Hi, new guy (40) on TRT from the Netherlands

[mrblonde01]

Welcome to Nelson's domain!

Was your blood work done in the early AM in a fasted state?

We always want to test at peak (highest point).

Although a TT 13.9 nmol/L (400.9 ng/dL) is far from stellar it is not a given that your FT is low.

Need to know where your SHBG sits.

You are missing the most critical blood marker which is free testosterone.

Keep in mind that 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.

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration.

If you do not have access to such then you will need to use/rely upon the linear law-of-mass action cFTV which is available online for free.

Need to know where your TT, SHBG, and Albumin sit to calculate your FT.

If you do not have Albumin then you can just use 4.3 ng/dL (default).

Free & Bioavailable Testosterone calculator

The bottom line here is you were missing the most critical blood marker FT yet still hopped on therapy without even knowing where it sits.

Too late now as the clinic treating you most likely jacked up your levels from the get-go.

Bad move without a thorough set of labs let alone getting one of those run-of-the-mill T clinics to manage your TTh.

Most of these idiots jack up your T straight out the gate without even understanding how esterified exogenous T works.

Start low and go slow on a T-only protocol is where it's at as we want to see how your body reacts to testosterone and where said protocol (dose of T/injection frequency) will have your trough TT, FT, and estradiol let alone other critical blood markers such as RBCs, hemoglobin and hematocrit.

When first starting TTh or tweaking a protocol (dose T/injection frequency) hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE) and it is common to experience ups/downs along the way as the body is trying to adjust.

More importantly, once blood levels have stabilized (4-6 weeks TC/TE) it will still take time (a few months) for the body to adapt to its new set-point and this is the critical time when one needs to gauge how they truly feel overall regarding relief/improvement of low-T symptoms.

Every protocol needs to be given a fighting chance (12 weeks) before claiming it was truly a success or failure.

The goal would be using the lowest weekly dose that would allow one to hit/maintain a healthy trough FT level to reap the beneficial effects while at the same time minimizing/preventing sides (cosmetic/blood markers).

Lots of time to increase your dose or add hCG if needed.

Should have looked into this deeper before hopping on.

Keep in mind any dysfunction of the thyroid/adrenals can easily mimic low-T symptoms.

Your starting protocol is overkill!

The common starting dose is 100 mg T/week or better yet 50 mg T twice weekly (every 3.5 days).

You blew past this out the gate!

Most men on TTh are injecting 100-200mg T/week whether once weekly or split into more frequent injections such as twice-weekly (every 3.5 days), EOD, or daily.

Even then the majority of men can easily hit a healthy let alone high trough FT injecting 100-150 mg T/week especially when split into frequent injections.

Yes, some outliers may need the higher-end dose of 200 mg/week but this is far from common.

175 mg T/week off the hop + hCG is going to most likely have your trough FT too high let alone drive up your RBCs, hemoglobin, and hematocrit.

Keep in mind running too high a trough FT can be just as bad in many ways as running too low an FT especially when it comes to libido/erectile function and mood.

Many make the mistake of getting caught up in that more T is better mentality jacking up their T levels off the hop.

Many may feel great when first starting (a few months in) only to be let down in the long run especially when it comes to libido/erectile function.

Only time will tell.

Luckily you are 3 months in and feel great overall.

Hopefully, it lasts.

Stick with what is working for you.

Will be interesting to see labs at the 6-week mark.

Again if you do not have access to the most accurate assays (ED/UF) for testing FT then you will need to use/rely upon the cFTV.

Thank you so much for this extensive reply!

Yes, my bloodwork was done in the morning in a fasted state.

I understand it was better to have had a more extensive blood report done beforehand, but this was also a journey of developing insights, and without proper guidance from the doctor, I had to do it myself.

Considering this seems to work very, very well, and I can't go back now, the best way forward would be to find a good place for bloodwork in the Netherlands or EU, if possible.

 

[Systemlord]

Yes, a shitload of vegetables (fibrous carbs).

The human digestion system can’t break down fiber, fiber dilutes stomach acid. Plant chemical interfere with acid and absorption of minerals. Plant based protein has very poor bioavailability.

