ED, No Libido, Seeing A Urologist Now

[Stpfan]

Just a quick rundown of what i'm going through. I'm 43 years old. Diagnosed with low testosterone in April of 2019 (age 41). Took about a year trying to dial in the right amount of Testosterone weekly. I've had an Endocrinologist take me completely off of Testosterone (which was the dumbest thing he could do.) And I've had several different dosages. 100mg of Test Cyp to around 190 mg of test cyp weekly.

During this time I have severe ED. I'm not even aroused by a mental image or a touch. It's the weirdest feeling I'm going through in my life. I've been married for 20+ years and my wife is beautiful... skinny, implants... a complete doll. A blessing in my life honestly. Unfortunately, with my medical condition... whatever it may be... I have lost sexual desire and naturally she believes she's causing it. Which clearly she's not. I'm financially secure... no house payments. No CC debt. No problems. Just trying to enjoy life... in which the last 2 years have been absolutely hell on earth. I have natural confidence typically in everything in life... just born that way... but the last 2 years... something is mechanically wrong with my brain.... and/or sexual function. Don't know exactly what's causing this... but I've been through so many medical tests. My PCP believes I'm depressed and prescribed me Lexapro 5mg about 3 months ago and I refuse to be on any form of anti-depressants because I don't feel like I'm depressed. My PCP keeps telling me to take the drug and I keep saying No!

My Endocrinologist has me on Test Cyp at 130mg a week roughly. I take 65mg every 4 days. So in all essence I guess it's 130mg every 8 days. I probably feel my best on it... if there is such thing as a best? I don't take an AI at all. Estradiol stays roughly around 35-40 at the low point.

I have noticed the last 2 years or so I tend to be more openly emotional. I cry when watching a touching part in a movie. If there's a song on the radio that makes me think of my younger days... I can cry all of a sudden. I never had this problem before. I just figured that the high and low Estradiol is causing this? I still don't feel like I'm depressed because I really don't worry or fear anything. I workout 3-4 times a week. 1 hour 30 minutes to 2 hours. Cardio included... I try to stay as healthy as possible.

One odd thing I've noticed with being on Testosterone is that my blood pressure was around 140+/82 when I wasn't on TRT. Who knows how long I was testosterone deficient? I wouldn't know? Maybe 2 years without being treated? But in 2020 my blood pressure stayed at 118-122/72 for about 6 months at each checkup and I was satisfied. Then, it lowered to 116.... 114.... 112.... 108.... 106... and it's now at 102/62 my last checkup January 2021. My Endocrinologist told me it's perfect at 102/62. My PCP said she's satisfied with it... she just doesn't want it lower than 100. And a new Urologist I just started seeing said... he's also happy with it being 102/62 as long as I never have any dizzy spells. I asked my Endocrinologist is being on TRT causing my blood pressure to drop? He said.... no... it could be another medical issue causing this... but he said 102 is fine.

So I just started seeing this Urologist... hoping that he could steer me in the right direction. He's very well known and nothing but excellent reviews online. During my first session I explained to him all of my issues. ED, no libido... and lack of penile sensation. He wanted me to do a "low point" testosterone reading. A "high point" testosterone reading. A free testosterone evaluation right after injection. He told me to wait 8 hours after injection and then run to the lab and get it done. I don't know exactly why he told me to do that? I thought after you inject test cyp it takes at least 36 hours-48 hours to reach your high point? Right??

So... here are my labs... can anyone explain to me why he told me to check my "high point" 8 hours after injecting???

Low Point Testosterone (Right Before Injection) 7:25 AM
Total Testosterone 798 ng/dL (Standard Range 175-781 ng/dL)

Low Point Estradiol (Right Before Injection) 7:25 AM
Estradiol 48 pg/mL (Standard Range <53 pg/mL)

(High Point Tests - After 2 Hours of working out around Noon) If it makes a difference?

High Point Testosterone (Approx. 8 Hours After Injection) 4:05 PM
Total Testosterone 803 ng/dL (Standard Range 175-781 ng/dL)

High Point Estradiol (Approx. 8 Hours After Injection) 4:05 PM
Estradiol 45 pg/mL (Standard Range <53 pg/mL)


Free Testosterone Evaluation (Approx. 8 Hours After Injecting 65mg Test Cyp) 4:05 PM
SHBG 14.7 nmol/L (Standard Range 13.3 - 89.5 nmol/L)
Free Androgen Index 189.6% (Standard Range 24.3% - 110.2%)
Calculation Free Testosterone 25.7 ng/dL (Standard Range 3.2 - 19.0 ng/dL)
Calculation Bioavailable Testosterone 603.1 ng/dL (Standard Range 80.7 - 446.7 ng/dL)

Testosterone Evaluation Comments - Free and Bioavailable Testosterone Calculated using Vermeulen formula and assumes an Albumin of 4.3 g/dL.

