1762 Total T after last lab test

[Sempersyko]

So my last labs were done the day before my injection. I usually inject sub-q twice a week. I use an insulin needle and before this lab I was injecting 40 units twice weekly. The results are 1762 Total T and 508.5 Free T. I had no idea it would be this high. Am I doing something wrong (are my measurements out of whack)? Or am I just responding really well. Advice?

 

[Cataceous]

So you're taking more than double the amount of testosterone that the average young man produces naturally, and your serum testosterone is more than double that of the average young man. I'd say you're responding as expected to an overdose. Less flippantly, your numbers, if correct, are comparable to what I would get with similar dosing, which means your metabolic clearance rate is a bit below average. This in turn means your testosterone requirements are likely to be below average. For comparison, I'm using under 4 mg of testosterone daily, versus your current apparent average of 16 mg.

 

[Sempersyko]

Thanks for the detailed response. So, I am a hyper responder and need to cut my dose quite a bit? How many units should I try? If I am injecting 40 units, cut it down to 30 or even 20? These numbers I assure you are straight from the lab, just picked it up today. "results Test Total is 1762 ng/dL Reference is 250-1100, Test free is 508.5 pg/mL reference is 35.0-155.0". Also included was my TSH T4 at 3.96 uIU/mL reference is 0.27-4.20. This is the best test I can do considering my location (overseas at a military installation).

 

[Cataceous]

I wouldn't characterize us as "hyper-responders". Normal daily testosterone production is in the range of 3-9 mg, with 6-7 being average. You and I would probably naturally be making around 3-5 mg daily at our best.

In any case, I think cutting the dose in half is a good start. I assume your testosterone is 200 mg/mL, so you will be dropping to 80 mg per week. Depending on how long you've been on the higher dose you may need to expect some unpleasantness with the reduction. You may feel hypogonadal for weeks or more until your body adapts to the lower level.

Have you measured SHBG? Your free testosterone suggests it may be on the low side. If free testosterone goes down in proportion to dose then it may still be high after the reduction. A further decrease in dose could be warranted, but cross that bridge when you get there.

 

[Sempersyko]

Great! Thank you for the help. I'll drop it and see how things go. I have not measured SHBG, but I'll ask the next time I see the Doc. Appreciate it!

 

[Ch257]

So my last labs were done the day before my injection. I usually inject sub-q twice a week. I use an insulin needle and before this lab I was injecting 40 units twice weekly. The results are 1762 Total T and 508.5 Free T. I had no idea it would be this high. Am I doing something wrong (are my measurements out of whack)? Or am I just responding really well. Advice?

What manufacturer was the vial of your T? Seems potent

 

[Sempersyko]

Just thought I'd post an update. Had labs run again ( Jan 2022) after decreasing my injections to 30 units twice weekly. My latest Total test is: 651, 172.8 Free, and 284.4 Total Estrogen. Both Test free and Estrogen are HIGH. Any idea's what I could do to get these under control? I have some AI left that I could start if advised. Sorry for asking questions on a board, but I am in an isolated environment (for work) and our Docs out here are limited in experience for this type of thing. We have to send labs out by air and wait for results, so I am just trying to get any info I can and make small adjustments to see if there is an improvement. Libido is kind of meh. Mood seems mostly okay.

 

[Trip McNeely]

Your free test isn't really that high. It looks like you're using Quest's lab ranges, which are ridiculously low for free test. Yours would be 17.2 on LabCorp, with a range of 9-26 or so, putting you in the dead center. I'd split the difference between your previous dose that was returning high numbers and your current dose, and do 70mg twice a week. Also, have you considered scrotal cream? The moment I switched, estrogen ceased to be an issue for me. I threw out my AI and don't even think about it anymore.

 

[MIP1950]

How did you feel when your Total & Free were 'high'? To me, that's the only measurement. Libido, erections, energy, sleep? There are men who believe higher is better. For some of them, yes. Their symptoms don't resolve until they break through the ceiling. Conversely, doctors who only treat by numbers and not by how the patient is feeling/functioning are doing a disservice to those men.

