Pre TRT bloodwork results

[337pep]

49yrs old, low sex drive, high blood pressure treated, no energy etc

Talked to doc he order non fasting blood work to test my testosterone at my request, he didn’t really want to, anyways attached are the results and would like you alls opinions on it?

He is wanting to test again in 6-8 weeks, if still low then refer me to another doc

 

[Systemlord]

Talked to doc he order non fasting blood work to test my testosterone at my request, he didn’t really want to, anyways attached are the results and would like you alls opinions on it?

Your doctor not wanting to talk about your testosterone panel, huge red flag!

Your doctor is using the Direct FT method, often inaccurate and overestimating FT results, the equilibrium dialysis method being the most accurate method or even the calculated method.

If your doctor had tested SHBG, we could then calculate your FT using your Total T and SHBG using -> FT calculator to verify if your FT result is accurate. Men with low TT will have lower SHBG, as SHBG is a function of SHBG.

He is wanting to test again in 6-8 weeks, if still low then refer me to another doc

There's no point in waiting 6-8 weeks, no reason why you can't retest in a few days to a week.

In our healthcare system you may have many hurdles to overcome to get a proper diagnosis and treatment through insurance based healthcare. For these folks, using private cash pay clinicals for TRT is another option.

Something you should know, low-T is a disease that always accompanies another medical problem and while TRT can give you to opportunity to correct your health, for some, for awhile TRT brings about many benefits if only temporarily, as the main cause of the low-T is left untreated.

It's advisable to find out the cause of your low-T.

How's your sleep? This is a big influence on testosterone production!

Describe your diet. Also, if eating processed foods, the western diet, creating western diseases, the leading cause of health problems worldwide.

Getting in a state of ketosis, like the carnivore diet has the potential to cure many diseases/health problems. Your doctor doesn't know this, because nutrition education is lacking in medical school and many doctors are dishing out wrong dietary information.

Do you exercise? Same here, lack of exercise, a body at rest tends to stay at rest and soon this becomes the normality for your body as you develop metabolic disorders. Low SHBG is strongly associated with metabolic disorders.

You're missing thyroid labs, checking TSH, fT3 and fT4. A thyroid problem can lead to low SHBG.

 

[337pep]

Your doctor not wanting to talk about your testosterone panel, huge red flag!

Your doctor is using the Direct FT method, often inaccurate and overestimating FT results, the equilibrium dialysis method being the most accurate method or even the calculated method.

If your doctor had tested SHBG, we could then calculate your FT using your Total T and SHBG using -> FT calculator to verify if your FT result is accurate. Men with low TT will have lower SHBG, as SHBG is a function of SHBG.

There's no point in waiting 6-8 weeks, no reason why you can't retest in a few days to a week.

In our healthcare system you may have many hurdles to overcome to get a proper diagnosis and treatment through insurance based healthcare. For these folks, using private cash pay clinicals for TRT is another option.

Something you should know, low-T is a disease that always accompanies another medical problem and while TRT can give you to opportunity to correct your health, for some, for awhile TRT brings about many benefits if only temporarily, as the main cause of the low-T is left untreated.

It's advisable to find out the cause of your low-T.

How's your sleep? This is a big influence on testosterone production! I do have sleep apnea

Describe your diet. Also, if eating processed foods, the western diet, creating western diseases, the leading cause of health problems worldwide. Actually pretty clean, high protein, reduction focus on cards and very very little sugar

Getting in a state of ketosis, like the carnivore diet has the potential to cure many diseases/health problems. Your doctor doesn't know this, because nutrition education is lacking in medical school and many doctors are dishing out wrong dietary information.

Do you exercise? Same here, lack of exercise, a body at rest tends to stay at rest and soon this becomes the normality for your body as you develop metabolic disorders. Low SHBG is strongly associated with metabolic disorders. This can be increased most definitely

You're missing thyroid labs, checking TSH, fT3 and fT4. A thyroid problem can lead to low SHBG. I had a full work up 3 month ago, all that was good to go across the board

 

[337pep]

On average going thru private TRT clinics, what’s the average cost a month?

