Desperate advice needed quickly..too late?

[AJS1]

First of all, I just want to thank all, for all the wealth of information that is shared here, more than anywhere else I have found on the internet. Excel Male, hands down the best! A special thanks to the moderators. Your knowledge on the subject of TRT, is better than any Dr. I have seen on this subject or am currently seeing now. Guess I was naive, probably like alot of people, in believing that Drs. are all knowledgeable and know everything. It just amazes me and saddens me that we put all of our trust, faith, health, and to some extent our lives, in their hands. But after dealing with a few Drs., on the subject of TRT, and cross referencing information (Excel Male/ Dr.), I have learned that nothing could be further from the truth. My only regret is not finding this website before I began my therapy. But since discovering this forum and realizing that there is so much more to this than what I had been told by Drs. I have taken this very serious and put matters into my own hands. I have made folders on every subject, dealing with TRT and copied and pasted all the information I could find on all the sup topics of TRT (ie. blood test, testing methods, SBHG, estradiol, etc.) I have copied and pasted hundreds of articles.

I am 55 years old and have been lifting weights hard my whole life. As I started getting older i was finding I had no energy whatsoever and decided to have some blood work done. My total testosterone levels were within range, but on the low end. I have done a few steroid cycles in my lifetime and was planning on starting another one but unlike the previous cycles I wanted to do this cycle right as far as bloodwork and monitoring. I did a precycle blood test through Lab Corp. My free testosterone level was flagged as low. For some reason it was at that time, that I would go see a TRT Dr. and do this the legal and right way, especially considering my age and some health issues. My initial visit with my TRT Dr. was on 9/14/21. He started me out at 100 mg of cypionate per week (one shot) and was to be retested in one month. I brought him my lab results from Lab Corp and all he did was look at it and said yes you are low and did not do any lab test of his own. My first set of bloods that he ordered was on 11/8/21, which consisted of CBC w/auto diff , assay of estradiol as well as total and bioavailable testosterone. I then visited with him on 11/15/21 to discuss those labs. This is when he upped my dose to 200 mg per week in one shot and wanted to retest again in four weeks. Labs were done again on 12/14/21 and met with him on 12/27 to go over those labs. Again he wanted me to stay on 200 mg for another 8 weeks and then get retested. I retested on 2/28/22(just tested for estradiol,lipid panel and total and bioavailable test,and was fasted) and went over labs on 3/4/22. And even though my numbers were high, he wanted to continue me on 200mg/weekly, for another 2 months. Saying something about,giving things another 2 months to stabilize. I just re-tested on May2nd(5 days after last injection), and for some reason, also wanted to check my D levels(which I found to be odd). I don't know, until tomorro, what tests were ordered.
After reading alot, i realize:
1)the wrong(inaccurate method) test was used for 'free t' was used(it says Free Test/direct).That inaccurate number kind of kicked off me starting TRT 2) all of my estradiol tests weren't ultra sensitive, or even sensitive 3) all of my current 'free test' tests are based on 'bioavailable test'(which I believe is not the best nor accurate 4) my SHBG levels were never tested.
I'm at a loss on how to move forward. I feel that everything up to this point,has been a waste of time. Do I start all over from scratch?, find a new doctor?, or try to work with the one I have and start over with him? Should I ask for a TSH,FreeT3 and T4 tests or is it too late?,as I know they should have been done prior to TRT. Is it too late for SBHG test as well? I visit with him tomorrow, to go over recent labs. How do I approach him and call him out on things I perceive him doing wrong without insulting him? Any advice would be helpful. Thanks for your time.
Testing methods:Estradiol,non sensitive;Total Test,LC-MS/MS(mayo clinic);Bioavailable Test,differential precipitation(mayo clinic)
Total Test:11/8(589)-12/14(454)-2/28(1350ng/dl,fasted)
Bioavailable Test:11/8(135)-12/14(104)-2/28(675ng/dl,fasted)
Estradiol:11/8(16)-12/14(42)-2/28(78pg/ml,fasted)-5/2(60pg/ml)--surprised it dropped
LDL:2/28(126ng/dl, high)---Chol/HDL risk ratio(5.69 ratio,high),and HDL(32mg/dl,low). Doctor wasn't too concerned about low HDL,nor high LDL, and stated the most important number was the Chol/HDL Risk Ratio and said we need to shoot for under 5.00
Hematocrit:11/8(42.7)-1/6/22(45.8)-2/28(49)
My total and bioavailable testosterone taken last week haven't been posted yet,but should find out tomorrow.
Also have high blood pressure and take 3 meds daily.

