Very High TT and E2 after starting TRT

[andrew1324]

I'll start off by linking my original thread here : Extremely high SHBG

Just got my results back after 4 weeks of being on TRT, attached my results.

My E2 and TT are way too high.
Total Testosterone : 69.5 nmol/L (2004 ng/dL)
Estradiol : 285 pmol/L (77 pg/mL)

I've been injecting 130mg Test E into thigh 1" 25g needle once every 6 days along with HCG 400iu 3x per week. I really havn't noticed much in terms of side effects other than not having as much energy as I did the first 2 weeks (maybe because of such high E?) I plan to do the water retention treadmill test later today.

I hope my doc's not gonna be pissed when I tell him I've been doing a higher dose than he originally recommended (100 mg/week). I thought it would be necessary since my SHBG has been so high (90 - 105 nmol/L) and Free T has been so low..

I feel like I really need to have my Free T and SHBG tested as well but the doctors nurse receptionist didn't seem to think that was as important. I have a follow up appointment this week and plan to ask to get those tested from now on.

Why is my Total T so high? Would the high SHBG be making me hold on to T for a much longer time?

Whats the best route to go from here? Should I cut doses down big time? Start injecting 2x weekly?

Thanks for your help

 

[madman]

I'll start off by linking my original thread here : Extremely high SHBG

Just got my results back after 4 weeks of being on TRT, attached my results.

My E2 and TT are way too high.
Total Testosterone : 69.5 nmol/L (2004 ng/dL)
Estradiol : 285 pmol/L (77 pg/mL)

I've been injecting 130mg Test E into thigh 1" 25g needle once every 6 days along with HCG 400iu 3x per week. I really havn't noticed much in terms of side effects other than not having as much energy as I did the first 2 weeks (maybe because of such high E?) I plan to do the water retention treadmill test later today.

I hope my doc's not gonna be pissed when I tell him I've been doing a higher dose than he originally recommended (100 mg/week). I thought it would be necessary since my SHBG has been so high (90 - 105 nmol/L) and Free T has been so low..

I feel like I really need to have my Free T and SHBG tested as well but the doctors nurse receptionist didn't seem to think that was as important. I have a follow up appointment this week and plan to ask to get those tested from now on.

Why is my Total T so high? Would the high SHBG be making me hold on to T for a much longer time?

Whats the best route to go from here? Should I cut doses down big time? Start injecting 2x weekly?

Thanks for your help

Lifelabs and Dynacare are the 2 main labs in Ontario as well as other provinces.

I have used Lifelabs many times but usually stick with Dynacare as the top end of the physiological range for TT is slightly higher at Dynacare 31.4 nmol/L as oppose to Lifelabs 28.8 nmol/L.

Are you sure that you are only injecting 130 mg once weekly as it would be shocking for one to hit a TT of 2000 ng/dL on such a dose.

When was your blood work done as it should be at trough as in if you are injecting Monday morning at 9 am than your blood work should be done the following Monday morning just before your 9 am injection as you want to know your lowest point.

Your estradiol test is the wrong test as it is the standard meant for women not the estradiol sensitive assay (LC/MS-MS) which you need!

 

[andrew1324]

Lifelabs and Dynacare are the 2 main labs in Ontario as well as other provinces.

I have used Lifelabs many times but usually stick with Dynacare as the top end of the physiological range for TT is slightly higher at Dynacare 31.4 nmol/L as oppose to Lifelabs 28.8 nmol/L.

I see, why exactly are the ranges relevant as long as you know where about you want to be?
The reason I use lifelabs over dynacare is so I can look up my results online

Are you sure that you are only injecting 130 mg once weekly as it would be shocking for one to hit a TT of 2000 ng/dL on such a dose.

I am certain. 0.65 on a 1 ml syringe is what I've been doing. Started out doing 0.6 (120 mg) the first week then went up to 130 the next 3.

When was your blood work done as it should be at trough as in if you are injecting Monday morning at 9 am than your blood work should be done the following Monday morning just before your 9 am injection as you want to know your lowest point.

My bloodwork was done on my peak day (3 days after injection) as per request by my doctor.

