Bumping up T and testing SHBG

[madman]

Thank you, madman.

You all don't know how much i appreciate the help.

Well we inject late because we aren't morning people. Last injection was Sunday at midnight, so next injection will be Thursday at noon, correct? Then repeat....

I don't think his doctor would mind either way what dosage. I was the one who asked him for an increase as i DO think he needs one and we wanted to see how he did after 6 weeks and then adjust. Seeing how he is mid/slightly over SHBG, then it sounds like he would do better going back to 2/wk.

I am still in a quandry whether to go with 125 or 150/wk. I had one guy who's same age, etc. say he went that route with no problems at all but YES everyone is different. I suppose i could look at it this way: If 125/wk isn't sufficient for him, we will know in 6 wks. But part of us wants to charge full steam ahead if indeed he would do better with 150. I think maybe i'll just go slower and we'll wait it out.

That is correct.....Sunday at midnight and Thursday at noon.

So either go with 125mg/week or 140mg/week instead of 150.

Keep in touch, best of luck and looking forward to hearing how he responds and his blood work in 6 weeks on new dose!

 

[Deleted member 16042]

The lab range for shbg is 22-77 nmol/L so the mean (mid-normal) is 49.5 and he is 55 which is not high it is just above mid-normal.

Regardless the injection protocol she is using M/W/F is wrong as the time between his injections is not consistent just as I explained to you before when you were injecting the way you were using M/W/F.

We know that there are many lab ranges where mid range is not even close to optimal. Dr Saya calls my 46-48 SHBG "high".

 

[madman]

We know that there are many lab ranges where mid range is not even close to optimal. Dr Saya calls my 46-48 SHBG "high".

Sure mid range may not be close to optimal for some but his free t is low.....does not mean he immediately needs to have it in the high-normal range to see benefits.

Sure having a lower shbg than 46-49 would allow one to achieve higher free t levels but it is by no means high regarding the reference range of 22-77 nmol/L.

My shbg was mid-range pre-trt and has not really budged in the 18 months I have been on trt (same protocol) from the get go and my free t levels are double the top end of the range.

 

[ReillyJ]

Sure mid range may not be close to optimal for some but his free t is low.....does not mean he immediately needs to have it in the high-normal range to see benefits.

Sure having a lower shbg than 46-49 would allow one to achieve higher free t levels but it is by no means high regarding the reference range of 22-77 nmol/L.

My shbg was mid-range pre-trt and has not really budged in the 18 months I have been on trt (same protocol) from the get go and my free t levels are double the top end of the range.

This is good to know as it is so individual and honestly it seems there is only so much micro-managing one can do.

If my H's SHBG is high end "for him"...then it seems that from reading here that the protocol would be less frequent injections which is what we are going to switch to... AND esp. a higher dosage which it seems is GENERALLY the protocol for both high SHBG AND low Free Test and we're trying to affect that Free Testosterone which has been consistently low, never even within normal range, thus my request to his doctor to up the minimum dosage he's been on for 8 months (keep doing the same thing, get the same results, theoretically speaking).

 

[madman]

We know that there are many lab ranges where mid range is not even close to optimal. Dr Saya calls my 46-48 SHBG "high".

Regarding free t and the various assay methods I would not even rely on the direct assay as it has been shown (to provide inaccurate estimates).

Equilibrium dialysis is the gold standard although not all laboratories offer it.

If anything calculated free t is better than the direct assay.

 

[FeelingLost]

This is good to know as it is so individual and honestly it seems there is only so much micro-managing one can do.

If my H's SHBG is high end "for him"...then it seems that from reading here that the protocol would be less frequent injections which is what we are going to switch to... AND esp. a higher dosage which it seems is GENERALLY the protocol for both high SHBG AND low Free Test and we're trying to affect that Free Testosterone which has been consistently low, never even within normal range, thus my request to his doctor to up the minimum dosage he's been on for 8 months (keep doing the same thing, get the same results, theoretically speaking).

I think you are on the right track Susie. He will know and hopefully tell you if something doesn't feel right that is very important.

 

[ReillyJ]

OK please don't laugh at this question but he's been on the higher dosage (roughly 140/wk) and we dropped it to 2 injections and it's been roughly 2-2.5 weeks and he's had a dramatic increase in libido (which is fine by me) but he's a bit freaked out by it, understandably, as he hasn't had a high libido for years (not being treated with TRT), i carefully asked him if there is any other symptoms that appear to be negative such as increase anger, aggression, unusual emotionalism (if that is the correct wording) and he said no, only increase appetite.

