New member - Lab Guidance

[Bosscwx]

New member here. Trying to get a grasp of all this information and it's like trying to drink from a fire hose. 34 year old male.
TRT protocol:
test 150mg weekly
hCG 500iu 3x week

12 week labs

Test: 959
Free: 20ng/DL
SHBG: 42.1
Estradiol: 45.6 using Roche ECLIA
Hermatocrit: 43.6
TSH 3.07 mIU/L

Overall feel great with no side effects. Curious if I should take the E2 sensitive test? I did not see the the following on the labs: PSA, liver enzymes, Free T3, Ferritin, Iron, Prolactin.

Anything else I should monitor closely? Any guidance is appreciated. Thanks.

EDIT:
Initial Labs

Test: 177 & 325
Prolactin: 8.2 ng/mL
PSA: 0.86 ng/mL
Estradiol: 27.9 pg/mL Roche ELCIE
SHBG: 45 nmol/L

 

[fifty]

If you feel great I wouldn't tempt fate and go down the rabbit hole looking for problems.

Never hurts to get PSA... at least next time.

 

[CoastWatcher]

Welcome to Excelmale.

You apparently received an inadequate, initial workup.

Was your LH and FSH tested? PSA at the initiation of therapy is a necessary value to capture. You certainly need the sensitive estradiol test - the standard test that you had is unreliable when used by men. Your TSH, though in range, raises a lot of questions. A full thyroid panel would be a good ideA. A faulty thyroid can undermine a TRT protocol.

 

[Bosscwx]

Welcome to Excelmale.

You apparently received an inadequate, initial workup.

Was your LH and FSH tested? PSA at the initiation of therapy is a necessary value to capture. You certainly need the sensitive estradiol test - the standard test that you had is unreliable when used by men. Your TSH, though in range, raises a lot of questions. A full thyroid panel would be a good ideA. A faulty thyroid can undermine a TRT protocol.

I had initial workup around Dec. 2017. However I was going thru fertility with my wife and I didn't want to risk any complication so I did not begin treatment till Nov. 2018
Levels at that time:
LH:5.1
FSH:7.2
TSH: 3.630

 

[Systemlord]

TSH is indicating thyroid that is struggling, the TSH ranges are invalid as the group that made up those ranges had 30% who were later found to have thyroid dysfunction. After re-evaluating the study showed normal healthy individuals have a TSH <2.5, yet doctors are still unaware.

Free T3 is where the rubber meets the road, but if say Reverse T3 is elevated alongside Free T3, Reverse T3 would negate a portion of the Free T3.

 

[Bosscwx]

TSH is indicating thyroid that is struggling, the TSH ranges are invalid as the group that made up those ranges had 30% who were later found to have thyroid dysfunction. After re-evaluating the study showed normal healthy individuals have a TSH <2.5, yet doctors are still unaware.

Free T3 is where the rubber meets the road, but if say Reverse T3 is elevated alongside Free T3, Reverse T3 would negate a portion of the Free T3.

so would u recommend this?

THYROID Panel (TSH + Free T3 + Free T4)

 

[Systemlord]

so would u recommend this?

THYROID Panel (TSH + Free T3 + Free T4)

Add Reverse T3, it must be run together with Free T3 as there is a balancing act of these two hormones. Free T3 speeds up metabolism, Reverse T3 if high enough can stop you in your tracks like when you get sick. Free T3 needs to be midrange or higher and Reverse T3 <15 ng/dL.

It would be nice to have these tests in case at a later date things go south you'll have a record of where things were and where they are going.

 

[fifty]

THYROID Panel - COMPREHENSIVE

 

[Bosscwx]

thanks for the guidance

 

[tmaxey1]

New member here. Trying to get a grasp of all this information and it's like trying to drink from a fire hose. 34 year old male.
TRT protocol:
test 150mg weekly
hCG 500iu 3x week

12 week labs

Test: 959
Free: 20ng/DL
SHBG: 42.1
Estradiol: 45.6 using Roche ECLIA
Hermatocrit: 43.6
TSH 3.07 mIU/L

Overall feel great with no side effects. Curious if I should take the E2 sensitive test? I did not see the the following on the labs: PSA, liver enzymes, Free T3, Ferritin, Iron, Prolactin.

Anything else I should monitor closely? Any guidance is appreciated. Thanks.

