First labs since starting TRT - very surprised by results!

[Goel]

Baseline labs were:

TT = 427
FT = 12.17

As stated in my Introduction post, that was higher than I'd tested a few years ago (324) when I felt better than I did this cycle. But I also tested this baseline first thing in the morning when T is usually higher.

Commenced Test Cyp at 100mg injected IM once/week. 7 weeks later my labs are:

TT = 980 (ref. range 264 - 916)
FT = 47.77 (ref. range 5.00 - 21.00)

Labcorp both tests.

Here's the kicker, I did my blood draw on a Friday late afternoon. I administer my injections Friday evenings, so I should have been at the bottom of my trough and I can feel it when I'm "due" for my next one.

I'm scheduled to meet with the Doc Wednesday to review and my thought was to go for a slight increase in dosage AND spread it out to twice/week to level the fluctuation. But with these labs I don't know if that's realistic to increase dosage?

As for subjective response: I notice a little more mental/emotional "well being" but not dramatic. Concentration and sleep seem unchanged. Libido has increased a tad but no morning wood or other changes to quality nor quantity of erections. Energy is a little better but not what I'd hoped for, but I also figure it's still early at 6wks in. I do notice I feel stronger when exercising though. My WAG based on how I feel now and felt when having taken a sublingual T several yrs ago was that I'd be at ~700ish TT. So I'm kinda shocked at 980 so far removed from my last injection.

Thoughts?

 

[Golfboy307]

It may be your internal production hasn't completely shutdown, but it should be close. Did you pull SHBG, albumin, E2 or DHT? It would be helpful to know these numbers before changing dosing.

 

[Vince]

It would be nice if you had more labs.

I don’t think it’s necessary to increase your dose. I do agree with injecting every 3 1/2 days.

Nice T levels.

 

[Goel]

No, just TT, FT, and % FT. The doc I'm working with specializes in HRT and he's said before that he goes a lot on "how you feel" at first to get it dialed in and then will follow up with detailed labs to keep other factors in spec while maintaining the desired "how you feel" threshold if at all possible.

 

[Vince]

No, just TT, FT, and % FT. The doc I'm working with specializes in HRT and he's said before that he goes a lot on "how you feel" at first to get it dialed in and then will follow up with detailed labs to keep other factors in spec while maintaining the desired "how you feel" threshold if at all possible.

I do agree with that. It’s not the numbers but how you feel. If your numbers are great and you feel bad. Does it really matter.

 

[Goel]

I don’t think it’s necessary to increase your dose. I do agree with injecting every 3 1/2 days.

Nice T levels.

Hm, that raises a question for me: While I do feel something, I'm not where I want to be in how I feel yet. But again, I'm only 7 weeks in, so if I remain on the same dosage should I expect to see the TT/FT continue to increase a bit over time albeit a bit slower? I don't want to increase my dosage yet if I'm not fully aclimitized and then screw it up by going up 10% or so in dosage to improve the "how I feel" but I"m wondering if my target TT might be north of 1200 or so

 

[madman]

Hm, that raises a question for me: While I do feel something, I'm not where I want to be in how I feel yet. But again, I'm only 7 weeks in, so if I remain on the same dosage should I expect to see the TT/FT continue to increase a bit over time albeit a bit slower? I don't want to increase my dosage yet if I'm not fully aclimitized and then screw it up by going up 10% or so in dosage to improve the "how I feel" but I"m wondering if my target TT might be north of 1200 or so

You need to understand that when starting trt not only will the hpta shutdown (2-6weeks depending on dose T) but more importantly hormones will be in FLUX during the weeks leading up until blood levels stabilize (4-6 weeks).

During this transition, some may experience what we call the honeymoon phase and notice a euphoric feeling along with an increase in libido due to increased dopamine/rising androgen levels but it is short-lived and temporary as the body adjusts and others may notice ups/downs (mood/energy/libido/erectile function/recovery).

Even then once blood levels stabilize it will take 2-3 months for the body to adapt and during this time is when one should gauge how they truly feel overall on such protocol (dose T/injection frequency) regarding relief/improvement of low-t symptoms and overall well-being.

Too many make the mistake of gauging how they feel during the first 6 weeks on such protocol as again the hpta will be shutting down and hormones will be in FLUX leading up until blood levels stabilize.

The best piece of advice is to start low and go slow than have blood work done at 6 weeks to see where such protocol (dose T/injection frequency) has your trough TT/FT/e2 levels let alone blood markers such as RBCs/hemoglobin/hematocrit.

Even if you do not feel great after 6 weeks and blood levels of TT/FT are in a healthy range then no need to jump the gun and increase the dose as your body will need time (2-3 months) to adapt let alone experience the full beneficial effects of having healthy T levels.

