Feedback on lab results

[madman]

@madman there’s a lot to unpack there and you were all over the place, while seeming somewhat frustrated (or at least that’s how it came off at times during that post). No need to “hammer into my dome” anything. I’m not talking about blasting and cruising. I’m simply stating that “absurdly high” could be subjective. You say it’s high whether injecting daily or once/week. However, there would be a HUGE difference in those two examples. If I inject once per week and my trough is at 30 then my peaks are way WAY higher than that 6 days of the week. If I inject daily and my trough is at 30 then my peak would not be nearly as high as in the first example.

Plus you are discussing “resolution of symptoms” and “getting the maximum benefits” at the same time…those two things are not the same. A person could take a very small dose to see some improvement of symptoms while not even getting close to levels that would bring the full benefits. Again, I agree about most people tending to start out too high and chasing their tails as they go round and round. I even remember being disappointed that my doctor originally started me at 120 mg/week. I was hoping for something closer to 200 just because that is a number that is often parroted. Luckily I frequented this forum more than lots of the other places that you called out, with a large reason being the posting of great studies and lots of anectdotal experiences from reasonable experienced people here. And I should say that I greatly enjoy all the resources you share here. Now my ideal dose is closer down to 100/week and I’m glad I went that way instead of higher. That being said, that along with my HCG put my trough in the high 20’s approaching the, as you would call it, “absurdly high” trough level. I feel great here, have incredible symptom resolution, and feel that I am maximizing the benefits of trt(not to be confused with simply resolving symptoms). All of my health markers look great. My sleep, well-being, energy levels, mental clarity, motivation, libido, and workouts are all great. If some people say I’m running “absurdly high” free t levels to accomplish that then so be it.

Edit to add - I also second your sentiments about being careful to take the “I feel great so I must be healthy” approach, and that’s a pet peeve of mine. Lots of people justify unhealthy habits by saying if they feel good then it can’t be too bad. Many even eat themselves into an early grave by saying their food makes them feel good. People should be careful and realize humans are good at justifying things even when they feel down understand it probably isn’t the best path. So again, I agree with calling out the dangers that may arise from that approach.

You would get the point as I have made it very clear on numerous posts that a trough FT 30-30+ng/dL is absurdly high and yes I also made it very clear in previous posts that there will be a big difference running a trough FT 30-30+ ng/dL injecting daily vs twice-weekly let alone once weekly!

Bottom line here is hitting a trough FT 30 ng/dL injecting daily is absurdly high compared to where a healthy young male would sit and that is at peak!

Again rare any natty male is hitting a peak FT 20-25 ng/dL.

As I stated previously.

What percentile of healthy young men would even be hitting a peak not trough FT 20-25 ng/dL.

Even if you took the outlier nattys (healthy young men) hitting a high FT 20-25 ng/dL again this is a short-lived daily peak.

Sure as hell not a trough - depending on injection frequency - dailies, 2 days later (EOD), 3 days later (M/W/F), 3.5 days later (twice-weekly), let alone 7 days later (once weekly)!

No I'm not buying into the one needs to be hitting an absurdly high trough FT, key word here being absurd in order to experience the maximum benefits of having a healthy FT level, now if we are speaking in terms of body composition (increased muscle/strength and recovery).....sure!

Most of the men struggling on these forums are overmedicated!

Regardless do what is best for you and yes just to be clear many may very well fare better running higher levels within reason!

 

[Phil Goodman]

You would get the point as I have made it very clear on numerous posts that a trough FT 30-30+ng/dL is absurdly high and yes I also made it very clear in previous posts that there will be a big difference running a trough FT 30-30+ ng/dL injecting daily vs twice-weekly let alone once weekly!

Bottom line here is hitting a trough FT 30 ng/dL injecting daily is absurdly high compared to where a healthy young male would sit and that is at peak!

Again rare any natty male is hitting a peak FT 20-25 ng/dL.

As I stated previously.

What percentile of healthy young men would even be hitting a peak not trough FT 20-25 ng/dL.

Even if you took the outlier nattys (healthy young men) hitting a high FT 20-25 ng/dL again this is a short-lived daily peak.

Sure as hell not a trough - depending on injection frequency - dailies, 2 days later (EOD), 3 days later (M/W/F), 3.5 days later (twice-weekly), let alone 7 days later (once weekly)!

No I'm not buying into the one needs to be hitting an absurdly high trough FT, key word here being absurd in order to experience the maximum benefits of having a healthy FT level, now if we are speaking in terms of body composition (increased muscle/strength and recovery).....sure!