Your estradiol test is the wrong test as it is the standard meant for women not the estradiol sensitive assay (LC/MS-MS) which you need!

I see, how do you know for sure it is not? I wasn't sure if it was the sensitive test or not, cause when I asked the nurse receptionist if it was the ultra sensitive E2 for men she kinda looked at me confused then said yes. The exact same test came back at only 12 pg/mL pre TRT.

 

[madman]

Lifelabs and Dynacare are the 2 main labs in Ontario as well as other provinces.

I have used Lifelabs many times but usually stick with Dynacare as the top end of the physiological range for TT is slightly higher at Dynacare 31.4 nmol/L as oppose to Lifelabs 28.8 nmol/L.

Are you sure that you are only injecting 130 mg once weekly as it would be shocking for one to hit a TT of 2000 ng/dL on such a dose.

When was your blood work done as it should be at trough as in if you are injecting Monday morning at 9 am than your blood work should be done the following Monday morning just before your 9 am injection as you want to know your lowest point.

Your estradiol test is the wrong test as it is the standard meant for women not the estradiol sensitive assay (LC/MS-MS) which you need!

As you should be aware seeing as your SHBG was so high pre-trt you will need to run a higher TT in order to achieve a healthy FT.

You are missing a critical test which is your FT and although your TT is extremely high we have no idea where your FT sits as even though it is good to know where your TT levels are.....FT is what truly matters as it is the unbound active fraction of testosterone responsible for the positive benefits.

Most uninformed doctors treating men with trt only test TT.....rarely ever FT or SHBG which are critical and many physicians do not even check e2 and if they do it is using the wrong e2 test which is the standard meant for women.

The estradiol sensitive test (LC/MS-MS) is now available in Ontario and a few other provinces but only through Dynacare as Lifelabs is still testing with the standard assay.

 

[madman]

I am certain. 0.65 on a 1 ml syringe is what I've been doing. Started out doing 0.6 (120 mg) the first week then went up to 130 the next 3.

My bloodwork was done on my peak day (3 days after injection) as per request by my doctor.


I see, how do you know for sure it is not? I wasn't sure if it was the sensitive test or not, cause when I asked the nurse receptionist if it was the ultra sensitive E2 for men she kinda looked at me confused then said yes. The exact same test came back at only 12 pg/mL pre TRT.

Regarding the right e2 testing.....I live in Canada and am from Ontario.

I can tell it is the wrong test by the reference range on your Lifelabs results and I have personally contacted Lifelabs and Dynacare to discuss the matter.

Dynacare is the only lab in Canada that is currently offering the sensitive estradiol assay (LC/MS-MS).

You can only get it done through Dynacare and you need your doctor to specify estradiol sensitive on your requisition form!

Dynacare will send your blood sample to the US and it will be tested at Labcorp one of the biggest labs in the states which offers the estradiol sensitive assay (LC/MS-MS).

A large majority of the members here on EM are from the US and many use Labcorp for blood testing.

 

[andrew1324]

Regarding the right e2 testing.....I live in Canada and am from Ontario.

I can tell it is the wrong test by the reference range on your Lifelabs results and I have personally contacted Lifelabs and Dynacare to discuss the matter.

Dynacare is the only lab in Canada that is currently offering the sensitive estradiol assay (LC/MS-MS).

You can only get it done through Dynacare and you need your doctor to specify estradiol sensitive on your requisition form!

Dynacare will send your blood sample to the US and it will be tested at Labcorp one of the biggest labs in the states which offers the estradiol sensitive assay (LC/MS-MS).

A large majority of the members here on EM are from the US and many use Labcorp for blood testing.

I see, Thanks for clarifying that. I am also in Ontario. So its possible my Estrogen isn't extremely elevated and its just a complete guessing game for now?

I hate feeling like I need to explain things to my doc. I feel like this should all be common knowledge among doctors by now.

I'll try my hardest to convince them That I need Free T, SHBG, and sensitive estradiol tests done, who knows how that'll go.

As for now though, whats the best route to go about adjusting my dose?

