If I were you I would drop your testosterone dose and drop your ai and see how you feel. You could probably lower your dose down to 120mg/ week and still have a higher free T than me. To get my free T to the top of the range at 244, I need my total T to be 1600+. To have your free T level of need my total T to probably be around 2500. My SHBG is usually in the 40’s. Your dose of 182mg/week is WAY too high for you, imo. Try to see how you feel with a free T level at the top of the range, or slightly over.
ED ongoing issues
- Thread starter TRTinNY
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madman
Super Moderator
Are you kidding me here?
You have been using/basing your FT levels of of an inaccurate testing method (direct immunoassay or the linear law-of-mass action model/equation (calculated Vermeulen) the whole time you have been on trt.
As I stated in your thread.....when using the newer calculated TruT method your FT levels are well over the top end of the reference range.
On your 2-20-19 protocol.
With a TT 1670 ng/dL, SHBG 44 nmol/L and Albumin 4.6 g/dL than your FT is 56.77 ng/dL (almost double the top end of the reference range of 16-31 ng/dL).
On your 4-30-19 protocol.
With a TT 1423 ng/dL, SHBG 63 nmol/L and Albumin 4.3 g/dL than your FT is 48.24 ng/dL (still well over the top end of the reference range of 16-31 ng/dL).
To get my free T to the top of the range at 244, I need my total T to be 1600+.
- hate to bust your bubble again.....but your FT was already almost double the top end of the reference range when your TT was 1670 ng/dL!
To have your free T level of need my total T to probably be around 2500.
- what?.....a TT 2500 ng/dL, SHBG 44 nmol/L and Albumin 4.3 g/dL would have your FT levels astronomically high at 92.63 ng/dL.....triple the top end of the reference rangeof 16-31 ng/dL.
Again the only way one is going to truly know where their FT levels sit on such dose of T is to use an accurate testing method such as the gold standard Equilibrium Dialysis (other methods are compared to) or Ultrafiltration or if anything the newer calculated TruT method which is on par with results obtained by the gold standard Equilibrium Dialysis.
No one should be wasting their time using an inaccurate testing method such as the piss poor direct immunoassay or tracer analog.....let alone the outdated linear law-of-mass action model/equation such as the calculated Vermeulen method!
No one has a clue what their FT levels really are.
If anything everyone should be buying the Equilibrium Ultrafiltration from Nelson's Discount labs or if anything using the newer calculated TruT method.
Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS- No Upper Limit
Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS- No Upper Limit
I've argued forcefully in many threads that this is not the case; the rate of absorption—from an injected depot—is the controlling factor, not the rate of clearance. This is because the half-life of clearance is on the order of minutes to an hour, while the half-life of absorption is on the order of days, depending on the testosterone ester. SHBG affects the clearance rate and not the absorption rate.
So the only thing that worries me about going by the tru T calculator is what are we comparing these values to? Are we comparing these results with the rest of the population? Where did they get the 16-31 range from? Is this based off of statistics of thousands of men, or is it a range they came up with based strictly off of numbers. Not sure if that makes sense or not. But do you know what I mean? A calculated value means nothing if we have nothing to compare it to.
Ya
Ya but if a guy with a low SHBG clears the testosterone faster, wouldn’t he start the absorption process faster, and therefore have levels that rise and fall much quicker than a high SHBG guy?
Ya but if a guy with a low SHBG clears the testosterone faster, wouldn’t he start the absorption process faster, and therefore have levels that rise and fall much quicker than a high SHBG guy?
madman
Super Moderator
*highlighted in blue- refer to the new Multi-step Dynamic Binding Model with Complex Allostery (TruT calculated)
The diagnosis of hypogoandism is based on ascertainment of low total testosterone levels, which can be misleading in conditions listed above in which binding protein concentrations are affected. Therefore, in these patients with alterations in binding protein concentrations, the diagnosis should be based on free testosterone levels. The Endocrine Society has published cut-off levels that define low free testosterone levels (Bhasin et al, Testosterone Therapy of Men with Androgen Deficiency Syndromes: An Endocrine Society Guideline. JCEM 2010). These cut-off levels for free testosterone were based on methods which are demonstrated herein to be inaccurate. Using the methods, assays, and/or systems described herein, new cut-offs for defining low free testosterone in men in different decades of age are provided herein. These reference values will facilitate accurate diagnosis of hypogonadism in men. Based on the distribution of free testosterone in men, the lower limit of the normal range is determined to be 114.6 pg/mL.
