Lowered TT and FT went Higher! Now What?

[Init2winit]

I don't want to go deep into my 10 year history on TRT. I have been reading these forums for a long time and finally decided to post. I have been on most all forms of T and Protocols, AI's, frequent Blood donations etc. Dealt with a lot of Dr. Quacks' in it for the money unfortunately. Needless to say I keep striving to get dialed in for a longer periods of time. I am a fast metabolizer and sensitive to most everything.

So over the last several months, I have eliminated AI's and blood donations. Which is pretty good for me as I would get caught up in that roller coaster. I have a super clean diet, exercise, take, mag, zinc, boron, Vit D and multi etc. BP is always around 112/70. Below was/is my protocol over the last several years/months

Nov 24, 2021 - Felt like crap - like Low T/E symptoms - Crashed my E
TT 759 (264-916)
FT 12.2 (7.2-24.0)
Estradiol 5.4 (7.6 - 42.6) Crashed it on crumbs of AI's
SHBG 44.6 (19.3-76.4)
Ferritin - 46 (30-400)
Iron - 208
Hemoglobin 16.9
Hematocrit - 50.8
Protocol EOD 26mg Test Cyp and crumbs (yes crumbs) of AI as needed for bloating, low mood (been on this for 3 years)
*labcorp

***Changed Protocol to bring back E****

Jan 18th, 2022 - Felt Great - almost best I have felt except the 24/7 anxiety and insomnia
TT 1167 (250-1100)
FT 173.9 (46-224.0)
Estradiol 40 (< or = 29)
SHBG 36.6 (22-77)
Ferritin 26 (38-380)
Hemoglobin 16.4
Hematocrit - 48.7
Protocol ED 16mg Cyp, no AI's. Added 6mg Boron, 10,000IU Vit D3 5 days per week, and curcumin 250mg daily
*Quest

****Doc told me to back down the T (wasn't quite the full 30 days on this dose)***

Present Day - Tired/lethargic, no motivation, don't feel strong, mood so so... Figured T was high but didn't expect this!
TT 897 (250-1100)
FT 196.7 (35 -155)
Estradiol 31 (< or = 29)
SHBG 33 (22-77)
Ferritin 22 (38-380)
Iron 197 (50-180)
Hemoglobin 17.3
Hematocrit - 33
Protocol ED 13mg Cyp, no AI's. Same as above except dropped curcumin. (on this for 30 days)
*Quest


So how did my TT drop yet my FT increase? Everything for me remained the same. Diet, exercise and supplements except the curcumin. So this begs the question, where do I go from here, up or down? I do better on higher T/E and midrange/upper FT. How do I get there?? I know I can somewhat change my SHeeBanG by eating animal proteins. When I tried to be a vegetarian, my SHeeBanG was in the mid to upper 40's. Once I started eating chicken again, it came down - and the more eat (maybe 8 0z breasts a day) the lower it goes and higher my FT goes. I am not going to lower my meat intake, I only eat about 10 different foods I can tolerate anyway lol.

Any thoughts, comments appreciated.

Thanks

 

[madman]

I don't want to go deep into my 10 year history on TRT. I have been reading these forums for a long time and finally decided to post. I have been on most all forms of T and Protocols, AI's, frequent Blood donations etc. Dealt with a lot of Dr. Quacks' in it for the money unfortunately. Needless to say I keep striving to get dialed in for a longer periods of time. I am a fast metabolizer and sensitive to most everything.

So over the last several months, I have eliminated AI's and blood donations. Which is pretty good for me as I would get caught up in that roller coaster. I have a super clean diet, exercise, take, mag, zinc, boron, Vit D and multi etc. BP is always around 112/70. Below was/is my protocol over the last several years/months

Nov 24, 2021 - Felt like crap - like Low T/E symptoms - Crashed my E
TT 759 (264-916)
FT 12.2 (7.2-24.0)
Estradiol 5.4 (7.6 - 42.6) Crashed it on crumbs of AI's
SHBG 44.6 (19.3-76.4)
Ferritin - 46 (30-400)
Iron - 208
Hemoglobin 16.9
Hematocrit - 50.8
Protocol EOD 26mg Test Cyp and crumbs (yes crumbs) of AI as needed for bloating, low mood (been on this for 3 years)
*labcorp