Thanks

 

[madman]

I see, why exactly are the ranges relevant as long as you know where about you want to be?
The reason I use lifelabs over dynacare is so I can look up my results online

I am certain. 0.65 on a 1 ml syringe is what I've been doing. Started out doing 0.6 (120 mg) the first week then went up to 130 the next 3.

My bloodwork was done on my peak day (3 days after injection) as per request by my doctor.


I see, how do you know for sure it is not? I wasn't sure if it was the sensitive test or not, cause when I asked the nurse receptionist if it was the ultra sensitive E2 for men she kinda looked at me confused then said yes. The exact same test came back at only 12 pg/mL pre TRT.

Ofcourse treating symptoms is what matters but blood work is critical when on trt as when using testosterone your e2, hemoglobin/hematocrit will increase and it can also effect your lipids ( lower your HDL).

Reference ranges are just that guidance to let you know how a specific dose of testosterone effects your TT, FT, e2 and overall health markers as trt is not only about treating a man for to improve/relieve symptoms of low t but to also keep the patient healthy in the long run.....so labs are critical.

As far as ranges for TT one can argue back and forth about what range may be optimal/healthy but FT is what truly matters and whether one needs there FT to be mid/top end or above the reference range comes down to the individual and what level is best for them.

Most men do well having FT in the 2-3% range of TT.

If your doctor is a stickler for numbers than choosing Dynacare allows a higher top end 31.4 nmol/L for the TT reference range but again if he is treating numbers and not symptoms let alone not even looking at FT which is what matters than you need to find a new doctor.

If you are sure you are only injecting 130 mg/week and your blood labs were done 3 days post injection than 2000 ng/dl would make sense especially with such a high SHBG.....mind you peak is usually 24-48 hrs post injection and I would say closer to 24 hrs post injection so you are likely higher!

As I stated earlier you need to be tested at trough not 3 days after injection.

Again due to the reference range and using Lifelabs it is the wrong e2 test.

 

[madman]

I see, Thanks for clarifying that. I am also in Ontario. So its possible my Estrogen isn't extremely elevated and its just a complete guessing game for now?

I hate feeling like I need to explain things to my doc. I feel like this should all be common knowledge among doctors by now.

I'll try my hardest to convince them That I need Free T, SHBG, and sensitive estradiol tests done, who knows how that'll go.

As for now though, whats the best route to go about adjusting my dose?

Thanks

I would not stress about your e2 as you need the sensitive assay to truly see where your e2 sits and the standard test you had done tends to overestimate in men so just because you are posting a 285 pmol/L (reference range <162) does not mean your e2 is high.

When I first started trt 2 months in after a dose increase 150 mg/week (75 mg every 3.5 days) injected strictly sub-q abdominal fat my TT trough 1000 + ng/dl and FT double top end range and at the time my e2 was tested using the standard assay and it was a whopping 256 pmol/L (reference range <162) and I have never experienced any high e2 symptoms.

My SHBG was mid range pre-trt almost smack dab in the middle of the reference range.

I do not use hcg and have never touched an aromatase inhibitor and am almost approaching 2 years into trt now.

 

[madman]

Lifelabs lets you sign up for an online account for free if you want to see your lab results as you know but Dynacare also offers the same but charges a low cost for a year membership so you can also view your results.

I have account with both.

If you plan on getting the estradiol sensitive assay you will have to get it done through Dynacare.

 

[andrew1324]

If your doctor is a stickler for numbers than choosing Dynacare allows a higher top end 31.4 nmol/L for the TT reference range but again if he is treating numbers and not symptoms let alone not even looking at FT which is what matters than you need to find a new doctor.

I believe my docs ideal range for total T is between 800-1100 ng/dL. Hopefully he understands the importance of Free T.

As I stated earlier you need to be tested at trough not 3 days after injection.

I wish I could just walk in and pay for what blood tests I need right then and there without a doc handing me the requisition, but for now I guess I just gotta do what the doc orders..

Lifelabs lets you sign up for an online account for free if you want to see your lab results as you know but Dynacare also offers the same but charges a low cost for a year membership so you can also view your results.

Thanks for this info, wasn't aware.

