Trough Total Testosterone on once weekly injections

[Eagles21]

Hello,

I know most people have moved away from once weekly injections in favor of more frequent injections. However right now I feel pretty good. Energy and libido isn’t amazing. But much better than it was pre-trt. Estrogen and HCT are both within an acceptable range. HDL is down a little bit. But not sure if that’s due to the testosterone, diet, or could just be hereditary because both my parents have high cholesterol. So will keep an eye on lipids.

After 9 weeks on 100mg once weekly my doctor has upped my dose to 150mg once weekly.

My trough total testosterone level on the 100mg was about 540. I’m curious what is supposed to be a good trough TT level on once weekly injections. It trough is 540 then surely at peak it could be 1000 or more. Where do you guys like to see your trough TT Levels at?
I’m thinking maybe I don’t even need to up my dose.

 

[madman]

Hello,

I know most people have moved away from once weekly injections in favor of more frequent injections. However right now I feel pretty good. Energy and libido isn’t amazing. But much better than it was pre-trt. Estrogen and HCT are both within an acceptable range. HDL is down a little bit. But not sure if that’s due to the testosterone, diet, or could just be hereditary because both my parents have high cholesterol. So will keep an eye on lipids.

After 9 weeks on 100mg once weekly my doctor has upped my dose to 150mg once weekly.

My trough total testosterone level on the 100mg was about 540. I’m curious what is supposed to be a good trough TT level on once weekly injections. It trough is 540 then surely at peak it could be 1000 or more. Where do you guys like to see your trough TT Levels at?
I’m thinking maybe I don’t even need to up my dose.

Keep in mind that although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

Need to know where your trough FT level truly sits.

You are hitting a descent trough (7 days post-injection) TT 540 ng/dL but what is your SHBG and where does your trough FT sit?

The kicker here too is your peak TT, FT, and estradiol are going to be much higher.

Need to post labs with assays/reference ranges (TT, FT, and estradiol).

Throw SHBG in there too.

Bumping up your weekly T dose by 50 mg is a huge jump and will jack up your TT, FT, and estradiol further let alone drive up your RBCs, hemoglobin, and hematocrit.

A far better move would be splitting up your weekly dose and injecting 50mg T twice weekly (every 3.5 days) which will clip the peak--->trough and result in more stable blood levels throughout the week.

You will be able to soften your peak and bring up your trough without even needing to increase your weekly dose.

If a dose increase is truly needed then I would go 25-30 mg T/week max.

Start low and go slow, much easier going up than having to come down.

Regardless need to know where your trough FT level truly sits on your current protocol (100 mg T once weekly).

Hope you have had your FT tested alone using the most accurate assays (ED/UF).

If not you can easily calculate it using the cFTV with your TT, SHBG, and Albumin.

 

[Eagles21]

Keep in mind that although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

Need to know where your trough FT level truly sits.

You are hitting a descent trough (7 days post-injection) TT 540 ng/dL but what is your SHBG and where does your trough FT sit?

The kicker here too is your peak TT, FT, and estradiol are going to be much higher.

Need to post labs with assays/reference ranges (TT, FT, and estradiol).

Throw SHBG in there too.

Bumping up your weekly T dose by 50 mg is a huge jump and will jack up your TT, FT, and estradiol further let alone drive up your RBCs, hemoglobin, and hematocrit.

A far better move would be splitting up your weekly dose and injecting 50mg T twice weekly (every 3.5 days) which will clip the peak--->trough and result in more stable blood levels throughout the week.

You will be able to soften your peak and bring up your trough without even needing to increase your weekly dose.

If a dose increase is truly needed then I would go 25-30 mg T/week max.

Start low and go slow, much easier going up than having to come down.

Regardless need to know where your trough FT level truly sits on your current protocol (100 mg T once weekly).

Hope you have had your FT tested alone using the most accurate assays (ED/UF).

If not you can easily calculate it using the cFTV with your TT, SHBG, and Albumin.

Thanks for the detailed response.

When I went in this morning their printer was down so I didn’t get a copy of the labs but they’re supposed to be emailing me the lab results. Once I get them I will post the full lab report. They did measure SHBG and free T as well I just can’t recall what the results were off the top of my head.

 

[Eagles21]

Keep in mind that although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

Need to know where your trough FT level truly sits.

