Need Help with First Labs Post TRT

[HootSnik]

First 8 Week Labs Post TRT Start

I need some advice from the experienced “Brain Trust” on actions to take based on my first labs after starting a TRT protocol.

In early June I was diagnosed with low Free T (Total T was 586-Free T was 5.7) after two consecutive blood tests. The Labs were conducted due to classic symptoms—low energy, E.D., suppressed mood, lack of motivation, and loss of lean body mass.

My family Doctor prescribed injections of testosterone enanthate and together we agreed to start very low, adjust slowly, see if I could preserve some of my natural production, and supplement with T.E. injections to bring the total and free test up in our attempt to alleviate the classic symptoms.

The protocol used: 20 mg T.E. every 3.5 days for a weekly total of 40 mg.

The following are my pre-TRT Labs and my 8 week labs on the noted protocol as well as the LabCorp ranges. Please note that the 5/24 estradiol count was based on the “sensitive” measure but the 8/24 was based on the CLIA measure—Lab error and therefore I don’t trust the notion that Estradiol went down that much.

Labs

May-24 Aug-24
Item Pre-TRT 8 Wk Post TRT LabCorp Range

Hemoglobin. 16.1 g/dL 15.1 g/dL 13-17.7

Hematocrit 46.5% 46.4 37.5-51

Platelets 265 266 150-450

Albumin 4.4 g/dL 4.4 3.8-4.8

Total T. 586 ng/dL 564 ng/dL 264-916

Free T. 5.7 pg/mL 5.0 6.6-18.1

cFT 8.4 9.9

Estradiol 23.6 pg/mL 15.9 7.6-42.6

LH 12.2 2.3 1.7-8.6

SHBG 58.4 44.5 19.3-76.4

Note: Red Cross blood donation July 20 (1 pint). I donate 2x/yr.

So—-as you can see my Total and Free T. actually went down on the 40 mg dose — per Lab Corp. It does appear that I am still producing some natural T. (LH is now 2.3 vs 12.2) but not enough in combination with the TE to bring the Free T up and alleviate symptoms— I have some mood stability improvement and minor improvement in skin moisture but that is it!

I see my Doc for f/u in a couple of weeks and we will be discussing possible courses of action on which I would like input/ideas. The options I see are:

1. Continue with the existing protocol and hope things get better as time goes by—low probability.
2. Drop the T.E. dose to 20 or 30 mg/wk and hope my natural production goes back up more than the effect of my reduction in exogenous T.
3. Increase the weekly dose from 40mg to 60 mg which would probably take my natural production to zero but should also bring the SHBG down even more and Free T. up. (Note: my SHBG went down 24% after starting the 40 mg dose). Re-lab in 3 months
4. Increase the dose to ??????? And re-lab in 3 months.

I am still on the 40 mg/wk protocol (20 @ 3.5 days) at 10 weeks and plan to adjust in Sept after the Doctor visit but just wanted some input/review of the labs for suggested ideas on course correction. I have many other markers that were in the labs (all in range) but thought the items listed were the most relevant.

I am trying to find the lowest possible dose which alleviates symptoms and do not mind going slow on adjustments to find my sweet spot.

Your thoughts or suggestions would be appreciated--this is relatively new to me.

Cheers

 

[Seagal]

This idea of supplementing your own testosterone production (with your prescribed injections) is not working out!
Someone else here will probably provide you with a detailed explanation.
My recommendation: twice per week 40mg if want to slow.
Good luck with your Doc...

 

[Systemlord]

My family Doctor prescribed injections of testosterone enanthate and together we agreed to start very low, adjust slowly, see if I could preserve some of my natural production, and supplement with T.E. injections to bring the total and free test up in our attempt to alleviate the classic symptoms.

No you can't have it both ways on injections, any amount will shut you down.

The protocol used: 20 mg T.E. every 3.5 days for a weekly total of 40 mg.

This dosage is too low. The average dosage is 100-150 mg per week and it seems you're in for a long dialing in process and at this rate you'll start feeling better in 6+ months.

Some men just feel better with high testosterone above a certain point and there really is no sweat spot. Don't overcomplicate it.

Don't torture yourself like this.

 

[Systemlord]

At what Free T level do you feel optimal?

As the thread title says, I want to compile a consensus and see at what Free T levels our members feel optimal. Please specify if levels are at trough, midpoint or peak. Also detail protocol and time of lab testing in relation to your injections. These poll questions are for Free T only either...

www.excelmale.com

 

[HootSnik]

This idea of supplementing your own testosterone production (with your prescribed injections) is not working out!
Someone else here will probably provide you with a detailed explanation.
My recommendation: twice per week 40mg if want to slow.
Good luck with your Doc...

Thanks for the input Seagal! Your first sentence is absolutely right--it is not working out. Although my LH did not go to 0 (went from 12.2 to 2.3), my natural production went down significantly with the 40 mg/wk dose. The current combination of natural and supplemental is insufficient to alleviate symptoms. Actually my Doctor wanted me to start at a higher dose but he knows how conservative I am regarding meds, respected my preferences, and agreed to work through this with me--for that I have the utmost respect for him.

BTW, thanks for struggling through the data I posted--when the thread was composed I had 4 columns of data under the four headings of: Item, PreTRT, 8 Wk Post TRT, and LabCorp Ranges--all evenly distributed across the page--when the thread was published the system pushed all the data to the left margin w/o spacing.