Most of the men struggling on these forums are overmedicated!

Regardless do what is best for you and yes just to be clear many may very well fare better running higher levels within reason!

I think we agree more than disagree here so I’ll start with that. However, I don’t think sitting at the top of the range is necessarily “absurd” as you like to constantly say. I’d also say we don’t have good solid data on what are considered top level testosterone levels for healthy young males. We’ve been wrecking our endocrine systems with chemicals and various substances for 100+ years. How long have we been getting testosterone levels for the population. Out of those tests, how many were done in healthy young males? For the ones that were done in healthy young males, how many were done with accurate testing methods? For the ones that were done in healthy young males, which ones were done at a time of day when they were actually at their peak? The list of questions could go on and on…but point being, there’s no way to go back and find a fully optimized society of natural males and test them to see what their levels were. And even if we could, that doesn’t mean being at or slightly above those levels would not be even better, or that maintaining those levels for the entire day instead of for a brief snapshot. And yes, I understand the down(and up)stream impacts on other hormones, but that is a different discussion outside of a strictly best level conversation. Finally, you say 30 is absurdly high. Is 29 absurdly high? How about 28? 27? Regardless of where you decide to drop the “absurd” label, that is a subjective take.

 

[madman]

I think we agree more than disagree here so I’ll start with that. However, I don’t think sitting at the top of the range is necessarily “absurd” as you like to constantly say. I’d also say we don’t have good solid data on what are considered top level testosterone levels for healthy young males. We’ve been wrecking our endocrine systems with chemicals and various substances for 100+ years. How long have we been getting testosterone levels for the population. Out of those tests, how many were done in healthy young males? For the ones that were done in healthy young males, how many were done with accurate testing methods? For the ones that were done in healthy young males, which ones were done at a time of day when they were actually at their peak? The list of questions could go on and on…but point being, there’s no way to go back and find a fully optimized society of natural males and test them to see what their levels were. And even if we could, that doesn’t mean being at or slightly above those levels would not be even better, or that maintaining those levels for the entire day instead of for a brief snapshot. And yes, I understand the down(and up)stream impacts on other hormones, but that is a different discussion outside of a strictly best level conversation. Finally, you say 30 is absurdly high. Is 29 absurdly high? How about 28? 27? Regardless of where you decide to drop the “absurd” label, that is a subjective take.

Again we are talking troughs/steady-state here whether injecting daily, EOD, twice-weekly, M/W/F, once weekly not a daily short-lived peak!

A trough FT 30-30+ ng/dL is absurdly high compared to where a healthy young male would sit 12 ng/dL (paper posted below) and this is tested using the most accurate assay, gold standard direct state of the art ED LC-MS/MS assay in healthy men, blood drawn in the early AM!

Again outliers are the ones that would be hitting the 90-95 th percentile and this would be far and few.

Most healthy young males are hitting a TT 500-600 ng/dL (peak), even going back to the 70s when testing was first available you would be looking at 600-800 ng/dL.

Take those TT 500-800 ng/dL (short-lived peak) and thrown in for shits sake a normal SHBG and calculate their FT using the go to linear law-of-mass action cFTV and none of these men would be hitting a peak FT of 20 ng/dL.

Top it off that cFTV tends to overestimated slightly compared against a standardized direct state of the art ED assay so FT would be slightly lower than the cFTV value given!

There is a reason we have a natural 24 hr circadian rhythm with T levels peaking in the early AM.

T was never meant to be elevated let alone amped up 24/7!

Fine balance we are talking about here especially when it comes to disruption of the hormonal milieu let alone neurotransmitters especially dopamine!

Again running too high a trough/steady-state FT level can be just as bad in many ways as running too low a level especially when it comes to libido and erectile function let alone mood!

Again I am not against one running high-end/slightly above trough FT levels if they truly feel great overall, blood markers are healthy and they are not struggling with any sides.

Also need to keep in mind injection frequency when speaking about trough as again there is a big difference between one running a high (20-25 ng/dL) or better yet absurdly high (30-30+ ng/dL) trough FT injecting daily vs every 3.5 days let alone once weekly!

Stressing the point here that a trough/steady-state FT 30-30+ ng/dL is absurdly high compared to where most healthy young males would sit at peak and that is short-lived to boot!

Clear as day here!

Look over the 2 papers posted below, healthy males, direct state of the art ED LC-MS/MS assay was used, blood was drawn in a fasted state in the early AM!




