Newish Member from Canada (Pre-TRT Bloodwork Inside)

[bubz24]

Good Afternoon Fella's,

Like I mentioned in the title I'm new to TRT. I signed up to the forum a while ago and been doing alot of reading/researching and finally have jumped in. It took me a bit to find a doctor to get me on but hopefully it was worth the wait which I have no doubts.

Attached is some blood work I took a few weeks ago. Based on that my doctor has got me on 110mg of Delatestryl per week which I took my first shot (IM quad) last Wednesday. He suggested I take them just once a week right now and when I suggested every 3.5 days he kind of balked at it. We'll have to see how it goes but so far so good.

He also said my thyroid is low so I'm taking 30mg of desiccated Thyroid (Thyroid Hormone).

You guys are so helpful around here so was just looking at some advice (if any) on my blood work.

Thanks in advance,
Bubz

 

[madman]

Good Afternoon Fella's,

Like I mentioned in the title I'm new to TRT. I signed up to the forum a while ago and been doing alot of reading/researching and finally have jumped in. It took me a bit to find a doctor to get me on but hopefully it was worth the wait which I have no doubts.

Attached is some blood work I took a few weeks ago. Based on that my doctor has got me on 110mg of Delatestryl per week which I took my first shot (IM quad) last Wednesday. He suggested I take them just once a week right now and when I suggested every 3.5 days he kind of balked at it. We'll have to see how it goes but so far so good.

He also said my thyroid is low so I'm taking 30mg of desiccated Thyroid (Thyroid Hormone).

You guys are so helpful around here so was just looking at some advice (if any) on my blood work.

Thanks in advance,
Bubz

If these are pre-try labs you are missing 2 critical tests SHBG and Free Testosterone?

Although TT is needed and good to know FT is what truly matters as it is the unbound active fraction of testosterone responsible for the positive benefits.

SHBG can make or break a protocol as it will dictate ones injection frequency/dose and will have a major impact on the effectiveness of ones trt protocol.

Why are you on trt with a robust TT of 24.1 nmol/L (694.5 ng/dL) unless your FT is low due to having high SHBG.....2 test you never even had done?

Your Vitamin D is on the lower end and DHEA-S can be improved upon.

The wrong estradiol test was done as it is the standard assay and you want the estradiol sensitive assay (LC-MS/MS) which is now available in Canada but only through Dynacare Labs as they are partnered with one of the biggest labs in the US (LabCorp).

As I stated not sure why you jumped on trt without knowing where your FT and SHBG sit as your TT is robust and unless you have low FT due to high SHBG than you have no business being on trt.

Even though your TT is in a healthy range trt would and should only be prescribed if your Free T was low due to high SHBG.

Seeing as your doctor put you on trt when your TT is robust and not even testing your SHBG and FT to truly see if you have low FT than it was idiotic!

 

[madman]

"Attached is some blood work I took a few weeks ago. Based on that my doctor has got me on 110mg of Delatestryl per week"

Unreal!

 

[bubz24]

Thanks for the info madman. As for why I’m on trt the last 3-4 years have been quite a downturn in mood, libido, recovery etc. Which a lot of guys here have expressed and based on those symptoms my doc (Komer out of Burlington) agreed to put me on. He’s quite experienced as you probably know and his plan is in the 38 TT range. I have follow up blood work in early January so I will see how those results are and inquire about the tests you suggest.

I looked at previous blood work done by Greenspan last year and he didn’t order those tests either. There was no FT just TT.

 

[madman]

Thanks for the info madman. As for why I’m on trt the last 3-4 years have been quite a downturn in mood, libido, recovery etc. Which a lot of guys here have expressed and based on those symptoms my doc (Komer out of Burlington) agreed to put me on. He’s quite experienced as you probably know and his plan is in the 38 TT range. I have follow up blood work in early January so I will see how those results are and inquire about the tests you suggest.

I looked at previous blood work done by Greenspan last year and he didn’t order those tests either. There was no FT just TT.

Of course symptoms is what matters but blood work is important and your TT is robust and to start someone on trt without knowing if your FT is truly low/sub-par as FT nor SHBG was tested is ludacris.

Do understand that ones mood/libido/recovery can also be negatively impacted from a dysfunctional thyroid/adrenals among other things.