Using the methods, assays, and systems described herein, the optimal range of free testosterone concentrations that should be targeted in hypogonadal men receiving testosterone replacement therapy have also been determined. The treatment of hypogonadism with testosterone is currently suboptimal. The analyses of clinical trials data described herein demonstrate that a large fraction of hypogonadal men treated with testosterone therapy have testosterone levels in the subtherapeutic range.
The current Endocrine Society guidelines suggest the use of total testosterone levels to guide therapy, which as discussed above, do not provide an accurate assessment of the androgen status. The free testosterone concentrations, determined the new method described herein, can provide accurate assessment of the adequacy of testosterone therapy in hypogonadal men. Based on the new data on the distribution of free testosterone levels in healthy men the target range of free testosterone has been determined to be 164 to 314 pg/ml (mean+/−1SD). If the on-treatment free testosterone concentrations determined using the methods described herein are outside this range, the dose of testosterone should be adjusted using the methods described herein to achieve testosterone levels in the target therapeutic range to maximize benefits and reduce the risks. Furthermore, the initial dose of testosterone therapy can be determined using the methods, assays, and/or systems described herein, e.g. the dosimeter methods described herein.
Again when testing FT the gold standard is Equilibrium Dialysis.....the newer TruT model/algorithm is based off the newer understanding of SHBG:T binding and when compared the newer TruT calculated method is on par with results obtained by the gold standard Equilibrium Dialysis.
"Based on the new data on the distribution of free testosterone levels in healthy men the target range of free testosterone has been determined to be 164 to 314 pg/ml (mean+/−1SD)"
Which would convert to 16-31 ng/dl
If you do not want to trust the newer calculated TruT method so be it.....if anything than start using accurate testing methods such as the gold standard Equilibrium Dialysis or Ultrafiltration.....plain and simple!
No. You have this hydrophobic depot under the skin or in the muscle. It dissolves slowly based on factors such as location, testosterone ester, and carrier oil. There is no way for SHBG and/or the clearance rate of testosterone to have a meaningful influence on the rate this depot dissolves. Only when the testosterone ester enters the bloodstream does it interact with esterase enzymes, cleaving the ester and allowing the testosterone to begin clearing.
Something I find really interesting about this is that it means the absorption rate is directly controlling free testosterone. You can vary SHBG up or down, and in theory free testosterone doesn't change. Instead, total testosterone adjusts to ensure the clearance rate matches the absorption rate, as it must in a steady state.
Very interesting, especially what you said at the end. You might be spot on. Here’s two sets of labs, 4 months apart. They were on basically the same protocol. The only difference was that the labs in August I was on Arimidex 0.25mg EOD, and the December labs I was on exemestane 6.25mg EOD. But notice how your theory is exactly what happened to me basically. My free T stayed identical, but my total T and SHBG adjusted accordingly to keep my free T the same, for whatever reason. I’m assuming since exemestane has been known to lower SHBG, that it lowered my SHBG, and therefore to keep free T at the same level, my body lowered my total T.
So can you explain briefly again why you think this happened?
8-15-17
Total T - 1299 (250-1100 ng/dL)
Free T - 146.6 (46.0-224.0)
Bio T - 307.8 (110.0-575.0 ng/dL)
SHBG 51 (10-50) E2 Sensitive - 8
E2 NOT Sensitive - 13
E2 Free - 0.28 (0.2-1.5)
12-13-17
Total T - 974 (250-1100 ng/dL)
Free T - 142.6 (46.0-224.0)
Bio T - 287.0 (110.0-575.0 ng/dL)
SHBG 36 (10-50)
E2 Sensitive - 9
E2 NOT Sensitive - 13
E2 Free - 0.28 (0.2-1.5)
Your numbers do seem to illustrate the concept nicely, provided some assumptions hold. To compare the two sets of numbers directly we're assuming that the rate of absorption of testosterone is roughly the same each time. This is probably the case because you're on the same protocol and presumably taking measurements at the same point in the injection cycle. The bigger assumption is that with respect to factors that influence the clearance rate of testosterone, only SHBG has changed. Further, we're assuming a localized steady state in testosterone, wherein the rate of absorption of testosterone is equal to the rate of clearance.
