Mystery of the 400pt TT swing!

[Louis]

I have been in Cypionate / Pregnyl injections since April. Prior to that I was on Androgel and HCG for a couple of year. I have had 3 sets of labs drawn between going on injections in April thru August and the values have all been consistent within a few points up until a recent 400+ point drop in TT over the last 2 draws.

*Draws taken at Labcorp 12-1pm Thursdays and include morning HCG injection.
50mg e3.5d Cypionate (Monday am, Thursday pm)
150iu ed HCG

April thru the first week of August, my labs have all fallen between the following ranges:

TT 1449 ng/dL 264.0 - 916.0
FT 24.2 pg/mL 6.8 - 21.5
E2 Sensitive 33 pg/mL 8.0 - 35.0
DHEA, 314 ug/dL 16 – 390
DHT 59 ng/dL 30 - 85
SHBG 57 nmol/L 16.5 - 55.9

I felt really good with these numbers.

Now keep in mind that I eat the same food almost every day (I have a lot of intolerances). I take the same 5 supplements at the same time every day. I don’t consume alcohol, coffee, and avoid sugar. Sleep pattern hasn’t changed, stress, exercise, all basically the same. By all accounts nothing has changed. Or has it?

The first week of August I had a cyst removed from my back (results were negative) that had been there for over a decade (at least). It presented as a small insignificant pimple (maybe the width of a pencil eraser) that has been there for at least a decade and I never gave it a second thought. When the cyst was removed, the surgeon told me it was about an inch in diameter and was deep in the tissue. A few weeks following the removal of the cyst, I began to feel off. Constipation and bloat, blurry vision (mostly upon waking), slight joint pain in hands and knees, I broke out in cystic acne on my face and back, and a few bouts with insomnia (all of which I'm still dealing with to varying degrees). I am well aware that the body is constantly trying to achieve homeostasis and it was logical that my body was going through some changes considering I had just cut out something that shouldn’t have been there. While I am unaware of what effect (if any) that cyst had on my system as a whole, I do know that my body needed to adjust and heal from having it removed. I digress.

At the end of August I had my usual labs drawn (every 4-5 weeks) and I was quite surprised with the results. My TT had dropped over 400 points!

TT 1039 ng/dL 264.0 - 916.0
FT 21 pg/mL 6.8 - 21.5
E2 Sensitive 36 pg/mL 8.0 - 35.0
DHEA, 325 ug/dL 16 – 390
DHT 52 ng/dL 30 - 85
SHBG 47 nmol/L 16.5 - 55.

My first inclination was that that I must have gotten a bad draw so I didn’t do anything different. I let myself continue to heal and didn’t change my protocol or diet or exercise routine at all. I figured I’d wait and see if I felt any improvement and just wait until the next draw before considering any changes.

At the end of September, I had my latest draw done and I just got the results. They look almost identical.

TT 1069 ng/dL 264.0 - 916.0
FT 22 pg/mL 6.8 - 21.5
E2 Sensitive 37 pg/mL 8.0 - 35.0
DHEA, 297 ug/dL 16 – 390
DHT 49 ng/dL 30 - 85
SHBG 38 nmol/L 16.5 - 55.9

It’s crazy to think that something as seemingly insignificant as a cyst could impact your hormones (I have a theory), but it just serves as a reminder that we need to remember to look at the body as a whole. No system exists independent of another.

Now I need to figure out how to adjust. My doctor’s suggestion is to increase my cypionate from 50mg to 60mg e3.5d to bring my TT back up a bit since my E2 hasn’t moved. Part of me wants to drop my HCG down from 150iu to 100iu ED to see if that would lower my E2 since my TT has already come down, plus it stabilzes quicker.

Any thoughts?

 

[MarkM]

Did you change from IM to SubQ, or the reverse, SubQ to IM injections.

 

[Louis]

Did you change from IM to SubQ, or the reverse, SubQ to IM injections.

Great question. No, I didn't change my protocol at all. 50mg shallow IM into deltoid every 3.5 days and 150iu Subq every morning.

 

[MarkM]

Maybe you had an extended honeymoon period when your started TRT and now that has worn off???

 

[blackebob]

Your free T ratio actually has risen. Free T is the work horse, how do you feel?

 

[Louis]

Maybe you had an extended honeymoon period when your started TRT and now that has worn off???

I didn't think of that. It's possible. I've also just updated the OP to clarify that I have been on TRT for like 3 years. Previously using Androgel and HCG.

Your free T ratio actually has risen. Free T is the work horse, how do you feel?