If by some chance your trough TT/FT levels are indeed still too low than a slight dose increase will be needed and in some cases leaving the weekly overall dose the same and increasing injection frequency may be all that is needed.

You are only injecting once weekly and your trough TT is in the high-end and more importantly, FT is very high (7 days post-injection) which would have your peak TT/FT/e2 levels much higher earlier in the week.

Although some men may do well injecting higher doses once weekly the downfall of such is that peak TT/FT/e2 levels will be very high post-injection (8-12 hrs) and elevated the first few days only to be followed by much lower levels come weeks end (trough) which in most cases can have a yo-yo effect on mood/energy/libido/erectile function/ recovery throughout the week.

Far from ideal, I would say and if anything seeing as your trough TT/FT levels is still high then you would most likely do better keeping your T dose 100 mg/week the same and splitting it up into twice-weekly injections (50 mg every 3.5 days) before making any dose adjustments.

 

[Goel]

Thanks for the detailed response. I was already planning on splitting into twice/week instead of once/week since I can feel the waning part of the curve. Where I am now is far from euphroric, so if this is a "honeymoon" phase and what little I do feel is going to subside in the coming months then I'm not looking forward to that! But, I'll be patient and hold the course at 100 mg / week administered twice/week and see what the doc says on Wednesday.

 

[madman]

No, just TT, FT, and % FT. The doc I'm working with specializes in HRT and he's said before that he goes a lot on "how you feel" at first to get it dialed in and then will follow up with detailed labs to keep other factors in spec while maintaining the desired "how you feel" threshold if at all possible.

Hard to believe he would throw you on such protocol (once weekly) injections without even testing your SHBG!

SHBG is critical to know and can very well make or break achieving an effective trt protocol.

The first 6 weeks is misleading to say the least and as long as one achieves a healthy TT/FT level than you would need to give the body time to adapt (2-3 months) let alone gauge how you truly feel overall regarding relief/improvement of low-t symptoms.

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.

 

[madman]

Post the reference ranges for your labs.

 

[madman]

He only tested TT/FT at 6 weeks and left out critical ones such as e2, SHBG, PSA, RBCs/hemoglobin/hematocrit and some would even throw in prolactin/DHT.

Hope you understand that when using exogenous testosterone that it will increase your RBCs/hemoglobin/hematocrit within the first 6 weeks and can take up to 9-12 months to reach peak levels.

Increasing T dose will drive this up further!

Was your H/H not tested pre-trt?

Did you even have a full thyroid/adrenal panel done?

Thyroid/adrenal dysfunction can also hinder one from achieving an effective protocol.

 

[Goel]

Original posted updated with lab reference range, Labcorp used both times so same range.

In the notes it says:

"Adult male reference interval is based on a population of healthy nonobese males (BMI <30) between 19 and 39 years old. "


My BMI is 23.7 and age is 57

 

[madman]

Original posted updated with lab reference range, Labcorp used both times so same range.

In the notes it says:

"Adult male reference interval is based on a population of healthy nonobese males (BMI <30) between 19 and 39 years old. "


My BMI is 23.7 and age is 57

TT = 980 (ref. range 264 - 916)
FT = 47.77 (ref. range 5.00 - 21.00)

The most accurate assays for FT are the gold standard Equilibrium Dialysis or Ultrafiltration.

I have to give credit that at least your doctor used an accurate assay when testing FT.

TT was not tested using the most accurate assay (LC-MS/MS) as it was tested using the electrochemiluminescence immunoassay (ECLIA)

081786: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone | Labcorp

Labcorp test details for Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone

www.labcorp.com

Your trough FT level is through the roof and that is using one of the most accurate assays for FT (Equilibrium Ultrafiltration).

Peak TT/FT/e2 levels post-injection and the days following will be much higher!

Bet your e2 is really high let alone your hemoglobin/hematocrit may very well be elevated depending on your pre-trt levels.

 

[madman]

Most men on trt do well with FT in the 20-30 ng/dL range and some may run higher levels.

Many doctors would aim to have their patients on the higher end although some do much better running lower levels as it comes down to the individual.

 

[Golfboy307]

Wouldn't that high of a FT (if accurate) suggest a low SHBG? If so, that would steer him to more frequent injections.

 

[Goel]

Had my follow up consult with Doc today after labs. He said that in 30+ yrs of HRT practice he's never seen such lab results so soon after commencing treatment and as a single "outlier" suspects it to be lab error. With that in mind and to confirm, he drew blood on the spot to test again with it being 3.5 days since my last injection. That was this afternoon, then tonight I administered 50mg and he wants to do another draw tomorrow post injection.

He said that changing from once/week to twice/week was a personal preference and he had no problem with it and suggested I continue with that protocol to try to flatter the peaks/troughs. He did say that he has other patients who like daily injection and that while those are not common he doesn't have a problem with it if the patient prefers it.