One could very well have healthy FT levels with your TT levels.

As far as Komer he is not as advanced in treating men for trt as he thinks.

For years he was prescribing testosterone injections every 2 weeks and only within the last few years switched to once weekly.

He only looks at TT and ignores FT and SHBG (which are critical).

I will put money on it that if you bring up FT and SHBG he will not listen!

We had another member on here that has high SHBG and it being treated by Komer and sad to say but Komer is only concerned with his TT and pays no attention to his FT/SHBG.

Regarding him aiming for a TT of 38 nmol/L.....not everyone needs to have TT levels there as it comes down to what TT level does one need in order to achieve a healthy FT level in order to experience relief/improvement of low t symptoms and overall improvement in ones well being.

Also most men do well having their FT 2-3% of TT and again ones SHBG will play a big role as men with low/lowish SHBG can usually achieve a healthy FT running a lower TT compared to one with high SHBG who may end up needing to run a higher TT 1200+ in order to achieve a healthy FT.

God forbid you have low SHBG as running a TT of 38 nmol/L may very well have your e2 through the roof!

You need to know your SHBG and where your FT sits as it is critical to the effectiveness of your protocol.....low/high SHBG men have to approach treatment differently regarding testosterone dose and most importantly injection frequency!

 

[bubz24]

I appreciate your advice. I'll bring that to his attention and see what he says. He mentioned he's treated over 4000 men so I have to take him at face value on that and trust him.

I did\do have low FT. My GP did some blood work after I insisted I wanted my Testosterone checked. It was originally like pulling teeth and after the 2nd appointment she finally agreed but that was the only test she did. I remember it was in the lower acceptable level. After doing some reading here and on the net I realized she didn't do the proper blood work and asked for a referral to Greenspan. Like I mentioned he only did a test for TT. No FT or SHBG I have a copy of that blood work. My TT values came back in around 21 and he just looked at me and said you're fine, I was kind of shocked since he said he treats symptoms. I guess I had to tell him I couldn't get it up at all. LOL

You go to him does he test for FT and SHBG now or did you have to ask him? If it's so critical then I wonder why he didn't do those tests for me.

 

[bubz24]

Also I was kind of at my wits end here. My GP said I was fine, Greenspan said I'm good but yet I continued to fell like crap most days. Reading all the success stories on the net with guys on TRT I just wanted to try and see how it worked for myself. Kromer was my last chance so we'll see how it goes.

If I have to get blood work on my own across the border in Buffalo/Niagara Falls I will do that but for the time being I'll go along with his program and see how I feel come the new year.

 

[Systemlord]

I seriously doubt your doctors claim to 4000 patients on TRT with him balking at twice weekly injections, if he had me as a patient I would have come in complaining of a crash on the 3rd day after my injection.

The fact is everyone is biochemically unique, some require more frequent injections (low SHBG men) and some need less (high SHBG men). Your doctor sounds arrogant and may be letting his ego run the show, I'm sure he felt intimidated by your suggestion of twice weekly injections hence the balking at the suggestion.

 

[bubz24]

I seriously doubt your doctors claim to 4000 patients on TRT with him balking at twice weekly injections, if he had me as a patient I would have come in complaining of a crash on the 3rd day after my injection.

Actually website says 5000 LOL ( The Komer Clinics - Treatment, Education, Consulting and Research in Women's Health, Men's Health and Brain Health - Burlington, Ontario, Canada ) he is definitely arrogant but he's an older fellow and has been doing it a long time. I'm just thinking he's a bit old school and when I asked about biweekly injections he didn't say no just "no need to complicate things." The wait list for a referral is like 8-10 months so he definitely has the clientele.

He gave me the blood work paper work to submit in January so I'll have a look at it and see if i can check the box for SBHG at least and see where that is. I'll have a look tonight.

I've only done one injection so far (last Wednesday) and so far so good. If I find I'm crashing a bit I'll definitely go to twice a week since that seems to be the norm.

 

[madman]

Actually website says 5000 LOL ( The Komer Clinics - Treatment, Education, Consulting and Research in Women's Health, Men's Health and Brain Health - Burlington, Ontario, Canada ) he is definitely arrogant but he's an older fellow and has been doing it a long time. I'm just thinking he's a bit old school and when I asked about biweekly injections he didn't say no just "no need to complicate things." The wait list for a referral is like 8-10 months so he definitely has the clientele.