Under these conditions it's clear that free testosterone can't change, except briefly during transitions. This is because the clearance rate of testosterone is proportional to free testosterone, and we've required that the clearance rate be fixed—to match the absorption rate.
So what happens when SHBG goes down, as in your case? This starts to push up free testosterone, which starts to increase the clearance rate. But these trends are counteracted by the fixed absorption rate, which forces total testosterone down to a lower equilibrium value so that the clearance rate returns to its original value, matching the absorption rate.
I went through the arguments in more detail using an analogy to tubs of water: [1], [2]
The math in particular is here.
There's an interesting complication with your free testosterone numbers. "madman" has been complaining that you're using an inaccurate free T test, and indeed the numbers don't seem to match either Vermeulen or Tru-T. However, it appears that Quest is doing some kind of calculation based on total T, SHBG and albumin [3], so maybe these numbers should not be dismissed so quickly.
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marcsmith79
New Member
Your t is too high. I am having the same issues and I also have low SHBG. From what read from my thread when your SHBG is low, then you will to better on a daily regimen or EOD of test....I have also read that HCG is easily converted to E2, so maybe cut that and the AI and see how you feel in mid to normal range.
Appreciate you taking the time to explain that. And whether quest’s Free T test is accurate or not, the only reason I continue to use it is because I’ve used it for the past 5 years, and it helps me analyze and compare current protocols to previous protocols, vs getting free T done by a different lab and not sure how that level compares to my previous 5 years of labs. This last set of labs I had done, I had all my labs done at quest, and then 20 minutes later went to labcorp to have them draw my total and free T. This way I’ll be able to compare my free T from quest, labcorp, and then any free online calculators as well. Already got my labs from labcorp back, just waiting on quest to finish up and send me my results.
I suspect that in the worst case the Quest free T results are comparable to Vermeulen computations, which I found to be pretty useful before Tru-T came along. It is possible that Quest improved on the method. The inexpensive LabCorp direct free T test is on average going to be less reliable than the calculations. Over at PeakT guys have reported all kinds of inexplicable inconsistencies in these tests.
@Cataceous So just got my labs back, and check this out! It just reinforces what you were saying.
Labs on 4-30-19
Protocol: 17.5mg prop ED
Total T - 1423 (250-1100 ng/dL)
Free T - 134.8 (46.0-224.0)
Bio T - 265.5 (110.0-575.0 ng/dL)
SHBG 63 (10-50)
Labs on 7-23-19
Protocol: 42mg prop EOD
Total T - 1002 (250-1100 ng/dL)
Free T - 134.2 (46.0-224.0)
Bio T - 287.7 (110.0-575.0 ng/dL)
SHBG 39 (10-50)
With the first set of labs, I had labs drawn 36 hours after last 17.5mg injection (due to issues with my work schedule and me being able to get labs drawn) 2nd set of labs were drawn morning before my EOD injection. SHBG dropped because I went off of all thyroid medication after getting my labs drawn in April. So the labs in July were while on no thyroid medication, and the April labs were while on 2.5 grains of NDT. Its just scary how identical my free T is between both labs.
