New T cyp dosage; Do I have this right?

[Blackhawk]

Just seeking to understand the why of my new dosage. I think I may have forgotten some of the explanation from Dr Saya during the phone consultation, and I don't want to pester him with questions outside the formal consultations. So throwing this out there for discussion;


I have been on T gel for 8-10 weeks and have been apparently converting a lot to DHT. As a result, I have a higher than needed DHT blood level, but my total and free T are still lower than optimal range.

My specific need for TRT is for anabolic reasons, not androgenic, so changing to T cyp theoretically will allow DHT to drop towards normal range, while raising total and free T towards optimal range.

Baseline SHBG before gel was fairly high in August at 49.3 nmol/L range 19.3-76.4 (will be rechecked next labs December).

So new Rx is for 150mg/wk T cyp (64mg E3D) (also take HCG, changed dose slightly, but i don't think that's very relevant)

This seems like potentially a lot of T cyp, but due to higher SHBG, seems the ultimate goal is to get Free T up and I may have to end up with pretty darn high total T to achieve therapeutic anabolic effect. Whereas many guys do well on T cyp 80-100mg/week, it seems comparatively that they would have lower SHBG.

I am a little concerned that as far as I know, I have never been a high T kind of guy, and this seems like it could push my Total T into the 1000+ range, so also of concern possibly pushing E2 too high.


P.S. A potential side benefit from the switch from Gel to T cyp: My hematocrit and hemoglobin went up enough on gel that I was told to ( and did ) donate blood. If I remember right, Dr Saya said that high DHT tends to do this more than high total and free T, so we'll have to wait and see, but the change may help keep HCT down.


Just kind of thinking out loud, Please let me know if my thinking is on the right track!

 

[FeelingLost]

Wow Blackhawk that does seen like a large jump from the T cream. If I might ask were you doing 4 clicks of the strong stuff the 200mg/mL?

I am also a Defy patient and use the high strength cream by choice.
I am surprized DHT was a big issue so big they want you to go to the needle. Are you concerned with MPB or hair loss?

 

[Blackhawk]

Wow Blackhawk that does seen like a large jump from the T cream. If I might ask were you doing 4 clicks of the strong stuff the 200mg/mL?

I am also a Defy patient and use the high strength cream by choice.
I am surprized DHT was a big issue so big they want you to go to the needle. Are you concerned with MPB or hair loss?

3 clicks. DHT is not a"big issue", but the bigger issue is anabolic vs androgenic. And not so much "they want me to go to the needle", the decision was mutual between Dr Saya and me. I am not that concerned about the higher DHT unto itself, but seems I also have lower ferritin (based on last year's labs) so am concerned about the hematocrit issue. Not good for people with low ferritin to donate blood regularly. If less DHT in favor of more T decreases hematocrit elevation, would be good!

 

[FeelingLost]

the bigger issue is anabolic vs androgenic

Please excuse my ignorance I am pretty new to all this. Could you give me a bit of schooling on this?

I did not realize high DHT increases your hematocrit. That makes sense to switch then.
Your high SHGB is probably why they started you on the higher dose.
A very good Free T number is what they like to see. Total T is kind of a secondary value.

I just looked at my June initial bloodtest for Defy and Septembers followup,
I requested a full panel not just the basics and my DHT was never tested.

I do have to give blood every two months my hema always runs high naturally do to living at altitude.

 

[Blackhawk]

Please excuse my ignorance I am pretty new to all this. Could you give me a bit of schooling on this?

I did not realize high DHT increases your hematocrit. That makes sense to switch then.
Your high SHGB is probably why they started you on the higher dose.
A very good Free T number is what they like to see. Total T is kind of a secondary value.

I just looked at my June initial bloodtest for Defy and Septembers followup,
I requested a full panel not just the basics and my DHT was never tested.

I do have to give blood every two months my hema always runs high naturally do to living at altitude.

A bit new to some of these concepts myself, the reason I posted all this!

Anabolic refers to tissue rebuilding. Promoting anabolic physiology enhances physical/athletic performance. I have had muscle impairment, reduced exercise capacity and recovery after problems with statins. Trying to get back my physical capabilities. I was seriously catabolic (muscle wasting/tissue break down mode) for an extended period of time. Anabolism and catabolism are opposites.

I am not as savvy on the term "Androgenic" it is more related to masculine traits and male development. info here: https://en.wikipedia.org/wiki/Dihydrotestosterone

Dr Saya said the effects of DHT are more androgenic, Total and free T more anabolic.

I've been living at over 9000 ft more than 30 years, and HCT runs high normal range, but this time at very top along with same for Hemoglobin... first time in my life it's been an issue

 

[FeelingLost]

OK I did a bit of google-fu looks like "anabolic" referring to muscle building and "androgenic" referring to increased male sexual characteristics.

Were you diagnosed with Sarcopenia? Loss of muscle mass do to aging.

Yeah if you need a high T dose to keep your Free T high HCT could become a problem. Can you take something to support your low ferritin?