 

[Systemlord]

I'm at a loss on how to move forward. I feel that everything up to this point,has been a waste of time. Do I start all over from scratch?, find a new doctor?

You could just use Discount Labs and order your own testing using the more accurate assays.

Testosterone, Free, Bioavailable, and Total, LC/MS/MS (No Upper Limit) plus SHBG

This Testosterone Panel Includes 5 Tests: Total Testosterone (LC/MS most accurate assay), Free Testosterone, Bioavailable Testosterone (Free T plus albumin-bound T), Sex Hormone Binding Globulin (SHBG), and Albumin.

www.discountedlabs.com

Should I ask for a TSH,FreeT3 and T4 tests or is it too late?

It's never too late to test thyroid markers. The real question is why would you want to test them?

all of my estradiol tests weren't ultra sensitive

As long as your C-reactive protein markers are not elevated, the standard estradiol test is fine.

Is it too late for SBHG test as well?

SHBG isn't something you have much control over, you can influence it by diet, exercise and protocol decisions as far as injection frequency.

TRT will decrease SHBG in almost everyone, with the exception of a diabetic.

 

[AJS1]

Systemlord, thank you for your response. What are C-Reactive markers? And as far as the thyroid markers i mentioned, from what i read, shouldnt they be done to make sure its not a thyroid problem causing low testosterone. And as far as SHBG, from everything i read, is an important number to know which leads to a better understandind on whats going on and giving you a better idea on how to go about your protocol as well as injection frequency

 

[Systemlord]

What are C-Reactive markers?

C-reactive protein is a biomarker for detecting inflammation. It's the inflammation that throws of the standard estradiol testing.

And as far as the thyroid markers i mentioned, from what i read, shouldnt they be done to make sure its not a thyroid problem causing low testosterone.

This usually isn't the case, but sometimes thyroid problems and low-T can overlap. So if you want to check thyroid, TSH, Free T4 and Free T3 will do.

And as far as SHBG

I don't think your SHBG levels are going to be a problem if you are T: E2 ratios have anything to say about it.

I predict that your SHBG levels are close to 30.

 

[AJS1]

Thanks again SystemLord. Youre input is much appreciated. So from this point forward, should i change anything about what tests i should get, and more importantly, the methods. Madman, is always preaching about the importance of accurate testing methods. My total test is done using an accurate method, but neither the estradiol test and the bioavailable test are not. And how acvurate is the bioavailable test in regards to a true measurement of ,free t,? Thats another reason why i thought an SBHG test was important so i could plug it into that formula to determine actual 'free t'.

 

[Systemlord]

Thats another reason why i thought an SBHG test was important so i could plug it into that formula to determine actual 'free t'.

Correct, you can calculate it using the Tru-T calculator which is how my healthcare provider determines my Free T.

This is the most accurate way to determine your Free T levels other than using the more accurate essays.

 

[AJS1]

Even if those levels were obtained with inaccurate testing methods?

 

[bixt]

Tru-T calculator which is how my healthcare provider determines my Free T.

This is the most accurate way to determine your Free T levels other than using the more accurate essays.

False. Use vermulean instead. Much more accurate from the data I have seen, for the vast majority. I have made a detailed comparison in a previous post where I showed how TruT gives almost anyone a high free T. You must have missed it.

Please Wait

After clicking the link, press the "I am an HCP" to get to the calculator.

 

[madman]

False. Use vermulean instead. Much more accurate from the data I have seen, for the vast majority. I have made a detailed comparison in a previous post where I showed how TruT gives almost anyone a high free T. You must have missed it.

Please Wait

After clicking the link, press the "I am an HCP" to get to the calculator.

Improving Diagnostic Accuracy and Treatment Decisions in Men with Hypogonadism

www.excelmale.com

post #5.....sit back and think more deeply!

29:33-31:33

*cFTV/cFTZ (EAM/TruT)

* most of the linear equations underestimate free testosterone concentrations



You are and always will be clueless when it comes to testosterone's binding to SHBG!

If it were only so simple.....LMFAO!

The new dynamic model leads to the reconsideration of several dogmas related to testosterone's binding to SHBG and has important physiologic and clinical implications.

*First, the fraction of circulating testosterone that is free is substantially greater (2.9±0.4%) than has been generally assumed (% cFTV 1.5±0.4%).

