High SHBG concerns and Ignorant doctors

[Valhalla]

I am 28 years old and found out on 5/15/18 that I had very low T

151 ng/dl total
29.8 ng/ml Free
Estradiol 18 pg/ml

The clinic put me on 210 mg per week via one IM shot every monday and 1000 IU HCG split up into two shots a week. I went to my primary care doc for follow up blood work that way it would be covered through my insurance. I actually had to tell my doctor what blood test to order because he had know idea. He didnt know about SHBG or the sensitive estradiol test. Anyways i forgot to tell him to check my free T because I figured that was done in the same test as the the total T test. Here are my results taken right before my next 210 mg injection. Overall I have felt a lot better than I had felt. I have facial hair starting to grow as well as a few pimples. I haven't lost any fat yet but I have noticed that im growing more muscle (i workout 4x per week).


I realize my total T is way too high especially since that is my trough day.
My concern is that I think im taking too much testosterone and I don't know how often I should be injecting. Also my Estradiol results haven't came back yet.

I am finally seeing a real endocrinologist on august 8th but Ive heard that sometimes even they dont know what they are doing when it comes to TRT.

 

[Vince Carter]

Given your SHBG your TT is not that high. You need to know/remember that TT is almost entirely bound up and of no good with SHBG. As you noted, you need have had your Free T pulled. Without that it's rather pointless to discuss it too much but rest assured your FT is most likely well under the lab range. You may have to, for reference, with that SHBG run a TT of 1300 or more in order to get your FT to come up. FT is what matters. Good job on knowing the sensitive E test, too.

At this point I don't disagree with 210mg once per week for you and your SHBG. Large dose (may) move your SHBG down a bit, too.

 

[MarkM]

Agree with Vince Carter. There is a real good chance that after 6 weeks of that large dose and it's compounding half life effect, when he reaches a steady state the SHBG will be much lower than it is right now. Maybe to a point he could lower his dose a little bit.

 

[Valhalla]

Would it makes since for my current free testosterone to be 20% of my total like it was before I started TRT?

 

[MarkM]

No,not normally, especially with that high SHBG. Your Total T was so low it probably threw the percentage out of whack. Most men hope to fall in the range of 2 - 3% of Total T is Free T, which is perfectly fine. May men fall below that.

 

[Vince]

Because of your high shbg, it's good that you're only injecting once-weekly. It should help to bring your shbg down some, hopefully your estradiol levels will be good. I think you're starting testosterone dosage should be lower maybe 150 mg, you can always raise it later if needed

 

[madman]

I am 28 years old and found out on 5/15/18 that I had very low T

151 ng/dl total
29.8 ng/ml Free
Estradiol 18 pg/ml

The clinic put me on 210 mg per week via one IM shot every monday and 1000 IU HCG split up into two shots a week. I went to my primary care doc for follow up blood work that way it would be covered through my insurance. I actually had to tell my doctor what blood test to order because he had know idea. He didnt know about SHBG or the sensitive estradiol test. Anyways i forgot to tell him to check my free T because I figured that was done in the same test as the the total T test. Here are my results taken right before my next 210 mg injection. Overall I have felt a lot better than I had felt. I have facial hair starting to grow as well as a few pimples. I haven't lost any fat yet but I have noticed that im growing more muscle (i workout 4x per week).

View attachment 5442
I realize my total T is way too high especially since that is my trough day.
My concern is that I think im taking too much testosterone and I don't know how often I should be injecting. Also my Estradiol results haven't came back yet.

I am finally seeing a real endocrinologist on august 8th but Ive heard that sometimes even they dont know what they are doing when it comes to TRT.

You state you found out on 5/15/2018 through blood work that you have very low TT/FT (although you did not provide ranges) and your e2 was tested but using the wrong testing method as it need to be the estradiol sensitive assay -LC/MS-MS and you did not have your SHBG tested until next set of labs.

You than state that the clinic started you on trt (210mg once weekly) along with 1000 IU HCG (split twice weekly).....so to me at first is seems like a standard t-mill protocol regarding starting a patient 0n 200+mg testosterone once weekly as you did not have SHBG tested on your first set of labs so how would the clinic have known you had high SHBG pre-trt as SHBG was not done until following blood work through your primary doctor after you started protocol from the clinic.

I am going to say that from the way your post is written that you started your trt protocol right around the time you found out you had low t from pre-trt blood work on 5/15/2018.....you than went for follow up blood work through your primary doctor so I would think you have already been on trt for 6-8 weeks as it is now 7/23/2018 and on your most recent blood work your TT is 1180 ng/dl and your SHBG is absurdly high at 76.6 nmol/L which basically has either not budged since starting your protocol or your pre-trt SHBG was actually higher than 76.6 nmol/L and it has dropped some.