I know it's early in the game but i see it as a good sign and told him it takes 6 weeks to reach full effect and maybe the libido will mediate a bit, even though it's early in the game i do not see anything negative right now.
Thoughts?

Susie

 

[madman]

OK please don't laugh at this question but he's been on the higher dosage (roughly 140/wk) and we dropped it to 2 injections and it's been roughly 2-2.5 weeks and he's had a dramatic increase in libido (which is fine by me) but he's a bit freaked out by it, understandably, as he hasn't had a high libido for years (not being treated with TRT), i carefully asked him if there is any other symptoms that appear to be negative such as increase anger, aggression, unusual emotionalism (if that is the correct wording) and he said no, only increase appetite.

I know it's early in the game but i see it as a good sign and told him it takes 6 weeks to reach full effect and maybe the libido will mediate a bit, even though it's early in the game i do not see anything negative right now.
Thoughts?

Susie

When increasing testosterone dose it is common to see an increase in libido in the beginning which should taper off after his body adjusts although once stabilized he should have a healthy functioning libido as long as other hormones are in check especially e2 but as you may know libido/erectile function can be effected negatively by many other factors even when one has healthy testosterone levels.

It is still early since he just recently increased his testosterone dose and even though it will take 6 weeks for levels to stabilize it will still take time to truly gauge how he responds to the new levels .

 

[ReillyJ]

When increasing testosterone dose it is common to see an increase in libido in the beginning which should taper off after his body adjusts although once stabilized he should have a healthy functioning libido as long as other hormones are in check especially e2 but as you may know libido/erectile function can be effected negatively by many other factors even when one has healthy testosterone levels.

It is still early since he just recently increased his testosterone dose and even though it will take 6 weeks for levels to stabilize it will still take time to truly gauge how he responds to the new levels .

i think it now has leveled off. He started the increase around May 30th.

I need to order tests, should we wait until Mid July? I think i'll be ordering E2, Free and Total Testosterone, cannot afford anything else. Got his SHBG tested a few weeks ago and right now due to finances, have to get the minimum amount tested. I think he feels better on this higher dose (around 140/wk up from 100/wk) and the libido did level off, no increase aggression or emotionalism i don't think.

Mid July (18th) will be the 7th week, is it OK to test then or wait a bit more?

Thanks again

Susie

 

[madman]

i think it now has leveled off. He started the increase around May 30th.

I need to order tests, should we wait until Mid July? I think i'll be ordering E2, Free and Total Testosterone, cannot afford anything else. Got his SHBG tested a few weeks ago and right now due to finances, have to get the minimum amount tested. I think he feels better on this higher dose (around 140/wk up from 100/wk) and the libido did level off, no increase aggression or emotionalism i don't think.

Mid July (18th) will be the 7th week, is it OK to test then or wait a bit more?

Thanks again

Susie

You can have blood work done 6 weeks on new protocol as his levels will be stabilized.

If you are only going to do labs for total t, free t and e2 just make sure the e2 is the LC/MS-MS(sensitive assay).

Glad to hear things are ok so far!

 

[FeelingLost]

Hi Susie, This sound like a big success congrats to you both.
I know you said cash is tight. Are you monitoring his blood pressure? Has it gone up? If so that could be a sign of high hematocrit (HCT)
Just something to think about when you get over 120mg/week.

Thank you for the update I love reading success stories.

 

[ReillyJ]

That is correct.....Sunday at midnight and Thursday at noon.

So either go with 125mg/week or 140mg/week instead of 150.

Keep in touch, best of luck and looking forward to hearing how he responds and his blood work in 6 weeks on new dose!

Hey guys,

We finally got BW done, T dosage was upped May 30th and just got BW done last week, Thursday morning in a trough before his shot, he injects Thursday mornings and Sunday night. It was Rx'd for 150 mg a week and i think he does roughly 140 mg.... we do .035 ml twice weekly, i'm guessing that's 140 mg. and we had dropped from pinning 3 x weekly to twice as recommended here because of his mid-high range of SHBG.