Fiber may also reduce the energy value of foods through inhibiting digestion and absorption of other energy-providing macronutrients in the diet. Thus, Baer et al. and Miles found that both fat and protein digestibility was negatively affected when fiber content in diets increased.

Our acid base digestion system is biologically optimized for fatty red meat, B12, protein, minerals all of which neutralize bacteria.

 

[madman]

The human digestion system can’t break down fiber, fiber dilutes stomach acid. Plant chemical interfere with acid and absorption of minerals. Plant based protein has very poor bioavailability.

Fiber may also reduce the energy value of foods through inhibiting digestion and absorption of other energy-providing macronutrients in the diet. Thus, Baer et al. and Miles found that both fat and protein digestibility was negatively affected when fiber content in diets increased.

Our acid base digestion system is biologically optimized for fatty red meat, B12, protein, minerals all of which neutralize bacteria.

Well versed here.

Never had an issue!

 

[mrblonde01]

Not sure how this turned into a carnivore diet discussion, but here we are

 

[Seagal]

Not sure how this turned into a carnivore diet discussion, but here we are

If you find a decent place to get all the bloodwork mentioned by madman, please let me know.

 

[mrblonde01]

I found this place for bloodwork: Davey's Check-up voor bodybuilders

It checks (this is in dutch):

• Leukocyten*
• Erytrocyten*
• Hematocriet*
• MCV*
• MCH*
• MCHC*
• Trombocyten*
• Hemoglobine* (Hb)*
• ASAT
• ALAT
• Albumine
• gamma-GT
• Ureum*
• Creatinine*
• Triglyceriden*
• HDL*
• LDL*
• Totaal cholesterol*
• Cholesterol/HDL ratio*
• HDL/LDL risico index*
• TSH, schildklier
• Creatinekinase (CK)*
• Testosteron
• Vrij testosteron
• SHBG
• Oestradiol (17-ß-Estradiol, E2)*

That looks alright, does it? So, since I pin twice a week (saturday and wednesday) what would be the best time to do this bloodtest?

 

[mrblonde01]

My local blood centre takes blood on Monday morning. Is that an ok time to test my blood when I pin Wednesday and Saturday?

 

[Systemlord]

My local blood centre takes blood on Monday morning. Is that an ok time to test my blood when I pin Wednesday and Saturday?

You always draw labs at trough.

 

[mrblonde01]

You always draw labs at trough.

Excuse me, I'm not a native speaker, what does 'drawing at trough' mean?

Edit; thank you ChatGPT:

"When someone mentions "drawing labs at trough" in the context of testosterone replacement therapy (TRT), they are referring to the timing of blood tests to measure testosterone levels. Here's a breakdown:

1. Trough: In TRT, "trough" refers to the lowest point in the testosterone concentration cycle, which typically occurs just before the next dose of testosterone is due. This is usually right before you take your next scheduled dose.
2. Drawing labs: This means taking blood samples for laboratory testing.

So, "drawing labs at trough" means taking blood samples for testing at the time when testosterone levels are at their lowest point in the dosing cycle. This timing provides a consistent baseline for assessing testosterone levels and helps healthcare providers make informed decisions about adjusting the TRT regimen if necessary. It ensures that testosterone levels are measured at a point when they are least influenced by recent dosages, providing a more accurate reflection of the body's natural testosterone production or the effectiveness of the TRT regimen."

So If I pin saturday and wednesday typically, but I can only draw blood on monday...should i maybe shift my moment of pinning T so I have a better 'low' time at that monday?

 

[mrblonde01]

Alright guys, I got the bloodwork, what do you think? Is estradiol a big concern? Again, I'm on 175mg testosterone a week, divided in 2 pins, and 500iu of HCG, also divided in 2 pins.

