T Nation

Help Understanding Lab Numbers, Appt with Doc Tomorrow

Got my labs today, meeting with doc tomorrow PM. Labcorp did the work. Would like to add to my knowledge so I can have a more informed conversation with the Dr… Free and total T are low. Estradiol is very low it seems, did not expect that. High SHBG. Can someone take a look at these?

I would also like input on the T3 numbers. Came in at 3.5 (1.7-8.6 ref range). I read that a normal number here can still be bad and that closer to 1 is optimal. I have checked body temp orally the last 3 days and I am usually around 96.9 degrees.

Your pituitary gland should be kicking into overdrive to get LH to high normal in an attempt to increase T in response to the elevated SHBG , but that’s not happening. This is twofold a pituitary failure to respond appropriately and the liver cranking out too much SHBG.

High SHBG can be the result of starvation diets, certain medications and excess alcohol consumption. Would have liked to see Reverse T3 as this provides a more complete picture.

You will require supraphysiological levels of T, something a sickcare doctor may not allow.

I’m going to a “anti-aging, restorative medicine” doc. Hope that helps…
-I spent most of the summer dieting down, got down to 1700-1900 cals a day at the lowest. Doesn’t seem like starvation
-I cut wayyyyy back on alchohol 18 months ago. I used to drink about 6 light beers a night, now I have like 3 beers a week, sometimes not at all.

There you go, these doctors don’t have one hand tied behind there back and have more medical freedom to do what’s necessary.

Can you elaborate on “supraphysiological levels “? Like aiming to get me above the 800-900 level? My plan was to look at starting out injecting 100mg a weekly divided EOD. Obviously my doc may have other plans after seeing these numbers.

Pituitary problem…sounds like I have more research to do in understanding it and thyroid function. Could this be related to iodine deficiency?

Your Total T is nearly 400 and Free T is in the gutter, you will need supraphysiological levels or above the natural ranges to get Free T to healthy ranges (20-25 pg/mL).

Forget about Total T as it’s not bioavailable, it’s bound to SHBG. Free T is the free hormone circulating in the blood that matters most.

My Total T is 500 on TRT and Free T is 22 pg/mL, this is do to my lower SHBG (22). Higher SHBG men will need more Total T to equal the same Free T.

You will most likely need 1000+ to get Free T between 20-25 pg/mL.

Temperatures checking should be waking and afternoon, lower in the morning 97.4 and 98.6 afternoon. A thyroid panel is in order, checking Free T4, Free T3, Reverse T3 and antibodies.

Google “Optimal VS Normal Thyroid Levels for all Lab Tests & Ages”

With that much exogenous T should I be concerned with excessive aromatization? Per our previous conversations I really want to avoid AIs @systemlord @BrickHead @physioLojik

You can always increase injection frequencies (daily) and low the dosage to lower estrogen. No reason to add drugs to the your TRT protocol.

I have no comment on thyroid numbers.

Many men feel symptoms when T values are in the 300s. Hence why you’re seeing the doctor.

Estradiol might be low because of a relatively low level of T.

None of us are doctors. Hence I and others do not know what’s causing a high SHBG.

I recommend people stay away from anti-aging doctors. So perhaps I’m the wrong guy to talk to.

800 to 900 ng/dL is not supraphysiological. It’s high normal.

100 mg per week is all that’s needes for most men.

NO, high E is likely not a concern while on 100 mg per week. Everyone is different but I don’t know one person on TRT who takes an AI. Of course that’s only about a dozen people I know taking REAL TRT but it says something.

You’ll likely need a high dose of test to get your free test up, perhaps 200mg/week and a total test as high as 1400-1500. You should not waste your time with 100mg per week, 150, OK, but you’ll likely need more. Maybe not though.

No aromatase inhibitor.

SHBG being so high could be due to liver dysfunction. I’m not ready to say a disease or anything, but your liver enzymes are a little high.

Free T3 of 3.2 is not optimal and as mentioned other tests are indicated. Treatment here needs to be based on symptoms.

I think an anti-aging/TRT/hormone optimization doctor is where you need to be. You can not be diagnosed with hypogonadism with a total test of 396, therefore will not qualify for treatment in the insurance model GPs, ENDOs, UROs typically follow.

