Need help with 6 week blood work please

[Weighty91]

I just got my first lot of blood tests done and I need some advice
Testosterone - 51.8 nmol/l
Free test - 1066 pmol/l
Shgb - 52 nmol/l
Oestradiol - 93 pmol/l
Dhea - 3.9 umol/l
120mg a week. Pinning eod. Currently not taking my ai as i feel worse when i have it. Plenty of energy but random get fatigued.. brain fog, no sex drive, no increase in libido. Just had a consultation with my clinic and they recommended I bump my dose up to 200mg a week or 250mg a week. I'm actually suprised they want me to up my dose with those levels as the blood test was done on the day of my next injection before having it. Lost on what I should be doing here? Any help would be great. Thanks

 

[madman]

I just got my first lot of blood tests done and I need some advice
Testosterone - 51.8 nmol/l
Free test - 1066 pmol/l
Shgb - 52 nmol/l
Oestradiol - 93 pmol/l
Dhea - 3.9 umol/l
120mg a week. Pinning eod. Currently not taking my ai as i feel worse when i have it. Plenty of energy but random get fatigued.. brain fog, no sex drive, no increase in libido. Just had a consultation with my clinic and they recommended I bump my dose up to 200mg a week or 250mg a week. I'm actually suprised they want me to up my dose with those levels as the blood test was done on the day of my next injection before having it. Lost on what I should be doing here? Any help would be great. Thanks

Always post the reference ranges.

What assay was used for TT, FT, and estradiol?

Even then your trough TT is absurdly high 51.8 nmol/L (1494 ng/dL) and although you have high SHBG your trough FT is still going to be high.

Top it off most men's estradiol will also be high due to high FT.

Keep in mind that your peak TT, FT, and estradiol will be higher.

The clinic treating you has no clue what they are doing.

Your trough FT is already high and they want you to increase your dose from 120 mg T/week to a whopping 200-250 mg/week which is ridiculous as not only is this an absurd jump in the dose but will surely have your TT, FT, and estradiol levels much higher.

Increasing the dose by only 20-30 mg T/week can easily have a big impact on driving up your levels.

You are already running a trough TT of almost 1500 ng/dL and high FT even with your high SHBG and these clowns want you to up your dose by 80-130 mg/week.

Most men on trt are injecting 100-200 mg T/week whether once weekly or split into twice-weekly (every 3.5 days), M/W/F, EOD, or daily.

Most men can easily achieve a healthy/high trough FT on 100-150 mg T/week.

Some may need the higher-end dose but it is far from common.

 

[Weighty91]

Always post the reference ranges.

What assay was used for TT, FT, and estradiol?

Even then your trough TT is absurdly high 51.8 nmol/L (1494 ng/dL) and although you have high SHBG your trough FT is still going to be high.

Top it off your estradiol will also be high due to your high FT.

Keep in mind that your peak TT, FT, and estradiol will be higher.

The clinic treating you has no clue what they are doing.

Your trough FT is already high and they want you to increase your dose from 120 mg T/week to a whopping 200-250 mg/week which is ridiculous as not only is this an absurd jump in the dose but will surely have your TT, FT, and estradiol levels much higher.

Increasing the dose by only 20-30 mg T/week can easily have a big impact on driving up your levels.

You are already running a trough TT of almost 1500 ng/dL and high FT even with your high SHBG and these clowns want you to up your dose by 80-130 mg/week.

Most men on trt are injecting 100-200 mg T/week whether once weekly or split into twice-weekly (every 3.5 days), M/W/F, EOD, or daily.

Most men can easily achieve a healthy/high trough FT on 100-150 mg T/week.

Some may need the higher-end dose but it is far from common.

