Gman's Test Prop Labs

[Gman86]

4-30-19
Labs were while on this protocol: (Testosterone Propionate only)
TEST - 122.5mg/ week. 17.5mg injected ED IM
No HCG
No AI

*Labs were drawn 34 hours after last 17.5mg injection. Basically 1.5 days after last injection*
Reason was because I held my injection the morning I was going to get labs, but wasn't able to make it to Quest before I had to go to work. So didn't get to inject before work, and ended up getting labs done right after work at 5pm.

Total Testosterone - 1423 (250-1100 ng/dL)
Free Testosterone - 134.8 (46.0-224.0)
Bioavailable Testosterone - 265.5 (110.0-575.0 ng/dL)
SHBG 63 (10-50) High due to being on desiccated thyroid (I'm assuming)
E2 Sensitive - 72
E2 NOT Sensitive - 49 (After analyzing all previous labs, this is my correct E2, IMO, not 72)
E2 Free - 1.02 (0.2-1.5)
Albumin - 4.3 (3.6-5.1)
IGF-1 - 202 (53-331)
B12 - 1081 (200-1100)
DHEA-S - 465 (106-464) No DHEA supplementation


For reference, here were the last labs I had done while on testosterone cypionate

2-20-19
Labs were while on this protocol:
TEST- 171.5mg/ week. 49mg injected EOD.
HCG- 1000iu. 290iu EOD
Exemestane - 6.25mg E3D - E4D

*Labs were done the morning I was supposed to inject, prior to injecting. So at trough, while injecting EOD*

Total Testosterone - 1670 (250-1100 ng/dL)
Free Testosterone - 242.8 (46.0-224.0)
Bioavailable Testosterone - 509.9 (110.0-575.0 ng/dL)
SHBG 44 (10-50)
E2 Sensitive - 28
E2 NOT Sensitive - 32
E2 Free - 0.76 (0.2-1.5)
Albumin - 4.6 (3.6-5.1)

 

[fifty]

Any difference in how you feel? Was your DHEA-S always that high?

1423 total and 134.8 free w/ shbg 63 makes no sense to me. The more labs I see the more it seems like some of them are done by the Wizard of Oz.

 

[Gman86]

Ya DHEA-S has been at the top of the range ever since I started getting labs done 5 years ago. Whether I was on nothing, or TRT, it’s always been on the high end.

So feeling about the same I guess. A little more foggy headed, and possibly a little more tired. Lost some muscle. Haven’t changed exercise routine or diet. But I think all the things I listed above could be more due to my thyroid labs all coming back high. Free T3 was almost twice the top of the range, and RT3 was much higher than it usually is. Too much free T3 eats muscle. Just got the okay from defy today to lower WP Thyroid dose down to 1 grain, and add in some Cytomel to lower RT3. So really looking forward to seeing how I feel on prop while having healthy thyroid levels.

So what part of my labs seem different than what you’d expect? With my total and SHBG, would you think my free T should be higher?

 

[fifty]

Seems like questionable Free T and sensitive e2. Thanks for the updates!

 

[Gman86]

Seems like questionable Free T and sensitive e2. Thanks for the updates!

Ya my free T is always lower than most people, even with a similar total T level, and similar SHBG level. Think my SHBG is more “sticky” or something. And ya no clue what’s up with my sens E2. That’s why I always get the sens E2, the standard E2, and the free E2 tests done. I feel bad for guys that can only get one of those done. I mean, what if I only had the sens E2 done? I’d be freaking out thinking it’s really high, when I know that’s not accurate, based on my other E2 labs, and using all my previous labs as a reference.

 

[madman]

4-30-19
Labs were while on this protocol: (Testosterone Propionate only)
TEST - 122.5mg/ week. 17.5mg injected ED IM
No HCG
No AI

*Labs were drawn 34 hours after last 17.5mg injection. Basically 1.5 days after last injection*
Reason was because I held my injection the morning I was going to get labs, but wasn't able to make it to Quest before I had to go to work. So didn't get to inject before work, and ended up getting labs done right after work at 5pm.

