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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Is my doctor being too cautious?
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<blockquote data-quote="madman" data-source="post: 146285" data-attributes="member: 13851"><p>You need to find a new doctor.</p><p></p><p>The main purpose of trt is to provide the patient <span style="color: rgb(184, 49, 47)"><strong>relief/improvement of low t symptoms </strong></span>and improve ones <span style="color: rgb(184, 49, 47)"><strong>overall well being.</strong></span></p><p></p><p>Your doctor clearly has no idea what he is doing.</p><p></p><p></p><p></p><p>You stated <strong>"When I transitioned to weekly injections we started at 100 mg (.5 ml)a week for the first 3 months. I had my blood work done and here’s what came out"</strong></p><p></p><p></p><p>Albumin: 4.3</p><p>T Total: 800</p><p>SHBG: 32</p><p>T Free 186.6</p><p>T Bioavailable: 437.4</p><p>Hematocrit: 48.8</p><p>TSH 2.65 on 100mg levothyroxine</p><p>(Continued to dial this in trying to get down to 2.0)</p><p></p><p>You stated <strong><span style="color: rgb(184, 49, 47)">"I felt great! Not only physically but emotionally"</span></strong></p><p></p><p>Although lab work is critical.....treating symptoms is what truly matters and your doctor is much more concerned about your numbers.</p><p></p><p>You felt great overall and he decided to lower your dose because of your T levels which are by no means too high and even than although TT is important to know FT is what truly matters as it is the unbound active fraction of testosterone responsible for the positive benefits.</p><p></p><p>You need to provide reference ranges for your labs and regarding your FT and e2 you most likely had the <strong><span style="color: rgb(184, 49, 47)">wrong tests</span> </strong>done as the estradiol sensitive assay (LC/MS-MS) is the correct test and regarding FT you most likely had the direct analog assay done instead of equilibrium dialysis or better yet save yourself the money and use the new <strong><span style="color: rgb(184, 49, 47)">TruT</span></strong> calculated free testosterone</p><p></p><p></p><p></p><p><a href="https://tru-t.org/" target="_blank">Try the public free testosterone calculator at tru-t.org</a></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p>For the calculated FT method all that is needed is <span style="color: rgb(184, 49, 47)"><strong>TT/SHBG/albumin</strong></span> and if one has not had albumin tested than 4.3 g/dL (mean) is the default as albumin levels would only have a drastic impact on FT levels when the level of albumin in the blood is abnormally low (significant hypoalbuminemia).</p><p></p><p>If we take your pre-trt labs TT 261 ng/dL, SHBG 34.5 nmol/L and albumin 4.1 g/dL using the Calculate free testosterone with <span style="color: rgb(184, 49, 47)"><strong>TruT </strong></span>by FPT:</p><p></p><p></p><p>Than your FT would be a dismal <strong><span style="color: rgb(184, 49, 47)">7.89 ng/dL </span></strong><span style="color: rgb(0, 0, 0)"><strong>reference range </strong></span><span style="color: rgb(184, 49, 47)"><strong>16-31 ng/dL</strong></span></p><p></p><p>[ATTACH=full]7323[/ATTACH]</p><p></p><p></p><p></p><p>Now on your protocol where you felt great overall you stated:</p><p></p><p><strong><span style="color: rgb(184, 49, 47)">"When I transitioned to weekly injections we started at 100 mg (.5 ml)a week for the first 3 months. I had my blood work done and here’s what came out"</span></strong></p><p></p><p>If we take your TT 800 ng/dL, SHBG 32 nmol/L and albumin 4.3 g/dL</p><p></p><p>Than as you can see your FT would be a healthy <span style="color: rgb(184, 49, 47)"><strong>28.07 ng/dL</strong></span> which is near the top end of the <strong>reference range <span style="color: rgb(184, 49, 47)">16-31 ng/dL</span></strong></p><p></p><p></p><p></p><p>[ATTACH=full]7325[/ATTACH]</p><p></p><p></p><p><strong><span style="color: rgb(184, 49, 47)">*</span></strong>Take home point being your TT/FT levels are where they need to be seeing as you clearly stated <strong><span style="color: rgb(184, 49, 47)">"I felt great! Not only physically but emotionally" </span></strong></p><p></p><p>So what did your doctor do.....hesitate over lab numbers and lowered your dose<img src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" class="smilie smilie--sprite smilie--sprite11" alt=":rolleyes:" title="Roll Eyes :rolleyes:" loading="lazy" data-shortname=":rolleyes:" />!