One thing that works for the ED is 100mg of Viagra (generic form). One pill lasts in my system for about 48 hours. The problem is I have no sensitivity. I'm not really aroused. Nothing goes to my brain saying... WOW! I'm having so much fun!! It's more like.... you're a machine and you are just performing the act with no feeling involved. Yeah... you get to see the girl get off... but honestly... it's really hard for me to reach orgasm. I could last probably an hour without reaching orgasm if I wanted to. Something is seriously wrong.

I'd even consider taking oral steroids to fix my mind.... whatever is causing this craziness in my brain. Nothing seems to excite me anymore.

Thanks for reading... any comments or ideas to fix this... I'd greatly appreciate it.

 

[Stpfan]

I just wanted to add... I see my Urologist Feb 4th for my follow up session. If there is a specific lab I should request.... let me know and I'll ask the Urologist to write the order.

 

[Frankie1234]

I get the same symptoms on T only without HCG. I'd trial that if you haven't, starting with 250iu EOD. Have you tried injecting more frequently? Like a MWF or EOD schedule?

Currently a really incomplete picture with your labs. Some things I would check:

-4 point salivary cortisol
-DHEAS
-pregnenolone
-progesterone
-TSH, FT3, FT4, RT3

 

[Systemlord]

I have noticed the last 2 years or so I tend to be more openly emotional. I cry when watching a touching part in a movie.

The problem is more than likely high estradiol and higher levels can dampen libido and erections in some men.

You mention your low point for estradiol is 35-40, at peak I would expect your estradiol to be much higher and it's not difficult to understand why you're having issues.

You should inject smaller dosages more often and it wouldn't hurt to decrease your dosage a little.

 

[Systemlord]

So... here are my labs... can anyone explain to me why he told me to check my "high point" 8 hours after injecting???

It's clear your doctor is the problem, levels peak closer to 48 hours, so drawing labs as hormones are climbing is rather pointless. You need a new doctor ASAP!

The chances of finding a doctor who is well versed in TRT is unlikely, but not impossible and it's one of the reasons some of us are forced to pay out of pocket for treatment.

 

[Cataceous]

... all of my issues. ED, no libido... and lack of penile sensation. ...

I've had these symptoms and others. Start by trying the easier things: hCG, boosting DHT, estradiol management, supplements, etc. But if you fail to get long-term relief then know that what's working for me is a multi-pronged approach that tries to restore all the relevant hormones to physiological levels.

As long as you're doing lab work then throw in progesterone. It's worth knowing if this is suppressed. In isolation, raising it from low levels isn't a panacea. But it's a start at chipping away at the problems. Progesterone opposes estradiol, so it could help a little with that emotionalism you're experiencing. It's also good for sleep and mood.

 

[madman]

It's clear your doctor is the problem, levels peak closer to 48 hours, so drawing labs as hormones are climbing is rather pointless. You need a new doctor ASAP!

The chances of finding a doctor who is well versed in TRT is unlikely, but not impossible and it's one of the reasons some of us are forced to pay out of pocket for treatment.

When using exogenous esterified T there will be an initial burst release and T levels start rising within the first few hours and true peak when using the most commonly prescribed esters will be 8-12 hrs post-injection/elevated during the first few days.

 

[Systemlord]

When using exogenous esterified T there will be an initial burst release and T levels start rising within the first few hours and true peak when using the most commonly prescribed esters will be 8-12 hrs post-injection/elevated during the first few days.

This would explain why I feel so damn good several hours after my injections and sometime after this period of time (evening) there is a ramping down feeling that follows into the next day throughout the day and a repeat of this experience the day of my next injection.

 

[DorianGray]

"...Just trying to enjoy life... in which the last 2 years have been absolutely hell on earth..."

Something telling here; not just "difficult" or "tough" but "hell". The mind's effect on the body are amplified.

The physiological effects of stress are enormous and subliminal, greatly underestimated by society and medical community. And with the multi-path feed back loops present in the male sexual response, ED is manifest. Likely balance of estradiol, dht and free T is not in optimal harmony for your body also as others pointed out. That's what did it for me, the subtle balance. You can't even feel it. It's just like after a few months, libido crept back up very well. Keep the mind clear, don't dwell, exercise.

 

[Stpfan]

I appreciate all the posts fellas! Great info. I plan on saying a lot more... just pressed for time today. But really quick....

