Testosterone too high after 8 weeks on 200 mg Cypionate / Week!

[Formula364]

Are you of Celtic origin - Irish, Scottish, Brits, etc? They sometimes hold on to iron.
http://americanhs.org/celtic.htm

 

[RSM]

Are you of Celtic origin - Irish, Scottish, Brits, etc? They sometimes hold on to iron.
http://americanhs.org/celtic.htm

Not that I am aware of. Mostly German / Dutch, French.

 

[MarkLA]

Yeah, but at 992 total, his E2, RBC's and Hematocrit are all high. Even his hemoglobin is at the upper limit. Now I know everyone is going to say, "get on an AI and start donating blood" but maybe he can drop his TT to the 800's and see if that'll help instead of him having to titrate AI's and deal with the hit on his lipids or donate blood and deal with the iron issues that come with that.

I'm not sure I have heard of any examples where a 20% drop in T dose has cured elevatedHGB/HCT or E2 that is about double what people seem to consider ideal.

An experienced doc (i.e. someone like Dr. Saya) would be able to advise whether a dose drop is worth trying. If the OP's doc is not at that level, might be a good time to consider getting with a Dr. who is more experienced...

 

[johndoesmith]

I'm not sure I have heard of any examples where a 20% drop in T dose has cured elevatedHGB/HCT or E2 that is about double what people seem to consider ideal.

An experienced doc (i.e. someone like Dr. Saya) would be able to advise whether a dose drop is worth trying. If the OP's doc is not at that level, might be a good time to consider getting with a Dr. who is more experienced...

Well, lowering dose will prevent HCT from rising further, but not decrease what he already has. You need to donate blood to do that, and lower dose.

OP is with defy...

 

[madman]

Yeah, but at 992 total, his E2, RBC's and Hematocrit are all high. Even his hemoglobin is at the upper limit. Now I know everyone is going to say, "get on an AI and start donating blood" but maybe he can drop his TT to the 800's and see if that'll help instead of him having to titrate AI's and deal with the hit on his lipids or donate blood and deal with the iron issues that come with that.

Completely agree, even bringing his TT down to the 700-800 range would definitely improve his E2/rbc's/hematocrit and hemoglobin let alone his lipids as his ldl/hdl need improvement. Some people are more sensitive to sides related to having their test levels in the high upper range and it is more common than not to have issues once you get beyond the upper range for trt hell in Canada Lifelabs range is 237-823 ng/dL and Dynacare is 218-900 ng/dL two of the biggest labs in Ontario. Understand everyone wants to feel their best but you hear it all the time on here guys injecting 150-200mg/week for trt with troughs @1000+ and wonder why now they are looking at adding in an AI and donating blood. Even Crisler states most do well on 100-120mg/week split twice weekly!

 

[madman]

Quick update: I had my levels tested again just before my next injection and will be consulting with Defy.

Below are the results...

TT 992 before injection....................well over the Canadian top of the reference range!Starting a patient off at 200mg/week is ridiculous.................start low and go slow give your body a chance to see what test levels you can attain at the lowest reasonable dosage would prevent many from encountering and having to deal with sides!

 

[johndoesmith]

Completely agree, even bringing his TT down to the 700-800 range would definitely improve his E2/rbc's/hematocrit and hemoglobin let alone his lipids as his ldl/hdl need improvement. Some people are more sensitive to sides related to having their test levels in the high upper range and it is more common than not to have issues once you get beyond the upper range for trt hell in Canada Lifelabs range is 237-823 ng/dL and Dynacare is 218-900 ng/dL two of the biggest labs in Ontario. Understand everyone wants to feel their best but you hear it all the time on here guys injecting 150-200mg/week for trt with troughs @1000+ and wonder why now they are looking at adding in an AI and donating blood. Even Crisler states most do well on 100-120mg/week split twice weekly!

One labs range is not indicative of another lab's range. Labcorp, one of the biggest in the USA, is 348-1197.

I've seen VA labs that are 300-600 and labs that are 120-750. Those are ridiculous.

The specific assay and method of calibration is important. If the range is based on population samples, then it's inherently skewed towards the sick people being tested at that lab, what healthy person gets their testosterone tested?

Some are based upon calibration of a known sample. It all depends.

 

[Vince Carter]

The curious part to me is the different medical opinions...my RBC is always a tick over lab range and no one I deal with on that end has a problem with it.

 

[johndoesmith]

The curious part to me is the different medical opinions...my RBC is always a tick over lab range and no one I deal with on that end has a problem with it.

You still have iron deficiency, right? What's your MCV on your CBC?

 

[Vince Carter]

You still have iron deficiency, right? What's your MCV on your CBC?

86.7 (80-100)

Iron deficient, yes, but taking iron hasn't resulted in any appreciable improvement in anything even when shown on tests to be higher (Iron and Ferritin).

 

[Dr Justin Saya MD]

The curious part to me is the different medical opinions...my RBC is always a tick over lab range and no one I deal with on that end has a problem with it.

It's the overall clinical picture of elevated RBC, top range HgB and HCT of 53, combined with higher dose T. The approach to dump blood and evaluate for sleep apnea is indeed sound.

