Target T levels & Defy

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Luke717

Member
New to TRT,
I have been searching this site for ideal or target levels of T free, total along with E2 and others. I haven't been able to find much... I realize each person is different but is there a general range that most try to shoot for? From what I understand a lot is based on how you feel...

I have been considering switching to Defy and some people seem to want their levels higher than what Defy Docs want them to be... Or perhaps I just read a few threads incorrectly?
 
Defy Medical TRT clinic doctor
Luke717 said:
New to TRT,
I have been searching this site for ideal or target levels of T free, total along with E2 and others. I haven't been able to find much... I realize each person is different but is there a general range that most try to shoot for? From what I understand a lot is based on how you feel...

I have been considering switching to Defy and some people seem to want their levels higher than what Defy Docs want them to be... Or perhaps I just read a few threads incorrectly?
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Speaking only for myself, you read some bad or misguided information.
 
fifty said:
Yes
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that’s pretty cool that they’re progressive enough to think like this. Do you mind if I ask where your free T was when they wanted to up your dose? (With free T reference range please) and do you mind if I ask who your consult was with at Defy that was this progrsssive minded?
 
My practitioner was Dr Caulkins.

Free T was 25.8 per direct free T before the change.

Irritability and anxiety on Testosterone

Original protocol was 80/500/.125 twice a week and I felt ok. Felt some flushing and red eyes the day of and day after my injections then felt good the final 24hrs before my next shot.

Switched to MWF 54/350/.125 for my second labs and now I’m noticing anxiety, irritability, etc the first two days after my shot. Usually feel good sunday eve-mon morning.
 
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slicktop said:
I was at 1067 total, 21.2 free (in a range of 6.8-21.5) and my NP told me I could increase my test a bit to get my free T up a little more. Patient input and how you feel means WAY more than numbers over at Defy.
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My NP at Defy has had no concern with my Free T #’s in 30 range. Within reason, it is all about how I feel and managing the side effects that are usually different for most of us.
 
We don't aim for targets at Defy. That sets everyone up for failure.

I'll explain: Each patient's treatment protocol is tailored to both how you feel (subjective) and what your biomarkers look like in lab results (objective) and also as a result of listening to you in your consults. That's why we schedule for 45 minutes (the very first consult is sometimes longer) - so that you can talk about anything that you want/need. All of that time has specifically been blocked off for you alone. Use every minute to your advantage. I like to write down questions and topics as I think of them in between consults so that I have a list.

There are some thresholds that are based on many years of experience. An example of that would be patients generally feel better with a Free T at 20 or more. Doesn't apply to everyone and it's a guideline, but it's pretty common. And you could say there are a few upper limit thresholds that we consider for safety and side effects such as hemoglobin, hematocrit, PSA - but those are not automatically going to deny you treatment. They are established again based on experience that generally speaking when something falls outside of a threshold then something is wrong and patients and providers both need to be particularly mindful of your complete health situation. That is what we are working for. To get you healthy and feeling great.

There are also some factors that make upper limits completely impractical when you think about it, and that's why we don't do that. What if your SHBG is low because you used anabolics in the past or you have insulin resistance? You probably don't even know or think that you could have IR, but the reality today is that you would likely be wrong in assuming that. You could have a Free T over 50 because of that and still feel terrible. I have been there myself. It's high, but it's just 1 number. That's where treating you subjectively, objectively, and proper lab testing comes into play.

We do more testing and test more often than most clinics (usually twice a year), and some people don't care for that. But there is good reason: we use that information to treat you as a whole person and not within a narrow tunnel of a couple of sex hormones. You would not make it very far safely driving in traffic only looking through a pair of binoculars. You couldn't see everything that is going on around you. So don't do that to your health. No person ever has only a single health problem. If it were that simple than this forum would never have existed. The testing has identified problems that were caught early enough to save some patients' lives. It's important.
 
Jason Sypolt said:
...
There are some thresholds that are based on many years of experience. An example of that would be patients generally feel better with a Free T at 20 or more. Doesn't apply to everyone and it's a guideline, but it's pretty common. ...
...
... You could have a Free T over 50 because of that and still feel terrible. I have been there myself. It's high, but it's just 1 number. ...
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I get that you're downplaying the importance of any one number, but it does seem as though the free testosterone measurement has significance to you. With this in mind, has Defy been following the evolving science showing that the standard direct measurement should not be trusted? Are there any thoughts of switching either to a more accurate test, such as equilibrium dialysis, or to the Tru-T calculation based on total testosterone and SHBG?
 