 

[Cataceous]

Just thought I'd post an update. Had labs run again ( Jan 2022) after decreasing my injections to 30 units twice weekly. My latest Total test is: 651, 172.8 Free, and 284.4 Total Estrogen. Both Test free and Estrogen are HIGH. Any idea's what I could do to get these under control? I have some AI left that I could start if advised. Sorry for asking questions on a board, but I am in an isolated environment (for work) and our Docs out here are limited in experience for this type of thing. We have to send labs out by air and wait for results, so I am just trying to get any info I can and make small adjustments to see if there is an improvement. Libido is kind of meh. Mood seems mostly okay.

I assume this is still the Quest equilibrium dialysis free testosterone test? This test method is considered the gold standard. Unfortunately there's currently no standardization across different labs, so you must ignore misguided assertions that this range is somehow low. Measurements using this test can be compared only to the reference range or to other measurements from the same test. In any case, you're still over the top of the reference range. Total estrogen isn't as useful as estradiol, but either is expected to be high in the presence of high free testosterone. The original recommendation of dropping to 80 mg per week still holds. It's likely your SHBG is low, so you can expect total testosterone to appear somewhat low even when free testosterone is normal. You should focus on free testosterone, as this parameter is best associated with the benefits from testosterone. But more is not better. There's virtually no case when it's healthier to have a hormone significantly outside of its reference range.

 

[eli]

So you're taking more than double the amount of testosterone that the average young man produces naturally, and your serum testosterone is more than double that of the average young man. I'd say you're responding as expected to an overdose. Less flippantly, your numbers, if correct, are comparable to what I would get with similar dosing, which means your metabolic clearance rate is a bit below average. This in turn means your testosterone requirements are likely to be below average. For comparison, I'm using under 4 mg of testosterone daily, versus your current apparent average of 16 mg.

What??? That's not how it works with medication especially Testosterone.

It's not a one size fit all

OP, what's your testosterone dosage and how many units are you taking?

Those numbers for 80mg is unheard of but it's possible, you absorb well

 

[Cataceous]

What??? That's not how it works with medication especially Testosterone.

It's not a one size fit all

OP, what's your testosterone dosage and how many units are you taking?

Those numbers for 80mg is unheard of but it's possible, you absorb well

The details are there, albeit a little vague. He'd presumably been using 160 mg per week of testosterone cypionate. This resulted in very high total and free testosterone. These were not even peak values. He reduced the dose to 120 mg per week, but still has free testosterone above the top of the reference range.

What is this supposed "one size" that fits all? Is it the one where you try dosing your TRT for normal physiology before heading off into body-building land?

 

[MIP1950]

The details are there, albeit a little vague. He'd presumably been using 160 mg per week of testosterone cypionate. This resulted in very high total and free testosterone. These were not even peak values. He reduced the dose to 120 mg per week, but still has free testosterone above the top of the reference range.

What is this supposed "one size" that fits all? Is it the one where you try dosing your TRT for normal physiology before heading off into body-building land?

Outliers perhaps, but men, under medical care, who feel and function better, with higher numbers. You know that every man on T isn't into weight lifting. All they want is to get their penis to stand at attention more than now and then. If higher total and free accomplish that, for those subset of men, whether it's injections, cream/gel or pellets, then so be it. I understand where you're coming from but, as I've stated on another thread; since none of us knew what our TT, free T, E2, DHT, DHEA, pregnenolone/progesterone were when we were teenagers/young men, it becomes a guessing game and even if one tries to emulate those lab values, that doesn't necessarily equal success.

As @Systemlord has noted, the men who are doing well on whatever protocol aren't always on these forums. You're quite knowledgeable and go far beyond a standard protocol, utilizing peptides and selegiline. Most men won't go that far unless their doctor suggests it or they bring it up to him or her. Systemlord and I are also on T-Nation forum and I've mentioned several times the physician on their, 'highpull', who's on a weekly T injection and prescribes that to his patients. I believe he's stated that 75% of those men do well. The other 25% are E3.5 days or EOD. No ai, no HCG.

So, truly, there is no 'one size fits all'. If a man has supraphysiologic TT & free T and experiences no improvement or feels worse, then, yes, cut the dose in half and give it a couple of months, but, if he feels good, physically/mentally/sexually, no reason to mess with success. If your protocol is proving to be successful, that's great, truly! This isn't an ideological debate. Let every man find a protocol that works, regardless of the way it's administered or the type or the dosage.

