T Nation

Initial Labs, What Do the Experts Think?

What is going on guys, I have been lurking here for a couple of weeks and finally pulled the trigger on getting testing done through Defy Medical. I had some tests done about 3 weeks ago with a TRT clinic here in Maryland and the doctor told me that he did not test for SHBG. Price was 299 a month so I decided to hold off on it. I contacted Defy and got the tests done again and got my results and got an appt on Tuesday with Dr. Saya. What do you guys think of my results, I am 32, been having low energy for years now, low motivation, moodiness, experiencing bad memory, brain fog, and gaining weight for the past 5 years no matter how much I kill myself in the gym which ties back to the loss of motivation. I know I gotta lose the extra weight and I have gotten myself in the gym 4x a week regularly. What do you guys think of these numbers?

Testosterone, Serum 248 ng/dL (264-916)
Free Testosterone(Direct) 11.5 pg/mL (8.7-25.1)
TSH 1.7 uIU/mL (0.450-4.500)
Estradiol, Sensitive 23.5 pg/mL (8.0 - 35.0)
DHEA-Sulfate 491.2 ug/dL (138.5-475.2)
Prolactin 14.6 ng/mL (4.0-15.2)
SHBG 28.1 nmol/L (16.5-55.9)

The previous TRT clinic is pricey and refusing the most important test for evaluating a testosterone deficiency is an indication this clinic is just selling products for profit without actual hormone knowledge.

Your levels are low and estrogen good, but once you start TRT I expect estrogen to shoot up high, there are two ways you can minimize estrogen sides, multiple injections per week or an AI which isn’t recommended without first attempting to alter your dosing frequency.

There are some men who are AI over-responders needing .125 once or twice weekly and some who AIs completely wreck everytime we tough AIs. Lose the extra weight and estrogen will decrease.

TRT will decrease your SHBG making you a low SHBG guy, low SHBG guys do best on more frequent dosing, everyday or EOD using 27-29 gauge insulin syringes in the shoulders and quads.

You definetely have low T but you also need more tests, like LH, FSH, Vitamin D, Ferritinin, CBC, PSA, T3, T4, Reverse T3, Prolactine. All these are very important and Magnesium and Zinc would be useful as well

I’ve seen this thrown around a bit - that low SHBG guys do best on frequent dosing. Could you please explain this? What is wrong with having low SHBG? To me that seems like a good thing. What are the consequences?

Low SHBG is associated with metabolic syndrome and diabetes, SHBG binds testosterone, estrogen, insulin and thyroid hormones. Lower levels will see less binding of androgens and estrogen making most of the hormone free, this is one reason why more frequent injections is needed.

Low SHBG men tend to metabolize testosterone more quickly do to most of the androgens being free rather than bound to SHBG. In my case I had low SHBG pre-TRT and TRT increased my SHBG because of high insulin levels and obesity were suppressing my SHBG.

See here your Total T is very low and your Free T is not super low, this is do to SHBG not binding androgen strongly, you actually appear to present with someone who’s SHBG is lower.

Your Total T and Free T ratios match up with someone who has lower SHBG (<15). Twice weekly dosing will be a mistake, daily injections will provide the best results, otherwise I expect excess T and E2 will cause sides.

When I say excess T and E2 I’m talking about when someone injects twice weekly, they are having to use more testosterone to compensate for the loss in testosterone that occurs between your injections.

Your estrogen is already about where you want it, probably closer to 30 (or <35), when you double your Total T and increase Free T, estrogen will climb as well, more than likely double or triple making you estrogen dominant.

Typically healthy male with the correct Total T to estrogen ratio = Total T 800 and estrogen <35. An estrogen dominant male = Total T 500 (264-916) and estrogen 60 (8-35). The total T is 500 mid-range, estrogen at 70 is double the reference ranges.

I see. In that case, would I be better off taking an AI? I have seen people here to advocate against it or at least avoid it for some time. I saw others that said that they would take it if they had any symptoms while they lost the weight which I think will be my case. I am planning on also doing a comprehensive thyroid panel once I start the govt job I start next month, since getting out of the military I have been working just one job that does not pay much while I wait for the other one. I heard iron deficiency may be another issue, I’d have to look deeper into that one as well. Thanks for everything so far systemlord.

You’re welcome.

It just so happens I started TRT 2.5 years ago with an iron deficiency, iron was barely in range and why doctors never said anything, but take a look at iron saturation or being capacity, both were dreadfully low. I had iron in the blood, very little in the organs.

You cannot just go to an ordinary doctors for endocrine disorders, if you are considering going to the VA for care, please save yourself the trouble and do not! Managed healthcare doctors and just not capable to deal with these problems related to the HPTA.

You need to seek someone private who specializes in this area of medicine. If you want to work with the best doctors, consider traveling, consider Dr. Rob Kominiarek, he has corrected testosterone deficiencies with iron and potassium. If this guy cannot fix you, no one can.

People fly from all over the world to see this guy.

So finally had the appointment with Dr. Saya. He put me on 128mg(64mg twice a week) to start and also 0.125mg of Anastrozole twice a week as well. He said that once I start losing the fat we may come off the AI completely since being overweight will make make the test convert more to estrogen. I am just waiting for supplies to arrive. He said to experiment with IM or SubQ and that it was up to me. I got a 25ga 1/2 inch needle from work and jabbed in in the belly and wasn’t bad at all (I did clean with alcohol pad), then I tried the thigh and damn did I feel that s****!! Anyways, that’s the starting protocol, we will revisit in 3 months but I think I may do some blood work before just so I can see how everything is going. You guys have been awesome, I definitely will stick around this site.

Well, had my first injection today. I’m doing 64mg E3.5D sub-q and was told to take 0.125 Anastrozole twice a week as well. Estradiol was 23.5 (8-35). Couple of questions:

  • Should I hold off on the AI until I have symptoms or should I take it anyways?
  • Does it make sense to take it the day after injection or same day?
    Thanks in advance guys.

I’d hold off on the AI. Most people don’t need it after they get through a few weeks.

Thank you. I appreciate the response. I will be holding off on it and maybe do some lab work in a couple of weeks to make sure that E2 isn’t getting out of control.