Lab Work - What to Track in the Future?

[RobDutch]

Hi everyone,

Also just new here and would like to have some advice, i am just about a year on TRT. Started out with compounded TD cream 10% (8 pumps per day = appr. 2,4 grams actual Test absorbed was 10%) in the beginning it raised my levels and felt good, after 7 months started to feel become worse again and did lab works and there it showed my TT levels dropped from 8438 ng/L till 3731 ng/L. See attached bloodwork) So my doctor thought my skin was not absorbing the TD cream optimal any more. So we decided to switch to IM first 250mg every 2 weeks, did this and got the following results (second attachment) PS. bloodwork was done at day 10 after injection. Than i learned from this side and see that frequently injections provide better/steady level. So after last lab work om 21-12-2018 i started from first week in january to IM with +/- 60 mg every 3,5 days (Sunday evenings and Thursday mornings) Next week hursday 21-03-2019 i will do another labwork still with 2 x pw IM injection @ 60mg (120mg weekly)

My current protocol is
every 3,5 day IM with 60mg Testoviron
every day after injection 0,25mg Arimidex (so twice a week)
every day 120mg erfa Thyroid
every day 7,5mg prednisolone
every day 30mg DHEA
every day 3mg copper (as it was lowish)
every week 1 small vial D-cure to raise Vitamin D
every day 22,5mg zinc

As i'am not a fan of IM and read on so many forums that SQ or shallow IM with 1/2" insuline needle is a preferred way to go, i will after my next lab work (next week) continue with every 3,5 days with 60mg SQ or Shallow IM

About my symptoms; I think i'am still not dialed in to my sweet spot,
- as my sleep is still far from good. (sleep average 5-6 hours, and wake up a few times a night)
- don't wake up very energized in the morning
- Although i do CrossFit 5 x per week, my diet/food is i guess in order with Macro's but very difficult to loose fat from chest and lovehandles etc.

anyone that would like to contribute to my views or my protocols are welcome, as most people on the forum we're all here to learn from eachother.

 

[Systemlord]

I felt tired all the time when my Free T levels were above ranges, yours are almost double.

Arimidex causes me fatigue even with E2 levels inrange, Arimidex destroys my energy.

 

[RobDutch]

Thx for reply, what would you suggest ?
I thought that high free T was a good thing, but appearantly not

 

[Systemlord]

Thx for reply, what would you suggest ?
I thought that high free T was a good thing, but appearantly not

Higher Free T can be a good thing, but it can also cause problems like high E2 which forces your hand towards needing an AI which can add side effects and decrease the effectiveness of TRT.

 

[RobDutch]

Clear, the last bloodwork with high free T was on my every 7 days / 125mg protocol and done the day before next injection. After that i started the every 3,5 days / 60mg. So just have to wait till next week lab work and see results and see from there. Will post lab work once I got them.
And advise of what I better can include in the lab work, I mean for what to check?
Thx

 

[Systemlord]

Clear, the last bloodwork with high free T was on my every 7 days / 125mg protocol and done the day before next injection. After that i started the every 3,5 days / 60mg. So just have to wait till next week lab work and see results and see from there. Will post lab work once I got them.
And advise of what I better can include in the lab work, I mean for what to check?
Thx

We use Total T, Free T, SHBG and E2 sensitive to track our progress and to make adjustments.

 

[YBWV]

And advise of what I better can include in the lab work, I mean for what to check?
Thx

I would suggest to include DHT in your next Labs.
The fact that you were feeling good on the T Cream, until absorbency became an issue, and are now having issues on the injectable (at your good levels of FT & E2), might be due to too low 5a-r conversion to DHT.

Typically DHT levels are significantly higher on transdermals and guys often report good results unless, or until, they have poor absorbency and therefore don't attain adequate levels of hormones.

 

[RobDutch]

Thx , will include this in bloodwork. What would be optimal level ?

 

[YBWV]

Normal conversion is around 10% of TT which for you would indicate DHT ~110ng/dl, probably a bit above top of your Lab's range.

How you function, as ever, is more important than the absolute number and serum DHT provides a "hint" of activity in tissue.
If the level appears low you can increase DHT to see if it helps to relieve symptoms.

