What factors could influence total T result?

[RickB]

I was taking 200mg cypionate every Thursday morning.

I got tested Thursday at absolute trough and was 1361.

I did not pin that day, and instead waited until Saturday morning.

I got tested the next Friday afternoon and was >1500.

While those second bloods were drawn about 16 before my new trough, I had taken my shot 47 hours later than usual, so I can't understand why my result is higher. I would've expected the 1361 to get down to below 1200, maybe as low as 1000, by the time I pinned. So I was expecting my new trough to be around 1100 (but slightly higher because I was testing 16 hours early).

My free went down from 24.9 to 20.5, which is what I expected. But I also expected that to happen to my total T.

My E2 went up considerably. I had tanked it to 5.8 for the first test by mistakenly double dosing my Exemestane. The one shot of 200mg brought it up to 40.5 for the second test. I don't see how or why this could mean a higher total T.

Could it be that Exemestane kills T that has been bound but not yet aromatized, meaning some of my >1500 was on the cusp of being aromatized?

 

[Systemlord]

I got tested Thursday at absolute trough and was 1361.

I did not pin that day, and instead waited until Saturday morning.

I got tested the next Friday afternoon and was >1500.

You may have postpone your injection, but there is a delay as far as seeing a change in your levels which is due to the half-life of the ester.

You also tested a different times.

 

[RickB]

You may have postpone your injection, but there is a delay as far as seeing a change in your levels which is due to the half-life of the ester.

You also tested a different times.

Per the half-life, it's still weird it's higher. I can understand it not being as low as I thought it should be. But I see no reason why it would be 139+ higher.

As far as the different times, does testing time matter for exongenous T?

 

[bixt]

I was taking 200mg cypionate every Thursday morning.

I got tested Thursday at absolute trough and was 1361.

Next time go test your peak levels 24, 48 hours later. You will probably find them to be 2500+.

I know my comment is unsolicited and that its
got nothing with the reason you posted, but its food for thought...

 

[RickB]

Next time go test your peak levels 24, 48 hours later. You will probably find them to be 2500+.

I know my comment is unsolicited and that its
got nothing with the reason you posted, but its food for thought...

I welcome the comment. I agree with you, and that's one of the reasons I'm doing so much testing. I don't want to be supra, and I want to get nice numbers before I sit back and give a protocol 8 to 10 weeks.

Even though this thread is dwelling on my total reading, I'm high SHBG, so free is the important number. I want a trough free right around 15.6, which is right in the middle of normal range. So right now I'm a little high (20.5) and will reduce my dosage next injection. If I get the free down to 15.6 and the total is sky-high, I'm ok with that.

 

[madman]

I was taking 200mg cypionate every Thursday morning.

I got tested Thursday at absolute trough and was 1361.

I did not pin that day, and instead waited until Saturday morning.

I got tested the next Friday afternoon and was >1500.

While those second bloods were drawn about 16 before my new trough, I had taken my shot 47 hours later than usual, so I can't understand why my result is higher. I would've expected the 1361 to get down to below 1200, maybe as low as 1000, by the time I pinned. So I was expecting my new trough to be around 1100 (but slightly higher because I was testing 16 hours early).

My free went down from 24.9 to 20.5, which is what I expected. But I also expected that to happen to my total T.

My E2 went up considerably. I had tanked it to 5.8 for the first test by mistakenly double dosing my Exemestane. The one shot of 200mg brought it up to 40.5 for the second test. I don't see how or why this could mean a higher total T.

Could it be that Exemestane kills T that has been bound but not yet aromatized, meaning some of my >1500 was on the cusp of being aromatized?

You are injecting a whopping dose of 200 mg T/week.

1st test was done at the true trough (7 days post-injection/Thur. morning) which had you hitting a very high TT 1361 ng/dL which means that your trough FT is going to be very high even if you have highish/high SHBG your trough FT would most likely be in the mid-high 40 ng/dL.