Thanks for the reply madman. I'm not to sure what you mean by assay? Sorry I'm all very new to this. I will attach my bloodwork if that helps

I agree that the guy I spoke to had no idea how to help me at all. He said he's never had a client that's had no libido and sex drive increase in there first 6 weeks

He's a advice was either to stay on 120mg a week and see if things balance out or increase the dose to see if that increases my libido. He even said that 250mg a week for 16 weeks would be a "blast" then the week before my next blood test to take a week off so my levels are in range and then cruise for a while

I'm smart enough to know not to do this.. I'm on trt to get my levels at a good range and feel better, not to do a cycle

So what should I do here? Lower my dose? Pin ed, eod or 3.5 days? Any help would be appreciated

 

[madman]

Thanks for the reply madman. I'm not to sure what you mean by assay? Sorry I'm all very new to this. I will attach my bloodwork if that helps

I agree that the guy I spoke to had no idea how to help me at all. He said he's never had a client that's had no libido and sex drive increase in there first 6 weeks

He's a advice was either to stay on 120mg a week and see if things balance out or increase the dose to see if that increases my libido. He even said that 250mg a week for 16 weeks would be a "blast" then the week before my next blood test to take a week off so my levels are in range and then cruise for a while

I'm smart enough to know not to do this.. I'm on trt to get my levels at a good range and feel better, not to do a cycle

So what should I do here? Lower my dose? Pin ed, eod or 3.5 days? Any help would be appreciated

The testing method used.

The most accurate assays for TT/estradiol/DHT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

Critical to have your FT tested using what would be considered the most accurate assays (Equilibrium Dialysis or Ultrafiltration), especially in cases of altered SHBG.

Your TT, SHBG, and estradiol were done using the direct immunoassay and FT was most likely calculated.

Look over the threads in post #6 when you have time!

THE IMPORTANCE OF ACCURATE HORMONE TESTS

https://www.hormoneassays.org/ Watch our video to learn about the importance of accurate hormone testing. Tests to measure the level of a specific hormone in the body are the third most common diagnostic in medicine today yet some current hormone tests are not sufficiently accurate or...

www.excelmale.com

You are missing lab work for CBC which will include critical blood markers RBCs, hemoglobin, and hematocrit.

Post up your numbers as these are critical to know at the 6-week mark after starting TRT.

Would be interesting to see where your DHT sits on your current protocol.

Also, post up your pre-TRT labs.

Keep in mind that when first starting TRT or tweaking a protocol (dose/injection frequency) hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE) and it is common to experience ups/downs during the transition as the body is trying to adjust.

Mind you most will experience what we call the honeymoon period euphoric-like state, a strong increase in libido, spontaneous/nocturnal/morning erections due to increased dopamine/T levels rising/AR lighting up.

Unfortunately, this is short-lived and temporary as the body will adjust and eventually level out.

Keep in mind that once blood levels have stabilized it will take time for the body to adapt to the new set-point and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-t symptoms.

The first 4-6 weeks can be very misleading when looking at the bigger picture.

Every protocol should be given 12 weeks before claiming it was a success or failure.

Always best to start low and go slow on a T-only protocol as we want to see how our body reacts to testosterone.

Lab work is done at the 6-week mark as we want to see where our trough TT, FT, estradiol, SHBG, and other important blood markers such as RBCs, hemoglobin, and hematocrit sit.

The only time the T dose should be increased at the 6-week mark is if your trough level is still too low (highly unlikely in most cases) which would result in a lack of improvement in low T symptoms.

On the other extreme many men are started on a high-dose protocol off the hop and end up struggling with sides/feeling unwell 6 weeks in because they are running too high a trough FT.

Too low or too high FT can easily have a negative impact on energy, mood, libido, and erectile function.

You can try and tough it out a little longer before deciding on your next move.

Only time will tell.

Even then you may fair better running a lower trough FT level.

You can look into adding low dose hCG eventually but keep in mind that it will drive up your TT, FT, and estradiol so you would need to make sure that you lower your T dose enough.

Would be a bad move to up your dose!

 

[Weighty91]

The testing method used.

The most accurate assays for TT/estradiol/DHT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

Critical to have your FT tested using what would be considered the most accurate assays (Equilibrium Dialysis or Ultrafiltration), especially in cases of altered SHBG.

Your TT, SHBG, and estradiol were done using the direct immunoassay and FT was most likely calculated.

Look over the threads in post #6 when you have time!

