T Nation

Can Wise Guy/KSMan Elaborate on Something?


WG and KSMan,
In the TRT Replacement sticky you two were discussing tests and Wise Guys said this:

First off you need to stop relying on inaccurate methods to measure steroids androgens. The FT serum assay is one of them, especially from Labcorp. It is known to be invalid and highly inaccurate.

And Just because increasing T = driving SHBG down = does not also equal increasing FT. You can easily increase TT and see no increase in FT, especially if SHBG is low (this will result in little circulating FT) or E is high.

You also continue to rely on an inaccurate estradiol assay as well (the one Labcorp uses through LEF)

Can you elaborate on this? Why are these tests inaccurate? Do you have any suggestions for more accurate tests? I am considering/researching TRT based on my LabCorp/LEF T numbers and would like to get the most accurate numbers possible (obviously.)



It is not generally true that TRT will not increase FT, quite the opposite.
Increased SHBG lowers FT. Low SHBG leads to more FT and lower TT.

Many work with Labcorp. Sometimes the report low end E2 falsely. This may be a regional problem. E2 is tested in local/regional labs. When one gets E2=22pg/ml while on TRT, guys feel very good. Quest is more of a problem for E2 as you need to know your levels before hand to order the right test.

I use Labcorp via LEF.

FT levels are variable for those not on TRT as it is released in pulses and has a short half life. When serum levels are variable... what is accurate? Note that there are different methods of measuring FT. FT from Quest can produce levels that are 4-5 times higher that Labcorp from the same blood drawing - yes that is bogus. You cannot compare FT across different testing labs.

Bio-t would be less variable. When on TRT with frequent injections, FT is quite steady and FT labs then are very useful. With transdermal T creams or gels, FT is variable through the day. Patches would be steadier than creams or gels. The FT patterns from creams or gels applied in the morning might be better than dead steady. But this is only speculation based on the fact that young men have this overall pattern to their pulsatile FT levels.


Well said Ksman.

I understand that for many, a grouped sale panel at LEF is all they have access to.

When trying to play guessing games w/ labs, also take into consideration that for many, symptoms can be a very valid indicator for whats going on, especially in respects to estrogen.

If your on 70mg worth of total T a week, be it from a gel or shot (and this 70mg seems to be the magical number; with shots, your getting a 70% rate, thus 100mg a week = 70mg. With gels, many take daily equivalent that factors out to about 7mg a day) and your not getting the libido/erection quality your looking for (and you have boosted DHEA and are using hcG) then your going to look to use arimidex. 1mg per week seems to be the magic number.

I would start @.25mg a week, and move up based on symptoms. Pay attention to erection quality.

Also note how Growth Hormone, thyroid levels and DHEA as well as cortisol plays a part.

I personally opt for a transdermally applied method of DHEA rather than pills.


I agree about symptoms and often recognize and get guys dealing with estrogen without labs. I just got a thank you PM from a guy who feels like KSman+adex saved his life.

Doctors are forcing us to become overly lab centric, because that is the way that they are and they are the gate keepers, sometimes the idiot at the gate, but the gate keepers nonetheless.

We know that guys who have low thyroid levels typically cannot absorb transdermal T. I have not ever seen a report of a guy with hypothyroidism who was successful with transdermal T. I think that there is really good reason to expect that they would also not absorb transdermal DHEA. There are others who are cannot absorb transdermal T and I have the same concerns about them too.


I have heard that too. It seems hypothyroid individuals have difficulty - I have heard that many retain water, and epidermal layer of water exists that prevents absorption. Something to note.

For those, for sure getting thyroid levels optimal is key. Shots of T and DHEA pills as well as pregnenolone pills may be more ideal.

Also note that Growth hormone does not always mean expensive recombinant GH. For many, a peptide such as GHRP-6 will suffice, and can be had for a dollar a day, some cheaper.

Oral GHRP is here now, and is going through some trials. Have not heard from those using it - yet.

But popping a pill rather than injecting at night seems much more ideal.

