Kaiser’s standard on blood normality confusion

[dicus30]

Hi guys: (I have add inattentive type)-I research things but at times get overwhelmed...

I am a 45 year old type one diabetic (31 years) that is currently taking .7mL a week of testosterone cypionate (140mg). I inject .25mL on Monday/Wednesday. Friday’s I inject .20mL. I’ve attached the results. My Kaiser endocrinologist may lower my dose due to their already low standard. I wanted to start 250mL of hcg on the alternate days I’m not injecting testosterone but have to play the HMO game (please their numbers not the patient). I do subQ injections (in a patch of fat above penis). Their standard says I am running high. My question is is it really high? After I please their number game and not have to test my blood for another 6 months...Can I take 200mg a week and be ok (the entire bottle) hoping for better gym gains? I work out routinely (weights and cardio) 5x a week fasting so I can loose some weight. I hear hcg can also increase testosterone levels. Any and all advice is welcomed. I just recently started trt 10/1/2020. If I do take 200mg a week how do I drop my dosage to please their numbers again? I took my .20mL around 2am Friday morning and did my blood work the following Monday around 12:30pm because she wanted a midpoint reading. She thinks I’m only doing once a week at .7mL. My estradiol is right at the max limit, 50pg/mL. I have also attached a picture of what Nelson suggests in his ebook, "TRT dosing" as a reference in case anyone suggests dosage amount.

Update: Spoke with endo via email today and she wants to drop me to .6 mL weekly.

 

[Systemlord]

My Kaiser endocrinologist may lower my dose due to their already low standard.

I have Kaiser and the endos are inept following outdated guidelines, but I don't settle for substandard care and therefore use Defy Medical.

Given your testosterone levels which isn't alarmingly high, your hemoglobin and hematocrit are both low, one of the benefits of TRT is higher hemoglobin and hematocrit.

 

[madman]

Hi guys: (I have add inattentive type)-I research things but at times get overwhelmed...

I am a 45 year old type one diabetic (31 years) that is currently taking .7mL a week of testosterone cypionate (140mg). I inject .25mL on Monday/Wednesday. Friday’s I inject .20mL. I’ve attached the results. My Kaiser endocrinologist may lower my dose due to their already low standard. I wanted to start 250mL of hcg on the alternate days I’m not injecting testosterone but have to play the HMO game (please their numbers not the patient). I do subQ injections (in a patch of fat above penis). Their standard says I am running high. My question is is it really high? After I please their number game and not have to test my blood for another 6 months...Can I take 200mg a week and be ok (the entire bottle) hoping for better gym gains? I work out routinely (weights and cardio) 5x a week fasting so I can loose some weight. I hear hcg can also increase testosterone levels. Any and all advice is welcomed. I just recently started trt 10/1/2020. If I do take 200mg a week how do I drop my dosage to please their numbers again? I took my .20mL around 2am Friday morning and did my blood work the following Monday around 12:30pm because she wanted a midpoint reading. She thinks I’m only doing once a week at .7mL. My estradiol is right at the max limit, 50pg/mL.

Update: Spoke with endo via email today and she wants to drop me to .6 mL weekly.

Unfortunately, your doctor is dead set on maintaining hormones in a specific range when symptom relief is what truly matters.

Many men may need higher-end TT levels to achieve a healthy FT.

It comes down to where your SHBG level sits and what TT level would be needed in order to achieve a healthy FT level which would result in relief/improvement of low-t symptoms and increased overall well-being.

The goal of trt is to replace physiological levels of testosterone through the use of exogenous testosterone in order to achieve a healthy TT/FT level which will result in the relief/improvement of low-t symptoms while at the same time minimizing/avoiding any potential side-effects (cosmetic/overall health) while keeping blood markers healthy long-term.

FT level 5-10 ng/dL would be considered low.

FT 16-31 ng/dL would be considered a healthy level.

Most men will do well with FT in the 20-30 ng/dL range and some may choose/need to run slightly higher levels

Again it comes down to the individual as some men will do better running higher TT/FT levels whereas others may feel better running lower levels.

Some men will always struggle with side-effects when running too high an FT level.

