Lab results help and dosage suggestions

[rayrock1]

Just got back my lab results. The doctor reviewed them. I told him that I had some left breast pain on the side of my left breast not the nipple area before I started TRT and noted that my left breast was more saggy in appearance, than the right side. He said he was not concerned by it. I mentioned maybe I should take Tamoxifen, he did not advise it. He suggested I donate blood and take Armidex .25mg once a week. I also have BPH which I was prescribed Cialis for 5mg daily, but have not taken yet,since I wanted to get my TRT protocol dialed in first.
I have been on the following regiment for 8 weeks.

My current protocol: 120mg Test Cyp per week split into 2 injections e3.5d
600 IU HCG split per week into 2 injections on non Test Cyp injection days
30 mg Armour Thyroid daily
Low carb Keto diet usually less than 30 carbs
Lab Results:
Hemoglobin 17.8 (13.0-17.7)
Hematocrit 52.0 (37.5-51.0)

Cholesterol 293.0 (100-199)
Triglycerides 83 (0-149)
HDL 73 (greater than 39)
VLDL 13 (5-40)
LDL 207 (0-99)

Testosterone: Total LC/MS 1385 ng/dl (0-916)
Free 50.44 ng/dl (5-21)
PSA 1.2 (0-4.0)
Estradiol sensitive LC/MS/MS 49.7 (8-35.0)
T3 28 (24-39)
T4 1.42 (.82-1.77)
TSH 1.51 (1.7-8.6)

The doctor mentioned that my high Estradiol was from the HCG, that lowering the dosage to 500 iu's a week will not make much difference. I thought that 600iu's per week was too low a dose to affect Test/Estradiol readings. He was not concerned about the high Testosterone values or Estradiol, said to leave protocol and just take Arimidex, see him in a month. He said he had patients as high as 60 on the Estradiol and made judgments based on symptoms of the patient.
I am hesitant to take the Arimidex and wondering if I should try micro-dosing to achieve a lower Estradiol and Hemocrit levels after my blood donation.
If so, what would be a good dosage/frequency?
Should I micro-dose Test Cyp and HCG ?
Any other suggestions? Thanks

 

[madman]

Just got back my lab results. The doctor reviewed them. I told him that I had some left breast pain on the side of my left breast not the nipple area before I started TRT and noted that my left breast was more saggy in appearance, than the right side. He said he was not concerned by it. I mentioned maybe I should take Tamoxifen, he did not advise it. He suggested I donate blood and take Armidex .25mg once a week. I also have BPH which I was prescribed Cialis for 5mg daily, but have not taken yet,since I wanted to get my TRT protocol dialed in first.
I have been on the following regiment for 8 weeks.

My current protocol: 120mg Test Cyp per week split into 2 injections e3.5d
600 IU HCG split per week into 2 injections on non Test Cyp injection days
30 mg Armour Thyroid daily
Low carb Keto diet usually less than 30 carbs
Lab Results:
Hemoglobin 17.8 (13.0-17.7)
Hematocrit 52.0 (37.5-51.0)

Cholesterol 293.0 (100-199)
Triglycerides 83 (0-149)
HDL 73 (greater than 39)
VLDL 13 (5-40)
LDL 207 (0-99)

Testosterone: Total LC/MS 1385 ng/dl (0-916)
Free 50.44 ng/dl (5-21)
PSA 1.2 (0-4.0)
Estradiol sensitive LC/MS/MS 49.7 (8-35.0)
T3 28 (24-39)
T4 1.42 (.82-1.77)
TSH 1.51 (1.7-8.6)

The doctor mentioned that my high Estradiol was from the HCG, that lowering the dosage to 500 iu's a week will not make much difference. I thought that 600iu's per week was too low a dose to affect Test/Estradiol readings. He was not concerned about the high Testosterone values or Estradiol, said to leave protocol and just take Arimidex, see him in a month. He said he had patients as high as 60 on the Estradiol and made judgments based on symptoms of the patient.
I am hesitant to take the Arimidex and wondering if I should try micro-dosing to achieve a lower Estradiol and Hemocrit levels after my blood donation.
If so, what would be a good dosage/frequency?
Should I micro-dose Test Cyp and HCG ?
Any other suggestions? Thanks

Dosage protocol and lab test change help

My blood results from 100mg Test Cyp only ,once weekly injections, after one month time, tested on trough day was as follows, this was from my Dr's own in house lab; Dr's in house lab results; Hemocrit 50.4 range; [40-54] Total T 524 [193-740 ng/dl] Free T...

www.excelmale.com

One of your previous: threads


rayrock1 said:
My blood results from 100mg Test Cyp only ,once weekly injections, after one month time, tested on trough day was as follows, this was from my Dr's own in house lab;


Dr's in house lab results;


Hemocrit 50.4 range; [40-54]


Total T 524 [193-740 ng/dl]


Free T 7.9 [2.9-20.7 ng/dl]


Bioavailable T 231 [15-575 ng/dl]


Estradiol 15 [11-43 pg/ml ]


SHGB 47 [19-76 nmol/l]


At this Dr visit, I complained of achy testicles, so my Dr put my on HCG, 500iu/week, split into 2 injections. I also complained of feeling a slump after the first 3 days had passed, on the once injection per week schedule, so he also increased my test dosage to 120 mg/week and suggested to also split the dose as well, into 2 injections per week e3.5d.