Boosting GH levels high is critical, and important, and, IMO, much more important that T. When GH levels are boosted high, sufficient overnight cellular repairs are made. Less T is needed to keep body at optimum.

Less T needed = less estrogen.

For those who have optimal GH levels, many are sufficient on 80mg of total T a week in conjunction with hCG. I have heard that from many. I have heard from many who have boosted GH and then were able to lower T, and did not need any estrogen control with less T.

For many, less T = Less E.


KSMan, I totally agree with you that low thyroid = non absorption. I have low thyroid and was on gel for 2 years with no results whatsoever. Almost made me giveup till I found this sight. Now, regarding E2: I am awaiting my E2 lab, but I am already going to start the adex because I know I have an E2 issue. I am only about 15 lbs overweight, but I have a bit of gyno. Also, I was feeling great for the first 3 weeks of TRT and now I am suddenly feeling not so good.

So, the reason for my post is to ask if someone could summarize the 'symptoms' of E2. I am a newbie and have read hours on this thread (this subject alone) and did not run across a summary. (I apologize if I missed it....)



'symptoms' of E2

Almost all of the symptoms of hypogonadism can occur to some degree when E2 is elevated while one otherwise has high T levels on TRT. With time, there would be more and more severe.

Your good three weeks then downhill is very typical of elevated E2 when starting TRT.


I'm another hypothyroid non-absorber. What is your current TRT protocol?


I am taking 50mg (.25ml of 200 strength) T-cyp, 2x/week for a total of 100 mg/week. I am injecting into my outer quad. Doc gave me script for 10ml bottle, so it will last me 10 weeks. I also take .25mcg of cytomel (pure T3). I used to take Armour, but discovered that I needed T3 more than T4. So, apparently I have a T4 to T3 conversion problem. I also have half of my eyebrows, which is a sign of low thyroid.

I find that when I go through a lot of stress at work, my adrenals can get burned out and cause heart palpitations. So, I have to take 5-10mg of Cortisol to heal the adrenals for a few months. (Had to buy it online cause doc does not know about adrenal fatigue). Recently, I have been having the palpitations after 5 weeks on TRT, so I took 5mg Cortisol 2x/day to help. But hopefully, it will get better when I get on AI in a few days and get rid of some E2.


tommyguy10: Your vial of T cyp will last 20 weeks. There are 20 1/2ml doses in 10ml

Armour was reformulated and many are having serous problems with its reduced bio-availability. Those who try other products are improving their conditions. I think that people are doing well on "nature thryoid" but I may not be recalling that correctly. Hopefully some others will jump in with more info.

Armour was the gold standard and now it is a disaster.


That is correct; however I believe many people are getting their doctors to use a compounding pharmacy to get their Armour fix with good results. What really hurt Forest Labs, who make Armour, was the AACE/ATA's stance that dessicated thyroid wasn't as effective for thyroid replacement as synthetic Synthroid because the dosage varied from batch to batch. A similar stance was taken against generics.

Either way, Armour had to reformulate. Even if you can get a prescription for it, there are frequent shortages and rumors that Armour may be pulled off the market...


Yes, you are correct about 20 weeks! I am embarassed to say I am an engineer....!

So, what exactly is the relationship between low thyroid and low T? Which one causes the other or are they totally independent? I've read to treat thyroid first, but then I've read where TRT can imnrove low thyroid. So, I am a bit confused.....


Low thyroid hormone reduces the testicles' ability to produce testosterone.

In a nutshell:

High Free Test
Low TT

Low Free Test
High TT

If low thyroid hormone is the cause, then proper treatment should result in an increase in TT. I believe hypothyroidism is also associated with higher gonadotropin levels (LH/FSH) which is in accordance with the notion that low thyroid levels negatively impact the testicles. Remember that primary hypogonads have higher gonadotropins due to testicular disruption. I believe this parallels people with hypothyroidism.

People with hypothyroidism also struggle with fertility since the Sertoli cells (responsible for spermatogenesis) appear to be impacted by low thyroid levels as well.

My opinion is that thyroid hormone is the theoretical horse while testosterone is the cart. You know the old adage you can't put the cart before the horse...