*Second, percent FT is not significantly related to total testosterone over a wide range of total testosterone concentrations. However, the percent FT declines as SHBG concentrations increase, although it does not decline as precipitously as predicted by Vermeulen's model. Due to the allostery between the two binding sites, SHBG is able to regulate FT levels in a much larger dynamic range.


Key points:

EAM (cFTZ) SHBG: T binding

*Intra-dimer complex allostery suggests that SHBG can regulate FT fraction over a wide range of total testosterone concentrations without getting saturated.

*Indeed, it was found that percent FT calculated using the new model changed very modestly over a wide range of total testosterone concentrations.

*Due to the allostery between the two binding sites, SHBG is able to regulate FT levels in a much larger dynamic range.





*Free testosterone concentration is ideally measured using the equilibrium dialysis method, performed under standardized conditions.1,31 Direct tracer analog methods for measuring free testosterone concentrations are inaccurate, and therefore, their use is not recommended.35 Although several equations to estimate free testosterone concentration from total testosterone, SHBG, and albumin concentrations have been published,36-38 the estimation of free testosterone concentration performed using these equations is predicated upon accurate measurements of total testosterone, SHBG, and albumin concentrations.31,35 Furthermore, equations that are based on a linear model of testosterone’s binding to SHBG assume a fixed binding affinity (approximately 1 nM)31 and ignore the competing presence of other sex steroids, such as dihydrotestosterone and estradiol.

*Recent studies using modern biophysical techniques have suggested that the binding of testosterone and estradiol to an SHBG dimer is a dynamic process that involves allosteric interactions between binding sites on each of the 2 SHBG monomers such that the binding affinities of the 2 sites are not equivalent.36,39 The binding of a ligand to the first monomer influences the conformational and energetic states of both the monomers.39 The estimation of free testosterone concentration based on an ensemble allosteric model provides a close approximation of concentrations measured using equilibrium dialysis36;

*the computations of free testosterone concentrations using the ensemble allostery model can be obtained at TruT Free Testosterone Calculator by FPT. Because of dynamic changes in the binding affinity of SHBG upon ligand binding, depending on the ligand and SHBG concentrations, no equation can accurately estimate free testosterone concentration under all conditions.39

 

[madman]

False. Use vermulean instead. Much more accurate from the data I have seen, for the vast majority. I have made a detailed comparison in a previous post where I showed how TruT gives almost anyone a high free T. You must have missed it.

Please Wait

After clicking the link, press the "I am an HCP" to get to the calculator.

Guess this went over your noggin too!

* Limitations of using free testosterone by equilibrium dialysis and calculated free testosterone concentrations in practice are the lack of assay standardization, an accuracy-based quality control program, and a harmonized reference range. Until these limitations are addressed, free testosterone by equilibrium dialysis and calculated free testosterone should use reference ranges established by individual laboratories or their specific assay method


Again for the last time!

My reply to previous threads:

When it comes to blood work whether one is following a strictly sub-q protocol, strictly IM protocol let alone sub-q vs IM protocol they are following the steps needed in order to make a fair comparison.


Critical Points

1. The protocol needs to be kept the same (ester/dose T/injection frequency)

2. 4-6 weeks for blood levels to stabilize before getting blood work done (6 weeks)

3. Testing is done at the true trough

4. Using the same lab

5. Using the same assays (most accurate) TT/e2 (LC-MS/MS) and FT (Equilibrium Dialysis or Ultrafiltration)

6. Each protocol needs to be given 12 weeks (claim success or failure)


Only then can one make the claim whether the protocol was truly a success or failure let alone when comparing blood levels.

 

[madman]

False. Use vermulean instead. Much more accurate from the data I have seen, for the vast majority. I have made a detailed comparison in a previous post where I showed how TruT gives almost anyone a high free T. You must have missed it.

Please Wait

After clicking the link, press the "I am an HCP" to get to the calculator.

Now, who the f**k knew!

Because of dynamic changes in the binding affinity of SHBG upon ligand binding, depending on the ligand and SHBG concentrations, no equation can accurately estimate free testosterone concentration under all conditions

 

[madman]

First of all, I just want to thank all, for all the wealth of information that is shared here, more than anywhere else I have found on the internet. Excel Male, hands down the best! A special thanks to the moderators. Your knowledge on the subject of TRT, is better than any Dr. I have seen on this subject or am currently seeing now. Guess I was naive, probably like alot of people, in believing that Drs. are all knowledgeable and know everything. It just amazes me and saddens me that we put all of our trust, faith, health, and to some extent our lives, in their hands. But after dealing with a few Drs., on the subject of TRT, and cross referencing information (Excel Male/ Dr.), I have learned that nothing could be further from the truth. My only regret is not finding this website before I began my therapy. But since discovering this forum and realizing that there is so much more to this than what I had been told by Drs. I have taken this very serious and put matters into my own hands. I have made folders on every subject, dealing with TRT and copied and pasted all the information I could find on all the sup topics of TRT (ie. blood test, testing methods, SBHG, estradiol, etc.) I have copied and pasted hundreds of articles.

