Surprising blood results . . . so is this it?

[Melody68]

I'm 68 and started TRT on the gel therapy on Dec 20/23. I was on that for 3.5 months before it was finally determined that it wasn't working right. I then went on TE injections on April 6, taking a rate of 10 mgs per day, injecting 40 mgs every 4th day (equivalent to 70mgs per week). Only been on the injections a month. My pre TRT Total Testosterone was 10.9 (range 8.4-28.8).

I'm in Canada; I've been to an Endo, Urologist and my GP. The GP is the best, at least a little open in his thinking; they all still only test Total Testosterone and CBC for hematocrit, a PSA, and that's it. The GP says the Canadian test for Free T is "notoriously inaccurate" and that he can't test for SHBG (he says the Endo might be able to). He thinks our estradiol test also sucks, and says I shouldn't need it anyway on such a small dose of T.

I tested blood yesterday, May 8; the results are a bit of a surprise. My TT was 24.3 (range 8.4-28.8) a BIG increase over the 10.9 prior TRT. My hematocrit was .494 (range .400-.500) and the hemoglobin a bit high at 176 (range 135-175). My PSA was 3.4 (range <4).

So is that it? It certainly will be for my endo; he'll look at 24.3 and give himself a big pat on the back. The problem is that I don't feel markedly different from my pre T self. I originally started because I had fatigue when working or riding my bike. My bike riding is a BIT better. I had hoped to lose weight, have lost a pound or two. I also notice that I get morning wood once in a while, whereas before I didn't. Still need the little blue pill and a million stars to align if I hope to hit a home run. It's really only been a month on injections, do I have better to look forward to? Many thanks for your input . . .

 

[Systemlord]

The problem is that I don't feel markedly different from my pre T self.

Unrealistic expectations will lead to disappointment. Depending on the ester type, cypionate for example will lead to steady blood levels in 42 days. Testosterone isn't like drugs, the effects aren't instant, testosterone causes structural changes within the body and that takes time.

Sadly without a Free T or SHBG value, there's no way to determine the Free T, the active portion of testosterone and its metabolites DHT and estrogen that provides all of the positive effects.

Many doctors are ill prepared and don't know how to manage male hormones, it doesn't matter what country you live in.

Most men notice significant changes in 4-6 months, with continued improvement for years.

TRT is a marathon, not a sprint!

 

[madman]

I'm 68 and started TRT on the gel therapy on Dec 20/23. I was on that for 3.5 months before it was finally determined that it wasn't working right. I then went on TE injections on April 6, taking a rate of 10 mgs per day, injecting 40 mgs every 4th day (equivalent to 70mgs per week). Only been on the injections a month. My pre TRT Total Testosterone was 10.9 (range 8.4-28.8).

I'm in Canada; I've been to an Endo, Urologist and my GP. The GP is the best, at least a little open in his thinking; they all still only test Total Testosterone and CBC for hematocrit, a PSA, and that's it. The GP says the Canadian test for Free T is "notoriously inaccurate" and that he can't test for SHBG (he says the Endo might be able to). He thinks our estradiol test also sucks, and says I shouldn't need it anyway on such a small dose of T.

So I have limited figures, but they're a bit of a surprise. My TT was 24.3 (range 8.4-28.8) a BIG increase over the 10.9 prior TRT. My hematocrit was .494 (range .400-.500) and the hemoglobin a bit high at 176 (range 135-175). My PSA was 3.4 (range <4).

So is that it? It certainly will be for my endo; he'll look at 24.3 and give himself a big pat on the back. The problem is that I don't feel markedly different from my pre T self. I originally started because I had fatigue when working or riding my bike. My bike riding is a BIT better. I had hoped to lose weight, have lost a pound or two. I also notice that I get morning wood once in a while, whereas before I didn't. Still need the little blue pill and a lotta luck if I hope to hit a home run. It's really only been a month on injections, do I have better to look forward to? Many thanks for your input . . .

As I stated in your previous thread although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

I have stated numerous times on the forum you need to have your FT tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration especially in cases of altered SHBG to know where it truly sits.

Unfortunately most doctors in Canada do not test FT using this method as it is too expensive and not routinely available to most.

Yes the older testing method the direct analog immunoassay (RIA/EIA) are known to be inaccurate and should not be used/relied upon when testing FT.

In Canada we no longer use this testing method/assay which has been replaced by the linear law-of-mass action cFTV.

You can use/rely upon the cFTV as it tends to agree well when compared against a standardized Equilibrium Dialysis assay although it tends to overestimate slightly.

All labs in Canada use this method.

Even then as I stated in your previous thread no need to fret over whether your doctor tests FT as you can easily use the online calculator for free but you need to have your TT, SHBG and Albumin.

