First labs 11 weeks into TRT. Should I be concerned?

[WharfRat]

I searched the posts and didn’t quite find the thing that satisfied, so apologies for risking a useless post (my first one, at that). Of course I plan to talk through with provider, but I can’t stop myself from wanting to get balls deep in research.

Took my first labs since starting TRT. Labs were drawn about 11 weeks since beginning a course of 120 Cyprionate split into two subq shots per week. Labs were taken at trough in the morning.

Prior to beginning, I was at

• 369 total,
• 6.9 free,
• SHBG 39.5,
• estradiol 9.4,
• IGF 1

These latest labs (attached) seem nuts for the amount I’m taking?

• >1500 total
• 35.7 free,
• Estradiol 24.9
• DHT 92

My blood pressure is on the high side of normal but unchanged from before therapy. The attached shows negligible movement in hematocrit (I think?). How do I feel? Fine. Felt super great for a bit, last few weeks not as super great but still better than before TRT by miles.

Is this super abnormal for the dose I’m on, and should I be concerned? I guess, all other things being equal, why not have more, if my other health markers are fine and I feel fine? But is this super excessive and risky? Would love any thoughts from folks smarter than me. I still struggle with how these numbers interact.

Thanks for any input.

 

[Cataceous]

...
Is this super abnormal for the dose I’m on, and should I be concerned? I guess, all other things being equal, why not have more, if my other health markers are fine and I feel fine? But is this super excessive and risky? Would love any thoughts from folks smarter than me. I still struggle with how these numbers interact.

Thanks for any input.

We have debated this subject a lot. You have been dosed at a level that is likely on the order of double what your healthy natural production would be. It's no surprise that your numbers are off the charts. A lack of acute effects does not imply long-term safety in such levels. Hematocrit may still rise over time, increasing blood viscosity and leading to unnecessary wear and tear on the vasculature. Some individuals may be susceptible to long-term cardiotoxicity. Other side effects can arise over time as the the full effects of HPTA suppression take hold. The worst part about this situation is that you have not been able to experience normal levels before heading off into La-la land. You have no point of reference as to whether physiological levels would give better results than what you're currently experiencing.

A low-and-slow approach is preferred, in which doses start around 50-70 mg TC/week, divided into at least two injections. You give this plenty of time to stabilize before evaluating, and then slowly increase over time if there's still evidence of hypogonadism. Starting with a high dose as you have is problematic because the habituation to higher levels can make dose decreases unpleasant and misleading; you think anything lower is too low, but that's only because your body needs a significant amount of time to readjust to normal levels. In contrast, dose increases are more likely to be nice; a honeymoon period is common when starting TRT because the boost in levels boosts neurotransmitters transiently. The initial effect is more pronounced because natural production of testosterone is initially adding to what you're taking before it is suppressed.

In any case, what I would do in your situation is cut back to 70-80 mg TC/week and then give it a few months. At that point evaluate the situation as objectively as you can. If you're doing well then stay with it. If you're having problems then try to determine whether they are a result of too much or too little testosterone. Some of us find that doses lower than midrange are needed to give the best results. Do not fall into the delusion that more testosterone must be better. This is not the case when good overall health is the goal.