T Nation

Help Interpreting Latest Results

Hello I’ve been on injections since last July. I’m 34, 5’6, 150 pounds. I take 0.25mg test cyp every 3.5 days. Prior to starting at all, FT was low, usually 9 or 10. SHBG was also low, I forget the number. Literally all other hormones were normal.

When I had my first blood test a month after starting…my testosterone was 650. Estrogen was 49. I had 6 month bloodwork and was surprised to see testosterone at 1050, FT was 35! They didn’t test estrogen and I’m kind of annoyed about that. Might ask them to send a script to check it as I’m concerned it might be high as i don’t have great libido still
Or great erections and I feel tired sometimes…as if I need an energy drink. To be honest - the libido, errctions, and tiredness are definitely better than when my T was in low 200s.

Anyways what does high FT mean? And why is my total so high? I thought when you are doing more frequent injections (compared to once every two weeks) you get small rises and small lows. I figured T would be in 600s.

Your injections of 2 times per week are not frequent at all. And 1 injection every two weeks is out of question for something that can possibly work.
Frequent injections means every day like many of us do. It is not necessary for everybody, but necessary for some people that are more sensitive or low - SHBG

Your free test of 35 is awesome if we speak in terms of numbers, dont care that it shows high on the lab ranges based on people with issues

The real questions are not the numbers but how you feel. What you described as downsides can be due to hormonal fluctuations caused by your low SHBG and not frequent enough injections.

I’m guessing .25mg of test is actually .25ml? .25mg would be nearly impossible to measure and big difference between 50mg, which if you have 200mg/ml, .25ml would equal and sounds about right. Or did you mean 25mg every 3.5 days? When in relation to your injections did you take labs?

Sorry that was a classic amateur mistake! You are correct, it was 0.25 mL every 3.5 days.

Although the timing is probably not ideal, I don’t really have any other times to do this…I took my injection Thursday night and then had blood draw Friday morning. In August when I had 650 testosterone I did the exact same thing. Thursday night injection, Friday morning blood work. Since timing is a constant between the two bloodworks, can you think of why testosterone jumped to 1050? And is it dangerous for me to have T levels this high long-term? Should I take less T…like 0.2mL?

Nobody knows. I would back off a bit and bring it down to the upper ref range.

Because you are measuring not at trough your numbers don’t really reflect what is going on accurately IMO. I would guess you would be peaking higher as it hasn’t quite peaked when you are taking labs, but numbers would actually be lower had you measured at trough, right before next injection. The lower trough numbers is what I would be more concerned with personally. Do you feel any better near your injection versus before your next? Do you feel a slump anywhere in the week?

So when the urology nurse told me to take once every 2 weeks and she made me do it in front of her to practice, that was shitty. I felt high for several days. Then normal for a few days, and then crappy for one whole week. Now that I’ve been doing every 3.5 days, the one great thing I’ve noticed is there is never a slump. Yes sometimes I’m tired but it’s completely random when. Right before next injection I usually feel completely fine. I basically never notice a high or low.

To me that says you are fine on the every 3.5 days. Not saying you won’t feel better with even more frequent, but its not screaming that you are feeling fluctuations causing your lingering symptoms.

Have you checked thyroid? Those symptoms could also be from a sluggish thyroid.

If it would ease your mind you could also try lowering your dosage slightly, but do believe if you measured at trough you wouldn’t be as concerned with your levels.

Yep I checked T3, T4, TSH at the same blood draw and all levels are normal.

Your problem is your SHBG was low prior to TRT and is more than likely even lower because TRT suppresses SHBG, so when SHBG decreases total testosterone decreases, free testosterone increases and now your protocol needs an adjustment.

Your free testosterone converts to estrogen and the best way to combat high estrogen is lower your dosage or inject your doses very frequently.

I had the same problem and is why I inject daily because I need significantly less testosterone to achieve similar levels and the only difference is estrogen is significantly lower. The majority of men aromatase less on frequent dosing because the amount injected is less and so you aromatase less.

Providers don’t typically test for estrogen and more often you have to fight with your doctors because they think it’s medically unnecessary and it’s just because they lack knowledge and doctors follow guidelines which are old and outdated.

@systemlord wait if SHBG suppresses testosterone, why did my total testosterone increase significantly since August?

TRT suppresses SHBG, not the other way around. You can see an increase in testosterone across the board because your body changed. As for total testosterone increasing, you put too much faith in lab testing as if it were the word of God, as if 1+1 = 2.

When you draw labs your levels are on a bell curve, not on a flat trajectory and the time of lab testing and when you test is, this bell curve will determine what you levels will be at that particular time.

The bell curves is much smaller if injecting daily, minimal peaks and troughs, but if injecting every 3.5 days, the bell curve is bigger and your levels are changing more rapidly.

Thanks for the info! So I’ll request a testing for estrogen because I’m curious where I am with that now. And then I’ll keep you updated.

Why do you think lab ranges are “based on people with issues”? That’s not how it works, at least in the US. (As in the range of TT is not determined based on patient samples submitted)

Because first these are average numbers of all people tested of all ages. Second who do you think goes to test for testosterone in most cases, people with complaints, right?

I can only speak for the US, but here no, saying they are “averages of all people tested” is not correct. I will say that I don’t work for a lab but I do often do work for companies involved with labs. When a lab is established or makes significant changes, they calibrate their ranges based on samples from the general population without regard to symptoms of low T or any other medical condition. They’ll get some healthy people, some sick people, etc…so sure, it could be better. Some (not all) labs will stratify some tests (such as testosterone) based on age ranges.

The best way I can put it is that 95% of the people off the street will test within reference ranges at a given lab for all tests - that’s the definition/standard of reference range. Procedures and equipment are documented down to model and serial number of equipment, vendor of consumables used in testing etc. Those ranges are then set in stone until they need to recalibrate / requalify / revalidate.

I’m not arguing they’re perfect for our purposes/needs…they’re definitely not.

This doesn’t just apply to testosterone testing. Your kidney function ranges may be stratified by ethnic background (my usual lab has a different range for kidney function (GFR) for african-americans vs others, for example.

I can see that for most labs, metabolic, cbc etc as those are ones that my GP would run with a yearly physical to make sure things are running well, not based on symptoms. But it seems most doctors do not ever run hormone panels unless there is an issue so it seems those type of labs would be heavily tainted with unwell patients. From what I have seen they are more of an investigative lab and not a routine one ordered by a doctor. I could be wrong but I believe the majority of the healthy population would not go in to get hormones done just to see where they are at nor would a doctor order them for the same reason. I never personally thought of it until issues starting rearing up. Based on that thought where would they get their “healthy” ranges if they are not ran routinely?

google eg ‘Framingham study’ and read the article below

Again - the mistake here is thinking the results are determined from “sick patient” specimens. They’re not. The reference ranges are determined before the first patient ever has their sample analyzed. As long as the lab is consistent there are several options they have - none of which is “the pool of all samples patients have sent to us.”

Sometimes equipment manufacturers list the ranges they’ve determined based on standardized sampes, then the labs will test against that with a given sample size (usually 100-200 patients) to verify that 95% of the patients fall into the range supplied by the manufacturer.

But again, the fact that only “sick” people request testosterone levels in no way affects the “reference range” - the ranges are determined before sick people send samples in.

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Alright that makes sense. I did believe that they were established from what was sent in from patients. When they say things like “established from healthy non-obese patients ages 19-39” I thought they were just eliminating those who had known conditions and fit the BMI standard of non-obese from actual doctor sent in labs.