I didn't think of FT ratio, thanks for pointing that out. It's probably because my SHBG has come down.

I don't feel bad but I don't feel good either if that makes sense. Kind of like numb emotionally if that makes sense. Vision is a little blurry in the morning which improves by mid morning and I have a sensitivity to bright lights and particularly headlights that I've never experienced before. I'm still dealing with constipation and some bloat (weight is up 9 lbs from August 1) and while it has mostly subsided, I'm still getting some new cystic acne break outs every 3-4 days. Morning wood has consistently been pretty good but erections/ejaculation are hit or miss day to day.

 

[Louis]

My random theory is that my liver was working harder due to the cyst (or whatever caused it) and as a result it didn't metabolize as much endogenous T leaving more in me?!?

 

[blackebob]

I am actually figuring out that more is not actually bettor in my case. I am reducing my dosage to bring it back down below the top of the range. I am noticing that my severe water retention has reduced a little. I had to eliminate HCG at the moment, to much E spike. I think your over thinking this cyst.

 

[blackebob]

I didn't think of that. It's possible. I've also just updated the OP to clarify that I have been on TRT for like 3 years. Previously using Androgel and HCG.



I didn't think of FT ratio, thanks for pointing that out. It's probably because my SHBG has come down.

I don't feel bad but I don't feel good either if that makes sense. Kind of like numb emotionally if that makes sense. Vision is a little blurry in the morning which improves by mid morning and I have a sensitivity to bright lights and particularly headlights that I've never experienced before. I'm still dealing with constipation and some bloat (weight is up 9 lbs from August 1) and while it has mostly subsided, I'm still getting some new cystic acne break outs every 3-4 days. Morning wood has consistently been pretty good but erections/ejaculation are hit or miss day to day.

I too was on Androgel ,why did you switch?

 

[madman]

Your free T ratio actually has risen. Free T is the work horse, how do you feel?

I have been in Cypionate / Pregnyl injections since April. Prior to that I was on Androgel and HCG for a couple of year. I have had 3 sets of labs drawn between going on injections in April thru August and the values have all been consistent within a few points up until a recent 400+ point drop in TT over the last 2 draws.

50mg e3.5d cypionate
150iu hcg ed

April thru the first week of August, my labs have all fallen between the following ranges:

TT 1449 ng/dL 264.0 - 916.0
FT 24.2 pg/mL 6.8 - 21.5
E2 Sensitive 33 pg/mL 8.0 - 35.0
DHEA, 314 ug/dL 16 – 390
DHT 59 ng/dL 30 - 85
SHBG 57 nmol/L 16.5 - 55.9

I felt really good with these numbers.

Now keep in mind that I eat the same food almost every day (I have a lot of intolerances). I take the same 5 supplements at the same time every day. I don’t consume alcohol, coffee, and avoid sugar. Sleep pattern hasn’t changed, stress, exercise, all basically the same. By all accounts nothing has changed. Or has it?

The first week of August I had a cyst removed from my back (results were negative) that had been there for over a decade (at least). It presented as a small insignificant pimple (maybe the width of a pencil eraser) that has been there for at least a decade and I never gave it a second thought. When the cyst was removed, the surgeon told me it was about an inch in diameter and was deep in the tissue. A few weeks following the removal of the cyst, I began to feel off. Constipation and bloat, blurry vision (mostly upon waking), slight joint pain in hands and knees, I broke out in cystic acne on my face and back, and a few bouts with insomnia (all of which I'm still dealing with to varying degrees). I am well aware that the body is constantly trying to achieve homeostasis and it was logical that my body was going through some changes considering I had just cut out something that shouldn’t have been there. While I am unaware of what effect (if any) that cyst had on my system as a whole, I do know that my body needed to adjust and heal from having it removed. I digress.

At the end of August I had my usual labs drawn (every 4-5 weeks) and I was quite surprised with the results. My TT had dropped over 400 points!

TT 1039 ng/dL 264.0 - 916.0
FT 21 pg/mL 6.8 - 21.5
E2 Sensitive 36 pg/mL 8.0 - 35.0
DHEA, 325 ug/dL 16 – 390
DHT 52 ng/dL 30 - 85
SHBG 47 nmol/L 16.5 - 55.

My first inclination was that that I must have gotten a bad draw so I didn’t do anything different. I let myself continue to heal and didn’t change my protocol or diet or exercise routine at all. I figured I’d wait and see if I felt any improvement and just wait until the next draw before considering any changes.

