My TRT Odyssey: Lab Results and More

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FunkOdyssey

Seeker of Wisdom
Time for an update. I ran some 8 week labs after increasing from 40 to 50 mg EOD SC (140 to 175 mg weekly) and the results are puzzling:

Test

12/19/2023

2/15/2024

Normal Range

Total Testosterone

893 ng/dL

1101 ng/dL

250 - 1100 ng/dL

Free T (EqD)

168.6 pg/mL

166.3 pg/mL

35 - 155 pg/mL

Free T (calc)

17.3 ng/dL

27 ng/dL

 

SHBG

44 nmol/L

35 nmol/L

10 - 50 nmol/L

Estradiol

43 pg/mL

83 pg/mL

<= 29 pg/mL

DHT

66 ng/dL

65 ng/dL

12 - 65 ng/dL

Hematocrit

41.8%

47.3%

38.5 - 50%

Ferritin

48 ng/mL

28 ng/mL

38 - 380 ng/mL


If you've noticed a shift in my attitude towards SC injections, this is why. I increased my dose by 25%, my free T and DHT stayed almost exactly the same, and my E2 doubled. WTF?

In the couple months between these tests I started cranking out the RBCs and Hemoglobin; this is reflected in my dropping ferritin level. I expect this should level out and maybe rise a little once my HCT plateaus. I recently increased my red meat consumption to 2 1/2 lbs per day so there's no doubt my iron intake is sufficient.

So how does 83 pg/mL E2 feel? Not too bad. Here's my 8 week assessment:
  • Mood is pretty good
  • Energy is pretty good
  • Frequent nocturnal erections
  • Sometimes having a little morning wood, doesn't last long though
  • Libido is not very good
  • Cognition is good
  • Sleep seems unaffected by testosterone and is pretty good
  • No anxiety
  • Hair is good, hair loss in shower is similar to baseline (ketoconazole shampoo may be helping a bit)
  • Have some annoying acne on my chest and upper back that I am partially controlling with Panoxyl. Face is mostly ok, but seems somewhat more acne prone than usual also, particularly when eating poorly.
  • I have noticeable water retention where it is difficult to put on my rings and my socks are leaving major indents.
  • Heart rate may be slightly elevated compared to before TRT (3-5 bpm)
  • Blood pressure is still good, last check was 114/70 I think.

I know I said I would give it a full 12 weeks but these labs are ridiculous. I switched to IM shots in the delts already, keeping dosage and frequency the same. Stay tuned for the next set of labs to find out if IM delivers superior results.

On the lifting front, I switched from the 5x5 scheme to 5 x 8-12 to go easier on my joints and focus more on hypertrophy. I made some adjustments that have solved all my lower back issues, including squatting only once per week instead of twice, using a more upright posture for squats, and replacing barbell deadlift with trap bar deadlift. However, my right knee is bothering me now so I need to figure that out. It might have coincided with the more upright squatting position.

I have also gained some more weight. I am now up from 190 lb to 213 lbs at 6'6". I think I'm about 17% body fat. I have mostly gained a mix of water and muscle weight and maybe slight bit of fat, not sure. Friends and family are noticing now and giving compliments on the more muscular physique.
 
Last edited:
Defy Medical TRT clinic doctor

Systemlord

Member
I have noticeable water retention where it is difficult to put on my rings and my socks are leaving major indents.
I notice erections aren't consistent if I'm urinating too much or not enough, indicating fluid retention as the cause without any visible bloating or indications of fluid retention.

Your body's fluid balance is off.

The testosterone induced sodium reabsorption -> kidneys is the cause.

I also notice more swelling, fingers, feet, legs due to a lack of oxygen -> low ferritin.

Perhaps a mild diuretic is needed, like dandelion root and at the very least get your ferritin up!
 
