Followup Labs 7 weeks into TRT- Comments?

[ZoomyR6]

Hey guys,

My labs just came in. They look OK but wanted some thoughts before going to see the Doc. I am very anxious.
Just a few things stand out:
1. My T3 uptake is slightly elevated. Normal from TRT? Interpretation?
2. E2 is at 32, 3pts higher than before starting TRT. I don't believe a AI is warranted.
3. My Free T went up from before being on TRT. Problem?
4. SHBG dropped a couple of points. Problem?
5. TT in trough is 447, wish it would have been higher. Possible upping dose if ok with Doc?

And the biggest problem I see...
6. DHT is low. I was wondering if the cause for some of my previous hair shedding was from high DHT but this is obviously not the case. I looked up symptoms of low DHT and they are slight loss of libido, easily frustrated, lethargic, etc... which describe what I am still feeling. Could only imagine what it was prior to TRT as this is supposed to increase it.

Here are the labs. Please tell me what you think. I will also include a semen analysis that I took.
Protocol:
Test Cyp - 100mg/wk
HCG - 250iu 2x/wk ( 2 days prior and day before shot)

 

[CoastWatcher]

Hey guys,

My labs just came in. They look OK but wanted some thoughts before going to see the Doc. I am very anxious.
Just a few things stand out:
1. My T3 uptake is slightly elevated. Normal from TRT? Interpretation?
2. E2 is at 32, 3pts higher than before starting TRT. I don't believe a AI is warranted.
3. My Free T went up from before being on TRT. Problem?
4. SHBG dropped a couple of points. Problem?
5. TT in trough is 447, wish it would have been higher. Possible upping dose if ok with Doc?

And the biggest problem I see...
6. DHT is low. I was wondering if the cause for some of my previous hair shedding was from high DHT but this is obviously not the case. I looked up symptoms of low DHT and they are slight loss of libido, easily frustrated, lethargic, etc... which describe what I am still feeling. Could only imagine what it was prior to TRT as this is supposed to increase it.

Here are the labs. Please tell me what you think. I will also include a semen analysis that I took.
Protocol:
Test Cyp - 100mg/wk
HCG - 250iu 2x/wk ( 2 days prior and day before shot)

Your protocol is failing you. With a basement level SHBG you will only achieve success if you start injecting more frequently. Every 3.5 days at a minimum, possibly every other day. This explains your total testosterone value as well as your rising free testosterone. DHT will rise if you pull your total testosterone up as well through a dose manipulation.

Your estradiol is fine. At LabCorp you'd still be "in range." There is nothing to worry about.

I'm not sure why you did t3 with uptake. It's of little value. The test to have run was ft3.

 

[ZoomyR6]

I thought a lower SHBG was good and so was a higher Free T
The SHBG is binding less and there is now more Free T roaming around waiting to be used and not being used up by the SHBG. This is wrong? Wouldn't just a higher single dose of say 150mg/wk raise the trough TT?

From Nelson's Blood Test Target table:
"Free Testosterone ≥ 2 % of total T
If low, test for sex hormone binding globulin. Higher TRT dose may increase
free T by decreasing SHBG. Low SHBG may be present in diabetes."

Isn't this whats happening to be and is a good thing?

The BW was taken in the afternoon at which time my pre TRT TT levels were 213, so it doubled at least.
Pardon my ignorance.

 

[meanbreen]

I thought a lower SHBG was good and so was a higher Free T
The SHBG is binding less and there is now more Free T roaming around waiting to be used and not being used up by the SHBG. This is wrong? Wouldn't just a higher single dose of say 150mg/wk raise the trough TT?

From Nelson's Blood Test Target table:
"Free Testosterone ≥ 2 % of total T
If low, test for sex hormone binding globulin. Higher TRT dose may increase
free T by decreasing SHBG. Low SHBG may be present in diabetes."

Isn't this whats happening to be and is a good thing?

The BW was taken in the afternoon at which time my pre TRT TT levels were 213, so it doubled at least.
Pardon my ignorance.

Though mainly anecdotal you will find that most guys on TRT with low SHBG have a tough time getting onto a good protocol and feeling the effects despite having such a high free T number (possibly high free Estradiol also). Myself being one of them with an SHBG of 11. I now inject daily and am getting better results albeit not great results.

One other comment - you have very low cholesterol. Are you on any medication for that? Are you on a low-fat diet?

 

[ZoomyR6]

I did not even realize the cholesterol issue, thanks.
No, I am not on any meds or any low fat diet. I do intermittent fasting daily but my cholesterol has never been an issue.

Whats the reasoning behind the low shbg issue?

 

[meanbreen]

Yeah I'm not an expert on the cholesterol part but I would look into that. I know that low cholesterol can contribute to hormonal issues but not sure how low that threshold is. It may not be anything to worry about.

Like I said with the low SHBG, super high free estradiol may be the issue but there is a lot of controversy with it. Injecting more frequently helps with it. Low SHBG can be from a few different things including fatty liver, sleep apnea, hypothyroid.

 

[ZoomyR6]

Actually, although it was always low, but within normal, I faintly remember doctors saying that its ok because my ldl to hdl ratio was perfect, that my hdl number was a non issue. I will make an appointment with a cardiologist though. Thanks again for pointing this out.

As for my E2, its far from high so i don't think thats the issue.

 

[meanbreen]

Yeah but you only tested total Estradiol, not free Estradiol. Like your total T is pretty low but free T is high. But again all of that is pretty debatable. I got free Estradiol tested for the first time last week and waiting on the results.

 

[ZoomyR6]

Also, my free t is 2.2% of my total t which I've read is considered optimal level.