ECE 2024 Poster Presentation

Age-stratified reference ranges for directly measured serum free testosterone in healthy men | ECE2024 | 26th European Congress of Endocrinology | Endocrine Abstracts

www.endocrine-abstracts.org

*Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies

* mFT levels were measured in 867 men using ED LC-MS/MS as previously reported (1). Subsequently, 95% reference ranges were determined using the non-parametric method

Reassessing Free-Testosterone Calculation by Liquid Chromatography–Tandem Mass Spectrometry Direct Equilibrium Dialysis

Reassessment of FT in women and men with state-of-the-art methodology confirms previously established FT percentages but highlights limitations of differen

academic.oup.com

Reference: 1. Fiers T, Wu F, Moghetti P, Vanderschueren D, Lapauw B, Kaufman JM. Reassessing Free-Testosterone Calculation by Liquid Chromatography–Tandem Mass Spectrometry Direct Equilibrium Dialysis. J Clin Endocrinol Metab. 2018;103(6). doi:10.1210/jc.2017-02360

​

Age-stratified reference ranges for directly measured serum free testosterone in healthy men (2024)
Joeri Walravens, Gido Snaterse, Nick Narinx, Leen Antonio, Tim Reyns, Tom Fiers, Jean-Marc Kaufman & Bruno Lupauw


Introduction

Determination of serum (calculated) free testosterone (FT) in clinical practice has been suggested by several clinical guidelines for the diagnosis of male hypogonadism in men with borderline total T concentrations and in situations with altered sex hormone-binding globulin, as it correlates better with androgen exposure than total T. The gold-standard for the determination of FT levels is considered to be directly measured free testosterone (mFT) using equilibrium dialysis followed by mass spectrometry (ED LC-MS/MS). However, no widely accepted reference ranges are available for this clinical parameter. We established mFT reference ranges for healthy men aged 18 to 69 years.


Objective

To establish reference ranges for measured FT in serum of healthy adult men.


Methods

Reference ranges were determined following Clinical & Laboratory Standards Institute guideline C28-A3c per age decade. Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies. Exclusion criteria were medications or conditions that affect sex steroid metabolism or a BMI larger than 35 kg/m2. mFT levels were measured in 867 men using ED LC-MS/MS as previously reported (1). Subsequently, 95% reference ranges were determined using the non-parametric method.


Results

We present 95% mFT age-stratified reference ranges. These reference ranges show an expected, decreasing trend of mFT with aging. Lower limits and median mFT decrease at a remarkably stable rate of, on average, 12% per decade up into the 6th decade of life. However, in the upper limit, a marked decrease of 25% occurs after 39 years, followed by smaller decreases of 6% per decade in older age categories.


We present 95% mFT age-stratified reference ranges

Age category (years)	Median mFT (ng/dl)	95% mFT reference range (ng/dl)
18-29 (n=140) 30-39 (n=252)	12.0 9.8	6.7-25.3 4.9-18.5
40-49 (n=207)	8.1	4.3.14.2
50-59 (n=146)	7.1	3.8-12.8
60-69 (n=126)	6.4	3.4-11.7
70-79 (n=125)	5.6	2.7-8.7

Conclusion


We have determined mFT reference ranges in healthy men aged 18 to 69. These reference ranges are a first step to improving the framework for further development and integration of free testosterone measurements and calculations in clinical practice.


Again how many healthy young males are running around with a peak FT 25.3 ng/dL!

The median FT value for healthy young men 18-29 years is 12.0 ng/dL!








Throw the Jasuja and Bhasin 2022 study in there too!

Again healthy males, direct state of the art standardized ED LC-MS/MS assay was used, blood was drawn in a fasted state in the early AM!

Critical point here!

Look at where the men 19-39 years in the 50th (14.1 ng/dL), 75th (19.0 ng/dL), 90th (24.0 ng/dL) and 97.5th (30.9 ng/dL) percentile values for absolute FT values sit!

* In healthy nonobese men, 19 years or older, the 2.5th, 10th, 25th, 50th, 75th, 90th and 97.5th percentile values for absolute free testosterone were 66, 91, 116, 141, 190, 240, and 309 pg/mL, respectively (Table 3).


Again how many healthy young males are running around with a peak FT 24.0-30.9 ng/dL!