Labs on 4-30-19
Protocol: 17.5mg prop ED
Total T - 1423 (250-1100 ng/dL)
Free T - 134.8 (46.0-224.0)
Bio T - 265.5 (110.0-575.0 ng/dL)
SHBG 63 (10-50)
Labs on 7-23-19
Protocol: 42mg prop EOD
Total T - 1002 (250-1100 ng/dL)
Free T - 134.2 (46.0-224.0)
Bio T - 287.7 (110.0-575.0 ng/dL)
SHBG 39 (10-50)
With the first set of labs, I had labs drawn 36 hours after last 17.5mg injection (due to issues with my work schedule and me being able to get labs drawn) 2nd set of labs were drawn morning before my EOD injection. SHBG dropped because I went off of all thyroid medication after getting my labs drawn in April. So the labs in July were while on no thyroid medication, and the April labs were while on 2.5 grains of NDT. Its just scary how identical my free T is between both labs.
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The data are at least suggestive, but the variations in protocol and test times add some uncertainty.
I know but it’s so weird that there’s 3 months in between labs, and my free T is literally identical! The human body is honestly fascinating. How it has different mechanisms to maintain homeostasis. I’m not trying to extrapolate any scientific data off of this or anything, as you’re right, a couple variables are different. Just thought it was very interesting how this is the second time this has happened to me. Where my SHBG drops, and my body compensates by dropping my total T, so that my free T will maintain at the exact same level. On these labs I was expecting my total T to be higher, not lower.
I would definitely say that my other example was more scientific. With my previous example, my protocol had stayed the exact same between labs. The only thing I changed was that I switched from 1/4 tab of anastrozole EOD, to 1/4 tab of aromasin EOD. Aromasin dropped my SHBG quite a bit, which should of increased my free T. But my free T came back identical, due to my total T being considerably lower. Idk, just interesting stuff imo.
marcsmith79
New Member
I would quit smoking immediately and try and drop down to around 10-12% body fat. My doc said that the leaner you stay the less test converts to e2. If you have high RBC's in a high normal or even a little above you can always donate some blood every 8 weeks to help keep it in check, along with cardio and lots of water everyday. I would also recommend lowering your dose. Everything that I have read on this site says that low SHBG males do better on lower doses of Test...I felt my best under 700ng/dL with high normal free and high normal e2. Your body needs estrogen. I believe that like test we all respond differently to varying levels of E2. Also drop your HCG or run a low dose once a week like 125ml to keep the loop open and no E2 spikes unless you are trying to have some kids, if that's the case I would drop everything and start clomid . There is a lot of literature on ED that says hormones are half the battle, the other half is lifestyle choices, diet, sleep, supplements. You said you quit porn and masturbation which is a great move, you could be overstimulated and your body just needs a break.
madman
Super Moderator
Unfortunately the FT testing method Quest uses is a modified form of the linear law-of-mass action Vermeulen calculated method and this model/equation is based off of a faulty understanding of SHBG:T binding.
As has been stated on TruT:
" However, we have demonstrated that even the calculated fT values derived from the prevailing equations, based on linear law-of-mass action models or empiric equations, differ systematically from free testosterone measured by equilibrium dialysis by as much as 40%"
Again if we look at your labs:
Labs on 4-30-19
Protocol: 17.5mg prop ED
Total T - 1423 (250-1100 ng/dL)
Free T - 134.8 (46.0-224.0)
Bio T - 265.5 (110.0-575.0 ng/dL)
SHBG 63 (10-50)
Using the newer TruT calculated method (which has been shown to be on par with results obtained by the gold standard Equilibrium Dialysis).
TT 1423, SHBG 63 nmol/L and Albumin 4.3 g/dL (mean) than your FT is 48.24 ng/dL (well over the top end of the reference range of 16-31 ng/dL).
Labs on 7-23-19
Protocol: 42mg prop EOD
Total T - 1002 (250-1100 ng/dL)
Free T - 134.2 (46.0-224.0)
Bio T - 287.7 (110.0-575.0 ng/dL)
SHBG 39 (10-50)
TT 1002 ng/dL, SHBG 39 nmol/L and Albumin 4.3 g/dL (mean) than your FT is 35.05 ng/dL (just over the top end of the reference range of 16-31 ng/dL).
So you can clearly see the difference in FT levels between protocols 48.24 ng/dL vs 35.05 ng/dL.....mind you we also need to keep in mind the variations in protocols.