THE IMPORTANCE OF ACCURATE HORMONE TESTS

https://www.hormoneassays.org/ Watch our video to learn about the importance of accurate hormone testing. Tests to measure the level of a specific hormone in the body are the third most common diagnostic in medicine today yet some current hormone tests are not sufficiently accurate or...

www.excelmale.com

You are missing lab work for CBC which will include critical blood markers RBCs, hemoglobin, and hematocrit.

Post up your numbers as these are critical to know at the 6-week mark after starting TRT.

Would be interesting to see where your DHT sits on your current protocol.

Also, post up your pre-TRT labs.

Keep in mind that when first starting TRT or tweaking a protocol (dose/injection frequency) hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE) and it is common to experience ups/downs during the transition as the body is trying to adjust.

Mind you most will experience what we call the honeymoon period euphoric-like state, a strong increase in libido, spontaneous/nocturnal/morning erections due to increased dopamine/T levels rising/AR lighting up.

Unfortunately, this is short-lived and temporary as the body will adjust and eventually level out.

Keep in mind that once blood levels have stabilized it will take time for the body to adapt to the new set-point and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-t symptoms.

The first 4-6 weeks can be very misleading when looking at the bigger picture.

Every protocol should be given 12 weeks before claiming it was a success or failure.

Always best to start low and go slow on a T-only protocol as we want to see how our body reacts to testosterone.

Lab work is done at the 6-week mark as we want to see where our trough TT, FT, estradiol, SHBG, and other important blood markers such as RBCs, hemoglobin, and hematocrit sit.

The only time the T dose should be increased at the 6-week mark is if your trough level is still too low (highly unlikely in most cases) which would result in a lack of improvement in low T symptoms.

On the other extreme many men are started on a high-dose protocol off the hop and end up struggling with sides/feeling unwell 6 weeks in because they are running too high a trough FT.

Too low or too high FT can easily have a negative impact on energy, mood, libido, and erectile function.

You can try and tough it out a little longer before deciding on your next move.

Only time will tell.

Even then you may fair better running a lower trough FT level.

You can look into adding low dose hCG eventually but keep in mind that it will drive up your TT, FT, and estradiol so you would need to make sure that you lower your T dose enough.

Would be a bad move to up your dose!

Thanks for posting this! It's really great information

I will attach those as well if you want to have a look over them. I dont have my dht levels unfortunately but will be making sure i get them on my nexy blood work. The first 3 are pre trt bloods, the other 2 are after. Also attaching my dhea levels which I'm concerned about but my GP wasn't interested in helping me with.. also concerned about my white blood cells but again he wasn't interested in looking in to it

Based on how I'm feeling I might move to Ed injections and keep the dose the same, see if that balances things out. I want to avoid taking a ai if I can

I will retest in 2 months and see how it looks and go off how I feel. Definely will not be taking current advice and upping the dose only lowering it!

Thanks

 

[Cataceous]

@Weighty91, adding to what @madman said, let me give you some perspective on dosing: The average healthy young guy produces around 45 mg of testosterone a week. This is equivalent to about 64 mg of testosterone cypionate a week. The normal range of human testosterone production is covered by 30-100 mg of testosterone cypionate per week. Very few men have a legitimate medical need to take more than this. So you can see that 120 mg is already excessive, particularly as a starting dose. Newer thinking, used for products such as Xyosted, says that 75 mg per week is a reasonable starting dose.

Dosing too high for the individual can lead to a lot of misery. I have personal experience with this, having gradually gone from 100 mg TC per week to the equivalent of 44 mg per week. I have a collection of anecdotes showing that this experience is not unique:

Answering some questions, new to forum. Much appreciated!

Hi, if anyone can help me out that would be great and much appreciated! I’ve been seeing a Dr. for about five years regarding my T levels and have been on the following regiment, I’m 39 yr old male. - 1x 1ml syringe of Testosterone Cypionate out of a (5ml) 200 mg/ml vial every Wednesday (once a...

www.excelmale.com

One caveat is that lower doses are likely to require injecting more frequently than once a week. Otherwise trough testosterone can be too low.