Last edited:

tropicaldaze1950

Well-Known Member
Time for an update. I ran some 8 week labs after increasing from 40 to 50 mg EOD SC (140 to 175 mg weekly) and the results are puzzling:

Test

12/19/2023

2/15/2024

Normal Range

Total Testosterone

893 ng/dL

1101 ng/dL

250 - 1100 ng/dL

Free T (EqD)

168.6 pg/mL

166.3 pg/mL

35 - 155 pg/mL

Free T (calc)

17.3 ng/dL

27 ng/dL

 

SHBG

44 nmol/L

35 nmol/L

10 - 50 nmol/L

Estradiol

43 pg/mL

83 pg/mL

<= 29 pg/mL

DHT

66 ng/dL

65 ng/dL

12 - 65 ng/dL

Hematocrit

41.8%

47.3%

38.5 - 50%

Ferritin

48 ng/mL

28 ng/mL

38 - 380 ng/mL


If you've noticed a shift in my attitude towards SC injections, this is why. I increased my dose by 25%, my free T and DHT stayed almost exactly the same, and my E2 doubled. WTF?


In the couple months between these tests I started cranking out the RBCs and Hemoglobin; this is reflected in my dropping ferritin level. I expect this should level out and maybe rise a little once my HCT plateaus. I recently increased my red meat consumption to 2 1/2 lbs per day so there's no doubt my iron intake is sufficient.

So how does 83 pg/mL E2 feel? Not too bad. Here's my 8 week assessment:
  • Mood is pretty good
  • Energy is pretty good
  • Frequent nocturnal erections
  • Sometimes having a little morning wood, doesn't last long though
  • Libido is not very good
  • Cognition is good
  • Sleep seems unaffected by testosterone and is pretty good
  • No anxiety
  • Hair is good, hair loss in shower is similar to baseline (ketoconazole shampoo may be helping a bit)
  • Have some annoying acne on my chest and upper back that I am partially controlling with Panoxyl. Face is mostly ok, but seems somewhat more acne prone than usual also, particularly when eating poorly.
  • I have noticeable water retention where it is difficult to put on my rings and my socks are leaving major indents.
  • Heart rate may be slightly elevated compared to before TRT (3-5 bpm)
  • Blood pressure is still good, last check was 114/70 I think.

I know I said I would give it a full 12 weeks but these labs are ridiculous. I switched to IM shots in the delts already, keeping dosage and frequency the same. Stay tuned for the next set of labs to find out if IM delivers superior results.

On the lifting front, I switched from the 5x5 scheme to 5 x 8-12 to go easier on my joints and focus more on hypertrophy. I made some adjustments that have solved all my lower back issues, including squatting only once per week instead of twice, using a more upright posture for squats, and replacing barbell deadlift with trap bar deadlift. However, my right knee is bothering me now so I need to figure that out. It might have coincided with the more upright squatting position.

I have also gained some more weight. I am now up from 190 lb to 213 lbs at 6'6". I think I'm about 17% body fat. I have mostly gained a mix of water and muscle weight and maybe slight bit of fat, not sure. Friends and family are noticing now and giving compliments on the more muscular physique.
Could the near doubling of E2 reflect injecting into fat versus IM? That seems to be a debating point since many men do sc but a concomitant rise in E2 isn't a given.
 

FunkOdyssey

Seeker of Wisdom
Could the near doubling of E2 reflect injecting into fat versus IM? That seems to be a debating point since many men do sc but a concomitant rise in E2 isn't a given.
That's my hypothesis:


 

FunkOdyssey

Seeker of Wisdom
I notice erections aren't consistent if I'm urinating too much or not enough, indicating fluid retention as the cause without any visible bloating or indications of fluid retention.

Your body's fluid balance is off.

The testosterone induced sodium reabsorption -> kidneys is the cause.

I also notice more swelling, fingers, feet, legs due to a lack of oxygen -> low ferritin.

Perhaps a mild diuretic is needed, like dandelion root and at the very least get your ferritin up!
I'm just going to wait it out. I think either I'll adapt to the T component of the water retention or the E2 will come down a bit and help or both. And same with the ferritin -- there's no way I don't replenish that with the amount of heme iron I'm eating.
 