Free & Bioavailable Testosterone calculator

Again I told you that you need to get your SHBG tested.

You are injecting 40 mg T every 4 days (70 mg/week).

Labs should be done at the 4-6 week mark (TC/TE) although most would wait 6 weeks.

Labs should always be done at the true trough (lowest point) before your next injection.

You never had your FT, estradiol or SHBG tested for reasons stated by your GP.

Keep in mind that although most labs use the standard estradiol assay it is still a reliable test if you do not have elevated CRP or are using an aromatase inhibitor and end up crashing or driving down your estradiol too low.

If such is the case then yes you would need to use/rely upon the estradiol sensitive (LC/MS-MS) which would be considered the most accurate assay and as I have stated in your previous thread it is available in the province of Ontario but only through Dynacare laboratories.

Seeing as you are injecting every 4 days then your labs should have been done 96 hrs post-injection.

You are injecting 40 mg T every 4 days (70 mg/week).

You stated that you are hitting a TT 24.3 nmol/L which is a robust TT 700.9 ng/dL.

If this is your true trough then your peak TT, FT and estradiol will be much higher!

Now the shitkicker here is even though you are hitting a robust TT 700.9 ng/dl (hopefully your trough) if you have high SHBG with such TT then your FT will not be high enough!

Again TT means nothing without knowing where your FT level sits.

Seeing as your doctor is ignoring the most important bloodmarker and relying upon TT you are in a world of hurt!

You need to test your SHBG then you can calculate your FT to see where it sits on such protocol!

Top it all off that I have clearly stated numerous times on the forum the first 6 weeks means nothing when looking at the bigger picture!

Every protocol needs to be given a fighting chance 12 weeks in order to claim whether it was truly a success or failure.

The only time you dose should be increased at the 6 week mark when first starting therapy or tweaking a protocol is if your trough FT level is too low (highly unlikely) in most cases.

 

[madman]

I'm 68 and started TRT on the gel therapy on Dec 20/23. I was on that for 3.5 months before it was finally determined that it wasn't working right. I then went on TE injections on April 6, taking a rate of 10 mgs per day, injecting 40 mgs every 4th day (equivalent to 70mgs per week). Only been on the injections a month. My pre TRT Total Testosterone was 10.9 (range 8.4-28.8).

I'm in Canada; I've been to an Endo, Urologist and my GP. The GP is the best, at least a little open in his thinking; they all still only test Total Testosterone and CBC for hematocrit, a PSA, and that's it. The GP says the Canadian test for Free T is "notoriously inaccurate" and that he can't test for SHBG (he says the Endo might be able to). He thinks our estradiol test also sucks, and says I shouldn't need it anyway on such a small dose of T.

I tested blood yesterday, May 8; the results are a bit of a surprise. My TT was 24.3 (range 8.4-28.8) a BIG increase over the 10.9 prior TRT. My hematocrit was .494 (range .400-.500) and the hemoglobin a bit high at 176 (range 135-175). My PSA was 3.4 (range <4).

So is that it? It certainly will be for my endo; he'll look at 24.3 and give himself a big pat on the back. The problem is that I don't feel markedly different from my pre T self. I originally started because I had fatigue when working or riding my bike. My bike riding is a BIT better. I had hoped to lose weight, have lost a pound or two. I also notice that I get morning wood once in a while, whereas before I didn't. Still need the little blue pill and a million stars to align if I hope to hit a home run. It's really only been a month on injections, do I have better to look forward to? Many thanks for your input . . .

If it turns out you have high SHBG (60 nmol/L) even with a robust TT 700s your FT would be far from stellar!

Many aiming for a high-end cFTV would be hitting 20 ng/dL.

Free & Bioavailable Testosterone calculator

 

[madman]

I'm 68 and started TRT on the gel therapy on Dec 20/23. I was on that for 3.5 months before it was finally determined that it wasn't working right. I then went on TE injections on April 6, taking a rate of 10 mgs per day, injecting 40 mgs every 4th day (equivalent to 70mgs per week). Only been on the injections a month. My pre TRT Total Testosterone was 10.9 (range 8.4-28.8).

I'm in Canada; I've been to an Endo, Urologist and my GP. The GP is the best, at least a little open in his thinking; they all still only test Total Testosterone and CBC for hematocrit, a PSA, and that's it. The GP says the Canadian test for Free T is "notoriously inaccurate" and that he can't test for SHBG (he says the Endo might be able to). He thinks our estradiol test also sucks, and says I shouldn't need it anyway on such a small dose of T.

I tested blood yesterday, May 8; the results are a bit of a surprise. My TT was 24.3 (range 8.4-28.8) a BIG increase over the 10.9 prior TRT. My hematocrit was .494 (range .400-.500) and the hemoglobin a bit high at 176 (range 135-175). My PSA was 3.4 (range <4).