At the end of September, I had my latest draw done and I just got the results. They look almost identical.

TT 1069 ng/dL 264.0 - 916.0
FT 22 pg/mL 6.8 - 21.5
E2 Sensitive 37 pg/mL 8.0 - 35.0
DHEA, 297 ug/dL 16 – 390
DHT 49 ng/dL 30 - 85
SHBG 38 nmol/L 16.5 - 55.9

It’s crazy to think that something as seemingly insignificant as a cyst could impact your hormones (I have a theory), but it just serves as a reminder that we need to remember to look at the body as a whole. No system exists independent of another.

Now I need to figure out how to adjust. My doctor’s suggestion is to increase my cypionate from 50mg to 60mg e3.5d to bring my TT back up a bit since my E2 hasn’t moved. Part of me wants to drop my HCG down from 150iu to 100iu ED to see if that would lower my E2 since my TT has already come down, plus it stabilzes quicker.

Any thoughts?

What is the big deal.....regardless of your TT levels coming back lower each lab draw your SHBG has dropped by roughly 10 points as originally your SHBG was 57 nmol/L.....than next labs 47 nmol/L.....than last set of labs 38 nmol/L.

Hence your FT has barely budged as it was 24.2 pg/ml.....than next labs 21 pg/ml.....than last set of labs 22 pg/ml.

FT is what truly matters as it is the unbound active fraction of testosterone responsible for the positive effects.

Even though your TT has dropped your FT barely moved due to your SHBG dropping.....why would you need to increase your dose!

 

[Louis]

I am actually figuring out that more is not actually bettor in my case. I am reducing my dosage to bring it back down below the top of the range. I am noticing that my severe water retention has reduced a little. I had to eliminate HCG at the moment, to much E spike. I think your over thinking this cyst.

That’s just a quick random thought. It doesn’t matter either way. Whether or not it had anything to do with by current values I don’t know but the timing is peculiar.

I too was on Androgel ,why did you switch?

The short answer is that I couldn’t increase my dose anymore because my DHT was already out of range. It’s for the best anyway. There really isn’t a great way to customize a protocol with a topical.

 

[Louis]

What is the big deal.....regardless of your TT levels coming back lower each lab draw your SHBG has dropped by roughly 10 points as originally your SHBG was 57 nmol/L.....than next labs 47 nmol/L.....than last set of labs 38 nmol/L.

Hence your FT has barely budged as it was 24.2 pg/ml.....than next labs 21 pg/ml.....than last set of labs 22 pg/ml.

FT is what truly matters as it is the unbound active fraction of testosterone responsible for the positive effects.

Even though your TT has dropped your FT barely moved due to your SHBG dropping.....why would you need to increase your dose!

Thanks for the reply. I am just reporting what the doctor suggested. As of right now, something is out of balance and I just don’t know what given the breakouts, bloat, digestion, and vision issues. I don’t want to simply assume I need more TT but I can understand his rationale.

This is precisely why I made this post,, for educated feedback and suggestions on how to best adjust my protocol.

 

[Vince Carter]

Hows you timing for injections and blood draws? Are they repeatable day after day or do you fluctuate with when you inject and have blood drawn? Same lab? i.e., Quest or Labcorp?

 

[Louis]

Vince, I inject cypionate Monday morning and Thursday night. My draws are always done at Labcorp on Thursdays at lunch between 12-1 and include my morning HCG dose of 150iu.

Madman and blackebob are right on point regarding SHBG amd FT. Also Madman makes an excellent point. While I did notice my FT barely moved and I did notice that SHBG has come down, it didn’t really click in my head that these are the most important variables that have changed in this equation.

At this point I feel like I just need a small tweak to get everything aligned. I am torn which way to go. Given all the great feedback I’m don’t think I should follow the doctors opinion of increasing my T to 60mg.

Im starting to feel my inclination to reduce my HCG might be a better course of action to alleviate the digestion, bloat, vision, and acne.

 

[Vince Carter]

Those symptoms on the last line are more often high E.

 

[Louis]

Those symptoms on the last line are more often high E.

Indeed they are Vince. This is why my doctor suggested increasing my T dose. In his opinion, if I felt better with 1400TT and an E2 in the mid 30's he believes that's why I am experiencing these symptoms with a TT of 1000 and an E2 in the mid 30's. He did not at all bring up FT or SHBG. He actually pays attention more to how I am feeling than just the numbers.

My thought was that I could reduce the daily HCG dose in hopes of reducing some testicular aromatization, but again, I am guessing here.