40yo, with a long history of sub 300ng/dl TT values. I finally hopped on trt 6 weeks ago and just got back first set of bloods.
It’s prescribed by my primary care doc. He’s old school and he started me on test cyp given as an 1ml injection of 200mg/ml every 2 weeks. So dose is 100mg/week.
I have been taking 0.5ml once weekly instead because I’m worried about the high peaks from only injecting twice a month.
Pre-TRT values:
TT: 222 Ng/dl
FT: 69: pg/ml
SHBG: 11 (yes I am 30-40 lbs overweight)
Estradiol (ultrasenstitive) - 18
6 weeks on TRT values (trough values-
bloods taken at exactly 7days post injection and before next injection):
TT: 450 Ng/dl
FT: 125 pg/ml
Estradiol (standard test) - 30
From a symptomatic standpoint, I’m fairly happy but not in a honeymoon phase: energy levels, libido and sleep have all been better.
But blood pressure has gone up, appetite has skyrocketed (not great when I’d love to lose weight), and I have been getting random headaches (maybe blood pressure related, maybe shifting hormone related )
- How do these new numbers look?
- Is my trough TT/FT reasonable and can you determine peak from these?
- Also is E2 gonna be much higher than 30 at my peak and if so, is this a problem?
Finally all my CBC values were good for now but hemocrit went up from about 41% pre-TRT to 43% on these bloods. Will this stabilize, and what’s a value where it starts getting concerning ?
Thanks for any thoughts !
6 weeks on TRT values (trough values-
bloods taken at exactly 7days post injection and before next injection):
TT: 450 Ng/dl
FT: 125 pg/ml
Estradiol (standard test) - 30
Welcome to Nelsons house!
Smart move ditching that old outdated 200 mg T every 2 weeks protocol.
When it comes to T-therapy that outdated protocol 200 mg TC/TE every 2 weeks still being pushed by those clueless doctor's is far from optimal as it would have one being back to hypogonadal before their next injection due to the PKs.
Sure some men may still fare well on such but it is far from optimal not only due to the rollercoaster effect where T levels are sky-high off the hop only to be followed by much lower levels come day 10-14 which can easily have a negative impact on ones mood, energy, libido and erectile function let alone you will not be getting/taking advantage of the full anabolic benefits of T (increase muscle, strength, enhanced recovery).
Always best to post testing method/referencesranges for labs.
Keep in mind although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.
Not sure what testing method was used for free testosterone (direct IA, ED, UF or calculated).
When it comes to testing the most critical fraction free testosterone you would need to have it tested using the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG to know where it truly sits.
Otherwise you would need to use/rely on the next best the calculated linear law-of-mass action Vermeulen (cFTV) which will give a good approximation mind you it tends to slightly overestimate.
No on should be using/relying on the known to be inaccurate direct IA.
Looking over you labs results which luckily were done at true trough (lowest point) before your next injection you are hitting a not so stellar trough TT 450 ng/dL and descent trough FT 12.5 ng/dL 7 days post-injection which means your peak TT/FT and estradiol will be much higher as in double.
Although your trough TT/FT may seem far from stellar and easily has room to come up if need be keep in mind this is 7 days post-injection.
You would be far better off splitting your weekly dose and injecting 50 mg twice-weekly (every 3.5 days) which will bring up your trough and clip your peak before even considering increasing your weekly dose.
Blood levels will also be more stable throughout the week vs once weekly.
Hammering this home as usual.
FT <5 ng/dL would be considerd low.
FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.
FT 10-15 ng/dL would be healthy.
FT 20-25 ng/dL would be high-end/high.
The majority of men will do well with a trough FT 15-25 ng/dL depending on the injection frequency.
Need to keep in mind that there is a big difference between one running a high-end/high trough FT 20-25 ng/dL injecting daily vs twice-weekly vs once weekly.
Also going to be a big difference in peak--->trough on said protocol.
Always need to be mindful trough/injection frequency.
Many tend to overlook this and gun for a high-end/high trough FT only to end up struggling with sides especilly in the long run.
Just to put this in perspective most healthy young males would be hitting a cFTV 13-15 ng/dL or 10-12 ng/dL tested using the most accurate assay the gold standard Equilibrium Dialysis and this is a short-lived daily peak to boot.
Even if you take those natty outliers in the 95th percentile hitting a high FT 25 ng/dL again this is a short-lived daily peak to boot.
Finally all my CBC values were good for now but hemocrit went up from about 41% pre-TRT to 43% on these bloods. Will this stabilize, and what’s a value where it starts getting concerning ?
Your baseline hematocrit was already bottom end so driving it up will be beneficial.
Keep in mind when one is starting therapy or tweaking a protocol (increasing dose of T)) the hematocrit will start to increase within the 1st month and the biggest increase will be seen at the 3-6 month mark.
For many men hematocrit will reach a plateau at 6 months but some men will continue to see increases until 9 to 12 months before levels fully stabilize.
You are only 6 weeks in and your hematocrit went from 41-43% so it will continue to increase further over the following months but even then you have lots of room before it would ever be considered too high as it will still end up within the physiological range and below 50%.
The cut-off for hematocrit is 54%.
As I stated in another thread If one has no underlying health issues and is not experiencing any negative sides most in the know specializing in testosterone therapy would not fret if the patient's hematocrit falls within 50-54%.
Yes some will be more cautious and take measures once hematocrit hits 52%.
Most of the endos and clueless GPs are sticklers and hesitate once your hematocrit gets over the top end and prefer to keep patients levels no higher than 50%.
Consider yourself one of the lucky ones as your baseline level was already at the bottom-end.
Based on the comments you made here about a hematocrit of below 54 being safe are you willing to stand liable for giving out this false information if the OP has a stroke or heart attack?
Also please enlighten us on where you attended medical school and where you got your degree in endocrinology?
If you are having to give blood to reduce the hematocrit, you are not on "TRT" you are taking a small steroid cycle and calling it TRT.
As for my advice to the poster, I know personally of two people I have given similar advice to, both had strokes under the age of fifty. One with a...