 

[Weighty91]

@Weighty91, adding to what @madman said, let me give you some perspective on dosing: The average healthy young guy produces around 45 mg of testosterone a week. This is equivalent to about 64 mg of testosterone cypionate a week. The normal range of human testosterone production is covered by 30-100 mg of testosterone cypionate per week. Very few men have a legitimate medical need to take more than this. So you can see that 120 mg is already excessive, particularly as a starting dose. Newer thinking, used for products such as Xyosted, says that 75 mg per week is a reasonable starting dose.

Dosing too high for the individual can lead to a lot of misery. I have personal experience with this, having gradually gone from 100 mg TC per week to the equivalent of 44 mg per week. I have a collection of anecdotes showing that this experience is not unique:

Answering some questions, new to forum. Much appreciated!

Hi, if anyone can help me out that would be great and much appreciated! I’ve been seeing a Dr. for about five years regarding my T levels and have been on the following regiment, I’m 39 yr old male. - 1x 1ml syringe of Testosterone Cypionate out of a (5ml) 200 mg/ml vial every Wednesday (once a...

www.excelmale.com

One caveat is that lower doses are likely to require injecting more frequently than once a week. Otherwise trough testosterone can be too low.

Thanks for this information. Iv already made the change to daily dosing and going go aim for 100mg a week and see how I feel

My understanding is that high shgb does better on bigger doses so will be interesting to see how I feel

 

[Cataceous]

...
My understanding is that high shgb does better on bigger doses so will be interesting to see how I feel

This is a common belief, but it's probably based on the incorrect assumption that total testosterone is driven proportionally by the testosterone dose rate. In this scenario higher SHBG at the same dose rate leads to lower free testosterone. However, the reality is that free testosterone is driven by the dose rate and it is total testosterone, not free, that changes in response to isolated changes in SHBG. Because total testosterone varies with SHBG, free testosterone is the more important parameter for determining your status.

 

[Weighty91]

This is a common belief, but it's probably based on the incorrect assumption that total testosterone is driven proportionally by the testosterone dose rate. In this scenario higher SHBG at the same dose rate leads to lower free testosterone. However, the reality is that free testosterone is driven by the dose rate and it is total testosterone, not free, that changes in response to isolated changes in SHBG. Because total testosterone varies with SHBG, free testosterone is the more important parameter for determining your status.

Great that's very reassuring to hear ! Here's hoping everything goes smoothly and I finally start to feel good appreciate your knowledgeable

 

[sammmy]

Your neutrophils and lymphocytes on April 1st are too low and worse than at the end of January. Your platelets levels are also too low and worse. Most probably, as the labs note, you are having some kind of ongoing infection.

As others pointed out, your weekly dose of T is too high but you need to resolve the infection first, before you evaluate how you feel on a given dose.

 

[Weighty91]

Your neutrophils and lymphocytes on April 1st are too low and worse than at the end of January. Your platelets levels are also too low and worse. Most probably, as the labs note, you are having some kind of ongoing infection.

As others pointed out, your weekly dose of T is too high but you need to resolve the infection first, before you evaluate how you feel on a given dose.

Thanks for pointing that out I will be seeing someone asap to get it looked into. Pretty mad that my gp brushed it off as nothing to worry about. He looked at bloodwork from a year ago and saw that I had low wbc..he made the assumption that I naturally have low levels

 

[Deleted member 12831]

I just got my first lot of blood tests done and I need some advice
Testosterone - 51.8 nmol/l
Free test - 1066 pmol/l
Shgb - 52 nmol/l
Oestradiol - 93 pmol/l
Dhea - 3.9 umol/l
120mg a week. Pinning eod. Currently not taking my ai as i feel worse when i have it. Plenty of energy but random get fatigued.. brain fog, no sex drive, no increase in libido. Just had a consultation with my clinic and they recommended I bump my dose up to 200mg a week or 250mg a week. I'm actually suprised they want me to up my dose with those levels as the blood test was done on the day of my next injection before having it. Lost on what I should be doing here? Any help would be great. Thanks

