Dose adjusted from 100mg/week to 150/week and free t is off the charts, normal total t

[loltestosterone]

Quick background

35 male active male, 6ft 1 ~185 pounds.

Before treatment total T levels were 190, 5 years ago. Started on gel with mixed results. Recently I moved city's and changed doctors, also switched to injections.

We started with 100mg/week 1x a week. This is the first set of labs I've attached which shows a trough read of 225, so dose was upped to 150mg/week. As you will note i am also very low SHBG. I've read low shbg tend to manage better with more frequent injections. Doc had no problem with me splitting the 150/wk dose, so I've been splitting in 3 doses a week, mon/wed/fri.

Since switching to the new doc and starting injections, i have also been on HCG 350iu 3x a week. And an AI of .5 1x week. I have a tad bit of gyno that i've had my entire life, so new doc suggested to add in an the AI.

I will be discussing latest labs in 6 days with the doctor, but wanted to share my most recent lab results. This is where is gets interesting.

Total T is 800s, trough reading (labs were down on a wednesday before Wednesday's pin, so i pretty much pinned right after the lab draw).

Free T, so high the lab checked it twice to make sure it was accurate. Is this cause for concern?

Overall, i feel great, however i will say my resting pulse has risen on the latest protocal which has me a bit concerned. My previous resting pulse always around 60. I noticed i seemed higher, so i bought a fitness band it monitor it recently. When sleeping, it gets down to 55, however, when awake instead of the previous 60, it not hangs out between 80-85. Could the sky high free T be the driver for this? Is my body simply adjusting to the new dose and will this resolve itself eventually?

The off the charts Free T and increase in resting pulse has me raising my eyebrows and wanted to know what everyones thought were. Would maybe lowering the dose back to 100/wk, but splitting into EOD as opposed to 1x a week be a good idea?

Thanks in advance to anyone with any ideas. Again overall i currently feel great, but would like to know if off the chart free test and raise in resting pulse while awake, is cause for concern.

All CBC metrics are great.

 

[madman]

Quick background

35 male active male, 6ft 1 ~185 pounds.

Before treatment total T levels were 190, 5 years ago. Started on gel with mixed results. Recently I moved city's and changed doctors, also switched to injections.

We started with 100mg/week 1x a week. This is the first set of labs I've attached which shows a trough read of 225, so dose was upped to 150mg/week. As you will note i am also very low SHBG. I've read low shbg tend to manage better with more frequent injections. Doc had no problem with me splitting the 150/wk dose, so I've been splitting in 3 doses a week, mon/wed/fri.

Since switching to the new doc and starting injections, i have also been on HCG 350iu 3x a week. And an AI of .5 1x week. I have a tad bit of gyno that i've had my entire life, so new doc suggested to add in an the AI.

I will be discussing latest labs in 6 days with the doctor, but wanted to share my most recent lab results. This is where is gets interesting.

Total T is 800s, trough reading (labs were down on a wednesday before Wednesday's pin, so i pretty much pinned right after the lab draw).

Free T, so high the lab checked it twice to make sure it was accurate. Is this cause for concern?

Overall, i feel great, however i will say my resting pulse has risen on the latest protocal which has me a bit concerned. My previous resting pulse always around 60. I noticed i seemed higher, so i bought a fitness band it monitor it recently. When sleeping, it gets down to 55, however, when awake instead of the previous 60, it not hangs out between 80-85. Could the sky high free T be the driver for this? Is my body simply adjusting to the new dose and will this resolve itself eventually?

The off the charts Free T and increase in resting pulse has me raising my eyebrows and wanted to know what everyones thought were. Would maybe lowering the dose back to 100/wk, but splitting into EOD as opposed to 1x a week be a good idea?

Thanks in advance to anyone with any ideas. Again overall i currently feel great, but would like to know if off the chart free test and raise in resting pulse while awake, is cause for concern.

All CBC metrics are great.

We started with 100mg/week 1x a week. This is the first set of labs I've attached which shows a trough read of 225,

On the first set of labs (100mg/week) protocol, you can clearly see that not only is your trough TT 229 ng/dL (7 days post-injection) absurdly low which would also have your FT very low (mind you was not tested using an accurate assay) but regardless with an absurdly low TT your FT would be dismal and top it off that your estradiol is low.