 

[RobDutch]

hi Guys,

Just got my labs back (the blooddraw was done in the morning of injection, i normally inject sunday evening 20:00 and than thursday morning 08:00), 2 weeks before blood draw i stopped Aridimex completely and just after the blood draw i injected 60mg subq in my delts (so i switched from IM to Subq) i must the injections subq or shallow IM are so much more comfortable.
As you can see on my labwork my estradiol sensative has rised from 29 till 54, a significant increase. So would like to get some advise from you guys, if i should go back to the ARI protocol or just wait it out.
Also after i switched to Subq my shoulders feel pretty sore, didn't worked out the last 3 days but i feel like i did 3 days in a row heavy shoulder work.
Could this have something to do with switching from IM to Subq, or is the testosteron not being absorbed well enough, or could it be due the high estradiol?

Looking forward to some advise

 

[Cataceous]

Expect a temporary dip in testosterone levels when switching from IM to subQ.

Your current calculated free T is about 20 ng/dL, which is pretty typical for guys on TRT. Calculated free estradiol is about 1.5 pg/mL, which is at the top of the range.

 

[RobDutch]

Thank you, but is it to be expect that T levels will be somewhat returning to same as on IM ? How long I should expect to return? Could this drop in levels also be related to the fatigue or Muscle soreness I have right now?
According my doctor optimal estradiol level should be arround 25, but under 30 is better. When I was as last time under 30 I had sensitive breast/nipple but since I quite arimidex I have already a 2 weeks an itchy nipple and like a warm / burning feeling in the chest / breast. Left side more than right.
So I thinking of adding twice a week 0,25 mg arimidex on the injection days.
Any thoughts or advise would be welcome.

 

[Cataceous]

Yes, levels should return to previous values after a stabilization period. At worst you'd need to wait about five half-lives for this to occur, four to six weeks for T cypionate. However, it's questionable that the size of such a dip would be enough to cause any symptoms.

You will get mixed advice on the AI use. I had estradiol in the 50s pg/mL for quite while and did ok, but am now preferring to lower it with an AI to more normal levels.

 

[RobDutch]

Thx for your quick reply, so could I assume it should be the same for test cyp. and test ent. Time wise to get back to previous levels.
On the AI I see your point, obviously there many people against and pro AI. But I think we all should go by how we feel and possible side effects. In my case I will for the moment resume twice 0,25 mg per week and do lab test after about 8 weeks (as I have a consultation with my doctor on May 23) in this time I hope the levels should be again as with IM.

 

[Cataceous]

T enanthate has a shorter half life, so three or four weeks to stabilize with it.

 

[madman]

T enanthate has a shorter half life, so three or four weeks to stabilize with it.

COMPARISON OF TESTOSTERONE, DIHYDROTESTOSTERONE, LUTEINIZING HORMONE, AND FOLLICLE-STIMULATING HORMONE IN SERUM AFTER INJECTION OF TESTOSTERONE ENANTHATE OR TESTOSTERONE CYPIONATE




They are basically interchangeable!







However, since no comparison of the serum testosterone levels achieved by injection of testosterone enanthate or cypionate in equivalent doses has been reported, it is undecided which of the two esters produces the longer-lasting effects and the more favorable plasma testosterone pattern. To perform this comparison, we analyzed serum testosterone, dihydrotestosterone (DHT), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) concentrations after injection of equal amounts of testosterone given either as enanthate or cypionate to normal men.





Protocol. The study was designed as a crossover study, so that three subjects first received testosterone enanthate, followed 7 weeks later by testosterone cypionate (cyclopentyl propionate). The other three subjects received testosterone cypionate first, and 7 weeks later testosterone enanthate. On the day prior to injection and on the day of the injection blood samples were collected for baseline determinations. Blood samples were obtained daily up to day 6 after the injections and every 2nd day from day 6 to day 26. They were always collected between 12 noon and 1 P.M. The serum was stored at - 20° C prior to analysis.



Testosterone Preparations. Commercially available testosterone preparations were used. Testosterone enanthate (194 mg) (Schering AG, Berlin! Bergkamen) and testosterone cypionate (200 mg) (Upjohn Co., Kalamazoo, Mich.) were injected so that the amount of unesterified testosterone was the same in both preparations (140 mg).