Total Testosterone - 1423 (250-1100 ng/dL)
Free Testosterone - 134.8 (46.0-224.0)
Bioavailable Testosterone - 265.5 (110.0-575.0 ng/dL)
SHBG 63 (10-50) High due to being on desiccated thyroid (I'm assuming)
E2 Sensitive - 72
E2 NOT Sensitive - 49 (After analyzing all previous labs, this is my correct E2, IMO, not 72)
E2 Free - 1.02 (0.2-1.5)
Albumin - 4.3 (3.6-5.1)
IGF-1 - 202 (53-331)
B12 - 1081 (200-1100)
DHEA-S - 465 (106-464) No DHEA supplementation


For reference, here were the last labs I had done while on testosterone cypionate

2-20-19
Labs were while on this protocol:
TEST- 171.5mg/ week. 49mg injected EOD.
HCG- 1000iu. 290iu EOD
Exemestane - 6.25mg E3D - E4D

*Labs were done the morning I was supposed to inject, prior to injecting. So at trough, while injecting EOD*

Total Testosterone - 1670 (250-1100 ng/dL)
Free Testosterone - 242.8 (46.0-224.0)
Bioavailable Testosterone - 509.9 (110.0-575.0 ng/dL)
SHBG 44 (10-50)
E2 Sensitive - 28
E2 NOT Sensitive - 32
E2 Free - 0.76 (0.2-1.5)
Albumin - 4.6 (3.6-5.1)

Still basing your FT off that garbage direct immunoassay I see?


Your FT levels are ridiculously high @ trough 56.77 ng/dL on the 2-20-19 protocol.




Using the newer calculated TruT method with a TT 1670 ng/dL, SHBG 44 nmol/L (by no means that high), Albumin 4.6 g/dL than your FT is 56.77 ng/dL (way too high.....reference range 16-31 ng/dL).

Could have easily brought your FT levels down and dropped the a.i.

You used to run a TT 1800+ ng/dL.....whole time your FT levels would have been absurdly high.....well over 60+ ng/dL.




Your FT levels are still very high 48.24 ng/dL on the new 4-30-19 protocol.


TT 1423 ng/dL, SHBG 63 nmol/L, Albumin 4.3 g/dL than your FT is 48.24 ng/dL (still very high.....reference range 16-31 ng/dL).

You still easily have room to bring your FT levels down if need be.....unless you feel great overall and are not experiencing any negative effects.....as you should know many can end up feeling just as good with FT levels at the top of or slightly above the top end of the reference range (using an accurate FT testing method such as the gold standard Equilibrium Dialysis or Ultrafiltration or the newer TruT Free Testosterone Calculator by FPT.....which is on par with results obtained when compared to the gold standard Equilibrium Dialysis.


Most can easily do well with FT levels in the 30 ng/dL range......sure some may need/choose to run higher levels 30-50 ng/dL.....but highly doubtful anyone needs to be running FT levels 50+ ng/dL to benefit from testosterone replacement therapy.

 

[madman]

Ya my free T is always lower than most people, even with a similar total T level, and similar SHBG level. Think my SHBG is more “sticky” or something. And ya no clue what’s up with my sens E2. That’s why I always get the sens E2, the standard E2, and the free E2 tests done. I feel bad for guys that can only get one of those done. I mean, what if I only had the sens E2 done? I’d be freaking out thinking it’s really high, when I know that’s not accurate, based on my other E2 labs, and using all my previous labs as a reference.

Unfortunately most are still basing their FT levels from results obtained by the piss poor direct immunoassay or tracer analog which is known to be inaccurate let alone no longer recommended.

The only way to truly know where your FT levels sit is to use an accurate testing method such as the gold standard Equilibrium Dialysis or Ultrafiltration or better yet use the free public TruT Free Testosterone Calculator by FPT

As I commented on a members previous thread.....due to the newer understanding of SHBG:T binding.....even with having a higher SHBG......running a very high TT (as in well over 1200 ng/dL) is not needed in order to achieve a healthy FT level.

