easily cause low-T symptoms for some men.</p><p></p><p>If anything I would at least retest using an accurate assay.</p><p></p><p>Where does your BF% sit?</p><p></p><p>Also, keep in mind that your estradiol is high mind you it was not tested using the most accurate assay (LC/MS-MS).</p><p></p><p>Chances are you if you jump on TRT you will be a high aromatizer.</p><p></p><p>Your LH is just above the top end but not very high.</p><p></p><p>What really stands out is your RBCs, hemoglobin, and hematocrit are at/near the bottom end yet your iron/ferritin is normal.</p><p></p><p>Hypogonadal men often present with markedly lowered hemoglobin and erythrocyte concentrations.</p><p></p><p></p><p></p><p></p><p></p><p></p><p>If you mean 80 mg twice weekly (160 mg T/week) run and find a new doctor as 160 mg T/week is too high a dose to start someone on.</p><p></p><p>We always say start low and go slow on a T-only protocol!</p><p></p><p>The common starting dose is 100 mg T/week or 50 mg T twice weekly (every 3.5 days).</p><p></p><p>Most men on TRT are injecting 100-200 mg T/week whether once weekly or split into more frequent injections such as twice-weekly (every 3.5 days), M/W/F, EOD, or daily.</p><p></p><p>Even then most men would never need the high-end dose of 200 mg T/week to achieve a healthy FT level.</p><p></p><p>Are there outliers sure but they are far and few.</p><p></p><p>Most and let me repeat that MOST men can easily achieve a high let alone very high trough FT levels of 100-150 mg T/week especially when split into more frequent injections.</p><p></p><p>You need to think this one through before you jump in head first.</p></blockquote><p></p>
[QUOTE="madman, post: 267691, member: 13851"] [B][I] I have some Low-T symptoms most notably brain fog, no drive, ED, and no libido.[/I][/B] [B][I]I believe some of this may be due to me not getting quality sleep. So recently I've had blood work done 3 times in the past 3 months and my total T has been between 630 and 680 with my free-t being around 13. I'm 46 years old so I believe the Total-T is a decent number.[/I][/B] Although having healthy free testosterone levels is critical lack of quality sleep, excess stress (physical/mental), and poor diet can easily hammer down libido/have a negative effect on erections, and cause a lack of drive/motivation/fatigue. Dysfunction thyroid/adrenals can easily mimic low-T symptoms. 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. On your most recent labs, you are hitting a robust TT 682 ng/dL and although your SHBG is high (not very high), based on the known to be inaccurate direct FT immunoassay your FT level is not low. Something that many lack the understanding of is just because one has high/highish SHBG it is not a given that they have low/bottom-end FT as again it depends on where your TT sits. Unfortunately, you never had your FT tested using an accurate assay. The only way to know where your FT level truly sits is to have it tested using what is considered the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration. This is critical, especially in cases of altered SHBG. Even then we can easily calculate your FT by taking your TT, SHBG, and Albumin. The most commonly used is the linear law-of-mass action cFTV. With a robust TT 682 ng/dL, high SHBG 51.7 nmol/L, and Albumin 4.6 g/dL your FT would be 11 ng/dL which is far from low although it is under where a healthy young male would be at peak which is around 13-14 ng/dL. [URL unfurl="true"]https://www.issam.ch/freetesto.htm[/URL] [ATTACH type="full" alt="1697583523454.png"]38235[/ATTACH] Also, keep in mind as of now cFTV tends to overestimate when compared against the gold standard Equilibrium Dialysis so your FT may very well be somewhat lower but it still would not be low/bottom-end. The shit kicker here is if you retested it using the gold standard Equilibrium Dialysis although it may be somewhat lower doubtful it would be really low but it may be in what we call the grey zone for you as in sub-par which can easily cause low-T symptoms for some men. If anything I would at least retest using an accurate assay. Where does your BF% sit? Also, keep in mind that your estradiol is high mind you it was not tested using the most accurate assay (LC/MS-MS). Chances are you if you jump on TRT you will be a high aromatizer. Your LH is just above the top end but not very high. What really stands out is your RBCs, hemoglobin, and hematocrit are at/near the bottom end yet your iron/ferritin is normal. Hypogonadal men often present with markedly lowered hemoglobin and erythrocyte concentrations. If you mean 80 mg twice weekly (160 mg T/week) run and find a new doctor as 160 mg T/week is too high a dose to start someone on. We always say start low and go slow on a T-only protocol! The common starting dose is 100 mg T/week or 50 mg T twice weekly (every 3.5 days). Most men on TRT are injecting 100-200 mg T/week whether once weekly or split into more frequent injections such as twice-weekly (every 3.5 days), M/W/F, EOD, or daily. Even then most men would never need the high-end dose of 200 mg T/week to achieve a healthy FT level. Are there outliers sure but they are far and few. Most and let me repeat that MOST men can easily achieve a high let alone very high trough FT levels of 100-150 mg T/week especially when split into more frequent injections. You need to think this one through before you jump in head first. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Considering starting TRT. My blood work is attached.
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