 

[Sempersyko]

Your free test isn't really that high. It looks like you're using Quest's lab ranges, which are ridiculously low for free test. Yours would be 17.2 on LabCorp, with a range of 9-26 or so, putting you in the dead center. I'd split the difference between your previous dose that was returning high numbers and your current dose, and do 70mg twice a week. Also, have you considered scrotal cream? The moment I switched, estrogen ceased to be an issue for me. I threw out my AI and don't even think about it anymore.

Yeah, Quest labs is what they use. I did try cream for a bit but my insurance provider would not pay for it. It was pretty pricey. They do pay for the test cyp at only $23 a vial and that I can get easily, so I am going that route. I have been running without any AI at the 30 units twice weekly that I have been recently using.

 

[Cataceous]

...
So, truly, there is no 'one size fits all'. If a man has supraphysiologic TT & free T and experiences no improvement or feels worse, then, yes, cut the dose in half and give it a couple of months, but, if he feels good, physically/mentally/sexually, no reason to mess with success. ...

With what other hormone is anyone going to say "Start out at double or triple the top-of-range and if you feel ok then stick with it."? I believe that's unwise and backwards. It makes more sense to explore the full physiological range before assuming you're special and need higher doses to feel ok. It's unequivocal that risks rise with dose, and for some guys the risks will even be present in upper parts of the physiological range. If your body naturally produced 4 mg of testosterone per day at your prime then is everything going to function properly if you take 8 mg for TRT? And even if you don't have overt problems, is it safe to continue for the next 20 years? The low-and-slow approach does fit all—at least all who are in this for good health along with symptom resolution.

 

[MIP1950]

With what other hormone is anyone going to say "Start out at double or triple the top-of-range and if you feel ok then stick with it."? I believe that's unwise and backwards. It makes more sense to explore the full physiological range before assuming you're special and need higher doses to feel ok. It's unequivocal that risks rise with dose, and for some guys the risks will even be present in upper parts of the physiological range. If your body naturally produced 4 mg of testosterone per day at your prime then is everything going to function properly if you take 8 mg for TRT? And even if you don't have overt problems, is it safe to continue for the next 20 years? The low-and-slow approach does fit all—at least all who are in this for good health along with symptom resolution.

I've not read of many men who do well on 4 mg per day. There was a long thread on T-Nation, last year, just about that, with one man saying that he didn't feel good until he dropped to 5 mg, daily. I tried 10 mg, daily, for several months, which, after subtracting the ester, would be 35 mg per week. The numbers looked good, but I didn't feel anything. And you could logically argue that most doctors wouldn't prescribe 5 mg, IM or subq, so we'll never know how well it does or doesn't work.

Men who do well on ultra low dose might be outliers in the same manner of men who need 200 mg or more, weekly. Again, I understand what you're saying regarding how much T we produced as young men but, still, that's in the context of other hormones, neurosteroids and peptides being produced in optimal, balanced amounts. How does one recreate that youthful endogenous symphony, if that's even possible?

 

[Cataceous]

... Again, I understand what you're saying regarding how much T we produced as young men but, still, that's in the context of other hormones, neurosteroids and peptides being produced in optimal, balanced amounts. How does one recreate that youthful endogenous symphony?

The million dollar question. As you suggest, we have to look beyond the single variable of testosterone. If we also need proper levels of GnRH/kisspeptin/LH/progesterone/etc. then chances are good that adjusting our testosterone intake alone is an exercise in futility. I think we have many of the other tools we need, but lack the knowledge to use them effectively. Admittedly without a better understanding of all the interactions, tweaking the other variables is not risk-free. However, it's likely that there are also risks in leaving some hormones in a disrupted state, either too low or too high.

 

[MIP1950]

Yes. We know that for some men, testosterone, alone, is restorative. I admire your inquisitiveness and knowledge, along with your determination. To invest the time and rigor necessary to attempt to optimize the endocrine milieu is daunting. I'm sure you've gone down a few rabbit holes and had to start over. That's why so many men use PDE-5 inhibitors in order to restore sexual function. Though those medications have other benefits, it's easier for the patient and the doctor, rather than getting heavily involved in restoring the endocrine system to its youthful state, if it's even known what one is looking for and if it's found, can that state be sustained.