 

[Systemlord]

On average going thru private TRT clinics, what’s the average cost a month?

It can vary, depending on your needs. Once you're dialed in on therapy, costs will drop. It's been awhile since I used a private clinic or had the need for one.

I've had more problems than anyone here. I fixed my issues on the carnivore diet.

Oral T, Jatenzo, Kyzatrex will make dialing in faster and easier than when using injections.

 

[madman]

Your doctor not wanting to talk about your testosterone panel, huge red flag!

Your doctor is using the Direct FT method, often inaccurate and overestimating FT results, the equilibrium dialysis method being the most accurate method or even the calculated method.

If your doctor had tested SHBG, we could then calculate your FT using your Total T and SHBG using -> FT calculator to verify if your FT result is accurate. Men with low TT will have lower SHBG, as SHBG is a function of SHBG.

There's no point in waiting 6-8 weeks, no reason why you can't retest in a few days to a week.

In our healthcare system you may have many hurdles to overcome to get a proper diagnosis and treatment through insurance based healthcare. For these folks, using private cash pay clinicals for TRT is another option.

Something you should know, low-T is a disease that always accompanies another medical problem and while TRT can give you to opportunity to correct your health, for some, for awhile TRT brings about many benefits if only temporarily, as the main cause of the low-T is left untreated.

It's advisable to find out the cause of your low-T.

How's your sleep? This is a big influence on testosterone production!

Describe your diet. Also, if eating processed foods, the western diet, creating western diseases, the leading cause of health problems worldwide.

Getting in a state of ketosis, like the carnivore diet has the potential to cure many diseases/health problems. Your doctor doesn't know this, because nutrition education is lacking in medical school and many doctors are dishing out wrong dietary information.

Do you exercise? Same here, lack of exercise, a body at rest tends to stay at rest and soon this becomes the normality for your body as you develop metabolic disorders. Low SHBG is strongly associated with metabolic disorders.

You're missing thyroid labs, checking TSH, fT3 and fT4. A thyroid problem can lead to low SHBG.

Labcorps direct immunoassay is unreliable and should not be used/relied upon as in many cases it can over/underestimate FT.

Even then the results from the recent CSP interlaboratory comparison study the direct IAs underestimated FT when compared to a standardized ED-LC-MS/MS method (CDC’s Clinical Standardization Programs (CDC CSP) .

A standardized ED assay is where at in order to know where the FT truy sits!

*CDC CSP developed an accurate, automated method using ED coupled with isotope dilution ultra-high-performance liquid chromatography tandem mass spectrometry (ED-UHPLC-MS/MS). The ED step follows an internationally recognized procedure. The method is calibrated with primary reference material (National Measurement Institute-M914)


As most who frequent the forum should be well aware that the only way to know where your FT level truly sits would be having it tested using the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.

Otherwise if you do not have access to such (highly doubtful) if you reside in the US than you will need to use/rely upon the linear law-of-mass action cFTV.

The OP is hitting a dismal TT 233 ng/dL and even if he had rock bottom SHBG and we calculated his FT using the linear law-of-mass action Vermeulen (cFTV) his FT would be bottom end!

Free & Bioavailable Testosterone calculator

As I have stated numerous times on the forum you always have the option of using/relying upon calculated FT which would be the linear law-of-mass action cFTV as it has already been validated twice (1st time was done using TT/SHBG assays no longer available) and was then eventually re-validated using current state-of-the-art ED method (higher order reference method) let alone more recently against CDCs standardized Equilibrium Dialysis assay.

Keep in mind it tends to overestimate FT 20-30%!


* However, the Vermeulen formula exhibits suboptimal accuracy and tends to overestimate measured free T by 20–30%.

* Calculated free T using high-quality T and SHBG assays has been considered the most useful for clinical purposes [99]. All algorithms suffer from some inaccuracies, including the variable quality of SHBG IAs [100], not replicating the non-linear nature of T-SHBG binding, different and inaccurate association constants for SHBG and albumin binding [101], and variable agreement with equilibrium dialysis results [99,100]. However, until further developments in the field materialize, the linear model algorithms [in particular, the most used Vermeulen equation [102]] appear to give, despite a small systematic positive bias, acceptable data for the clinical management and research[37,103].