Guided_by_Voices

Well-Known Member
Time for an update. I ran some 8 week labs after increasing from 40 to 50 mg EOD SC (140 to 175 mg weekly) and the results are puzzling:

Test

12/19/2023

2/15/2024

Normal Range

Total Testosterone

893 ng/dL

1101 ng/dL

250 - 1100 ng/dL

Free T (EqD)

168.6 pg/mL

166.3 pg/mL

35 - 155 pg/mL

Free T (calc)

17.3 ng/dL

27 ng/dL

 

SHBG

44 nmol/L

35 nmol/L

10 - 50 nmol/L

Estradiol

43 pg/mL

83 pg/mL

<= 29 pg/mL

DHT

66 ng/dL

65 ng/dL

12 - 65 ng/dL

Hematocrit

41.8%

47.3%

38.5 - 50%

Ferritin

48 ng/mL

28 ng/mL

38 - 380 ng/mL


If you've noticed a shift in my attitude towards SC injections, this is why. I increased my dose by 25%, my free T and DHT stayed almost exactly the same, and my E2 doubled. WTF?


In the couple months between these tests I started cranking out the RBCs and Hemoglobin; this is reflected in my dropping ferritin level. I expect this should level out and maybe rise a little once my HCT plateaus. I recently increased my red meat consumption to 2 1/2 lbs per day so there's no doubt my iron intake is sufficient.

So how does 83 pg/mL E2 feel? Not too bad. Here's my 8 week assessment:
  • Mood is pretty good
  • Energy is pretty good
  • Frequent nocturnal erections
  • Sometimes having a little morning wood, doesn't last long though
  • Libido is not very good
  • Cognition is good
  • Sleep seems unaffected by testosterone and is pretty good
  • No anxiety
  • Hair is good, hair loss in shower is similar to baseline (ketoconazole shampoo may be helping a bit)
  • Have some annoying acne on my chest and upper back that I am partially controlling with Panoxyl. Face is mostly ok, but seems somewhat more acne prone than usual also, particularly when eating poorly.
  • I have noticeable water retention where it is difficult to put on my rings and my socks are leaving major indents.
  • Heart rate may be slightly elevated compared to before TRT (3-5 bpm)
  • Blood pressure is still good, last check was 114/70 I think.

I know I said I would give it a full 12 weeks but these labs are ridiculous. I switched to IM shots in the delts already, keeping dosage and frequency the same. Stay tuned for the next set of labs to find out if IM delivers superior results.

On the lifting front, I switched from the 5x5 scheme to 5 x 8-12 to go easier on my joints and focus more on hypertrophy. I made some adjustments that have solved all my lower back issues, including squatting only once per week instead of twice, using a more upright posture for squats, and replacing barbell deadlift with trap bar deadlift. However, my right knee is bothering me now so I need to figure that out. It might have coincided with the more upright squatting position.

I have also gained some more weight. I am now up from 190 lb to 213 lbs at 6'6". I think I'm about 17% body fat. I have mostly gained a mix of water and muscle weight and maybe slight bit of fat, not sure. Friends and family are noticing now and giving compliments on the more muscular physique.
Congratulations on your lifting progress! Any number of things could be going on with your knee but I have found that stretching (which seems to settle the knee-cap), gait and form are the first places to look for a resolution, along with DMSO. A knees-over-toes stretch helped my knees a lot, as did short bursts on the stationary bike a few times a day to get blood into the joint.
 

StormnNJ

New Member
Appreciate the tough love madman. I'll tell you what: I already bumped up to the 50 mg EOD, but I will try my damnedest to stay here for the full 12 weeks as a concession to your wisdom. I just wanted to lock in a free T of 20+ ng/dL before playing the waiting game in earnest.
I would be careful with chasing numbers that will bring side effects. Is the end goal quality of life or a free T of 20+?

Finding the sweet spot takes time and after only 8 weeks your body is still adjusting to all of the hormone levels increasing not just testosterone. Stick to one T protocol, exercise, diet, supplement regimen for at least 3 to 4 months before testing and seeing what labs look like.

Everyone is different but this journey for me is for QoL

Don't overthink it
 

FunkOdyssey

Seeker of Wisdom
I would be careful with chasing numbers that will bring side effects. Is the end goal quality of life or a free T of 20+?