 

[madman]

Even with a higher SHBG of 70 nmol/L.....running a TT 1000 ng/dL would have FT at 31.30 ng/dL (of the top end of the reference range 16-31 ng/dL).

Most would have thought running a TT well over 1200 ng/dL would have been needed!





TT 1000 ng/dL, SHBG 70 nmol/L, Albumin 4.3 g/dL (mean).....FT is 31.30 ng/dL (top of the reference range of 16-31 ng/dL).

Just so you understand I have no issues with one needing/choosing to run higher FT levels above the reference range as long as health markers are in check and any potential negative side effects are avoided.


That being said people need to start using accurate testing methods to truly know where their FT levels sit on such protocol as in many cases their FT levels are much higher than what they think.

As we very well know there are many who struggle on a protocol due to having too high FT levels without even knowing it....let alone many men can end up feeling just as good running lower FT levels while at the same time avoiding any potential negative effects.

It needs to be stressed that high T is not always needed as many other factors can come into play regarding the effectiveness of ones trt protocol.....thyroid/adrenal function, quality sleep, stress levels, diet, physical activity, body fat level....and so on.....you get the point!

 

[Cataceous]

Yet another win for the free estradiol calculator. It says 1.07 pg/mL with the standard estradiol test versus 1.02 measured.

@madman — Why are the calculated free estradiol results always so close to measured values, when the multi-ligand model it's based on gives free testosterone close to the Vermeulen method, and not the new Tru-T approach?

 

[fifty]

Can someone make the free e calculator into a google sheets document?

 

[xqfq]

Yet another win for the free estradiol calculator. It says 1.07 pg/mL with the standard estradiol test versus 1.02 measured.

@madman — Why are the calculated free estradiol results always so close to measured values, when the multi-ligand model it's based on gives free testosterone close to the Vermeulen method, and not the new Tru-T approach?

So is the tentative verdict here that if we want to figure out free E2 cheaply, it's best to get the standard E2 test and use the calculator?

 

[madman]

Yet another win for the free estradiol calculator. It says 1.07 pg/mL with the standard estradiol test versus 1.02 measured.

@madman — Why are the calculated free estradiol results always so close to measured values, when the multi-ligand model it's based on gives free testosterone close to the Vermeulen method, and not the new Tru-T approach?

2. Free E2: calculate or measure?

2.1. Calculate

Substantially more effort has gone into examining the vagaries of free T than free E2. Although there are distinct differences in estimating free T and free E2, the general approaches are the same and, as appropriate, we will cite papers dealing with the approach to calculating/measuring free T. To calculate free estradiol one must first have an accurate measure of total estradiol, SHBG, albumin, and the appropriate Ka’s. The difficulties with, and problems of, assaying estradiol constitute a large part of this special issue and I would simply emphasize that without a proper assay for total estradiol, there can be no accurate determination of free estradiol. SHBG can be measured, either by its ligand binding capacity, by immunoassay or, more recently by mass spectrometry [9]. Commercial methods are available for its immunoassay. At least some of those assays have been standardized against the binding capacity of a standard SHBG preparation obtained from the WHO. There are however problems with the standard; its binding capacity is lower than the previous standards, and its Ka for the SHBG steroid interaction is also lower [10]. Further, one need be sure that the standard’s binding activity is equal to its immunologic activity as the two activities must be proven to be identical and are differentially sensitive to denaturation. Estimation of the proper association constants for E2-SHBG and E2-albumin are problematic (Table 1). As can be seen, there is a >3-fold difference in the highest vs. the lowest Ka for estradiol-SHBG and an almost 2-fold difference in the highest vs. the lowest Ka for estradiol–albumin. Thus, depending on the choice of Ka, widely discrepant values would be calculated. Finally, it is possible for a variety of other steroids to compete for binding with E2. This would raise the concentration of free estradiol, but is not ordinarily taken into account in calculated values. For the most part, this does not appear to be a problem in non-pregnant women (in whom competing steroids do not circulate in sufficiently high concentrations to increase free estradiol) but can yield incorrect results in the presence of unsuspected competitors or in known situations, such as male plasma, where the concentration of T far exceeds that of estradiol and displaces it from SHBG binding sites. If competitors are present and measured, the overall binding equations can be altered and appropriate corrections can be made [11]. Despite all these caveats, calculation is the prevalent way that free E2 is estimated. For those agreeing on the various measurements, and using the same Ka’s, the results can be comparable, thus giving the false impression of ‘‘accuracy by the majority.’’ Finally, it has been suggested that the binding of ligands to SHBG is allosteric and that the two binding sites on the homodimer do not have the same Ka. Occupancy of one of the sites on the homodimer is posited to alter the Ka of the other. Modeling based on this concept is said to result in calculated values in better agreement with careful measurements of free estradiol than previous models [12].