Thread 'Comparability of Free Testosterone Measurements- Results of the Interlaboratory Study'

Jul 4, 2024

A-075 Comparability of Free Testosterone Measurements- Results of the Interlaboratory Study

AbstractBackground. Assessment of free testosterone (FT) has been recommended as a biomarker for diagnosis and management of hypogonadism and female hypera

academic.oup.com

Assessment of free testosterone (FT) has been recommended as a biomarker for diagnosis and management of hypogonadism and female hyperandrogenism. Reliable laboratory measurements are essential for correctly diagnosing and treating these diseases. FT is currently measured using direct commercial immunoassays, assays employing equilibrium dialysis (ED) or other separation techniques, or it is estimated by calculating free testosterone (cFT). There are concerns about the accuracy and...

• madman
• free t; testing methods; ed; ias; cftv; accuracy
• Replies: 5
• Forum: Testosterone and Men's Health Articles

• 

*The agreement among IA and among ED-LC-MS/MS assays was close. However, FT concentrations obtained by IAs were in average 6 times lower compared to the ED-LC-MS/MS methods

*Results estimated using the Vermeulen equation overestimated FT in average by 15% compared to the ED-LC-MS/MS methods and by over 6 times compared to IAs




*Preliminary findings of the CSP interlaboratory comparison study found large variability among participating assays. The agreement among IA and among ED-LC-MS/MS assays was close. However, FT concentrations obtained by IAs were in average 6 times lower compared to the ED-LC-MS/MS methods. Results estimated using the Vermeulen equation overestimated FT in average by 15% compared to the ED-LC-MS/MS methods and by over 6 times compared to IAs.

Post in thread 'TRT and low estrogen'

Aug 12, 2024

As far as I know alcohol increases aromatization, but I could be wrong.

Amazing that your E2 is that low with Free T that high and some hCG on top. With that Free T number and the hCG my E2 would probably be around 60-70pg/mL and I'd be a walking bloated panic attack.

@madman will almost certainly drop by in a bit to trash the Direct Free T method. I'm honestly not sure how inaccurate it is; personally the few times I used it before I knew about equilibrium dialysis, the numbers came out as expected if you used all the equilibrium dialysis results as data points and built...

• madman

 

[337pep]

Labcorps direct immunoassay is unreliable and should not be used/relied upon as in many cases it can over/underestimate FT.

Even then the results from the recent CSP interlaboratory comparison study the direct IAs underestimated FT when compared to a standardized ED-LC-MS/MS method (CDC’s Clinical Standardization Programs (CDC CSP) .

A standardized ED assay is where at in order to know where the FT truy sits!

*CDC CSP developed an accurate, automated method using ED coupled with isotope dilution ultra-high-performance liquid chromatography tandem mass spectrometry (ED-UHPLC-MS/MS). The ED step follows an internationally recognized procedure. The method is calibrated with primary reference material (National Measurement Institute-M914)


As most who frequent the forum should be well aware that the only way to know where your FT level truly sits would be having it tested using the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.

Otherwise if you do not have access to such (highly doubtful) if you reside in The US than you will need to use/rely upon the linear law-of-mass action cFTV.

The OP is hitting a dismal TT 233 ng/dL and even if he had rock bottom SHBG and we calculated his FT using the linear law-of-mass action Vermeulen (cFTV) his FT would be bottom end!

As I have stated numerous times on the forum you always have the option of using/relying upon calculated FT which would be the linear law-of-mass action cFTV as it has already been validated twice (1st time was done using TT/SHBG assays no longer available) and was then eventually re-validated using current state-of-the-art ED method (higher order reference method) let alone more recently against CDCs standardized Equilibrium Dialysis assay.

Keep in mind it tends to overestimate FT 20-30%!


* However, the Vermeulen formula exhibits suboptimal accuracy and tends to overestimate measured free T by 20–30%.