So is that it? It certainly will be for my endo; he'll look at 24.3 and give himself a big pat on the back. The problem is that I don't feel markedly different from my pre T self. I originally started because I had fatigue when working or riding my bike. My bike riding is a BIT better. I had hoped to lose weight, have lost a pound or two. I also notice that I get morning wood once in a while, whereas before I didn't. Still need the little blue pill and a million stars to align if I hope to hit a home run. It's really only been a month on injections, do I have better to look forward to? Many thanks for your input . . .

Even then looking over your pre-TT highly doubtful you have high SHBG!

Throw in the increased hemoglobin/hematocrit (pre/post TTh) and it is doubtful your FT would be subpar.

Even then you are only 4 weeks in and although hematocrit will increase within the 1st month it can take anywhere from 6-9 months and in some cases up to a year to reach peak levels so where it sits 4 weeks in is not where it will be 6-9 months from now.

 

[Melody68]

Hello Madman and Systemlord; thank you both very much for your timely input - I suspected as much but needed to hear it yet again.

Madman had kindly sent a link to private blood testing that's available in Ontario through Dynacare. I intend to continue the TRT another couple of months and then explore a more complete set of blood tests.

I'll find out if the Free Testosterone test available in Ontario is, in fact, the "linear law-of-mass action cFTV" as Madman suggests. If so, I think I can twist the GP's arm to test for it. I could ask the Endo for SHBG, but that will likely be pointless - numerous emails and phone calls have gone unanswered.

Easy to get frustrated with all this testing BS in Canada. If I can't get any satisfaction with my doctor requisitions, then I'll go Dynacare in July and at least get estradiol and SHBG (and FT if not available through normal req).

Madman, my blood was tested about 1 hour before my next injection when T levels were completely in the trough. For what it's worth, my Albumin tested at 47 g/L (range 35-52). You guys are a HUGE help, thanks again!

 

[madman]

Hello Madman and Systemlord; thank you both very much for your timely input - I suspected as much but needed to hear it yet again.

Madman had kindly sent a link to private blood testing that's available in Ontario through Dynacare. I intend to continue the TRT another couple of months and then explore a more complete set of blood tests.

I'll find out if the Free Testosterone test available in Ontario is, in fact, the "linear law-of-mass action cFTV" as Madman suggests. If so, I think I can twist the GP's arm to test for it. I could ask the Endo for SHBG, but that will likely be pointless - numerous emails and phone calls have gone unanswered.

Easy to get frustrated with all this testing BS in Canada. If I can't get any satisfaction with my doctor requisitions, then I'll go Dynacare in July and at least get estradiol and SHBG (and FT if not available through normal req).

Madman, my blood was tested about 1 hour before my next injection when T levels were completely in the trough. For what it's worth, my Albumin tested at 47 g/L (range 35-52). You guys are a HUGE help, thanks again!

If you are hitting a robust trough TT 700s 4 days (96 hrs) post-injection then your peak TT would be much higher!

This would also apply to FT and estradiol.

If no doctor is willing to test SHBG then I would just up the $$$ and pay out of pocket to get it done.

The cost is ridiculous but it is what it is as your options for private pay out of pocket testing in Canada are limited.

Sex Hormone Binding Globulin (SHBG)

This Private Blood Test for sex-hormone-binding-globulin-shbg is available in Ontario, Quebec and Manitoba - Simply Order Online, attend a Dynacare Service Centre and get your sex-hormone-binding-globulin-shbg results online. Free phlebotomy and GP referral.

bloodtestscanada.com

Then you can calculate your FT using the cFTV available online for free!

Otherwise you will be shooting in the dark here as again TT means nothing without knowing where your FT sits!

Dynacare - Change in Methodology for Measurement of Free Testosterone Levels

Change in Methodology for Measurement of Free Testosterone Levels

www.dynacare.ca

Dynacare - FREE TESTOSTERONE

FREE TESTOSTERONE

www.dynacare.ca

(1)
Free testosterone is estimated from
measured total testosterone and
sex hormone-binding globulin using
Vermeulen's algorithm
[J Clin Endocrinol Metab 84 (10):3666-3672, 1999]

 

[Melody68]

If you are hitting a robust trough TT 700s 4 days (96 hrs) post-injection then your peak TT would be much higher!
It is hard to believe that I got such a strong response from only 70mgs per week. I have always, however, been quite sensitive to any drugs that I took, so this seems consistent. Because I wasn't really feeling any great symptom relief, I was going to up the dose to 84mgs (!) from 70, but I think I'll stay here for a few months and give it more time. Patience, grasshopper . . .