The downfall of injecting a larger dose of T once weekly is that your peak TT/FT levels 8-12 hrs post-injection/during the first few days will be very high only to be followed by much lower levels come week's end.

The downfall of such is that there will be a big difference in the peak--->trough levels which can result in one experiencing ups/downs throughout the week causing a negative impact on energy/mood/libido/erections/recovery.

SHBG is critical to know as it will have a significant impact on TT/FT level let alone may very well dictate what injection frequency suits you best.

Most men with low/lowish SHBG will do better injecting a lower dose of T more frequently as in daily or EOD.

This is not set in stone as others may do well injecting less frequently (trial/error).

I would prefer starting off on more frequent injections if SHBG is low/lowish.

No need to have tested LH/FSH as the hpta will be shut-down when using exogenous testosterone (excluding Natesto).

so dose was upped to 150mg/week. As you will note i am also very low SHBG. I've read low shbg tend to manage better with more frequent injections. Doc had no problem with me splitting the 150/wk dose, so I've been splitting in 3 doses a week, mon/wed/fri.

Since switching to the new doc and starting injections, i have also been on HCG 350iu 3x a week. And an AI of .5 1x week. I have a tad bit of gyno that i've had my entire life, so new doc suggested to add in an the AI.

I would have to say that although your doctor was okay with you switching over to more frequent injections it would have been more sensible to not up the dose so drastically to 150 mg/week and top it off that you are also adding hCG which will increase your ITT (intra-testicular testosterone) and drive up your TT/FT levels further let alone many may experience a big increase in estradiol!

Regardless of the tad bit gyno (genetically prone) in the past and seeing as you have low SHBG 11.4 nmol/L it would have been better to try and avoid jumping on an AI right away without knowing where your trough e2 level will sit let alone TT/FT on such protocol 150 mg/week (50 mg split M/W/F) but seeing as he jacked up your dose T from 100 mg/week--->150 mg/week he most likely felt the need to dish out the AI as increasing your T dose by a whopping 50 mg would drive up your TT/FT/e2 levels let alone the addition hCG may have on e2.




I will be discussing latest labs in 6 days with the doctor, but wanted to share my most recent lab results. This is where is gets interesting.

Total T is 800s, trough reading (labs were down on a wednesday before Wednesday's pin, so i pretty much pinned right after the lab draw).

Free T, so high the lab checked it twice to make sure it was accurate. Is this cause for concern?

Again not sure why your doctor would test LH/FSH again as your hpta will be shut-down on trt.

You can see where your estradiol sits on such protocol but this is with the use of an AI and not sure when it was taken prior to the Wednesday morning blood draw.

Need to look into getting a full thyroid panel as your TSH is low.

On your most recent set of labs 150 mg/week (50 mg split M/W/F) protocol, you can clearly see that your trough TT 806 ng/dL is on the higher end but more importantly, your FT level is high (mind you was not tested using an accurate assay) and is most likely much higher than labs show let alone what you may think.

Keep in mind that peak TT/FT levels 8-12 hrs post-injection will be higher.

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.

It is critical to know where your FT level sits on such protocol (dose T/injection frequency) and the only way to know where it truly sits is to have it tested using an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

I would not rely on the piss poor direct immunoassay or outdated calculated methods especially in cases of altered SHBG.

I would look into retesting your FT using the most accurate assays (ED or UF).

You can purchase these through Nelsons Discounted labs.

Either would suffice!

1.https://www.discountedlabs.com/hematocrit-total-and-free-testosterone-1500-ng-dl

2. Testosterone, Total, LC/MS and Free (Equilibrium Ultrafiltration)

The off the charts Free T and increase in resting pulse has me raising my eyebrows and wanted to know what everyones thought were. Would maybe lowering the dose back to 100/wk, but splitting into EOD as opposed to 1x a week be a good idea?

Thanks in advance to anyone with any ideas. Again overall i currently feel great, but would like to know if off the chart free test and raise in resting pulse while awake, is cause for concern.

All CBC metrics are great.