You are hitting a descent trough (7 days post-injection) TT 540 ng/dL but what is your SHBG and where does your trough FT sit?

The kicker here too is your peak TT, FT, and estradiol are going to be much higher.

Need to post labs with assays/reference ranges (TT, FT, and estradiol).

Throw SHBG in there too.

Bumping up your weekly T dose by 50 mg is a huge jump and will jack up your TT, FT, and estradiol further let alone drive up your RBCs, hemoglobin, and hematocrit.

A far better move would be splitting up your weekly dose and injecting 50mg T twice weekly (every 3.5 days) which will clip the peak--->trough and result in more stable blood levels throughout the week.

You will be able to soften your peak and bring up your trough without even needing to increase your weekly dose.

If a dose increase is truly needed then I would go 25-30 mg T/week max.

Start low and go slow, much easier going up than having to come down.

Regardless need to know where your trough FT level truly sits on your current protocol (100 mg T once weekly).

Hope you have had your FT tested alone using the most accurate assays (ED/UF).

If not you can easily calculate it using the cFTV with your TT, SHBG, and Albumin.

Okay so here are the labs. It does not tell me what testing methods were used.

TT - 548 NG/DL. Range - 300-1080
Calculated FT - 142.1 PG/ML. Range - 47-244
SHBG - 22.6 Nmol/L. Range - 16.5-55.9
Estradiol 28.1 PG/ML. Range - <=60.7
Hematocrit 48.7%. Range - 40-51%

 

[Systemlord]

Estradiol 28.1 PG/ML. Range - <=60.7

This is non-sensitive testing, but the older testing method. The Total T and SHBG don't matter as much as the Free T testing, but you can just calculate the Free T.

TT - 548 NG/DL. Range - 300-1080
Calculated FT - 142.1 PG/ML. Range - 47-244

I wouldn't expect this trough level to cause problems and if it did I would just recommend twice weekly dosing, the same dosage, to keep the trough levels higher.

 

[Eagles21]

This is non-sensitive testing, but the older testing method. The Total T and SHBG don't matter as much as the Free T testing, but you can just calculate the Free T.


I wouldn't expect this trough level to cause problems and if it did I would just recommend twice weekly dosing, the same dosage, to keep the trough levels higher.

They have an option that I can pay more for to get the sensitive estradiol test. Should I do that next time?

And yes I feel much better than I did before I started trt. My FT levels seem pretty good for a trough reading. I was curious as to why the doctor wanted to move the dose up to 150mg. She said she wanted my trough levels to be a little bit higher. 50mg more per week does seem like a big jump though. So I decided to move up to 130mg. But im staying with the once a week injections unless I start noticing problems with it.

I’ve heard people mention SHBG matters a lot when determining injection frequency. Does my SHBG look okay to continue the once weekly injections? What else do I need to look out for that would signal that it would be wise to switch to twice weekly?

 

[Systemlord]

I’ve heard people mention SHBG matters a lot when determining injection frequency.

That's a myth, a conclusion based on an idea and not medical science fact.

What else do I need to look out for that would signal that it would be wise to switch to twice weekly?

Some men feel unwell at the end of the injection cycle, whereas the first 3-4 days after the injection they feel better. In other words they feel like they have low-T again to varying degrees as they get closer to the next injection.

 

[madman]

Okay so here are the labs. It does not tell me what testing methods were used.

TT - 548 NG/DL. Range - 300-1080
Calculated FT - 142.1 PG/ML. Range - 47-244
SHBG - 22.6 Nmol/L. Range - 16.5-55.9
Estradiol 28.1 PG/ML. Range - <=60.7
Hematocrit 48.7%. Range - 40-51%

It was calculated and includes the lab's reference range.

As I stated previously you can easily calculate your free testosterone using the cFTV which is available free online.

Need to know your TT, SHBG, and Albumin.

Seeing as you did not post your Albumin you can figure out where it sits when you plug your numbers in the calculator.

With a decent trough (7 days post-injection) TT 548 ng/dL, somewhat lowish SHBG 22.6 nmol/L, and Albumin 4.35 g/dL your trough FT would be 14.2 ng/dL.

Keep in mind that although your trough FT may not seem stellar your levels are sitting where a healthy young male would be and this is 7 days post-injection so your peak TT FT and estradiol are going to be much higher.

