TT in blood test why are troughs more important than peaks?

[FeelingLost]

I read alot on the forum that you always want to draw blood in the morning (before 11am) on the day of your T cyp shot to capture your TT trough.

I do understand knowing how low your TT lvl dips is good. It might help you deside if you need to shorten you frequency or maybe even lengthen it.
Why do we not seem to care about peak TT? Are ther not bad side effects if ones TT goes too high?

 

[johndoesmith]

I read alot on the forum that you always want to draw blood in the morning (before 11am) on the day of your T cyp shot to capture your TT trough.

I do understand knowing how low your TT lvl dips is good. It might help you deside if you need to shorten you frequency or maybe even lengthen it.
Why do we not seem to care about peak TT? Are ther not bad side effects if ones TT goes too high?

It's a rather tough question, and one that is a bit controversial.

The way I understand it is that trough is more indicative of your metabolism of testosterone, whereas peak is such a transient period that it's not really "felt".

I can tell you that my peak has been 1100 or so, with my trough at 900, and another time at 900 700. I never felt a difference day to day. I did not feel that "peak".

From my understanding, AUC(area under the curve) plays a role in how we test, because hormones don't elicit an immediate action, unlike other "drugs" like say caffeine or alcohol. With those, the onset of action is minutes to hours, but with testosterone, it is weeks to months. There are some immediate effects, like vasodilation but the REAL effects we look for take weeks to months, like libido, mood, energy, erections, muscle mass, or mental benefits. Some say they noticed it "immediately" but science is clear, steroid hormones do not elicit noticable actions immediately, we are not injecting morphine, we are injecting testosterone.

So it's more about the AVERAGE stimulation of the androgen and estrogen receptors, as opposed to the immediate stimulation. Think of it as extremely delayed, what happens today, doesn't show up until next month, so day to day changes more or less average out.

This is entirely to my own understanding. Hopefully someone like Dr Saya will chime in on this as well.

 

[johnt]

I read alot on the forum that you always want to draw blood in the morning (before 11am) on the day of your T cyp shot to capture your TT trough.

I do understand knowing how low your TT lvl dips is good. It might help you deside if you need to shorten you frequency or maybe even lengthen it.
Why do we not seem to care about peak TT? Are ther not bad side effects if ones TT goes too high?

In Dr. Crisler's book he notes to draw your blood the day before your injection which is where you live. Does not recommend drawing on the day of the injection.

 

[FeelingLost]

In Dr. Crisler's book he notes to draw your blood the day before your injection which is where you live. Does not recommend drawing on the day of the injection.

As I understand it there is no "place where you live" Your T lvl is always in flux. You are always somewhere between your peak and trough.
T lvl is the highest sometime right after injection and lowest just before your next injection. Isn't this a reason no one does once or twice a month anymore?

So my question is which lvl (peak or trough) gives you the most info to help you adjust your protocol.
It seems there are side effects to both.

 

[Vince]

We know more frequent injections means less spikes, which means less issues. I think we all do better with stable levels of testosterone. That's why I'm trying daily injections, even though I felt great before.

 

[FeelingLost]

We know more frequent injections means less spikes, which means less issues. I think we all do better with stable levels of testosterone. That's why I'm trying daily injections, even though I felt great before.

Hi Vince thanks for joining in.
Since you inject daily you probably don't have a peak and trough anymore.
With the half-life of Testosterone Cypionate when injected intramuscularly is approximately eight days I would think EOD and E3.5D would not see very big swings either.

Vince do you ever care what your peak TT is? Is your trough the only TT number you need to help you keep your protocal tuned?
I would think if hemocrits #s, the hassle of frequent blood donations, HBP, over the top E2(crap I have to stick myself with another drug to get E2 down) was a concern then peak TT would be very important.
What is this newbie(me) not understanding?

 

[Vince]

I'll post my last T labs, but as you know I've changed my protocol since then.

https://www.excelmale.com/forum/showthread.php?8533-My-New-LabCorp-Labs
I felt very good on my old protocol, but my workouts are going even better with my daily protocol, ever though I'm injecting less T.

 

[johndoesmith]

Hi Vince thanks for joining in.
Since you inject daily you probably don't have a peak and trough anymore.
With the half-life of Testosterone Cypionate when injected intramuscularly is approximately eight days I would think EOD and E3.5D would not see very big swings either.

Vince do you ever care what your peak TT is? Is your trough the only TT number you need to help you keep your protocal tuned?
I would think if hemocrits #s, the hassle of frequent blood donations, HBP, over the top E2(crap I have to stick myself with another drug to get E2 down) was a concern then peak TT would be very important.
What is this newbie(me) not understanding?

I made a thread with the results of when I tested my levels every day of my E3D injection cycle.

