Help With Lab Results and TRT

[DorianGray]

Started TRT and HCG 5/16/20. Now, symptoms of fatigue, periodic, mild anxiousness (almost shaky), mild brain fog.

Here is Lab before starting TRT/HCG:

 

[DorianGray]

Lab Results Now (One is from LabCorp other from Quest. These were taken one hour apart 8am and 9am, respectively. Daily Test Cream applied at 6am before tests-3 pumps):

I know there is difference in analytical methods but there is a huge difference in Total Testosterone. Does this seem right? I have stopped TRT since three days ago. Feel a bit less jittery.

 

[Systemlord]

Started TRT and HCG 5/16/20. Now, symptoms of fatigue, periodic, mild anxiousness (almost shaky), mild brain fog.

TRT can't work when there is a thyroid problem, your TSH is 4.1 indicating your thyroid is struggling.

Your Free T3 is on the low side and should be at least midrange. The Free T3 hormone provides energy for every organ in the body, including the liver which metabolizes testosterone.

You're also need to address the low ferritin and isn't uncommon to see iron deficiency in people with hypothyroidism.

 

[DorianGray]

My T3 has always been in the low range 2.3-2.9 over the years but this is the first time I've ever felt real fatigue. I'll up the vitamin C to address the iron for now also.

 

[madman]

Lab Results Now (One is from LabCorp other from Quest. These were taken one hour apart 8am and 9am, respectively. Daily Test Cream applied at 6am before tests-3 pumps):

I know there is difference in analytical methods but there is a huge difference in Total Testosterone. Does this seem right? I have stopped TRT since three days ago. Feel a bit less jittery.

.
Why would you have testing done twice using different labs let alone assays for FT?

Labcorp and Quest TT are both LC/MS-MS and it is odd that there is such a drastic difference as labs were done at 2 and 3hr.

Transdermal gels peak 2-4hr post application.

Mind you with the scrotal application levels will start to rise within 1hr and a swift peak is reached between 2-3 hr so say if you applied the cream and had blood work done twice (1hr and 2hr instead of 2 and 3hr) then I could see a large difference in TT.

Labcorp FT is the direct immunoassay that I would not rely on and Quest is Equilibrium Dialysis (most accurate) which is what matters.

Your FT is so high due to your TT 1600+ ng/dL and that is even with highish SHBG.

Your FT is even high on your Labcorp results with a TT 927 ng/dL even with highish SHBG but I would not rely on the direct immunoassay.

As you can see your TT/FT levels are very high but it is your peak on (transdermal compounded cream).

Where are you applying the cream (scrotal or standard application) as your DHT is through the roof?

 

[DorianGray]

@madman Thanks for your reply. I did the different labs because of the fundamental question about decision points for the doctor prescribing such treatments. I hope it provides some perspective for others. So, yes, it was basic scientific curiosity on my part to compare labs. This is why I wanted to get them done as close to the same time as possible. I use the cream from Empower. 200mg/ml. 1 click to scrotum, 2 clicks to shoulder. As I mentioned I applied the cream that day at 6am, then LabCorp test at 8am, then Quest (Discount Lab) dialysis test at 9am. Could there have been an extreme peak in absorption at that last hour accounting for the wide difference in results?

I'm thinking of cutting back on dose until my consult with MD which, unfortunately is booked out due to his schedule about three weeks.

 

[madman]

@madman Thanks for your reply. I did the different labs because of the fundamental question about decision points for the doctor prescribing such treatments. I hope it provides some perspective for others. So, yes, it was basic scientific curiosity on my part to compare labs. This is why I wanted to get them done as close to the same time as possible. I use the cream from Empower. 200mg/ml. 1 click to scrotum, 2 clicks to shoulder. As I mentioned I applied the cream that day at 6am, then LabCorp test at 8am, then Quest (Discount Lab) dialysis test at 9am. Could there have been an extreme peak in absorption at that last hour accounting for the wide difference in results?

I'm thinking of cutting back on dose until my consult with MD which, unfortunately is booked out due to his schedule about three weeks.

I would have only done this if you were using the same assays for TT/FT.

The assay for TT (LC-MS/MS) was the same but the assay for FT (direct/Equilibrium Dialysis) was not.

Regarding the absorption, hard to say and you used different application sites scrotal/shoulder.

 

[madman]

TT is important to know but FT is what truly matters as it is the active unbound fraction of testosterone responsible for the beneficial effects.

Critical that you have it tested using the most accurate assays so you will know where your FT level truly sits on such protocol (dose T/injection frequency).

Some men are running much higher levels than they think due to the use of piss poor testing methods.

 

[DorianGray]

Well I definitely think that was the case here.