T Nation

Bloodwork on TRT - 6 Weeks Into It

Hello everyone,

I’m a 21 year old who has been diagnosed with low t just recently, and wanted to know how my lab work looks.

My doctor had me prescribed on 120mgxweek of test cyp and asked for blood work in 6 weeks time.

Here is what my values were for the 4 things he tested on trt (many other works been done pre-trt like lh/fsh/prolactin/etc)

Total test: 575 ng/dl
Free test: 161 ng/dl
Estradiol: 40 pg/dl
SHBG: 15 nmol/l

The test was done on the same day just before my next injection, as ordered by the doctor. So this is my lowest point.

Also, just to note, I have tried clomid and it didn’t work, so thats when he put me on trt. He seems quite knowledgeable on trt, even saying that he could put me on HcG if i face problems in terms of fertility down the road. I know many people have trouble finding knowledgeable doctors, and I know I must have lucked out on him.

Anyways, I just wanted thoughts on what you guys who are more experienced in this topic think in terms of my blood work and dosage. Thank you.

We need reference ranges for all labs.

Your SHBG is low, most men with low SHBG do better on more frequent dosing and some men are sensitive to fluctuating hormone levels, a perfect example, a man peaks 36-48 hours after an injection and peaks at 835 and 6 days later 575, this decrease in testosterone is felt by some men and can make TRT less effective.

Total T is not bioavailable, testosterone is bound to SHBG and loosely bound to albumin, the Free T is where the rubber meets the pavement and may be suboptimal and to feel like a normal 21 year old you may need optimal Free T levels, optimal Free T levels is at the top of the ranges or higher because often the lab testing method used is direct immunoassay which tends to overestimate Free T causing you to have suboptimal Free T.

My most recent SHBG test two days ago was 15 and while injecting EOD does work, daily by far produced much better results, however twice weekly produce pathetic results. You will see a lot of low SHBG men on T-Nation and other forums injecting very frequent, I find that using less to achieve a hormone level translates into me feeling amazing.

Frequent dosing also decreases estrogen without the need for estrogen blocking medications, of note your estrogen is high in relation to your SHBG and I would expect it to cause problems.

Of course if you feel great, then there is no need to fix what isn’t broke.

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I appreciate the response. Here are the reference ranges:

Total test: 249 - 836 ng/dL
Free test: 47 - 244 pg/mL
Estradiol: 8 - 43 pg/mL
SHBG: 10 - 80 nmol/L

Currently the way my testosterone is prescribed is in 1ml vials (200mg/1ml), so when i do my weekly injections, I end up tossing away whatever is left in the vial since it’s for single use and doesn’t have any preservation. So, this kinda limits me to weekly injections. I suppose I can send my doctor a email on this and if he is fine with me injecting everyday.

The truth is, I don’t feel much different, as someone coming from 280 total test(in the morning). Maybe it would help to split my dosages as u say.

I think my doctor said that he wouldn’t mind my trough days for my test to be in the 800s, so maybe he will increase my dosage and let me get to better levels.

In terms of estrogen, much like how my test is at the lowest level right before my next injection, does this also apply to my estrogen? Meaning, i might be in the upper end of normal on my lowest test day, but maybe im high during the early part of the week?

Exactly what I thought, suboptimal Free T levels. There are some men who see an increase in SHBG on TRT which is do to insulin resistance and/or obesity which can suppress SHBG. TRT also increased my SHBG and is less common, most men see a decrease.

I knew there had to be a reason for seeking help on a forum, people who do not have problems usually do not end up on T-Nation. These large decreases in levels between your peak and trough does one thing, puts estrogen over the top creating estrogen dominance because Free T is about mid-range and estrogen over the range.

Daily injections will keep testosterone higher in relation to estrogen, estrogen will come down while testosterone is higher. You’ll probably need Total T at least 650 to see Free T in the optimal ranges, daily injections will bring estrogen down.

Your estrogen at trough is over the range, it is likely much higher at peak, this is no good. Once you communicate with your doctor and he changes your script, I recommend 12mg daily to start out.

Losing weight (if overweight) will also go a long way to reducing estrogen, the aromatase enzyme that is responsible for converting Free T–> estrogen is found inside belly fat.

I also recommend a thyroid panel if you don’t have one already, TRT cannot work when there are thyroid problems. Those with thyroid problems will often state it feels like they are injecting water and they feel no different.

An iron panel, ferritin and cortisol is a good idea if you don’t already have them. I started TRT with an iron deficiency which block the metabolism boosting properties of thyroid hormones.

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Here are my thyroid values with the reference on the right:

T3: 3.3 pg/mL | 2.0 - 4.4 pg/mL
T4: 1.3 ng/dL | 0.9 - 1.8 ng/dL
TSH: 0.91 uIU/mL | 0.55 - 4.78 uIU/mL

How do these values look in your opinion?

That’s pretty good, I don’t see any problem and looks similar to my own. You want Free T3 about mid-range or slightly higher, but sometimes Reverse T3 can be elevated and block Free T3, but usually TSH is elevated 3.0> in these cases. 95% of the healthy population has a TSH <1.5.

I believe your issue is these infrequent injections, spend some time on T-Nation and you’ll see it’s quite common. High estrogen has a way of making it seem like TRT isn’t working.

Be aware it can take 6-12 months to see massive improvements, mosty see significant improvements in about 3 months with continuing to see improvements to up 12 months.

I started out once weekly and didn’t really start feeling it until I started injecting EOD and then ED which really forced change quickly.

Please do yourself a favor, use 27-29 gauge insulin syringes and make your life painless, inject in the shoulders and quads.

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Thank you so much for the help. I’m going to see if my doctor is okay with daily injections since I personally have no issue with it. He seems very cool, so I doubt he will reject it. He probably will also prescribe me an AI if i need it. He has explained to me that a lot of people on trt use an AI when they don’t really need it and end up being too low, and he said being a bit higher is better than being a bit low.

But like you said, I’m probably way too high early in the week.

Another thing, do you think it’s okay to reuse single use vials? In theory, it goes bad after your first use, but if I were to just keep reusing it throughout the week, would it be a problem?

Also, just to be clear, it’s an actual vial not a ampule. I know both can be 1ml.

I would be careful with an AI, most don’t need it with TRT doses. And it has some negative effects longer term. Also if you are going to inject every day try to do subq injections. less holes in your muscles in the longer term. Or do a smaller gauge needle so you can do more shallow injections into the delt and thighs. Always rotate injection sites with frequent injections.

You really don’t want to be on an AI, it can cause problems, let’s try daily dosing first and see it you can dial-in without the AI. Seen too many men on AI induce E2 roller coaster come out of it with wrecked joints, this would ruin your summer.

All test should have a preservative in it, you can check with the instructions inserted with the vial.

I have single dose vials which say “single dose vial” yet lists an preservative and alcohol which is used to prevent bacteria.

Ah yes, you are right. My pharmacist said it didn’t have any for some reason. It has 9.45mg of benzyl alcohol/1ml

Mine says the same, 9.45mg of benzyl alcohol. You’re going to use it up quickly, remember you are injecting daily. Be careful listening to pharmacist’s, not everything coming out of their months is entirely accurate, their only human.

Back in the day men injected 200mg every 2 weeks from 100mg/10ml vials that wouldn’t be used up for months, yet today pharmacist’s are saying discard after 28 days.

It’s big brother being overly cautious, like an overbearing parent.