Good luck.

Thanks HP, and @BrickHead @systemlord . So doc gave me a scrip for Test Cyp and is letting me self inject. He tried to push AI but I pushed back and he relented. So for now no drugs. I am going to go with 150 mg a week to start divided into EOD, we have labs and a follow up appointment set for 6 weeks so we can re-asses.

My Thyroid numbers and liver enzymes do concern me somewhat and he did not have a whole lot to say (a bit disturbed about that). I have started this week supplementing with 25mg daily of iodoral to address any deficiency there. Selenium is not a problem, I eat Brazil nuts several times a week.

I guess we will see what happens with liver and Thyroid numbers in 6 weeks…
Can I expect the exogeneous T to help with those at all? You know, the body sorting itself out once you address a major issue?

I know yall aren’t docs but you’ve been a huge help and I really appreciate your input and advice.

You’re welcome. Why are you starting without 150? That’s a bit high.

@systemlord and @highpull both mentioned supraphys levels of T and up to 200mg weekly, I think because of the high SHBG levels. I’d love to get you guys chatting about this for more insight. Start at 100mg/week and go from there? I just want to do the right thing…I have read and learned so much in the last month but still feel overwhelmed at the complexity of this…

You’ll be more than fine injecting twice weekly, I don’t expect estrogen to become a problem and you doctor should see it as well. You’ll never need an AI, good call on refusing the AI.

If if estrogen became a problem which I seriously doubt, it’s nothing more frequent injections can’t fix.

There is no right thing, the right thing is whatever works for you. I think you’ll need at least 150mg per week. As I mentioned, starting lower is a waste of time. But, it’s your time and money. If you start at 100mg and are happy with the results you get, great. It’s your call. I’ll suggest that if you feel better and are happy taking 100mg, you’ll be even happier and better with 150mg. However, nothing wrong with the low and slow approach.

I know a lot of guys on TRT. None are taking less than 140mg/week. Zero. Probably two thirds are using 180-200mg. Some up to 250mg. Regarding injection frequency, 85% are weekly. The rest are twice weekly, zero qod or qd. If you want to inject every day, fine, it won’t hurt. As mentioned, more frequent injections will keep E2 down, as well as Hct and Hgb, neither of which are of concern to me.

It’s my impression that most of the guys here are here because they were not happy with their program/protocol. For example, a guy taking 200mg every three weeks is not going to be happy and might look to the internet to see what he can learn. The guys I know doing once a week, 150mg+ dosing are happy. They are not searching the internet looking for solutions.

I believe some over think this. One constantly “dialing in” their protocol, running multi doses and schedules, with and without AI, etc., never happy with whatever they are doing for long, jumping from doctor to doctor, are possibly looking for something that does not exist. Obsessing with tender nipples is another example. It’s not gynecomastia. It’ll subside.

I can tell you what I do, but that is n=1. Still, what works for me, might work for others. Likewise, I’m interested in what the other n=1s out there are doing.

You asked for it. For us hormone junkies, this is all good stuff. Good luck.

HP and @systemlord so I am 7 days into my protocol. Injecting 80mg Test, sub Q twice a week (third injection this morning). We’ll see what that amount does for my free T in about 6 weeks.

I gained 3 pounds since last Wednesday, I have changed absolutely nothing with my very consistent diet and exercise routine. Water retention?

Will the exogenous T have an affect on my high SHBG numbers?
Will it affect my thyroid numbers?

What and when should I start experiencing positive effects of TRT? I understand it’s not an overnight process…

Also curious how one differentiates a thyroid problem from low T, Seems many of the symptoms are the same.

3lbs is nothing. You might of Only gained 1 but the 3 is because the scale might not be perfect. Or maybe it’s water weight or the food form yesterday: who knows::: it takes a couple weeks of consistent checking to really realize if you gained weight that’s going to stick to you.

Body’s changing with hormones. It takes weeks. I’m 6/7 weeks in and I have glimpses Of feeling great and then horrid. I did change my protocol 3 weeks ago and that means I’m really at week 3. The goal is to stick to one dosage for 6 weeks at least. I had very sensitive nipples and on and off labido. My nipples are not as sensitive and now it goes away 3 hours after injection.