I may try switching to 2x weekly then eventually subq and see how that goes for me. Should I lower my dose?

Thanks

 

[madman]

You are in a tough situation seeing as your doctor is not even testing your FT.

Even though you had blood work done 4 weeks in instead of 6 which is needed for blood levels to stabilize and we do not know where your SHBG sits now since it was not tested on your recent blood work.

Using ones TT and SHBG in the online Free & Bioavailable Testosterone calculator:
Free & Bioavailable Testosterone calculator

It would show you where your FT sits.....but we do not know where your SHBG sits as it was not tested on your most recent blood work 4 weeks into your trt protocol.

Here is a recent article written by the Abraham Morgentaler whom is a well known and highly respected urologist who specializes in trt.

It discusses the importance of FT.....

Print it off and bring it to your doctor at your follow up.

 

[madman]

I believe my docs ideal range for total T is between 800-1100 ng/dL. Hopefully he understands the importance of Free T.


I wish I could just walk in and pay for what blood tests I need right then and there without a doc handing me the requisition, but for now I guess I just gotta do what the doc orders..


Thanks for this info, wasn't aware.

I may try switching to 2x weekly then eventually subq and see how that goes for me. Should I lower my dose?

Thanks

When is your follow up and again your doctor needs to know that testing should be done at trough for TT, FT, e2 and SHBG needs to be tested also.

We know that your SHBG was extremely high pre-trt 90 nmol/L and now 4 weeks in on 130 mg/week including HCG (3 x weekly) you are posting a TT 2004 ng/dl 3 days post injection.....we have no idea where your SHBG (how much has it decreased?) nor FT sit so for your doctor to just simply look at TT numbers you are in a bad situation.

As I stated above at least if you had your SHBG tested than we could easily use the Free & Bioavailable Testosterone calculator to see what your FT is and you would not have to get it tested.

No point in adjusting your dose as we have no idea what your FT is and even than do understand that is takes 6 weeks for blood levels to stabilize when one adjust their testosterone dose.

It is not like you just increase/decrease dose and than a few weeks later your levels have changed dramatically.....it takes 6 weeks for levels to stabilize.

 

[fifty]

How do you know your doc didn't want you to just start conservative at 100mg then possibly up the dose in the future?

I know everyone wants to think their doctor is stupid but hell can't we give it ~6 weeks before we go questioning absolutely everything?

When is your follow up appt?

 

[madman]

How do you know your doc didn't want you to just start conservative at 100mg then possibly up the dose in the future?

I know everyone wants to think their doctor is stupid but hell can't we give it ~6 weeks before we go questioning absolutely everything?

When is your follow up appt?

Unfortunately he decided to increase his dose on his own, his blood work was not done at trough and he had his blood test done to early at 4 weeks as oppose to 6!

If FT and SHBG are not even being tested than knowing ones TT is just shooting in the dark.

 

[andrew1324]

How do you know your doc didn't want you to just start conservative at 100mg then possibly up the dose in the future?

Did you read my original post and read the advice I was given? You are correct I likely should have started at the 100 mg my doctor originally recommended, but having no idea what level I would get to off a certain dose I decided I'd rather my level slightly higher than lower given such a high SHBG. I did not expect my level to be near this high.

When is your follow up appt?

My follow up appointment is this upcoming Thursday.

When is your follow up and again your doctor needs to know that testing should be done at trough for TT, FT, e2 and SHBG needs to be tested also.

This upcoming Thursday.

We know that your SHBG was extremely high pre-trt 90 nmol/L and now 4 weeks in on 130 mg/week including HCG (3 x weekly) you are posting a TT 2004 ng/dl 3 days post injection.....we have no idea where your SHBG (how much has it decreased?) nor FT sit so for your doctor to just simply look at TT numbers you are in a bad situation.

Yes I realise this is an unfortunate situation, I am going to try for the very minimum to at least get the SHBG and E2 sensitive tests. I really hope my doctor will order them. As for printing off that PDF and showing him, I kind of doubt he'd actually sit down and read it at that given point in time and change his decision based upon it, but I suppose it doesn't hurt to try.

