Been on TRT for right around a year now. 50mg 2x week of Test Cyp. Most recent blood work looks good, I think. My only concern is the Hematocrit is towards the top of range and E2 is at 48 which is high, but I really haven't noticed any side effects from that, so might be a non issue. Anyway, just curious as to what the "pro" think or would have concerns about? Free T has gone from 62 to 145 and BioT has gone from 131 to 316 over that time frame.
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Would not fret over where your hematocrit sits as you are well within what would be considered high!
Where does your iron/ferritin sit as it is critical to have a baseline and on therapy especially if you are one that is caught up and that donating too frequently merry go round trying to control elevated hematocrit which in the majority of cases is due to running too high a trough/steady-state FT.
Forget testing BAT as FT is what truly matters here!
Keep in mind the standard estradiol immunoassay which tends to overestimate when compared against the LC/MS-MS assay (most accurate) especially in cases of high CRP (C-reactive protein) or men crushing their estradiol levels with the overuse of an AI.
If you have normal CRP and you are not crushing/driving down your estradiol too low with the use of an AI then the standard e2 assay should suffice.
The only way to know where your FT truly sits is to have it tested using the most accurate assay the gold standard Equilibrium Dialysis otherwise you would need to use/rely on the next best testing method which is the linear law-of-mass action Vermeulen (cFTV).
Based on your calculated trough FT 144.5 pg/mL (14.4 ng/dL) which was done through Quest using a modified Vermeulen (cFTV) method you would be hitting a healthy trough FT.
If anything your trough FT is going to be higher because it was not calculated using the go to linear law-of-mass action Vermeulen (cFTV)
Keep in mind as of now the go to calculated method is the linear law-of-mass action Vermeulen (cFTV) which is considered the most accurate as it has been validated against a standardized ED assay which is the gold standard testing method for free testosterone.
Yes it tends to overestimate slightly but will still give a good approximation.
If we calculated your FT using the Vermeulen method with a robust TT 836 ng/dL, normalish SHBG 27 nmol/L and Albumin 4.8 g//dL then your FT 20 ng/dL would high-end!
Not 14.4 ng/dL which your Quest results give.
You are hitting a high-end TT 836 ng/dL with a normalish SHBG 27 nmol/L so it is a given that your trough FT is going to be on the high-end.
Your estradiol is high because your trough/steady-state FT is high which means your peak TT and more importantly FT and estradiol will be higher.
If you feel great overall are not experiencing any sides and your overall blood markers are healthy I see no issue with where your trough FT sits and consider yourself lucky.
Next time round test your FT by Equilibrium Dialysis if you want to know where it truly sits otherwise just use the online calculator (cFTV) which is available for free to the general public!
How often should men on TRT check their hematocrit?
The standard monitoring schedule includes a baseline CBC before starting TRT, a recheck at 3 to 6 weeks, another at 3 months, and then at 6 and 12 months once stable. Any dose or formulation change resets the monitoring clock, requiring a recheck 4 to 6 weeks later. Men with risk factors for elevated hematocrit (sleep apnea, smoking, COPD, or a history of clotting) should check more frequently: every 3 months until the trend is stable.
* The monitoring schedule, the intervention ladder, and the attention...
E2 - Immunoassay (IA)
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E2 Sensitive (LC-MS/MS)
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TT - (LC-MS/MS))
FT and BAT - Calculation (modified Vermeulen equation))
Albumin - Spectrophotometry (SP)
SHBG • Immunochemiluminescent Assay (EIA)
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This is the panel you want when testing TT and more importantly FT which uses the most accurate assays!