On the following month, I returned to the Dr. I told him that I split the dosage on the Test as he recommended but left the dosage per week the same ,at the 100 mg, and initiated the 500 iu HCG as he suggested. I did not want to change to many variables and figured he would retest to see where things were with the dosage split at e3.5d and the HCG addition.

The Dr. did not want to retest, as he said, nothing in the Test dosage had changed. I told him my Testicles were still an issue and I still felt a slump the day before and day of my injection day. He suggested to increase my HCG to 700iu/week and my Test Cyp. to 140 mg/week, still injecting e3.5d.

I decided to modify his suggestions once again, bad patient I quess, to increase the HCG to only 600iu/week and my Test Cyp to 120 mg/week injecting e3.5d, and try it for another month before increasing to the dosages he recommended. At this months end, the lab results were as follows from a different lab, Quest Lab

Quest Labs;

Hemocrit 50.3 range; [38-50]

Total T 1296 [250-827 ng/dl ]

Free T 132 [46-224 pg/ml ]

Bioavailable T 300 [110-575 ng/dl ]

Estradiol [35384-7] 57 [0-29 pg/ml]

SHGB 55 [10-50 nmol/l ]

Can these values actually be possible? His in house lab had my values so much lower, while Test Cyp level was only changed 20 percent. Also I read, that dosages of HCG below 700 iu per week had minimal impact on Testosterone levels? is this not the case? Does Quest lab calculate testosterone and estradiol levels differently some how?

While waiting for the blood test results, I went ahead and increased my dosage of HCG and Test Cyp to what the Dr recommended as I was still getting a slight testicle ache and still had the slump feeling on the day before my injection, thinking he was probably right, and should have done so all along, not imagining my total Testosterone level would come back from the new lab, to be at 1200 plus already.

Ironically, after doing so, [700 iu HCG and 140mg Test], I had the best week since I started TRT treatment. I feel more calm, great libido and more leveled out. Can't imagine what my blood levels will be at these dosages............................ Any suggestions? Thank you for your help.

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My reply:

This is a complete mess!

If anything after starting when you had blood work done on the once-weekly 100 mg/week protocol although your trough TT 524 ng/dl which may very well seem sub-par let alone not high enough to achieve a healthy FT as your levels are still too low the main issue is you did not use an accurate assay so we have no idea where your FT truly sits.

You need to have it tested using the most accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration.


At this Dr visit, I complained of achy testicles, so my Dr put my on HCG, 500iu/week, split into 2 injections. I also complained of feeling a slump after the first 3 days had passed, on the once injection per week schedule, so he also increased my test dosage to 120 mg/week and suggested to also split the dose as well, into 2 injections per week e3.5d

As you can clearly see the downfall of injecting higher doses of T once-weekly is that not only will there be a significant difference between peak--->trough levels (high post-injection and elevated within the first few days only to be much lower come weeks end) but blood levels will not be as stable throughout the week which can result in a yo-yo effect on energy/mood/libido/erectile function/recovery.

Switching to twice weekly and splitting the overall weekly dose 100 mg (50 mg every 3.5 days) would have been a sensible move but your doctor not only added hCG but increased your T dose when you would have most likely achieved better trough TT/FT levels leaving the dose as is 100 mg/week (50 mg every 3.5 days).


On the following month, I returned to the Dr. I told him that I split the dosage on the Test as he recommended but left the dosage per week the same ,at the 100 mg, and initiated the 500 iu HCG as he suggested. I did not want to change to many variables and figured he would retest to see where things were with the dosage split at e3.5d and the HCG addition.

The Dr. did not want to retest, as he said, nothing in the Test dosage had changed. I told him my Testicles were still an issue and I still felt a slump the day before and day of my injection day. He suggested to increase my HCG to 700iu/week and my Test Cyp. to 140 mg/week, still injecting e3.5d.

Bad move on your doctors part even though T dose was left the same 100 mg/week (50 mg every 3.5 days) the injection frequency was changed which will have a big impact on your peak--->trough levels and blood work should have been done to see where your trough TT/FT/e2 let alone hemoglobin/hematocrit sit on such.