Cataceous said:
I get that you're downplaying the importance of any one number, but it does seem as though the free testosterone measurement has significance to you. With this in mind, has Defy been following the evolving science showing that the standard direct measurement should not be trusted? Are there any thoughts of switching either to a more accurate test, such as equilibrium dialysis, or to the Tru-T calculation based on total testosterone and SHBG?
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The difference between direct free testosterone and Tru-T is staggering. Plugging in my own values, at one point my direct free testosterone was 19.5 pg/mL(6.8-21.5) but Tru-T was at 329.7 pg/mL. WTF??
 
slicktop said:
The difference between direct free testosterone and Tru-T is staggering. Plugging in my own values, at one point my direct free testosterone was 19.5 pg/mL(6.8-21.5) but Tru-T was at 329.7 pg/mL. WTF??
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In absolute terms the direct free T measurement has no relationship with reality. We know that a typical free T fraction is around 2% of total, so for total T of 600 ng/dL that yields 120 pg/mL, much greater than 20. However, the absolute numbers aren't so important; if direct free T measurements were well correlated with Tru-T then you would be able to multiply one by a constant to get the other. It's the lack of a linear correlation that makes the direct free T test unreliable. Simply put, it's going to be wrong often enough that it should not be used.
 
Cataceous said:
In absolute terms the direct free T measurement has no relationship with reality. We know that a typical free T fraction is around 2% of total, so for total T of 600 ng/dL that yields 120 pg/mL, much greater than 20. However, the absolute numbers aren't so important; if direct free T measurements were well correlated with Tru-T then you would be able to multiply one by a constant to get the other. It's the lack of a linear correlation that makes the direct free T test unreliable. Simply put, it's going to be wrong often enough that it should not be used.
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For me, direct T and Trut T are somewhat linear.

In Sept, my direct T was 24.7 9 (6.6-18.1), truT (48.6 16-31). (That was 20 days after Nebido, my total T was 1492, I was curious what levels were at a peak.)

We know for E2, c-reactive protein can raise your standard E2 test level Vs the sensitive E2 test.

I wonder what makes direct T measurements not accurate for some people and more accurate for others?

Tru-t problem for me, I don't often check shbg and it does change, so I can't really tell what my trut result would be in more than half my test results.

But for me, I don't try and micromanage levels, so total T from 600-1500 is OK by me, and that directly changes everything else.

And I am getting to the point where I am tending towards only checking at most once a year.
 
Cataceous said:
In absolute terms the direct free T measurement has no relationship with reality. We know that a typical free T fraction is around 2% of total, so for total T of 600 ng/dL that yields 120 pg/mL, much greater than 20. However, the absolute numbers aren't so important; if direct free T measurements were well correlated with Tru-T then you would be able to multiply one by a constant to get the other. It's the lack of a linear correlation that makes the direct free T test unreliable. Simply put, it's going to be wrong often enough that it should not be used.
Click to expand...
Is there a suggested target range of values for Tru-T? I'm not necessarily defending the direct free T method, but it was one tool in the toolbox that got me to where I am (feeling good, keeping fat off and muscle on). My NP at Defy had a suggested target value to shoot for, I did, I feel good. If it's not 100% accurate, I'm ok with that. If there's an accepted range of target values for Tru-T and Tru-T is more accurate (which I think we all agree it is), that's great, I'm all for switching to it, but if there's no established values, I'm not sure what good it really is. Without an established range, having a Tru-T number is about as helpful as being lost without a map but having accurate GPS coordinates.
 
slicktop said:
Is there a suggested target range of values for Tru-T? I'm not necessarily defending the direct free T method, but it was one tool in the toolbox that got me to where I am (feeling good, keeping fat off and muscle on). My NP at Defy had a suggested target value to shoot for, I did, I feel good. If it's not 100% accurate, I'm ok with that. If there's an accepted range of target values for Tru-T and Tru-T is more accurate (which I think we all agree it is), that's great, I'm all for switching to it, but if there's no established values, I'm not sure what good it really is. Without an established range, having a Tru-T number is about as helpful as being lost without a map but having accurate GPS coordinates.
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Do you mind if I ask what the target free T range was that your NP prefers?
 
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DragonBits said:
For me, direct T and Trut T are somewhat linear.
...
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I have a lot of data. The correlation is not great:
Untitled 30.jpeg

The clincher is when I compare free testosterone to dose. Here's Tru-T:
Untitled 21.jpeg

Here's the direct test:
Untitled 24.jpeg
 
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