Target Labs

[galaxy]

Hi all,

I just visited my endo and had a question regarding target lab ranges. He mentioned that with gels/creams it's often hard to correctly assess the true serum testosterone levels and that it can sometimes be off by a significant amount. He's especially concerned about not maintaining supra physiological levels for any amount of times and feels that we should be targeting around 500-600 in order to make sure that the transdermals don't put me at the high end of the range. Similarly he's also concerned with using high concentration compounded creams b/c of the difficulty in tracking true absorption, and prefers to stick with 1.62 androgel or 1x/week cypionate shots. I have no problem using the androgel as insurance covers it.

He mentioned on weekly injections he'd be targeting a midpoint (3.5 day) lab of roughly 500, because of concerns of once again super physiological levels on injection days. My response was that perhaps we could get around that by ED, EOD, or 3x/week injections but his response is they don't to any more frequency than 1x/week b/c of the concerns that the actual volume being injected would be to little and hard to gauge/can be wasted. (i feel like this can be managed by regular testing no?)

My question is what are people generally targeting for the Total and Free T? Peak, trough, and midpoints? for both gels/creams & injections.

He seems to be very concerned with any sort of super physiological level which is where long term complications can occur. I completely understand his point b/c even 1/7 days of super physiological levels can really start too add up. He also stressed that while the normal range tops out at 1200 that's based on epidemiology and that my normal range may be lower (obviously the opposite may be true, but with no way of knowing he prefers to be conservative) so once again another reason to target the 500-600.

 

[Vince]

Midweek level of 500 it's too low, I will consider it for a trough level. But I do like my trough level be at least a thousand.

 

[CoastWatcher]

Hi all,

I just visited my endo and had a question regarding target lab ranges. He mentioned that with gels/creams it's often hard to correctly assess the true serum testosterone levels and that it can sometimes be off by a significant amount. He's especially concerned about not maintaining supra physiological levels for any amount of times and feels that we should be targeting around 500-600 in order to make sure that the transdermals don't put me at the high end of the range. Similarly he's also concerned with using high concentration compounded creams b/c of the difficulty in tracking true absorption, and prefers to stick with 1.62 androgel or 1x/week cypionate shots. I have no problem using the androgel as insurance covers it.

He mentioned on weekly injections he'd be targeting a midpoint (3.5 day) lab of roughly 500, because of concerns of once again super physiological levels on injection days. My response was that perhaps we could get around that by ED, EOD, or 3x/week injections but his response is they don't to any more frequency than 1x/week b/c of the concerns that the actual volume being injected would be to little and hard to gauge/can be wasted. (i feel like this can be managed by regular testing no?)

My question is what are people generally targeting for the Total and Free T? Peak, trough, and midpoints? for both gels/creams & injections.

He seems to be very concerned with any sort of super physiological level which is where long term complications can occur. I completely understand his point b/c even 1/7 days of super physiological levels can really start too add up. He also stressed that while the normal range tops out at 1200 that's based on epidemiology and that my normal range may be lower (obviously the opposite may be true, but with no way of knowing he prefers to be conservative) so once again another reason to target the 500-600.

"Starting low and going slow" is a perfectly appropriate approach to TRT. That said, your endocrinologist seems to be terribly anxious, building in all sorts of warnings and traffic-calming impediments to your therapy. Not that this is surprising - I initially consulted an endocrinologist who held an endowed chair in one of our local medical schools and he was a miserable failure when it came to understanding how to manage a hypogonadal patient.

You don't start by targeting a specific number, you target symptom relief. If you are starting with a topical testosterone application, a rational approach, you may well fail to see any sort of progress. Topicals fail for a large number of men. they also work for some. You will know soon enough if you initiate treatment with them. Unlike injections, one obtains serum levels on topicals a few hours after application (patients injecting test at trough, just prior to an injection).

He is...let's be polite and say he is simply "uninformed" if he says smaller and more frequent injections fail. The vast majority of our members inject at least twice a week. In fact, unless you have a very high SHBG value a single weekly injection is likely to work against you. His comments about volume being too little and hard to judge are bizarre. I inject 16mg every day and have for three years. Using a syringe without any dead-space means nothing is wasted. I exhaust my vial of enanthate on the exact date I should.

One tests at trough because it's the only way one can determine if the protocol prescribed is delivering sufficient testosterone across the course of the timeframe. It also gives you a realistic approach to capturing estradiol at its peak, E at peak, T at trough (E follows T). Midpoint and peak levels for testosterone are interesting, but don't impact a protocol unless challenges are encountered. A good doctor will look at SHBG and know much of this intuitively.

You may feel wonderful with a total testosterone in the 500-600 range. You may not. I wonder, though, if this doctor is the physician who can guide you toward optimal, hormonal health.

 

[galaxy]

Thanks Vince and CoastWatcher for the quick replies.

Agreed CoastWatcher about targeting symptom relief and not #s, I think he's highly wary of approaching any kind of supraphysiological levels and that's why he's mentioned an upper limit target. The plan is to give the gels a short for 4 months, and if they don't work I'll try out injections. I think I'll push for at least 2x/week if not 3x/week injections. May have to educate him on the latest protocols that people are using with success (your being a perfect example).