Keep in mind that although your trough FT is high due to having low SHBG with a higher-end TT (your SHBG even slightly lower as it went from 11.4 nmol/L (first set of labs)--->9.2 nmol/L (most recent labs).

Regardless if you feel great overall so far and blood markers are healthy then no need to change anything up as of yet.

Mind you would be in your best interest to know where your FT truly sits (tested using an accurate assay) as you may have room to eventually lower your dose slightly if need be let alone possibly drop the AI.

How you truly feel overall is what really matters and if you feel great so far and blood markers are healthy then no need to start changing things.

Just keep in mind that although you feel great as of now we have no idea how long you have been on your current protocol and judging by your most recent labs posted and also stating that you will be discussing them with your doctor in 6 days tells me you just started the new protocol 150 mg/week (50 mg split M/W/F).

Many fail to realize that when starting trt that not only will your hpta shutdown (2-6 weeks) depending on dose T but hormones will be in flux during the weeks leading up until blood levels stabilize (4-6 weeks) and it is common for many during this transition to experience what we call the honeymoon period where there may be a strong increase in libido/erections and overall euphoric feeling due to increasing T levels/dopamine.

Unfortunately, this is temporary and short-lived for most as the body will eventually adjust.

It is also very common for many men to experience ups/downs in energy/mood/libido/erections/recovery during the transition as the body is trying to adjust which can be very misleading.

Even then do understand that once blood levels have stabilized (4-6 weeks) it will take another 2-3 months for the body to fully adapt to those new levels and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-t symptoms.

When looking at the big picture the first 4-6 weeks is very misleading for most!

2-3 months after blood levels have stabilized if you continue to feel great overall and blood markers remain healthy then you can truly claim that your protocol is effective!

Patience is key.


* Keep in mind that all of this would apply to men already on trt when tweaking a protocol (dose T/injection frequency).

 

[loltestosterone]

We started with 100mg/week 1x a week. This is the first set of labs I've attached which shows a trough read of 225,

On the first set of labs (100mg/week) protocol, you can clearly see that not only is your trough TT 229 ng/dL (7 days post-injection) absurdly low which would also have your FT very low (mind you was not tested using an accurate assay) but regardless with an absurdly low TT your FT would be dismal and top it off that your estradiol is low.

The downfall of injecting a larger dose of T once weekly is that your peak TT/FT levels 8-12 hrs post-injection/during the first few days will be very high only to be followed by much lower levels come week's end.

The downfall of such is that there will be a big difference in the peak--->trough levels which can result in one experiencing ups/downs throughout the week causing a negative impact on energy/mood/libido/erections/recovery.

SHBG is critical to know as it will have a significant impact on FT level let alone may very well dictate what injection frequency suits you best.

Most men with low/lowish SHBG will do better injecting a lower dose of T more frequently as in daily or EOD.

This is not set in stone as others may do well injecting less frequently (trial/error).

I would prefer starting off on more frequent injections if SHBG is low/lowish.

No need to have tested LH/FSH as the hpta will be shut-down when using exogenous testosterone (excluding Natesto).

View attachment 13067
View attachment 13070



so dose was upped to 150mg/week. As you will note i am also very low SHBG. I've read low shbg tend to manage better with more frequent injections. Doc had no problem with me splitting the 150/wk dose, so I've been splitting in 3 doses a week, mon/wed/fri.

Since switching to the new doc and starting injections, i have also been on HCG 350iu 3x a week. And an AI of .5 1x week. I have a tad bit of gyno that i've had my entire life, so new doc suggested to add in an the AI.

I would have to say that although your doctor was okay with you switching over to more frequent injections it would have been more sensible to not up the dose so drastically to 150 mg/week and top it off that you are also adding hCG which will increase your ITT (intra-testicular testosterone) and drive up your TT/FT levels further let alone many may experience a big increase in estradiol!

Regardless of the tad bit gyno (genetically prone) in the past and seeing as you have low SHBG 11.4 nmol/L it would have been better to try and avoid jumping on an AI right away without knowing where your trough e2 level will sit let alone TT/FT on such protocol 150 mg/week (50 mg split M/W/F) but seeing as he jacked up your dose T from 100 mg/week--->150 mg/week he most likely felt the need to dish out the AI as increasing your T dose by a whopping 50 mg would drive up your TT/FT/e2 levels let alone the addition hCG may have on e2.




