T Nation

KSman is Here

KSman, I updated my thread. Could you provide some feedback on my last post? Thank you sir!

http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/45_yo_starting_trt?id=6085392&pageNo=1

KSMan,

Thanks so much for your time! I have learned a lot from you already. And, as evidenced by the countless “Thank Yous” on here, you have changed many lives for the better!

When you get a chance, I added my labs as requested. Please take a look, let me know what you see, and how you think I should proceed.

Is there an optimum TT to fT ratio or a specific number we would be shooting for? I know E2 22 is usual sweet spot but is there a fT goal?

First, different labs have vastly different ranges and numbers. So you cannot easily compare or define such things in some cases. Quest FT has very high numbers.

FT near or at high range for old guys seems to work well, but many will not get there when their TT is limited to normal ranges and docs will often not want any labs exceeding normal high range. Younger guys will get more benefit from a given FT than old guys.

And FT:E2 is probably good metric as long as E2 is not so low that adverse things start to happen. So FT=30 with E2=30 would be 30/30=1.0 and FT=30 with E2=20 would b e 30/20 = 1.5. There is not real science behind that and I just made that up, but it does have merit. Similar to some androgen indexes that factor in SHBG. Note that more E2 typically increases SHBG and more FT or bio-T lowers SHBG. And also note that E2 blocks some of the molecular action of T at the cell walls. Both T and E2 affect gene expression inside the cell nuclei and the effects of one can also involve inhibiting the effects of the other.

SHBG is a big factor. SHBG is thought to increase with age. In many cases that would result from guys simply getting older and fatter with T levels that are also dropping. But in a TRT context, there can still be some odd things going on in time when T levels, E2 levels are maintained the same over the years. In my case, with 100mg T per week I started off with FT around 35 [Labcorp]. With no weight changes and waist size not changing, my FT levels dropped over the years and T dose was increased to restore some of the energy and libido benefits of the past.

Another issue is that labs have age brackets for ranges. Suddenly your high-normal range T levels can become high above range after a certain birthday. Many progressive TRT docs want to restore T levels to youthful levels. Ranges that decrease with age are contrary to that intent.

When there is a problem with higher levels of SHBG, TT levels become exaggerated vs FT levels. In such cases, TT should be driven above range to get FT to high normal. Most doctors simply do not understand the implications of T+SHBG been non-bio-available. In that case, bio-T would be the best target, but few use that. Higher FT may then drive down SHBG over time. Note that there can be other medical causes or drugs that affect SHBG and the liver’s ability to remove E2 from the blood stream that then increases E2 which can then increase SHBG. So functionally, there is a lot of potential complexity and variability and we seek simple metrics as guides. Sometimes we need to see when one needs to change the game.

Regarding Quest, is that the same company as Quest Diagnostics? Just curious, because that is where I had my last labs done.

If I come across information that I feel might be useful in a general sense for the thyroid and iodine, where is the best place to post that? The “Thyroid Basics” sticky?

Also, I posted one more set of questions before I start IR. I appreciate you looking at it!

Lab posted. Thought? Thank you.

http://tnation.T-Nation.com/hub/Fingerstyle#myForums/thread/5899094/

Can you please give me your thoughts on my current situation, KS?

You think better than I do!!

10 weeks in on TRT, diet is perfect, had lost 10 pounds in the first 8 wks now gained 4 pounds back and noticing quite a bit of lower leg swelling Any suggestions ?

Would really appreciate for you to have a look at my thread, KSman, thanks brother.

Hey KSMAN, I want to thank you again for the impressive help I have received through this forum and your replies to my questions.

I would appreciate your opinion on my new lab tests and the next actions to take: http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/trt_prescribed_infertility_concerns

Thanks again!

Howdy, KSman

I’d appreciate any thoughts you have on my case. Thanks.

No, no, no!

I had made a huge post and apparently it didn’t go through or I forgot to submit it. I re-wrote it, I’m really upset I wasted your time.

You’ve been a huge inspiration to me, thanks for everything.

KSman, question for you please.

Thank you for your time!

KSman, I have updates and questions for you.

Thanks a bunch.

Heya KSman, new to the board and hrt. Having some problems finding a competent doctor that will look more into things other than just my test levels and thyroid. Any help for finding one around the kc area. I tried pming but it said I’m not allowed to. Thanks man

KSman: Thank you my friend.

Hi Ksman,

Got back with some more labs. If you have time to have a look:

http://tnation.T-Nation.com/hub/shakespear#myForums/thread/6082070/

Cheers

I am New to the forum. I like the fact that you guys have taken a proactive approach! I recently started TRT and have noticed good results thus far. It took forever to find a doc that understood my needs in the Jacksonville Florida area. Thankfully I found him! No weird explanation needed… Seems like there are tons of docs in CA that know what’s up. Are most of you using HCG dosing every other day along with TRT?

The half life of hCG makes EOD dosing possible. Many have trouble getting hCG. That can be because of doctor ignorance or insurance driven restrictions.

Please read the advice for new guys sticky. Open your own thread and post your labs and details.

Hey KSman, you had given me a reply to my thread last week which I responded to. Been a few days now and I don’t think you’ve had a chance to see it since it’s buried in other threads now. I was hoping to hear back from your thoughts; http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/low_t_hypothyroidism_at_20

Your insight is appreciated man, thanks.