Yes, you could increase your dose slightly by 25-30 mg T/week if you want to aim for a higher trough but again this will also drive up your peak TT, FT, and estradiol further.

Always best to stick with a protocol for 12 weeks to gauge whether it was truly a success or failure before deciding if a dose increase is needed.

The only way one would need to increase the dose 6 weeks in is if your trough FT level was too low (highly unlikely) in most cases.

As I stated previously the smarter move would be to stick with your current dose of 100 mg T/week and split it up into twice-weekly injections (every 3.5 days) as this allows you to soften the peak and bring up your trough without having to increase your dose let alone blood levels will be more stable throughout the week.

Not the end of the world as there will always be time to increase your dose further if need be.

Regardless if you are dead set on sticking with a weekly injection protocol then bump up your weekly dose to 25-30 mg.

Also remember that every time you increase your dose not only are you going to bring up your TT, FT, and estradiol but you are also going to drive up your hematocrit further.

You are sitting at 48% as of now on your current protocol.

When starting TRT or tweaking a protocol (increasing dose of T) hematocrit will start to rise within the 1st month and more importantly will take 6-9 months or in some cases up to a year to reach peak levels.

Many tend to overlook this.

You are only 9 weeks in on your current protocol 100 mg T/week and where your hematocrit sits as of now 48% is not where it will end up 6-9 months from now so it will most likely end up higher on your current dose of T.

Bottomline do what you feel is best for you!

 

[madman]

This is non-sensitive testing, but the older testing method. The Total T and SHBG don't matter as much as the Free T testing, but you can just calculate the Free T.


I wouldn't expect this trough level to cause problems and if it did I would just recommend twice weekly dosing, the same dosage, to keep the trough levels higher.

Thought someone already told him this (post #2) LOL!

 

[Eagles21]

It was calculated and includes the lab's reference range.

As I stated previously you can easily calculate your free testosterone using the cFTV which is available free online.

Need to know your TT, SHBG, and Albumin.

Seeing as you did not post your Albumin you can figure out where it sits when you plug your numbers in the calculator.

With a decent trough (7 days post-injection) TT 548 ng/dL, somewhat lowish SHBG 22.6 nmol/L, and Albumin 4.35 g/dL your trough FT would be 14.2 ng/dL.

View attachment 40945


Keep in mind that although your trough FT may not seem stellar your levels are sitting where a healthy young male would be and this is 7 days post-injection so your peak TT FT and estradiol are going to be much higher.

Yes, you could increase your dose slightly by 25-30 mg T/week if you want to aim for a higher trough but again this will also drive up your peak TT, FT, and estradiol further.

Always best to stick with a protocol for 12 weeks to gauge whether it was truly a success or failure before deciding if a dose increase is needed.

The only way one would need to increase the dose 6 weeks in is if your trough FT level was too low (highly unlikely) in most cases.

As I stated previously the smarter move would be to stick with your current dose of 100 mg T/week and split it up into twice-weekly injections (every 3.5 days) as this allows you to soften the peak and bring up your trough without having to increase your dose let alone blood levels will be more stable throughout the week.

Not the end of the world as there will always be time to increase your dose further if need be.

Regardless if you are dead set on sticking with a weekly injection protocol then bump up your weekly dose to 25-30 mg.

Also remember that every time you increase your dose not only are you going to bring up your TT, FT, and estradiol but you are also going to drive up your hematocrit further.

You are sitting at 48% as of now on your current protocol.

When starting TRT or tweaking a protocol (increasing dose of T) hematocrit will start to rise within the 1st month and more importantly will take 6-9 months or in some cases up to a year to reach peak levels.

Many tend to overlook this.

You are only 9 weeks in on your current protocol 100 mg T/week and where your hematocrit sits as of now 48% is not where it will end up 6-9 months from now so it will most likely end up higher on your current dose of T.

Bottomline do what you feel is best for you!

I’ll plug my albumin numbers into the calculator tonight and see what it says and compare it with my results from my doctor.

For right now I decided to stick with the once a week injections cause I didn’t feel much of a dip in energy or anything doing it once a week. I felt pretty good all week long. I have went up to 130mg.

I didn’t realize hematocrit took that long to reach its peak. My hematocrit is up 2% from pre trt baseline. I imagine upping the dose to 130mg will lead to having to go donate blood. And I hate blood draws.