Heah man sorry if I'm hogging up your thread. I can get a bit chatty from time to time. Lots to learn.

 

[Blackhawk]

Were you diagnosed with Sarcopenia? Loss of muscle mass do to aging.

No. It was due to Lipitor and though onset took months became an acutely serious issue.. Confirmed by blood tests. Not just a general aging circumstance

Yeah if you need a high T dose to keep your Free T high HCT could become a problem. Can you take something to support your low ferritin?

No clue.

Heah man sorry if I'm hogging up your thread. I can get a bit chatty from time to time. Lots to learn.

No worries, the learning is mutual.

 

[Saul]

Your high SHGB is probably why they started you on the higher dose.

Are higher T doses recommended for low SHGB levels or high SHGB levels? I thought I recalled from another thread that low SHGB made higher T doses more suitable.

 

[Blackhawk]

I thought low SHBG means better conversion to free T, but shorter useful life in the body, easily gets washed out in urine, hence need for more frequent doses.

Don't know about relative weekly total dose.

 

[madman]

Just seeking to understand the why of my new dosage. I think I may have forgotten some of the explanation from Dr Saya during the phone consultation, and I don't want to pester him with questions outside the formal consultations. So throwing this out there for discussion;


I have been on T gel for 8-10 weeks and have been apparently converting a lot to DHT. As a result, I have a higher than needed DHT blood level, but my total and free T are still lower than optimal range.

My specific need for TRT is for anabolic reasons, not androgenic, so changing to T cyp theoretically will allow DHT to drop towards normal range, while raising total and free T towards optimal range.

Baseline SHBG before gel was fairly high in August at 49.3 nmol/L range 19.3-76.4 (will be rechecked next labs December).

So new Rx is for 150mg/wk T cyp (64mg E3D) (also take HCG, changed dose slightly, but i don't think that's very relevant)

This seems like potentially a lot of T cyp, but due to higher SHBG, seems the ultimate goal is to get Free T up and I may have to end up with pretty darn high total T to achieve therapeutic anabolic effect. Whereas many guys do well on T cyp 80-100mg/week, it seems comparatively that they would have lower SHBG.

I am a little concerned that as far as I know, I have never been a high T kind of guy, and this seems like it could push my Total T into the 1000+ range, so also of concern possibly pushing E2 too high.


P.S. A potential side benefit from the switch from Gel to T cyp: My hematocrit and hemoglobin went up enough on gel that I was told to ( and did ) donate blood. If I remember right, Dr Saya said that high DHT tends to do this more than high total and free T, so we'll have to wait and see, but the change may help keep HCT down.


Just kind of thinking out loud, Please let me know if my thinking is on the right track!

What was your total t/free t numbers on your transdermal protocol? Transdermal as oppose to injectable are more prone to excess conversion of t-->dht due high expression of 5-alpha reductase in the skin. Many men using transdermal have difficulty attaining testosterone levels in the upper end(high/normal) of the physiological range due to absorption/excess dht conversion and usually end up switching to injectable which are more effective at raising testosterone to the upper end (depending on dosage/ones shbg levels) and easily absorbed as they are injected directly in the muscle/adipose tissue bypassing the skin and ( more than likely the reason for the change in your protocol). As far as your shbg I would not consider it fairly high as the range is 19.3-76.4 nmol/L so 47.85 is the mean and your level is 49.5 nmol/L so slightly above mid-normal. If your levels were closer to the upper end of the range or higher than once weekly injection of a higher dose testosterone would help lower shbg. As far as having to hit 1000+ total you may not have to as your free t may get into a healthier range with a 700-900 total. There is a few studies that link higher dht levels to increases in hematocrit but there are also studies stating that injectable are more prone to raising hematocrit than transdermal and dosage/age of patient also play a role.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4475414/
http://ajpendo.physiology.org/content/308/12/E1035.long

 

[madman]

I thought low SHBG means better conversion to free T, but shorter useful life in the body, easily gets washed out in urine, hence need for more frequent doses.

Don't know about relative weekly total dose.

https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2006-0822

 

[Blackhawk]

What was your total t/free t numbers on your transdermal protocol? Transdermal as oppose to injectable are more prone to excess conversion of t-->dht due high expression of 5-alpha reductase in the skin. Many men using transdermal have difficulty attaining testosterone levels in the upper end(high/normal) of the physiological range due to absorption/excess dht conversion and usually end up switching to injectable which are more effective at raising testosterone to the upper end (depending on dosage/ones shbg levels) and easily absorbed as they are injected directly in the muscle/adipose tissue bypassing the skin and ( more than likely the reason for the change in your protocol).

Consistent as i understand it, Thanks for confirmation!

As far as your shbg I would not consider it fairly high as the range is 19.3-76.4 nmol/L so 47.85 is the mean and your level is 49.5 nmol/L so slightly above mid-normal.

Logical if it is a linear scale. My point of reference is Dr Saya saying it's somewhat higher.