Anyway, thanks for the response.

Cheers,
Hoot

 

[aloetard]

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www.merckmanuals.com

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[aloetard]

No you can't have it both ways on injections, any amount will shut you down.

Nope. The data he shared directly contradicts your comments. Some suppression? Sure. If he injects 1 mg/week of TE, is his HPTA shut down? Of course not. See the literature, lots of data out there on HPTA level of suppression vs weekly dose.

@HootSnik you have lots of options. If you want to keep HPTA suppression as low as possible on TRT then try nasal gel or a buccal troche.

If you want to keep going with injections then up your weekly dose and titrate fT based on dose. Given you are cautious go with an increase you are comfortable with.

Why did you donate blood?

Also is your fT measurement the "direct" IA method? Sure you have the right units? Use Vermeluen cFT or measure with ED+LC/MS.

Public Service Announcement: "Piss Poor" Direct RIA fT measurement (HELP is on the way)

Hey Folks, thought I would update the graph for free T reference ranges based on LC-MS/MS+ED and compare with Labcorp's direct RIA fT reference range. What the hell do you do with with your direct fT measurement if you want to compare with equibrium dialysis reference ranges? Take the Labcorp...

www.excelmale.com

 

[HootSnik]

aloetard thanks for the thoughtful response. You are right on the fT units---it is pg/ml not pg/dl--I have corrected the data. The LabCorp measure is "direct" for fT but I also included the Vermeluen calculations in the data--which I understand can overstate fT so I am not really sure which one to use as a guide. Maybe it does not matter which one I use as long as I use the same each time and correlate it to how I feel-- feeling better/aleviating symptoms is the ultimate measure.

I give blood twice a year--July and December--been doing it for years--my father once told me it was just a good thing to do.

At this point I think I am going to stick with the injections and talk with my Doc about how much to increase the dose. Playing with "steroid tracker" software and doing some calculations on expected fT levels, I was thinking a bump to 60mg to 70mg a week (1/2 every 3.5 days) might be what I need to try next but I will use fT as the guide. I don't mind going slow.

Again, thanks for the info--I am new at this.

Cheers,
Hoot

 

[aloetard]

aloetard thanks for the thoughtful response. You are right on the fT units---it is pg/ml not pg/dl--I have corrected the data. The LabCorp measure is "direct" for fT but I also included the Vermeluen calculations in the data--which I understand can overstate fT so I am not really sure which one to use as a guide. Maybe it does not matter which one I use as long as I use the same each time and correlate it to how I feel-- feeling better/aleviating symptoms is the ultimate measure.

I give blood twice a year--July and December--been doing it for years--my father once told me it was just a good thing to do.

At this point I think I am going to stick with the injections and talk with my Doc about how much to increase the dose. Playing with "steroid tracker" software and doing some calculations on expected fT levels, I was thinking a bump to 60mg to 70mg a week (1/2 every 3.5 days) might be what I need to try next but I will use fT as the guide. I don't mind going slow.

Again, thanks for the info--I am new at this.

Cheers,
Hoot

Smart man.

CFTV usually 10 to 25% higher than equilibrium dialysis FT - decent heuristic. But you are right just go with CFTV and use as consistent tool as you titrate.

Great job on the donations. Your philosophy on treatment is commendable. And best wishes on your journey!

 

[aloetard]

All my old posts at Tnation are behind a firewall now but here's a nice paper that gets into the dose response of HPTA suppression for injectable Test Cyp in case it's helpful.

Figure - PMC

A randomized, double‐blind clinical trial was conducted to investigate long‐term abuse effects of testosterone cypionate (TC). Thirty‐one healthy men were randomized into a dose group of 100, 250, or 500 mg/wk and received 14 weekly injections of ...

www.ncbi.nlm.nih.gov

There are a few more I can dig up if you want. IIRC some of the other papers looked at weekly doses more applicable to your situation ( < 100 mg/week).

Edit: also see Fig 3 here and discussion.

Figure - PMC

Injections with intramuscular (IM) testosterone esters have been available for almost 8 decades and not only result in predictable serum testosterone levels but are also the most inexpensive modality. However, they are difficult to self-administer ...

www.ncbi.nlm.nih.gov

50 mg/week exogenous replaces the endogenous Test that is suppressed (notice the transients for 50 and 100 mg/week data).

 

[HootSnik]

Good Stuff!!! Still trying to absorb.

Ref the first item, it appears (looking at the median lines), that 100mg/wk (or lower) does not result in maximum suppression until around week 12 whereas 200mg+ hits max suppression much sooner--week 7 or 8. This would suggest that my 8 week labs on 40mg/week may not have been reflecting the lowest protocol TT level yet. It also appears (again median lines) that the 100mg column never hits total suppression (maybe 85%) of natural T whereas 200mg+ does hit total suppression???? My LH, at 8 weeks, had gone down by 81% (12.2 to 2.3) so that is right in the range.

Applying this to my plans for protocol adjustment, if I go to 60-70mg week I will probably still produce some natural T, although at a very low level. What I do not understand is the dotted line (baseline)--is there natural T production that is not the result of LH stimulation??

Still getting into the second article--but thanks for posting!!

HootSnik

 

[Systemlord]

Maximum suppression on TRT will take decades.