The 50th percentile value is 14.1 ng/dL!




https://onlinelibrary.wiley.com/doi/abs/10.1111/andr.13310

Reference Intervals for Free Testosterone in Adult Men Measured Using a Standardized Equilibrium Dialysis Procedure (2022)
Ravi Jasuja, Ph.D.; Karol M. Pencina, Ph.D.; Daniel J. Spencer, BS; Liming Peng, MS; Fabiola Privat, BS; Waljit Dhillo; MD, Ph.D.; Channa Jayasena, MD, Ph.D.; Frances Hayes, MD; Bu B. Yeap, MB, BS, Ph.D.; Alvin M. Matsumoto, MD; Shalender Bhasin, MB, BS

Reference Intervals for Free Testosterone in Adult Men Measured Using a Standardized Equilibrium Dialysis Procedure

Again you heard it here first only at Nelson's ExcelMale! @Nelson Vergel Was going to drop this bomb a few days ago but you let down the curtains early LOL! https://onlinelibrary.wiley.com/doi/abs/10.1111/andr.13310 Reference Intervals for Free Testosterone in Adult Men Measured Using a...

www.excelmale.com

ABSTRACT

Background

Free testosterone (FT) determination may be helpful in evaluating men suspected of testosterone deficiency, especially in conditions with altered binding-protein concentrations. However, methods for measuring FT by equilibrium dialysis and reference intervals vary among laboratories.


Objective

To determine reference intervals for FT in healthy, nonobese men by age groups as well as in healthy young men, 19 to 39 years, using a standardized equilibrium dialysis procedure.


Methods

We measured FT in 145 healthy, nonobese men, 19 years or older, using a standardized equilibrium dialysis method performed for 16 hours at 37ºC using undiluted serum and dialysis buffer that mimicked the ionic composition of human plasma. FT in the dialysate was measured using a CDC-certified liquid chromatography-tandem mass spectrometry assay.


Results

In healthy nonobese men, the 2.5th, 10th, 50th, 90th, and 97.5th percentile values for FT were 66, 91, 141, 240, and 309 pg/mL, respectively; corresponding values for men 19 to 39 years, were 120, 128, 190, 274 and 368 pg/mL, respectively. FT levels by age groups exhibit the expected age-related decline. FT levels were negatively associated with body mass index, age, and SHBG levels. Percent FT was lower in middle-aged and older men than young men adjusting for SHBG level.


Discussion

Further studies are needed to determine how these reference intervals apply to the diagnosis of androgen deficiency in clinical populations and in men of different races and ethnicities in different geographic regions.


Conclusion

Reference intervals for free FT levels (normative range 66-309 pg/mL [229- 1072 pmol/L] in all men and 120-368 pg/mL [415-1274 pmol/L] in men, 19-to-39 years), measured using a standardized equilibrium dialysis method in healthy nonobese men, provide a rational basis for categorizing FT levels. These intervals require further validation in other populations, in relation to outcomes, and in randomized trials.








Put the nail in the coffin here!

This is coming from the man who would be considered the father of testosterone who has made huge contributions regarding testosterone therapy and men's health let alone has treated 1000s of men over decades!

Would be considered one of the top heavyweights when it comes to (research/clinical experience) in the field of hormone replacement therapy!

Puts most endos to shame when it comes to treating symptoms vs numbers!

Even then one of the main points he always stresses:


Dr.Abraham Morgentaler

* what's important to understand though is that the concept of testosterone therapy in theory is designed to replicate youthful levels of testosterone to help people who are deficient in this hormone, the goal isn't to make them into supermen and the real question is why do people want to go above normal if at all, much of the concept of treating up lets say a 1000 let's say our normal upper limit, in the anti-aging community or age management community there are some people who believe the there's an optimal level of testosterone that may be 1200 or 1500 or even I've heard 1800 and the basis for that is WEAK!

 

[madman]

Would not go that far here!

Much more to the story.

The downfall here is many men jumping on oral TU start on the lower end dose let alone do not always put in the time to truly gauge the effectiveness of the protocol and even then many bailout before even titrating up in dose which may be needed in many cases in order to achieve a high enough TT/FT.

Even when using oral TU (Jatenzo or Kyzatrex) steady-state is achieved fairly quick but one still needs to put in the time let alone titrate up in dose if need be before jumping to any conclusions.

Another critical point that needs to be made here is there are a fair amount of men already on injectable T running high let alone absurdly high FT levels trough/steady-state that decide to give oral TU a go.

This is going to make a huge difference here as to how one feels when first starting oral TU as it will take time for the body to adapt to the 2 daily peaks/troughs vs coming down from the high/absurdly high trough/steady-state FT levels achieved on injectables.