For Pregnenolone and DHEA can you just pick it up at amazon? Or are you prescribed this by a PCP? Or is any manufacturer better than another? Also, what mg? 50? 100? I have looked into this before but never messed around with it because I didn't want to screw any lab reports up. I probably feel my best at 65mg of test cyp every 4 days. I have just enough strength at the gym for mild gains and decent energy. I would probably like to dial everything else in while leaving the test cyp dosage right where it is.

And for people who are curious... yes I donate blood every 58 days. Hard to believe but I'm going for my 8th straight donation without skipping any additional days. I spoke to my Hematologist and asked him if this was safe? He said... he doesn't see anything wrong with it. So... I donate 6 times a year. Yes, I feel like sh#$ for about 7-8 days (after each donation...) but... if you want to live... what else can you do?

 

[madman]

Just a quick rundown of what i'm going through. I'm 43 years old. Diagnosed with low testosterone in April of 2019 (age 41). Took about a year trying to dial in the right amount of Testosterone weekly. I've had an Endocrinologist take me completely off of Testosterone (which was the dumbest thing he could do.) And I've had several different dosages. 100mg of Test Cyp to around 190 mg of test cyp weekly.

During this time I have severe ED. I'm not even aroused by a mental image or a touch. It's the weirdest feeling I'm going through in my life. I've been married for 20+ years and my wife is beautiful... skinny, implants... a complete doll. A blessing in my life honestly. Unfortunately, with my medical condition... whatever it may be... I have lost sexual desire and naturally she believes she's causing it. Which clearly she's not. I'm financially secure... no house payments. No CC debt. No problems. Just trying to enjoy life... in which the last 2 years have been absolutely hell on earth. I have natural confidence typically in everything in life... just born that way... but the last 2 years... something is mechanically wrong with my brain.... and/or sexual function. Don't know exactly what's causing this... but I've been through so many medical tests. My PCP believes I'm depressed and prescribed me Lexapro 5mg about 3 months ago and I refuse to be on any form of anti-depressants because I don't feel like I'm depressed. My PCP keeps telling me to take the drug and I keep saying No!

My Endocrinologist has me on Test Cyp at 130mg a week roughly. I take 65mg every 4 days. So in all essence I guess it's 130mg every 8 days. I probably feel my best on it... if there is such thing as a best? I don't take an AI at all. Estradiol stays roughly around 35-40 at the low point.

I have noticed the last 2 years or so I tend to be more openly emotional. I cry when watching a touching part in a movie. If there's a song on the radio that makes me think of my younger days... I can cry all of a sudden. I never had this problem before. I just figured that the high and low Estradiol is causing this? I still don't feel like I'm depressed because I really don't worry or fear anything. I workout 3-4 times a week. 1 hour 30 minutes to 2 hours. Cardio included... I try to stay as healthy as possible.

One odd thing I've noticed with being on Testosterone is that my blood pressure was around 140+/82 when I wasn't on TRT. Who knows how long I was testosterone deficient? I wouldn't know? Maybe 2 years without being treated? But in 2020 my blood pressure stayed at 118-122/72 for about 6 months at each checkup and I was satisfied. Then, it lowered to 116.... 114.... 112.... 108.... 106... and it's now at 102/62 my last checkup January 2021. My Endocrinologist told me it's perfect at 102/62. My PCP said she's satisfied with it... she just doesn't want it lower than 100. And a new Urologist I just started seeing said... he's also happy with it being 102/62 as long as I never have any dizzy spells. I asked my Endocrinologist is being on TRT causing my blood pressure to drop? He said.... no... it could be another medical issue causing this... but he said 102 is fine.

So I just started seeing this Urologist... hoping that he could steer me in the right direction. He's very well known and nothing but excellent reviews online. During my first session I explained to him all of my issues. ED, no libido... and lack of penile sensation. He wanted me to do a "low point" testosterone reading. A "high point" testosterone reading. A free testosterone evaluation right after injection. He told me to wait 8 hours after injection and then run to the lab and get it done. I don't know exactly why he told me to do that? I thought after you inject test cyp it takes at least 36 hours-48 hours to reach your high point? Right??

So... here are my labs... can anyone explain to me why he told me to check my "high point" 8 hours after injecting???

Low Point Testosterone (Right Before Injection) 7:25 AM
Total Testosterone 798 ng/dL (Standard Range 175-781 ng/dL)

Low Point Estradiol (Right Before Injection) 7:25 AM
Estradiol 48 pg/mL (Standard Range <53 pg/mL)

(High Point Tests - After 2 Hours of working out around Noon) If it makes a difference?