I am jsut going to wait 3 more weeks, take a blood test and asses how I feel. It’s hard work.

Some folks feel the beneficial effects of T quickly. I don’t for some reason. I envy them. 6-7 years ago I tried a shot of testasterone . 3 days later I felt so fabulous… I decided to not take anymore because I knew what long term usage would do to me: also I have addictive behavior. Anyways, that experience reminds me of what I am working towards. Mental stabikity and peace of mind damnit.

At week 3 My levels were 1300 and 27.5 free t. That is super high… but I didn’t feel any better.: my e2 was 27… not high at all.what the F right?

Anyways 2 weeks into the new protocol I was so relieved . I felt great. Then Sunday I hit depression. Three days later today I feel much better. It might suck again tomorrow; but eventually I will stabilize:

Everyone from my doc to people on this forum say this is expected. So have confidence in the majority concensus and stick with it: in the long run you will save allot of time doing this right.

You will see everyone’s response to TRT is different, some men have raging erections hours after their first injection and see improvements rather quick, then others take longer do to androgen receptor sensitivity.

The exogenous T will more than likely reduce SHBG, to what extent is anyone’s guess, it could be dramatic or then again you could be see a less dramatic reduction. Understanding that this process can be slow and drawn out will make this whole process easier on the mind.

The symptoms of hypothyroidism can overlap the symptoms of low testosterone, but they are some distinct differences, like waking up in the morning and feeling drained of energy and cold which would point to hypothyroidism.

My testosterone was slow low it affected my cardiovascular system and my blood flow throughout my body was low, this made me cold all of the time even though thyroid labs looked good.

Those 3 extra pounds is water weight and may not necessarily be estrogen related, you body should adapt weeks or months down the road as you improve lipids, liver metabolism etc.

Yep, I would gain 10 lbs about 10 days after starting a AAS cycle, and practically overnight about 10 days in. Probably estrogen causing water retention. Would slowly gain about 5 more pounds later, probably muscle.

Usually it does, decreasing, which will increase free testosterone percentage.

No.

Most feel some improvement within a month, some may take longer, especially if they need dosing adjustments. Increased energy, libido, strength, overall sense of well being. Decreased visceral fat which will take up to six months.

True, can make it challenging. Some end up needing both. Consider all symptoms and correlate with serum levels. If it’s not obvious both are deficient, nothing wrong with starting with one and go from there.

Is I am sorry I am late to respond.

My input:

I would have simply ignored the SHBG value and started with 100 mg per week. However, from reading your posts here, I am wondering who is running the program here, you or your doctor? Of course I am aware that a patient should have a say in what he receives or questions about why he is receiving a prescription in regards to dose and drug. Do you or someone just say, “I’d like to use 160 mg per week.” I know that’s not how my doc works, and he is great.

Anyway, I would have started with that amount and ignored everything in regards to TRT for one month. This would mean no thinking about estradiol, SHBG, dosage, other drugs (aside from another diagnosis), or even input from an internet poster such as myself or others. And then I would simply see what happened and how I felt.

Only then and if something was not right would I go back to the doctor with complaints.

Who knows? And if it is actual water retention, this might be an implication that you’re taking too much medication. Edema is not normal! Did you weight yourself before eating breakfast on all days you weighed yourself?

After being untreated for hypogonadism for over a year, it took me over six months to feel like I fully had my well-being and function back. However I strongly suspect some of the delay was because of a psychosomatic factor of a depressive mood because of a lack of treatment. Libido and erection quality took quite some time to come back.

At first I thought perhaps I wasn’t even getting the correct dose despite normal T levels because my symptoms were subsisting.

But after some time, I did what I just recommended: ignoring my symptoms while being treated and moving the heck on with my life. It worked out for me, which is obvious from my posts in this forum. So did HCG.

I tell men who are starting TRT to NOT discuss anything on the internet, think about “optimal” values (there is not any such thing), or think about every nuance of their function and well-being.

And as someone here said he doesn’t know anyone taking under 140 mg, I don’t know anyone taking anything other than 100 mg per week.

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