These guys are already amped up on T 24/7!

As you should very well know from hanging out on this forum let alone those other so called men's health/HRT forums loaded with all those blast n cruizerrzzz pushing that more T is better mentality bullshit that unfortunately most men are overmedicated on T from the get-go!

You have guys running around with high/absurdly high trough/steady-state FT levels well beyond their genetic set-point.

Blown the suicide doors of the LAMBO here!

FT levels through the roof 24/7!

No way most of these men could truly give an oral TU protocol a fair shake!

You would need to bite the bullet and expect to feel shitty from the get-go as again it will take time for the body to adapt.

Put money on it if the individual started TTh using oral TU and put in the time let alone was titrated properly so he achieved a high enough TT/FT level many would fair well overall on such protocol!

Even much better when it comes to the sides (cosmetic/blood markers) than most using injectable T!

I could name off quite a few of the top uros treating men with oral TU that have many satisfied patients and it was mentioned in a recent interview Nelson posted with Marius Pharmaceuticals CEO Shalin Shah that common dosing regimens for Kyzatrex are 300-400 mg BID (2X/day) /600-800 mg daily!

The starting dose is 200 mg BID/400 mg daily.

KYZATREX (oral testosterone undecanoate) now available in all states across the US

Did you get any nasty side effects by the way? None. I am looking at all the warnings and one of them says increase risk of death. That's a load of sh**! There's an increase risk of death living life, like crossing the street. There's increase risk of death with any other medicines.

www.excelmale.com

Oral TRT Products: Jatenzo, Tlando, Kyzatrex, & DiTest

I have tried Jatenzo on a few occasions, but never got to seven days. Have you tried Jatenzo after no injections for a couple of weeks? Stacking both may be causing your problems. I felt bad on Jatenzo 2, 3 and 4th week and I’ll bet it has to do with the cypionate leaving my system and my T...

www.excelmale.com

As I stated previously much more to the story.

The downfall here is many men jumping on oral TU start on the lower end dose let alone do not always put in the time to truly gauge the effectiveness of the protocol and even then many bailout before even titrating up in dose which may be needed in many cases in order to achieve a high enough TT/FT.

Even when using oral TU (Jatenzo or Kyzatrex) steady-state is achieved fairly quick but one still needs to put in the time let alone titrate up in dose if need be before jumping to any conclusions.




Key point here!

*The high dose was well-tolerated and resulted in substantial symptom improvement, high patient satisfaction, and adherence. These findings support considering a higher starting dose for hypogonadal men considering oral TU therapy.

High-Dose Oral TU Kyzatrex in Men with Low Testosterone: Safety, Efficacy, and Patient Satisfaction

Hot off the press! You heard it here first, Nelson's domain is where it's at! High-dosed oral TU (Kyzatrex 400 mg) BID, LH/FSH while lower were maintained at non-zero levels, minimal impact on hematocrit! *At a mean follow up time of 6 months, patients demonstrated a significant increase in...

www.excelmale.com

*At a mean follow up time of 6 months, patients demonstrated a significant increase in TT (263 to 798 ng/dL), drop in SHBG (32.4 to 17.83 nmol/L), and increase in calculated fT (7.24 to 26.74 ng/dL). FSH and LH, while lower, were maintained at non-zero levels (FSH from 5.7 to 2.9 mIU/mL and LH from 3.3 to 1.9 mIU/mL). Estradiol modestly increased (20.5 to 24.7 pg/mL) while hematocrit did not significantly increase (44.9% to 47.4%). No patients reported testicular atrophy or were initiated on aromatase inhibitors. One patient had a hematocrit rise above 52% (53.2%) and was reduced to 300 mg BID.

* Initiating oral TU therapy with Kyzatrex at 400 mg BID is safe and effective in achieving therapeutic serum testosterone levels. The high dose was well-tolerated and resulted in substantial symptom improvement, high patient satisfaction, and adherence. These findings support considering a higher starting dose for hypogonadal men considering oral TU therapy.

Asi

 

[Phil Goodman]

Interesting implications from the study. A big thing I’d like to see studied in the future is whether or not FSH and LH continue to decline over time, or if they stabilize at lower levels that aren’t nearly as low as levels seen when using other delivery methods. Then, if they do stabilize at higher levels compared to other methods, could it be used as part of a PCT approach to maintain higher levels of testosterone while FSH and LH come back online? Or would levels stay crushed even after switching over since they were so low going in? Just a few things I’d like to see studied in the future.