</p><p></p><p></p><p></p><p>Now on the new protocol 80 mg/week if we take your TT 523 ng/dL, SHBG 30.6 nmol/L and albumin 4.4 g/dL</p><p></p><p>Your FT is now <strong><span style="color: rgb(184, 49, 47)">17.23 ng/dL </span><span style="color: rgb(0, 0, 0)">reference range </span><span style="color: rgb(184, 49, 47)">16-31 ng/dL</span></strong><span style="color: rgb(0, 0, 0)">.....although still in range you are on the lower end</span></p><p></p><p></p><p>[ATTACH=full]7324[/ATTACH]</p><p></p><p></p><p>Now as you stated this is the situation you are in <strong><span style="color: rgb(0, 0, 0)">"After those results </span><span style="color: rgb(184, 49, 47)">my doctor lowered my dose to 80mg a week (.4 ml)</span><span style="color: rgb(0, 0, 0)">and I’m still better but</span><span style="color: rgb(184, 49, 47)"> still somewhat symptomatic.</span><span style="color: rgb(0, 0, 0)"> A day and a half before my next injection </span><span style="color: rgb(184, 49, 47)">my energy is really low and I’m extra cranky</span><span style="color: rgb(0, 0, 0)"> and if I push hard at the gym </span><span style="color: rgb(184, 49, 47)">it takes twice as long to recover.</span> <span style="color: rgb(184, 49, 47)">Emotionally</span><span style="color: rgb(0, 0, 0)"> I’m not with it either. I also seem to have a tough time the day after my shot and </span><span style="color: rgb(184, 49, 47)">I’ve communicated with my doctor about that but he doesn’t seem to have a response. </span><span style="color: rgb(0, 0, 0)">Days 2-5.5 are fantastic and I’ve put all of my hard training days around that window of time" </span></strong></p><p></p><p></p><p>Sure seeing as you are only injecting once weekly T levels are going to be peaking early in the week only to be followed by lower levels later in the week before your next injection.</p><p></p><p>It would be more sensible to split dose and inject twice weekly as T levels will be more stable throughout the week mind you I would say you should be back on 100 mg/week (50 mg every 3.5 days) as oppose to the 80 mg/week.</p><p></p><p>As others have stated you need to get a complete thyroid panel.</p><p></p><p>My advice is the main goal of trt should be to attain a healthy FT level which provides the patient relief/improvement of low t symptoms and overall well being while minimizing potential side effects/negative effects on ones overall health markers (full blood work).</p><p></p><p>Even though symptom relief is what truly matters as oppose to just numbers do understand that lab work is critical regarding health markers and hormone levels as there is such a thing as <strong><span style="color: rgb(184, 49, 47)">too high</span></strong> or <span style="color: rgb(184, 49, 47)"><strong>too low</strong></span> when it comes to <strong><span style="color: rgb(184, 49, 47)">testosterone levels.</span></strong></p></blockquote><p></p>
[QUOTE="madman, post: 146285, member: 13851"] You need to find a new doctor. The main purpose of trt is to provide the patient [COLOR=rgb(184, 49, 47)][B]relief/improvement of low t symptoms [/B][/COLOR]and improve ones [COLOR=rgb(184, 49, 47)][B]overall well being.[/B][/COLOR] Your doctor clearly has no idea what he is doing. You stated [B]"When I transitioned to weekly injections we started at 100 mg (.5 ml)a week for the first 3 months. I had my blood work done and here’s what came out"[/B] Albumin: 4.3 T Total: 800 SHBG: 32 T Free 186.6 T Bioavailable: 437.4 Hematocrit: 48.8 TSH 2.65 on 100mg levothyroxine (Continued to dial this in trying to get down to 2.0) You stated [B][COLOR=rgb(184, 49, 47)]"I felt great! Not only physically but emotionally"[/COLOR][/B] Although lab work is critical.....treating symptoms is what truly matters and your doctor is much more concerned about your numbers. You felt great overall and he decided to lower your dose because of your T levels which are by no means too high and even than although TT is important to know FT is what truly matters as it is the unbound active fraction of testosterone responsible for the positive benefits. You need to provide reference ranges for your labs and regarding your FT and e2 you most likely had the [B][COLOR=rgb(184, 49, 47)]wrong tests[/COLOR] [/B]done as the estradiol sensitive assay (LC/MS-MS) is the correct test and regarding FT you most