High SHBG and larger, first TRT dose >100mg?

[BackToRegular]

Seems the standard protocol for TRT is to start at 100mg Test C per week. Should one consider a higher starting dose if they are:

1.) Larger (in my case 6'3", 200lbs, <10%bf)
2.) Have low total T of which a very high amount is SHBG

My last test results are:
Total test: 499 ng/dL
SHBG: 55.1 nmol/L
Albumin: 4.6 g/dL
Free T: 7.26 ng/dL = 1.45 %
(Free T calculated using: Free & Bioavailable Testosterone calculator )

I understand the SHBG range to be 16.5-55.9 nmol/L, which would put me at the top of the range.

As always thanks for all the great advice y'all give.

 

[Systemlord]

Your height and weight have nothing to do with dosing, but if SHBG is on the higher end you may very well need slightly more than 100mg weekly.

Stating you have very high SHBG is vague, very high as in within range but at the top of the range or way above it?

Big difference.

 

[BackToRegular]

Your height and weight have nothing to do with dosing, but if SHBG is on the higher end you may very well need slightly more than 100mg weekly.

Stating you have very high SHBG is vague, very high as in within range but at the top of the range or way above it?

Big difference.

Thanks Systemlord. I've added my test results (including SHBG) to the original post.

 

[Vince Carter]

100mg once per week for at least 6 weeks and then test in your weekly trough, base any dose change on your Free T level. One large shot per week can tend to push down SHBG to a varying extent, or not at all. You'll just have to start and then test and see where things are.

 

[Systemlord]

Thanks Systemlord. I've added my test results (including SHBG) to the original post.

You're welcome.

Depending on where estrogen sits, this should dictate your injection frequency. There is no hard fast rule that says a high SHBG guys can't inject more frequently, in the TRT world everyone is truly unique.

In the absence of estrogen, 1-2 injections per week should be good enough, but if estrogen is say 30 pg/mL (5-35 pg/mL) with FT low, then this changes things a bit and I would consider increasing injection frequencies.

I wouldn't start out on AI's, these are to be avoided if at all possible.

 

[BackToRegular]

You're welcome.

Depending on where estrogen sits, this should dictate your injection frequency. There is no hard fast rule that says a high SHBG guys can't inject more frequently, in the TRT world everyone is truly unique.

In the absence of estrogen, 1-2 injections per week should be good enough, but if estrogen is say 30 pg/mL (5-35 pg/mL) with FT low, then this changes things a bit and I would consider increasing injection frequencies.

I wouldn't start out on AI's, these are to be avoided if at all possible.

To make sure I understand; the amount of estrogen is dependent more on injection frequency than injection amount (dose)?

Too much aromatizing (can aromatase be made a verb?) is why I'm worried about too high a dose of TRT - I don't want to develop tits, become moody, carry water, moonface, etc. This is why I'm keeping my body fat below 10%.

I assume 30 pg/mL (5-35 pg/mL) a high value given your range. Are SHBG and E2 directly or inversely related? I asked the nurse to measure my E2 to set a "baseline" in my second set of initial bloodwork but he declined saying it isn't necessary until I've started the TRT.

 

[Systemlord]

To make sure I understand; the amount of estrogen is dependent more on injection frequency than injection amount (dose)?

I have seen similar numbers between 7mg daily (49mg weekly) and 20mg EOD (80mg weekly), the only difference is estrogen, <35 and 53 on the EOD protocol. I used less testosterone the achieve those levels and I was not dealing with any excess, I had only what I needed.

Are SHBG and E2 directly or inversely related?

This will depend on the individual, but SHBG is a natural buffer for androgens. I guess it will depend on the binding force of your SHBG which can vary between individuals. Your body fat percentage will have a big impact on estrogen levels, but every now and then I see a guy who is lean and aromatising like crazy.

I'm worried about too high a dose of TRT - I don't want to develop tits, become moody, carry water, moonface, etc.

Gyno is not as common as you may believe, in fact I don't see it much on Excelmale. I see a guy with gyno maybe every 4-6 months, that is not common. The more common things I see is the symptoms of high testosterone and estrogen which is 100% reversible.

I think estrogen gets a bad rap on these forums, it's required for erections, libido, joints, bones just as much as testosterone, excess testosterone can cause mood problems like aggression and moodiness.

Believe it or not, testosterone can also cause nipple burning sensations and water retention.

I asked the nurse to measure my E2 to set a "baseline" in my second set of initial bloodwork but he declined saying it isn't necessary until I've started the TRT.

Your doctor has a lot to learn and is compromising treatment at every step to save on healthcare costs, really she is concerned about excess lab testing which insurance companies dislike. When you take insurance companies out of the equation, treatment is no longer compromised.

That's alright, you can go to Discount Labs and order your own estrogen testing if your doctor doesn't allow it in the future. Your pre-TRT estrogen levels will tell you how much testosterone is being converted to estrogen, this is invaluable for selecting the appropriate injection frequency.