* Calculated free T using high-quality T and SHBG assays has been considered the most useful for clinical purposes [99]. All algorithms suffer from some inaccuracies, including the variable quality of SHBG IAs [100], not replicating the non-linear nature of T-SHBG binding, different and inaccurate association constants for SHBG and albumin binding [101], and variable agreement with equilibrium dialysis results [99,100]. However, until further developments in the field materialize, the linear model algorithms [in particular, the most used Vermeulen equation [102]] appear to give, despite a small systematic positive bias, acceptable data for the clinical management and research[37,103].

Thread 'Comparability of Free Testosterone Measurements- Results of the Interlaboratory Study'

Jul 4, 2024

A-075 Comparability of Free Testosterone Measurements- Results of the Interlaboratory Study

AbstractBackground. Assessment of free testosterone (FT) has been recommended as a biomarker for diagnosis and management of hypogonadism and female hypera

academic.oup.com

Assessment of free testosterone (FT) has been recommended as a biomarker for diagnosis and management of hypogonadism and female hyperandrogenism. Reliable laboratory measurements are essential for correctly diagnosing and treating these diseases. FT is currently measured using direct commercial immunoassays, assays employing equilibrium dialysis (ED) or other separation techniques, or it is estimated by calculating free testosterone (cFT). There are concerns about the accuracy and...

• madman
• free t; testing methods; ed; ias; cftv; accuracy
• Replies: 5
• Forum: Testosterone and Men's Health Articles

• 

*The agreement among IA and among ED-LC-MS/MS assays was close. However, FT concentrations obtained by IAs were in average 6 times lower compared to the ED-LC-MS/MS methods

*Results estimated using the Vermeulen equation overestimated FT in average by 15% compared to the ED-LC-MS/MS methods and by over 6 times compared to IAs




*Preliminary findings of the CSP interlaboratory comparison study found large variability among participating assays. The agreement among IA and among ED-LC-MS/MS assays was close. However, FT concentrations obtained by IAs were in average 6 times lower compared to the ED-LC-MS/MS methods. Results estimated using the Vermeulen equation overestimated FT in average by 15% compared to the ED-LC-MS/MS methods and by over 6 times compared to IAs.




------------

Post in thread 'TRT and low estrogen'

Aug 12, 2024

As far as I know alcohol increases aromatization, but I could be wrong.

Amazing that your E2 is that low with Free T that high and some hCG on top. With that Free T number and the hCG my E2 would probably be around 60-70pg/mL and I'd be a walking bloated panic attack.

@madman will almost certainly drop by in a bit to trash the Direct Free T method. I'm honestly not sure how inaccurate it is; personally the few times I used it before I knew about equilibrium dialysis, the numbers came out as expected if you used all the equilibrium dialysis results as data points and built...

• madman

So are you saying something like this is what I need to do?

Erectile Dysfunction (ED) Hormone Panel

The Erectile Dysfunction (ED) Hormone Panel panel contains 5 tests with 9 biomarkers.

www.ultalabtests.com

 

[madman]

So are you saying something like this is what I need to do?

Erectile Dysfunction (ED) Hormone Panel

The Erectile Dysfunction (ED) Hormone Panel panel contains 5 tests with 9 biomarkers.

www.ultalabtests.com

Its a shame that your doctor would ignore your request for testing let alone your results (flagged low TT) especially that you are experiencing some symptoms which are common in men with borderline/low FT!

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.

Although your FT result is not low it was tested using a known to be inaccurate assay.

Your best bet would be paying out of pocket using Nelson's discounted labs which would be the most cost effective option for testing TT and more importantly FT using the most accurate assays.

Testosterone, Free (Equilibrium Dialysis) and Total, MS - Most Affordable and Accurate Test

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

www.discountedlabs.com

Regardless with a dismal TT 233 ng/dL your FT would be bottom-end/low!

If you knew where your SHBG sat you could easily calculate it for free using the online calculator (linear law-of-mass action Vermeulen).

Free & Bioavailable Testosterone calculator