Also, iron deficiency concurrent with upper range RBC/HgB/HCT is a different, and unique, animal in its own right as it's a balancing act of not having too high of RBC/HCT, but also trying to minimize or avoid dumping blood to support iron levels. Hence, the approach and thresholds of action can be quite different.

 

[johndoesmith]

It's the overall clinical picture of elevated RBC, top range HgB and HCT of 53, combined with higher dose T. The approach to dump blood and evaluate for sleep apnea is indeed sound.

Also, iron deficiency concurrent with upper range RBC/HgB/HCT is a different, and unique, animal in its own right as it's a balancing act of not having too high of RBC/HCT, but also trying to minimize or avoid dumping blood to support iron levels. Hence, the approach and thresholds of action can be quite different.

Elevated RBC, HCT, and HgB is a major concern, but what about isolated elevated RBC?

Is isolated elevated RBC itself a concern requiring phlebotomy? Say 45 HCT, 16 HgB, and say 6.20 RBC. I imagine it'd indicate microcytic anemia, but not necessitate phlebotomy, right?

 

[Dr Justin Saya MD]

Elevated RBC, HCT, and HgB is a major concern, but what about isolated elevated RBC?

Is isolated elevated RBC itself a concern requiring phlebotomy? Say 45 HCT, 16 HgB, and say 6.20 RBC. I imagine it'd indicate microcytic anemia, but not necessitate phlebotomy, right?

That is essentially correct. We see that very pattern in certain clinical situations including thalassemia trait carriers.

 

[johndoesmith]

That is essentially correct. We see that very pattern in certain clinical situations including thalassemia trait carriers.

I understand it's a very limited clinical picture of course, but you're agreeing with me that isolated elevated RBCs aren't a concern indicating phlebotomy, correct?

Is it possible that microcytosis can be caused by IDA due to excessive blood donation?

 

[Dr Justin Saya MD]

I understand it's a very limited clinical picture of course, but you're agreeing with me that isolated elevated RBCs aren't a concern indicating phlebotomy, correct?

Is it possible that microcytosis can be caused by IDA due to excessive blood donation?

Yes on both counts.

 

[johndoesmith]

Yes on both counts.

Thanks Dr. Saya! Good to know that my understanding of what I'm reading is correct. Have a happy new year and thanks for what you do!

 

[RSM]

Update:

Ok I started back on 50mg testosterone, 400iu HCG and .2mg Anastrozole twice per week. So far I have done Sunday 2PM and Thursday 2AM. Sunday I combined test and HCG in the same syringe and did not like how it went in terms of the mixing in the syringe so this morning I took the shots separate. Test via 27g in the quad and HCG via 31g in the stomach fat. This worked out great. And I took one Anastrozole capsule.

I am noticing slight pain running down the outside of my left upper leg to knee area when I lean over in a chair at an angle or walking sometimes. Is this one of the side effects of Anastrozole? I want to be careful developing joint problems.

I also had trouble with my left hand grip on Monday evening when I was training triceps and biceps. I was doing barbell arm curls and had cramps in my fingers and a weak grip. A new experience for me in over 25 years of lifting weights and I was not using crazy heavy weights either. The gripping problem went away.

Looks like I need to be very cautious with the estrogen blocker. Should I back off the capsules to once per week? If I could break them in half I would but these are gel caps.

I will say my strength has gone up decently since I started TRT 6 months ago. I can now bench 315lbs for 6-8 reps on the smith machine (incline, decline or flat) without issues. But I need to be careful with lifting too much to avoid injury even though it seems I can go past 315lbs.. I do wear good elbow wraps for the heavier lifts.

 

[CoastWatcher]

Update:

Ok I started back on 50mg testosterone, 400iu HCG and .2mg Anastrozole twice per week. So far I have done Sunday 2PM and Thursday 2AM. Sunday I combined test and HCG in the same syringe and did not like how it went in terms of the mixing in the syringe so this morning I took the shots separate. Test via 27g in the quad and HCG via 31g in the stomach fat. This worked out great. And I took one Anastrozole capsule.

I am noticing slight pain running down the outside of my left upper leg to knee area when I lean over in a chair at an angle or walking sometimes. Is this one of the side effects of Anastrozole? I want to be careful developing joint problems.

I also had trouble with my left hand grip on Monday evening when I was training triceps and biceps. I was doing barbell arm curls and had cramps in my fingers and a weak grip. A new experience for me in over 25 years of lifting weights and I was not using crazy heavy weights either. The gripping problem went away.

Looks like I need to be very cautious with the estrogen blocker. Should I back off the capsules to once per week? If I could break them in half I would but these are gel caps.

I will say my strength has gone up decently since I started TRT 6 months ago. I can now bench 315lbs for 6-8 reps on the smith machine (incline, decline or flat) without issues. But I need to be careful with lifting too much to avoid injury even though it seems I can go past 315lbs.. I do wear good elbow wraps for the heavier lifts.

You've just resumed TRT, taken one dose of the AI and you're considering a protocol change? That's not a wise move. It's wise to be aware of how an AI can impact you, but you'll get nowhere if you start moving pieces all over the board. If yiu sense problems developing test the appropriate level - otherwise you're just guessing.