High Point Testosterone (Approx. 8 Hours After Injection) 4:05 PM
Total Testosterone 803 ng/dL (Standard Range 175-781 ng/dL)

High Point Estradiol (Approx. 8 Hours After Injection) 4:05 PM
Estradiol 45 pg/mL (Standard Range <53 pg/mL)


Free Testosterone Evaluation (Approx. 8 Hours After Injecting 65mg Test Cyp) 4:05 PM
SHBG 14.7 nmol/L (Standard Range 13.3 - 89.5 nmol/L)
Free Androgen Index 189.6% (Standard Range 24.3% - 110.2%)
Calculation Free Testosterone 25.7 ng/dL (Standard Range 3.2 - 19.0 ng/dL)
Calculation Bioavailable Testosterone 603.1 ng/dL (Standard Range 80.7 - 446.7 ng/dL)

Testosterone Evaluation Comments - Free and Bioavailable Testosterone Calculated using Vermeulen formula and assumes an Albumin of 4.3 g/dL.

One thing that works for the ED is 100mg of Viagra (generic form). One pill lasts in my system for about 48 hours. The problem is I have no sensitivity. I'm not really aroused. Nothing goes to my brain saying... WOW! I'm having so much fun!! It's more like.... you're a machine and you are just performing the act with no feeling involved. Yeah... you get to see the girl get off... but honestly... it's really hard for me to reach orgasm. I could last probably an hour without reaching orgasm if I wanted to. Something is seriously wrong.

I'd even consider taking oral steroids to fix my mind.... whatever is causing this craziness in my brain. Nothing seems to excite me anymore.

Thanks for reading... any comments or ideas to fix this... I'd greatly appreciate it.

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.

As I stated earlier when using exogenous esterified T there will be an initial burst release and T levels start rising within the first few hours and true peak when using the most commonly prescribed esters (TC/TE) will be 8-12 hrs post-injection/elevated during the first few days.

When on trt we test at the true trough and as we want to see where your levels sit (lowest point) to make sure TT/FT levels are not too low or high which could lead to lack of relief low-t symptoms/side-effects.

Blood work is important and using accurate assays is critical.

As you can see your trough TT sits in the 800s and your FT is high which would mean that your peak TT/FT levels will be much higher!

Unfortunately you a relying on the calculated FT let alone we have no idea if your TT was tested using LC/MS-MS.

The only way to know where your FT level truly sits on such protocol (dose T/injection frequency) is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration.

Let alone TT would need to be tested using (LC/MS-MS) even when using calculated methods.

Regardless you can be rest assured that with a TT 800s and seeing as you have low SHBG 14 nmol/L that your FT will be high.

If anything you should have labs done again and make sure to use the most accurate assays as you may be surprised that your FT level may very well be much higher than you think.


When testing your FT either one will suffice!

1. Testosterone, Total and Free (NO Upper Limit) plus Hematocrit

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





I would also test your free estradiol (LC/MS-MS).

free estradiol test

This test measures the free (unbound to SHBG or albumin) estradiol in blood. The test is performed using liquid chromatography/mass spectrometry (LC/MS).

www.discountedlabs.com

From your post #10.

And for people who are curious... yes I donate blood every 58 days. Hard to believe but I'm going for my 8th straight donation without skipping any additional days. I spoke to my Hematologist and asked him if this was safe? He said... he doesn't see anything wrong with it. So... I donate 6 times a year. Yes, I feel like sh#$ for about 7-8 days (after each donation...) but... if you want to live... what else can you do?

Not sure where your RBCs/hemoglobin/hematocrit sit on your current protocol (65 mg T E4D) but it is most likely high due to your high FT.

Again even though your TT 800 may not seem absurdly high seeing as you have low SHBG 14 nmol/L you can rest assured that your FT is high.

I would take a step back and think deeply on this as donating frequently is a surefire way to crash your ferritin.

Many get caught up in that constantly donating merry go round to control hematocrit only to end up crashing ferritin/iron which can lead to many other issues.

I would look into injecting more frequently as in daily or EOD using a lower dose of T.

 

[madman]

I appreciate all the posts fellas! Great info. I plan on saying a lot more... just pressed for time today. But really quick....

For Pregnenolone and DHEA can you just pick it up at amazon? Or are you prescribed this by a PCP? Or is any manufacturer better than another? Also, what mg? 50? 100? I have looked into this before but never messed around with it because I didn't want to screw any lab reports up. I probably feel my best at 65mg of test cyp every 4 days. I have just enough strength at the gym for mild gains and decent energy. I would probably like to dial everything else in while leaving the test cyp dosage right where it is.

And for people who are curious... yes I donate blood every 58 days. Hard to believe but I'm going for my 8th straight donation without skipping any additional days. I spoke to my Hematologist and asked him if this was safe? He said... he doesn't see anything wrong with it. So... I donate 6 times a year. Yes, I feel like sh#$ for about 7-8 days (after each donation...) but... if you want to live... what else can you do?

