"Trough" consistently in the 900's -- too high?

[croaker24]

My PCP is concerned because my "trough" T levels have been in the 900's over the past few months. I do shots (cypionate) Wed AM and Sat PM, 100mg per week. I do my blood tests Wed AM before the next shot.

Overall - most days I feel almost super-energetic with good libido. Almost a bit too energetic. My BP is higher than we would like, and my hematocrit / hemoglobin are steadily inching up to the top range of the scale.

We are thinking of dialing this down because of concerns of long-term damage. I know everyone is different, but is there an optimal trough range? And if we dial it down, by how much?

 

[Vince]

croaker, personally I would never think 900 is too high

 

[Vettester Chris]

What is your free test number at, and E2 if you have it?

 

[croaker24]

My last E2 (sensitive) on prior test was 21, my free T was 10.5pg/mL (range 7.2 - 24.0). Note my PCP does not handle my TRT. The only thing he tests is overall so I'm not inclined to follow his directions. What defines being "too high"?

 

[CoastWatcher]

What is your hemoglobin and hematocrit looking like?

 

[croaker24]

Hematocrit - 48.4, hemoglobin - 17.1. Back in August 2014, I was at 40.4, 14.1.

 

[Vettester Chris]

If anything, your SHBG is high if you only have a 10.5ng of FT against a 900ng of total serum. That's just above 1%!

15 to 20ng on FT is a good place IMO. Your doc is doing you no favors with only monitoring total serum.

E2 is fine ... You'd probably do fine if it went up just a tad.

 

[croaker24]

Chris -

How do we get to 15/20?

 

[Vettester Chris]

Chris -

How do we get to 15/20?

Well, it's all directly related to your total serum, and primarily your SHBG, with some consideration to albumin. IMO, if you can fall into the 2% to 3% range on free testosterone, that's an ideal area, and it makes dialing in your TRT protocol pretty easy. In your case, if you were at 2%, you would be a 18pg/dl on free test, see how that works?

So, I guess the first thing is to verify the above. Was your free testosterone lab taken at the same time as your recent total serum lab that was reported at 900ng/dl? If this is the case, you will probably find your SHBG to be in the 60's or 70's, pending that albumin is in a normal range of 4 to 4.5g/dl. I would run SHBG just to be sure, you will normally find albumin on your metabolic panel. Prior to any actions, I would have your physician (or another) review your condition to ensure there's no liver/hepatic or other issues that are responsible for the protein elevation. In some cases the thyroid can be linked as well, and even Vitamin D deficiency can play a role.

If nothing serious, and it's just a case of needing to lower SHBG to increase bio-available test, you can look at therapeutic dosages of vitamin D, or even a script of Drisdol .. Nettle root has worked for some, and adding sufficient amounts of omegas with krill oil. Beyond that, review your diet, make sure you add ample amounts of protein, eat clean, and take note of any drugs or alcohol that could be causing the liver to respond adversely.

 

[croaker24]

My albumin was 4.1 and it has always been normal. Going back to late Jan, here's what it looked like:
total 986, free 10.5, SBHG 61.8. Vitamin D was 50. I already eat a primarily plant-based diet with the helping of fish a few times a week - but I don't think I'm getting that much protein - mostly from eating beans/quinoa, nuts/seeds, and a vegan protein powder with my daily smoothie.

 

[Vettester Chris]

How does your thyroid numbers look? Not just TSH, but the entire gamut .. FT4, FT3, RT3?

Vitamin D at 50 is in the right direction ... Maybe 70 or 80 would provide more benefit IMO. Run it by your doctor.

Yeah, protein can play a role in it. Review your diet and see if you can ramp it up a bit. Add some of that krill oil I mentioned, and you can even get some great protein with a variety of nuts. I usually eat a couple servings of unsalted nuts an hour before bed (excellent protein & essential fat), plus omegas. Add some vitamin D (which is fat soluble) and plenty of good things can happen. Read up on some of this, it's real interesting and very scientific on how it all correlates.