There is nothing wrong with where your TT sits as it would be considered on the high-end and even then although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

As you can see your FT is high but unfortunately it was done using the calculated method which I would not rely upon.

The only way to know where your FT truly sits on such protocol (dose T/injection frequency) is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration.

Even then seeing as you are injecting M/W/F and your blood work was done on Monday then these are your trough levels and your peak TT/FT (8-12 hrs) post-injection will be much higher.

Mind you if you are injecting M/W/F morning then your true trough would be Monday morning just before your injection.

Find a new doctor if they are dead set on your numbers being too high!

Need to get out of that mind-set that ramping your trt dose up to the higher end 200 mg/week is going to magically have you packing on muscle.

Sure you will make some gains in muscle/strength but even then do not expect any miracles as we are on trt here and steroid doses in the 300-600 mg range would be needed to truly reap the anabolic benefits of testosterone and even then higher-end doses 500-600 mg/week would result in greater gains muscle/strength!

Diet/training protocol is key let alone genetics will have the final say.

Keep in mind that your trough TT level is already on the high-end but more importantly, your FT is very high and that is on 140 mg/week split M/W/F.

Jacking your dose up to 200 mg is going to drive your TT/FT let alone e2 levels up way too high let alone your RBCs/hemoglobin/hematocrit.

We are on trt here and seems as though you are too caught up in gaining muscle!

To each his own but keep in mind that going from 140--->200 mg/week is a big jump.

 

[madman]

This says it all!

100 mg/week or 50 mg twice per week. Check TT and FT at follow up and titrate dose to achieve TT >600 ng/dL while assessing symptoms.

Yet the piss poor reference range is 240-700 ng/dL from the lab where they send you for blood work!

Many men will need a TT >1000 ng/dL to achieve a healthy FT level where they feel best overall regarding relief/improvement of low-t symptoms.

Seeing as your trough TT 937 ng/dL but more importantly, FT is high than if you feel well overall regarding relief/improvement of low-t symptoms and blood markers are healthy then there is no need to lower your dose let alone worry about where your levels sit.

Top it all off that your doctor wants to lower your T dose stating your TT/FT levels are too high yet under the TRT DOSING information it clearly states: Max Dose 250 mg/week (or 125 mg twice per week).

LMFAO/WTF.....rare that anyone on hormone replacement therapy would need 250 mg/week (125 mg twice per week) in order to achieve a healthy TT/FT level let alone relief/improvement of low-t symptoms.

Sure some men may require a slightly higher dose than 200 mg/week (considered the high-end for trt) but far and few would need such dose.

Even 200 mg/week would have most men's TT/FT/e2 levels through the roof let alone drive up one's RBCs/hemoglobin/hematocrit.

I would look into finding a new doctor as yours is clearly out to lunch.

 

[madman]

You need to have your SHBG tested.

Again it is critical to know where your FT level truly sits on such protocol and you would need to have it tested using the most accurate assays (ED or UF).

Either assay will suffice!

1. Testosterone, Total and Free (NO Upper Limit) plus Hematocrit

2. Testosterone, Total, LC/MS and Free (Equilibrium Ultrafiltration)

 

[dicus30]

Unfortunately, your doctor is dead set on maintaining hormones in a specific range when symptom relief is what truly matters.

Many men may need higher-end TT levels to achieve a healthy FT.

It comes down to where your SHBG level sits and what TT level would be needed in order to achieve a healthy FT level which would result in relief/improvement of low-t symptoms and increased overall well-being.

The goal of trt is to replace physiological levels of testosterone through the use of exogenous testosterone in order to achieve a healthy TT/FT level which will result in the relief/improvement of low-t symptoms while at the same time minimizing/avoiding any potential side-effects (cosmetic/overall health) while keeping blood markers healthy long-term.

FT level 5-10 ng/dL would be considered low.

FT 16-31 ng/dL would be considered a healthy level.

Most men will do well with FT in the 20-30 ng/dL range and some may choose/need to run slightly higher levels

Again it comes down to the individual as some men will do better running higher TT/FT levels whereas others may feel better running lower levels.

Some men will always struggle with side-effects when running too high an FT level.

There is nothing wrong with where your TT sits as it would be considered on the high-end and even then although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

As you can see your FT is high but unfortunately it was done using the calculated method which I would not rely upon.

