TRT & Lab Results Advice

[Cali65]

I am a 58 years old and and I started TRT on 12/5/22 as my T level was 300 ng/dL.

My TRT info and Lab results:
12/5/22 I started injecting Cypionate 50mg twice a week (100mg total weekly)

1/23/23 My Total T was 941 ng/dL and Free was 243.9 pg/mL
RBC = 6.23 M/uL H (Range:4.20 M/uL - 5.80 M/uL)
HGB = 17.5 gm/dL H (Range:13.2 gm/dL - 17.1 gm/dL)
HCT = 53% H (Range:38.5 % - 50.0 %)

I then continued with the 100mg weekly but switched to daily shots with 29g needle into delts and no other changes were made for the higher levels of RBC, HGB or HCT as per my Dr.

3/22/23 My Total T was 1210 ng/dL and Free was 347.7 pg/mL
RBC = 6.61 M/uL H (Range:4.20 M/uL - 5.80 M/uL)
HGB = 18.1 gm/dL H (Range:13.2 gm/dL - 17.1 gm/dL)
HCT = 55% H (Range:38.5 % - 50.0 %)
Estriodol = 76 H (Range: < or = 39 pg/mL)

I have now been told to see an Endocrinologist by my Urologist to talk about Phlebotomy.
For the high Estriodol he said only TRT specialty clinics offer medication for that.
I have left a message for Defy to contact me for options moving forward but wanted ask for thoughts in this forum as well.

Even with a T level of 941 and 1210, I have not felt any difference at all since I started TRT. Libido was not and issue before and still isn't, but depression, fatigue, focus, concentration etc were and still are the main issue for me.

 

[Systemlord]

HGB = 17.5 gm/dL H (Range:13.2 gm/dL - 17.1 gm/dL)
HCT = 53% H (Range:38.5 % - 50.0 %)

The ratio of HCT to HGB suggests you’re dehydrated. My HGB is 17.6 and HCT at 49%, but when I was dehydrated, my ratios looked exactly like yours, 18.9 and 53%.

 

[Cali65]

The ratio of HCT to HGB suggests you’re dehydrated. My HGB is 17.6 and HCT at 49%, but when I was dehydrated, my ratios looked exactly like yours.

Thank you for the response. I am 5'2" and weigh 163lbs and I drink 80-90 ounces of water daily......not sure if I can drink more as I have to pee many times already in the day and can't wake up to go in the night.
From what I understand Hct>3 x Hb = dehydrated and Hct<3 x Hb = you're over-hydrated.
in my case HCT 55> HGB 54.3

Do you think I should increase water intake from 80-90 ounces?

 

[Cataceous]

Don't get led off on some tangent about hydration. HCT and HBG are high because your testosterone is high. If you cut your dose in half then your testosterone will still be almost average for a healthy guy half your age. Although 100 mg TC per week is considered a reasonable starting dose, newer thinking is that ~75 mg is more appropriate, and even this has negative consequences for the guys who do better on 40-75 mg. Cutting the dose is usually more difficult than raising it.

The symptoms you describe are not exclusive to low testosterone. You may have something going on that is unrelated. Have you done more extensive blood testing?

 

[Belekas]

Right with @Cataceous on this one. Cut the dose. Stay there. Take notes how you feel, pull labs and go from there. I wouldn't touch any medication at this point as you only will be masking the real issue and activating another moving part in the puzzle which is hard enough on its own to figure out. I'm at 100mg as well and have high end of range test levels at through as well only my CBC levels are way lower and in good range FWIW. So def would work on getting your CBC levels down into the normal range by reducing the dose and also normalising your E2 as its nearly 2x range.

 

[Cali65]

Don't get led off on some tangent about hydration. HCT and HBG are high because your testosterone is high. If you cut your dose in half then your testosterone will still be almost average for a healthy guy half your age. Although 100 mg TC per week is considered a reasonable starting dose, newer thinking is that ~75 mg is more appropriate, and even this has negative consequences for the guys who do better on 40-75 mg. Cutting the dose is usually more difficult than raising it.

The symptoms you describe are not exclusive to low testosterone. You may have something going on that is unrelated. Have you done more extensive blood testing?

Only the normal bloodtests and those are all good, I am considering getting my thyroid checked.
What tests would you think I should get done by "extensive blood testing".....I will talk to my pcp and research myself but just wondering if you have any thoughts too.