I am 55 years old and have been lifting weights hard my whole life. As I started getting older i was finding I had no energy whatsoever and decided to have some blood work done. My total testosterone levels were within range, but on the low end. I have done a few steroid cycles in my lifetime and was planning on starting another one but unlike the previous cycles I wanted to do this cycle right as far as bloodwork and monitoring. I did a precycle blood test through Lab Corp. My free testosterone level was flagged as low. For some reason it was at that time, that I would go see a TRT Dr. and do this the legal and right way, especially considering my age and some health issues. My initial visit with my TRT Dr. was on 9/14/21. He started me out at 100 mg of cypionate per week (one shot) and was to be retested in one month. I brought him my lab results from Lab Corp and all he did was look at it and said yes you are low and did not do any lab test of his own. My first set of bloods that he ordered was on 11/8/21, which consisted of CBC w/auto diff , assay of estradiol as well as total and bioavailable testosterone. I then visited with him on 11/15/21 to discuss those labs. This is when he upped my dose to 200 mg per week in one shot and wanted to retest again in four weeks. Labs were done again on 12/14/21 and met with him on 12/27 to go over those labs. Again he wanted me to stay on 200 mg for another 8 weeks and then get retested. I retested on 2/28/22(just tested for estradiol,lipid panel and total and bioavailable test,and was fasted) and went over labs on 3/4/22. And even though my numbers were high, he wanted to continue me on 200mg/weekly, for another 2 months. Saying something about,giving things another 2 months to stabilize. I just re-tested on May2nd(5 days after last injection), and for some reason, also wanted to check my D levels(which I found to be odd). I don't know, until tomorro, what tests were ordered.
After reading alot, i realize:
1)the wrong(inaccurate method) test was used for 'free t' was used(it says Free Test/direct).That inaccurate number kind of kicked off me starting TRT 2) all of my estradiol tests weren't ultra sensitive, or even sensitive 3) all of my current 'free test' tests are based on 'bioavailable test'(which I believe is not the best nor accurate 4) my SHBG levels were never tested.
I'm at a loss on how to move forward. I feel that everything up to this point,has been a waste of time. Do I start all over from scratch?, find a new doctor?, or try to work with the one I have and start over with him? Should I ask for a TSH,FreeT3 and T4 tests or is it too late?,as I know they should have been done prior to TRT. Is it too late for SBHG test as well? I visit with him tomorrow, to go over recent labs. How do I approach him and call him out on things I perceive him doing wrong without insulting him? Any advice would be helpful. Thanks for your time.
Testing methods:Estradiol,non sensitive;Total Test,LC-MS/MS(mayo clinic);Bioavailable Test,differential precipitation(mayo clinic)
Total Test:11/8(589)-12/14(454)-2/28(1350ng/dl,fasted)
Bioavailable Test:11/8(135)-12/14(104)-2/28(675ng/dl,fasted)
Estradiol:11/8(16)-12/14(42)-2/28(78pg/ml,fasted)-5/2(60pg/ml)--surprised it dropped
LDL:2/28(126ng/dl, high)---Chol/HDL risk ratio(5.69 ratio,high),and HDL(32mg/dl,low). Doctor wasn't too concerned about low HDL,nor high LDL, and stated the most important number was the Chol/HDL Risk Ratio and said we need to shoot for under 5.00
Hematocrit:11/8(42.7)-1/6/22(45.8)-2/28(49)
My total and bioavailable testosterone taken last week haven't been posted yet,but should find out tomorrow.
Also have high blood pressure and take 3 meds daily.

Welcome to Excel!

This is looking like a messy situation.

Your doctor seems to be clueless when it comes to trt.

Although he started you on a sensible dose of T 100 mg/week he was clueless when it comes to testing as SHBG was not done let alone FT was not tested using an accurate assay.

When was lab work done as we want to test at true trough (lowest point) just before your next injection?

You were hitting a robust TT 598 ng/dL but again your FT was not tested using an accurate assay let alone we have no clue where your SHBG truly sits.