The only way to know where your FT truly sits on such protocol (dose T/injection frequency) is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration.

Even then seeing as you are injecting M/W/F and your blood work was done on Monday then these are your trough levels and your peak TT/FT (8-12 hrs) post-injection will be much higher.

Mind you if you are injecting M/W/F morning then your true trough would be Monday morning just before your injection.

Find a new doctor if they are dead set on your numbers being too high!

Need to get out of that mind-set that ramping your trt dose up to the higher end 200 mg/week is going to magically have you packing on muscle.

Sure you will make some gains in muscle/strength but even then do not expect any miracles as we are on trt here and steroid doses in the 300-600 mg range would be needed to truly reap the anabolic benefits of testosterone and even then higher-end doses 500-600 mg/week would result in greater gains muscle/strength!

Diet/training protocol is key let alone genetics will have the final say.

Keep in mind that your trough TT level is already on the high-end but more importantly, your FT is very high and that is on 140 mg/week split M/W/F.

Jacking your dose up to 200 mg is going to drive your TT/FT let alone e2 levels up way too high let alone your RBCs/hemoglobin/hematocrit.

We are on trt here and seems as though you are too caught up in gaining muscle!

To each his own but keep in mind that going from 140--->200 mg/week is a big jump.

Hi MadMan:

Thank you for taking the time to respond. Much is appreciated. I started TRT when I was in my early 20's (spent a lot of time in gym), then went on clomid, then back on TRT, then on clomid (11 years) now ending in TRT. I've attached a picture recently I took, I'm not trying to pack on size as I already achieved that in my 20's (I am gifted with some genetics in my opinion). I just want to reduce my fat (diet and exercise) now and I believe I was on .7mL back then. The headless shot I was 35, and this other shot (with face is a few weeks ago). I just want to look better than I did at 35 is all, I don't want to gain a lot more additional muscle (will accept a little more, but not my goal). So my logical mind was thinking "can't go below .7mL"..."what if I go a little higher?" Since I am older thought I would possibly need more, but back then I was being injected IM 1x a week. So trying to be smarter this time around and be in control of my health.

 

[dicus30]

This says it all!

100 mg/week or 50 mg twice per week. Check TT and FT at follow up and titrate dose to achieve TT >600 ng/dL while assessing symptoms.

Yet the piss poor reference range is 240-700 ng/dL from the lab where they send you for blood work!

Many men will need a TT >1000 ng/dL to achieve a healthy FT level where they feel best overall regarding relief/improvement of low-t symptoms.

Seeing as your trough TT 937 ng/dL but more importantly, FT is high than if you feel well overall regarding relief/improvement of low-t symptoms and blood markers are healthy then there is no need to lower your dose let alone worry about where your levels sit.

Top it all off that your doctor wants to lower your T dose stating your TT/FT levels are too high yet under the TRT DOSING information it clearly states: Max Dose 250 mg/week (or 125 mg twice per week).

LMFAO/WTF.....rare that anyone on hormone replacement therapy would need 250 mg/week (125 mg twice per week) in order to achieve a healthy TT/FT level let alone relief/improvement of low-t symptoms.

Sure some men may require a slightly higher dose than 200 mg/week (considered the high-end for trt) but far and few would need such dose.

Even 200 mg/week would have most men's TT/FT/e2 levels through the roof let alone drive up one's RBCs/hemoglobin/hematocrit.
View attachment 12915
View attachment 12916

I would look into finding a new doctor as yours is clearly out to lunch.

Hi MadMan:

I apologize for any confusion. The TRT protocol, that I took a picture of, is from Nelson's eBook. I had attached it so people could reference to his recommendations so that I could cross reference it as well. My doctor originally started me off at .7mL every 2 weeks when she started me back on TRT on 10/1/2020, but I asked her to check my dosage 12 years ago and reminded her that I felt better with the once a week injection, she agreed to see what it did for me at .7mL weekly. She's also agreed to allow me to be on the higher end of the levels, so she is somewhat working with me. Kaiser is somewhat limited with what they do and I will be looking into another health system this coming November, but for now everything is free with Kaiser since I am double covered.