I will be discussing latest labs in 6 days with the doctor, but wanted to share my most recent lab results. This is where is gets interesting.

Total T is 800s, trough reading (labs were down on a wednesday before Wednesday's pin, so i pretty much pinned right after the lab draw).

Free T, so high the lab checked it twice to make sure it was accurate. Is this cause for concern?

Again not sure why your doctor would test LH/FSH again as your hpta will be shut-down on trt.

You can see where your estradiol sits on such protocol but this is with the use of an AI and not sure when it was taken prior to the Wednesday morning blood draw.

Need to look into getting a full thyroid panel as your TSH is low.

On your most recent set of labs 150 mg/week (50 mg split M/W/F) protocol, you can clearly see that your trough TT 806 ng/dL is on the higher end but more importantly, your FT level is high (mind you was not tested using an accurate assay) and is most likely much higher than labs show let alone what you may think.

Keep in mind that peak TT/FT levels 8-12 hrs post-injection will be higher.

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.

It is critical to know where your FT level sits on such protocol (dose T/injection frequency) and the only way to know where it truly sits is to have it tested using an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

I would not rely on the piss poor direct immunoassay or outdated calculated methods especially in cases of altered SHBG.

I would look into retesting your FT using the most accurate assays (ED or UF).

You can purchase these through Nelsons Discounted labs.

Either would suffice!

1.https://www.discountedlabs.com/hematocrit-total-and-free-testosterone-1500-ng-dl

2. Testosterone, Total, LC/MS and Free (Equilibrium Ultrafiltration)

View attachment 13068
View attachment 13069




The off the charts Free T and increase in resting pulse has me raising my eyebrows and wanted to know what everyones thought were. Would maybe lowering the dose back to 100/wk, but splitting into EOD as opposed to 1x a week be a good idea?

Thanks in advance to anyone with any ideas. Again overall i currently feel great, but would like to know if off the chart free test and raise in resting pulse while awake, is cause for concern.

All CBC metrics are great.

Keep in mind that although your trough FT is high due to having low SHBG with a higher-end TT (your SHBG even slightly lower as it went from 11.4 nmol/L (first set of labs)--->9.2 nmol/L (most recent labs).

Regardless if you feel great overall so far and blood markers are healthy then no need to change anything up as of yet.

Mind you would be in your best interest to know where your FT truly sits (tested using an accurate assay) as you may have room to eventually lower your dose slightly if need be let alone possibly drop the AI.

How you truly feel overall is what really matters and if you feel great so far and blood markers are healthy then no need to start changing things.

Just keep in mind that although you feel great as of now we have no idea how long you have been on your current protocol and judging by your most recent labs posted and also stating that you will be discussing them with your doctor in 6 days tells me you just started the new protocol 150 mg/week (50 mg split M/W/F).

Many fail to realize that when starting trt that not only will your hpta shutdown (2-6 weeks) depending on dose T but hormones will be in flux during the weeks leading up until blood levels stabilize (4-6 weeks) and it is common for many during this transition to experience what we call the honeymoon period where there may be a strong increase in libido/erections and overall euphoric feeling due to increasing T levels/dopamine.

Unfortunately, this is temporary and short-lived for most as the body will eventually adjust.

It is also very common for many men to experience ups/downs in energy/mood/libido/erections/recovery during the transition as the body is trying to adjust which can be very misleading.

Even then do understand that once blood levels have stabilized (4-6 weeks) it will take another 2-3 months for the body to fully adapt to those new levels and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-t symptoms.

When looking at the big picture the first 4-6 weeks is very misleading for most!

2-3 months after blood levels have stabilized if you continue to feel great overall and blood markers remain healthy then you can truly claim that your protocol is effective!

Patience is key.


* Keep in mind that all of this would apply to men already on trt when tweaking a protocol (dose T/injection frequency).

Latest labs are after being on current protocol for 8 weeks. I take the ai dose on Thursdays and both labs were down on Wednesday.

