T Nation

New to TRT. Looking for Advice After Bloods


#1

Just got my blood work done.
I’m 31, 5’9" 79KG @14-16% BF

SHBG: 26.22
Total T: 377
Free T: 8.41 / 2.2%
Bioavailable T: 207 / 55%

The doctor (I live in Thailand mind you) gave me a prescription for test e. 250ml every other week for 3 months, then a recheck. Any advice you can give? based on experience please

Thanks so much. In this area I’m very clueless


#2

You would need to post lab ranges for better insight into your bloodwork, but your starting protocol is possibly setting you up for failure. 250mg (assuming you meant mg and not ml) every other week equates to 125mg / week. There are some guys who will do well with once weekly injections, but a lot will need at least 2X / week. Every two weeks is going to be a roller coaster ride for you.


#3

Lab ranges:
SHBG: 18.3 - 54.1
TOTAL: 249 - 836
FREE: 5.71 - 17.48 / 1.53 - 2.88
BIO: 125 - 412 / 35 - 66.3%


#4

So what would your recommendation be based on the lab ranges?


#5

I am not an expert or a Dr mind you, but your labs are pretty typical for what we see here. Most guys do great starting at 100mg / week with split dose at 50mg X2 /week.

For example… 50mg Monday morning and 50mg Thursday night.

At this dose, you are very highly unlikely to have E2 issues. Run this for 6-8 weeks and then have blood tests run again on Monday morning before your injection (assuming the above protocol)


#6

That’s sounds like a good idea to me. Forgive my ignorance but what is E2 and why would the doctors protocol maybe give issues?


#7

E2 is Estradiol (estrogen). It is naturally produced in the testes, but when you start exogenous T, the testes shut down T production. The Free T that you inject that is not bound to SHGB will be used by your body, and the rest either converted to E2 via aromatase, or excreted through the urine.

Too high of E2 level can cause anxiety, loss of libido, ED, and gyno. Too little can cause bone density issues and clicking in the joints. Either one (too high or too low) is bad.

No forgiveness needed. None of us knew ANYTHING about this stuff when we started.

Your Dr’s protocol will cause excess aromatase of E2 due to the high volume of T being injected all at one time. Due to the half life of the Test, your levels will peak in 48hrs or so. So if you look at the peak of a 250mg injection, then there will potentially be a fairly high amount of Free T available 48 hrs later, and thus, a higher amount being converted to E2. T starts falling after a few days but E2 takes a lot longer to come down. The long time between injections just begs for excess aromatase and higher E2 levels, which could cancel any positive benefits of TRT.

Injecting smaller amounts will lead to a more gradual buildup of serum level test in your system, and will most likely be utilized as needed instead of being converted to E2 due to too high of a concentration at one time.


#8

Thanks a lot for your time!

In 8 weeks what would I he looking for? What will the numbers do if E2 is high or low? Or do I need a separate test?


#9

You should have E2 tested separately. Ideally, and if your finances allow it, you should get…

Total T
FreeT
E2 (sensitive test if available)
SHGB
DHT
TSH
T3
T4
Reverse T3
Standard lipids and chem labs

I would tell you to throw in LH and FSH, but you’ve already started so that will do no good. If you have those numbers pre-TRT, it would be helpful to know if your issues were due to primary or secondary hypoganism. (This means whether your nuts stopped working, or your pituitary gland stopped asking for the nuts to produce T).


#10

These every other week protocol are not ideal and it seems whoever started these bonehead protocols never took into account the half life of T-cypionate which is on paper 12 days but 7 days in the real world, so it makes no sense to inject every 2 weeks.

Any doctor suggesting such a protocol is indicating your doctor is new at prescribing TRT and doesn’t do it often enough to see patient complain about the hormonal roller coaster effects.

Estrogen would be helpful in selecting a protocol since the larger the injection, injectable testosterones creates spikes in estrogen. Lower SHBG men tend to do much better on multiple doses per week. My SHBG is a few points above 18 and I do very well on 20mg every 2 days.


#11

I can’t for the life of me figure out why / how Dr’s prescribing TRT have not caught on to this!

I’ve never been to medical school, and only been doing TRT and learning about it for around 6 months and even I know that E2W is a very stupid, not to mention medically RISKY protocol!


#12

Standard of care suggests 200mg every 2-4 weeks, standard of care hasn’t been updated as with a great many things is ignored. Doctors have to answer questions on tests incorrectly to pass the exams because no one has updated the questions which are now proven wrong, it’s a crazy world we live in.

These lousy protocols drive hematocrit high and force doctors to suspend a patients TRT and it’s all the doctors fault, then the doctor says I’m sending you to someone else because he doesn’t want the headache anymore.

Doctors don’t give a F*** about learning how to do TRT the right way.


#13

Another great point.