***Changed Protocol to bring back E****

Jan 18th, 2022 - Felt Great - almost best I have felt except the 24/7 anxiety and insomnia
TT 1167 (250-1100)
FT 173.9 (46-224.0)
Estradiol 40 (< or = 29)
SHBG 36.6 (22-77)
Ferritin 26 (38-380)
Hemoglobin 16.4
Hematocrit - 48.7
Protocol ED 16mg Cyp, no AI's. Added 6mg Boron, 10,000IU Vit D3 5 days per week, and curcumin 250mg daily
*Quest

****Doc told me to back down the T (wasn't quite the full 30 days on this dose)***

Present Day - Tired/lethargic, no motivation, don't feel strong, mood so so... Figured T was high but didn't expect this!
TT 897 (250-1100)
FT 196.7 (35 -155)
Estradiol 31 (< or = 29)
SHBG 33 (22-77)
Ferritin 22 (38-380)
Iron 197 (50-180)
Hemoglobin 17.3
Hematocrit - 33
Protocol ED 13mg Cyp, no AI's. Same as above except dropped curcumin. (on this for 30 days)
*Quest


So how did my TT drop yet my FT increase? Everything for me remained the same. Diet, exercise and supplements except the curcumin. So this begs the question, where do I go from here, up or down? I do better on higher T/E and midrange/upper FT. How do I get there?? I know I can somewhat change my SHeeBanG by eating animal proteins. When I tried to be a vegetarian, my SHeeBanG was in the mid to upper 40's. Once I started eating chicken again, it came down - and the more eat (maybe 8 0z breasts a day) the lower it goes and higher my FT goes. I am not going to lower my meat intake, I only eat about 10 different foods I can tolerate anyway lol.

Any thoughts, comments appreciated.

Thanks

You made the mistake of not having your FT tested using an accurate assay on all of your labs.

You most likely had it tested using the piss poor direct immunoassay (Nov.24/2021), using the older outdated calculated linear law-of-mass action cFTV (Jan.18/2022), and on your most recent set luckily what would be considered one of the most accurate assays the gold standard equilibrium Dialysis.

When comparing labs whether TT, FT, or estradiol you need to use the same lab and the same assays (most accurate) TT/estradiol (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

The only way to know where your FT level truly sits is to have it tested using the most accurate methods such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

Unfortunately many are using/relying upon the piss poor known to be inaccurate direct immunoassay.

Even more critical to use the most accurate assays (ED or UF), especially in cases of altered SHBG.

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

FT 16-31 ng/dL is healthy.

Most men will do well with FT 20-30 ng/dL.

Some may choose/want to run higher levels.

Comes down to the individual.




Nov 24, 2021 - Felt like crap - like Low T/E symptoms - Crashed my E
TT 759 (264-916)
FT 12.2 (7.2-24.0)
Estradiol 5.4 (7.6 - 42.6) Crashed it on crumbs of AI's
SHBG 44.6 (19.3-76.4)
Ferritin - 46 (30-400)
Iron - 208
Hemoglobin 16.9
Hematocrit - 50.8
Protocol EOD 26mg Test Cyp and crumbs (yes crumbs) of AI as needed for bloating, low mood (been on this for 3 years)
*labcorp


You were injecting 91mg T/week (26 mg EOD).

If your labs were done at the true trough (this is when we want to test) then with a robust TT 759 ng/dL, SHBG 44.6 nmol/L, Albumin 4.3 g/dL (fixed) then your trough FT would most likely be around 25 ng/dL (just above mid-range).

Keeping in mind peak TT, FT will be higher.

TruT Free Testosterone Calculator by FPT

Free testosterone calculator by FPT. Improved accuracy of free T calculations.

tru-t.org

As you can see estradiol was horribly low and most likely why you felt like shit!

Ferritin is closer to the lower end most likely from frequent blood donations from trying to manage elevated RBCs/hemoglobin/hematocrit.




