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Follow Up Labs, But What Do They Mean?

These are the follow up lab results at 3 months. I take 50mg (4 pumps) every morning at 7 AM of testosterone 12.5 mg/ 1.25 gram (1 %) gel in metered-dose pump (Commonly known as: VOGELXO 1%). My initial numbers were 303 Total T and 38.3 free T. Test was taken at 7 AM BEFORE taking my normal morning dose so this is what my levels look like 24 hours after application. Presumably they would be higher the day before.

Component Your Value Standard Range
Testosterone, Total 516 ng/dL 250 - 1,100 ng/dL
FREE TESTOSTERONE 77.8 pg/mL 35.0 - 155.0 pg/mL
ESTRADIOL 16 pg/mL < OR = 39 pg/mL
LUTEINIZING HORMONE <0.2 mIU/mL 1.5 - 9.3 mIU/mL
5-A-DIHYDROTESTOSTERONE BY TMS 141 ng/dL 16 - 79 ng/dL
Hemoglobin 16.6 g/dL 13.7 - 17.7 g/dL
Hematocrit 49.0 % 41.5 - 53.8 %
PSA Total EXT 1.0 ng/mL < OR = 4.0 ng/mL
Cholesterol 200 mg/dL <200 mg/dL
High Density Lipoprotein Chol 52 mg/dL >40 mg/dL
Triglycerides 76 mg/dL <150 mg/dL
LDL 131 mg/dL (calc) <100 mg/dL
Total HDL-C Direct 3.8 (calc) <5.0 (calc)
Non HDL 148 mg/dL (calc)<130 mg/dL (calc)

They mean that your free test is mid-range and everything else sucks. Any other questions?

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I got the mid-range part. Want to be a little more specific about the “everything else sucks”?

Your E2 is too low, your total T is not great, your HDL’s are actually awful. You are underdosed, I don’t think that you’re getting enough absorption from the gel and should consider using something else, from a purely numbers perspective. But, how do you feel?

I feel much better than I did before I started treatment. More energy, improved libido, improved erection quality, getting good results in the gym. My only complaint right now is I feel like I might be at a low ebb first thing in the morning. Sometimes my wife wants to get busy in the morning and I feel like saying leave me alone, let me sleep. That’s certainly not what I would have done 15 - 20 years ago. But during the day and at night I’m ready to go. That’s why I tested first thing in the morning before taking my dose. As far as absorption, based on the documentation that comes with the gel I’m pretty close to where it says I should be: 516 vs 555 for the 50mg dose. I could see if the doc will bump it up to 100mg.

Your trough levels are low, you need more T-gel. This is where injections is king, you can have Free T levels high normal all the time and keep levels static. Men over time find levels decreasing on T gels developing poor absorption over time, creams applied to the scrotum are more effective with 8x times more absorption than anywhere else on the body.

Where your numbers are at, near 24 hours and about to apply again, i personally think your numbers are relatively good. Your e2 needs to come up though. I imagine if i tested then, rather where I do now I would have similar numbers. I test 10 hours or so later and i am at 800 with free t just slightly above range. You are only that low for a couple hours.

How would you get your e2 up? If free T metabolisms into e2, then I’d have to use more gel to get the total and free T higher, right? What are the issues with low e2?

This stuff (generic Volgelxo) specifically says not to apply to scrotum. I wonder if that is because the absorption would be higher and mess up their dosing rate. I’m going to ask the doc to up my dosage to 100mg and see what he says. With any luck that would boost my total up to around 700ng/dl, raise free T and e2, and eliminate that low trough. I think that would be a reasonable level, nothing that he should be overly concerned about.

Are you taking any supplements or AI? If not, yeah getting more T is probably your only option of getting your e2 up.

I’m guessing the stuff your using is a gel? That is why they say not to apply to the scrotum. Gels are usually alcohol based and would cause irritation/burning on the sensitive skin of the scrotum

Yeah, it’s an alcohol based gel. I’m not taking an AI or any supplements.

What about the dihydrotestosterone level? That looks really high. I haven’t really read anything about that.

High DHT is actually probably making your free T higher, as SHBG has a greater affinity for that than test. It also wil mean your libido is better. Lots of things raise E2, but mostly your test level isn’t high enough and they try to be in ratio with each other.

Yeah I’m not sure how big of issue that is on the DHT. I know they fear for the prostate with it but I dont know how much of that is outdated thinking. Mine is at 260 right now and trying to get it down with saw palmetto. If i dont ger it down i am switching to injections

My doc actually believes that it lowers it due to it being eaten up by the conversion and leaving less available. He says that more for the total though not necessarily for free. Not saying i believe him on that, just different perspective.

I found this really interesting article on the role of estradiol in men: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854098/.

Of particular interest for me is this section:

In addition, a study by Ramasamy et al . in 2014 showed that libido was increased in men receiving TST when testosterone levels were >300 ng dl-1 and estradiol levels were >5 ng dl-1. Most compelling is the fact that in men with serum testosterone <300 ng dl-1, sexual drive was seen to be markedly higher when estradiol levels were >5 ng dl-1.19 In addition, when patients with low testosterone were treated with letrozole, a potent aromatase inhibitor, libido was decreased, suggesting that complete elimination of estradiol and decreasing the T/E ratio too severely, adversely affects sexual desire in men.20

  1. Schlegel PN. Aromatase inhibitors for male infertility. Fertil Steril. 2012;98:1359–62.

I had to convert from pg/mL in my lab report to ng/dL but it looks like my 16 pg/mL is only 1.6 ng/dL, well below the 5 ng/dL they are saying raises sex drive. Of course that would mean I’d need 50 pg/mL and the lab range only goes to 37 so I’m not sure that is directly comparable. Labs result are weird like that sometimes. Not that sex drive is really an issue right now but it could be better in the morning.

Looks like this was the wrong E2 test. Admittedly I didn’t know there was more than one and apparently the doc didn’t either but I noticed some mention of this in some other forum posts and went back and checked my lab report and found this:

ESTRADIOL 16 pg/mL < OR = 39 pg/mL
Reference range established on post-pubertal patient
population. No pre-pubertal reference range
established using this assay. For any patients for
whom low Estradiol levels are anticipated (e.g. males,
pre-pubertal children and hypogonadal/post-menopausal
females), the Quest Diagnostics Nichols Institute
Estradiol, Ultrasensitive, LCMSMS assay is recommended

(order code 30289).

So it looks like I need to have that test redone.