 

[fifty]

I read this thread and your original thread. Sorry, I’m not trying to be combative.

It’s easier to get solid data when dosages are steady. Remember it’s a marathon not a sprint. I would be honest with your doc about your dosages so you have the most accurate picture of how to best make adjustments.

 

[madman]

Did you read my original post and read the advice I was given? You are correct I likely should have started at the 100 mg my doctor originally recommended, but having no idea what level I would get to off a certain dose I decided I'd rather my level slightly higher than lower given such a high SHBG. I did not expect my level to be near this high.

My follow up appointment is this upcoming Thursday.
This upcoming Thursday.

Yes I realise this is an unfortunate situation, I am going to try for the very minimum to at least get the SHBG and E2 sensitive tests. I really hope my doctor will order them. As for printing off that PDF and showing him, I kind of doubt he'd actually sit down and read it at that given point in time and change his decision based upon it, but I suppose it doesn't hurt to try.

If by chance you are being treated at the clinic in Burlington.....he should know better!

You also need to get your hemoglobin/hematocrit checked as levels will increase within the first 1-3 months when starting trt and can take up to 9-12 months to reach peak levels.....mind you most men start to donate well before the 1 year mark.

Seeing as your hemoglobin/hematocrit were already high pre-trt your levels will definitely be higher now so you may need to look into donating blood eventually!

Make sure you know where your ferritin/iron levels are before you start donating when the time comes as many men end up in a vicious cycle donating too frequently and end up crashing their iron/ferritin which can have negative effects especially regarding your thyroid and your TSH is already high!

 

[fifty]

Madman i think his hemoglobin hematocrit values are on the labs that show his high total T.

 

[andrew1324]

If by chance you are being treated at the clinic in Burlington.....he should know better!

I am indeed. I would suspect he does but the thing is the nurse gave me the bloodwork req not him.

Make sure you know where your ferritin/iron levels are before you start donating when the time comes as many men end up in a vicious cycle donating too frequently and end up crashing their iron/ferritin which can have negative effects especially regarding your thyroid and your TSH is already high!

Thanks for this info. My yearly bloodwork showed my TSH had come down since then to 1.3 after supplementing iodized salt and selenium, need to have another full thyroid panel soon. Just annoying how I always need a doctors req. Fingers crossed my RT3 has come down too especially now being on TRT.

 

[madman]

I am indeed. I would suspect he does but the thing is the nurse gave me the bloodwork req not him.

Thanks for this info. My yearly bloodwork showed my TSH had come down since then to 1.3 after supplementing iodized salt and selenium, need to have another full thyroid panel soon. Just annoying how I always need a doctors req. Fingers crossed my RT3 has come down too especially now being on TRT.

You can have blood work done on your own through Bluehorizon Blood Test Canada:Blood Tests Canada

They are based out of the UK and are affiliated with Dynacare so as long as you live in Ontario you can use their service and pay for your own tests as they offer many single tests such as TT, FT, SHBG, LH/FSH, Prolactin, Dhea among many others although unfortunately they only offer the e2 standard test and not the estradiol sensitive.

You just go to the online site order your test, payment is made and they email you the requisition and than you print it off and take it to any Dynacare location in Ontario and have the blood work done.....your results will be emailed to you privately and if you have an online account with Dynacare you can usually look at the results.

The main downfall is the tests are very expensive $99 for most single tests although there are a few male hormone profile tests which include 2-4 of the ones I listed above which would bring down the cost slightly.

Sad fact of the matter is all the testing they offer can easily be requested by your own treating physician and as you know is free for us Canadians due to OHIP.

The main reason to use the service and pay out of pocket is if you want to get tests done on your own as the results are private and you can mange your own protocol instead of going through your doctor all the time as most physicians would not do blood work too frequently as on average it is every 6 months unless your protocol was adjusted than your doctor may get you to have blood work done at the 3 month mark.

I wish we had something similar to Discounted Labs offered by Nelson here on the forum but unfortunately we are not US citizens.

In the US they have access to numerous pay out of pocket personal private blood testing where as in Canada we are basically sh$$ out of luck!