You need to get this done.

Ferritin Test

Get insights into ferritin testing and its significance in assessing iron levels. By buying a ferritin test you can learn how ferritin can guide your health journey on Discounted Labs.

www.discountedlabs.com

 

[Systemlord]

So... I donate 6 times a year. Yes, I feel like sh#$ for about 7-8 days (after each donation...)

I'll eco what Madman stated, all I can think is what's happening to your ferritin levels after each blood donation. I wonder if why you feel run down is because it's taking 7-8 days for ferritin to recover.

If the frequent blood donation is a must, you might talk with your doctor about a short term iron supplement after each blood donation if ferritin levels are indeed being crushed by frequent blood donation.

 

[Stpfan]

You need to get this done.

Ferritin Test

Get insights into ferritin testing and its significance in assessing iron levels. By buying a ferritin test you can learn how ferritin can guide your health journey on Discounted Labs.

www.discountedlabs.com

I'll eco what Madman stated, all I can think is what's happening to your ferritin levels after each blood donation. I wonder if why you feel run down is because it's taking 7-8 days for ferritin to recover.

If the frequent blood donation is a must, you might talk with your doctor about a short term iron supplement after each blood donation if ferritin levels are indeed being crushed by frequent blood donation.

I was reviewing lab work right after donating blood at the Red Cross.

I donated blood on May 4, 2020.

I had lab work done on May 5, 2020 (Ferritin, And Iron Transferrin TIBC)

Ferritin 53 ng/mL (Standard Range 14 - 338 ng/mL)

Iron 63 mcg/dL (Standard Range 65 - 175 mcg/dL)

Transferrin 254 mg/dL (Standard Range 163 - 382 mg/dL)

TIBC 356 ug/dL (Standard Range 250 - 425 ug/dL)

Iron Saturated Percentage 18% (Standard Range 13% - 48%)

Based on these numbers... my Hematologist says my body recovers well from donated blood. And there's nothing to be alarmed about. I asked him about an Iron supplement and he said absolutely not. It would do more harm than good.

Furthermore, After donating blood on one day.... then fasting the next day getting 6-7 vials drawn for testing.... um... don't ever do that. Right after doing my lab work. I fainted at the lab in the hospital. Last thing I remember... I asked the lab tech... I normally don't ask for anything... but could someone please get me some orange juice or apple juice? She said yes... I will get that for you. Seconds later... from what people told me... I got up... from a seated position... crashed on the floor. Twisted my ankle... and a Rapid Response Code was issued. I was blacked out for approximately 9 minutes. That was the first time I ever fainted in my life. I was extremely pale in my face. There was a nurse on staff that kept on saying oh sh#$ oh sh#$ when I woke up... and the lab tech lady was in tears when I woke up. I could only imagine what it looked like to her. I won't ever do that again.

The moral of the story.... Don't donate blood and then the next day fast for 8 hours and get lab work drawn up. Yes, I had lab work done on a Monday... ate like crazy that day... and donated on Tuesday... I didn't have any issues. Yeah it sucks in life.... I didn't think donating on a Monday... and then fasting for 8 hours and getting labs drawn on Tuesday would screw you up? But yeah... that was a nightmare.

 

[Stpfan]

I even found more lab work....

This is what my Iron looks like a day before a blood donation.

March 3, 2020

Ferritin N/A Was Not Tested (Standard Range 14 - 338 ng/mL)

Iron 133 mcg/dL (Standard Range 65 - 175 mcg/dL)

Transferrin 250 mg/dL (Standard Range 163 - 382 mg/dL)

TIBC 350 ug/dL (Standard Range 250 - 425 ug/dL)

Iron Saturated Percentage 38% (Standard Range 13% - 48%)

 

[madman]

I was reviewing lab work right after donating blood at the Red Cross.

I donated blood on May 4, 2020.

I had lab work done on May 5, 2020 (Ferritin, And Iron Transferrin TIBC)

Ferritin 53 ng/mL (Standard Range 14 - 338 ng/mL)

Iron 63 mcg/dL (Standard Range 65 - 175 mcg/dL)

Transferrin 254 mg/dL (Standard Range 163 - 382 mg/dL)

TIBC 356 ug/dL (Standard Range 250 - 425 ug/dL)

Iron Saturated Percentage 18% (Standard Range 13% - 48%)

Based on these numbers... my Hematologist says my body recovers well from donated blood. And there's nothing to be alarmed about. I asked him about an Iron supplement and he said absolutely not. It would do more harm than good.

