T Nation

Switched from Cream to Injections, Feeling Worse/Numbers Dropped

I am a 66 year old male/retired engineer. I have been on TRT since 12/2017.
I am not a body builder and the only work outs I do is on a daily basis around my mini-farm.
My PCP started me on a testosterone cream after doing blood work. I was constantly tired, experienced a lack of libido and began having E.D. problems.

Please see numbers below.
The cream did nothing for me… he believes I was not absorbing it.

He started me on Testosterone Cypionate - 200mg/ml inj.1ml.
I inject 1ml every two weeks in my thigh.
The last few months I have felt like I did when before I started… tired all the time, low libido, etc.
My question is why have my recent numbers dropped the way they have?

Blood was drawn fasting on the day of the draw. Also, I was due for injection (pre-injection each time.)
12/2/2017
PSA = 2.1
Total Testosterone = 345
Free Testosterone= 43.8
Bioavailable Testosterone= 86.2
SHBG = 34
Albumin, Serum = 4.3

After using T-cream from compounding pharmacy.
4/12/2018
PSA = 2.6
Total Testosterone= 383
Free Testosterone= 54.9
Bioavailable Testosterone= 115.2
SHBG = 29
Albumin, Serum = 4.6

After using T-cypionate i.m.
7/13/2018
T3, Free = 3.1
Red Blood Count = 6.14
Hematocrit = 54.1
MCHC = 31.4
RDW = 18.3
(blood numbers corrected with daily intake of one low dose baby aspirin.)
PSA = 2.4
Total Testosterone= 522
Free Testosterone= 67.5
Bioavailable Testosterone= 138.8
SHBG = 35
Albumin, Serum = 4.5

12/22/2018
PSA = 2.4
Total Testosterone= 1237
Free Testosterone= 189.7
Bioavailable Testosterone= 390.2
SHBG = 37
Albumin, Serum = 4.5

6/22/2019
PSA = 2.6
Total Testosterone= 271
Free Testosterone= 31.2
Bioavailable Testosterone= 62.7
SHBG = 37
Albumin, Serum = 4.4

As you can see, my numbers have dropped substantially in the latest test. Thoughts?

Please provide lab ranges for Free T. You need to describe dosing in mgs, if injecting 1ml 200mg strength then it’s 200mg or .5ml is 100mg.

These protocols suggested by the guidelines do not work because the person who wrote them never understood things very well, the half life of T-cypionate is 7-8 days. Clinical studies show these every two week protocols to be no good, this is not an ideal way to replace testosterone.

Most men inject one or more times per week to keep off the hormonal roller coaster, SHBG is a good biomarker for determining injection frequencies. I see a lot of men still have trouble injecting T once weekly.

If you inject T twice weekly by 3.5 days later levels will have decline slightly, more fluctuations can decrease TRT effectiveness in some men. You should inject (60mg) T two times per week (Mon morning/Thurs night) unless having sides, then more frequent injections may be necessary.

Most men are closer to 100-140mg per week split up however many ways you prefer, but SHBG should be considered. If you were to split up you dosage to 100mg weekly, it may not be enough based off your labs.

Your labs indicating you are drawing labs at inconsistent times. You should be drawing labs at trough or right before your injection, mid week is no good because we have no idea how low levels would be at injection time, if they are low then symptoms may be encountered and you would never know why.

I would also like to see an iron panel, MCHC is low normal and may be indicating an iron deficiency. Usually if your MCHC value is below 33 you more than likely have an iron deficiency which TRT will take to the next level.

A high RDW is usually indicating macrocytic anemia, we have something in common.

I had to stop TRT do to life threatening complications do to an iron deficiency, it can take a several months to recover.

This one is a little hard to believe, are you sure it was on shot day before the shot?
Inject at least once a week. Cypionate has a 7-9 day half-life, at least once a week to smooth out the levels. 100 mg is probably not going to get it for you, you probably need at least 150 mg a week. But, try once a week, 0.5 mL, for now and discuss bumping dose with your doc. Personally, I prefer twice a week, and some guys are every day low dose.

hardartery -

Yes. I am sure. As I mentioned in my introduction I am a retired engineer so I understand the importance of consistency in order to achieve consistent test results.
I too was very surprised to see those numbers.

Thank you for your input.

systemlord -

The dosage is 200mg/ml. I inject 1ml (200mg) every two weeks and always on Saturday morning.

I have been having blood drawn on the Friday or Saturday before I inject which I assume would be the trough or valley. Most of the time the draw has been on Saturday. I have the draw done the first thing in the morning and then I go home inject.

Thank you for your input.

This is the standard protocol used by PCPs, endocrinologists and urologists. Instead of 200mg every two weeks, you need to go to weekly injections. Most guys take 150-200mg once weekly. Some inject two or three times weekly.

Yeah, those levels drawn on day 14 after last injection pretty much put me on 200mg once a week. You could try 150mg and move up if needed, but I’m thinking you’ll be at 200mg eventually anyway. Given your levels at trough, and ongoing symptoms, your doctor may be talked into changing your dose. If not, you’ll need another doctor.

highpull -
Thank you for your input. I will see him tomorrow. I don’t know if he will let me go to 200mg once a week but I’ll see what I can do. Being on medicare as well as a fixed income do not leave me a lot of options. If he won’t do it then I’ll try splitting up the dosage into 100mg per week. I pay for the testosterone out of pocket as it is not covered by medicare. This old age ain’t all it’s cracked up to be…lol

systemlord -
The iron panel numbers all good with most being right in the mid-range. I did have high numbers in those areas you mentioned back in July of last year. Did some research before going to see the doc… gave me a pretty good scare. He put me on baby aspirin to correct the issues and the numbers have been fine since… go figure???

Yes, however, a good TRT program sure makes it better. I’m at the point where I think everyone over 60 should be on testosterone.

I agree 100%.