likely had the direct analog assay done instead of equilibrium dialysis or better yet save yourself the money and use the new [B][COLOR=rgb(184, 49, 47)]TruT[/COLOR][/B] calculated free testosterone [URL='https://tru-t.org/']Try the public free testosterone calculator at tru-t.org[/URL] For the calculated FT method all that is needed is [COLOR=rgb(184, 49, 47)][B]TT/SHBG/albumin[/B][/COLOR] and if one has not had albumin tested than 4.3 g/dL (mean) is the default as albumin levels would only have a drastic impact on FT levels when the level of albumin in the blood is abnormally low (significant hypoalbuminemia). If we take your pre-trt labs TT 261 ng/dL, SHBG 34.5 nmol/L and albumin 4.1 g/dL using the Calculate free testosterone with [COLOR=rgb(184, 49, 47)][B]TruT [/B][/COLOR]by FPT: Than your FT would be a dismal [B][COLOR=rgb(184, 49, 47)]7.89 ng/dL [/COLOR][/B][COLOR=rgb(0, 0, 0)][B]reference range [/B][/COLOR][COLOR=rgb(184, 49, 47)][B]16-31 ng/dL[/B][/COLOR] [ATTACH=full]7323[/ATTACH] Now on your protocol where you felt great overall you stated: [B][COLOR=rgb(184, 49, 47)]"When I transitioned to weekly injections we started at 100 mg (.5 ml)a week for the first 3 months. I had my blood work done and here’s what came out"[/COLOR][/B] If we take your TT 800 ng/dL, SHBG 32 nmol/L and albumin 4.3 g/dL Than as you can see your FT would be a healthy [COLOR=rgb(184, 49, 47)][B]28.07 ng/dL[/B][/COLOR] which is near the top end of the [B]reference range [COLOR=rgb(184, 49, 47)]16-31 ng/dL[/COLOR][/B] [ATTACH=full]7325[/ATTACH] [B][COLOR=rgb(184, 49, 47)]*[/COLOR][/B]Take home point being your TT/FT levels are where they need to be seeing as you clearly stated [B][COLOR=rgb(184, 49, 47)]"I felt great! Not only physically but emotionally" [/COLOR][/B] So what did your doctor do.....hesitate over lab numbers and lowered your dose:rolleyes:! Now on the new protocol 80 mg/week if we take your TT 523 ng/dL, SHBG 30.6 nmol/L and albumin 4.4 g/dL Your FT is now [B][COLOR=rgb(184, 49, 47)]17.23 ng/dL [/COLOR][COLOR=rgb(0, 0, 0)]reference range [/COLOR][COLOR=rgb(184, 49, 47)]16-31 ng/dL[/COLOR][/B][COLOR=rgb(0, 0, 0)].....although still in range you are on the lower end[/COLOR] [ATTACH=full]7324[/ATTACH] Now as you stated this is the situation you are in [B][COLOR=rgb(0, 0, 0)]"After those results [/COLOR][COLOR=rgb(184, 49, 47)]my doctor lowered my dose to 80mg a week (.4 ml)[/COLOR][COLOR=rgb(0, 0, 0)]and I’m still better but[/COLOR][COLOR=rgb(184, 49, 47)] still somewhat symptomatic.[/COLOR][COLOR=rgb(0, 0, 0)] A day and a half before my next injection [/COLOR][COLOR=rgb(184, 49, 47)]my energy is really low and I’m extra cranky[/COLOR][COLOR=rgb(0, 0, 0)] and if I push hard at the gym [/COLOR][COLOR=rgb(184, 49, 47)]it takes twice as long to recover.[/COLOR] [COLOR=rgb(184, 49, 47)]Emotionally[/COLOR][COLOR=rgb(0, 0, 0)] I’m not with it either. I also seem to have a tough time the day after my shot and [/COLOR][COLOR=rgb(184, 49, 47)]I’ve communicated with my doctor about that but he doesn’t seem to have a response. [/COLOR][COLOR=rgb(0, 0, 0)]Days 2-5.5 are fantastic and I’ve put all of my hard training days around that window of time" [/COLOR][/B] Sure seeing as you are only injecting once weekly T levels are going to be peaking early in the week only to be followed by lower levels later in the week before your next injection. It would be more sensible to split dose and inject twice weekly as T levels will be more stable throughout the week mind you I would say you should be back on 100 mg/week (50 mg every 3.5 days) as oppose to the 80 mg/week. As others have stated you need to get a complete thyroid panel. My advice is the main goal of trt should be to attain a healthy FT level which provides the patient relief/improvement of low t symptoms and overall well being while minimizing potential side effects/negative effects on ones overall health markers (full blood work). Even though symptom relief is what truly matters as oppose to just numbers do understand that lab work is critical regarding health markers and hormone levels as there is such a thing as [B][COLOR=rgb(184, 49, 47)]too high[/COLOR][/B] or [COLOR=rgb(184, 49, 47)][B]too low[/B][/COLOR] when it comes to [B][COLOR=rgb(184, 49, 47)]testosterone levels.[/COLOR][/B] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Is my doctor being too cautious?
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