Two years on and confused w/last labs

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FloresJosh1984

New Member
Hi everyone,
First post here, but have been reading a ton... Will try to keep this short.

I'm very confused. I started TRT two years ago when my initial labs came in with a total T of ~250ng/dl. I don't have my first labs handy at the moment, but I remember that number. I've been seeing the "Low T Center" here in San Antonio since then. Fluctuated weekly injections starting at 120mg a week up to 200mg a week and most recently have been at 180mg a week for the past 3 months. My experience with them hasn't been terrible, but lately something has been feeling "off" for me. I've noticed that surge post injection really hitting me 2-3 days after and it just doesn't feel good. Anxious, super hot, weird appetite, etc... I know it could be nothing to do with the TRT, but still weird. I decided I wanted to try switching to more frequent, less volume dosings to see if that helps. They do not do that and got frustrated when I asked, so I switched to a new doc here that was good with home injections and was also a doc on the "doc finder" tool here.

Just before I left Low T, they pulled 6 week labs (7/10/2019) and my results were as follows:
- Total T = 685 (range 350-1000 ng/dl)
- SHBG = 43.3 (range 16.5-55.9 nmol/L)
- Estradiol = 19 (range 7.6-42.6 pg/mL)

Those were taken just before my weekly injection (180mg) with the Low T Center... Had one more visit with the Low T Center a week later, got my last shot there, and then met with my new doc two days later. He used my last labs to give me a Cyp prescription, but also drew some more labs to check Free T and some other things knowing that I had just had an injection two days prior.

In the meantime, while waiting for my script to fulfill, I decided I wanted to get my own labs done so I could get serious about tracking everything on my own as well. Went through discount labs and got a few tests run. I did the draw exactly one week AFTER my last injection, so should be my trough. I'll attach my results here. After receiving these results back, I'm extremely confused. My T is MUCH higher than I would've ever expected a week after an injection. I mean, MUCH higher (1024 ng/dl).

I'm at a loss on what to do. I have an appt with my doc Monday morning to discuss everything, but wanted to post this all here in case anyone has had the same experience. I mean, can someone be Low T and then not anymore? Should I consider not taking any replacements for a few weeks and then retest to see what's happened? I mean, my SHBG is getting high, so that could be a driver for some symptoms I'm having,I guess, but yeah, just confused.

TL/DR - Two years ago had a total T of 250... now have reading of 1024 on trough day (one week post injection)... Haven't taken anything in 1.5 weeks, trying to decide if I should hold off on it for a while and wondering if normal T production can somehow "kick" in on its own to where replacement therapy isn't needed anymore.

Really appreciate any help and feel free to ask any clarifying questions!

-Josh
 

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I felt the same 3 days after an injection, lost all benefits of TRT because my levels were swinging. I have to inject minimum EOD to see full benefits on TRT.

Your low T it's more likely for life, it's not like getting cancer and going into remission, few guys ever recover optimal levels.

Your 2nd problem you have to overcome is your high SHBG, not that you can because it's going to increase as you get older..
 
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I guess my main worry was that I’m hitting such a high number of total test on what should be my lowest day. Would have to assume my peak days are really high.
 
I guess my main worry was that I’m hitting such a high number of total test on what should be my lowest day. Would have to assume my peak days are really high.

What I have read is Test C peaks between 4-5 days and troughs at 14 days. Some recommend every 2 weeks even though on EM that isn't a common protocol.

So was it exactly 7 days later? 7 days isn't that are off your peak day.

It seems pretty sure 2 days earlier your total t was higher, more like 1300 maybe.
 
Yeah, the labs I posted were taken exactly 7 days after my injection.

Thinking I’d be fine to drop my dosage overall down to 160 a week and give it 6-8weeks to settle in. Thoughts?
 
Hi everyone,
First post here, but have been reading a ton... Will try to keep this short.

I'm very confused. I started TRT two years ago when my initial labs came in with a total T of ~250ng/dl. I don't have my first labs handy at the moment, but I remember that number. I've been seeing the "Low T Center" here in San Antonio since then. Fluctuated weekly injections starting at 120mg a week up to 200mg a week and most recently have been at 180mg a week for the past 3 months. My experience with them hasn't been terrible, but lately something has been feeling "off" for me. I've noticed that surge post injection really hitting me 2-3 days after and it just doesn't feel good. Anxious, super hot, weird appetite, etc... I know it could be nothing to do with the TRT, but still weird. I decided I wanted to try switching to more frequent, less volume dosings to see if that helps. They do not do that and got frustrated when I asked, so I switched to a new doc here that was good with home injections and was also a doc on the "doc finder" tool here.

