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).
