T Nation

TRT Blood Work Question

Hello, I started TRT @the beginning of 2013. Took a while to educate my doctor with what I have learned here.
Beginning total T 437
Free T 67.4
She didn’t think I needed to test E2
Started with Androgel and no improvement
Had me try the other cream T went down to 360
Finally put me on test cyp 100/mg 2 times/wk 50mg ea
This started in September and I just got results.
Total T 1335 ng/dL
Free T 353
E2 42 pg/mL

She wants me to stop for 3 months and get blood work again. I think that it’s bullcrap to have to start over. Suggested she reduce my Test. Cyp. And prescribe an ai. What do you guys think? Also, I will try to get SHBG tested next time. Thanks

Other stats
Age 58
Wt 200
4 years training- currently a 5 day split
No alcohol, cigs or drugs for 5 years.
Very good diet and plenty of rest.
Mentally clearer than ever and all equipment works.

Did you have symptoms of low T when you had T = 437? A lot of men (even athletes) will do fine on those levels naturally. You should really have had another test to get a better picture of what is going on before getting on TRT, since maybe you just had a non-optimal day when the test was done.

Having said that, I don’t see why she would take you off for 3 months unless she wants your natural production to kick back in and then retest your natural levels to confirm whether you are really low. She may be having second thoughts about having put you on TRT with a level that would not normally make you a candidate for TRT. Either that or she has no idea of the half life of T-cyp, which is also possible.

437 total T at 58 is impressive.

Based on your Total and Free T I’d bet your SHBG is somewhat low,
meaning your natural level of free T at 437 was probably mid upper range.

That said, if you are feeling way better than pre TRT and you are 58, shit…stay
on it. I just turned 45, and it seems to me that as you pass 35, everything seems
to go downhill as far as health. I plan to be a beast when I turn 55, 65 even 75.
This takes effort on my part in terms of lifestyle, diet, exercise and proper supplementation
including TRT.

As far as the three month break, you are spot on…total crap. At this point you have been
shut down for a year. Your natural T will have a lot of trouble restarting on it’s own, let alone with
a proper pct. The three months will be agony for you.

You can try and reason with her, or find a new doc, but based on the comment of her not thinking
e2 testing isn’t necessary you should start looking for the replacement now.

Thanks guys. As I remember when I started, the 437 was towards the low end but I could be mistaken. All I know now is that I’m finally losing that belly and lower back fat while gaining some lean muscle. PKNY, so are you saying that the reason my free t went so much higher, percentage-wise, is my SHBG?

Wanted to update you guys. Told her nurse about how I would crash. Just got a call and we are going to try the 75/mg and she prescribed 1/4 tab of arimidex (got anastrozole) eod and I will try this for 3 weeks and blood test then. Thanks for the info and I’ll report results later.

[quote]Almostnormal wrote:
Wanted to update you guys. Told her nurse about how I would crash. Just got a call and we are going to try the 75/mg and she prescribed 1/4 tab of arimidex (got anastrozole) eod and I will try this for 3 weeks and blood test then. Thanks for the info and I’ll report results later. [/quote]

Are you getting your prescription in small 1ml of 200mg testosterone cypionate or a larger 10ml vial? Do you use LabCorp Quest?

Let me give you some advice. When a doctor gives you an amount of testosterone… take it and don’t ever say anything to indicate you need a lower dose. If that is the case just inject less. Don’t tell your doctor.

Doctors know less about male hormone therapy than anything else in medicine. So become an amateur endocrinologist and don’t just read the stickies, memorize them.

Also if you do subcutaneous injections you can rotate several inches around your navel. Rotating injections is a subject you need to familiarize yourself with or you will develop corky hard areas from scar tissue (even with the insulin syringes.) The sub q injections will give slower absorption and less of a T spike and should be less aromatase.

This will lower your estradiol levels which is a good thing. Ideally you want it to be in the low twenties, yours was 42. If it goes too low you will have problems and if it goes too high you will have problems. Ironically both high and low E2 levels affect your libido negatively.

I would lower my T dose a bit the week before having blood/lab work. If your blood/lab work is on a Friday then inject on the Saturday before. Don’t do two injections on lab week, do it all in one.

T peaks at 48 hours and you don’t want to test at it’s peak either or you get a false high reading.

If they are including a PSA lab (prostate) don’t have sex for 48 hours prior to drawing blood because that can give false levels.