He gave me the blood work paper work to submit in January so I'll have a look at it and see if i can check the box for SBHG at least and see where that is. I'll have a look tonight.

I've only done one injection so far (last Wednesday) and so far so good. If I find I'm crashing a bit I'll definitely go to twice a week since that seems to be the norm.

As I stated of course symptoms is what matters but again one also needs blood work to show that testosterone levels are low or sub-par as in (low normal) and in order to get a complete picture one can not just look at TT as some men can have a descent TT but a low or sub-par FT due to having high SHBG and there are also some men that can have an average TT but still have a healthy FT due to having low SHBG.

At a minimum FT and SHBG levels need to be known as even though it is important to know ones TT….. FT is what truly matters as it is the unbound active fraction of testosterone responsible for the positive benefits.

In your situation your TT is robust and unless you have high SHBG (which you have no clue) for all we know if your SHBG is normal (mid range) or slightly lower you would have descent FT levels.

Just to throw some scenarios out there we will use the Law of Mass Action calculated Free Testosterone (Vermuelen) method: Free & Bioavailable Testosterone calculator

Your TT is 694.5 ng/dL and seeing as we have no idea what your SHBG is.....lets say it is near the high end 60 nmol/L of the reference range which was 10-70 nmol/L and was recently changed to 10-60 nmol/L at both labs (Dynacare and Lifelabs in Canada).

If we take your TT and SHBG using the Free & Bioavailable Testosterone Calculator (Vermuelen) method.

With a TT of 694.5 ng/dL and SHBG of 60 nmol/L than your FT would be 1.49% and BT 34.8%


Now lets say your SHBG was normal (mid-range) which would be 35 nmol/L.

With a TT of 694.5 ng/dL and SHBG of 35 nmol/L than your FT would be 2.16% and BT 50.7%

Most men need FT 2-3% of TT and even than many do not need to have FT near or at 3% as many do well closer to 2%.

Every individual is different and ones SHBG will play a big role in what TT level one needs in order to achieve a healthy FT.

In your situation FT nor SHBG was tested so pre-trt you have no idea where your FT levels sit and with a TT of 694.5 ng/dl (almost 700) unless your SHBG is high..... you should have a descent FT level.

I think you should have had the proper testing done before jumping on trt.

Depending on ones situation there are other methods one can try before using exogenous testosterone!

 

[madman]

Actually website says 5000 LOL ( The Komer Clinics - Treatment, Education, Consulting and Research in Women's Health, Men's Health and Brain Health - Burlington, Ontario, Canada ) he is definitely arrogant but he's an older fellow and has been doing it a long time. I'm just thinking he's a bit old school and when I asked about biweekly injections he didn't say no just "no need to complicate things." The wait list for a referral is like 8-10 months so he definitely has the clientele.

He gave me the blood work paper work to submit in January so I'll have a look at it and see if i can check the box for SBHG at least and see where that is. I'll have a look tonight.

I've only done one injection so far (last Wednesday) and so far so good. If I find I'm crashing a bit I'll definitely go to twice a week since that seems to be the norm.

Long enough to know that he should be testing for SHBG and FT let alone the proper e2 test estradiol sensitive assay (LC-MS/MS) which is now available in Canada through Dynacare Labs.

 

[madman]

I appreciate your advice. I'll bring that to his attention and see what he says. He mentioned he's treated over 4000 men so I have to take him at face value on that and trust him.

I did\do have low FT. My GP did some blood work after I insisted I wanted my Testosterone checked. It was originally like pulling teeth and after the 2nd appointment she finally agreed but that was the only test she did. I remember it was in the lower acceptable level. After doing some reading here and on the net I realized she didn't do the proper blood work and asked for a referral to Greenspan. Like I mentioned he only did a test for TT. No FT or SHBG I have a copy of that blood work. My TT values came back in around 21 and he just looked at me and said you're fine, I was kind of shocked since he said he treats symptoms. I guess I had to tell him I couldn't get it up at all. LOL

You go to him does he test for FT and SHBG now or did you have to ask him? If it's so critical then I wonder why he didn't do those tests for me.

How many men one has treated does not always equate to QUALITY of treatment!

