T Nation

Doubling Dose Resulting in Only 50ng/dL Gain?


#1

Hey, brief question.

I'm on trt with my doc, and just peeped my recent blood test. He has me doing a TT test 5 days after injection, at 100mg/E3W my numbers were at 394ng/dL from pre-therapy 277ng/dL level. He doubled me to 200mg/E3W, new TT shows 446ng/dL.

Test taken 5 days after injection, and the recent one was taken on my second dose at 200mg. I would have assumed that the doubling of the dose would result in a comparable increase 277 > 394 being 117, I would have expect a result closer to 500ng/dL. Is it unwise to assume a linear increase would be seen? I don't know my current free t, the lab hasn't finished that one yet, so I lack said data. I'm also going to be changing to 200mg/E2W, I'd like E1W, but my doc wants to move through the process.

EDIT TO ADD MORE INFO:
-age - 35
-height - 5' 9"
-waist - size 36 pant, don't have waist measurement
-weight - 238#
-describe body and facial hair - body is a wookiee full coverage, not sparse or wispy, beard needs a shave every two days, full head of hair, but thinning.
-describe where you carry fat and how changed - I carry fat mostly in my stomach, only change within the last couple years is loss of about 45#.
-health conditions, symptoms [history] - answered further down stream in post #5
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - no hair loss or prostate drugs. OTC: Aleve. Rx: Albuterol, but I don't use it. testosterone cypionate, and diamox for use in climbs over 7000'. I just came off a 3 month run of Terbinafide for a particularly nasty case of foot fungus. Other than that, I don't use and Rx on a constant basis.
-lab results with ranges - provided downstream in post #5, can and will update THAT post with added data needed.

-describe diet - basics: shooting for 1900-2k calories daily, min of 140gr protein, carbs around 120gr, and then fats to round out the remainder. I've started a DIY Soylent, that can be found here: http://diy.soylent.me/recipes/choco-drank . It's 1847 calories, full RDA of micros, and gives me room to add in a whey shake after lifting. I'll use that 3 days a week or so. Otherwise, I eat a good amount of meat, veg, butter. Peanut butter to cut hunger as needed. Not a ton of starches, but a good amount of veg and veg juices (love carrot juice.) I tend to take in a lot of electrolytes, because I sweat like a horse, and if I don't, I get horrid cramping.

-describe training: Nothing too crazy, from May '14 until January '15, power lifting focus, 3 to 4 days of lifting a week, switching back and forth between squats or deads day, and then upper body day. Not a ton of cardio during this period, but a good amount of mobility like walking lunges, box jumps, pushups, dips and a good amount of work attempting to fix a medial rotation of the shoulders and quad/ham imbalance. Starting Feb, increased cardio to about 4 hours a week, stopped powerlifting training for now and started olympic lifting with a coach 2x a week for about 1-1.5 hours a session, and then an added extra day for back work. I had a peak in strength around the beginning of November, then things fell off. I'm just starting to get back to those weights with the squat, bench, and deadlift when I do test them. (seldom)

Prior to April/May, I've lifted, but nothing consistent or committed,and was mostly a lazy slob during my 20s.

-testes ache, ever, with a fever? No. I have had recent cramping in that region though when my potassium levels are fucked up.

-how have morning wood and nocturnal erections changed
Before TRT started, morning wood stopped, completely for about three weeks. Came back a few days after the first injection. Had some ED problems prior to getting my TT tested, and even instances of being unable to stay hard or orgasm during the sex act. That was a low point.

EDIT two, March 4 2015 to move lab data to one single place:
Labs:
TT - Current 446 ng/dL [range not shown on this report, I believe it was 300-900 ](I believe my OP was 449, which was incorrect.) Initial pre-TRT was 277 ng/dL
FT - 5.9 pg/mL range: {4.3-30.4}
E2 - Not tested.
TSH - 2.23 u[iU]/mL (lab range: {0.34 - 5.6}
What was pre-TRT LH/FSH? - Not tested.
If younger, test prolactin - Not tested.
fT3 - Not tested.
fT4 [please not T3, T4] - Not tested.