Finding the sweet spot takes time and after only 8 weeks your body is still adjusting to all of the hormone levels increasing not just testosterone. Stick to one T protocol, exercise, diet, supplement regimen for at least 3 to 4 months before testing and seeing what labs look like.
The long-term goal is quality of life, but that is not the short-term goal. The short-term goal is to chase the numbers, collect objective and subjective data on the effects of those numbers, and adjust from there. Pushing the limits, bringing on side effects, and compromising quality of life in the short term is all part of the process.

You'll notice I didn't change my dose after these labs, so if I run labs in another 8 weeks, I'm sitting at 175 mg for 4 months which should make everyone happy. The minor SC to IM change shouldn't make any difference if you subscribe to the prevailing paradigm on the matter.

Don't overthink it
If you knew me, you'd know that's an impossible suggestion.
 
Last edited:

Cataceous

Super Moderator
Time for an update. I ran some 8 week labs after increasing from 40 to 50 mg EOD SC (140 to 175 mg weekly) and the results are puzzling:

Test

12/19/2023

2/15/2024

Normal Range

Total Testosterone

893 ng/dL

1101 ng/dL

250 - 1100 ng/dL

Free T (EqD)

168.6 pg/mL

166.3 pg/mL

35 - 155 pg/mL

Free T (calc)

17.3 ng/dL

27 ng/dL

 

SHBG

44 nmol/L

35 nmol/L

10 - 50 nmol/L

Estradiol

43 pg/mL

83 pg/mL

<= 29 pg/mL


...
Most likely a misfire in the EqD FT testing. EqD may be the gold standard, but it's still a tricky test that's going to give garbage when not done perfectly. The calculated FT is probably closer to reality.

Not sure this applies here, but interestingly the inhibitory effect between DHT and estradiol may be bidirectional in some sense. That is, DHT is known to inhibit aromatase, and now I see the suggestion that estradiol "may exert an inhibitory effect on the enzyme 5-alpha-reductase ..."

... I'm sitting at 175 mg for 4 months which should make everyone happy. ...
Except the advocates of physiological dosing.
 

FunkOdyssey

Seeker of Wisdom
Most likely a misfire in the EqD FT testing. EqD may be the gold standard, but it's still a tricky test that's going to give garbage when not done perfectly. The calculated FT is probably closer to reality.
I was wondering about the large discrepancy between the EqD and calc values. If the equilibrium dialysis isn't trustworthy than what is? I tended to believe the EqD here because DHT didn't move either.

Not sure this applies here, but interestingly the inhibitory effect between DHT and estradiol may be bidirectional in some sense. That is, DHT is known to inhibit aromatase, and now I see the suggestion that estradiol "may exert an inhibitory effect on the enzyme 5-alpha-reductase ..."
So that is interesting, and I would like to learn more and determine if there is any truth to the idea. I notice that article doesn't have any references though. In a natural man, estrogen therapy would reduce DHT by reducing testosterone production. I wonder if that is what they're talking about?

Except the advocates of physiological dosing.
I know you're disappointed with my approach here. If there's a lesson to be learned about the consequences of supraphysiological dosing, I guess I'm going to learn it the hard way.
 

Cataceous

Super Moderator
I was wondering about the large discrepancy between the EqD and calc values. If the equilibrium dialysis isn't trustworthy than what is? I tended to believe the EqD here because DHT didn't move either.
...
Well nothing is completely trustworthy. I favor the Vermeulen calculation, but even an immunoassay-based TT test can be botched on occasion.

Your DHT didn't move, but estradiol nearly doubled. Even if some injection-site aromatization occurs, it seems pretty doubtful that estradiol production would be of that magnitude. The aromatase activity in those small volumes of tissue around a depot has to be pretty insignificant compared to total body activity. How can they alone make 60-100% of total body production? Higher local T concentrations don't help much because aromatase starts saturating at upper-end physiological levels.