EDIT: Check the PDF for values

 

[Seagal]

Alright guys, I got the bloodwork, what do you think? Is estradiol a big concern? Again, I'm on 175mg testosterone a week, divided in 2 pins, and 500iu of HCG, also divided in 2 pins:

**HEMATOLOGY**
- Leucocytes: 5.8 x 10^9/L → 5.8 x 10^3/µL
- Erythrocytes: 4.6 x 10^12/L → 4.6 x 10^6/µL
- Hemoglobin: 8.5 mmol/L → 13.8 g/dL
- Hematocrit: 0.41 L/L → 41%
- MCV: 82 fL → 82 µm^3
- MCH: 1.59 fmol → 26 pg
- MCHC: 1.86 mmol/L → 186 g/L
- RDW-CV: 13.9% (no conversion needed)
- Thrombocytes: 286 x 10^9/L → 286 x 10^3/µL

**CLINICAL CHEMISTRY**
- Cholesterol: 5.62 mmol/L → 217 mg/dL
- HDL-Cholesterol: 1.06 mmol/L → 41 mg/dL
- Cholesterol/HDL ratio: 5.3 (no conversion needed)
- LDL-Cholesterol: 3.63 mmol/L → 140 mg/dL
- LDL/HDL risk index: 3.4 (no conversion needed)
- Triglycerides: 2.39 mmol/L → 211 mg/dL
- ASAT (GOT): 22 U/L (no conversion needed)
- ALAT (GPT): 19 U/L (no conversion needed)
- Gamma-GT: 84 U/L (no conversion needed)
- CK (Creatine Kinase): 90.2 U/L (no conversion needed)
- Urea: 3.84 mmol/L → 11 mg/dL
- Creatinine: 59.2 - 103.4 umol/L → 0.67 - 1.17 mg/dL

**PROTEIN DIAGNOSTICS**
- Albumin: 45.2 g/L → 4.52 g/dL

**ENDOCRINOLOGY**
- TSH: 1.23 mU/L → 1.23 µIU/mL
- Estradiol: 216.9 pmol/L → 59 pg/mL
- Testosterone: 39.6 nmol/L → 1143 ng/dL
- Free Testosterone: 0.961 nmol/L → 27.7 pg/mL
- SHBG: 33.1 nmol/L → 956 ng/dL

Your hematocrit is at 0.59, according to the attached lab report. That seems to be too high.
How are you feeling?

 

[mrblonde01]

Your hematocrit is at 0.59, according to the attached lab report. That seems to be too high.
How are you feeling?

Generally I feel good, I could have more energy though, sometimes I feel tired. Mood is good, slightly faster annoyed but it's subtle. Libido is great, motivation high.

Looking at blood pressure; when I have sex or excersize it does cause a exertion headache.

 

[Seagal]

Generally I feel good, I could have more energy though, sometimes I feel tired. Mood is good, slightly faster annoyed but it's subtle. Libido is great, motivation high.

Looking at blood pressure; when I have sex or excersize it does cause a exertion headache.

My advice is to look at the previous post of @madman and maybe try 150mg instead of 175mg. Hematocrit sometimes goes down again after a while. Checking your BP is a good idea. Drink enough water. Most here will probably say that your estradiol is normal wrt the TT. Are you injecting SC or IM?

 

[mrblonde01]

My advice is to look at the previous post of @madman and maybe try 150mg instead of 175mg. Hematocrit sometimes goes down again after a while. Checking your BP is a good idea. Drink enough water. Most here will probably say that your estradiol is normal wrt the TT. Are you injecting SC or IM?

Good to hear about that estradiol! Drinking enough water makes a big difference for me indeed. I could also excersize some more, even though I walk for about one hour every morning, always.

I'll try to check my BP, do you think it's high because of those exertion headaches?

I'm injecting shallow IM. Lowering to 150 sounds like a good idea. Do a lot of people end up at that point?