No bloodwork and having ABSOLUTELY no idea where your TT/FT/e2 levels sit he turns around and increase your dose from 100mg/week (50 mg every 3.5 days) to 140mg/week (70mg every 3.5 days) which is a large jump 40 mg/week and top it off with the fact that he also ups your hCG dose.

Increasing the overall weekly T dose by 20 mg can have a big impact on bumping up TT/FT/e2 levels yet he bumped you up by 40 mg which is a big increase.


I decided to modify his suggestions once again, bad patient I quess, to increase the HCG to only 600iu/week and my Test Cyp to 120 mg/week injecting e3.5d, and try it for another month before increasing to the dosages he recommended. At this months end, the lab results were as follows from a different lab, Quest Lab

Quest Labs;

Hemocrit 50.3 range; [38-50]

Total T 1296 [250-827 ng/dl ]

Free T 132 [46-224 pg/ml ]

Bioavailable T 300 [110-575 ng/dl ]

Estradiol [35384-7] 57 [0-29 pg/ml]

SHGB 55 [10-50 nmol/l ]




You then take it in your own hands and decided to go from 100mg/week (50 mg every 3.5 days) to 120 mg/week (60 mg every 3.5 days) and slightly lower your hCG dose.

Not surprised to say the least that at the trough on the higher dose T 120 mg/week (60 mg every 3.5 days) + hCG that you are now hitting a much higher trough TT and although FT is only in the mid-range you had it tested using an inaccurate method (calculated).

Seeing as you are hitting a trough TT 1296 ng/dL even with a higher SHBG of 55 nmol/L than I bet your FT level would have been much higher if you would have had it tested using an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration.

Imagine how much higher your levels would have been if you took your doctor's piss poor advice and jumped up from 100 mg/week to 140 mg/week.
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Look over the last part highlighted in blue.

Notice how I stated that it was no surprise that you were now hitting a higher trough TT 1296 ng/dL and although FT was only in the mid-range it was done using an inaccurate method.

My gut instinct was that even though your SHBG is on the higher end 55 nmol/L that your FT level would be much higher if it was tested using the most accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration.

Now if we look at your most recent labs which were done using the most accurate assays for TT (LC/MS-MS) and for FT (Equilibrium Ultrafiltration):

Lab Results:
Hemoglobin 17.8 (13.0-17.7)
Hematocrit 52.0 (37.5-51.0)

Cholesterol 293.0 (100-199)
Triglycerides 83 (0-149)
HDL 73 (greater than 39)
VLDL 13 (5-40)
LDL 207 (0-99)

Testosterone: Total LC/MS 1385 ng/dl (0-916)
Free 50.44 ng/dl (5-21)
PSA 1.2 (0-4.0)
Estradiol sensitive LC/MS/MS 49.7 (8-35.0)
T3 28 (24-39)
T4 1.42 (.82-1.77)
TSH 1.51 (1.7-8.6)



Your trough TT is very high (even higher than before) on 120 mg/week split 60 mg every 3.5 days and more importantly, your trough FT is through the roof.

A healthy FT level would be 16-31 ng/dL with 31 being the higher end.

Most healthy young males are hitting 16-20 ng/dL on average.

Many men on trt do well with FT 20-30 ng/dL.

Some may do better running higher levels and others may feel better running lower levels.

Many would tend to aim for higher-end FT level 30ng/dL.

Even then although some may feel better running slightly higher levels highly doubtful one would need a trough FT level 50-60 ng/dL to benefit from trt.

The sad fact of the matter is most men pre-trt have low or low/normal FT.

FT 5-10 ng/dL would be considered low and many can experience issues with levels higher than such.

You are hitting a trough FT 50 ng/dL and your peak levels on twice-weekly injections will be much higher.

As you can see your hemoglobin/hematocrit and e2 have shot up.

Not sure how you feel overall as it has only been 8 weeks but you easily have room to lower your dose slightly which will lower your hemoglobin/hematocrit and e2.

You should have just stayed at 100 mg/week (50 mg every 3.5 days) or if anything switch to lowering the dose and injecting more frequently to clip your peak--->trough and keep blood levels more stable while still being able to achieve a healthy TT/FT level.

If one feels well overall and blood markers are in a healthy range than I would see no issue with running higher levels but again if your pre-trt levels were 5-9 ng/dL or slightly higher and you were experiencing low-t symptoms does it really seem sensible that one would than need to jack up their FT trough levels trough the roof to 50-60 ng/dL to benefit from trt.

 

[rayrock1]

thanks for your reply. I brought this up with the doctor but he was un-phased by the test levels and estradiol. yes I agree to lower dose but should I reduce or eliminate the hcg as well? should i split dose of testto injecting 3 or 4 days a week.? it seems there is a mixed camp on any clinical difference on e3d or eod. My doctors advise was to just to make a blood donation and take .25mg arimidex per week. I donated blood but am looking for a way to avoid arimidex.