High bioavailable and dht

[bluerage]

Currently injecting 45 mg e3d (100 mg weekly) via shallow IM (alternating between glutes and delts). Latest labs look good except for my bioavailable and dht.
Total T 13.3 nnmol/L (6.0-27.0) or 383 ng/dL
Free T 492 pmol/L (196-636) or 38.23 ng/dL
Bioavailable 12.5 nmol/L (3.6-11.2) or 360.2 ng/dL
DHT 3755 pmol/L (860-3406) or 291.8 ng/dL
My SHBG measures at the lower end but within range. Should I be concerned with the high bioavailable and dht or should I be trying to increase my total T and free T numbers to the upper range?
If anyone from Canada reads this can you tell me if we our labs do the sensitive estradiol test here? My doctor wasn't sure what test the labs do with the estradiol. For reference my result was
73 pmol/L (0-172) or 21pg/mL???

 

[Vince Carter]

Low SHBG often shows itself in high Free T, which is a very good thing, trade off is low TT, as shown here. Think of it as though the speed to which your body goes through that 45mg. Most of us like you do best on EOD injections, if not daily injections of Cyp.
DHT I wouldn't do anything about that, DHT is NOT a bad thing but PSA should be monitored, as well as any hairloss. If nothing bad is going on DHT such as yours in not at all bad. In fact, I have to purposely try to raise my DHT from being low.
I don't know about your Estradiol, those numbers are different too me. look up member Coastwatcher, he's Canadian.

 

[bluerage]

Thanks.
PSA results came back well in range.
In my case I my total T and free T are both more or less midrange. It's only my bioavailable T this is upper end.
So which of the 3 is most important to dial in, total t, free t or bioavailable T?

 

[Vince Carter]

Thanks.
PSA results came back well in range.
In my case I my total T and free T are both more or less midrange. It's only my bioavailable T this is upper end.
So which of the 3 is most important to dial in, total t, free t or bioavailable T?

That doesn't mean anything around here...like you did, numbers with lab ranges are what we can work with here. You can have a PSA of 4 and be "in range" yet would be a severe indicator of a potential problem. Just like your SHBG, "in range" is useless info.
Assuming your blood draw was in a trough, I think you're total T has a long way to go, we typically have troughs of >800 if not to a 1000. Let's assume your SHBG is <15 in which case you could consider 50mg EOD for 6 weeks and retest. It's important to only change one thing at a time.

 

[CoastWatcher]

If anyone from Canada reads this can you tell me if we our labs do the sensitive estradiol test here? My doctor wasn't sure what test the labs do with the estradiol. For reference my result was
73 pmol/L (0-172) or 21pg/mL???

You face a challenge, as most men living outside of the US do when it comes to estradiol testing. You want the sensitive test, LC,MS/MS - and it is very hard to obtain in Canada. I have tested at one of the large hospitals in Toronto, but I typically obtain estradiol levels when I travel to the States (which I regularly do). As my - very capable - doctor says, "What in the world am I supposed to do with those results?", when confronted with the sort of reports you just posted.

Send me a private message, and I will share some ideas on how you might proceed.

 

[bluerage]

That doesn't mean anything around here...like you did, numbers with lab ranges are what we can work with here. You can have a PSA of 4 and be "in range" yet would be a severe indicator of a potential problem. Just like your SHBG, "in range" is useless info.
Assuming your blood draw was in a trough, I think you're total T has a long way to go, we typically have troughs of >800 if not to a 1000. Let's assume your SHBG is <15 in which case you could consider 50mg EOD for 6 weeks and retest. It's important to only change one thing at a time.

Wouldn't increasing my dose also result in a further increase in bio available and dht? Anyway my doctor would not agree to increase my dose since I'm already over range with my bio available. He's already strongly suggested that we lower the dose. While trt has greatly improved my mood and physique, I feel that I'm still missing out on the full benefits.

 

[ERO]

You would be increasing your weekly dose but most importantly increasing your injection frequency, which would most likely raise your Total T levels. I would be happy with high DHT and not want to lower it unless I had high PSA readings if it were me.

 

[bluerage]

While I do believe that increasing my dose and frequency of injection would raise my total T, I am concern that it would also raise my bio available and dht by the similar amounts. Since I'm already over the high end of the range in both, I would imagine I would be off the charts if I managed to get my total t to a respectable level.
My main concern with high dht levels are the cystic acne I'm getting on my face and the thinning hair on the top of my head.

 

[Vince Carter]

While I do believe that increasing my dose and frequency of injection would raise my total T, I am concern that it would also raise my bio available and dht by the similar amounts. Since I'm already over the high end of the range in both, I would imagine I would be off the charts if I managed to get my total t to a respectable level.
My main concern with high dht levels are the cystic acne I'm getting on my face and the thinning hair on the top of my head.

The acne, trust me, is most likely estrogen related first and foremost. Yes DHT can be there along with the balding, so reduce your dose if you like, that's a key marker for just about everything, if you're not satisfied with where YOU are at, you can change it.

 

[bluerage]

Most posts on here refer to TT but my doctor insists that bio available T is what we should be focusing on. Thoughts?

 

[Vince Carter]

Some do focus on Free T, it's not common here as an end goal of HRT, an important part but as you notice we tend to focus on TT and then free T, even that over range, is seen as a good thing. You are indeed captured to what your Dr is willing to treat to a great extent.

 

[bluerage]

Yes it wasn't easy finding a doctor willing to start me on TRT so I'm hesitant to suggest changes that I'd like to see. I don't want to risk him telling me to find someone else.

 

[bluerage]

Some do focus on Free T, it's not common here as an end goal of HRT, an important part but as you notice we tend to focus on TT and then free T, even that over range, is seen as a good thing. You are indeed captured to what your Dr is willing to treat to a great extent.

For those with above range TT/FT/Bio Available T do you have any trouble convincing your doctor that this is a good thing if all your other values are in a good place?

 

[CoastWatcher]

Free/bioavailable testosterone are notoriously tough to measure. I sent you a message with an overview of the challenges.