Free testosterone question

[jgaviri]

Hi Guys:

New to this forum and new to TRT so please forgive me if I ask a dumb question. I started TRT about 10 weeks ago. I have a high SHBG (74). My last blood work show Testosterone at 1,194 ng/dl (was 434.8) and Free Testosterone (Direct) at 12.4 pg/ml. Estradiol 31.1 pg/ml (not sensitive. I am getting a sensitive Estradiol test next week). Looking at this site's targets sheet, it says that Free Testosterone should be >2%.

The question I have is: I assume the table refers to Calculated Free Testosterone, which is based on Albumin and SHBG. According to this calculator I need to take my testosterone to 2,500 ng/dl to get to 2% Free Testosterone in order to overcome the high SHBG. Is this the correct calculation? What am I missing?

This is what I am taking:

- Mix of three esters (cypionate/ Propionate/Enanthate) 0.4 ml twice a week.
- Anastrolzole 0.5 ml twice a week
- HCG Twice a week

Thanks for the help!

J

 

[Systemlord]

You need to calculate Total T and SHBG to get more accurate free T scores, yours is a dreadful 0.0609 ng/dL = 0.0823 % do to your high SHBG and 2-3 percent is considered normal. Your protocol doesn't tell us how many mgs you're injecting, only volume. .40mL from a 100mg vial versus a 200mg vial is quite a bit of a discrepancy. You need large once weekly injections to make TRT work for you, 140mg once weekly to start. You might also be needing to donate blood on a regular basis, but I doubt you'll ever have enough free T unless you push insane Total T levels.

Also remember your estrogen score is rather useless because it's all bound to SHBG, almost known of it is free very much like your free T.

Use this --> http://www.issam.ch/freetesto.htm

 

[jgaviri]

Thank you for your response. I will check the testosterone dosage with my doc. Based on your response, it seems then that anybody with high SHBG will never be able to get enough free T? Not sure where you are getting 0.0823%. Using the link for the free T calculated that you provided I get 1.44% (calculated):

Total Testosterone: 1194 ng/ml
Albumin: 4.3 g/dl
SHBG : 74 nmol/L

Gives:
Free Testosterone: 17.2 ng/dL = 1.44 %
Bioavailable: 404 ng/dL = 33.9 %

Using the same Calculator, I need my T to be 2,500 ng/ml ( assuming SHBG and Albumin remain the same) to get to 2%, thus my question above.

The free testosterone value that I provided of 12.4 pg/ml (normal range is 6.6 - 18.1 as per labcorp) is based on Labcorps Direct Analog Enzyme Inminoassay (EIA) method which I understand is different than the calculated one.

Thanks

J

 

[Systemlord]

Thank you for your response. I will check the testosterone dosage with my doc. Based on your response, it seems then that anybody with high SHBG will never be able to get enough free T? Not sure where you are getting 0.0823%. Using the link for the free T calculated that you provided I get 1.44% (calculated):

Total Testosterone: 1194 ng/ml
Albumin: 4.3 g/dl
SHBG : 74 nmol/L

Gives:
Free Testosterone: 17.2 ng/dL = 1.44 %
Bioavailable: 404 ng/dL = 33.9 %

Using the same Calculator, I need my T to be 2,500 ng/ml ( assuming SHBG and Albumin remain the same) to get to 2%, thus my question above.

The free testosterone value that I provided of 12.4 pg/ml (normal range is 6.6 - 18.1 as per labcorp) is based on Labcorps Direct Analog Enzyme Inminoassay (EIA) method which I understand is different than the calculated one.

Thanks

J

For some strange reason I'm getting bogus calculations, even my numbers are off. Larger injections or rather the large peaks is what lowers SHBG and not the high levels, so inject larger dose and watch SHBG fall. I don't pay attention to just free T measured directly do to the short half life of free T, it's not constant or linear, it varies from hour to hour. I prefer that TT+SHBG, bioavailable and free T together so they back up one another.

You can't just assume your free T is going to be frozen at 12.4 pg/ml, the target is always moving.

 

[Vince Carter]

You need to shoot once per week like SL said to get your SHBG to move downward, how much lower no one knows but one larger shot should effect SHBG lower = Free T. Adjust your dosing based on the Free T...primarily.

 

[jgaviri]

Yes, thank you. That is consistent with what I have read in this forum. Free T is a point in time, calculated is a better reference. Not sure why my Doc put me on twice a week when once a week is better for high SHBG. He also put me on a three mix of esters: Cypionate/Propienate/ Enanthate combo arguing (and charging me more for it) that it is better that a single or duo (I was on Cypionate/Propienate for the first 8 weeks)

Maybe it is time to get a second opinion.

 

[CoastWatcher]

Yes, thank you. That is consistent with what I have read in this forum. Free T is a point in time, calculated is a better reference. Not sure why my Doc put me on twice a week when once a week is better for high SHBG. He also put me on a three mix of esters: Cypionate/Propienate/ Enanthate combo arguing (and charging me more for it) that it is better that a single or duo (I was on Cypionate/Propienate for the first 8 weeks)

Maybe it is time to get a second opinion.

If you think that it may be time to get a second opinion...it is. I say that not to be snide, but to emphasize how important it is for you, the patient, to be in sync with what your doctor is prescribing and testing. Yes, testing. You had a Standard e2 lab run initially. If that's what the doctor ordered a new viewpoint is required.

 

[jgaviri]

Yes that is what he ordered: standard e2 instead of sensitive. He prescribed AI based on that. That was a red flag for me. I am dissapointed as this is supposed to be a boutique, high end and very expensive TRT clinic. Sometimes you DO NOT get what you pay for! Time to look at other options starting tomorrow. Good I found this forum. I also read a couple of books. Important to be informed! Thank you for the input

 

[CoastWatcher]

Yes that is what he ordered: standard e2 instead of sensitive. He prescribed AI based on that. That was a red flag for me. I am dissapointed as this is supposed to be a boutique, high end and very expensive TRT clinic. Sometimes you DO NOT get what you pay for! Time to look at other options starting tomorrow. Good I found this forum. I also read a couple of books. Important to be informed! Thank you for the input

You aren't the first, and - sadly - won't be the last member here who walked through the valley of medical ignorance. So many of us did. I spent far too long wandering in the wilderness. You deserve better care.