I just got my labs back and my emotions are a mixture of concern and confusion. I will try to summarize this:
12/25 Dr prescribes test gel 150 mg daily
12/25 Dr prescribes test gel 150 mg daily
3/26 3 month checkup
Total test- 775 ng/dl
SHBG- 60 nmol/L HIGH
Test Free- 66.3 pg/ml
Bioavailable Test- 127.8ng/dl
Hematocrit- 48%
Hemoglobin- 16.3 g/dl
PSA- 1.76
Estradiol- 47 ng/dl HIGH
Standard Immunoassay tests
I tell Dr the gel sucks ass and the last couple weeks of the gel doesnt absorb well. I also was concerned about complete shutdown. He switches to injectable Test Enanthate 200mg/ml inject .30ml 3 times a week, and gives me a super small Anastrazole 0.25 mg a week. Finally he prescribes 250 units of HCG 3 x a week.
My primary Dr was unhappy when I told him I was on TRT because of my dads prostate cancer and my previous DVT due to COVID 4 years ago. He ordered more accurate testing for my hormones after my physical this month. So my new labs just 1 month later. Im only attaching/highlighting concerns that were high.
Hematocrit-51.6% HIGH
Hemoglobin- 18g/dl HIGH
Triglycerides 235mg/dl HIGH
HDL- 28mg/dl LOW
LDL- 118 mg/dl HIGH
Apolipoprotein B 121 mg/dl HIGH
Iron -212 ug/dl HIGH
Iron saturation - 63 ugdl HIGH
ADMA 120 ng/ml HIGH
Total Test-2154 ng/dl using LC/MS assay testing EXTREMELY HIGH
Free Test(direct)- 35.1 pg/ml HIGH
Estradiol sensitive 55.9pg/ml HIGH using LC/MS essay testing
SHBG- 76.4 nmol/L
How the hell can my test go from 775 to 2100+ in one month time?
1. Is the standard immunoassay that inaccurate?
2. Would the timing of when I administered my testosterone throw the 2100+ number off? My primary said just use your Test as normal prior to test. The day I had my labs I injected in the morning.
3. How can my free test be high on one test and in range on another? Is it because one goes off of Standard immunoassay and the other LC/MS?
Of note:
My entire family has genetic cholesterol issues. My triglycerides are actually lower than anyone else.
I eat a ton of almonds, drink a shot of EVOO high phenol olive oil a day and do 180 minutes of cardio with lifting a week. The highest my HDL has ever been was 36. My diet is not horrible. I eat smart M-F and cheat on the weekends. I do intermittent fasting on Wednesdays.
I dont see how my total is 2100+. No aggression, no acne, libido is good. BP is normal. No issues peeing.
I have another appointment with my TRT Dr in two months. If I want to talk about my labs I have to pay him $250 lab viewing and consult fee.
Thanks!
Feel bad for you that your doctor is clueless when it comes to getting blood work when using the transdermal formulations.
No way in hell he should have made you wait 3 months before getting blood work done.
Steady-state will be achieved 48-72 hrs and testing should be done 1-2 weeks after starting in order to make sure you are absorbing the gel and hitting a high enough TT and more importantly FT on said dose.
If such is the case arose titration would be needed and if levels. are not improving then you would be considered a poor absorber!
You could have easily avoided the 3 month wait!
Looking over your labs it is clear as day your FT is sub-par as in close to the bottom end mind you it was not tested using an accurate assay as you had it tested using the known to be inaccurate direct IA (CLIA/RIA).
No one should be using/relying on the direct IA!
12/25 Dr prescribes test gel 150 mg daily
3/26 3 month checkup
Total test- 775 ng/dl
SHBG- 60 nmol/L HIGH
Test Free- 66.3 pg/ml
Bioavailable Test- 127.8ng/dl
Hematocrit- 48%
Hemoglobin- 16.3 g/dl
PSA- 1.76
Estradiol- 47 ng/dl HIGH
Standard Immunoassay tests
In order to know where your FT truly sits you would need to have it tested using the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.
Otherwise you would need to use/rely on the next best testing method the go to calculated linear law-of-mass action Vermeulen (cFTV) which will give a good approximation.
The calculator is available online for free to the general public.
If we take your robust TT 775 ng/dL, high SHBG 60 nmol/L and Albumin 4.3 g/dL (default) then your FT 11.8 ng/dL would be far from low but under where a healthy you natty male cFTV 13-15 ng/dL sits and that is a daily short-lived peak to boot.