 

[BackToRegular]

SystemLoad - again unbelievably helpful response. Great news on not getting quick tits - phew! If they did start growing I assume I could just reduce/cease TRT. I'm hoping I can handle the other non-fertility related side effects if E2 creeps up.

I do have a Estradiol results from a few years ago where the total T was 410 and the E2 was 24 pg/mL. Seems to be slightly above midrange. Is this of use in determining injection frequency? The test did not include SHBG (however it did include albumin).

Based on your sage advice appears I need to contact the office and:
1.) Lower their starting weekly dose from 210 to 100~150mg Test C
2.) Check if my insurance will cover two office visits a week with half dose each time. If not I'll have to ask if they'll let me take the second dose home with me.

To utilize Discount Labs it appears I'll still need to find a phlebotomist to take my blood - or can someone take their own blood?

 

[madman]

Seems the standard protocol for TRT is to start at 100mg Test C per week. Should one consider a higher starting dose if they are:

1.) Larger (in my case 6'3", 200lbs, <10%bf)
2.) Have low total T of which a very high amount is SHBG

My last test results are:
Total test: 499 ng/dL
SHBG: 55.1 nmol/L
Albumin: 4.6 g/dL
Free T: 7.26 ng/dL = 1.45 %
(Free T calculated using: Free & Bioavailable Testosterone calculator )

I understand the SHBG range to be 16.5-55.9 nmol/L, which would put me at the top of the range.

As always thanks for all the great advice y'all give.

Although your TT is average 499 ng/dL.....seeing as your SHBG is higher (top end of the range) at 55.1 nmol/L your FT level is low.

I would not say it is very high as in well over the top end of the range.

The linear law-of-mass action calculated (Vermeulen method) used above is outdated and tends to under estimate FT by as much as 40% when compared to the gold standard Equilibrium Dialysis.

If you truly want to know where your FT level sits than you would need to use the most accurate testing the gold standard Equilibrium Dialysis or Ultrafiltration (next best).....or if anything use the newer calculated TruT model/algorithm which is based on the newer research/understanding of SHBG:T binding and has been shown to be on par with results obtained by the gold standard Equilibrium Dialysis testing method.

It is available online toi the general public.....TruT Free Testosterone Calculator by FPT

As you can see if we take your TT 499 ng/dL, SHBG 55.1 nmol/L, Albumin 4.3 g/dL (mean) than your FT is 14.33 ng/dL (LOW).....(reference range 16-31 ng/dL).

Regardless of pre-trt level/SHBG.....most sensible piece of advice is to start low and go slow.

Sure with a high/highish SHBG one will need to attain a higher TT than one with low/lowish
SHBG to attain a healthy FT level but even than the TT level needed will not need to be extremely high as most would seem to think.....due to the newer research/understanding of SHBG:T binding.

No one can say if.....let alone to what degree your SHBG may drop when on trt as some notice minimal if any changes whereas others may experience a larger drop.

Sure larger doses of T injected less frequently as in once weekly may have a more significant impact on lowering ones SHBG when on trt but even than it is usually high doses of androgens as in 250+ which have been shown in studies to have such an effect.

You can start of on once weekly injections if you wish but it would be more sensible to split your dose and inject twice weekly (every 3.5 days) as not only will your T levels be more stable throughout the week but you will also soften the extremes between your peak--->trough level.

100 mg is a descent starting dose.....you could go higher but I would definitely not jump into the 200-210 mg once weekly injections your clinic is prescribing.....even with an SHBG of 55 nmol/L......210 mg/week is way too high a starting dose and in many cases most would never need such.

Most men on trt on average are injecting 100-150 mg/week.....and yes some using 200 mg/week (not common) as most would never need such a dose to hit a healthy FT level.

Most men on trt do well having a FT trough in the 30--->30+ ng/dL range.

 

[Systemlord]

I do have a Estradiol results from a few years ago where the total T was 410 and the E2 was 24 pg/mL. Seems to be slightly above midrange. Is this of use in determining injection frequency?

We don't know if FT was optimal when you scored these TT and E2 numbers. SHBG is big peice if the puzzle. You push for self injections at home.

Discount labs is no different than going in for lab work by your doctor, it's done at Labcorp.

 

[BackToRegular]

It is available online to the general public.....TruT Free Testosterone Calculator by FPT
As you can see if we take your TT 499 ng/dL, SHBG 55.1 nmol/L, Albumin 4.3 g/dL (mean) than your FT is 14.33 ng/dL (LOW).....(reference range 16-31 ng/dL).

Thank you for this really detailed response and sharing this resource

 

[BackToRegular]

We don't know if FT was optimal when you scored these TT and E2 numbers. SHBG is big peice if the puzzle. You push for self injections at home.

Discount labs is no different than going in for lab work by your doctor, it's done at Labcorp.

Hmm, sounds like I should do one more pre-TRT blood test where Total T, SHBG, Albumin, and E2 is checked.

 

[BackToRegular]

If I'm ordering a "Free and Total Testosterone" and the "Sensitive Estradiol" from discount labs, do I need to order an Albumin or any other test?

Trying to get the complete picture before starting TRT and hoping it'll guide injection frequency.