CBC - lot of data:
red blood cell distribution width: 13.2% range: {11.0-15.0}
platelet count: 269 10*3/mm3 range: {140-425}
neutrophils, segmented as percent of blood leukocytes: 58% range: {38-70}
monocytes as percent of blood leukocytes: 7% range: {3-11}
mean platelet volume: 10.9 fL range: {7.0-11.5}
mean corpuscular volume, RBC: 85.5 fL range: {80.0-98.0}
mean corpuscular hemoglobin, RBC: 29.6 pg range: {27.0-33.0}
mean corpuscular hemoglobin concentration, RBC: 34.6% range: {32.0-36.0}
lymphocytes as percent of blood leukocytes: 33% range: {15-48}
leukocyte count, blood: 7.64 10*3/mm3 range: {4.00-11.00}
hemoglobin, blood: 14.9 g/dL range: {14.1-18.1}
hematocrit, blood: 43.1% range: {43.0-54.0}
erythrocyte (RBC) count: 5.04 10*6/mm3 range: {4.60-6.00}
eosinophils as percent of blood leukocytes: 1% range: {0-7}
basophils as percent of blood leukocytes: 1% range: {0-2}

AST/AST - aspartate aminotransferase, serum: 32 U/L alanine: 44 U/L, lab range for both: {0-50}
fasting glucose - 99mg/dL, lab range {65-100}
fasting cholesterol [some guys are too low] - LDL 126 mg/dL range: {0-130}, HDL 45 mg/dL range: {40-60}, total 199 mg/dL range: {<200}


#2

Four reasons:

1) An increase takes time to build up. At a given point in time, your body has in it not only some fraction (say still 1/2) of the most recent injection, but say 1/4 of the one before that, 1/8 of the one before that, etc.

If your test had been done after an extended period of increased dosage, then all those previous doses would have been larger ones, leaving more in your system for the test. But that wasn't the case. The previous dosings, which might make up about half the total amount, were relative to the reduced dosings.

2) You may not have been fully suppressed at the lower dose; in other words, some natural testosterone production may have remained. Some of that may have been lost due to more suppression at the high dose. So the net increase may be lessened, with the increased injected amount partly counterbalanced by reduced natural production.

3) SHBG could have gone down a little, which would downplay how much your free T may have increased. SHBG is not constant.

4) There is day to day variation in levels.

Levels don't really come out to match exact calculations.

Every two weeks is not good for permanent HRT, but I don't know your doctor's plans.


#3

Hi DB

This is all more complex that most doc's understand. But you can do some reading here and understand more than they do.

If you are younger, we need to try to find the cause and see if can be fixed.

Please read these stickies in this forum: - they are not visually tagged, 7 in total
- advice for new guys
-- we need to know a lot more about you
-- note the first paragraph
- advice for new guys
- protocol for injections
- finding a [new] TRT doc

Standard protocol suggested here:
100mg T per week, inject 50mg twice a week [some inject EOD]
0.5mg anastrozole at time of bi-weekly injection
250iu hCG SC EOD
(read that first sticky to understand this)

Labs:
TT
FT
E2
TSH
What was pre-TRT LH/FSH?
If younger, test prolactin
fT3
fT4 [please not T3, T4]
CBC
AST/AST
fasting glucose
fasting cholesterol [some guys are too low]

Have you always used iodized salt?

If you are self injecting, you can spit doses as you please. You can't be tied to office visits!

Other than the technical stuff: What have been your health/libido/mood issues and what happing so far. Whats the time line. What other health issues? When do you think that T levels were becoming a problem? Did anything notable happen before that?

We do have some hyper-metabolizers of testosterone here who need 300mg/week to get what most have from 100mg/week. You doc will not understand that.


#4

Hey Bill, thanks.
I agree with your last statement, even though i have a mild issue with needles, I'd rather be on a once a week dosing, for a few reasons I'll get into.

As for point one, My understand was that test cyp has a half life of 6 days, so 18 days after injection it should be essentially kaput, and not contributing to t increase. If it does contribute over a longer period, and it finally surpressed my natural production, then yeah it makes sense.

As for SHBG, that makes sense, I'll have the free t value "soon", it's still in awaiting results status in the clinic's system. The BMP and Total T tests came out quickly.


#5

Yeah, working on that, the data available here is dense.