Furthermore, After donating blood on one day.... then fasting the next day getting 6-7 vials drawn for testing.... um... don't ever do that. Right after doing my lab work. I fainted at the lab in the hospital. Last thing I remember... I asked the lab tech... I normally don't ask for anything... but could someone please get me some orange juice or apple juice? She said yes... I will get that for you. Seconds later... from what people told me... I got up... from a seated position... crashed on the floor. Twisted my ankle... and a Rapid Response Code was issued. I was blacked out for approximately 9 minutes. That was the first time I ever fainted in my life. I was extremely pale in my face. There was a nurse on staff that kept on saying oh sh#$ oh sh#$ when I woke up... and the lab tech lady was in tears when I woke up. I could only imagine what it looked like to her. I won't ever do that again.

The moral of the story.... Don't donate blood and then the next day fast for 8 hours and get lab work drawn up. Yes, I had lab work done on a Monday... ate like crazy that day... and donated on Tuesday... I didn't have any issues. Yeah it sucks in life.... I didn't think donating on a Monday... and then fasting for 8 hours and getting labs drawn on Tuesday would screw you up? But yeah... that was a nightmare.

This was last year May 4th!

Where do your levels sit as of now?

Post up your most recent labs.....full set including TT/FT/e2 and CBC.

Again where does your RBCs/hemoglobin/hematocrit sit on your current protocol?

 

[Stpfan]

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.

As I stated earlier when using exogenous esterified T there will be an initial burst release and T levels start rising within the first few hours and true peak when using the most commonly prescribed esters (TC/TE) will be 8-12 hrs post-injection/elevated during the first few days.

When on trt we test at the true trough and as we want to see where your levels sit (lowest point) to make sure TT/FT levels are not too low or high which could lead to lack of relief low-t symptoms/side-effects.

Blood work is important and using accurate assays is critical.

As you can see your trough TT sits in the 800s and your FT is high which would mean that your peak TT/FT levels will be much higher!

Unfortunately you a relying on the calculated FT let alone we have no idea if your TT was tested using LC/MS-MS.

The only way to know where your FT level truly sits on such protocol (dose T/injection frequency) is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration.

Let alone TT would need to be tested using (LC/MS-MS) even when using calculated methods.

Regardless you can be rest assured that with a TT 800s and seeing as you have low SHBG 14 nmol/L that your FT will be high.

If anything you should have labs done again and make sure to use the most accurate assays as you may be surprised that your FT level may very well be much higher than you think.


When testing your FT either one will suffice!

1. Testosterone, Total and Free (NO Upper Limit) plus Hematocrit

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





I would also test your free estradiol (LC/MS-MS).

free estradiol test

This test measures the free (unbound to SHBG or albumin) estradiol in blood. The test is performed using liquid chromatography/mass spectrometry (LC/MS).

www.discountedlabs.com

From your post #10.

And for people who are curious... yes I donate blood every 58 days. Hard to believe but I'm going for my 8th straight donation without skipping any additional days. I spoke to my Hematologist and asked him if this was safe? He said... he doesn't see anything wrong with it. So... I donate 6 times a year. Yes, I feel like sh#$ for about 7-8 days (after each donation...) but... if you want to live... what else can you do?

Not sure where your RBCs/hemoglobin/hematocrit sit on your current protocol (65 mg T E4D) but it is most likely high due to your high FT.

Again even though your TT 800 may not seem absurdly high seeing as you have low SHBG 14 nmol/L you can rest assured that your FT is high.

I would take a step back and think deeply on this as donating frequently is a surefire way to crash your ferritin.

Many get caught up in that constantly donating merry go round to control hematocrit only to end up crashing ferritin/iron which can lead to many other issues.

I would look into injecting more frequently as in daily or EOD using a lower dose of T.

I appreciate all of your knowledge Madman. Much appreciated! I was trying to find old lab work that would show you Free Test and Bioavailable just before injection. So this would be my LOW POINT.

Judging from my notes... at this point I was injecting Every 3rd day (roughly 60 to 62.5mg of Test Cyp again.. every 3rd day.) 1 injection I actually went 4 days. So, I just did the math... I would say weekly I was injecting 130mg when this lab work was done.

February 3, 2020

Total Testosterone 917 ng/dL (Standard Range 250 - 1,100 ng/dL)

Free Testosterone 189.8 pg/dL (Standard Range 46.0 - 224.0 pg/dL)

Bioavailable Testosterone 390.2 ng/dL (Standard Range 110.0 - 575.0 ng/dL)

SHBG 23 nmol/L (Standard Range 10 - 50 nmol/L)

Serum Albumin 4.5 g/dL (Standard Range 3.6 - 5.1 g/dL)

Just posting more labs to see if this is sufficient or not? Thank you.

 

[Stpfan]

This was last year May 4th!

Where do your levels sit as of now?