If no doctor is willing to test SHBG then I would just up the $$$ and pay out of pocket to get it done.
Yup, that's what I'll do. I consider myself fortunate that I have doctors to prescribe the T, I don't pay for the T, and I get some of the testing paid for. I don't mind the occasional fee.

I was also pleased that the GP said he'd prescribe a phlebotomy if need be.

Hopefully I never have to complicate the therapy with a second drug . . .

 

[Systemlord]

Madman had kindly sent a link to private blood testing that's available in Ontario through Dynacare.

Maybe you could work with Dr. Adam Millar at Mount Sinai Hospital in Ontario. A reputable TRT doctor.

I was also pleased that the GP said he'd prescribe a phlebotomy if need be.

Be aware that a slight elevation in hematocrit and hemoglobin is fine as long as there are no symptoms. Many doctors get this wrong and freak out thinking testosterone, hematocrit and hemoglobin above the normal limit to be harmful without any evidence that is the case.

 

[Melody68]

Yet another option that I'll keep tucked away, thanks!

 

[madman]

Hello Madman and Systemlord; thank you both very much for your timely input - I suspected as much but needed to hear it yet again.

Madman had kindly sent a link to private blood testing that's available in Ontario through Dynacare. I intend to continue the TRT another couple of months and then explore a more complete set of blood tests.

I'll find out if the Free Testosterone test available in Ontario is, in fact, the "linear law-of-mass action cFTV" as Madman suggests. If so, I think I can twist the GP's arm to test for it. I could ask the Endo for SHBG, but that will likely be pointless - numerous emails and phone calls have gone unanswered.

Easy to get frustrated with all this testing BS in Canada. If I can't get any satisfaction with my doctor requisitions, then I'll go Dynacare in July and at least get estradiol and SHBG (and FT if not available through normal req).

Madman, my blood was tested about 1 hour before my next injection when T levels were completely in the trough. For what it's worth, my Albumin tested at 47 g/L (range 35-52). You guys are a HUGE help, thanks again!

Dynacare and Lifelabs are the 2 big boys in Ontario.

Dynacare - Change in Methodology for Measurement of Free Testosterone Levels

Change in Methodology for Measurement of Free Testosterone Levels

www.dynacare.ca

*Effective September 29, 2014, Gamma-Dynacare Medical Laboratories will be changing the methodology for free testosterone (FT) measurement. FT results will be calculated using Vermeulen’s equation1, incorporating the levels of serum total testosterone, sex hormone binding globulin (SHBG) and albumin. The current analog based measuring method will be discontinued. For more information, please see the Client Notice below.




Lifelabs

*The reference ranges for free testosterone listed here are calculated via the Vermeulen equation according to the current practice at Lifelabs

 

[madman]

Maybe you could work with Dr. Adam Millar at Mount Sinai Hospital in Ontario. A reputable TRT doctor.


Be aware that a slight elevation in hematocrit and hemoglobin is fine as long as there are no symptoms. Many doctors get this wrong and freak out thinking testosterone, hematocrit and hemoglobin above the normal limit to be harmful without any evidence that is the case.

Typical endo he is a stickler when it comes to numbers!

Would not even waste my time.

 

[madman]

Hello Madman and Systemlord; thank you both very much for your timely input - I suspected as much but needed to hear it yet again.

Madman had kindly sent a link to private blood testing that's available in Ontario through Dynacare. I intend to continue the TRT another couple of months and then explore a more complete set of blood tests.

I'll find out if the Free Testosterone test available in Ontario is, in fact, the "linear law-of-mass action cFTV" as Madman suggests. If so, I think I can twist the GP's arm to test for it. I could ask the Endo for SHBG, but that will likely be pointless - numerous emails and phone calls have gone unanswered.

Easy to get frustrated with all this testing BS in Canada. If I can't get any satisfaction with my doctor requisitions, then I'll go Dynacare in July and at least get estradiol and SHBG (and FT if not available through normal req).

Madman, my blood was tested about 1 hour before my next injection when T levels were completely in the trough. For what it's worth, my Albumin tested at 47 g/L (range 35-52). You guys are a HUGE help, thanks again!

I would not lead you astray, that's a promise!

 

[Melody68]

I would not lead you astray, that's a promise!

Most certainly not! I have great confidence in your words first and then those of a select few others on the forum.

I was checking for a Dynacare in my hometown and discovered, to my shock, that a new one has located in an office building about a stone's throw from where I live (ok, you'd have to have a pretty good arm . . . but it's there). So I think I could work with the GP to provide me with most of the tests, and those that aren't possible I'll just buy (will wait a couple of months to let the T really entrench itself before I retest). Other than that, I'll rely on the expertise here on the forum, so glad I found it!