I'm definitely younger than I'd expect for TRT, 35. I do have a history of testicular trauma, two bouts of testicular torsion prior to 22. So, I haven't sat down with an Endo yet, but it would not surprise me if that was the reason.

They're dense, working through them. I'm glad the data is there.

I have a very strong feeling that to work this protocol, I'll have to go mix of legit and black market. We've been playing this trt game since December, and this is the first free t test I've been able to get him to order.

For example, I've been able to get TT, but not FT, no E2.

Labs:
TT - Current 446 ng/dL [range not shown on this report, I believe it was 300-900 ](I believe my OP was 449, which was incorrect.) Initial pre-TRT was 277 ng/dL
FT - Awaiting result.
E2 - Not tested.
TSH - 2.23 u[iU]/mL (lab range: {0.34 - 5.6}
What was pre-TRT LH/FSH? - Not tested.
If younger, test prolactin - Not tested.
fT3 - Not tested.
fT4 [please not T3, T4] - Not tested.

CBC - lot of data:
red blood cell distribution width: 13.2% range: {11.0-15.0}
platelet count: 269 10*3/mm3 range: {140-425}
neutrophils, segmented as percent of blood leukocytes: 58% range: {38-70}
monocytes as percent of blood leukocytes: 7% range: {3-11}
mean platelet volume: 10.9 fL range: {7.0-11.5}
mean corpuscular volume, RBC: 85.5 fL range: {80.0-98.0}
mean corpuscular hemoglobin, RBC: 29.6 pg range: {27.0-33.0}
mean corpuscular hemoglobin concentration, RBC: 34.6% range: {32.0-36.0}
lymphocytes as percent of blood leukocytes: 33% range: {15-48}
leukocyte count, blood: 7.64 10*3/mm3 range: {4.00-11.00}
hemoglobin, blood: 14.9 g/dL range: {14.1-18.1}
hematocrit, blood: 43.1% range: {43.0-54.0}
erythrocyte (RBC) count: 5.04 10*6/mm3 range: {4.60-6.00}
eosinophils as percent of blood leukocytes: 1% range: {0-7}
basophils as percent of blood leukocytes: 1% range: {0-2}

AST/AST - aspartate aminotransferase, serum: 32 U/L alanine: 44 U/L, lab range for both: {0-50}
fasting glucose - 99mg/dL, lab range {65-100}
fasting cholesterol [some guys are too low] - LDL 126 mg/dL range: {0-130}, HDL 45 mg/dL range: {40-60}, total 199 mg/dL range: {<200}

Have you always used iodized salt? - almost never.

I've been training fairly hard since last May, and things were "ok" and by ok, I used to be a moody, sarcastic asshole with a total lack of empathy. I'd also have depressive periods, hunting, camping, or shooting generally helped clear that out of my head though. Come halloween, the depression got real deep, almost fed myself a bullet. Around this time, I started noticing some ED issues that had been happening on and off since summer, but were starting to make me question my masculinity. Health was ok, except I hit a plateau in my strength increases, and began backsliding and losing strength in November.

Other general health issues: Issues with my knees, lot of joint inflammation. Migraines, which I keep under control with massive amounts of magnesium, non-malignant tremors that are controlled by magnesium and shooting (hunch from a neuro, and it worked...), and a smattering of food allergies that range from most grains inducing asthma and joint soreness, to nuts and wines causing itching. Other than that... over my life I've not had any broken bones, a few concussions, two instances of testicular torsion, one at 10, one at 22.

There was a question about hair...
My body is a bit like a wookiee, I shave once every other day and it's usually not too bad, and hair is thinning up top... which I don't think I can stop, if my uncle is any indication.
Fat, I had a recent DEXA scan, shows most of my fat is in my stomach area, and at the time of the scan, I was at 28.1% bf. (An improvement from a much higher number)

I'll edit my OP with some other questions found within the stickies.


#6

You cannot do TRT with an injection every three weeks. At the very least you need a once a week injection.


#7

Since I'm trying to work with my doctor here, I can get to once a week once I convince him. As of late last night he gave a go ahead for 200mgs once every 2 weeks.