Post up your most recent labs.....full set including TT/FT/e2 and CBC.

Again where does your RBCs/hemoglobin/hematocrit sit on your current protocol?

All these labs were pulled January 21, 2021

I can't tell you if it was e2 or not? I always ask the doctor for the e2 test. It's whatever he orders. Always listed as Estradiol on my lab report.

Low Point Testosterone (Right Before Injection) 7:25 AM
Total Testosterone 798 ng/dL (Standard Range 175-781 ng/dL)

Low Point Estradiol (Right Before Injection) 7:25 AM
Estradiol 48 pg/mL (Standard Range <53 pg/mL)

(High Point Tests - After 2 Hours of working out around Noon) If it makes a difference?

High Point Testosterone (Approx. 8 Hours After Injection) 4:05 PM
Total Testosterone 803 ng/dL (Standard Range 175-781 ng/dL)

High Point Estradiol (Approx. 8 Hours After Injection) 4:05 PM
Estradiol 45 pg/mL (Standard Range <53 pg/mL)


Free Testosterone Evaluation (Approx. 8 Hours After Injecting 65mg Test Cyp) 4:05 PM
SHBG 14.7 nmol/L (Standard Range 13.3 - 89.5 nmol/L)
Free Androgen Index 189.6% (Standard Range 24.3% - 110.2%)
Calculation Free Testosterone 25.7 ng/dL (Standard Range 3.2 - 19.0 ng/dL)
Calculation Bioavailable Testosterone 603.1 ng/dL (Standard Range 80.7 - 446.7 ng/dL)

Testosterone Evaluation Comments - Free and Bioavailable Testosterone Calculated using Vermeulen formula and assumes an Albumin of 4.3 g/dL.

WBC Count 8.2 K/uL (Standard Range 3.8 -10.6)
RBC Count 6.00 M/uL (Standard Range 4.40 - 6.00)
Hemoglobin 16.9 g/dL (Standard Range 13.5 -17.0)
Hematocrit 52.0% (Standard Range 41.0 - 53.0%)
MCV 86.6 fl (Standard Range 80 - 100)
MCH 28.1 pg (Standard Range 26 - 34)
MCHC 32.5 g/dL (Standard Range 31 - 37)
RDW 14.6% (Standard Range <14.5%)
Platelet Count 283 K/uL (Standard Range 150 - 450)

PSA 1.0 ng/mL (Standard Range <4.1 ng/mL)

I'm scheduled to donate blood February 8, 2021.

Last TSH checked... August 6, 2020 TSH 2.43 ulU/mL (Standard Range 0.4 - 4.5)

That's all the lab work I have until my follow up appointment... which is February 4, 2021 If there's any additional labs that I need to order I will ask my Urologist to order them. Thank you.

 

[madman]

I appreciate all of your knowledge Madman. Much appreciated! I was trying to find old lab work that would show you Free Test and Bioavailable just before injection. So this would be my LOW POINT.

Judging from my notes... at this point I was injecting Every 3rd day (roughly 60 to 62.5mg of Test Cyp again.. every 3rd day.) 1 injection I actually went 4 days. So, I just did the math... I would say weekly I was injecting 130mg when this lab work was done.

February 3, 2020

Total Testosterone 917 ng/dL (Standard Range 250 - 1,100 ng/dL)

Free Testosterone 189.8 pg/dL (Standard Range 46.0 - 224.0 pg/dL)

Bioavailable Testosterone 390.2 ng/dL (Standard Range 110.0 - 575.0 ng/dL)

SHBG 23 nmol/L (Standard Range 10 - 50 nmol/L)

Serum Albumin 4.5 g/dL (Standard Range 3.6 - 5.1 g/dL)

Just posting more labs to see if this is sufficient or not? Thank you.

These are labs from last year.

As you can see your trough TT is on the high-end 900s and seeing as your SHBG is only 23 nmol/L then your FT would be high.

Although you had it tested and it came back on the higher end of the reference range it was tested using the calculated method as 46-224 pg/mL is the reference range used by Quest.

I would not rely on such a method if you want to know where your FT level truly sits.

Again you would need to have used the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best) to know where your FT level truly sits on such protocol (dose T/injection frequency) and I would say that it will be much higher than you think.

Also, keep in mind that the above labs are trough numbers and tour peak levels would be higher.

 

[madman]

All these labs were pulled January 21, 2021

I can't tell you if it was e2 or not? I always ask the doctor for the e2 test. It's whatever he orders. Always listed as Estradiol on my lab report.

Low Point Testosterone (Right Before Injection) 7:25 AM
Total Testosterone 798 ng/dL (Standard Range 175-781 ng/dL)

Low Point Estradiol (Right Before Injection) 7:25 AM
Estradiol 48 pg/mL (Standard Range <53 pg/mL)

(High Point Tests - After 2 Hours of working out around Noon) If it makes a difference?