 

[FeelingLost]

I'll post my last T labs, but as you know I've changed my protocol since then.

https://www.excelmale.com/forum/showthread.php?8533-My-New-LabCorp-Labs
I felt very good on my old protocol, but my workouts are going even better with my daily protocol, ever though I'm injecting less T.

I really like your thought process or plan Vince. Folks do inject more T to compensate for the trough. Eliminate the trough and it makes perfect sense one could use less.

 

[FeelingLost]

I made a thread with the results of when I tested my levels every day of my E3D injection cycle.

Hi JDS, thanks so much for posting your thoughts and ideas.
Do you have a link to that experiment? Were you just testing TT in your blood daily? What was the goal for the test, your bodies absorption rate?

 

[Dr Justin Saya MD]

Both johndoesmith and feeling lost are on point from different angles. The AUC (the shape of your "level curve") is important and "where we live" really isn't a valid clinical term as "we live" where our levels are every individual day...whether that be the day of your shot, the day after, the day before, etc, etc.

Neither the peak or trough is necessarily "more important", but many guys have a biased concern for "too low" as opposed to "too high" (when it comes to symptoms) and thus want to make sure they're not dipping too low on trough day. Both peak and trough supply useful info (thus the AUC). With that said, the goal of more frequent injections (BIW and progressing to TIW, EOD or even daily) is to minimize the presence/relevance of the peak/trough itself.

 

[johndoesmith]

Hi JDS, thanks so much for posting your thoughts and ideas.
Do you have a link to that experiment? Were you just testing TT in your blood daily? What was the goal for the test, your bodies absorption rate?

https://www.excelmale.com/forum/showthread.php?9607-Labs-from-everyday-of-my-injection-cycle

I tested total, free, and sensitive E2. Also SHBG on the last day just to assess the free testosterone assay's accuracy. There wasn't really a goal in mind. It was entirely curiosity. I also wanted to use it to prove a point to someone, but I forget what that was

Both johndoesmith and feeling lost are on point from different angles. The AUC (the shape of your "level curve") is important and "where we live" really isn't a valid clinical term as "we live" where our levels are every individual day...whether that be the day of your shot, the day after, the day before, etc, etc.

Neither the peak or trough is necessarily "more important", but many guys have a biased concern for "too low" as opposed to "too high" (when it comes to symptoms) and thus want to make sure they're not dipping too low on trough day. Both peak and trough supply useful info (thus the AUC). With that said, the goal of more frequent injections (BIW and progressing to TIW, EOD or even daily) is to minimize the presence/relevance of the peak/trough itself.

I just find it so difficult to draw meaningful or actionable information from anything other than a trough level.

I'd love to hear you opinion on what I had said, if it's not too much for you at this time of day, because those are theories I've come to on my own. I've never asked anyone with more knowledge or experience.

So clinically, when do you recommend testing? Trough?

 

[Dr Justin Saya MD]

https://www.excelmale.com/forum/showthread.php?9607-Labs-from-everyday-of-my-injection-cycle

I tested total, free, and sensitive E2. Also SHBG on the last day just to assess the free testosterone assay's accuracy. There wasn't really a goal in mind. It was entirely curiosity. I also wanted to use it to prove a point to someone, but I forget what that was



I just find it so difficult to draw meaningful or actionable information from anything other than a trough level.

I'd love to hear you opinion on what I had said, if it's not too much for you at this time of day, because those are theories I've come to on my own. I've never asked anyone with more knowledge or experience.

So clinically, when do you recommend testing? Trough?

In reality, in an *ideal* world, NEITHER the peak nor trough is precisely "actionable" without knowing the other. Though obviously we have to weigh the practicality of obtaining laboratory testing, costs, etc in the REAL world. For instance, a "high" peak may indicate the need for a dosage reduction...but what if that same patient's trough is "low"...then it indicates perhaps neither a dosage reduction or increase is the best first approach, but rather a change to a more frequent injection schedule (again to smooth these extremes - peak/trough - out). The opposite holds true as well: if a trough is "low", but the peak is "high"...again a dosage increase isn't likely the best first approach, but rather a change in administration frequency.

 

[Dr Justin Saya MD]

To answer the last part of your question, johndoesmith, by tradition we generally check labs close to trough day, by the exact timing is of little concern to a skilled and experienced practitioner as they can assess the levels in the context of the timing, SHBG levels, etc.

 

[johndoesmith]

To answer the last part of your question, johndoesmith, by tradition we generally check labs close to trough day, by the exact timing is of little concern to a skilled and experienced practitioner as they can assess the levels in the context of the timing, SHBG levels, etc.

That explains so much. I admit I do not have the real world experience necessary to interpret labs as well as someone who does it all day.

I remember a consult with you where I tested at 48 hours after injection, and my levels were 1150 or so. Once I told you they weren't trough, your tone completely changed and you provided meaningful interpretation that was accurate.

Oh well, time to stop researching as I do eventually have to get up to go to work tomorrow