My doctor wants to see me again at 15 weeks after starting the new protocol. Should I go in earlier than that and just ask for a CBC to keep an eye on my hematocrit?

 

[madman]

I’ll plug my albumin numbers into the calculator tonight and see what it says and compare it with my results from my doctor.

For right now I decided to stick with the once a week injections cause I didn’t feel much of a dip in energy or anything doing it once a week. I felt pretty good all week long. I have went up to 130mg.

I didn’t realize hematocrit took that long to reach its peak. My hematocrit is up 2% from pre trt baseline. I imagine upping the dose to 130mg will lead to having to go donate blood. And I hate blood draws.

My doctor wants to see me again at 15 weeks after starting the new protocol. Should I go in earlier than that and just ask for a CBC to keep an eye on my hematocrit?

The most recent labs from your doctor already had your FT calculated using the linear law-of-mass action Vermeulen.

If you are going to stick with the once-weekly protocol then a dose increase of 30 mg is a sensible move.

Mind you every protocol should be given 12 weeks before deciding on whether or not any adjustments need to be made.

The reason behind this is that when first starting TRT or tweaking a protocol (increasing dose T/injection frequency) hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE) and it is common for one to experience ups/downs during the transition as the body is trying to adjust.

More importantly even once blood levels have stabilized (4-6 weeks TC/TE) it will still take time (a few more months) for the body to adapt to its new set-point and this is the critical period when one needs to gauge how they truly feel overall regarding relief/improvement of low-T symptoms and overall well-being.

Every protocol needs to be given a fighting chance.

12 weeks to claim whether it was truly a success or failure.

Unfortunately many lack the understanding of how exogenous T works.

Everyone is gung-ho for instant results let alone brainwashed into that more T is better mentality.

These are the individuals who end up on that never-ending merry-go-round switching their protocols every 6 weeks because they do not feel stellar.

Left in a constant state of confusion chasing that so-called optimal!

Patience is key.

You need to have realistic expectations.

As I have stated numerous times on the forum running too high a trough FT can be just as bad in many ways as having too low a trough FT especially when it comes to libido/erectile function and mood.

Again you are only 9 weeks in and your hematocrit is sitting at 48% which is nothing to fret over for the time being but keep in mind that it will be even higher at 3-6-9 months in on the current dose of 100 mg T/week.

You just bumped up your dose another 30 mg T which will increase your peak/trough TT, FT, and estradiol let alone it is a given your hematocrit will be driven up further.

You can get blood work done after 6 weeks on the new protocol to see where your trough TT, FT, and estradiol sit and a quick snapshot for CBC which includes critical blood markers ( RBCs, hemoglobin, and hematocrit) but I would retest at the 3, 6, and 9-month mark to see where it truly ends up in the long run.

 

[Eagles21]

The most recent labs from your doctor already had your FT calculated using the linear law-of-mass action Vermeulen.

If you are going to stick with the once-weekly protocol then a dose increase of 30 mg is a sensible move.

Mind you every protocol should be given 12 weeks before deciding on whether or not any adjustments need to be made.

The reason behind this is that when first starting TRT or tweaking a protocol (increasing dose T/injection frequency) hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE) and it is common for one to experience ups/downs during the transition as the body is trying to adjust.

More importantly even once blood levels have stabilized (4-6 weeks TC/TE) it will still take time (a few more months) for the body to adapt to its new set-point and this is the critical period when one needs to gauge how they truly feel overall regarding relief/improvement of low-T symptoms and overall well-being.

Every protocol needs to be given a fighting chance.

12 weeks to claim whether it was truly a success or failure.

Unfortunately many lack the understanding of how exogenous T works.

Everyone is gung-ho for instant results let alone brainwashed into that more T is better mentality.

These are the individuals who end up on that never-ending merry-go-round switching their protocols every 6 weeks because they do not feel stellar.

Left in a constant state of confusion chasing that so-called optimal!

Patience is key.

You need to have realistic expectations.

As I have stated numerous times on the forum running too high a trough FT can be just as bad in many ways as having too low a trough FT especially when it comes to libido/erectile function and mood.

Again you are only 9 weeks in and your hematocrit is sitting at 48% which is nothing to fret over for the time being but keep in mind that it will be even higher at 3-6-9 months in on the current dose of 100 mg T/week.