***Changed Protocol to bring back E****

Jan 18th, 2022 - Felt Great - almost best I have felt except the 24/7 anxiety and insomnia
TT 1167 (250-1100)
FT 173.9 (46-224.0)
Estradiol 40 (< or = 29)
SHBG 36.6 (22-77)
Ferritin 26 (38-380)
Hemoglobin 16.4
Hematocrit - 48.7
Protocol ED 16mg Cyp, no AI's. Added 6mg Boron, 10,000IU Vit D3 5 days per week, and curcumin 250mg daily
*Quest


You were injecting 112 mg T/week (16 mg daily).

If your labs were done at the true trough (this is when we want to test) then with a very high TT 1167 ng/dL, SHBG 36.6 nmol/L, Albumin 4.3 g/dL (fixed) then your trough FT would most likely be around 41-42 ng/dL (very high).

As you can see estradiol is back up due to stopping the AI and although you felt great overall you were experiencing anxiety/insomnia which was most likely due to your very high FT level.

Keep in mind that testosterone has a tonic effect on the CNS and high FT levels can easily cause insomnia/anxiety in some individuals.

Ferritin is crashed most likely from frequent blood donations trying to manage elevated RBCs/hemoglobin/hematocrit.




****Doc told me to back down the T (wasn't quite the full 30 days on this dose)***

Present Day - Tired/lethargic, no motivation, don't feel strong, mood so so... Figured T was high but didn't expect this!
TT 897 (250-1100)
FT 196.7 (35 -155)
Estradiol 31 (< or = 29)
SHBG 33 (22-77)
Ferritin 22 (38-380)
Iron 197 (50-180)
Hemoglobin 17.3
Hematocrit - 33
Protocol ED 13mg Cyp, no AI's. Same as above except dropped curcumin. (on this for 30 days)
*Quest


You are injecting 91 mg T/week (13 mg daily).

If your labs were done at the true trough (this is when we want to test) then with a high TT 897 ng/dL, SHBG 33 nmol/L, Albumin 4.3 g/dL (fixed) then your trough FT would most likely be around 31-32 ng/dL (high).

You are definitely hitting a high-end FT level injecting 91 mg T/week split 13 mg daily.

On your first protocol when you were running a robust TT 759 ng/dL which would have had your FT just above mid-range (around 25 ng/dL) you felt like crap which was most likely due to crashing your estradiol.

You said you felt great overall when you were running a very high TT 1167 ng/dL which would have had your FT very high (most likely low 40 ng/dL) but you were experiencing insomnia/anxiety.

On your current protocol, you stated.....Present Day - Tired/lethargic, no motivation, don't feel strong, mood so so... Figured T was high but didn't expect this!

I would say there is a good chance that your crashed ferritin has finally caught up to you.

Keep in mind that crashed ferritin/iron can cause numerous issues especially when it comes to the thyroid.

Would look into getting your ferritin back up to a healthy level before tweaking your protocol further!

 

[madman]

So how did my TT drop yet my FT increase? Everything for me remained the same.


My reply from a previous thread:

When it comes to comparing blood work whether one is following a strictly sub-q protocol, strictly IM protocol let alone sub-q vs IM protocol they are following the steps needed in order to make a fair comparison.


Critical Points

1. The protocol needs to be kept the same (ester/dose T/injection frequency)

2. 4-6 weeks for blood levels to stabilize before getting blood work done (6 weeks)

3. Testing is done at the true trough

4. Using the same lab

5. Using the same assays (most accurate) TT/e2 (LC-MS/MS) and FT (Equilibrium Dialysis or Ultrafiltration)

6. Each protocol needs to be given 12 weeks (claim success or failure)


Only then can one make the claim whether the protocol was truly a success or failure let alone when comparing blood levels.

 

[eli]

Because you're aromatizing less, more free T.
The numbers are there, you can see your estradiol gone down. I assume you're injecting less

 

[Init2winit]

So how did my TT drop yet my FT increase? Everything for me remained the same.


My reply from a previous thread:

When it comes to comparing blood work whether one is following a strictly sub-q protocol, strictly IM protocol let alone sub-q vs IM protocol they are following the steps needed in order to make a fair comparison.