High Point Testosterone (Approx. 8 Hours After Injection) 4:05 PM
Total Testosterone 803 ng/dL (Standard Range 175-781 ng/dL)

High Point Estradiol (Approx. 8 Hours After Injection) 4:05 PM
Estradiol 45 pg/mL (Standard Range <53 pg/mL)


Free Testosterone Evaluation (Approx. 8 Hours After Injecting 65mg Test Cyp) 4:05 PM
SHBG 14.7 nmol/L (Standard Range 13.3 - 89.5 nmol/L)
Free Androgen Index 189.6% (Standard Range 24.3% - 110.2%)
Calculation Free Testosterone 25.7 ng/dL (Standard Range 3.2 - 19.0 ng/dL)
Calculation Bioavailable Testosterone 603.1 ng/dL (Standard Range 80.7 - 446.7 ng/dL)

Testosterone Evaluation Comments - Free and Bioavailable Testosterone Calculated using Vermeulen formula and assumes an Albumin of 4.3 g/dL.

WBC Count 8.2 K/uL (Standard Range 3.8 -10.6)
RBC Count 6.00 M/uL (Standard Range 4.40 - 6.00)
Hemoglobin 16.9 g/dL (Standard Range 13.5 -17.0)
Hematocrit 52.0% (Standard Range 41.0 - 53.0%)
MCV 86.6 fl (Standard Range 80 - 100)
MCH 28.1 pg (Standard Range 26 - 34)
MCHC 32.5 g/dL (Standard Range 31 - 37)
RDW 14.6% (Standard Range <14.5%)
Platelet Count 283 K/uL (Standard Range 150 - 450)

PSA 1.0 ng/mL (Standard Range <4.1 ng/mL)

I'm scheduled to donate blood February 8, 2021.

Last TSH checked... August 6, 2020 TSH 2.43 ulU/mL (Standard Range 0.4 - 4.5)

That's all the lab work I have until my follow up appointment... which is February 4, 2021 If there's any additional labs that I need to order I will ask my Urologist to order them. Thank you.

All these labs were pulled January 21, 2021

I can't tell you if it was e2 or not? I always ask the doctor for the e2 test. It's whatever he orders. Always listed as Estradiol on my lab report.

Low Point Testosterone (Right Before Injection) 7:25 AM
Total Testosterone 798 ng/dL (Standard Range 175-781 ng/dL)

Low Point Estradiol (Right Before Injection) 7:25 AM
Estradiol 48 pg/mL (Standard Range <53 pg/mL)
-----------------------------------------------------------------------------------------------


These are your trough levels for TT/e2 and the e2 assay was most likely the standard, not the sensitive (LC/MS-MS).




Free Testosterone Evaluation (Approx. 8 Hours After Injecting 65mg Test Cyp) 4:05 PM
SHBG 14.7 nmol/L (Standard Range 13.3 - 89.5 nmol/L)
Free Androgen Index 189.6% (Standard Range 24.3% - 110.2%)
Calculation Free Testosterone 25.7 ng/dL (Standard Range 3.2 - 19.0 ng/dL)
Calculation Bioavailable Testosterone 603.1 ng/dL (Standard Range 80.7 - 446.7 ng/dL)

Testosterone Evaluation Comments - Free and Bioavailable Testosterone Calculated using Vermeulen formula and assumes an Albumin of 4.3 g/dL.
-------------------------------------------------------------------------------------------------


These labs for FT were done 8 hrs post-injection and I would have rather seen trough levels let alone your FT was tested using the calculated method which I would not rely upon.

We want to see where your FT level truly sits so you need to have it tested using the ED or UF assay.

Either way seeing as your SHBG is low 14.7 nmol/L then you can rest assured that your FT level is high.




WBC Count 8.2 K/uL (Standard Range 3.8 -10.6)
RBC Count 6.00 M/uL (Standard Range 4.40 - 6.00)
Hemoglobin 16.9 g/dL (Standard Range 13.5 -17.0)
Hematocrit 52.0% (Standard Range 41.0 - 53.0%)
MCV 86.6 fl (Standard Range 80 - 100)
MCH 28.1 pg (Standard Range 26 - 34)
MCHC 32.5 g/dL (Standard Range 31 - 37)
RDW 14.6% (Standard Range <14.5%)
Platelet Count 283 K/uL (Standard Range 150 - 450)
-------------------------------------------------------------------------------------------------


Top it off that your RBCs and hemoglobin are right at the top end let alone your hematocrit.

Clear as day that your FT level is most likely too high.