Latest results, 6 weeks w/defy

[Dr Justin Saya MD]

With your free T so high, I am betting that you have low SHBG.

Generally true, but difficult to use the free T to anticipate SHBG unless we know the EXACT total T measurement (which unfortunately wasn't his case as the lab simply reports >1500).

As seen below with his SHBG level, the free T can sometimes be misleading in these type of cases (very high total T)...the free T measurement is also prone to A LOT of variability (some even stretch to call it "inaccurate", but it is mostly reliable within the ranges we typically see).

 

[johndoesmith]

Generally true, but difficult to use the free T to anticipate SHBG unless we know the EXACT total T measurement (which unfortunately wasn't his case as the lab simply reports >1500).

As seen below with his SHBG level, the free T can sometimes be misleading in these type of cases (very high total T)...the free T measurement is also prone to A LOT of variability (some even stretch to call it "inaccurate", but it is mostly reliable within the ranges we typically see).

Yeah I'm guilty of that, calling the free testosterone assay inaccurate. It's misleading. Then again, it's measuring a concentration in the trillionths of a gram so one must be forgiving.

 

[ERO]

Good point, thank you for clarifying this Dr. Saya!

I have always found the >1500 cut-off annoying as one doesn't know if his level is 1501 or say 1700 or something.

 

[Dr Justin Saya MD]

Good point, thank you for clarifying this Dr. Saya!

I have always found the >1500 cut-off annoying as one doesn't know if his level is 1501 or say 1700 or something.

I agree. In fact I usually say same to patients "could be 1501, could be 2000"... in either case suffice to say "too high".

 

[LTChris]

Updated protocol:

test cyp - .35mL to .25mL (50mg.) E3.5D
HCG - .40mL to .35mL (350 ui) E3.5D
DHEA - 25mg every day

Also prescribed a AI .15mg to take as needed. I plan to resist taking it until I see how I feel and get my next lab result at my 90 day consult. I also was directed to skip next injection if I wanted.

 

[Vince Carter]

I would advise you to keep pulling labs start at 4 weeks for your E (and TT) before you delve in to that AI. discountedlabs is a tremendous resource.

 

[Vince]

I would advise you to keep pulling labs start at 4 weeks for your E (and TT) before you delve in to that AI. discountedlabs is a tremendous resource.

Personally, I like to do labs later. I let my protocol adjust my levels. But it's probably from feeling good.

 

[endopa-c]

@ LTChris...not "as needed"- only if you experience high E2 symptoms on the new regimen (take on injection days only - twice/week) but it's always best to pull a lab prior. Just wanted to remind you...we definitely do not want your estradiol to crash for the all the reasons we discussed.

Updated protocol:

test cyp - .35mL to .25mL (50mg.) E3.5D
HCG - .40mL to .35mL (350 ui) E3.5D
DHEA - 25mg every day

Also prescribed a AI .15mg to take as needed. I plan to resist taking it until I see how I feel and get my next lab result at my 90 day consult. I also was directed to skip next injection if I wanted.

 

[LTChris]

understood, thanks again

 

[johndoesmith]

This is still odd, as usually people with supraphysiological levels don't report fatigue or depression, in fact they report the opposite or no change at all.

Do you have any other tests? Adrenals, thyroid, or CBC? Especially on a dose that puts you so high.

I still can't figure out why your total is so high, at trough, with a decent SHBG. How long you been on TRT?

Either a dosing error, lab error(unlikely) or some incredibly odd response which would probably need a dose reduction.

 

[LTChris]

No other test. I have been on injections for six weeks. I had pellets inplanted back in may 2016, should have run their course by now

 

[johndoesmith]

No other test. I have been on injections for six weeks. I had pellets inplanted back in may 2016, should have run their course by now

Hmm did you have any labs before starting injections to show that the pellets have run their course?

I'd still get a CBC, TSH, free T3, free T4, cortisol, and DHEA-S. Especially with fatigue or depression as it's entirely possible it's something else, probably even a sleep study, with supraphysiological test I'd think about sleep apnea.

I don't think I've seen such a great response to a mid range dose of test before.

 

[ERO]

Pellets last 12 weeks, max so if you had them in May you are well past any residual at this point.

 

[LTChris]

pre injection labs in this thread
https://www.excelmale.com/forum/showthread.php?8724-Changing-from-pellets-to-injections

 

[LTChris]

I never slept great. Sleep has gotten worse since starting injections. Sleep apnea is an interesting idea. Although I rarely snore. I have to look into it, I don't know a lot about it

 

[johndoesmith]

I never slept great. Sleep has gotten worse since starting injections. Sleep apnea is an interesting idea. Although I rarely snore. I have to look into it, I don't know a lot about it

Interesting that sleep has gotten worse since starting TRT. Definitely get looked at for sleep apnea, especially with supraphysiological levels, and get thyroid tests. Ever had anything more substantial than TSH? Adrenals can be a problem as well.

 

[LTChris]

due to get more in-depth thyroid labs at 90 day consult