If your blood work was done at true trough and you were hitting a robust TT of almost 600 ng/dL then keep in mind that your peak TT, FT, and estradiol levels would be much higher.

Your doctor stated that your levels (trough/peak?) were too low and did a 360 upping your dose by a whopping 100 mg T/week.

Now has you on that cookie-cutter run-of-the-mill trt protocol of 200 T/week!

Huge mistake bumping up your dose that much.

If anything would have been more sensible to increase 20-40 mg T.

As you can clearly see you are now hitting a very high TT 1350ng/dL which would easily have your FT levels very high even if you have high/highish SHBG.

Again when was blood work done as we want to test at true trough (lowest point) just before your next injection.

Most men on trt are injecting 100-200mg T/week whether once weekly, split twice-weekly, M/W/F, EOD, or daily.

Most would never need what would be considered the higher end dose of 200 mg T/week to achieve a healthy FT level.

Sure there may be some outliers but far and few!

Many can easily achieve a healthy, high let alone absurdly high FT by injecting 100-150 mg T/week, especially when split into more frequent injections.

FT 5-10 ng/dL would be considered low.

FT 16-31ng/dL (top-end) is healthy.

Most men will do well with FT 20-30 ng/dL.

Some may choose/want to run higher levels.

Comes down to the individual.

Unfortunately, many have no clue where their FT level truly sits as again they are using/relying upon inaccurate testing methods.

Most that end up struggling are running FT levels much higher than they think.

Would have been helpful to see your pre-trt labs which should have included TT, FT, estradiol, SHBG, DHT, prolactin, DHEA, LH/FSH, PSA, and full thyroid panel, 4 point cortisol, VITD, lipids, CMP, CBC.

Keep in mind that when it comes to testing it is critical to use the most accurate assays TT/estradiol/DHT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

Although TT is important to know FT is what truly matters as it is the active unbound fraction responsible for the positive effects.

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Equilibrium Ultrafiltration (next best).

Especially in cases of altered SHBG!

Unfortunately, most are using/relying upon the piss poor direct immunoassay which is known to be inaccurate let alone the older outdated calculated methods which tend to underestimate free testosterone, especially in cases of altered SHBG!

You need to get a more thorough set of labs and make sure to have your FT tested using the most accurate assays (ED or UF).

This is critical!

These are the tests/assays everyone should be using/relying upon.

Any one of these would suffice.

Most are using #2/3.


Labcorp

1. 500726: Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences) | Labcorp

Free: equilibrium dialysis; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)


2. 070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp

Free: equilibrium ultrafiltration; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)



Quest Diagnostics

3. Testosterone, Total, LC/MS and Free (Equilibrium Dialysis)

Free: equilibrium dialysis; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)





My reply from a previous thread:

Start low and slow on a T-only protocol.

Stay consistent with your protocol (dose/injection frequency).

Blood work is done once blood levels have stabilized (4-6 weeks TC/TE).

Testing should be done at the true trough as we want to see where said protocol (dose of T/injection frequency) has your TT, FT, estradiol, let alone other important blood markers such as RBCs/hemoglobin/hematocrit, DHT, and prolactin.

Expect to experience ups/downs during the first 6 weeks as hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE).

Almost everyone will experience what we call the honeymoon period where there is an overall euphoric feeling and a strong increase in libido/erections due to the rising T-levels/increased dopamine, lighting up of the AR (androgen receptor) when first starting trt or tweaking a protocol (increasing T dose) and unfortunately this is temporary and short-lived.

Do not get caught up in chasing the honeymoon!

Blood work should be done using the most accurate assays.

Once blood levels have stabilized (4-6 weeks) it will take time for the body to adapt to the new set-point and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-T symptoms.

Every protocol should be given 12 weeks to claim whether it was truly a success or failure.

The dose of T should not be increased at the 6-week mark unless trough FT levels were too low (highly doubtful in most cases).