Some would consider Masters Men's Clinic a standard T-Mill and I would say he treats QUANTITY over QUALITY.

 

[madman]

Not trying to discourage you in any way as I clearly understand how hard it is to find treatment for trt let alone quality treatment in Canada.

I think you should have looked into this a little deeper before jumping in head first!

 

[madman]

I appreciate your advice. I'll bring that to his attention and see what he says. He mentioned he's treated over 4000 men so I have to take him at face value on that and trust him.

I did\do have low FT. My GP did some blood work after I insisted I wanted my Testosterone checked. It was originally like pulling teeth and after the 2nd appointment she finally agreed but that was the only test she did. I remember it was in the lower acceptable level. After doing some reading here and on the net I realized she didn't do the proper blood work and asked for a referral to Greenspan. Like I mentioned he only did a test for TT. No FT or SHBG I have a copy of that blood work. My TT values came back in around 21 and he just looked at me and said you're fine, I was kind of shocked since he said he treats symptoms. I guess I had to tell him I couldn't get it up at all. LOL

You go to him does he test for FT and SHBG now or did you have to ask him? If it's so critical then I wonder why he didn't do those tests for me.

Even if previously done you should have had SHBG and FT tested on your most recent labs before starting trt to truly understand your situation.

SHBG will not only play a critical role in ones FT levels but it will also dictate ones injection frequency/dose.

 

[bubz24]

@madman Love the advice man. I really appreciate it. Your passion is bleeding out of my monitor here. LOL

Follow up blood work in January is grabbing FT by the looks of it. I was thinking writing in the test for SHBG. What do I right in that box there or is it being tested for? Sorry, I should maybe look it up in the forums but being lazy here.

 

[madman]

He is only testing TSH (Free T4 and Free T3), Vitamin D and Total Testosterone (Day 3) after your injection which is wrong as you want your testosterone level tested at trough (lowest point before next injection)…..so if you are injecting once weekly say Monday morning at 9am than your blood work should be done the following Monday morning before your 9am injection.

Again he is not testing SHBG or Free T and to top it off he is not testing your trough T levels!

Ones testosterone levels will peak 24-48 hrs post injection and I would say closer to 24 hrs.

If he is testing your levels 3 days following your injection you will have no idea what your trough would be at day 7 as one does not want their trough levels to be too low.

Once weekly injections can benefit some (men with high or normal SHBG) but even than twice weekly (every 3.5 days) is more effective regarding having stable testosterone levels.

If one had low/lowish SHBG than once weekly injections would be a piss poor protocol and one would feel horrible fairly early in the week and surely be sub-par before day 7.

 

[bubz24]

I had some more blood work done the last 8 weeks.

My 6 week results were done 3 days after injection and are attached below. I was on 110mg weekly IM injections and my doc said to go down to 100 after the 6 week mark. The 12 weeks are from yesterday and were done before my injection. I'm kind of shocked at the SHBG being so high. Should I be worried about that?

I know I don't have any sensitive e2 tests done. I actually called my local Dynacare office and offered to pay for my own test and they said I still need a doctor to order the test, really frustrating to say the least.

I would just like to add that I feel really good still and having awesome workouts at the gym. Recovery from training and sporting activities has been great also.

Any advice on my most recent results would be much appreciated. I've also been taking synthroid to get my thyroid elevated a bit. I have noticed the last few weeks an increase in my metabolism.

 

[bubz24]

I've been doing some reading and I did do a decent chest workout before I went for my bloodwork yesterday morning. I'm thinking that could of skewed the SHBG results. Is that fair to say?

 

[Systemlord]

It seems your extremely high SHBG was the problem from the start choking your Free T, you more than likely need to raise those Free T levels as they are not even midrange and should be towards the top end of the range.

I would prefer to see Reverse T3 someone who is on T4 medicine to make sure you are no conversion issues and to make sure Reverse T3 is <15 ng/dL.

I doubt working out is going to change your prognosis regarding your out of control SHBG production, sure it might be a little elevated by a smaller margin.

 

[bubz24]

Hey thanks for the opinion. I do remember my original doctor only testing for FT and it was just above low normal a few years ago.

I've been taking 10000iu of Vit D a day the past few months also taking a DIM supplement (200mg) as well. Anything else I could do to raise Free T?

I'll also ask about reverse T3 on my next blood test.