 

[Cataceous]

By "normal blood tests" do you mean CBC, CMP and lipids? These should all be done. Comprehensive thyroid testing isn't a bad idea. Panels such as this or this plus this will tell you if anything is going on there. Vitamin D status and zinc are additional candidates. Cortisol could be worth looking at, although the blood test is said to have limited value.

Your symptoms could also be tied to neurotransmitter activity, which is not easy to measure. There are some fairly safe supplements and medications with which you can experiment. If the issue is low dopaminergic activity then one could try the supplement N-acetyl-L-Tyrosine (NALT). Medications include selegiline and bupropion. Other supplements can be used to augment acetylcholine and excitatory neurotransmitters.

How do you respond to caffeine? In theory it should ameliorate some of your symptoms, at least temporarily.

How is your sleep? Any chance you have apnea?

 

[Cali65]

By "normal blood tests" do you mean CBC, CMP and lipids? These should all be done. Comprehensive thyroid testing isn't a bad idea. Panels such as this or this plus this will tell you if anything is going on there. Vitamin D status and zinc are additional candidates. Cortisol could be worth looking at, although the blood test is said to have limited value.

Your symptoms could also be tied to neurotransmitter activity, which is not easy to measure. There are some fairly safe supplements and medications with which you can experiment. If the issue is low dopaminergic activity then one could try the supplement N-acetyl-L-Tyrosine (NALT). Medications include selegiline and bupropion. Other supplements can be used to augment acetylcholine and excitatory neurotransmitters.

How do you respond to caffeine? In theory it should ameliorate some of your symptoms, at least temporarily.

How is your sleep? Any chance you have apnea?

Yes all 3 of them CBC,CMP and Lipids.
I don't drink tea or coffee, never have....hate the taste.
Sleep is good and no apnea.

 

[Belekas]

Only the normal bloodtests and those are all good, I am considering getting my thyroid checked.
What tests would you think I should get done by "extensive blood testing".....I will talk to my pcp and research myself but just wondering if you have any thoughts too.

Your CBC panel is far from good or I'm missing something?

 

[Cali65]

Your CBC panel is far from good or I'm missing something?

The only abnormal results on CBC are listed in original post.......my RCB, HGB & HCT were the only issue. Other than my cholesterol being a little high everything else is normal.

 

[Belekas]

The only abnormal results on CBC are listed in original post.......my RCB, HGB & HCT were the only issue. Other than my cholesterol being a little high everything else is normal.

Thats exactly what I'm talking about but seems these high readings are not an issue for you?

 

[Cali65]

Thats exactly what I'm talking about but seems these high readings are not an issue for you?

Of course the abnormal results are an issue for me that's why I made this post.
I have all the abnormal results listed in my original post and asking for members their thoughts. I am going see a local endocrinologist and talk to Defy and decide what to do, most likely lower my cypionate to 75mg per week and get tests done again in 4 weeks.

 

[Belekas]

Of course the abnormal results are an issue for me that's why I made this post.
I have all the abnormal results listed in my original post and asking for members their thoughts. I am going see a local endocrinologist and talk to Defy and decide what to do, most likely lower my cypionate to 75mg per week and get tests done again in 4 weeks.

Then my bad as I thought you wasn't paying much attention to them. Yes lowering the dose would be a smart move imo. I just went from 100mg to 75mg just to see how I'm feeling and performing. 100mg puts me right at the top of the range with nicely looking CBC panel, no additional meds or supps. Hope you feel better soon. Good luck.

 

[Guided_by_Voices]

My two cents...While I agree with lowering your dose and donating blood, your symptoms could be from many things such as some form of infection/parasite, micro-biome issues, micronutrient issues, or other things. You may want to consider 1) reading the book Perfect Health Diet and making that your diet and supplement home base, and 2) getting a full workup from a holistic/functional functional medicine doc (e.g. Dr. Will Cole) who is experienced in dealing with the types of issues above.

 

[Cali65]

Is 3 weeks ok to get lab work done after lowering my trt dose?
Just want to make sure that 3 weeks is enough time for high Testosterone, RBC, HBG & HCT levels to stabilize after lowering my dosage.

 

[Systemlord]

Is 3 weeks ok to get lab work done after lowering my trt dose?

No, at 4-6 weeks levels are steady.