 

[AJS1]

Thanks for your time Madman, input and all of the links you posted with great information on measuring free T. I have read thru much of it. Some i understand and some of it is difficult and complicated with all the medical terms. Im rather new to all of this and am spending so much time trying to learn everything. This is so very important to me and my well-being.
Im seeing my doctor later on today,and desperate for some answers and how to proceed. I dont want to waste my time and ecspecially put on the wrong protocol due to false/inaccurate testing methods and values(results).
1) Should i continue as is and change nothing and not ask for different testing methods. Methods used now are, as stated earlier, are: Total T(LC-MS/MS), Estradiol(standard, not sensitive), Free T(doctor just measured bioavailable testosterone via the differential precipitation method, whatever that is). I know the total t is the accurate testing method yet the estradiol is not accurate because it wasnt sensitive, and not quite sure on the bioavailable t
2)Is measuring free t via bioavailable t, as they did with me, the same thing as just measuring free t using another method, such as Equilibrium Dialysis, and what is differential precipitation
3) Should i have my SHBG tested so i have that number to plug into a free t caculator, although from what i understand, they may be a little flawed

I just want to do this right, plesse help

 

[AJS1]

Sorry madman. As i was typing my last post i didnt see the last post you posted, which will have some answers to my last post to you. Im going to read your post now. I was hoping you would respond because i respect you and your opinion.

 

[AJS1]

As far as true trough, maybe its not so true. He has me come in, usually a day before my next injection(is this not acceptable?) I understand the need for more thorough testing. My intial visit, he didnt do any labs, just looked at labs i brought in from LabCorp, which were done 4-5 months prior to my first visit with him and consisted of CBC w/diff,FSH/LH,Free and Totsl test, estradiol(sensitive),CMP. He didnt do any bloodwork on his own until a month later, after being on 100mg/weekly for a month. And he only did CBC, total and bioavailable t and estrogen.
I think i have a pretty much clear understanding of the tests i need and the methods of those tests, but what puzzles me is this:::Since these tests werent done right away before i started my therapy, i basically dont have any starting reference points. So if i get all these markers tested now(4-5months after being on trt, at high dosages), how true and accurate are these tests going to be? What i mean is, is all the test i have been injecting going to give mw a true representation of those markers or are they going to be off because of already injecting for the last four mths of so? Of course the free, total and estradiol wont be true but what about the others(thyroid panel, lioid,cbc,cmp,lh,fsh,etc.)? Thats what i meant by, is it too late. Or do i need to just stop my whole trt protocal and wait a few months or so and just start over with the correct tests and methods, which i really dont want to cause i will probably crash pretty hard. But if that is what i have to do then i will. I dont and wont do this half ass and just want to put myself in the best possible situation ti succeed, in being the best i can be and feeling the best, without causing any damage. Hope to hear from you soon. My appoint. is in 4hrs and i desperately need to know how to proceed. Again, i cant thank you enough for your help

 

[Systemlord]

Your lab values aren't going to be drastically different testing a day before your injection versus the day of your injection.

All you have to do from this point forward is use the most accurate essays when testing.

It doesn't matter that you didn't test thyroid markers pre-TRT, if you want to test thyroid markers, then do so.

I saw a decreases in TSH (0.9->0.45) after starting TRT, which indicates thyroid hormone production increased forcing my pituitary to reduce TSH to keep my levels from getting abnormally high.

The only thing that matters is where your thyroid markers are now.

 

[madman]

As far as true trough, maybe its not so true. He has me come in, usually a day before my next injection(is this not acceptable?) I understand the need for more thorough testing. My intial visit, he didnt do any labs, just looked at labs i brought in from LabCorp, which were done 4-5 months prior to my first visit with him and consisted of CBC w/diff,FSH/LH,Free and Totsl test, estradiol(sensitive),CMP. He didnt do any bloodwork on his own until a month later, after being on 100mg/weekly for a month. And he only did CBC, total and bioavailable t and estrogen.
I think i have a pretty much clear understanding of the tests i need and the methods of those tests, but what puzzles me is this:::Since these tests werent done right away before i started my therapy, i basically dont have any starting reference points. So if i get all these markers tested now(4-5months after being on trt, at high dosages), how true and accurate are these tests going to be? What i mean is, is all the test i have been injecting going to give mw a true representation of those markers or are they going to be off because of already injecting for the last four mths of so? Of course the free, total and estradiol wont be true but what about the others(thyroid panel, lioid,cbc,cmp,lh,fsh,etc.)? Thats what i meant by, is it too late. Or do i need to just stop my whole trt protocal and wait a few months or so and just start over with the correct tests and methods, which i really dont want to cause i will probably crash pretty hard. But if that is what i have to do then i will. I dont and wont do this half ass and just want to put myself in the best possible situation ti succeed, in being the best i can be and feeling the best, without causing any damage. Hope to hear from you soon. My appoint. is in 4hrs and i desperately need to know how to proceed. Again, i cant thank you enough for your help

Stick to your current protocol for now especially if you feel good overall and your blood markers are healthy.