Just before I left Low T, they pulled 6 week labs (7/10/2019) and my results were as follows:
- Total T = 685 (range 350-1000 ng/dl)
- SHBG = 43.3 (range 16.5-55.9 nmol/L)
- Estradiol = 19 (range 7.6-42.6 pg/mL)

Those were taken just before my weekly injection (180mg) with the Low T Center... Had one more visit with the Low T Center a week later, got my last shot there, and then met with my new doc two days later. He used my last labs to give me a Cyp prescription, but also drew some more labs to check Free T and some other things knowing that I had just had an injection two days prior.

In the meantime, while waiting for my script to fulfill, I decided I wanted to get my own labs done so I could get serious about tracking everything on my own as well. Went through discount labs and got a few tests run. I did the draw exactly one week AFTER my last injection, so should be my trough. I'll attach my results here. After receiving these results back, I'm extremely confused. My T is MUCH higher than I would've ever expected a week after an injection. I mean, MUCH higher (1024 ng/dl).

I'm at a loss on what to do. I have an appt with my doc Monday morning to discuss everything, but wanted to post this all here in case anyone has had the same experience. I mean, can someone be Low T and then not anymore? Should I consider not taking any replacements for a few weeks and then retest to see what's happened? I mean, my SHBG is getting high, so that could be a driver for some symptoms I'm having,I guess, but yeah, just confused.

TL/DR - Two years ago had a total T of 250... now have reading of 1024 on trough day (one week post injection)... Haven't taken anything in 1.5 weeks, trying to decide if I should hold off on it for a while and wondering if normal T production can somehow "kick" in on its own to where replacement therapy isn't needed anymore.

Really appreciate any help and feel free to ask any clarifying questions!

-Josh



180 mg/week is a large dose of T and could easily have ones TT trough very high.

Bet your peak is a lot higher!

Some studies have shown TT trough levels at 900-1200 ng/dL after weekly injections 200 mg testosterone enanthate.

Not shocking that your TT trough would be 1000+ ng/dL from 180 mg/week injection.

Seeing as you had the direct immunoassay done which has been show to be inaccurate let alone underestimated FT levels when compared against the gold standard Equilibrium Dialysis testing.....your FT trough levels are much higher than you think.....even with a fairly high SHBG of 54 nmol/L.

The only way to truly know where your FT levels sit is to use the most accurate testing methods such as the gold standard Equilibrium Dialysis or Ultrafiltration or if anything use the newer calculated TruT method which has been shown to be on par with results obtained when compared to the gold standard Equilibrium Dialysis.

As an example if we use the newer TruT calculated method.....
TruT Free Testosterone Calculator by FPT


Taking your TT (trough) 1024 ng/dL, SHBG 54.5 nmol/L and Albumin 4.7 g/dL than your FT (trough) is 31.45 ng/dL (top of the reference range of 16-31 ng/dL).
Screenshot (482).png



Many do well having a FT trough in the 30 ng/dL range and some may need/choose to run higher levels in the 30-50 ng/dL range.

One needs to keep in mind when looking at ones FT trough levels that depending on injection protocol whether following once weekly, every 3.5 days (twice weekly), EOD, or daily that you pay attention to where your trough levels sit as there will be a big difference in ones peak----->trough levels when injecting once weekly compared to EOD or daily.

Seeing as your TT/FT trough levels are in the 30 ng/dL range than your peak levels will be much higher!
 
Yeah, the labs I posted were taken exactly 7 days after my injection.

Thinking I’d be fine to drop my dosage overall down to 160 a week and give it 6-8weeks to settle in. Thoughts?

I would look into splitting dose and injecting more frequently as in every 3.5 days (twice weekly).

Depending on how you feel overall seeing as your TT/FT trough is in the 30 ng/dL range injecting once weekly your TT/FT levels will be a lot higher post injection and you stated.....

"My experience with them hasn't been terrible, but lately something has been feeling "off" for me. I've noticed that surge post injection really hitting me 2-3 days after and it just doesn't feel good. Anxious, super hot, weird appetite, etc... I know it could be nothing to do with the TRT, but still weird"

I would bet this is because your peak levels are too high for you injecting such a large dose of T 180 mg once weekly!
 