I been on the same dose of ai and hcg throughout for ~16 weeks. First set of labs was after 8 weeks on the 100mg a week protocol and 2nd set of labs was 8 weeks after adjustments were made.

When the first labs shows estradiol so low I asked about dropping the ai but doctor suggested keeping for now as we were upping the dose of testosterone.

I will look into getting free t tested with a more accurate assay.

Thank you for your comment

 

[madman]

I take the ai dose on Thursday, labs were drawn on Wednesday.

Latest labs are after being on current protocol for 8 weeks. I take the ai dose on Thursdays and both labs were down on Wednesday.

I been on the same dose of ai and hcg throughout for ~16 weeks. First set of labs was after 8 weeks on the 100mg a week protocol and 2nd set of labs was 8 weeks after adjustments were made.

When the first labs shows estradiol so low I asked about dropping the ai but doctor suggested keeping for now as we were upping the dose of testosterone.

Still should have never been thrown on the AI from the get-go without knowing where your e2 level would truly sit on the 100 mg/week protocol.

Regardless you are only 8 weeks in and as I stated the following 2-3 months after blood levels have stabilized it the critical time period to gauge how one truly feels overall regarding relief/improvement of low-t symptoms.

Although you feel great as of now give it another few months to see where things end up before you can claim success.

Even then I would still have your trough FT tested using an accurate assay to know where it truly sits as you may very well end up tweaking your protocol down the road.

 

[madman]

Where do your RBCs/hemoglobin/hematocrit levels sit as of now.....you did not post labs?

Keep in mind that using exogenous T will increase RBCs/hemoglobin/hematocrit within the 1st month and can take up to 9-12 months to reach peak levels.

Anytime you increase your T dose it will drive up levels further.

 

[Blackhawk]

SHBG=9 ?

Seems like more frequent injections might be a good start in protocol tweaks. Personally, I'd try daily dosing without raising the dosage.

 

[loltestosterone]

Still should have never been thrown on the AI from the get-go without knowing where your e2 level would truly sit on the 100 mg/week protocol.

Regardless you are only 8 weeks in and as I stated the following 2-3 months after blood levels have stabilized it the critical time period to gauge how one truly feels overall regarding relief/improvement of low-t symptoms.

Although you feel great as of now give it another few months to see where things end up before you can claim success.

Even then I would still have your trough FT tested using an accurate assay to know where it truly sits as you may very well end up tweaking your protocol down the road.

While I feel great, most certainly not claiming success just yet. My main concerns were the raise in resting pulse that I mentioned and the FT numbers.

I will get FT tested with a more accurate assay. Besides the urologist who is managing my T, I also have a doctor in my family who is always willing to order me any labs I want, so I will get a full thyroid panel done as suggested as well as free t retested. Appreciate your comments.

 

[loltestosterone]

Where do your RBCs/hemoglobin/hematocrit levels sit as of now.....you did not post labs?

Keep in mind that using exogenous T will increase RBCs/hemoglobin/hematocrit within the 1st month and can take up to 9-12 months to reach peak levels.

Anytime you increase your T dose it will drive up levels further.

The separate cbc attachment is the results on the current protocol. All are normal. Hemoglobin 14 and hematocrit 43

 

[Blackhawk]

Where do your RBCs/hemoglobin/hematocrit levels sit as of now.....you did not post labs?

Keep in mind that using exogenous T will increase RBCs/hemoglobin/hematocrit within the 1st month and can take up to 9-12 months to reach peak levels.

Anytime you increase your T dose it will drive up levels further.

HGB 14.6 HCT 43.2 He's fine there.They are posted as attachments in the first post

 

[madman]

HGB 14.6 HCT 43.2 He's fine there.They are posted as attachments in the first post

Yes, I did see where they sat on the 100 mg once weekly protocol which had his trough TT/FT absurdly low.

I want to know where the 150 mg/week (50 mg split M/W/F) has his levels as of now.

Seeing as they were fine on the first set of labs then doubtful they would be drastically higher but we have no clue where they sit.

 

[loltestosterone]

Yes, I did see where they sat on the 100 mg once weekly protocol which had his trough TT/FT absurdly low.

