T Nation

3 Months into TRT. Advice/Discussion on Most Recent Labs


#1

I started TRT about 12 weeks ago and just had my most recent labs done after getting on a good trt schedule. I was wanting to see if anyone could give me any advice on changes or things I may want to look out for based on my most recent labs. My Dr. did agree to bump my dose up to 90mg per week (he’s relatively conservative). Here’s a little history prior to starting and along the way up until this week.

Went to Dr. in December 2016 checked T again. He only did Total even though I always ask for full T work up. Surprisingly this came back at

Total T - 193 300-1100.

Dr. said he’d treat this time wanted me to do gel but for all the obvious reasons and my 4yr. old daughter and 2 yr old son I asked for injections. To no surprise he originally wanted to do 100mg T cyp every 3 weeks. I told him why this wasn’t going to be good for me and he reduced it to every 2 weeks with a recheck at 6 weeks. I started IM injects on his schedule for those 6 weeks and like one would expect there were 5-6 good days after a shot, nothing profound, but then 8 pretty bad days. Rechecked bloods after 6 weeks. I asked for a lot more BW but got full T work up and E2.

Total T - 272 250-1100
Free T - 46.9 46-224
Bio T - 102.6 110-575
SHBG - 21 10-50
Albumin - 4.8 3.6-5.1
E2 <5 0-52

These bloods were taken on day 13 about 30 hours before next inject. Dr. saw these and agreed to start weekly doses at 80mg. which I am doing 40mg 2x a week. Since I started doing the shots altogether, even on a horrible schedule, I have noticed a couple positives, and they seem to be increase in libido and way less irritability. I almost actually feel quite calm all the time in a sense. I am hoping to not have to use an AI and am highly considering HCG. although I don’t know when or how much. I would like to see where things are at after 6 weeks of my current regiment but don’t know if that feasible or advisable.

Most recent labs taken about 8hrs. before next injection:

Testosterone Total LC/MS/MS 522ng/dl 250-1100 ng/dl
Free T 120 pg/ml 46-224 pg/dl
Bioavialable 267.7 ng/dl 110-575 ng/dl
E2 12pg/ml 0-52 pg/ml
SHBG 15nmol/L 10-50 nmol/L
Albumin 4.9 g/dl 3.6-5.1 g/dl
AST 32 U/L 0-46 U/L
ALT 25 U/L 0-60 U/L
Total Cholesterol 190
Triglycerides 66 (a little higher than pre trt)
HDL 48
LDL 129 (about 30 points higher than pre trt)
RBCC 5.34 m/mm3 4.40-5.80 m/mm3 (up from 4.9 pre trt)
Hemoglobin 16.6 g/dl 13.8-17.2 g/dl (up from 15.10 g/dl pre trt)
Hematocrit 47.7% 41-50% (up from 44.20% pre trt)
PSA 1.00 ng/ml <4.0ml

My very amateur assessment of these number tells me there could be some room to up the T dose some, how much remains to be seen. I was also wanting to know if upping to say 100mg ultimately, how much that will continue to move my hemoglobin, hematocrit, red blood cell count. I plan on donating blood but have not yet. The other question is how would I adjust my dose or change my regimen based on what appears to be historically lower SHBG. It also appears I don’t aromatize much i.e., lower E2 levels w/o an AI. I also plan on trying HCG to see if it is of a benefit. Not sure yet how much or often. Any advice or discussion is greatly appreciated. Thanks


#2

I’m no doctor, but if you are at 522 total right before your weekly injection I would think you are right on, as far as TRT goes. Of course I would always try to get my doctor to prescribe more T :wink:


#3

You have a valid point and I’m right there with you on having a little room to play with dose, but some where in my post I should have stated that I was splitting my 80mg dose into 40mg every 3.5 days. That makes me think that just roughly 76 hours later I shouldn’t be too far from my peak. I could be mistaken, but that was one of the reasons I was questioning a dose adjustment…


#4

It sounds as though you are feeling good? If so, I’d consider staying the course. However, I would not be opposed to going up, you might feel even better.

Do you want more children? If so, HCG.


#5

Thanks for the reply highpull. I am feeling better than pre trt for sure and also better than before that “experiment” I was on doing 100mg every two weeks lol. I’m in the process of trying to get this dialed in to be as close to optimal as I can, if I’m gonna do this. Probably guilty of being a little impatient during the process too. One thing I’ve noticed is that the first 3-4 weeks after I got on a weekly schedule I felt amazing, then that seemed to level off some, so I’m kind of chasing that or trying to get that back. Unfortunately more kids are not in the cards for me at this age, but I do plan on giving hcg a run soon. Actually have some on the way. Should be here within a week. Don’t know what my dose of that or schedule will be.


#6

250u EOD SC


#7

Okay, so I am still I the process of getting my dose dialed in and wanted some opinions. Since my last appt. and blood work I have been doing 50mg every 3.5 days along with 250iu 24 hrs prior to T dose. I’m feeling better than pre trt but don’t feel like I’m exactly where I need to be. Still have some lingering pre trt symptoms such as fatigue, libido not completely right etc. my most recent bloods are:

Total T 732 250-1100
Free T 145.7 46-224
Bioavailable T 306 110-575
SHBG 22 10-50
E2 19 0-52

Seems like there is room for me to bump up to 120mg a week or even 140mg per week. I hate having to ask my Dr. For an increase because he feels like I should be fine where I’m at. I appreciate and welcome any opinions or comments.


#8

Good to see SHBG increasing a bit.

Please fix: E2 0-52
you can also edit the post

Try to do labs half way between injections, closer to average. Time of office visit can be wrong or know what are good testing days and make office visits then. Do not change lab timing as that alone will shift labs.

hCG 250iu SC EOD is good. If you want to do every 3.5 days, do at same time as T injections to keep routine simpler.