Good to know about testing at the trough. I think once again because he is so conservative with where we should be shooting for Total T he isn't too concerned with E2, and in fact doesn't pull it. I've been pulling the E2 labs myself though just to monitor them in case. I get the sense that irrespective of symptom relief he wouldn't push much farther beyond 700 TT. I've already done a clomid restart twice and had TT at 600 and he mentioned that TRT may not show any benefit given I saw no symptom relief from clomid. Note my only symptom at the moment is fatigue, and nothing else (no ED, anxiety....). Anyhow, I'll report back over the next couple months as to how the gels are working.

Thanks for the help.

 

[CoastWatcher]

Thanks Vince and CoastWatcher for the quick replies.

Agreed CoastWatcher about targeting symptom relief and not #s, I think he's highly wary of approaching any kind of supraphysiological levels and that's why he's mentioned an upper limit target. The plan is to give the gels a short for 4 months, and if they don't work I'll try out injections. I think I'll push for at least 2x/week if not 3x/week injections. May have to educate him on the latest protocols that people are using with success (your being a perfect example).

Good to know about testing at the trough. I think once again because he is so conservative with where we should be shooting for Total T he isn't too concerned with E2, and in fact doesn't pull it. I've been pulling the E2 labs myself though just to monitor them in case. I get the sense that irrespective of symptom relief he wouldn't push much farther beyond 700 TT. I've already done a clomid restart twice and had TT at 600 and he mentioned that TRT may not show any benefit given I saw no symptom relief from clomid. Note my only symptom at the moment is fatigue, and nothing else (no ED, anxiety....). Anyhow, I'll report back over the next couple months as to how the gels are working.

Thanks for the help.

It's always a possibility that TRT may not result in what you hope for. However, we have many members here who, like you, undertook a Clomid protocol in good faith, were disappointed, and now thrive on a testosterone protocol. Clomid easily produces "lab-test success" that fails to relieve symptoms. One should not infer that Clomid disappointment will lead to TRT failure.


Gels for four months??? You'll know if four weeks if you're one of the men topicals will work for. It's not necessary to prolong the process if you fail to respond to topical testosterone.

His hesitancy and lack of confidence is discouraging.

 

[galaxy]

Ah right ok. Ya he had me schedule a follow up for 4 months. I guess I'll have my PCP pull labs then in 6 weeks and evaluate how I'm feeling. At that point I'll send a note to my endo requesting a switch to injections if it doesn't seem like gels are working out. He was indifferent b/w using injection or gels so shouldn't be an issue. Just curious CW where does 16mg daily enanthate put your TT and FT? Also what kind of needles are you using? 29 guage 1/2" easy touch? Thanks for helping me get this dialed in.

 

[blackebob]

When I was on AndroGel 1.62 percent, I started feeling better but I didn't see my best results for 9 months. The ED problems didn't go away for 5 months until we increased the number of pumps.

 

[galaxy]

Huh, ok. So perhaps wait the 4 months then? How many pumps were you using in the end? FWIW I only have faitgue/concentration issues. No ED or anxiety.

 

[CoastWatcher]

Ah right ok. Ya he had me schedule a follow up for 4 months. I guess I'll have my PCP pull labs then in 6 weeks and evaluate how I'm feeling. At that point I'll send a note to my endo requesting a switch to injections if it doesn't seem like gels are working out. He was indifferent b/w using injection or gels so shouldn't be an issue. Just curious CW where does 16mg daily enanthate put your TT and FT? Also what kind of needles are you using? 29 guage 1/2" easy touch? Thanks for helping me get this dialed in.

At 16mg daily the peak/valley phenomenon is largely (though not entirely) overcome. It's as close to a true steady-state as I'm likely to get. I've been rock solid at 1000 total testosterone and my free testosterone comes in at 22.2 (just shy of the upper value of 24.0). LabCorp arbitrarily lowered the upper range on the total testosterone last summer putting a lot of men in the bad books of ill-informed doctors. My Hct and Hgb never climb, I'm very fortunate in that regard. I live in Canada and use a 30g, 1/2 - standard in Canada. Little difference between that and the 29g at use in the States.

 

[blackebob]

Huh, ok. So perhaps wait the 4 months then? How many pumps were you using in the end? FWIW I only have faitgue/concentration issues. No ED or anxiety.

It was I am not 20 anymore ED. If I did not try it every day sometimes twice, it was good. Three days between there was no issue.

Looking back we started low and took it it slow. I was doing three pumps at the end. I was very happy. Enter jack ass Dr. and clomid. Three months later, 20 pounds back on, no more daily sex, and I switch back on the Gel. I bumped it up to four pumps, I knew how I should feel, and I am afraid the clomid screwed something up. This time at five months out I am back down to trim, but not at libido I was before clomid. So, I made a bad decision and switched to a new DR. with a cream protocol.

600 mg T is not where I enjoy being. Trust you body, not the number.