Either way even though you did not have your FT tested which is critical to know as it is the unbound active fraction of testosterone even though your TT of 1180 ng/dL may seem really high for a trough reading because your SHBG is still absurdly high your FT will still be low even at that TT level and as VC stated higher doses of testosterone injected once weekly are usually effective to help lower high SHBG .....BUT yours has not budged unless it was higher than 76.6 nmol/L pre-trt.....if I am correct that you have already been on this protocol for 6-8 weeks.

You need to have your FT tested to see where your levels sit which I would say are still low due to your absurdly high SHBG.

Even than one can use the Free % Bioavailable Testosterone calculator (calculated method for free testosterone) and if you take your TT of 1180 ng/dL and your SHBG of 76.6 nmol/L along with albumin which is set as 4.3 g/dl (as the mean in most men) than your FREE T is still very low at 1.39% and your BIOAVAILABLE T would be 32.7%.

http://www.issam.ch/freetesto.htm
.................................................

Ideally most men need their FT to be 2-3% of TT to experience the beneficial effects of testosterone.

 

[Valhalla]

madman you are correct on many things that you stated. I am on my 8th week of this protocol. At the T-mill he did the correct sensitive Estradiol Test. I wasnt aware of "t-mills" back in may I just trusted that this clinic knew what they were doing. They didnt test my SHBG. All that the clinic ordered back in may was Total Test, Free Test, Sensitive E, PSA and CBC. Here are my labs from may.


Basically the Family nurse practitioner at the clinic told me he was going to put me on 210 mg once a week of test cyp because my testosterone was so low. There was on other reasoning behind it but I was ignorant on TRT at the time so it made sense.

 

[madman]

madman you are correct on many things that you stated. I am on my 8th week of this protocol. At the T-mill he did the correct sensitive Estradiol Test. I wasnt aware of "t-mills" back in may I just trusted that this clinic knew what they were doing. They didnt test my SHBG. All that the clinic ordered back in may was Total Test, Free Test, Sensitive E, PSA and CBC. Here are my labs from may.
View attachment 5445View attachment 5446

Basically the Family nurse practitioner at the clinic told me he was going to put me on 210 mg once a week of test cyp because my testosterone was so low. There was on other reasoning behind it but I was ignorant on TRT at the time so it made sense.

So the way I see it since you have already been on the protocol 210mg/week testosterone weekly along with 1000 IU ( split twice weekly) for 8 weeks and from your most recent labs your SHBG is still absurdly high which would tell me that either it was higher pre-trt and has come down some or it has not budged.

As I stated even though your TT 1080 ng/dl may seem high your FT would still be lower due to your high SHBG.

How do you feel overall now at the 8 weeks mark as you stated in the first post that overall you felt a lot better than pre-trt but the when first starting trt it is truly hard to tell how things will be once your hpta is shutdown and you get through the honeymoon period.

Where do you live as it would be a good idea to get in touch with Defy which is run by Dr. Saya as you need to be working with a trt specialist to improve your current situation.

 

[Valhalla]

Overall I feel better. I didn't realize I had low libido until I started TRT. In highschool I never really went through that pervy horndog phase that my friends went through so I didnt know what it was like to have normal libido. I have more energy and less social anxiety. I feel like im starting to be able to gain muscle. Ive gained muscle but haven't lost fat yet. The side effects Ive had are pimples, oily skin, and rapid and very hard heart beats (but that has calmed down alot in the last couple of weeks) also Ive noticed that when I stand up after sitting for a while my head starts pounding and I kind of lose my hearing and can hear my heartbeat for about 45 seconds. That never happend before TRT.

After my Endo meeting on august 8th Im going to decide if im going to get treatment through them or through defy.

 

[madman]

Overall I feel better. I didn't realize I had low libido until I started TRT. In highschool I never really went through that pervy horndog phase that my friends went through so I didnt know what it was like to have normal libido. I have more energy and less social anxiety. I feel like im starting to be able to gain muscle. Ive gained muscle but haven't lost fat yet. The side effects Ive had are pimples, oily skin, and rapid and very hard heart beats (but that has calmed down alot in the last couple of weeks) also Ive noticed that when I stand up after sitting for a while my head starts pounding and I kind of lose my hearing and can hear my heartbeat for about 45 seconds. That never happend before TRT.

After my Endo meeting on august 8th Im going to decide if im going to get treatment through them or through defy.

I doubt you will have much luck with the endo as far as getting the proper treatment.....I would urge you to contact Defy and work with Dr. Saya as he is highly recommended!

 

[Valhalla]

My sensitive estradiol test hadnt came in as of this morning so I called my doctor and one of the nurses told me over the phone that it is 24.9. I forgot to ask what the ranges were though.

 

[Vince Carter]

Ya we'd need to see the lab range to know if its right...from Labcorp the range is 8-35, and QuestDiagnostics is <29

 

[Valhalla]

It was done at Labcorp