2.2. Measure

As stated above, free E2 in plasma is a theoretical construct that follows from the Law of Mass Action which was formulated by chemists in the late 1800’s and ‘‘explains and predicts behaviours [sic] of solutes in dynamic equilibrium.’’ Acceptance of the Law of Mass Action does not necessarily imply that all the components of an equilibrium mixture can be accurately measured or, indeed, how it is to be done. Whatever method is used ideally should not: disturb the equilibrium that exists in vivo; change the environment that exists in vivo (ionic strength pH, etc); and be accomplished at the same temperature that exists in vivo. The two methods that best approximate these criteria are equilibrium dialysis and centrifugal ultrafiltration (see Table 2)

2.2.3. Choose a method

The choice is guided by both convenience/ease and the desire to obtain the answer most likely to coincide with the true value of free E2. Whichever method one chooses, E2 must be accurately and reproducibly measured; this is required whether one calculates or measures. Once having conceded the ability to measure E2, then the calculation offers the advantages of simplicity and economy. SHBG and albumin are easily measured and the calculation is automated. On the negative side: there is disagreement about the proper Ka’s and SHBG is not properly standardized/harmonized. In spite of these potential hazards, a number of communications have claimed excellent agreement between calculated and measured values for free testosterone [13,16,20] and free estradiol [13]; however, a number of publications find disagreement between measured and calculated values [21–23]. In addition the calculation of free E2 has been compared to measured values, and found to be satisfactory, in only a small sample of postmenopausal patients [13]; the authors caution against using the calculated value in other populations. Moreover, it should be recalled that E2 is bound to SHBG 2–3-fold less tightly to SHBG than is testosterone, rendering the assumption of a fixed value for albumin unacceptable until the appropriate calculations and experiments are at hand. This is still an unsettled issue and no irreversible recommendations as to the best way to proceed can be issued at this time.


We need to keep this in mind

 

[madman]

Regarding accuracy when measuring free E2 one needs to make sure they are using Liquid chromatography tandem mass spectrometry (LC/MS/MS); equilibrium dialysis.





Labcorp:500649: Estradiol Free, Equilibrium Dialysis, With... | LabCorp


Estradiol Free, Equilibrium Dialysis, With Total Estradiol, HPLC/MS-MS (Endocrine Sciences)
TEST:500649
Test number copied

CPT: 82670; 84999


Methodology
Liquid chromatography tandem mass spectrometry (LC/MS/MS); equilibrium dialysis







OR



Quest:Quest Diagnostics: Test Directory

Estradiol, Free
Test Code
36169
CPT Code(s)
82670 (x2)


Methodology
Chromatography/Mass Spectrometry (LC/MS) • Equilibrium Dialysis

 

[Gman86]

Still basing your FT off that garbage direct immunoassay I see?


Your FT levels are ridiculously high @ trough 56.77 ng/dL on the 2-20-19 protocol.




Using the newer calculated TruT method with a TT 1670 ng/dL, SHBG 44 nmol/L (by no means that high), Albumin 4.6 g/dL than your FT is 56.77 ng/dL (way too high.....reference range 16-31 ng/dL).
View attachment 7793


Could have easily brought your FT levels down and dropped the a.i.

You used to run a TT 1800+ ng/dL.....whole time your FT levels would have been absurdly high.....well over 60+ ng/dL.