RESULTS
Figure 1 shows the serum hormone levels in six normal men after intramuscular injection of either testosterone enanthate or cypionate. The serum testosterone profiles were identical after both preparations. The concentrations increased sharply, reaching maximal levels 3 times above basal on days 1 and 2 after injection, and decreased gradually thereafter, so that basal levels were reached on day 10. Values continued to fall below basal concentrations on days 12 and 14 (P < 0.05) and then returned to basal. DHT showed a significant elevation above basal levels on days 1 to 5. LH concentrations after injection were significantly (P < 0.05) suppressed until day 10. LH levels then began to increase while testosterone levels were still below basal. FSH levels were already below basal on day 1 and remained significantly (P < 0.01) suppressed until day 14. The lowest concentrations were found between days 6 and 10. The serum profiles of hormones measured in this study, achieved after the administration of either testosterone enanthate or cypionate, were at no point significantly different from each other.

 

[Cataceous]

COMPARISON OF TESTOSTERONE, DIHYDROTESTOSTERONE, LUTEINIZING HORMONE, AND FOLLICLE-STIMULATING HORMONE IN SERUM AFTER INJECTION OF TESTOSTERONE ENANTHATE OR TESTOSTERONE CYPIONATE

They are basically interchangeable!

That was one group in 1980. I haven't seen other research attributing such a short half life to T cypionate.

The Pfizer data sheet says about 8 days.
This 1997 work finds 6.9 days.
This 2018 work finds 6.87 days.

 

[madman]

Population Pharmacokinetic/Pharmacodynamic Modeling of Depot Testosterone Cypionate in Healthy Male Subjects (2018)​

It is difficult to calculate the PK parameters of TC using traditional noncompartmental methods, especially when the endogenous testosterone secretion rate is suppressed during the course of TC administration and the testosterone secretion rate is regulated by the LH‐testosterone feedback loop system in the HPG axis. Our estimated post hoc median tT half‐life was 4.05 days, which is shorter than the mean reported elimination half‐life of 6.9 days determined using noncompartmental analysis.11 Such inconsistency is believed to result from failure to consider endogenous testosterone production. When we assume endogenous testosterone secretion is 0 in the PPK analysis, the median estimated half‐life increases to 6.87 days.

 

[Cataceous]

The dangers of skimming... But I'm not quite ready to concede the point, as I've seen a number of measurement pairs from individuals that have yielded 4-5 days for TE and 6-7 days for TC.

 

[RobDutch]

Good morning Guys,

In my search to find my sweetsport (and man, this is pretty difficult) i did another bloodtest to see where i'am on bloodwork and on feeling.
First i would like to mention that i'am happy i switched over to shallow IM in the delts, it is so much more comfortable than deep IM and the bloodwork reading or values for TT & FT are the same on IM and Shallow IM.
Than back to the other issue E2, the 6 weeks before blooddraw i asked myself (after reading many pro's and cons about e2) do i need Arimidex? So i stopped taking Arimidex for 6 weeks, and as you can see in the attached sheet my e2 is creeping up to 58 and there was almost always an itchy or burning sensation in my nipple area and my joint where stiff and especialy knees where popping. But i just waited out the whole 6 weeks, because i wanted to give it a real change to go without AI.
So after the the bloodwork was done i went back to 2 x 0,25 arimidex per week at the same time as my TE injection (I inject 2 x per week 62,5 mg TE on THU and SUN). And the sensitivity around my nipples became lesser, but not gone yet. The joints are also improved but also not optimal. So I will stay on this protocol for another 5 - 6 weeks and see how i feel and what bloodwork tell me.
One thing that always comes up on the bloodwork is low cortisol free 8AM, don't realy know what this does or what negative symptomes it is related to.

My current protocol is
every 3,5 day IM with 62,5mg TE
every day with injection 0,25mg Arimidex (so twice a week)
every day 120mg erfa Thyroid
every day 7,5mg prednisolone
every day 30mg DHEA
every day 3mg copper (as it was lowish)
every week 1 small vial D-cure to raise Vitamin D
every day 22,5mg zinc


About my symptoms; I think i'am still not dialed in to my sweet spot,
- as my sleep is still far from good. (sleep average 5-6 hours, and wake up a few times a night)
- don't wake up very energized in the morning
- Although i do CrossFit 4/5 x per week, my diet/food is i guess in order with Macro's but very difficult to loose fat from chest and lovehandles etc.

anyone that would like to contribute to my views or my protocols are welcome, as most people on the forum we're all here to learn from eachother.