Critical Points

1. The protocol needs to be kept the same (ester/dose T/injection frequency)

2. 4-6 weeks for blood levels to stabilize before getting blood work done (6 weeks)

3. Testing is done at the true trough

4. Using the same lab

5. Using the same assays (most accurate) TT/e2 (LC-MS/MS) and FT (Equilibrium Dialysis or Ultrafiltration)

6. Each protocol needs to be given 12 weeks (claim success or failure)


Only then can one make the claim whether the protocol was truly a success or failure let alone when comparing blood levels.

Thanks for all that info! Very helpful. The interesting part about the ferritin is my Iron is at 197 which is above range, the question is it still safe to take additional iron. I haven't donated blood in 7 mos. Was concerned about iron overload.

 

[Init2winit]

Because you're aromatizing less, more free T.
The numbers are there, you can see your estradiol gone down. I assume you're injecting less

I am injecting more frequently now ED rather than EOD and 91mg week same as I was at EOD (of course injecting ED will bring it higher) but less than the last protocol of 112mg per week. I am feeling effect of higher T with some anxiety, insomnia, no motivation etc. Everything looks good on paper but I just not feeling it. If I go lower, I reduce the E and then my mood sufferers. If I go higher, well then I presume I will be more tired and lethargic, lol motivation etc. Just a tough call. would be easier if FT was low or midrange but never ran into this. Not sure about increasing ferritin with higher Iron levels - don't want Iron overload. I wondered if it was the boron I started back in Dec 21 or the increase in vit D from 46 --> 85. Just a thought.

 

[madman]

Thanks for all that info! Very helpful. The interesting part about the ferritin is my Iron is at 197 which is above range, the question is it still safe to take additional iron. I haven't donated blood in 7 mos. Was concerned about iron overload.

Post labs for iron, TIBC, TSAT?

Full thyroid panel?

 

[Init2winit]

Post labs for iron, TIBC, TSAT?

Full thyroid panel?

The last I had those done was in November (attached) except the TIBC/TSAT. Those are coming up in a couple of weeks. Will Total Iron deplete faster if there is none in reserve (Ferritin)? Not sure I fully understand how that works and I can have higher Iron than Ferritin - I have read that is a symptom of TRT but not the higher Iron levels and lower Ferritin.

 

[eli]

I am injecting more frequently now ED rather than EOD and 91mg week same as I was at EOD (of course injecting ED will bring it higher) but less than the last protocol of 112mg per week. I am feeling effect of higher T with some anxiety, insomnia, no motivation etc. Everything looks good on paper but I just not feeling it. If I go lower, I reduce the E and then my mood sufferers. If I go higher, well then I presume I will be more tired and lethargic, lol motivation etc. Just a tough call. would be easier if FT was low or midrange but never ran into this. Not sure about increasing ferritin with higher Iron levels - don't want Iron overload. I wondered if it was the boron I started back in Dec 21 or the increase in vit D from 46 --> 85. Just a thought.

You need to wait 6-8 weeks for the hormones to stabilize, it's normal to feel down, lethargic during this time since you're changing your protocol

 

[Systemlord]

You need to wait 6-8 weeks for the hormones to stabilize, it's normal to feel down, lethargic during this time since you're changing your protocol

I didn't have this problem on Jatenzo, probably due to reaching a steady state in 7 days. I supect this is because you're speading less time with hormone levels in flux.

 

[Init2winit]

You need to wait 6-8 weeks for the hormones to stabilize, it's normal to feel down, lethargic during this time since you're changing your protocol

Do you think the High FT will subside in the next couple of weeks or that I could stabilize with the Higher FT? If I do feel like crap still, then which direction do I go - up would lead to more FT (I assume) and down would lead to lower E, TT and FT. I tend to feel better on Higher TT/E - go figure..

 

[Init2winit]

I didn't have this problem on Jatenzo, probably due to reaching a steady state in 7 days. I supect this is because you're speading less time with hormone levels in flux.

I would like to try that Jatenzo however I did try some sublingual pills awhile back and they made me super lathergic in the first few days and drove my blood pressure way up! My T Doc (Dr. Kominiarek) said to stop. I know I metabolize things quickly so maybe that's why it hit me much quicker than shots - IDK. Gets very frustrating after a while. almost 10 years of this - still having hope that one day I will feel good for an extended period of time

 

[Init2winit]

Here is my Lab result from when I last had my thyroid checked back in Nov 21. Forgot to attach them.