She is concerned with my blood work so to be safe she is adjusting the dosage. I am also type 1 diabetic so I am thinking she wants to be safer than sorry. The only fall back is that I am have high libido (where it was non existent on Clomid) but with ED it is quite frustrating, no morning woods, and only partial erections (welcome to the world of diabetes and sleep apnea). SO maybe going a little lower may help that as well?

 

[dicus30]

You need to have your SHBG tested.

Again it is critical to know where your FT level truly sits on such protocol and you would need to have it tested using the most accurate assays (ED or UF).

Either assay will suffice!

1. Testosterone, Total and Free (NO Upper Limit) plus Hematocrit

2. Testosterone, Total, LC/MS and Free (Equilibrium Ultrafiltration)

I will probably order it and compare notes. I want to wait 6 weeks and see where this .6mL leaves me. I started HCG 250mg EOD on days I don't inject test. Should I stop that a couple of weeks before my next blood exam?

 

[madman]

Hi MadMan:

Thank you for taking the time to respond. Much is appreciated. I started TRT when I was in my early 20's (spent a lot of time in gym), then went on clomid, then back on TRT, then on clomid (11 years) now ending in TRT. I've attached a picture recently I took, I'm not trying to pack on size as I already achieved that in my 20's (I am gifted with some genetics in my opinion). I just want to reduce my fat (diet and exercise) now and I believe I was on .7mL back then. The headless shot I was 35, and this other shot (with face is a few weeks ago). I just want to look better than I did at 35 is all, I don't want to gain a lot more additional muscle (will accept a little more, but not my goal). So my logical mind was thinking "can't go below .7mL"..."what if I go a little higher?" Since I am older thought I would possibly need more, but back then I was being injected IM 1x a week. So trying to be smarter this time around and be in control of my health.

You have been training long enough and regardless of having healthy testosterone levels diet is key when it comes to body composition (muscle gain/fat loss).

One's genetics plays a big role!

Sure achieving a healthy FT level on trt and following a proper diet/training protocol will give someone an advantage when it comes to muscle gain/fat loss but seeing as your trough TT level is on the high end let alone FT is high doubtful going from 140--->200 mg/week is going to have a huge impact if fat loss is your goal.

Mind you I would have your FT tested using the most accurate assays such as ED or UF if you want to know where it truly sits.

Sure you may make some better gains in muscle but it is not going to be significant.

You already have the size/bulk but your body fat level is too high.

Not sure what type of diet you are following let alone if your thyroid function is optimal as it will have a big impact not only on body composition but overall well-being.

 

[madman]

Hi MadMan:

I apologize for any confusion. The TRT protocol, that I took a picture of, is from Nelson's eBook. I had attached it so people could reference to his recommendations so that I could cross reference it as well. My doctor originally started me off at .7mL every 2 weeks when she started me back on TRT on 10/1/2020, but I asked her to check my dosage 12 years ago and reminded her that I felt better with the once a week injection, she agreed to see what it did for me at .7mL weekly. She's also agreed to allow me to be on the higher end of the levels, so she is somewhat working with me. Kaiser is somewhat limited with what they do and I will be looking into another health system this coming November, but for now everything is free with Kaiser since I am double covered.

She is concerned with my blood work so to be safe she is adjusting the dosage. I am also type 1 diabetic so I am thinking she wants to be safer than sorry. The only fall back is that I am have high libido (where it was non existent on Clomid) but with ED it is quite frustrating, no morning woods, and only partial erections (welcome to the world of diabetes and sleep apnea). SO maybe going a little lower may help that as well?

My mistake as I thought the protocol was from your clinic!

Either way, I still stand by what I stated:

Rare that anyone on hormone replacement therapy would need 250 mg/week (125 mg twice per week) in order to achieve a healthy TT/FT level let alone relief/improvement of low-t symptoms.

Sure some men may require a slightly higher dose than 200 mg/week (considered the high-end for trt) but far and few would need such dose.

Even 200 mg/week would have most men's TT/FT/e2 levels through the roof let alone drive up one's RBCs/hemoglobin/hematocrit.


Horrible protocol 140 mg every 2 weeks she started you on which would have definitely had you back to being hypogonadal well before your next injection.