If you are struggling with sides/keeping blood markers healthy then you would easily have room to lower your dose and bring down your trough FT which is going to be very high seeing as you are hitting a very high TT 1350 ng/dL 6 days post-injection.

Even if you have high/highish SHBG your trough FT would still be high running a very high trough TT 1350 ng/dL.

Again your peak TT, FT, and estradiol level will be much higher.

You would need to have your FT retested using the most accurate assays (ED or UF) to know where it truly sits.

I would also test your SHBG to see where it currently sits mind you it will most likely be lower than your pre-trt level as high doses of T can drive down SHBG.

SHBG is important to know as it can dictate what injection frequency may suit you best.

Most men on trt will see a reduction in SHBG but it depends on the protocol/individual.

Some men may notice a bigger drop whereas many others not so much.

My SHBG pre-trt was 34 nmol/L and on trt 150 mg T/week split into twice-weekly injections (75 mg every 3.5 days) my SHBG hovers around 30-32 nmol/L and this is 6 years in on trt.

Your true trough would be 7 days post-injection just before your next shot and I would not be too concerned that you tested 1 day early as there will not be a big difference in blood levels if you had tested at the true trough.

The downfall of injecting a high dose of T once weekly is that there will be a big difference in the peak--->trough let alone blood levels will not be as stable throughout the week which can lead to the rollercoaster effect (ups/downs) which can have a negative impact on mood/energy/libido/erectile function for some.

Although some men prefer injecting once weekly I would say it is more common to split up the weekly dose and inject twice-weekly (every 3.5 days) let alone many are following an EOD or daily injection protocol using lower doses of T.

Injecting more frequently will clip the peak--->trough let alone result in more stable blood levels throughout the week.

If anything the main differences between pre-trt/post-trt results aside from an increase in TT, FT, estradiol, and DHT would be LH/FSH (trt results in shutdown of the HPGA), SHBG (may be driven down), HDL (may be driven down), and it is a given that your RBCs, hemoglobin and hematocrit will increase.

Make sure to get a full thyroid panel and salivary cortisol (four-point) as dysfunctional thyroid/adrenals can have a negative impact on the effectiveness of your TRT protocol.

Many struggling with sides let alone feeling shitty overall are running too high a trough FT level.

The more T is better mentality has taken over let alone many are clueless as to where their FT level truly sits due to relying on inaccurate testing methods.

You can put the blame on all of the misinformed brozzz on those dime-a-dozen forums/gootube spewing that mumbo jumbo!

To make matters even worse unfortunately many doctors (GPs/endos/uros/TRT clinics) are also clueless when it comes to testing Free Testosterone!

Moving forward make sure to test using the most accurate assays TT/estradiol/DHT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

Always test at the true trough (lowest point) just before your next injection.

I prefer Labcorps FT (EU) which has a reference range of 5.00-21.00 ng/dL.

070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp

Free: equilibrium ultrafiltration; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)

 

[tareload]

False. Use vermulean instead. Much more accurate from the data I have seen, for the vast majority. I have made a detailed comparison in a previous post where I showed how TruT gives almost anyone a high free T. You must have missed it.

[IMG alt="[URL="http://www.nebido.com"]www.nebido.com[/URL]"]https://www.nebido.com/sites/g/files/vrxlpx38566/files/2022-04/testosterone-effects-onset.jpg[/IMG]

Free testosterone calculator​

.tb_button {padding:1px;cursorointer;border-right: 1px solid #8b8b8b;border-left: 1px solid #FFF;border-bottom: 1px solid #fff;}.tb_button.hover {borer:2px outset #def; background-color: #f8f8f8 !important;}.ws_toolbar {z-index:100000} .ws_toolbar .ws_tb_btn {cursorointer;border:1px solid...

After clicking the link, press the "I am an HCP" to get to the calculator.
Click to expand...

Now, who the f**k knew!