He feels better on this dosage and protocol, his libido is fine, no sign of symptoms of high E2 and his BW is:

Labs now (on 140 ish weekly):
Total Testosterone, Serum 691 ng/dL reference range: 264 - 916

Free Testosterone (Direct) 9.5 pg/mL reference range : 6.6 - 18.1

Estradiol, Sensitive 27.5 pg/mL referemce range: 8.0 - 35.0 02

Labs before (on 100 mg weekly):
Total Testosterone, Serum 560 ng/dL

Free Testosterone (Direct) 3.1 pg/mL (LOW)

Estradiol, Sensitive 24.7

So it looks like all is well so far... and he feels better ...

Susie

 

[madman]

Hey guys,

We finally got BW done, T dosage was upped May 30th and just got BW done last week, Thursday morning in a trough before his shot, he injects Thursday mornings and Sunday night. It was Rx'd for 150 mg a week and i think he does roughly 140 mg.... we do .035 ml twice weekly, i'm guessing that's 140 mg. and we had dropped from pinning 3 x weekly to twice as recommended here because of his mid-high range of SHBG.

He feels better on this dosage and protocol, his libido is fine, no sign of symptoms of high E2 and his BW is:

Labs now (on 140 ish weekly):
Total Testosterone, Serum 691 ng/dL reference range: 264 - 916

Free Testosterone (Direct) 9.5 pg/mL reference range : 6.6 - 18.1

Estradiol, Sensitive 27.5 pg/mL referemce range: 8.0 - 35.0 02

Labs before (on 100 mg weekly):
Total Testosterone, Serum 560 ng/dL

Free Testosterone (Direct) 3.1 pg/mL (LOW)

Estradiol, Sensitive 24.7

So it looks like all is well so far... and he feels better ...

Susie

Definitely looks like he is going to need to increase his dose and may need to get his TT over 1000 ng/dl in order to increase his FT to at least mid or upper levels as his FT is still on the lower end due to his highish SHGB.

If he is injecting 70-75 mg/week (every 3.5 days) and his FT is still in the lower end he may very well need to increase dose to 90-100 mg every 3.5 days to achieve a healthy FT level.

How is he feeling overall regarding mood/energy/libido/erections?

Men with highish/high SHBG usually have to run higher TT in order to achieve a healthy FT.

Even though TT is good to know FT is what really matters as it is the unbound active fraction of testosterone responsible for the positive benefits.

Again how he feels overall regarding relief/improvement of low t symptoms is what matters.....so if he truly feels well overall he does not need to change anything!

 

[ReillyJ]

Definitely looks like he is going to need to increase his dose and may need to get his TT over 1000 ng/dl in order to increase his FT to at least mid or upper levels as his FT is still on the lower end due to his highish SHGB.

If he is injecting 70-75 mg/week (every 3.5 days) and his FT is still in the lower end he may very well need to increase dose to 90-100 mg every 3.5 days to achieve a healthy FT level.

How is he feeling overall regarding mood/energy/libido/erections?

Men with highish/high SHBG usually have to run higher TT in order to achieve a healthy FT.

Even though TT is good to know FT is what really matters as it is the unbound active fraction of testosterone responsible for the positive benefits.

Again how he feels overall regarding relief/improvement of low t symptoms is what matters.....so if he truly feels well overall he does not need to change anything!

TY so much for replying, madman!

Oh wow, i hope his doc ok's the dosage change if that is what is really needed. i think..for his age...he definitely did notice an improvement in mood, energy, and libido. I am very pleased his Estradiol is within range.... erections are OK but then again, he's taking generic daily Cialis. So i would say he's definitely doing better on this dosage than on the 100 mg in which he didn't really have hugely positive results and was somewhat disappointed with TRT.

I am wondering if we should ask for an increase, i think his doc worries that with increases come possible increased risks (Estradiol issues, aggression, etc.)

Susie

 

[MarkM]

Hi Susie, I have been following your thread since it started and glad to see that your husband is doing better. You've gotten extremely good advice and feedback from madman.

It won't hurt to ask the doctor for an increase. He might have concerns but once you explain to him how well you are monitoring things he is likely to be open to it. You will be the first to notice if your husband gets more aggressive and you can always test the Estradiol to make sure it remains in check.

Best wishes on the journey and I hope it continues to improve for your husband.

 

[ReillyJ]

Yes, thank you, you all have been so very helpful and my husband is reaping the benefits. I will try to bring it up with the doctor, i guess all i can do is ask, hopefully H will do even better on it although right now we have zero complaints! At least his Free is FINALLY within normal range.

i was going to ask, is anyone else on the forum taking 90-100 mg every 3.5 days?