You just bumped up your dose another 30 mg T which will increase your peak/trough TT, FT, and estradiol let alone it is a given your hematocrit will be driven up further.

You can get blood work done after 6 weeks on the new protocol to see where your trough TT, FT, and estradiol sit and a quick snapshot for CBC which includes critical blood markers ( RBCs, hemoglobin, and hematocrit) but I would retest at the 3, 6, and 9-month mark to see where it truly ends up in the long run.

Okay, thank you again for the detailed response.
I think I’ll go in earlier than they want me to just to get an idea how much the hematocrit is increasing. I think people worry about the hematocrit a little too much, but definitely still good to keep an eye on.

And I will stick with this new protocol for at least 15 weeks before I think about changing anything. I have a feeling I won’t have to increase the dose beyond 130mg but if trough FT is too high or hematocrit starts rising too much I will switch to twice weekly injections.

 

[madman]

Okay, thank you again for the detailed response.
I think I’ll go in earlier than they want me to just to get an idea how much the hematocrit is increasing. I think people worry about the hematocrit a little too much, but definitely still good to keep an eye on.

And I will stick with this new protocol for at least 15 weeks before I think about changing anything. I have a feeling I won’t have to increase the dose beyond 130mg but if trough FT is too high or hematocrit starts rising too much I will switch to twice weekly injections.

Yes, many do tend to fret when it comes to hematocrit.

Two camps are at play here!

Numerous threads on the forum.

Regardless it is a critical blood marker.

Now when it comes to your TRT protocol I will put it to you like this.

The smarter move would have been to split your current weekly dose of 100 mg T into twice-weekly injections (50 mg every 3.5 days) which would soften the peak and bring up your trough without even having to increase your T-dose.

It is not a given that increasing your trough FT is going to make you feel better overall!

Again even though your trough TT/FT may not seem stellar you are still hitting a healthy trough FT level 7 days post-injection.

Your peak TT/FT (12-24 hours) post-injection let alone during the first 2-3 days every week is going to be very high.

Now you are bumping up your T dose to bring up your trough FT which is all fine and dandy but the downfall is your peak TT/FT levels are going to be driven up much higher seeing as you are injecting once weekly (every 7 days) which will result in a big difference in your peak--->trough.

The downfall of injecting once weekly is the big difference in peak--->trough let alone blood levels will not be as stable throughout the week.

Too many try to aim for a very high trough FT without even thinking about the injection frequency.

Hitting a very high trough FT injecting once weekly vs daily or EOD is a world of difference!

 

[Eagles21]

Yes, many do tend to fret when it comes to hematocrit.

Two camps are at play here!

Numerous threads on the forum.

Regardless it is a critical blood marker.

Now when it comes to your TRT protocol I will put it to you like this.

The smarter move would have been to split your current weekly dose of 100 mg T into twice-weekly injections (50 mg every 3.5 days) which would soften the peak and bring up your trough without even having to increase your T-dose.

It is not a given that increasing your trough FT is going to make you feel better overall!

Again even though your trough TT/FT may not seem stellar you are still hitting a healthy trough FT level 7 days post-injection.

Your peak TT/FT (12-24 hours) post-injection let alone during the first 2-3 days every week is going to be very high.

Now you are bumping up your T dose to bring up your trough FT which is all fine and dandy but the downfall is your peak TT/FT levels are going to be driven up much higher seeing as you are injecting once weekly (every 7 days) which will result in a big difference in your peak--->trough.

The downfall of injecting once weekly is the big difference in peak--->trough let alone blood levels will not be as stable throughout the week.

Too many try to aim for a very high trough FT without even thinking about the injection frequency.

Hitting a very high trough FT injecting once weekly vs daily or EOD is a world of difference!

Yes I do agree with you that injecting smaller more frequent doses is more ideal. With one big injection a week there can be side effects that are hard to manage. And like you said, bigger fluctuations with your levels.

Even though I’ve injected myself plenty of times now. I still hate doing it. That’s why I’ve stuck with once weekly injections. But I may have to just get over it and do twice weekly.

But I will continue with this new protocol for awhile and see how I feel and how the labs look before I make the decision to move to twice weekly.

I thank you for all your responses.
I will start a new thread once I get labs done on this new protocol.