It's not!

The best I can give you, the report you referenced was from

"FERTILITY AND STERILITY
Copyright i 1980 The American Fertility Society"

There it said, 24-48 hrs, but there are many other more current reports that quote 4-5 days.

"Pharmacology of testosterone replacement therapy preparations".


"IM testosterone cypionate " "Supratherapeutic T levels 4–5 days after dose and subtherapeutic day 14 "

Pharmacology of testosterone replacement therapy preparations

So how are you deciding which one is right?
 
The best I can give you, the report you referenced was from

"FERTILITY AND STERILITY
Copyright i 1980 The American Fertility Society"

There it said, 24-48 hrs, but there are many other more current reports that quote 4-5 days.

"Pharmacology of testosterone replacement therapy preparations".


"IM testosterone cypionate " "Supratherapeutic T levels 4–5 days after dose and subtherapeutic day 14 "

Pharmacology of testosterone replacement therapy preparations

So how are you deciding which one is right?




From that paper the reference would be from the 1987 Nankin study.

42. Nankin HR. Hormone kinetics after intramuscular testosterone cypionate. Fertil Steril 1987;47:1004-9. 10.1016/S


It does show TT levels peaking between days 2-3 in some of the subjects and 4-5 in others.
Screenshot (483).png



Also shows FT levels peaking days 2-3 in some of the subjects and 4-5 in others.
Screenshot (485).png





The study I posted in another members thread was from 1980

COMPARISON OF TESTOSTERONE, DIHYDROTESTOSTERONE, LUTEINIZING HORMONE, AND FOLLICLE-STIMULATING HORMONE IN SERUM AFTER INJECTION OF TESTOSTERONE ENANTHATE OR TESTOSTERONE CYPIONATE



Both studies had a small number of subjects.

The only way for one to truly know when T levels peak from said ester injected once weekly is to have lab work done 24/48/72/96/120 hrs post injection.....which would be costly.
 

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We also need to keep in mind that these studies were done injecting intramuscular and although the T ester will control the release rate of T.....absorption sub-q may be some what slower than i.m.

Not everyone on trt is injecting strictly i.m. as sub-q is very common!

Also when looking at peak levels it is not just about the T-ester used.

The pharmacokinetics and pharmacodynamics of androgen esters is mainly determined by ester side-chain length, volume of oil vehicle, and site of injection.

Having blood work done at specific time points post injection is the only way to truly know when ones T levels peak on said protocol.
 
Here is a 2017 study using TC sub-q.


Serum Testosterone Concentrations Remain Stable Between Injections in Patients Receiving Subcutaneous Testosterone




Purpose: Intramuscular (IM) testosterone is the most common modality for testosterone therapy of both male hypogonadism and female-to-male (FTM) gender transition. However, IM injections can be painful and often are not self-administered by the patient. The objective of this study was to further characterize subcutaneous (SC) administration of testosterone as an effective and safe alternative to IM injections by evaluating the pharmacodynamics of serum total and free testosterone concentrations between weekly testosterone injections.

Methods: Eleven FTM transgender patients already receiving weekly SC testosterone cypionate with documented therapeutic levels prior to enrollment had free and total serum testosterone levels measured at eight different time points during a 1-week dosing interval.

Results: Mean levels of total and free testosterone were stable and remained well within the normal range between injections. Overall mean 6 standard deviation levels for the seven samples taken between injections were 627 ± 206 ng/dL (range, 205 to 1410) for total testosterone and 146 ± 51 pg/mL (range, 38 to 348) for free testosterone. No adverse effects were encountered.

Conclusions: The results of this study support use of SC testosterone to achieve therapeutic and stable serum testosterone levels for the purpose of gender transition. It is anticipated that these results can be extended to hypogonadal men. This route may be preferred over IM testosterone because it is relatively painless and easy to self-inject thus allowing for the convenience and economy of patient self administration.



































Mean serum concentrations of total testosterone and free testosterone over 1 week are displayed for the 11 patients in Fig. 1(a) and 1(b), respectively. Mean serum total testosterone remained within the normal range throughout the 7-day interval between doses. There was a significant effect of time on serum total testosterone level (ptime = 0.006 by mixed models analysis) and on free testosterone level (ptime = 0.003 by mixed models analysis) during the 7 days between injections.