If it were me, I would be testing free t3, free t4, tsh and both sets of thyroid antibodies if you have not. I would also be testing am cortisol and acth serum to see where that is at since your dhea is very low and that is in the same pathway. SHBG is suppose to go down with testosterone not up. I take meds to bring mine down and I take less testosterone now than I did. I feel way better . Adding testosterone on top of a high shbg is like adding water on a clogged drain in my opinion. Usually there are other things that are off is another part of the issue. SHBG increases the half life of testosterone and that means it stays in the body longer and builds up. At the same time the higher the shbg is the less free bioavable testosterone you will have. I personally thing xenoestrogens and genetics are to blame for higher shbg but I also do think more anabolic compounds for those guys with higher shbg would be in order here. Just my opinion

 

[Jed Dorsey]

I just got my first lot of blood tests done and I need some advice
Testosterone - 51.8 nmol/l
Free test - 1066 pmol/l
Shgb - 52 nmol/l
Oestradiol - 93 pmol/l
Dhea - 3.9 umol/l
120mg a week. Pinning eod. Currently not taking my ai as i feel worse when i have it. Plenty of energy but random get fatigued.. brain fog, no sex drive, no increase in libido. Just had a consultation with my clinic and they recommended I bump my dose up to 200mg a week or 250mg a week. I'm actually suprised they want me to up my dose with those levels as the blood test was done on the day of my next injection before having it. Lost on what I should be doing here? Any help would be great. Thanks

Bro if you would rather not up your dose any higher I don’t blame you as it’s more likely to start seeing negative side effects such as hair loss and higher BP. Have you considered 5 mg Cialis eod? It works great with TRT living proof right here. When I first started TRT my libido was through the roof but after about a year on it my erections became somewhat unpredictable but still better than before TRT. When I told my doctor he Rx 5mg Cialis eod and man my erections are alway predictable now it’s always there when I need it.

 

[Weighty91]

If it were me, I would be testing free t3, free t4, tsh and both sets of thyroid antibodies if you have not. I would also be testing am cortisol and acth serum to see where that is at since your dhea is very low and that is in the same pathway. SHBG is suppose to go down with testosterone not up. I take meds to bring mine down and I take less testosterone now than I did. I feel way better . Adding testosterone on top of a high shbg is like adding water on a clogged drain in my opinion. Usually there are other things that are off is another part of the issue. SHBG increases the half life of testosterone and that means it stays in the body longer and builds up. At the same time the higher the shbg is the less free bioavable testosterone you will have. I personally thing xenoestrogens and genetics are to blame for higher shbg but I also do think more anabolic compounds for those guys with higher shbg would be in order here. Just my opinion

Thanks for the response. I will be making sure to test these as well on my next lot of blood work I'm a month

I have attached my cortisol results. There in range but on the higher side?

Since doing my dose daily iv been feeling abit more stable and mood feels is slightly better but there's still abit of fatigue especially at night when I get home from work. Been sleeping a solid 7-8 hours with is unheard of for me

I tried talking to my gp about my problems but he isn't keen on helping until unless I speak with a endocrinologist.. I want to avoid a higher dose if possible

 

[Weighty91]

Bro if you would rather not up your dose any higher I don’t blame you as it’s more likely to start seeing negative side effects such as hair loss and higher BP. Have you considered 5 mg Cialis eod? It works great with TRT living proof right here. When I first started TRT my libido was through the roof but after about a year on it my erections became somewhat unpredictable but still better than before TRT. When I told my doctor he Rx 5mg Cialis eod and man my erections are alway predictable now it’s always there when I need it.

Hair loss is a major fear of mine so want to avoid it at all costs does cialis lower your bp? My bp has always been pretty low but it's actually moved to better range since starting trt. Does it just give you erections or does it make you horny and actually want sex?

 

[Jed Dorsey]

Hair loss is a major fear of mine so want to avoid it at all costs does cialis lower your bp? My bp has always been pretty low but it's actually moved to better range since starting trt. Does it just give you erections or does it make you horny and actually want sex?

Cialis does lower BP to some it increases blood flow to that specific area when needed. No it doesn’t increase libido but as you get in the mood it never disappoints. I believe that testosterone is what increases our libido that’s why they work so well together. Hope this helps

 

[Systemlord]

Low DHT will hinder libido, but save your hair. From some the choice is, save your hair or your libido, but not both.

If you’re genetically prone to losing hair as you age, you’re going to lose your hair.