TRT Success Story - 1 Year Progress

RangerDad · Dec 26, 2024

First, I truly thank and appreciate the wisdom shared by users on this forum! Wanted to share my own TRT success story.

Labs from over the previous year below:

Started TRT exactly one year ago today under the care of an EXCELLENT doctor in NYC.

Protocol from 26 Dec 2023 to 12 Sept 2024 was 120mg/week split every 3.5 days. Had an increase of oily skin (mostly on my face) - an issue I have had throughout my entire life.

13 Sept shifted protocol to 100mg/week (injecting every morning) and added HCG 0.5mg/week (dosage split into every-other day). I combined the medications in a single injection - using knowledge from users on the forum.

Shifting to an everyday testosterone injection, my oily skin issue was resolved - lowering my Estradiol to 42 and increasing my FT while lowering the overall dosage. I don't mind daily injections - has just become part of my daily routine and I am a very disciplined person.

I feel like a new man! Libido, cognitive abilities, physical strength, and just overall sense of well-being has majorly improved. Starting TRT was truly the best decision I have made!

madman · Dec 26, 2024

RangerDad said:
First, I truly thank and appreciate the wisdom shared by users on this forum! Wanted to share my own TRT success story.

Labs from over the previous year below:

View attachment 49475

Started TRT exactly one year ago today under the care of an EXCELLENT doctor in NYC.

Protocol from 26 Dec 2023 to 12 Sept 2024 was 120mg/week split every 3.5 days. Had an increase of oily skin (mostly on my face) - an issue I have had throughout my entire life.

13 Sept shifted protocol to 100mg/week (injecting every morning) and added HCG 0.5mg/week (dosage split into every-other day). I combined the medications in a single injection - using knowledge from users on the forum.

Shifting to an everyday testosterone injection, my oily skin issue was resolved - lowering my Estradiol to 42 and increasing my FT while lowering the overall dosage. I don't mind daily injections - has just become part of my daily routine and I am a very disciplined person.

I feel like a new man! Libido, cognitive abilities, physical strength, and just overall sense of well-being has majorly improved. Starting TRT was truly the best decision I have made!

Great to hear!

You would need to have tested your FT using the most accurate assay which would be the gold standard Equilibrium Dialysis especially in cases of altered SHBG in order to know where it truly sits.

Keep in mind that your FT was not tested using an accurate assay and although it was calculated which would suffice if one did not have access to the most accurate assay ED but the go to calculated method used would need to be the linear law-of-mass action cFTV.

Your FT was tested at Quest Diagnostics which uses a modified Vermeulen equation.

The results from your FT seem suspect when compared against cFTV seeing as the difference in your TT 768--->741----727 ng/dL is not too far off between the 2 protocols yet there is a big difference between your SHBG 31--->23--->16 nmol/L as you started therapy with a normal SHBG only to end up with lowish SHBG.

6-Mar-24

If we use the go to calculator which would be the linear law-of-mass action cFTV with a robust TT 768 ng/dL, normal SHBG 31 nmol/L and Albumin 4.8 g/dL your FT is 16.9 ng/dL.

12-Sept-24

With a robust TT 741 ng/dL, somewhat lowish SHBG 23 nmol/L and Albumin 4.5 g/dL your FT is 19.5 ng/dL.

18-Dec-24

With a robust TT 727 ng/dL, lowish SHBG 16 nmol/L and Albumin 4.7 g/dL your FT is 21 ng/dL.

Also keep in mind if your labs were done at the true trough (lowest point) before your next injection than your peak TT/FT would have been much higher when you were injecting 120 mg T/week (60 mg every 3.5 days) vs the minimal difference in the peak--->trough on your current daily injection protocol.

Although you lowered your weekly daily dose you also threw in the hCG which can easily bump up ones TT/FT and estradiol depending on the dose used.

Your estradiol may also be suspect as it was not tested using the most accurate assay (LC/MS-MS).

Good news is you feel great overall and you are hitting a high FT on dailies to boot!

RangerDad · Dec 26, 2024

Madman,

Thanks for your response! I have actually read dozens of your other replies - appreciate your feedback and insight.

I added a column on my protocol & lab results excel sheet to capture my FT & Bioavailable Testosterone. You're correct - I was only tracking values produced from Quest. Additionally, I haven't - yet - gotten a LC/MS-MS test for Estradiol, but I have one scheduled for my next round of blood work (6 months from now). Using Nelson's discountedlabs.com - another great resource from this forum!

Still unsure what could cause my consistency lowered SHBG. I'll discuss with my doctor next week - but assuming it is not alarming as it remains within the reference range.

madman · Dec 27, 2024

RangerDad said:
Madman,

Thanks for your response! I have actually read dozens of your other replies - appreciate your feedback and insight.

I added a column on my protocol & lab results excel sheet to capture my FT & Bioavailable Testosterone. You're correct - I was only tracking values produced from Quest. Additionally, I haven't - yet - gotten a LC/MS-MS test for Estradiol, but I have one scheduled for my next round of blood work (6 months from now). Using Nelson's discountedlabs.com - another great resource from this forum!

Still unsure what could cause my consistency lowered SHBG. I'll discuss with my doctor next week - but assuming it is not alarming as it remains within the reference range.

Would not waste your time testing BAT.

Trough TT and more importantly trough FT is what truly matters,

As I have stated numerous times on the forum over the years 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!

It is critical to use the most accurate assays when testing TT/FT/BAT.

BAT is not commonly used/relied upon as FT is what truly matters.

The most accurate assays for TT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration next best) would be the assays which need to be used.

The only way to know where FT truly sits is to have it tested using the most accurate methods/assays (ED/UF) especially in cases of altered SHBG.

The gold standard would be Equilibrium Dialysis.

If you do not have access to such then use would need to use/rely upon the go to calculated linear law-of-mass action cFTV which will give a good approx. but keep in mind it tends to slightly underestimate FT.

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.

Yes it tends to overestimate slightly but it is nothing to fret over!

*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]

TRT Success Story - 1 Year Progress

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