So although your TT is robust with high SHBG your cFTV 11.8 ng/dL is not so stellar!
To make matters worse you had to wait 3 months to find out that you are not even hitting a robust FT when you could have easily found out 1-2 weeks after starting if your doctor knew what the f**k he was doing.
3 months of your time wasted only to end up with a FT that is far from stellar and much lower then where it would need to be to reap the beneficial effects of having a healthy robust FT.
I tell Dr the gel sucks ass and the last couple weeks of the gel doesnt absorb well. I also was concerned about complete shutdown. He switches to injectable Test Enanthate 200mg/ml inject .30ml 3 times a week, and gives me a super small Anastrazole 0.25 mg a week. Finally he prescribes 250 units of HCG 3 x a week.
To make matters worse the clown does a 360 and starts you off on a high dose of injectable T + hCG and a micro-dose AI.
180 mg T/week whether injected once weekly or split into more frequent injections is way too high a starting dose.
The standard starting dose across the board by those in the know is 100 mg T/week or better yet 50 mg T split twice-weekly.
Yes some in the know will start men on <100 mg T/week but it is far from common and lower starting doses would usually be prescribed to older men.
Most men on therapy are injecting 100-200 mg T/week whether once weekly or split into more frequent injections.
The majority of men can easily achieve a healthy/high trough FT injecting 100-150 mg T/week especially when injecting more frequently.
There will always be those outliers/strays who may need the higher-end dose 200. mg T/week but its far from common as in rare.
Such dose would easily have the majority overmedicated!
Keep in mind there are some men who can achieve stellar levels injecting <100 mg T/week especially when injecting more frequently.
You were gassed up off the hop here.
My primary Dr was unhappy when I told him I was on TRT because of my dads prostate cancer and my previous DVT due to COVID 4 years ago. He ordered more accurate testing for my hormones after my physical this month. So my new labs just 1 month later. Im only attaching/highlighting concerns that were high.
Again looking over your labs you are hitting an absurdly high TT 2154 ng/dL most likely due to your very high SHBG 76.4 nmol/L but even then more importantly you are hitting a very high FT 35.1 pg/mL mind you it was not tested using an accurate assay as it was tested using the known to be inaccurate direct IA (CLIA/RIA).
Luckily your TT was tested using the most accurate assay (LC-MS/MS) as the direct IA caps out at 1500 ng/dL.
You could always retest to verify but with a very high SHBG 76.4 nmol/L and the dose of T you are injecting weekly let alone time of testing post-injection it could easily be very high.
Total Test-2154 ng/dl using LC/MS assay testing EXTREMELY HIGH
Free Test(direct)- 35.1 pg/ml HIGH
Estradiol sensitive 55.9pg/ml HIGH using LC/MS essay testing
SHBG- 76.4 nmol/L
Again In order to know where your FT truly sits you would need to have it tested using the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.
Otherwise you would need to use/rely on the next best testing method the go to calculated linear law-of-mass action Vermeulen (cFTV) which will give a good approximation.
If we take your absurdly high TT 2154 ng/dL, very high SHBG 76.4 nmol/L and Albumin 4.3 g/dL (default) then your FT 38.8 ng/dL is absurdly high.
Keep in mind if this is at the true trough (lowest point) before your next injection then your peak TT and more importantly FT and estradiol will be even higher!
You easily have room to lower your weekly dose and bring down your FT.
Definitely would not cut your dose in half but you can easily go down to 100 mg T/week split and retest in 6 weeks once steady-state is achieved.
It is always best to start low and go slow as there will always be time to increase the dose if need be.
Hematocrit-51.6% HIGH
Hemoglobin- 18g/dl HIGH
Keep in mind it is expected one will see an increase in hematocrit when using exogenous T especially when running a high FT.
It will start to increase within the first month of therapy and the biggest increase will be seen at the 3-6 month mark as levels tend to stabilize for many 6 months in whereas for some it can take upwards 9-12 months before levels fully stabilize.
When using injectable T you can easily expect a 3-5 point increase and the higher you run your trough/steady-state FT the bigger the impact on driving up the hematocrit, this is a given.
No need to fret if you hematocrit is just over the top-end of the reference range especially if you are healthy and your blood pressure is in check as the cutoff is 54%.