Keep in mind peak TT, FT and estradiol will be much higher.

Testing at peak would be much sooner 8-24 hrs post-injection and much sooner than most would think.

You then waited roughly 2 days (Saturday morning) before doing your next injection then you had blood work done 6 days 8 hrs later and you were hitting a whopping trough (-16 hrs true trough) TT >1500 ng/dL which should have had your FT absurdly high.

Pushing up your TT is going to drive up your FT further.

Was blood work done at the same lab using the same assay?

Even then sounds like you did not use the most accurate assay for TT (LC-MS/MS) otherwise you would have known where your level sat as the analytical measurement range 1.0 ng/dL - 2,000+ ng/dL.


Method Used for Total Testosterone:

– Liquid chromatography-tandem mass spectrometry (LC-MS/MS)- No upper or lower limit

– Analytical sensitivity: 1.0 ng/dL

– Analytical specificity: no cross-reactivity with other steroid compounds or supplements like biotin/

– Analytical Measurement Range: 1.0 ng/dL to 2,000+ ng/dL


Would have been better off comparing labs only if TT/FT were both tested using the same lab/same assays (most accurate).

You most likely used the same lab but doubtful the most accurate assays, especially for FT.

Would pay no attention to your FT unless you had it tested using the most accurate assays such as Equilibrium Dialysis or Ultrafiltration (next best).

Especially in cases of altered SHBG and as you stated yours is high!

200 mg/week is a fair amount of T.

The downfall of injecting high doses of T once weekly is your peaks will be absurdly high and troughs much lower but even then some are still hitting very high troughs on such protocol (dose T/injection frequency).

Let alone blood levels will not be as stable throughout the week which can wreak havoc for some when it comes to energy/mood/erections/libido (ups/downs) due to the rollercoaster ride.

If you are one who feels great overall, blood markers are healthy and you are not struggling with any sides then go nuts but you are clearly overmedicated.

Would be far better off lowering your dose and injecting twice weekly if your goal is to avoid absurdly high levels let alone at the true trough.

 

[madman]

I welcome the comment. I agree with you, and that's one of the reasons I'm doing so much testing. I don't want to be supra, and I want to get nice numbers before I sit back and give a protocol 8 to 10 weeks.

Even though this thread is dwelling on my total reading, I'm high SHBG, so free is the important number. I want a trough free right around 15.6, which is right in the middle of normal range. So right now I'm a little high (20.5) and will reduce my dosage next injection. If I get the free down to 15.6 and the total is sky-high, I'm ok with that.

Makes absolutely no sense to inject high doses of T once weekly if such is your goal.

Again you are not understanding this.

If your TT is sky-high your FT is going to be very/absurdly high even if you have high/highish SHBG.

Most men can hit a healthy let alone high FT running a TT 1000 ng/dL and yes even men with high/highish SHBG.

FT 5-10 ng/would be considered low.

FT 16-31 ng/dL (high-end) is healthy.

Most men will do well with FT 20-30 ng/dL.

Some may choose/want to run higher levels.

Comes down to the individual.

You have seen this posted on the forum numerous times.

My reply from a previous thread:

When it comes to comparing blood work whether one is following a strictly sub-q protocol, strictly IM protocol let alone sub-q vs IM protocol they are following the steps needed in order to make a fair comparison.


Critical Points

1. The protocol needs to be kept the same (ester/dose T/injection frequency)

2. 4-6 weeks for blood levels to stabilize before getting blood work done (6 weeks)

3. Testing is done at the true trough

4. Using the same lab

5. Using the same assays (most accurate) TT/e2 (LC-MS/MS) and FT (Equilibrium Dialysis or Ultrafiltration)

6. Each protocol needs to be given 12 weeks (claim success or failure)


Only then can one make the claim whether the protocol was truly a success or failure let alone when comparing blood levels.