 

[madman]

Alright guys, I got the bloodwork, what do you think? Is estradiol a big concern? Again, I'm on 175mg testosterone a week, divided in 2 pins, and 500iu of HCG, also divided in 2 pins:

**HEMATOLOGY**
- Leucocytes: 5.8 x 10^9/L → 5.8 x 10^3/µL
- Erythrocytes: 4.6 x 10^12/L → 4.6 x 10^6/µL
- Hemoglobin: 8.5 mmol/L → 13.8 g/dL
- Hematocrit: 0.41 L/L → 41%
- MCV: 82 fL → 82 µm^3
- MCH: 1.59 fmol → 26 pg
- MCHC: 1.86 mmol/L → 186 g/L
- RDW-CV: 13.9% (no conversion needed)
- Thrombocytes: 286 x 10^9/L → 286 x 10^3/µL

**CLINICAL CHEMISTRY**
- Cholesterol: 5.62 mmol/L → 217 mg/dL
- HDL-Cholesterol: 1.06 mmol/L → 41 mg/dL
- Cholesterol/HDL ratio: 5.3 (no conversion needed)
- LDL-Cholesterol: 3.63 mmol/L → 140 mg/dL
- LDL/HDL risk index: 3.4 (no conversion needed)
- Triglycerides: 2.39 mmol/L → 211 mg/dL
- ASAT (GOT): 22 U/L (no conversion needed)
- ALAT (GPT): 19 U/L (no conversion needed)
- Gamma-GT: 84 U/L (no conversion needed)
- CK (Creatine Kinase): 90.2 U/L (no conversion needed)
- Urea: 3.84 mmol/L → 11 mg/dL
- Creatinine: 59.2 - 103.4 umol/L → 0.67 - 1.17 mg/dL

**PROTEIN DIAGNOSTICS**
- Albumin: 45.2 g/L → 4.52 g/dL

**ENDOCRINOLOGY**
- TSH: 1.23 mU/L → 1.23 µIU/mL
- Estradiol: 216.9 pmol/L → 59 pg/mL
- Testosterone: 39.6 nmol/L → 1143 ng/dL
- Free Testosterone: 0.961 nmol/L → 27.7 pg/mL
- SHBG: 33.1 nmol/L → 956 ng/dL

Where did your hematocrit sit pre-TRT?

Screenshot of your labs is showing an extremely high hematocrit 59% which is well over the cut-off 54%.

If anything I would be retesting it and regardless it will most likely come back high due to your very high trough FT level which also means your peak levels will be much higher.

Although other factors such as dehydration, sleep apnea, smoking, asthma, COPD can cause elevated hematocrit this is a common side-effect when using exogenous testosterone especially from running too high a trough FT level.

Clear as day that your starting dose 175 mg T/week split into twice-weekly injections (87.5 mg every 3.5 days) is too high seeing as you are hitting a very high trough TT 1143 ng/dL with a normal SHBG 33.1 nmol/L which has your trough FT 27.8 ng/dL very high!

Your peak TT, FT and estradiol will be even higher.

Estrogen is expected to be higher due to high FT.

Your FT wass calculated using the linear law-of-mass action cFTV.

Again with a very high trough TT 1143 ng/dL, normal SHBG 33.1 nmol/L and Albumin 4.5 g/dL your trough FT 27.8 ng/dL is very high!

You were overmedicated on T from the get-go let alone hCG was thrown in to boot.

Common starting dose is 100 mg T/week or better yet 50 mg T every 3.5 days.

Most men are injecting 100-200 mg T/week.

The majority of men can easily hit a healthy/high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.

Yes there are some outliers that may need the higher-end dose 200 mg T/week but it is far from common as in RARE!

Complete overkill to say the least.

You need to rethink this one through.

Too many caught up on that more T is better mentality let alone thinking they need to be hitting >1000 trough TT with an absurdly high trough FT to boot!

Pure nonsense pushed by those dime a dozen T-mills let alone all those blast n cruizerzzz polluting all the so called men's health forums littered on the internet!

T.Cyp 100 mg/week - Night sweats, anxiety

Sorry to hear you are struggling there mate. Something similar I had as well or at least some of the symptoms you've listed. Most of mine were- elevated BP and RHR, some anxiety, feeling hot and overstimulation, as I believe. My protocol of choice, since starting TRT less then 12 months ago...

www.excelmale.com

 

[mrblonde01]

Update: apparently I pasted the reference values instead of the actual values, please check the pdf for the correct ones

 

[mrblonde01]

T

Where did your hematocrit sit pre-TRT?

Screenshot of your labs is showing an extremely high hematocrit 59% which is well over the cut-off 54%.