I want to know where the 150 mg/week (50 mg split M/W/F) has his levels as of now.

Seeing as they were fine on the first set of labs then doubtful they would be drastically higher but we have no clue where they sit.

The CBC I posted is on the current protocol

 

[madman]

The separate cbc attachment is the results on the current protocol. All are normal. Hemoglobin 14 and hematocrit 43

Okay, my mistake as I had thought it was related to the first set due to the way you posted up the pdfs.....CBC--->old labs--->most recent labs.

My apologies!

 

[madman]

HGB 14.6 HCT 43.2 He's fine there.They are posted as attachments in the first post

My mistake!

 

[Cataceous]

Lots of good information above. I'm going to differ on one point: I would revert to a lower dose in the hope that a reduction in AI use is possible. It's quite normal for guys with low SHBG to have lowish total testosterone and normal free testosterone. You're looking for the lowest effective dose. Just because you're not seeing side effects from high free T now doesn't mean they won't sneak up on you in the future.

 

[loltestosterone]

Lots of good information above. I'm going to differ on one point: I would revert to a lower dose in the hope that a reduction in AI use is possible. It's quite normal for guys with low SHBG to have lowish total testosterone and normal free testosterone. You're looking for the lowest effective dose. Just because you're not seeing side effects from high free T now doesn't mean they won't sneak up on you in the future.

I agree with this thinking. When I chat with with doctor on Friday I am going to suggest dropping the ai and dose of .15 every other day, which would bring me to a dose of 105mg/week and see how I manage.

 

[madman]

Latest labs are after being on current protocol for 8 weeks. I take the ai dose on Thursdays and both labs were down on Wednesday.

I been on the same dose of ai and hcg throughout for ~16 weeks. First set of labs was after 8 weeks on the 100mg a week protocol and 2nd set of labs was 8 weeks after adjustments were made.

When the first labs shows estradiol so low I asked about dropping the ai but doctor suggested keeping for now as we were upping the dose of testosterone.

I will look into getting free t tested with a more accurate assay.

Thank you for your comment

Damn, he drove your e2 into the ground on your 1st protocol 100 mg T once weekly!

Mind you it was not tested using the most accurate assay (LC/MS-MS).

140244: Estradiol, Sensitive, LC/MS | Labcorp

Labcorp test details for Estradiol, Sensitive, LC/MS

www.labcorp.com

 

[madman]

I agree with this thinking. When I chat with with doctor on Friday I am going to suggest dropping the ai and dose of .15 every other day, which would bring me to a dose of 105mg/week and see how I manage.

He means mainly dropping your dose of T which I had stated previously:

*Mind you would be in your best interest to know where your FT truly sits (tested using an accurate assay)as you may have room to eventually lower your dose slightly if need be let alone possibly drop the AI.

 

[Cataceous]

Damn, he drove your e2 into the ground on your 1st protocol 100 mg T once weekly!

Mind you it was not tested using the most accurate assay (LC/MS-MS).
...

Actually, he gained valuable information by having undetectable estradiol via the standard test: If he had cross-reactivity from inflammation then the result would not have been undetectable. Therefore it is now better and cheaper for him to continue using the more reliable standard test.

 

[loltestosterone]

He means mainly dropping your dose of T which I had stated previously:

*Mind you would be in your best interest to know where your FT truly sits (tested using an accurate assay)as you may have room to eventually lower your dose slightly if need be let alone possibly drop the AI.

Sorry the way I typed was confusing. I meant drop the ai dose completely and lower test dose to .15 every other day.

 

[madman]

Sorry the way I typed was confusing. I meant drop the ai dose completely and lower test dose to .15 every other day.

All is good.

Again just keep in mind that you are only 8 weeks in and you feel great overall.

I would give it a few months before jumping the gun and switching things up.

If you are dead set on dropping the AI and trying a lower dose of T then I would at least test your trough FT (using accurate assay) to see where it truly sits as going from 150 mg--->105mg/week is still a big drop in T.

Keep in mind some men do better running higher FT levels.....comes down to the individual and if one feels great overall and blood markers are healthy I see no issue.

That is just me though.

Do what is best for you!