Luckily she agreed to switch your protocol to 140 mg once weekly.....mind you SHBG should have been tested and depending on where it sits if it turns out to be low/lowish then you may very well fair much better injecting more frequently (EOD or daily) using lower doses of T.

As you can see on your current protocol that your trough TT is on the higher end (almost 1000 ng/dL) but more importantly, your FT is high.

Would be pointless to lower your dose if blood markers are healthy and you feel great overall but seeing as you just mentioned that you are experiencing issues with ED many factors can come into play.

I would look into testing SHBG, TT again using LC/MS-MS, and FT using Equilibrium Dialysis or Ultrafiltration along with estradiol LC/MS-MS before deciding on your next move.

 

[madman]

I will probably order it and compare notes. I want to wait 6 weeks and see where this .6mL leaves me. I started HCG 250mg EOD on days I don't inject test. Should I stop that a couple of weeks before my next blood exam?

If you want to know where your TT/FT/e2 levels truly sit on T only then drop the hCG before you have blood work done but if I were already using T + hCG then would prefer to know where my TT/FT/e2 levels sit on such protocol.

Would recommend that when one first starts trt to leave out the addition of hCG so one can see how they react to a T only protocol let alone where such protocol (dose T/injection frequency) will have their trough TT/FT/e2 level.

 

[gerardo]

Hi MadMan:

Thank you for taking the time to respond. Much is appreciated. I started TRT when I was in my early 20's (spent a lot of time in gym), then went on clomid, then back on TRT, then on clomid (11 years) now ending in TRT. I've attached a picture recently I took, I'm not trying to pack on size as I already achieved that in my 20's (I am gifted with some genetics in my opinion). I just want to reduce my fat (diet and exercise) now and I believe I was on .7mL back then. The headless shot I was 35, and this other shot (with face is a few weeks ago). I just want to look better than I did at 35 is all, I don't want to gain a lot more additional muscle (will accept a little more, but not my goal). So my logical mind was thinking "can't go below .7mL"..."what if I go a little higher?" Since I am older thought I would possibly need more, but back then I was being injected IM 1x a week. So trying to be smarter this time around and be in control of my health.

Did you spend 11 years alone with Clomid? This is interesting. Did you have libido with clomid? What made you stop clomid and start injections?

 

[madman]

Did you spend 11 years alone with Clomid? This is interesting. Did you have libido with clomid? What made you stop clomid and start injections?

post #6

Thank you for taking the time to respond. Much is appreciated. I started TRT when I was in my early 20's (spent a lot of time in gym), then went on clomid, then back on TRT, then on clomid (11 years) now ending in TRT. I've attached a picture recently I took, I'm not trying to pack on size as I already achieved that in my 20's (I am gifted with some genetics in my opinion). I just want to reduce my fat (diet and exercise) now and I believe I was on .7mL back then. The headless shot I was 35, and this other shot (with face is a few weeks ago). I just want to look better than I did at 35 is all, I don't want to gain a lot more additional muscle (will accept a little more, but not my goal). So my logical mind was thinking "can't go below .7mL"..."what if I go a little higher?" Since I am older thought I would possibly need more, but back then I was being injected IM 1x a week. So trying to be smarter this time around and be in control of my health.





post#7

I apologize for any confusion. The TRT protocol, that I took a picture of, is from Nelson's eBook. I had attached it so people could reference to his recommendations so that I could cross reference it as well. My doctor originally started me off at .7mL every 2 weeks when she started me back on TRT on 10/1/2020, but I asked her to check my dosage 12 years ago and reminded her that I felt better with the once a week injection, she agreed to see what it did for me at .7mL weekly. She's also agreed to allow me to be on the higher end of the levels, so she is somewhat working with me. Kaiser is somewhat limited with what they do and I will be looking into another health system this coming November, but for now everything is free with Kaiser since I am double covered.

She is concerned with my blood work so to be safe she is adjusting the dosage. I am also type 1 diabetic so I am thinking she wants to be safer than sorry. The only fall back is that I am have high libido (where it was non existent on Clomid) but with ED it is quite frustrating, no morning woods, and only partial erections (welcome to the world of diabetes and sleep apnea). SO maybe going a little lower may help that as well?