... In a natural man, estrogen therapy would reduce DHT by reducing testosterone production. I wonder if that is what they're talking about?
...
Presumably not, since it refers specifically to enzyme inhibition. A quick search turns this up, though it's limited to one rat cell line:
 

madman

Super Moderator
Time for an update. I ran some 8 week labs after increasing from 40 to 50 mg EOD SC (140 to 175 mg weekly) and the results are puzzling:

Test

12/19/2023

2/15/2024

Normal Range

Total Testosterone

893 ng/dL

1101 ng/dL

250 - 1100 ng/dL

Free T (EqD)

168.6 pg/mL

166.3 pg/mL

35 - 155 pg/mL

Free T (calc)

17.3 ng/dL

27 ng/dL

 

SHBG

44 nmol/L

35 nmol/L

10 - 50 nmol/L

Estradiol

43 pg/mL

83 pg/mL

<= 29 pg/mL

DHT

66 ng/dL

65 ng/dL

12 - 65 ng/dL

Hematocrit

41.8%

47.3%

38.5 - 50%

Ferritin

48 ng/mL

28 ng/mL

38 - 380 ng/mL


If you've noticed a shift in my attitude towards SC injections, this is why. I increased my dose by 25%, my free T and DHT stayed almost exactly the same, and my E2 doubled. WTF?





























In the couple months between these tests I started cranking out the RBCs and Hemoglobin; this is reflected in my dropping ferritin level.
I expect this should level out and maybe rise a little once my HCT plateaus. I recently increased my red meat consumption to 2 1/2 lbs per day so there's no doubt my iron intake is sufficient.

So how does 83 pg/mL E2 feel? Not too bad. Here's my 8 week assessment:
  • Mood is pretty good
  • Energy is pretty good
  • Frequent nocturnal erections
  • Sometimes having a little morning wood, doesn't last long though
  • Libido is not very good
  • Cognition is good
  • Sleep seems unaffected by testosterone and is pretty good
  • No anxiety
  • Hair is good, hair loss in shower is similar to baseline (ketoconazole shampoo may be helping a bit)
  • Have some annoying acne on my chest and upper back that I am partially controlling with Panoxyl. Face is mostly ok, but seems somewhat more acne prone than usual also, particularly when eating poorly.
  • I have noticeable water retention where it is difficult to put on my rings and my socks are leaving major indents.
  • Heart rate may be slightly elevated compared to before TRT (3-5 bpm)
  • Blood pressure is still good, last check was 114/70 I think.

I know I said I would give it a full 12 weeks but these labs are ridiculous. I switched to IM shots in the delts already, keeping dosage and frequency the same. Stay tuned for the next set of labs to find out if IM delivers superior results.

On the lifting front, I switched from the 5x5 scheme to 5 x 8-12 to go easier on my joints and focus more on hypertrophy. I made some adjustments that have solved all my lower back issues, including squatting only once per week instead of twice, using a more upright posture for squats, and replacing barbell deadlift with trap bar deadlift. However, my right knee is bothering me now so I need to figure that out. It might have coincided with the more upright squatting position.

I have also gained some more weight. I am now up from 190 lb to 213 lbs at 6'6". I think I'm about 17% body fat. I have mostly gained a mix of water and muscle weight and maybe slight bit of fat, not sure. Friends and family are noticing now and giving compliments on the more muscular physique.

If you've noticed a shift in my attitude towards SC injections, this is why. I increased my dose by 25%, my free T and DHT stayed almost exactly the same, and my E2 doubled. WTF?


Would put money on it that the ED results are way off!

Your FT was tested using Quests ED assay.

Keep in mind this is not a standardized Equilibrium Dialysis assay.

Not all ED devices/assays are the same let alone there are numerous issues when it comes to comparing ED vs ED, ED vs UF let alone ED/UF vs cFT between the different labs.

Accurate and standardized free testosterone ED assays will become the norm once we have a harmonized reference range for free testosterone.

We need accurate and standardized free testosterone assays with harmonized reference ranges!

This shitshow will be coming to an end soon enough!

Take home points:

*Assays that are standardized are designed to provide accurate results, traceable to “true” value-assigned certified reference materials and gold-standard reference methods. Results obtained using standardized methods can be compared across assays, institutions, populations, and past and future test results, thereby improving diagnosis, treatment, and outcomes of patients

No way your FT barely budged!

You drove your trough TT from 893---> a whopping 1101 ng/dL which is an increase of 208 ng/dL and your SHBG is normal as it was driven down from 44--->35 nmol/L (far from high) and more importantly your FT would be closer to where the cFTV sits which would be in the mid-high 20s!