EDIT:
Initial Labs

Test: 177 & 325
Prolactin: 8.2 ng/mL
PSA: 0.86 ng/mL
Estradiol: 27.9 pg/mL Roche ELCIE
SHBG: 45 nmol/L

Im surprised your initial estrogen levels were 27.9 with a total T of only 177.

My initial T was almost exactly the same as yours but my Estrogen was only 5.
I may be wrong but I would like to see my free T higher than 20. I would be looking for more Testosterone to get my free levels up.

 

[Bosscwx]

Im surprised your initial estrogen levels were 27.9 with a total T of only 177.

My initial T was almost exactly the same as yours but my Estrogen was only 5.
I may be wrong but I would like to see my free T higher than 20. I would be looking for more Testosterone to get my free levels up.

My free T is just over 2% which as I understand is the minimum level that is acceptable

 

[Gman86]

My free T is just over 2% which as I understand is the minimum level that is acceptable

Were these labs done at trough, the morning of your testosterone injection? If they were, your free T is most likely at least around 30-35 at peak. But honestly, it doesn’t even matter. All that matters is that you feel good. If you feel good, I wouldn’t change a thing, or be concerned with anymore labs. I would just keep on doing what you’re doing, and enjoy life!

As far as getting the sensitive E2 test, I wouldn’t worry about it. If you feel good, it doesn’t matter. Plus, I get both the standard E2 test and the sensitive E2 test done every single time I do labs, and there’s usually not a big difference between the two. On my last labs there was a difference of 4 points. The labs before that there was a difference of 2 points. The labs before that there was a diffence of 5 points. So usually, they both come back about the same, at least for me. I use quest diagnostics for my labs.

 

[Bosscwx]

Were these labs done at trough, the morning of your testosterone injection? If they were, your free T is most likely at least around 30-35 at peak. But honestly, it doesn’t even matter. All that matters is that you feel good. If you feel good, I wouldn’t change a thing, or be concerned with anymore labs. I would just keep on doing what you’re doing, and enjoy life!

As far as getting the sensitive E2 test, I wouldn’t worry about it. If you feel good, it doesn’t matter. Plus, I get both the standard E2 test and the sensitive E2 test done every single time I do labs, and there’s usually not a big difference between the two. On my last labs there was a difference of 4 points. The labs before that there was a difference of 2 points. The labs before that there was a diffence of 5 points. So usually, they both come back about the same, at least for me. I use quest diagnostics for my labs.

yes they were at trough

 

[Bosscwx]

TSH is indicating thyroid that is struggling, the TSH ranges are invalid as the group that made up those ranges had 30% who were later found to have thyroid dysfunction. After re-evaluating the study showed normal healthy individuals have a TSH <2.5, yet doctors are still unaware.

Free T3 is where the rubber meets the road, but if say Reverse T3 is elevated alongside Free T3, Reverse T3 would negate a portion of the Free T3.

I recently got some thyroid labs completed. Unfortunately he didn't run reverse T3 and I'm beginning to feel frustrated. I've noticed I'm beginning to feel tired and lethargic more than usual. I suspect my thyroid is the cause of this.

Trough 5/23/19
Test: 651
Free: 14.3 ng/DL 2.2%
BioAval: 336 ng/DL 51.6%
SHBG: 33.2
Estradiol: 29.6 using Roche ECLIA
Hermatocrit: 46.8
PSA: 1.5

Peak 5/25/19
Test: 1288
Free: 34.9 ng/dL 2.71%
BioAval: 817 ng/dL 63.5%
SHBG: 30.3
Estradiol: 63.2 using Roche ECLIA
Hermatocrit: 43.7
PSA: 1.25

TSH 3rd GEN: 6.46 UIU/ML ----- optimal 0.5-1
Free T3: 3.3 pg/mL --------------- optimal 3.8-4.4
Free T4: 0.87 ng/dL -------------- optimal 1.4-1.77
TgAb: 3 IU/mL --------------------- normal 0-0.9
TPOAb: 354 IU/mL --------------- normal 0-34

I think this indicates Hashimoto's. Unsure what to do.

 

[madman]

New member here. Trying to get a grasp of all this information and it's like trying to drink from a fire hose. 34 year old male.
TRT protocol:
test 150mg weekly
hCG 500iu 3x week

12 week labs

Test: 959
Free: 20ng/DL
SHBG: 42.1
Estradiol: 45.6 using Roche ECLIA
Hermatocrit: 43.6
TSH 3.07 mIU/L

Overall feel great with no side effects. Curious if I should take the E2 sensitive test? I did not see the the following on the labs: PSA, liver enzymes, Free T3, Ferritin, Iron, Prolactin.