You have two threads for your case, so posting the following perhaps a 2nd time.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you <<<<<<<<<<<<<<
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#9

Thanks for the reply. I apologize I forgot I had started an original thread and just added my most recent update to the most recent post. I submitted a very sound request to up my dose to 120mg through the patient portal. We’ll see. To me it doesn’t seem illogical or unreasonable at all. I have been testing on day of inject on a schedule of every 3.5 days because that’s what I’ve always read to do. I didn’t think it would matter much because I read a study about test peaks and of course day 1 is the highest but between days 1 and 4 there was only about 15% difference in the levels. I would like to see how I feel in the uppper third of the ranges as I have read most feel the best there. By the way ksman, what’s your take on free test vs bioavailable? What is the best indicator or test that’s available for use? Thought I had read where a certain prominent figure in the trt field felt bioavailable was the best measure bang for buck.


#10

FWIW my Dr. Agreed to bump me up to 120mg a week which I think might get me dialed in right where I need to be. What I am curious about is why is my total T pushing toward the upper limits just to get a free in the uppper third of the range. What will likely be the bottom of the upper third, especially with lower SHBG? Now my concern will be that my Dr. Will get freaked out when I have my next bloods and my total T will be around 950 but free and bio will just be getting good.


#11

Okay, because I have two threads going with my case I will link to my initial post here

I wanted to update my case and hopefully @KSman or those of you more knowledgeable than myself can offer some insight. As my last post stated, I have been doing 120mg of test cypionate a week, split into .6 2x a week. Previously when I was doing 100mg a week split, I was also taking 250iu hcg 2x a week as well, but I stopped that about 7 weeks ago so I was only working with 1 variable and I wanted to see where that put everything. Also I was worried about coming in high on this next set of bloodwork and it freaking my dr. and him wanting to dial me back, even if I felt best at 120mg a week. To summarize the last 6 weeks on 120mg, it has been okay but I think I may have felt better before at 100mg + hcg and maybe even 80mg + hcg. I was thinking that 120mg my have been pushing my e2 to the limits because I was more moody/ irritable, a little anxious at times and just not as relaxed. I also noticed less morning wood on the 2 days after my inject, but by the day of inject, I felt better and the morning wood returned. I also was not very interested in lifting or getting my workouts in although I did, and other days I was just dog tired. In addition I felt I was not sleeping as well. So I’m thinking this could be from lack of hcg, too high dose of T, or e2 creeping up. Last week I had private labs done to see where I was at peak, so I would know what to expect at the Dr. office this week and I also tested sensitive e2 (because I don’t think my dr. is running the correct test, as well has hematocrit because he failed to check that on my last bw) Here are my numbers from that draw:

Total T 941 348-1197
free T 38.77 High 5-21
% free 4.12 1.5-4.20
e2 34.1 8-35
Hematacrit 45.5 37-51%

Again, this was about 32 hours after my last inject which should have represented a peak. I had been testing on day of inject with my Dr. My questions are:

  1. why is free so high on this test? On the lc/ms/ms test my dr. runs for total, bio, and free, my free and bio are barely in the middle of the range. That’s why I increased dose to 120mg a week. (see previous posts). I am lower shbg and think I could be burning through my exo T pretty quickly. Can any comparisons be made between this test and the one my dr. runs? I have bw this Wednesday and again it will be on day of inject and actually just about 8 hours prior to inject.

  2. my e2 is at the top of the range and I believe my e2 generally runs low, but my dr. may not have been running an lc/ms test that is not sensitive, but regardless on the e2 tests he has run, it has always come up low in the range. And I have never taken an AI. So what inferences can be made between this test and the test my dr. has been running for e2? Could I be correct in that I have not felt as good on this dose because of e2 getting high, where mine is normally rather low? in other words could I have a lower threshold for the effects of e2 because I normally run low?

  3. I plan on starting hcg and may very well dial my dose back to 100mg or even 80mg a week after my next set of bloods. My Dr. shouldn’t want to see me for at least 3 months as I have been going every 6 weeks since January. I am reluctant to try hcg at my current dose even if that’s whats missing because I fear it causing e2 to go up more. When I dial dial back the dose, should I wait a period for e2 and T to lower/ stabilize before I start hcg? I’m really anxious to start it again, because I do believe it has value for me in the way I feel.

I apologize if this post is disjointed, I’m typing in a hurry and may have forgot somethings. As always I appreciate the time anyone takes to read and reply to my post.


#12

Just had another set of labs come back after going back down to 100mg per week, 2 injections and adding 250iu hcg 2x a week. I’ve also been taking 400mg of DIM 12 hours apart. Most recent labs were taken 32 hours after an injection:

8/14/17
Total T 882 264-916
Free T 31.13 5-21 High
E2 25.7 8-35

I’ve been at this dose before and that is stated previously in this thread but when I was tested that time it was on the day of injection about 8hrs prior to injection. At that time the numbers looked like this:

Total T 732 250-1100
Free T 145 46-224
Bio T 306 110-575
SHBG 22 10-50
Albumin 4.6 3.6-5.1
e2 19 0-52

Here you can see a stark difference in Free T values even though these are different tests. What I am trying to figure out is, does the 1st mentioned test calculate free T more loosely than the lc/ms 2nd test? Does it not include Albumin in the equation? Why is my free T coming out of the gates so damn high and then much lower in the range just 44 hours later. I’m thinking a lot of this is from me being lower SHBG. I want to know if it’s healthy to have free T high out of range and if that test is truely accurate. Is there something I should be doing differently in my protocol? Any help especially from @KSman on the matter would be greatly appreciated.