Remember as of now cFTV tends to overestimate slightly when compared to a gold standard standardized ED assay.

This should kill any doubts about your most recent (2/15/24) Quest ED assay vs cFTV results!

These are your trough FT levels (EOD injections).

Your peak (12-24 hrs post-injection) TT, FT, and estradiol will be higher.

Anyone hitting a whopping trough TT of 1100 ng/dL with normal SHBG is going to have a very high trough FT.

This is a given.

This is the main reason why your hematocrit increased and this is only 8 weeks in.

Again where your levels sit 8 weeks in is not where they will end up as it can take anywhere from 6-9 months and in some cases up to a year to reach peak levels.

Driving up your FT increased your estradiol and there is a good chance you may have added some body fat.

17% is still a fair amount.

10-12% is where it's at if you want to look decent.

Even then you put on a whopping 22 lbs and there is no way in hell this is quality gains, definitely a fair amount of water weight (extra/intracellular), and some adipose.

The acne is from driving up your FT which would be high now and this is at the trough.

Switching over to IM is not going to save you if you truly believe your FT has not budged let alone your e2 is high due to injecting strictly sub-q!

If you truly feel good running a very high FT then do what you feel is best for you.

Again need to give it 12 weeks to claim whether it was truly a success or failure.

The first 6 weeks mean nothing when looking at the bigger picture.

As I have been preaching on the forum for years it takes time for the body to adapt to the new set point.

This is where many fail!

If you were struggling with sides then you would easily have room to bring down your trough FT.

As I stated previously it is expected that you are going to drive up your FT jumping from 140--->175 mg T/week.

35 mg T/week is a big jump.

As stated in my previous post (#4) far too eager here.













Key Points:

* Limitations of using free testosterone by equilibrium dialysis and calculated free testosterone concentrations in practice are the lack of assay standardization, an accuracy-based quality control program, and a harmonized reference range. Until these limitations are addressed, free testosterone by equilibrium dialysis and calculated free testosterone should use reference ranges established by individual laboratories or their specific assay method

*Currently, the CDC is developing a harmonized method for free T based on calculated free T using REVISED FORMULAE. This may bring the measurement of free T to a referable standard in clinical laboratories and common reference intervals that all clinicians can use

*Assays that are standardized are designed to provide accurate results, traceable to “true” value-assigned certified reference materials and gold-standard reference methods. Results obtained using standardized methods can be compared across assays, institutions, populations, and past and future test results, thereby improving diagnosis, treatment, and outcomes of patients





The Need to Harmonize Clinical Laboratory Test Results-----

Laboratory test results are a critical component of patient care. These values help physicians diagnose disease and are critical to developing clinical guidelines that direct treatment options and are instrumental in ongoing efforts to improve and measure the quality of patient care. Most tests report a numeric value for healthcare providers to interpret and the range of numbers reported for a test for a certain condition may vary depending on the method used

Different test methods, however, may report different numeric values for the same condition
. Although these test results may be accurate within the context of its own method, this variation can create confusion for physicians and patients. Clinical laboratory test results need to be harmonized so that healthcare providers and the public receive the same numeric result regardless of the method or instrument used or the setting where it was performed




post #11


*Equilibrium dialysis (ED) followed by LC-MS/MS is considered the gold standard methodology

*FH concentrations measured by UF-based methods often do not agree with ED-based methods because of UF conditions (temperature, time, centrifugation speed), the type of the UF device (MWC membrane material, material of the of the housing, seal around the membrane, etc.), and inconsistencies in the filtration rate. Therefore, reference intervals are typically not interchangeable across methods for measurement of the same FH
 

madman

Super Moderator
Most likely a misfire in the EqD FT testing. EqD may be the gold standard, but it's still a tricky test that's going to give garbage when not done perfectly. The calculated FT is probably closer to reality.

Not sure this applies here, but interestingly the inhibitory effect between DHT and estradiol may be bidirectional in some sense. That is, DHT is known to inhibit aromatase, and now I see the suggestion that estradiol "may exert an inhibitory effect on the enzyme 5-alpha-reductase ..."


Except the advocates of physiological dosing.

$$$
 
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