 

[RickB]

^ I used same standard LabCorp assay both times. My FT was 24.9, and then 20.5, neither of which are absurdly high...according to that assay of course. I am paying out of pocket, so I want to try to get closer to an optimal dosage and then pay for the Equilibrium Dialysis to confirm.

I want to lower my dose, but stay at once per week, to try to get a trough FT around 16. I had tried 100mg e4d and my FT was around 13, which was just too low.

 

[madman]

^ I used same standard LabCorp assay both times. My FT was 24.9, and then 20.5, neither of which are absurdly high...according to that assay of course. I am paying out of pocket, so I want to try to get closer to an optimal dosage and then pay for the Equilibrium Dialysis to confirm.

I want to lower my dose, but stay at once per week, to try to get a trough FT around 16. I had tried 100mg e4d and my FT was around 13, which was just too low.

Again absolutely pointless to test your FT using the piss poor direct immunoassay which is known to be inaccurate.

You need to have it tested using Equilibrium Dialysis or Ultrafiltration (next best) to know where it truly sits especially in cases of altered SHBG.

Period end of the story.

I would pay no attention to your FT results!

 

[madman]

^ I used same standard LabCorp assay both times. My FT was 24.9, and then 20.5, neither of which are absurdly high...according to that assay of course. I am paying out of pocket, so I want to try to get closer to an optimal dosage and then pay for the Equilibrium Dialysis to confirm.

I want to lower my dose, but stay at once per week, to try to get a trough FT around 16. I had tried 100mg e4d and my FT was around 13, which was just too low.

Take a hard long look at post #20.

post #20

Lowered TT and FT went Higher! Now What?

I don't want to go deep into my 10 year history on TRT. I have been reading these forums for a long time and finally decided to post. I have been on most all forms of T and Protocols, AI's, frequent Blood donations etc. Dealt with a lot of Dr. Quacks' in it for the money unfortunately. Needless...

www.excelmale.com

 

[madman]

Hard to believe not one person on here asked how your FT was tested!

 

[RickB]

Hard to believe not one person on here asked how your FT was tested!

Ok, I will use the ED assay next time. I posted a thread about two weeks ago asking about what I'm missing out on by using "piss poor" assays. I got no replies regarding FT, but the replies about E2 made it seem that I'm better off sticking with piss poor for that.

Also, although FT is the important number, this thread was asking how my TT could've gone up like it did. No one has been able to explain that.

 

[Systemlord]

Hard to believe not one person on here asked how your FT was tested!

That's beside the point, his Total T is sky high and Free T has got to mirror the Total T.

 

[RickB]

That's beside the point, his Total T is sky high and Free T has got to mirror the Total T.

Since you're posting on this thread again, I'll take the opportunity to mention that I asked a follow-up to your original reply yesterday. Maybe you saw it, and of course you don't have to answer. I just thought you might want to clarify, because I don't see how either of the factors you mentioned would explain a higher second result.

 

[madman]

That's beside the point, his Total T is sky high and Free T has got to mirror the Total T.

No shit sherlock must have gone over your head!

Even then you and anyone should be asking the OP how FT was tested before jumping on this that and the other.




post #6

You then waited roughly 2 days (Saturday morning) before doing your next injection then you had blood work done 6 days 8 hrs later and you were hitting a whopping trough (-16 hrs true trough) TT >1500 ng/dL which should have had your FT absurdly high.

*Pushing up your TT is going to drive up your FT further.

Was blood work done at the same lab using the same assay?

*Even then sounds like you did not use the most accurate assay for TT (LC-MS/MS) otherwise you would have known where your level sat as the analytical measurement range 1.0 ng/dL - 2,000+ ng/dL.


Method Used for Total Testosterone:

– Liquid chromatography-tandem mass spectrometry (LC-MS/MS)- No upper or lower limit

– Analytical sensitivity: 1.0 ng/dL

– Analytical specificity: no cross-reactivity with other steroid compounds or supplements like biotin/

– Analytical Measurement Range: 1.0 ng/dL to 2,000+ ng/dL


*Would have been better off comparing labs only if TT/FT were both tested using the same lab/same assays (most accurate).