Looking for any other input

 

[ERO]

Low SHBG is not "better" than a higher level. Like all other hormones, too high or too low is problematic. Many of us with low SHBG (myself included) have a very difficult time feeling the same benefits from TRT as guys with normal SHBG experience. Also, SHBG levels are not something that typically can be adjusted much so its the hand that you have been dealt and that you have to work with.

Our best bet for some sort of TRT success is usually small daily T doses (injections or transdermal). DHT levels can be raised by applying transdermal T directly to the scrotum. I have being doing that for a few months. It helps a little bit.

 

[CoastWatcher]

Keep in mind that low SHBG can be idiopathic, and not related to dire issues that, most certainly, can present in its wake. I remember my doctor saying that in her practice no more that 20% of the low SHBG patient population were dealing with metabolic syndrome, diabetes or fatty liver, any of the issues that low SHBG can serve as a marker for. While hardly a representative sample, it is certainly supported by what is seen here at EM.

Most of of us just have to factor it in...another variable.

 

[ZoomyR6]

Fortunately, I don't have a fatty liver or diabetes (not prone as of now)
I am on hgh for the past 5 months prior to even being on TRT. I am using it for therapeutic doses for back pain as well as the many other benefits which I probably should have said from the beginning. Could this be affecting any of this?

So what was the final say in dealing with the shbg? Just the multiple injections during the week? What about for the DHT issue. Whats the fix for that?

Sorry for the ignorance. Just when I thought I figured everything out by reading every book I could get my hand on, something like this just blindsides me.

 

[meanbreen]

Basically don't get hung up on your low SHBG. Can't really do anything about raising it. Just inject more frequently. Only ways to raise DHT is to raise testosterone and/or ERO's advice.

 

[CoastWatcher]

Fortunately, I don't have a fatty liver or diabetes (not prone as of now)
I am on hgh for the past 5 months prior to even being on TRT. I am using it for therapeutic doses for back pain as well as the many other benefits which I probably should have said from the beginning. Could this be affecting any of this?

So what was the final say in dealing with the shbg? Just the multiple injections during the week? What about for the DHT issue. Whats the fix for that?

Sorry for the ignorance. Just when I thought I figured everything out by reading every book I could get my hand on, something like this just blindsides me.

It's a typical problem - no reason to be upset. I went to daily injections of testosterone, 16mg every morning over two years ago. Since then my total testosterone sits just above 1000, my DHT is in the upper quartile, my estradiol is in the 30-32 range. I feel great.

As soon as my doctor saw my low SHBG she said I'd be doing at least two shots per week, possibly three. When it still wasn't where we wanted the daily protocol was proposed. I haven't looked back.

Your DHT will rise as your testosterone does.

At at the very least move to a twice weekly protocol. Keep an open mind about more frequent injections. I think you will be pleased.

 

[ZoomyR6]

It's a typical problem - no reason to be upset. I went to daily injections of testosterone, 16mg every morning over two years ago. Since then my total testosterone sits just above 1000, my DHT is in the upper quartile, my estradiol is in the 30-32 range. I feel great.

As soon as my doctor saw my low SHBG she said I'd be doing at least two shots per week, possibly three. When it still wasn't where we wanted the daily protocol was proposed. I haven't looked back.

Your DHT will rise as your testosterone does.

At at the very least move to a twice weekly protocol. Keep an open mind about more frequent injections. I think you will be pleased.

Thank you for this. I will discuss this my doc this thursday. Instead of 100mg 1x/wk, try 50mg 2x/wk? Would that be a good starting dose? I will definitely not be doing IM at twice per week, subQ for sure with hcg mixed in to minimize the injections.
As for daily, I am hoping it wont come to that. I am already doing that ED with hgh and I can't wait till I run out in another month. Getting so annoying.

 

[ZoomyR6]

I don't believe I've asked this but what would be the down side of a larger single injection dose? Say 150mg-200mg/week?
Wouldn't that raise my TT in the trough?
But that might also tank the SHBG too, correct?

 

[CoastWatcher]

I don't believe I've asked this but what would be the down side of a larger single injection dose? Say 150mg-200mg/week?
Wouldn't that raise my TT in the trough?
But that might also tank the SHBG too, correct?

A dose like this, given your low SHBG, is counterproductive. If your SHBG was in the upper end of the range a large single dose should be given consideration. My own low SHBG undermined an ill-advised protocol that called for 120mg in a single, weekly dose.

 

[CoastWatcher]

Thank you for this. I will discuss this my doc this thursday. Instead of 100mg 1x/wk, try 50mg 2x/wk? Would that be a good starting dose? I will definitely not be doing IM at twice per week, subQ for sure with hcg mixed in to minimize the injections.
As for daily, I am hoping it wont come to that. I am already doing that ED with hgh and I can't wait till I run out in another month. Getting so annoying.

Frequent injections become second nature once you begin to realize the benefits they bring. Twice weekly, every other day, or daily, they are administered on auto-pilot.

 

[ERO]

Daily T injections took me maybe 3 minutes a day, tops - likely less. Just use an insulin syringe and do it when you first get up and it will be second nature in no time.

A single large dose is the exact OPPOSITE of what you need to do your SHBG level. In fact even with normal SHBG, smaller, more frequent doses are the way to go for best results and fewest E2 issues.

 

[ZoomyR6]

Daily T injections took me maybe 3 minutes a day, tops - likely less. Just use an insulin syringe and do it when you first get up and it will be second nature in no time.

I have been doing this with HGH for the past 5 months. Takes me 2 minutes first thing in the morning. I can't stand pinning ED and am trying to avoid it, if possible, at all cost.