#8

You are iodine deficient and TSH=2.3 agrees.
TSH should be closer to 1.0, the ranges are totally stupid and the docs don't get it.
Do you get cold easily?

Are you adverse to salt?

Please read the thyroid basics sticky.
- check your oral body temperature when you first wake up AND in mid-afternoon, post results [IMPORTANT]

Many/most who inject once a week have problems from falling T levels. Less often is all the worse. Don't get caught up thinking that you can rationalize doing things differently.

Get a good quality probiotic and take for a month. Find a good product at a health food store, hopefully refrigerated. Your gut flora is leading to leaky gut syndrome and food sensitivities result. Past use of antibiotics can lead to these problems. Adverse gut flora can also be responsible for mental health things going on the brain.


#9

Actually I misread your post and thought there had been only one preceding injection at the higher dose, rather than two.

The older injections still contribute even at that point, but to the extent of only about 1/4 of the total amount in the system, rather than the 1/2 in the above, mis-read example.

Agreed that that wouldn't be a principal cause then: it would be only a small contributor. The other reasons must be the main ones.


#10

It's quite simple to add in iodized salt. I just tend to use sea salt for everything because the flavor profile works with my cooking better, iodized salt is a bit acrid.
I'm definitely NOT adverse to salt, most people think I eat too much of it, my labs say different.

I don't really get cold until it's sub 30's F. Even then, it's not uncommon for me to be in shorts until about 10F. My issue is that I'm usually too hot, so it could be 50F with a slight breeze, and I'll be sweating a little. It's inconvenient and odd. I'll get the body temps. I'm traveling right now, but back home friday, so I can get data starting during the weekend at the latest.

I'm not really trying to rationalize much other than, for now I'd like to work with my doc as much as can to make him a contributing aspect of this therapy. However, if he doesn't start getting with the program, I'll start supplementing with black market stuff as needed. For example, just got my Free T number:
Testoterone, Free Adult Males: 5.9 pg/mL range: {4.3-30.4}

^ that makes me think it's time for an AI, no?

I'll be honest, I've always thought that probiotic stuff was bunk, but sure. I'll try it. The foods I can't eat jive a bit with a large spectrum allergy test I had done about a decade back. A month cycle of a probiotic definitely couldn't hurt though, and would probably be more effective than the yogurt I eat.

Thanks, KSman.


#11

Ok Bill, I'll keep that in mind. I'm working through the thyroid info today, and then SHBG.

KSman has me thinking about thyroid, I know my mom has a slow one, I wonder if this is part hereditary.


#12

ok, adding this post for three things:
1. Started iodine supplementation @ 450mcg+ daily
2. Started probiotic supplementation for the next month.
3. To chronicle daily body temps, taken orally, as requested, this will be added to this post as edits.

March 7: 97.4 @ 0915, 97.1 @ 1745

Adding new link:
Google spreadsheet I started for tracking my body temp for the next month.


#13

Ok, so a small update:

  1. Libido tanked since Sunday. (Last injection was the day prior.)
  2. Increasing iodine dosing.
  3. Consistent body temp checking shows low body temp.
  4. Right nipple is becoming sensitive, particularly to minimal stimulus, such as the t-shirt brushing against it.
  5. Taking a probiotic.
  6. I'm finding that inflammation is not healing at all. (Not sure if related, location is both knees, impacting squatting.)

#14

As yet, prolactin hasn't been tested, nor estradiol. On the other hand, it's been only a week since your post, perhaps you have these values on their way.

Philosophically speaking, for anything, among methods of diagnosis there are these:

1) Measure something which is a variable of direct interest. For example, measure estradiol level in the blood.
2) Try something which is a cure or correction for a given condition, and see if it cures or corrects. If yes, then this supports that the condition may exist; if not, it argues against the condition existing. ("Diagnosis ex juvantibus")

I'm a big, big proponent of #2 so long as it's backed up by #1 wherever feasible.

I would get your estradiol and prolactin levels for sure

Your condition could also be evaluated by seeing what happens with particular doses of pramipexole and letrozole. With your nipple evidence, I'd try the pramipexole first.

Well that is, I'd try it first after immediately ordering a blood test and getting the draw done post haste. I'd start the above while waiting for results if it were me; another person might well wait for the results.