Your FT levels are still very high 48.24 ng/dL on the new 4-30-19 protocol.


TT 1423 ng/dL, SHBG 63 nmol/L, Albumin 4.3 g/dL than your FT is 48.24 ng/dL (still very high.....reference range 16-31 ng/dL).
View attachment 7794


You still easily have room to bring your FT levels down if need be.....unless you feel great overall and are not experiencing any negative effects.....as you should know many can end up feeling just as good with FT levels at the top of or slightly above the top end of the reference range (using an accurate FT testing method such as the gold standard Equilibrium Dialysis or Ultrafiltration or the newer TruT Free Testosterone Calculator by FPT.....which is on par with results obtained when compared to the gold standard Equilibrium Dialysis.


Most can easily do well with FT levels in the 30 ng/dL range......sure some may need/choose to run higher levels 30-50 ng/dL.....but highly doubtful anyone needs to be running FT levels 50+ ng/dL to benefit from testosterone replacement therapy.

Man, thanks for taking the time to assess my labs and give your feedback on them. Much appreciated.

So do you think that everyone’s SHBG sticks to free hormones the exact same in everybody? For instance, do you think that every guy with identical total T, SHBG, and albumin values have identical free T levels? You don’t think that there’s such a thing as some men’s SHBG binding to free hormones more or less than someone else with the same total T, SHBG, and albumin levels? Honest questions. Just curious what your thoughts are. Thanks.

 

[Cataceous]

So is the tentative verdict here that if we want to figure out free E2 cheaply, it's best to get the standard E2 test and use the calculator?

Maybe. It's bothering me that the agreements between calculated and "measured" seem almost too good to be true. @Gman86 has provided many samples and @GeauxBears provided one here. I'd like to be sure these are direct measurements and are not just calculated by the labs. The LabCorp test and Quest test appear to be the real deal. But it's less clear for the Mayo Clinic version, which includes SHBG.

 

[Gman86]

The test I’ve been getting done for years is the Total, free and bioavailable testosterone test from quest. It includes total T, free T, bio T, SHBG and albumin. Check out the methodology. Does this mean that the free T test that I’ve been getting done is calculated?

 

[Cataceous]

The test I’ve been getting done for years is the Total, free and bioavailable testosterone test from quest. It includes total T, free T, bio T, SHBG and albumin. Check out the methodology. Does this mean that the free T test that I’ve been getting done is calculated?

They are measuring total T, SHBG and albumin. From these they calculate free T and bio T. The method of calculation isn't clear, as your result above is much lower than what the standard calculators say.

 

[Gman86]

They are measuring total T, SHBG and albumin. From these they calculate free T and bio T. The method of calculation isn't clear, as your result above is much lower than what the standard calculators say.

Wow, so I guess my free T levels for the past 5 years have been calculated this whole time. I’ve always thought that my free T levels have come back lower than most due to “stickier” SHBG than most guys. But maybe it’s just due to Quest’s calculation method calculating lower free T levels than other calculation methods.

What I’m going to do from now on is when I get my labs done through quest, I’ll just separately pay out of pocket and get my total and free T tested, the same day, using discountedlabs.com. They have a test that’s around $30 that will tell me my directly measured total and free T level, using labcorp. Here’s the details. This test uses directly measured free T correct? This way I’ll be able to compare my calculated free T with quest vs my direct free T with labcorp.

 

[Gman86]

Has anyone used discounted labs before? I assume you don’t need a prescription, and just pay, print out the requisition, and go to labcorp to get ur blood drawn.

 

[Cataceous]

...
What I’m going to do from now on is when I get my labs done through quest, I’ll just separately pay out of pocket and get my total and free T tested, the same day, using discountedlabs.com. They have a test that’s around $30 that will tell me my directly measured total and free T level, using labcorp. Here’s the details. This test uses directly measured free T correct? This way I’ll be able to compare my calculated free T with quest vs my direct free T with labcorp.

Save your money. This is the inaccurate and unreliable free T test, and you already have total. Instead, plug past and current numbers into the Tru-T calculator. These results should correlate well with what the expensive free T tests would give.