One year in. Just had my 6month check in.
Peak Total T 1144, (injected 12 hours before test)
SHBG 19
Hematocrit 53
Cypionate: 120mg divided into twice weekly injections.
Any reason to back off to 100, given the low SHBG and hematocrit levels?
Dr wasn’t concerned and mentioned it could be dehydration or because I injected so recently, but that we’ll keep an eye on it.
Why are you testing at the peak as we always want to test at the true trough (lowest point) before your next injection.
Even then peak will be within 24 hrs so you will have a hard time testing at the true peak.
Chances are your true peak may be a little higher.
Nothing wrong with trying to get an idea of where your peak sits but you need to know where your trough sits which would be 84 hrs post-injection when injecting twice-weekly.
Even then you are missing the most important blood marker here free testosterone.
Although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.
As you can see you are hitting a high peak ? TT 1144 ng/dL 12 hrs post-injection and more importantly seeing as you have lowish SHBG 19 nmol/L it is a given your FT would be very high.
The only way to know where your FT truly sits would be testing it 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 calculated linear law-of-mass action Vermeulen (cFTV) which will give a good approximation.
Tends to overestimate slightly but nothing to fret over.
You can easily calculate your FT using the online calculator which is available to the general public for free.
Just plug in your TT, SHBG and Albumin.
If we take your high peak ? TT 1144 ng/dL, lowish SHBG 19 nmol/L and Albumin 4.3 g/dL (default) your peak? FT 36 ng/dL is very high which would be expected.
Even then your trough FT would still be high.
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.
Most men struggling with elevated RBCs, H/H is because they are running too high a trough/steady-state FT.
Also keep in mind that other factors such as sleep apnea, smoking, asthma, and COPD can have a negative impact on hematocrit.
If you feel good overall, minus any sides and blood markers are healthy then I see no reason to change anything.
Again if one has no underlying health issues and is not experiencing any negative sides most in the know specializing in testosterone therapy would not fret if the patient's hematocrit falls within 50-54%.
Yes some will be more cautious and take measures once hematocrit hits 52%.
* hematocrit of ≥54% appears to be consistent threshold to discontinuing or reducing treatment utilized by major urologic governing bodies, while the evidence for this specific cutoff is lacking
*The Endocrine Society uses a hematocrit threshold of >50% as a relative contraindication to initiating TT and >54% as an indication to discontinue treatment [1]. The European Association of Urology (EAU) guidelines on hypogonadism also state that the hematocrit should not exceed 54%, while recent Canadian guidelines cite 55% as the safe upper limit [15, 40]. The AUA guidelines on testosterone deficiency define polycythemia as a hematocrit of 52% and recommend stopping or reducing treatment if the hematocrit reaches 54% [14]