 

[Init2winit]

One thing I found interesting is I had some Genome Sequencing done and I am in the 97th percentile for - Very high genetic predisposition to higher testosterone level-
I guess past life choices took that away - lol

 

[madman]

You need to wait 6-8 weeks for the hormones to stabilize, it's normal to feel down, lethargic during this time since you're changing your protocol

More like 4-6 weeks when using TE/TC.

Whether starting trt or tweaking a protocol (dose T/injection frequency) hormones will be in FLUX during the weeks leading up until blood levels have stabilized (4-6 weeks).

During the transition, it is common for many to experience ups/downs as the body is trying to adjust and things tend to settle down 4-5 weeks in.

Even then once levels have stabilized it will take time for the body to adapt to the new set-point and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-t symptoms.

He has been on his most recent protocol for 30 days and his levels would be fairly stable by then.

He is hitting a high trough TT 897ng/dL with an SHBG 33 nmol/L.

His trough FT would be high.

I would put more weight behind the crashed ferritin/thyroid.





Jan 18th, 2022 - Felt Great - almost best I have felt except the 24/7 anxiety and insomnia
TT 1167 (250-1100)
FT 173.9 (46-224.0)
Estradiol 40 (< or = 29)
SHBG 36.6 (22-77)
Ferritin 26 (38-380)
Hemoglobin 16.4
Hematocrit - 48.7
Protocol ED 16mg Cyp, no AI's. Added 6mg Boron, 10,000IU Vit D3 5 days per week, and curcumin 250mg daily
*Quest

****Doc told me to back down the T (wasn't quite the full 30 days on this dose)***




Present Day - Tired/lethargic, no motivation, don't feel strong, mood so so... Figured T was high but didn't expect this!
TT 897 (250-1100)
FT 196.7 (35 -155)
Estradiol 31 (< or = 29)
SHBG 33 (22-77)
Ferritin 22 (38-380)
Iron 197 (50-180)
Hemoglobin 17.3
Hematocrit - 33
Protocol ED 13mg Cyp, no AI's. Same as above except dropped curcumin. (on this for 30 days)
*Quest

 

[madman]

Do you think the High FT will subside in the next couple of weeks or that I could stabilize with the Higher FT? If I do feel like crap still, then which direction do I go - up would lead to more FT (I assume) and down would lead to lower E, TT and FT. I tend to feel better on Higher TT/E - go figure..

You had blood work done 30 days in so levels should be fairly stable and if anything your TT, FT, and estradiol would be slightly higher at the 6-week mark.

Again trough FT on your current protocol 91 mg T/week (13 mg daily) would be high.

If your labs were done at the true trough (this is when we want to test) then with a high TT 897 ng/dL, SHBG 33 nmol/L, Albumin 4.3 g/dL (fixed) then your trough FT would most likely be around 31-32 ng/dL (high).

 

[Init2winit]

More like 4-6 weeks when using TE/TC.

Whether starting trt or tweaking a protocol (dose T/injection frequency) hormones will be in FLUX during the weeks leading up until blood levels have stabilized (4-6 weeks).

During the transition, it is common for many to experience ups/downs as the body is trying to adjust and things tend to settle down 4-5 weeks in.

Even then once levels have stabilized it will take time for the body to adapt to the new set-point and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-t symptoms.

He has been on his most recent protocol for 30 days and his levels would be fairly stable by then.

I would put more weight behind the crashed ferritin!

His hematocrit went from 48.7--->33 in 2 months, a huge drop.




Jan 18th, 2022 - Felt Great - almost best I have felt except the 24/7 anxiety and insomnia
TT 1167 (250-1100)
FT 173.9 (46-224.0)
Estradiol 40 (< or = 29)
SHBG 36.6 (22-77)
Ferritin 26 (38-380)
Hemoglobin 16.4
Hematocrit - 48.7
Protocol ED 16mg Cyp, no AI's. Added 6mg Boron, 10,000IU Vit D3 5 days per week, and curcumin 250mg daily
*Quest