Anything else I should monitor closely? Any guidance is appreciated. Thanks.

EDIT:
Initial Labs

Test: 177 & 325
Prolactin: 8.2 ng/mL
PSA: 0.86 ng/mL
Estradiol: 27.9 pg/mL Roche ELCIE
SHBG: 45 nmol/L

New member here. Trying to get a grasp of all this information and it's like trying to drink from a fire hose. 34 year old male.
TRT protocol:
test 150mg weekly
hCG 500iu 3x week

12 week labs

Test: 959
Free: 20ng/DL
SHBG: 42.1
Estradiol: 45.6 using Roche ECLIA
Hermatocrit: 43.6
TSH 3.07 mIU/L

Overall feel great with no side effects. Curious if I should take the E2 sensitive test? I did not see the the following on the labs: PSA, liver enzymes, Free T3, Ferritin, Iron, Prolactin.

Anything else I should monitor closely? Any guidance is appreciated. Thanks.

EDIT:
Initial Labs

Test: 177 & 325
Prolactin: 8.2 ng/mL
PSA: 0.86 ng/mL
Estradiol: 27.9 pg/mL Roche ELCIE
SHBG: 45 nmol/L

Your FT levels are truly much higher than you think!

The calculated method you used is based of of the old linear model.....law-of-mass action Vermuelen which has been shown to be inaccurate.

The newer calculated method TruT Free Testosterone Calculator by FPT
is the one you should be using if you want to truly know what your FT levels are.




Why TruT™?
The only FDA-registered free testosterone calculator

• Improved biophysical characterizations have suggested the importance of models that consider allosteric coupling of testosterone with dimeric SHBG. This model, as implemented by TruT™ provides the most accurate estimates for free testosterone.
• Commonly available free testosterone calculators (issam.ch, nebido.com, pctag.uk) use models of testosterone:SHBG binding (proposed by Vermeulen et al. and Sodergard et. al) which were developed before the crystal structure for SHBG:T complexes were available. These models assume that the two SHBG monomers behave identically in binding testosterone. Detailed experimental data show that the "simplified linear model is erroneous." References.
• The Endocrine Society has issued position statements which highlights the laboratory- and operator-dependent variability inherent in direct free testosterone measurements. For this reason they advocate for indirect "calculator" based methods References.
• The TruT™ calculator provides the ideal solution by using measurements of total testosterone, SHBG, and albumin to calculate free testosterone while taking into account the complex, non-linear allostery in SHBG's association with testosterone. TruT™ is the only calculator available that uses this more complex formulation. References

Here is the Free & Bioavailable Testosterone calculator which is based of of the old linear model.....law-of-mass action Vermuelen.....which you used to calculate your FT.




Using your TT 959 ng/dL, SHBG 42.1 nmol/L and Albumin 4.3 g/dL (mean) than your FT is 20 ng/dL.

Now using the newer more accurate calculated TruT method.


Using your TT 959 ng/dL, SHBG 42.1 nmol/L and Albumin 4.3 g/dL (mean) than your FT is 33.02 ng/dL (over the top end of the reference range 16-31 ng/dL)

As you can see your FT is much higher than what the calculated Vermeulen method is showing.

Most men do well having FT in the 25-30 ng/dL range and others may do/feel better having levels in the 30-50 ng/dL range but even than most would never need to be running FT levels as high as 50--->50+ range in order to benefit from testosterone replacement.....let alone some could not tolerate such levels.

You are injecting 150 mg weekly so if the labs you posted are your trough.....7 days after your injection (just before your next weekly injection).....than your peak TT/FT levels will be much higher injecting such dose (150 mg once weekly).







The calculated Vermeulen method is outdated and past due it's time and as stated from the newer research regarding T:SHBG binding.



"Our patent protected, novel TruT™ companion diagnostic framework provides accurate determination of free testosterone concentrations. This algorithm is based on experimental data demonstrating that testosterone’s binding to SHBG is a multi-step process involving an allosteric interaction between the two binding sites on the SHBG dimer. Estimates of free testosterone derived incorporating the allosteric coupling of SHBG monomers within the dimer provide accurate determination of free testosterone without systematic deviation from values obtained using equilibrium dialysis"