Why you are dead set on comparing FT levels using calculated testing methods that are outdated let alone have been shown to grossly underestimate FT values when compared to the gold standard Equilibrium Dialysis is beyond me.
Again regarding FT testing methods whether direct immunoassay or tracer analog both have been shown to be inaccurate let alone no longer recommended by the Endocrine Society and as for the linear law-of-mass action calculated methods the models/equations are based off of a faulty understanding of SHBG:T binding.
As we know ones SHBG level is critical to what FT level is achieved at said TT level.
The only way to truly know where ones FT levels sits is to use an accurate testing method such as the gold standard Equilibrium Dialysis or Ultrafiltration and now we have the newer calculated TruT method which model/equation is based off of the new research.................
understanding of SHBG:T binding and the TruT calculated method is on par with results obtained by ED.
So again if you want to keep on using/relying/comparing your FT levels whether using the piss poor inaccurate direct immunoassay or the outdated linear law-of-mass action equtaions if it truly makes you feel better so be it.
But do not go on claiming such about your FT levels based off inaccurate testing methods.
Get back to me when you start testing your FT levels on varying trt protocols using accurate testing methods such as Equilibrium Dialysis or Ultrafiltration.
As has been stated on the TruT:
- Commonly available free testosterone calculators (issam.ch, nebido.com, pctag.uk) use models of testosterone:SHBG binding (proposed by Vermeulen et al. and Sodergard et. al) which were developed before the crystal structure for SHBG:T complexes were available. These models assume that the two SHBG monomers behave identically in binding testosterone. Detailed experimental data show that the "simplified linear model is erroneous." References.
- The TruT™ calculator provides the ideal solution by using measurements of total testosterone, SHBG, and albumin to calculate free testosterone while taking into account the complex, non-linear allostery in SHBG's association with testosterone. TruT™ is the only calculator available that uses this more complex formulation. References
I honestly appreciate you taking the time to review and analyze my labs like this, and appreciate the advice on free T. You’re definitely right about all this free T stuff. I’m pretty much sold on the new method. I just have a lot of old labs that use the old methods. I’ll eventually convert all my old free T levels with the tru T calculator, so I can then compare all my labs accurately.
Nelson Vergel
Founder, ExcelMale.com
Drop the anastrozole and increase hCG to 500 IU twice per week. Continue tadalafil and add 1000 mg of citrulline per day.
Hey I know I’m not a guru on the forums but want to give my two cents as I’m a low shbg guy and i have been on trt for three years. So being low shbg we obviously suffer from high free e2 and We tend to aromatize faster as well and excret testosterone rapidly. In my case I’m i have the perfect recipe for disaster which is low shbg , highly aromatize and hyper excrete test and on top of all that I’m an anastrozole over responder. For about a year and half my sex life revolved around cialis And vigra and that was a guessing game if it would would work. I have tried every protocol under sun once ,twice, three times , daily and eod protocol with hcg and without with adex and without also with DHEA and without as well as different testosterone esthers and blends . My final solution was going to EOD injections sub q , with pregnenalone 20mg daily ,no hcg , no DHEA and micro dosing adex eod with injections
Here’s my protocol
40mg Dual blend cypionate with prop eod sub q
Adex microdose 0.05 capsule diluted with vodka intake 0.01 with shots yes that’s small of a dose has crashed me before and i have labs to prove and without it I have gyno and Ed I tried lowering the testosterone but my levels are too low so it’s my only choice
Pregenenalone 20mg everyday
Labs are 720 total t
Free t around 22
And e2 sensitive 31
Shbg 16
I have sex all the time multiple times a day I don’t always wake up with morning wood but the erection is there if I need it be. I’m 31 years old btw also a former bodybuilder . Also I want to bring up something about cialis when have taken cialis consecutively in 10mg dose or sometimes 5 after a while I have symptoms of crashed e2 and this was when i had removed adex from the equation it’s known For altering ur e2 and testosterone ratio i have experienced this several times if I were to take it now it would give me symptoms of low e2 anxiety, insomnia and constant urination. I know it sounds crazy but it’s what’s happened luckily I don’t need it but when I have experimented it’s has occuree
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