View attachment 42616

If anything I would be retesting it and regardless it will most likely come back high due to your very high trough FT level which also means your peak levels will be much higher.

Although other factors such as dehydration, sleep apnea, smoking, asthma, COPD can cause elevated hematocrit this is a common side-effect when using exogenous testosterone especially from running too high a trough FT level.

Clear as day that your starting dose 175 mg T/week split into twice-weekly injections (87.5 mg every 3.5 days) is too high seeing as you are hitting a very high trough TT 1143 ng/dL with a normal SHBG 33.1 nmol/L which has your trough FT 27.8 ng/dL very high!

Your peak TT, FT and estradiol will be even higher.

Estrogen is expected to be higher due to high FT.

Your FT wass calculated using the linear law-of-mass action cFTV.

Again with a very high trough TT 1143 ng/dL, normal SHBG 33.1 nmol/L and Albumin 4.5 g/dL your trough FT 27.8 ng/dL is very high!

View attachment 42615



You were overmedicated on T from the get-go let alone hCG was thrown in to boot.

Common starting dose is 100 mg T/week or better yet 50 mg T every 3.5 days.

Most men are injecting 100-200 mg T/week.

The majority of men can easily hit a healthy/high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.

Yes there are some outliers that may need the higher-end dose 200 mg T/week but it is far from common as in RARE!

Complete overkill to say the least.

You need to rethink this one through.

Too many caught up on that more T is better mentality let alone thinking they need to be hitting >1000 trough TT with an absurdly high trough FT to boot!

T.Cyp 100 mg/week - Night sweats, anxiety

Sorry to hear you are struggling there mate. Something similar I had as well or at least some of the symptoms you've listed. Most of mine were- elevated BP and RHR, some anxiety, feeling hot and overstimulation, as I believe. My protocol of choice, since starting TRT less then 12 months ago...

www.excelmale.com

Thanks for the extensive reply! I do have asthma and have corticosteroïd medication (inhalation + nose spray for separate allergies) for that.

Hematocrit pre test was unknown, unfortunately

Edit: looks like I might have to reevaluate indeed. Lower the dose to 100mg a week, keep that up for 3 months and re-test bloodwork. Sounds like a plan?

 

[madman]

T

Thanks for the extensive reply! I do have asthma and have corticosteroïd medication (inhalation + nose spray for separate allergies) for that.

Hematocrit pre test was unknown, unfortunately

CBC (complete blood count) which includes critical blood markers RBCs, hemoglobin and hematocrit needs to be done pre/post testosterone therapy.

If anything I would be retesting your H/H!

Make sure you are well hydrated (fluids/electrolytes) days before you have your blood drawn otherwise the results can be skewed.

Even if it does not come back in the high 50s it is most likely still high due to your very high trough FT level on your current protocol!

 

[madman]

T

Thanks for the extensive reply! I do have asthma and have corticosteroïd medication (inhalation + nose spray for separate allergies) for that.

Hematocrit pre test was unknown, unfortunately

Edit: looks like I might have to reevaluate indeed. Lower the dose to 100mg a week, keep that up for 3 months and re-test bloodwork. Sounds like a plan?

I already laid out my advice a month ago in post #10 which you clearly did the opposite.

Key point here being start low and go slow on a T-only protocol.

Yes you easily have room to lower your trough FT level but I am not going to tell you what to do here other then do what you feel is best for you!

Again retest your H/H.

 

[mrblonde01]

I already laid out my advice a month ago in post #10 which you clearly did the opposite.

Key point here being start low and go slow on a T-only protocol.

Yes you easily have room to lower your trough FT level but I am not going to tell you what to do here other then do what you feel is best for you!

Again retest your H/H.

Thank you. To be fair though, after your message I put some pressure on getting a relevant blood test here in the netherlands to see my values, before just altering my protocol. Without data it doesn't make sense to hastily change the protocol that already seems to work wonders. I was in the wrong to start off without having that extensive data, I know that now. But after that I think I did what I could, looking at the fact that it's quite a bit harder to get guidance here in the Netherlands, I had to do everything myself.

After what time adjusting my protocol do you guys think it is relevant to retest h/h?