****Doc told me to back down the T (wasn't quite the full 30 days on this dose)***




Present Day - Tired/lethargic, no motivation, don't feel strong, mood so so... Figured T was high but didn't expect this!
TT 897 (250-1100)
FT 196.7 (35 -155)
Estradiol 31 (< or = 29)
SHBG 33 (22-77)
Ferritin 22 (38-380)
Iron 197 (50-180)
Hemoglobin 17.3
Hematocrit - 33
Protocol ED 13mg Cyp, no AI's. Same as above except dropped curcumin. (on this for 30 days)
*Quest

I looked at that now at is was a typo for the Hematocrit. I must have cut and pasted it from the SHBG. Hema is 49.9 at this point in time. Sorry for the confusion. I understand the wait - as hard as it is. I am at 30 days at this point and will wait another 2 weeks - I am a pretty good judge of where I am headed based on the last 10 years of doing this - but nonetheless I will stick it out. Thanks!

 

[madman]

Here is my Lab result from when I last had my thyroid checked back in Nov 21. Forgot to attach them.

Need to look into getting more thorough labs CBC, TIBC, TSAT let alone a full thyroid panel for your most recent protocol.

You only posted ferritin/iron, hemoglobin/hematocrit.

Present Day - Tired/lethargic, no motivation, don't feel strong, mood so so... Figured T was high but didn't expect this!
TT 897 (250-1100)
FT 196.7 (35 -155)
Estradiol 31 (< or = 29)
SHBG 33 (22-77)
Ferritin 22 (38-380)
Iron 197 (50-180)
Hemoglobin 17.3
Hematocrit - 33
Protocol ED 13mg Cyp, no AI's. Same as above except dropped curcumin. (on this for 30 days)
*Quest

 

[madman]

Here is my Lab result from when I last had my thyroid checked back in Nov 21. Forgot to attach them.

Why was your LH/FSH even tested on the labs you just put up in post #13?

Why was FT tested twice (2 different assays) the piss poor direct immunoassay and the one everyone should be using/relying upon Equilibrium Dialysis or Ultrafiltration (most accurate) as yours was also tested by Equilibrium Ultrafiltration?


Nov 24, 2021 - Felt like crap - like Low T/E symptoms - Crashed my E
TT 759 (264-916)
FT 12.2 (7.2-24.0) * this would be the piss poor direct immunoassay
Estradiol 5.4 (7.6 - 42.6) Crashed it on crumbs of AI's
SHBG 44.6 (19.3-76.4)
Ferritin - 46 (30-400)
Iron - 208
Hemoglobin 16.9
Hematocrit - 50.8
Protocol EOD 26mg Test Cyp and crumbs (yes crumbs) of AI as needed for bloating, low mood (been on this for 3 years)
*labcorp

***Changed Protocol to bring back E****

 

[madman]

Nov.24/2021

*protocol 91mg T/week split 26 mg EOD.


Your FT was tested using 2 different assays (direct immunoassay/Equilibrium Ultrafiltration).

The same day you had your blood work done.

Your TT 759 ng/dL (reference range 264-916 ng/dL) was tested using the most accurate assay LC/MS-MS yet FT 12.2 pg/mL (reference range 7.2-24.0 pg/mL) was tested using the piss poor direct immunoassay which is known to be inaccurate and should not be used/relied upon when testing free testosterone!

Would have you and anyone believing that your trough FT is on the lower end.

Second FT test result.

Your TT 759 ng/dL (reference range 264-916 ng/dL) was tested using the most accurate assay LC/MS-MS and FT 29.45 ng/dL (reference range 5.00-21.00 ng/dL) was tested using Equilibrium Ultrafiltration which is one of the most accurate assays.

ED or UF are the assays people should be using/relying upon when testing free testosterone.

As you can clearly see your trough FT is high.

You are hitting almost 4% FT.

Yes, this is even with a highish SHBG 44.6 nmol/L.....who knew lol!

Just imagine how much higher it would have been if you had tested it using the same lab (Labcorp)/assay (Equilibrium Ultrafiltration) when you were running a very high TT 1167 ng/dL with an SHBG 36.6 nmol/L back when you had labs done on Jan.18/2022?

This is why it is critical for anyone pre/post trt to always use the same lab/same assay (most accurate) when getting blood work done!

Just imagine how many men have no clue where their trough FT level truly sits.