If your levels were closer to the upper end of the range or higher than once weekly injection of a higher dose testosterone would help lower shbg. As far as having to hit 1000+ total you may not have to as your free t may get into a healthier range with a 700-900 total. There is a few studies that link higher dht levels to increases in hematocrit but there are also studies stating that injectable are more prone to raising hematocrit than transdermal and dosage/age of patient also play a role.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4475414/
http://ajpendo.physiology.org/content/308/12/E1035.long

Thanks that's new info for me! Exactly the kind of considerations I am looking to learn more about! I'll read the references in detail.

So possibly if SHBG is indeed just a little above mid range I may convert to free T more readily than anticipated, which would be welcome. I just like the idea of achieving more in range numbers across the board, rather than high total T, but of course depends on physiological effect and resolution of symptoms.

I certainly hope that a lower total T as you said 700-900 will bring free T into excellent range. I am a little concerned about overshooting on 150mg/wk.

 

[Blackhawk]

https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2006-0822

Quick scan of the study looks consistent but using different terminology... higher SHBG (related to age of patients) also related to lower free T and slower clearance. I'll read it more completely when I get the chance.

 

[lexer]

Blackhawk
what was your actual DHT level and what is the range?

 

[TheDude]

Are higher T doses recommended for low SHGB levels or high SHGB levels? I thought I recalled from another thread that low SHGB made higher T doses more suitable.

Typically, low SHGB levels require lower, more frequent injections. High SHGB typically use higher doses, less frequent.

 

[Blackhawk]

Blackhawk
what was your actual DHT level and what is the range?

I purposely left total T, free T and DHT numbers out to foster more general conceptual discussion to gain understanding of the relationships/effects of treatment changes rather than debating my specific numbers, but at this point, here you go:

Total T: 443 ng/dl range 264-916
Free T: 14 pg/ml range 7.2-24
DHT: 149 ng/dl range 30-85
SHBG: 49.3 nmol/L range 19.3-76.4

 

[DaveK22]

I personally think it isn't good for any hormone to run at supraphysiological levels. Due to the 5 alpha reductase conversion that test cream is known to do, which raises DHT, I personally think it's a bad choice regardless of effect on the hair line. Just my 2 cents.

 

[Blackhawk]

I personally think it isn't good for any hormone to run at supraphysiological levels. Due to the 5 alpha reductase conversion that test cream is known to do, which raises DHT, I personally think it's a bad choice regardless of effect on the hair line. Just my 2 cents.

I ultimately don't know, experientially we overshot both DHT and DHEA which was quite low before supplementation. While I don't perceive a symptomatic problem from these, it's only been 8-10 weeks, and I don't know the potential longer term negative effects.

But I agree in theory for my own treatment that I would rather increase up to higher total and free T levels while avoiding overshooting.

 

[madman]

I purposely left total T, free T and DHT numbers out to foster more general conceptual discussion to gain understanding of the relationships/effects of treatment changes rather than debating my specific numbers, but at this point, here you go:

Total T: 443 ng/dl range 264-916
Free T: 14 pg/ml range 7.2-24
DHT: 149 ng/dl range 30-85
SHBG: 49.3 nmol/L range 19.3-76.4

If your total t was only 442 ng/dl (lower than mid range) as mean would be 590 ng/dL (range 264-916 ng/dl) and your free t 14 pg/ml (just slightly under mid range) as mean would be 15.8 pg/ml (range 7.2-24 pg/ml) now wonder you have issues. I would say more than likely if you get your total t in the 700-900 range your free t will increase enough and you should see benefits. I think jumping to 150 mg/week is too high and it would have been better to start at 100-120mg/week but worse case scenario is after 6 weeks you do not feel well overall and depending on blood work you can always lower dose but I would personally start lower on injectable than jumping right on 150mg/week.

 

[FeelingLost]

I purposely left total T, free T and DHT numbers out to foster more general conceptual discussion to gain understanding of the relationships/effects of treatment changes rather than debating my specific numbers, but at this point, here you go:

Total T: 443 ng/dl range 264-916
Free T: 14 pg/ml range 7.2-24
DHT: 149 ng/dl range 30-85
SHBG: 49.3 nmol/L range 19.3-76.4

Dang Blackhawk you really are a DHT making machine.
If you have a concern about your T dose and how much it might raise your TT
I believe you can call Defy in 3-4 weeks after you have been njecting and order a mini blood test of just the important values at any time.
Since you are paying for it there is no waiting period between blood tests. TT FT, E2 and Prolactin would be the ones I would look at.

I don't know what high T feels like since I have never been there but I do know what a 60 E2 18 prolactin feels like.
Your nipples will get hard and stay hard they will be very sensitive, even wearing a cotton tee shirt will bug you. You know those Sarah McLachlan save the dog commercials for the aspca? You will not be able to watch them without crying your eyes out.

I am surprised he did not start you on a very low dose AI like .125 twice a week. Was your E2 low with your TT443 FT14? I suppost a high E2 can easly be corrected on your next followup where a super low E2 can really suck if you listen to the guys that post about here.