Because of dynamic changes in the binding affinity of SHBG upon ligand binding, depending on the ligand and SHBG concentrations, no equation can accurately estimate free testosterone concentration under all conditions

Improving Diagnostic Accuracy and Treatment Decisions in Men with Hypogonadism

www.excelmale.com

Harmonized reference ranges for Total and Free T levels

Accurate Measurement and Harmonized Reference Ranges for Total and Free Testosterone Levels (2022) Ravi Jasuja, Ph.D., Karol M. Pencina, Ph.D., Liming Peng, MSc, Shalender Bhasin, MB, BS* INTRODUCTION A central tenet of endocrinology is that the hormones secreted by the endocrine glands...

www.excelmale.com

May be of interest if you really want to understand relationships between various fT assays:

Confused by American Standard Unit for Free Test

The number they typically mention in a good Free T level is 30 and above. My Free Test is 529 pmol/L. Is it ng/dL or ng/mL or other variations of ng or pg/mLthat I see and typically referenced? LOL Component Your Value Standard Range Flag Testosterone Free Calculated 529 pmol/L...

forums.t-nation.com

Here down in particular:

Confused by American Standard Unit for Free Test

Ok I went back and pieced this together: As I shared above, Labcorp direct FT test is correlated but not absolute measure of fT. Quest dialysis fT test is. Maybe a picture will help: Note the slope of the line on the left panel of the figure. Note that slope (approx 0.15) is very...

forums.t-nation.com

Obviously this isn't going to change the overall excellent advice @madman has given you.


Adding for completeness as it is an open question I haven't seen answered on Tru-T vs linear cfTV (Vermeulen calculator).

And we won't get the answer until we have a standardized method for accurate fT measurement as @madman has discussed on here.

 

[tareload]

An example from a post today at T-Nation:




cfTV about 11% higher than Quest fT via LC/MS-MS with ED:




Tru-T is 50% higher than Quest measured fT:

I'll continue to use my current heuristic of cfTV minus 10-20% to get within spitting distance of measured fT via LC/MS-MS + ED.

 

[AJS1]

Stick to your current protocol for now especially if you feel good overall and your blood markers are healthy.

If you are struggling with sides/keeping blood markers healthy then you would easily have room to lower your dose and bring down your trough FT which is going to be very high seeing as you are hitting a very high TT 1350 ng/dL 6 days post-injection.

Even if you have high/highish SHBG your trough FT would still be high running a very high trough TT 1350 ng/dL.

Again your peak TT, FT, and estradiol level will be much higher.

You would need to have your FT retested using the most accurate assays (ED or UF) to know where it truly sits.

I would also test your SHBG to see where it currently sits mind you it will most likely be lower than your pre-trt level as high doses of T can drive down SHBG.

SHBG is important to know as it can dictate what injection frequency may suit you best.

Most men on trt will see a reduction in SHBG but it depends on the protocol/individual.

Some men may notice a bigger drop whereas many others not so much.

My SHBG pre-trt was 34 nmol/L and on trt 150 mg T/week split into twice-weekly injections (75 mg every 3.5 days) my SHBG hovers around 30-32 nmol/L and this is 6 years in on trt.

Your true trough would be 7 days post-injection just before your next shot and I would not be too concerned that you tested 1 day early as there will not be a big difference in blood levels if you had tested at the true trough.

The downfall of injecting a high dose of T once weekly is that there will be a big difference in the peak--->trough let alone blood levels will not be as stable throughout the week which can lead to the rollercoaster effect (ups/downs) which can have a negative impact on mood/energy/libido/erectile function for some.

Although some men prefer injecting once weekly I would say it is more common to split up the weekly dose and inject twice-weekly (every 3.5 days) let alone many are following an EOD or daily injection protocol using lower doses of T.

Injecting more frequently will clip the peak--->trough let alone result in more stable blood levels throughout the week.

If anything the main differences between pre-trt/post-trt results aside from an increase in TT, FT, estradiol, and DHT would be LH/FSH (trt results in shutdown of the HPGA), SHBG (may be driven down), HDL (may be driven down), and it is a given that your RBCs, hemoglobin and hematocrit will increase.

Make sure to get a full thyroid panel and salivary cortisol (four-point) as dysfunctional thyroid/adrenals can have a negative impact on the effectiveness of your TRT protocol.

Many struggling with sides let alone feeling shitty overall are running too high a trough FT level.

The more T is better mentality has taken over let alone many are clueless as to where their FT level truly sits due to relying on inaccurate testing methods.

You can put the blame on all of the misinformed brozzz on those dime-a-dozen forums/gootube spewing that mumbo jumbo!

To make matters even worse unfortunately many doctors (GPs/endos/uros/TRT clinics) are also clueless when it comes to testing Free Testosterone!

Moving forward make sure to test using the most accurate assays TT/estradiol/DHT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

Always test at the true trough (lowest point) just before your next injection.

I prefer Labcorps FT (EU) which has a reference range of 5.00-21.00 ng/dL.

070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp

Free: equilibrium ultrafiltration; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)