Is free T the best metric when thinking about symptom improvement?

[SomeG]

Hi

I've recently (3weeks ago) switched from HCG monotherapy (2500iu 3/wk) to 60 mg test 2/wk + 750 iu hcg 3/wk because I was only slightly responding to monotherapy (total T went from 350 to 475 over 4 months)

my free T , however, seemed to be stuck under 1% (0.8% mostly )

While I've seen the guidance that Nelson has posted regarding how long to expect results
https://www.excelmale.com/forum/showthread.php?1519-How-long-does-testosterone-take-to-show-effects

I wonder if my extra low Free T will delay improvements in energy, mood, etc.

( I'm already in good physical shape and my libido has improved since the HCG regimen. )

 

[Nelson Vergel]

SomeG

The free T under 1 % was from blood work before you switched dose programs, right?

 

[Vince Carter]

Yes the Free T is sometimes where the desirable number is at. At your next bloodwork I would suggest SHBG, it could be a telling test. If SHBG is high, meaning your T is bound up and useless, your Free T will be low(er).

 

[SomeG]

Nelson, yes, as far as I remember the free T has been stubbornly stuck at that.. (0.8% or so) before, under HCG Monotherapy. Little change. Only the total T has gone from 350 to 475 over four months.


I won't have additional blood work for another five weeks.

(Btw, I always bug my doctor 's office for copies of my blood work, but they never get around to sharing it.. It's frustrating)

 

[Nelson Vergel]

The higher the dose of testosterone (plus HCG), the lower your sex hormone binding globulin will be (in general). This means that free T ( as a percent of total T) can be increased by increasing T dose in most men.

Some men metabolize testosterone faster than others. If I understand what you are saying, you are using 120 mg of T and and 2250 IU of HCG per week and your total T is 475 ng/dL. You are definitely a fast metabolizer since that combined dose would bring most men's total T over 700 ng/dL.

Where are you getting both your testosterone and HCG from? Are you 100 % sure of the doses?

 

[SomeG]

Some men metabolize testosterone faster than others. If I understand what you are saying, you are using 120 mg of T and and 2250 IU of HCG per week and your total T is 475 ng/dL. You are definitely a fast metabolizer since that combined dose would bring most men's total T over 700 ng/dL.
?

Nelson

My total test before starting this Test + HCG regimen was 475 (my June blood work). I imagine that my levels will go up very soon.

In terms of metabolizing, my experience with HCG monotherapy shows that either I'm a fast metabilizer and/or my testes capacity is pretty lethargic/slow. (My doctor suggested the fast metabolism was an issue when he upped my HCG dose) For two months I was on 1500iu 3/wk and for the second two months of monotherapy I was using 2500 iu 3/wk.

In 5 weeks, I'll have more labs to report.

In the mean time, I'm just slowly getting a little relief from fatigue and brain fog. Don't feel cured miraculously yet, but things are slowly getting better.

 

[Re-Ride]

You didn't mention any A.I. Hope you are getting all the recommended labs. Post up what you have and specify starting point, hCG only and the new results when you get them.

It seems like you are getting the hCG from the pharmacy. Brand? Are you certain that you are not mishandling it? Not shaking the vial, promptly refrigerating the reconstitute?

Did your doc initially perform a response test with clomid or high dose hCG prior to this regimen to rule out primary hypoG?

Old protocols called for a massive kick-start dose in the 4,000 iu range. In fact 12,000 weekly is one protocol listed on the APP pkg insert. I question the wisdom or validity of this but was what I was prescribed (no AI). At six weeks tot T more than doubled from the stating point: [[298 ng/dL, 88 pg/ml free or 3.4% free, prolactin: 8 ( 2.1-17.7)]] At six weeks tot T was 700 on mono. Libido and performance like a kid but this was accompanied by high E2= 83 pg/mL and very painful nips. DHEA-s was 442H ( 25-95 ug/dL) from taking an OTC male enhancer which complicates interpretation of my result. Went cold turkey for a few weeks then re-started 500iu daily with cautious use of Arimidex. Seems like my threshold for libido is now 1,000 i.u. bit I'll stick with 500 until I see the labs.

The only thing your doc did differently from the pkg insert was not waiting a month prior to re-starting at 2500iu hCG. Even with the very modest increase in T on mono it is helpful for others to see your numbers and to fully describe the other perceived benefits such as feeling "fuller", firmer, ejac. volume, satisfaction ect.

GLWNR good luck new regimen!

 

[SomeG]

No labs to report on the test plus HCG regimen yet(I am not on an AI.). The 475 figure was from before, so I have no idea about numerical effectiveness ...yet.

As an aside, my doctor's office does not share my labs with me.. period. The reason why I don't have detailed reams of numbers is that I get a quick two-second flash/look at my Dr's computer where my labs are entered. and we discuss the symptoms once every two months. This is frustrating, because I really want to like my doctor- as finding a doctor who is covered by regular insurance that is flexible and willing to explore TRT at all is like finding a unicorn. I don't want to rock the boat.


I'll have basic numbers (but probably not full labs) in a couple weeks when I have my appointment. I am only 6 weeks into the Test + HCG regimen.

 

[Nelson Vergel]

SomeG

You may want to read this. Legally, you should be provided with a copy of your lab test results.

New Privacy Rule Gives Patients Right to Access Lab Test Reports

 

[HarryCat]

SomeG

If you have the labs done at Labcorp or Quest you can sign up with them and get the results directly. I get e-mail notification when the results are available and see them before my doctor.

 

[Re-Ride]

Nelson, thanks for posting the new rule. A better way is to insist that the doc writes "CC patient upon initial and final result" on the lab request.

The doc can write that or "cc pt asap" in the notifications box or anywhere on the lab order.

This way you get the results mailed to you right away not 30 days later. Also ask him to notify other docs such as your primary care.

"CC PT ASAP" means you will not waste time driving to the lab office to so they can verify your identity which is also a new requirement.

On line electronic reporting offers trend visualization and graphing but you should still insist on a hard copy. Not all of my results have appeared on line. There are dates for creatinine and metabolic panel missing online for example. Without "cc pt asap" on he form the lab may delay posting for up to several weeks.

Many docs do not bother looking at your labs even if they are flagged. In one such case a year ago I had a serious infection that went untreated. I only learned of it 6 weeks later when the lab report arrived in the mail. Doc had written "cc pt" but not "cc pt upon result". In this case TWO docs in different offices each failed to notify even though the lab report went as far as to recommend the effective antibiotic. and flagged the results in red.

The person most likely to kill you is your doctor.

 

[Vince Carter]

SomeG

If you have the labs done at Labcorp or Quest you can sign up with them and get the results directly. I get e-mail notification when the results are available and see them before my doctor.

this does indeed work like a charm for both companies

 

[Superman]

SomeG

If you have the labs done at Labcorp or Quest you can sign up with them and get the results directly. I get e-mail notification when the results are available and see them before my doctor.

labcorb only does that for me about half of the time. not really sure why. for example, all of my labs from when i was with lowtesosterone.com are in my labcorp account. i used to use privatemdlabs on my own from time to time and those never ended up in my account. only 1 of the 2 labs ive had with defy made it to my labcorp account.