In post hoc analysis, paired comparisons between time points indicated no significant difference among serum total testosterone levels measured 6 hours to 5 days after injection; there was, however, a significant decrease at 7 days, compared both with the initial postinjection measurement (656 ± 244 ng/dL and 477 ± 185 ng/dL, P = 0.012) and the 5-day measurement (621 ± 321 ng/dL and 477 ± 185 ng/dL, P = 0.023). Compared with baseline preinjection values, serum concentrations increased significantly at 6 hours after injection for both total testosterone (497 ± 140 and 656 ± 244, P = 0.02) and free testosterone 118 ± 46 pg/mL and 151 ± 69 pg/mL, P = 0.003). There was no significant difference in serum levels between the two samples drawn 7 days apart immediately prior to testosterone injections for both total testosterone (497 ± 140 and 477 ± 185 ng/dL, P = 0.58) and free testosterone (118 ± 46 and 107 ± 49 pg/mL, P = 0.25). Individual total testosterone and free testosterone data are shown in Fig. 2(a) and 2(b), respectively. One patient (testosterone dose, 50 mg) had one total testosterone measurement below normal range (immediately prior to subsequent dose) and one patient (testosterone dose, 100 mg) had four measurements above normal range [Fig. 2(a)]. The rise in serum testosterone levels above the normal range was confirmed by duplicate serum testosterone measurements using the reserve samples. We confirmed with this patient and all others that they did not take any testosterone (injection or otherwise) in addition to the injections prescribed at 7-day intervals. All patients with serum testosterone levels within the lower half of the normal range were receiving a dose of 50 mg per week. The median (range) interindividual CV for serum total testosterone was 37.2% (25.6% to 51.7%) and the intraindividual CV was 20.2% (7.0% to 30.4%). There was a significant inverse relationship between intraindividual CV and body mass index (BMI; r 2 = 0.486, P = 0.017).




Screenshot (487).png

Figure 1. Serum total and free testosterone over a 1-week treatment cycle. Serum measurements taken at 0 and 7 days were from samples drawn immediately prior to SC testosterone injection. Dashed lines represent the lower and upper values of normal range for each total free testosterone. Data are shown as mean 6 standard deviation.


Peak TT/FT levels 24 hrs.
 

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Madman, in your 2017 study using TC sub-q, looking at figure 2 graph, two patients had peaks on days 4-5, one peaked on day 7, the rest peaked either at 6 hours or 1,2 and 4 days. Many had a lower level at day 3, meaning levels at day 2 and day 4-5 were higher than day 3.

The person who peaked on day 5 had a total 100 mg dose as was close to 900 on day 7, falling from the peak 1400 on day 5.

Maybe I could conclude that there is a 90% chance that day 7 will be lower than one of the previous 6 days after a sub-q injection, though which day would be the peak seems all over the place.

The op said he takes 180 mg and measured 1024 ng/dl on day 7. That seems reasonable and a guess would be his peak was around 1500-1600, though what day is anyone's guess, likely day 4-5, though who knows. I say likely because his total T was still 1024 on day 7.

Maybe the day you peak is related to total initial dose, though one can only speculate from such limited data as 11 females undergoing FTM transgender hormone treatment.

"There was a significant inverse relationship between intraindividual CV and body mass index " the lowest BMI of this group was 20.2, average 28, though I am not sure what to make of that.

And perhaps males react differently to Test-C than females.
 
I would look into splitting dose and injecting more frequently as in every 3.5 days (twice weekly).

Depending on how you feel overall seeing as your TT/FT trough is in the 30 ng/dL range injecting once weekly your TT/FT levels will be a lot higher post injection and you stated.....

"My experience with them hasn't been terrible, but lately something has been feeling "off" for me. I've noticed that surge post injection really hitting me 2-3 days after and it just doesn't feel good. Anxious, super hot, weird appetite, etc... I know it could be nothing to do with the TRT, but still weird"

I would bet this is because your peak levels are too high for you injecting such a large dose of T 180 mg once weekly!



Thanks for all the info everyone...

I’m thinking of droping my dose to 160 split into twice weekly (Monday AM/Thurs PM) and sticking with that for several weeks. Would love to not have to inject EOD, but open to it if you guys think that would just be best.

Seem like a decent approach to shift down to? Or should I consider dropping even further down in overall dosing?
 
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