Although you need to keep in mind that you are only 4 weeks in so where your hematocrit 51.6% sits now is not will it will end up.
You are already hitting a hematocrit 51.6% so chances are 6 months in it may very well be too high especially seeing as you are hitting an absurdly high cFTV almost 40 ng/dL.
As I have always stressed on the forum!
Always need to be mindful of your injection frequency/where trough FT sits.
FT <5 ng/dL would be considerd low.
FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.
FT 10-15 ng/dL would be healthy.
FT 20-25 ng/dL would be high-end/high!
The majority of men will do well with a trough FT 15-25 ng/dL depending on the injection frequency.
Need to keep in mind that there is a big difference between one running a high-end/high trough FT 20-25 ng/dL injecting daily vs twice-weekly vs once weekly.
Also going to be a big difference in peak--->trough on said protocol!
Many tend to overlook this and gun for a high-end/high trough FT only to end up struggling with sides especilly in the long run.
Just to put this in perspective most healthy young males would be hitting a cFTV 13-15 ng/dL or 10-12 ng/dL tested using the most accurate assay the gold standard Equilibrium Dialysis and this is a short-lived daily peak to boot!
Even if you take those natty outliers in the 95th percentile hitting a high FT 25 ng/dL again this is a short-lived daily peak to boot!
You have guys on T hitting a trough FT 25-30+ ng/dL injecting daily with FT elevated 24/7, EOD as in every 2 days (48 hrs post-injection),twice-weekly as in every 3.5 days (84 hrs post-injection), once weekly as in 7 days post-injection.
I dont see how my total is 2100+. No aggression, no acne, libido is good. BP is normal. No issues peeing.
Would not get too caught up fretting over your TT as you need to pay attention to your FT which is absurdly high as in almost 40 ng/dL.
Even then although your libido is good and you are not experiencing any sides I would be cautious here as you are only 4 weeks in and still most likely experiencing that honeymoon phase where many men tend to experience a euphoric feeling, increase in libido and erections (nocturnal/spontaneous) due to increasing dopamine, rising hormones (T, estradiol and DHT) and lighting up of the ARs (androgen receptors).
It is common for one to experience the honeymoon phase which unfortunately is short-lived and temporary as the body will eventually adapt and libido tends to wane back more into the norm for most.
Even then the first 6 weeks means nothing when looking at the bigger picture here.
There are many men gassed up on FT off the hop that may feel stellar in the short-term only to end up struggling win the long-run especially when it comes to libido and erectile function.
Running too high a trough/steady-state FT can easily backfire in the long run here as you will be hammering the s**t out of your dopamine and CNS 24/7.
You need to keep in mind that when first starting therapy or tweaking a protocol (doseT) it will take 4-6 weeks to reach steady-state when using esterified TC/TE and it is common for one to. experience ups/downs during the weeks leading up until blood levels have stabilized (4-6 weeks) as the body it trying to ADJUST.
Even then once blood levels have stabilized it will still take a few more months for the body to ADAPT to its new SET-POINT and this is the critical time period when one needs to gauge how they truly feel regarding relief/improvement of low-T symptoms and overall well-being.
Every protocol needs to be given a fighting chance as in 12 weeks to truly assess otherwise you will be chasing your tail endlessly!
If you want to stay where you are at and see where things end up then do what you feel is best for you but you would easily have room to bring down your FT if need be.
Sit and dwell on that!
Think of all those overmedicated men on T-therapy gassed up on FT well beyond their natty genetic set-point and unfortunately many off them off the hop!
You can blame all those run of the mill T clinics, kiddie forums loaded with all those numbskulls, throw those blast n cruisers in there too and put the icing on the cake the cesspool of so called gurus polluting gootube!
Gotta love all those kiddie forums loaded with the brainwashed sheep still pushing that more T is better mentality dishing out piss poor advice!
So much misinformation littered on the net its...
How often should men on TRT check their hematocrit?
The standard monitoring schedule includes a baseline CBC before starting TRT, a recheck at 3 to 6 weeks, another at 3 months, and then at 6 and 12 months once stable. Any dose or formulation change resets the monitoring clock, requiring a recheck 4 to 6 weeks later. Men with risk factors for elevated hematocrit (sleep apnea, smoking, COPD, or a history of clotting) should check more frequently: every 3 months until the trend is stable.
* The monitoring schedule, the intervention ladder, and the attention...