Just based on experience, he said he expected my trough to be mid-400s at ~6 weeks in and that with 100mg / week I still had room for a higher dosage but let's continue as-is until the newest labs come back.

 

[madman]

Had my follow up consult with Doc today after labs. He said that in 30+ yrs of HRT practice he's never seen such lab results and as a single "outlier" believes it to be lab error. With that in mind and to confirm, he drew blood on the spot to test again with it being 3.5 days since my last injection. I administered 50mg tonight and he wants to do another draw tomorrow post injection.

He said that changing from once/week to twice/week was a personal preference and he had no problem with it and suggested I continue with that protocol to try to flatter the peaks/troughs. He did say that he has other patients who like daily injection and that while those are not common he doesn't have a problem with it if the patient prefers it.

Just based on experience, he said he expected my trough to be mid-400s at ~6 weeks in and that with 100mg / week I still had room for a higher dosage but let's continue as-is until the newest labs come back.

He has no clue what he is doing!

You just switched from once weekly injections (100 mg)--->twice weekly injections (50 mg every 3.5 days) and have already done your 50 mg injection.

Testing now is pointless and you need to wait 6 weeks until blood levels stabilize before getting blood work done as levels will be in FLUX seeing as you just recently switched your dose let alone injection frequency.

What day did you start your new protocol (do your first 50 mg injection) tonight or 3.5 days ago?

Come 6 weeks on the new protocol your TT trough may very well end up being much higher than 400+ ng/dL when injecting 50 mg every 3.5 days and regardless of where TT sits at trough your FT level is what TRULY matters.

Did he test your SHBG, estradiol let alone hemoglobin/hematocrit?

 

[madman]

The protocol needs to be consistent (dose T/injection frequency) for 6 weeks before any blood work is done.

Any time dose is tweaked (increased/decreased) or injection frequency changed than blood levels will be in FLUX during the weeks leading up until they stabilize (4-6 weeks) and it is pointless to have blood work done anytime before levels have stabilized.

Let alone we test at the true trough (lowest point) before your next injection.

You just changed your dose T/injection frequency, it is pointless to get bloodwork and why he would want to do it again tomorrow after you just injected 50 mg is beyond me!
I administered 50mg tonight and he wants to do another draw tomorrow post injection.

 

[sh1973]

Baseline labs were:

TT = 427
FT = 12.17

As stated in my Introduction post, that was higher than I'd tested a few years ago (324) when I felt better than I did this cycle. But I also tested this baseline first thing in the morning when T is usually higher.

Commenced Test Cyp at 100mg injected IM once/week. 7 weeks later my labs are:

TT = 980 (ref. range 264 - 916)
FT = 47.77 (ref. range 5.00 - 21.00)

Labcorp both tests.

Here's the kicker, I did my blood draw on a Friday late afternoon. I administer my injections Friday evenings, so I should have been at the bottom of my trough and I can feel it when I'm "due" for my next one.

I'm scheduled to meet with the Doc Wednesday to review and my thought was to go for a slight increase in dosage AND spread it out to twice/week to level the fluctuation. But with these labs I don't know if that's realistic to increase dosage?

As for subjective response: I notice a little more mental/emotional "well being" but not dramatic. Concentration and sleep seem unchanged. Libido has increased a tad but no morning wood or other changes to quality nor quantity of erections. Energy is a little better but not what I'd hoped for, but I also figure it's still early at 6wks in. I do notice I feel stronger when exercising though. My WAG based on how I feel now and felt when having taken a sublingual T several yrs ago was that I'd be at ~700ish TT. So I'm kinda shocked at 980 so far removed from my last injection.

Thoughts?

Your numbers aren’t that unusual. My trough on 100mg are nearly 1000ng seven full days after a shot. I now only do 60mg every 7 days. I’m betting your shbg is high like mine. I’ve been on trt 11 years and have tried multiple injection protocols and once weekly is by far the best for me.

 

[Goel]

Your numbers aren’t that unusual. My trough on 100mg are nearly 1000ng seven full days after a shot. I now only do 60mg every 7 days. I’m betting your shbg is high like mine. I’ve been on trt 11 years and have tried multiple injection protocols and once weekly is by far the best for me.

I asked about SHBG and he pointed to the %FT result at 4.67 (1.5 - 4.2) and said that because that's calculated with SHBG he could infer that SHBG was good.

Once/week I could tell where my peaks/troughs were and I was starting to drag a bit the couple days before I was due again. So my thought was by splitting to twice/week I'd flatten the cycle a bit and if that was still not enough go to every other day. I'm not fond of the idea of every day injections but wouldn't rule it out.