Thanks C-dog
The first 2 times were 10ml vials but insurance switched to the 200mg ones. The only reason I agreed to cutting the dose was that she wanted to shut down totally. You’re right on about the lack of knowledge of my hormones. Hell, if it was my wife there would be no questions! At least with what I’ve learned here through the stickies and also posts for from men like you,PKNY,etc?.., I’ve been able to get her to try new things.
You can bet I will be following your advice about the week before my test. Any thing I need to do to my AI dosage that week?
Thanks again

but insurance is now on

If your dosage is 100mgs per week split into two injections

Dropping your dosage down to 30mgs twice per week will probably give you a Total T of 800 with estrogen in range without the use of an AI. This is the best suggestion honesly. Your Total T is 200 points over the range so you need to lower your dose anyways for the long term to avoid issues.

Adding an ai, you will have to end up tinkering here and there to try to dial in and I doubt you’ll ever feel 100% with hormones varying all of the time.

800 total T is great anyways without the use of an AI.

Lower your dose, then re-test blood work in a month to see if an ai is needed but it shouldn’t be with your current levels. It’s just another drug with side effects that you’ll have to worry about.

Don’t just chase a number though, remember TRT is about feeling great not Acing a blood test. If you have High E symptoms, then this is an issue.

Lastly when was this blood work taken in relation to your injection?

[quote]PKNY wrote:
437 total T at 58 is impressive.

Based on your Total and Free T I’d bet your SHBG is somewhat low,
meaning your natural level of free T at 437 was probably mid upper range.[/quote]

Well not quite, I mean test drives down SHBG and age increases it. Before going on trt my SHBG was 70, now it’s 30, but I do agree that at 58 you should definitely be on TRT and you almost surely had high levels during your youth. I’ve only seen a few people who can get away with a 1000+ test level without their estrogen being ridiculously high, without the use of an ai. That combined with the fact that you have a 437 test now a days at 60.

Anorm,
Super High Free test is a dead give away for low SHBG.
You didn’t list the range for free T, but If it was Quest, the upper limit is about 150.
Yours was 353. I’ve had #'s very close to yours with 200mg Cyp per week and no AI.

Are you certain you were using just 100mg per week ?
Were you maybe doing 1cc of 200mg/ml per week thinking it was 100mg/ml ?
I’ve seen that mistake a lot of times.

In either case 100mg or 200mg per week shouldn’t take you more than double the
upper limit for free T unless you have low SHBG.

There are goods and bads to having low SHBG, the bad part is that Adex usually crashes
your E2, and makes balancing TRT difficult. The other bad part is that excessive high free T
is usually a libido killer, although, in your case it seems to not have that effect.
Excessive high free T can also lead to hypertension and erythrocytosis (thickening of the blood),
but your doc should be testing for both.

The good part is that you can use low amounts of Test to get the results you desire.

Here is the tricky part, everyone reacts differently to TRT. What works for a certain set of people with
close to the same hormone profile won’t necessarily work for all of them. Each person has his
own unique set of issues. Your case seems like it may be an exception to what I have found with myself and others with low SHBG in that you report great mental clarity, and no erection problems.
I am wondering how you will do on Adex, so please keep your thread updated as you go.

[quote]jomamma007 wrote:
If your dosage is 100mgs per week split into two injections

Dropping your dosage down to 30mgs twice per week will probably give you a Total T of 800 with estrogen in range without the use of an AI. This is the best suggestion honesly. Your Total T is 200 points over the range so you need to lower your dose anyways for the long term to avoid issues.

Adding an ai, you will have to end up tinkering here and there to try to dial in and I doubt you’ll ever feel 100% with hormones varying all of the time. [/quote]

Yes, it is always better to control E by reducing the T dose than to jump on an AI. (Assuming there is room for reducing the dose while keeping high enough T, as is the case here.) There are a lot of people who use an AI, despite having problems with it, so that they can keep a higher T level, for no good reason other than the “more is better” psychology.

If it is true that SHBG is low (as seems the case here) there is another reason to avoid injecting too much T. Keeping T too high will cause SHBG to drop even further. Low SHBG is not a good thing (it is associated with diabetes, metabolic syndrome, liver problems, etc.). So don’t let free T go over range.

Jeez, I can’t believe what great advice you guys are giving. PKNY, I’m pretty sure I was dosing right. I was filling .250 on the syringe so I think that is what I do w/200 mg test.
T
I think I will try the 75mg/injecting 2/wk with the 1/4 tab of arimidex EOD and watch for signs. Any problems and I will drop the AI and go sub-q. I keep posting what happens. Thanks again, men!

don’t know why you would hassle with an that has sides and is hard to dial in your protocol.
Your free test is high, this is what’s important not free test. If you lower your dosage your free test will still probably be over the range yet you’ll avoid the need for an ai. Less drugs the better.

Lowering your dose and adding an ai might drop your estrogen too much. This is why we suggest once change at a time, as simply lowering your dose might get you in range alone.
The ai will just free up from free test and lead to you probably having crazy high Hematocrit and hemoglobin levels and RBC counts leading you to have to donate all the time and other issues. But the choice is yours bud, good luck and keep us posted.