Again it is not low as I stated it is on the high-end of what would be considered the reference range for cFTV.
My reply from post #4
Looking over the lab results you posted a month ago when you were injecting 9 mg TPP daily you were hitting a robust TT 730 ng/dL, with a normal SHBG 29 nmol/L and seeing as you did not post your Albumin we can use 4.3 g/dL (default) which would have your FT 17.7 ng/dL on the higher end but far from absurdly high.
Most healthy young males would be peaking around 13-15 ng/dL.
Again keep in mind that as of now cFTV tends to overestimate when compared against what would be considered the most accurate assay which is the gold standard Equilibrium Dialysis.
So your FT level may very well be lower than 17.7 ng/dL but even than it is still going to be robust and no where close to low/low normal!
Forget getting caught up on needing your trough FT in the 20-30 ng/dL range.
My repy from post #11
Only at Excel, are we gonna take you deep! Clinical Utility and Analytical Aspects of Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods (2022) Mark M. Kushnir, Heather A. Nelson, and Kelly Doyle Background The free hormone (FH) hypothesis states that hormone...
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Regarding labs, FT assays/reference ranges.
For the time being, if you have access to such then stick to testing your FT using what would be considered the most accurate assays such as the gold standard Equilibrium Dialysis or Equilibrium Ultrafiltration (next best), especially in cases of ALTERED SHBG!
Forget getting caught up in the different reference ranges for the same assays (ED, UF) used by different labs.
Let alone trying to compare the results of ED vs UF, or ED/UF vs the cFT methods.
Test using the same lab/same assay (most accurate).
Compare your blood work using the same lab/same assay (most accurate).
Top it all off that the calculated methods even have flaws!
We need accurate and standardized free testosterone assays with harmonized reference ranges!
Take home points:
*Because FHs are present in biological samples in trace concentrations, highly sensitive and specific methods are required for accurate measurement of FH concentrations
*A limitation of calculation-based methods is in the assumption of uniform hormone affinity to binding proteins among individuals. However, binding protein variants, posttranslational modifications, and other factors may alter binding affinity, causing erroneous results and biases (10). Direct immunoassay methods show discrepancy among methods of different manufacturers and often perform poorly when binding protein concentrations are very elevated or decreased, with some methods suffering from biotin interference (9)
*When a binding protein abnormality is suspected (15). Equilibrium dialysis (ED) followed by LC–MS/MS is considered the gold standard methodology, with a number of LC–MS/ MS methods developed and introduced in routine patient testing (12, 16–22)
*FH concentrations measured by UF-based methods often do not agree with ED-based methods because of UF conditions (temperature, time, centrifugation speed), the type of the UF device (MWC membrane material, material of the of the housing, seal around the membrane, etc.), and inconsistencies in the filtration rate. Therefore, reference intervals are typically not interchangeable across methods for measurement of the same FH
CDC STANDARDIZED TOTAL T AND ESTRADIOL TESTS and soon-to-be FREE TESTOSTERONE!
Key Points:
* Limitations of using free testosterone by equilibrium dialysis and calculated free testosterone concentrations in practice are the lack of assay standardization, an accuracy-based quality control program, and a harmonized reference range. Until these limitations are addressed, free testosterone by equilibrium dialysis and calculated free testosterone should use reference ranges established by individual laboratories or their specific assay method
*Currently, the CDC is developing a harmonized method for free T based on calculated free T using REVISED FORMULAE. This may bring the measurement of free T to a referable standard in clinical laboratories and common reference intervals that all clinicians can use
*Assays that are standardized are designed to provide accurate results, traceable to “true” value-assigned certified reference materials and gold-standard reference methods. Results obtained using standardized methods can be compared across assays, institutions, populations, and past and future test results, thereby improving diagnosis, treatment, and outcomes of patients
The Need to Harmonize Clinical Laboratory Test Results-----
Laboratory test results are a critical component of patient care. These values help physicians diagnose disease and are critical to developing clinical guidelines that direct treatment options and are instrumental in ongoing efforts to improve and measure the quality of patient care. Most tests report a numeric value for healthcare providers to interpret and the range of numbers reported for a test for a certain condition may vary depending on the method used
Different test methods, however, may report different numeric values for the same condition. Although these test results may be accurate within the context of its own method, this variation can create confusion for physicians and patients. Clinical laboratory test results need to be harmonized so that healthcare providers and the public receive the same numeric result regardless of the method or instrument used or the setting where it was performed
No need to fast when testing for TT, FT, or BAT as your hpta is shutdown due to using exogenous testosterone.
Seeing as you had labs drawn 14 hrs post-injection using TPP than your peak levels will be slightly higher.
True trough on dailies would be 24 hrs post-injection so your levels will be lower and the difference in peak--->trough will always come down to the dose of T, injection frequency and ester used (TC/TE/TPP/TP).
Dose of T, injection frequency and ester used will have a big impact on the difference between peak--->trough levels.
If you felt good overall on your previous protocol, no sides and overall blood markers are healthy injecting 9 mg TPP daily than stick with it!
Your RBCs, hemoglobin and hematocrit are fine!
Other than your daily peak--->trough on daily TPP let alone TP neither will mimic the natural 24 hr circadian rhythm of a healthy young male.
No esterfied T will do such!
The only formulation which most closely mimics this would be the T-patch (Androderm) applied before bed!
My reply from post #31
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Many fail to realize that T levels gradually rise overnight reaching peak in the early AM.
*elevated and near peak TT level during nighttime sleep, peak TT level around the time of morning awakening
*T production occurs in the greatest amount during sleep as recurring pulses at approximately 90 min intervals in healthy young males and approximately 140 min in healthy middle-aged males (91).
This is key:
(i) elevated and near peak TT level during nighttime sleep, (ii) peak TT level around the time of morning awakening, (iii) moderately elevated TT level during the initial hours of wakefulness, (iv) reduced TT level in the late afternoon, and (v) lowest TT level in the evening. Based upon these criteria, only the Androderm® transdermal patch (Figure 3D), when applied in the evening (∼22:00 h) as recommended, closely mimics the TT circadian rhythm of normal young adult males.
https://www.androderm.com/about-androderm ANDRODERM® (testosterone transdermal system) is designed to deliver testosterone continuously for 24 hours following application to intact, non-scrotal skin (e.g., back, abdomen, thighs, upper arms). Four strengths of ANDRODERM® are available that...
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