*You most likely used the same lab but doubtful the most accurate assays, especially for FT.

Would pay no attention to your FT unless you had it tested using the most accurate assays such as Equilibrium Dialysis or Ultrafiltration (next best).

Especially in cases of altered SHBG and as you stated yours is high!




post#7

Again you are not understanding this.

*If your TT is sky-high your FT is going to be very/absurdly high even if you have high/highish SHBG.

 

[Systemlord]

As far as the different times, does testing time matter for exongenous T?

Try to test when fasting and at the same time of day to get the most consistency.

TRT is not a set and forget therapy, hormone levels will still fluctuate.

 

[madman]

Ok, I will use the ED assay next time. I posted a thread about two weeks ago asking about what I'm missing out on by using "piss poor" assays. I got no replies regarding FT, but the replies about E2 made it seem that I'm better off sticking with piss poor for that.

Also, although FT is the important number, this thread was asking how my TT could've gone up like it did. No one has been able to explain that.

This has been beaten to death on here it is known to be an inaccurate assay and should not be used/relied upon when testing FT.

Hard to say forsure and would have been better if you used the most accurate assay for TT (LC-MS/MS) and FT (Equilibrium Dialysis or Ultrafiltration) when comparing labs.


From my previous reply (post #6):

*Pushing up your TT is going to drive up your FT further.

Was blood work done at the same lab using the same assay?

*Even then sounds like you did not use the most accurate assay for TT (LC-MS/MS) otherwise you would have known where your level sat as the analytical measurement range 1.0 ng/dL - 2,000+ ng/dL.


Method Used for Total Testosterone:

– Liquid chromatography-tandem mass spectrometry (LC-MS/MS)- No upper or lower limit

– Analytical sensitivity: 1.0 ng/dL

– Analytical specificity: no cross-reactivity with other steroid compounds or supplements like biotin/

– Analytical Measurement Range: 1.0 ng/dL to 2,000+ ng/dL


*Would have been better off comparing labs only if TT/FT were both tested using the same lab/same assays (most accurate).

*You most likely used the same lab but doubtful the most accurate assays, especially for FT.

Would pay no attention to your FT unless you had it tested using the most accurate assays such as Equilibrium Dialysis or Ultrafiltration (next best).

 

[RickB]

What about LC/MS instead of LC/MS-MS? Is that assay good enough? I can do that and ED for $89.

If I need to do LC/MS-MS, then that's $93 plus $89 for the ED.

 

[tareload]

I would've expected the 1361 to get down to below 1200, maybe as low as 1000, by the time I pinned. So I was expecting my new trough to be around 1100 (but slightly higher because I was testing 16 hours early).

Hard to completely rationalize your result based on the pharmacokinetics of TC without invoking relative standard error of the TT assay. If you follow along with my example graph below your two TT data points should have been pretty close. Of course if you wanted to repeat the experiment and measure above 1500 ng/dl you'd need to get the LC-MS/MS test. As @bixt mentioned, your peak is most likely really getting up there.

 

[madman]

What about LC/MS instead of LC/MS-MS? Is that assay good enough? I can do that and ED for $89.

If I need to do LC/MS-MS, then that's $93 plus $89 for the ED.

Any of these would suffice but test #1 is expensive and #3 from Nelson's discountedlabs. would be the cheapest option!

Test #2 is the one I would get (cost/reference range).




1. 500726: Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences) | Labcorp
Methodology: Testosterone: high-pressure liquid chromatography (HPLC)/tandem mass spectrometry; free testosterone: equilibrium dialysis


2. 070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp
Methodology: Free: equilibrium ultrafiltration; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)


3. Testosterone, Total, LC/MS and Free (Equilibrium Dialysis)
Methodology: Free: equilibrium dialysis; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)