#15

Correct, not tested, and no, not on the way. Doc wanted to wait 3-6 months into treatment before checking E2, and prolactin has never been discussed. With my nipple issue, I'm going to force his hand with E2. I'm going to see what research I can find for prolactin to "make the case" to him. As of now, currently not on an AI or hcg, so... while he was open to trt, he may not be the most experienced with administering it.

I deal with P&L amongst other things. I'm pretty sure we'd agree on this subject. :slight_smile:

So it might take time to get my blood tests, and I know I won't get an AI from my doc prior, is this where I should probably go source that for myself? Or would it probably be ok to let it go until results come in, which could be a week to two weeks max. (To be clear, not asking for medical advice, just advice based on experience, and a "what would you do if I were kin".)


#16

Another question Bill.

I'm taking the iodine and thought a light IR plan paired with monitoring body temp over a month period would make sense, and potentially rule out iodine deficiency. My assumption based on reading is, if iodine is too low, over the month period as I increase daily intake, I'll see a correlation in increased body temp, hopefully climbing to optimal levels.

Iodine supplement being used is a kelp supplement that supplies 225mcg per tab, and the plan over the month is to take in 112.5mg over the 30 day period, which gives a surplus of 105.5mgs, assuming a baseline dosage of 225mcg daily will be meet minimum daily need. It's far less than the example value of 750mg in the thyroid sticky, but my operational belief is that if I am deficient, this increase in iodine will aid in building stores, and will result in higher body temps, and a lower tsh if I can only get that tested.

I have a request in to an MD friend of mine for a referral to an endo that has actual experience with trt and thyroid issues, who can also deal with someone like me. We'll see how that goes.


#17

While body temperature, both generally and waking temperature, is often a valid indicator of thyroid status, it's not 100%. So long as temperature stays low I would want to be sure I had the best information I could reasonably have on thyroid status, but sometimes that isn't the cause of low temperature, but rather hypothalamic heat regulation.

For example, a person's body may maintain 37 C while generating tremendous amounts of heat, due to cooling being greatly ramped up, or maintain 37 C despite absolute rest. Thyroid is by no means the sole determinant of thermoregulation. Point being, temperature can't be taken as absolute proof.

I'm not sure if you meant mcg throughout but sometimes wrote mg, or indeed meant mg. I'm writing the next part if you meant mg... if you meant mcg, then never mind!

The elemental composition of the human body is very measurable (once a person is dead, but the value will not change much) and examples ahve been measured many times. I've never seen a value that would work out to much more than roughly 20 milligrams.

For example, in Elemental Analysis of Biological Systems, Volume 1 (CRC Press) 0.2 mg per kg is reported, which for an 80 kg individual would come to 16 mg. In The Elements, 3rd ed. (Clarendon Press) 0.3 mg per kg is reported, which would come to 24 mg in this example.

At any rate as personal opinion I don't think it takes a surplus intake of any large number of milligrams.

Now back to what would apply whether you meant mcg or mg:

I'd aim for about 1000 mcg (1 mg) iodide intake a day for a few weeks after which you could back down a bit.


#18

Ok, small update, wish I had more data than this.

Had an e2 check done.

Lab range: <29 pg/ml
My value: 68 pg/ml

Free T and Total T were supposed to have been ordered, but we not done.

Regarding iodine statements above, I went ahead with upping iodine supplementation, and I've since become fairly sensitive to cold, and paired with my sensitivity to heat, I'm finding I should probably live in an area that is 68F all the time. lol.

Bill - in relation to your last post, mcg where mcg is appropriate, mg the same. :slightly_smiling:


#19

I'll add, E2 value came in last thursday, doctor messaged me said he was going to confer with an endo to get dosage for arimidex. Haven't heard boo since.

Is it about high time to look for a new doc for this particular care? I'm not quite sure where to go from here except maybe look for an anti-aging clinic, and figure out if there would be a way for my insurance to cover it, as it is a PPO.


#20

Absolutely (as you know) you'll want to get that estradiol level taken care of.

Well, meaning mg, I would say that 100 mg-plus over and above daily need is more than necessary, many have had full improvement at much less and there's no evidence that so much is needed, but it least it's not at the extremes some go to.