 

[MarkM]

I am sure there are others on the forum injecting 90 to 100mg every 3.5 days. Maybe they will see this and respond. I am injecting 80 mg every 3.5 days myself.

 

[madman]

TY so much for replying, madman!

Oh wow, i hope his doc ok's the dosage change if that is what is really needed. i think..for his age...he definitely did notice an improvement in mood, energy, and libido. I am very pleased his Estradiol is within range.... erections are OK but then again, he's taking generic daily Cialis. So i would say he's definitely doing better on this dosage than on the 100 mg in which he didn't really have hugely positive results and was somewhat disappointed with TRT.

I am wondering if we should ask for an increase, i think his doc worries that with increases come possible increased risks (Estradiol issues, aggression, etc.)

Susie

As far as his FT levels, most men do well having FT in the 2-3% range.

If we take his TT 691 ng/dL and SHBG 55 nmol/L and use the Free & Bioavailable Testosterone calculator: http://www.issam.ch/freetesto.htm

His FT is 1.59% and his BT is 37.2%.....his FT still is not optimal but again numbers are good to know but it comes down to relief/improvement of low t symptoms and the individuals overall well being.....so if he feels well on that dose than he does not have to try increasing his FT levels.

Intra-individual variability plays a big part on how one responds to testosterone and just because some may need to have their FT levels in the higher end to feel benefits there are many others who do well with levels less robust.

You are right that when one increases testosterone levels, increased e2 will follow and hemoglobin/hematocrit will also increase.

Some struggle with e2, hemoglobin/hematocrit levels when FT levels get too high.

It is all about finding a balance where one can experience the positive benefits and minimize side effects.

You should definitely get his hemoglobin/hematocrit tested as going from 100---> 140-150mg/week will increase his levels and it is critical to know where his levels sit.

As far as dose increase if he felt the need to increase his FT than it is better start low and go slow.....160mg/week (80mg every 3.5 days) as one would not have to jump right into 180-200mg/week (90-100mg every 3.5 days).

I was just stating that if he needed to increase his FT than he may need 180-200mg/week ( 90-100 mg every 3.5 days) in order to get his FT into the higher end.

 

[ReillyJ]

Hi guys, i have an update.

Husband had been doing fairly well on around 140 mg of T a week (shot twice as we were advised to drop back from 3x a week due to his slightly high SHGB which did work), given all of his health issues he was doing "OK"... libido was fine. SO we decided to test the 150 mg a week which was the actual RX.

Noticed that his ED worsened, libido didn't increase (i had noticed the 140 was the sweet spot but he wanted to try the full RX) and now he wants to sleep 12 hours a day and has zero energy.

We are waiting the lab results for T and FT but got his E2 back and what i had feared, it is high at 41.0 (35.0 being upper limit) so of course we are backing the T down to 140. Didn't get the SHBG tested as we're paying for the tests ourselves and don't have the $$ right now, but it's the E2 i'm concerned about..

He was being monitored by his Naturopath and when first of the year came around, insurance denied coverage of meds so we had to switch to his primary doc which usually does not handle TRT but he agreed this time. I have no idea what he'll say IRT the E2. I don't know if we should ask for an AI... i know to be EXCEEDINGLY careful with those to the point that they scare me but we need to figure out something to do to help him. He does take DIM, Zinc, eats a healthy diet, isn't particularly overweight but i noticed a bit of a gut returning in the last couple weeks (i know high E2 can cause that), i feel so bad for him. I am trying my best to do this pretty much on my own... Also to clarify, he's 70 (doesn't look or act it except for the fatigue) and he has NON alcoholic cirrhosis of liver (had Hep C) and works around chemicals so his detox pathways i am sure are not optimal which is part of the problem in managing his hormones, his liver enzymes are normal...

If his GP rx's an AI, i do know to start very low. Anyway, any suggestions besides of course lowering the dose?

Wonder if the next shot should be what it was when he was on 100 mg? Not good at math but when he was on 100 mg it was 03.25 on the syringe and 140 mg we did 03.50, 150 mg was 03.75 so wondering if we should go back to 03.25 for a few shots?

EDIT: emailed his Naturopath and he said :
I’d typically have him take anastrazole 1/4mg (1/4 tab) every three days. I haven’t personally seen any significant issues with it.

Thanks for any advice

Susie