Hi, new guy (40) on TRT from the Netherlands

[madman]

Thank you. To be fair though, after your message I put some pressure on getting a relevant blood test here in the netherlands to see my values, before just altering my protocol. Without data it doesn't make sense to hastily change the protocol that already seems to work wonders. I was in the wrong to start off without having that extensive data, I know that now. But after that I think I did what I could, looking at the fact that it's quite a bit harder to get guidance here in the Netherlands, I had to do everything myself.

After what time adjusting my protocol do you guys think it is relevant to retest h/h?

Snapshot at 3-4 months and >6 months in many cases to see the true impact!

Key point here!

*the lifespan of a erythrocyte is 120 days.

Management of erythrocytosis during TRT

Dear Editor, Testosterone is the primary sex hormone and anabolic steroid in men. It is a widely used drug which is used by males as an anabolic–androgenic steroid but it is also the cornerstone in treatment of both hypogonadal men and transgender people. This letter will focus on the use of...

www.excelmale.com

This needs to be stressed!

Patience is key when tweaking a protocol (decreasing/increasing T dose).


*It has to be noted that the largest increase in hematocrit levels is seen in the first year after initiation of testosterone therapy. On the other hand it is expected that a decrease can take a similar amount of time. Especially when taking into account that the lifespan of a erythrocyte is 120 days. Hence, interventions to lower hematocrit levels should be evaluated after 6 months and a decrease can be expected until 1 year after the intervention.

 

[mrblonde01]

New blood work is in, and it is...puzzling.

I've lowered my dose to 125mg, divided over 3 injections. Hcg also stays the same at 500iu, but is also divided over 3 days. My hematocrit is higher than last time, and alarmingly so. I think I was a bit dehydrated when taking the blood though, so that didn't help. But still, 64% is alarming (it was 59%, also alarming). Also, I've done a blood donation approximately 2 weeks before this.

And another strange thing is; my testosterone level is about the same as last time? Only thing that improved is my estradiol. I feel pretty good, stable, but could be better. I've been working out in the gym as well.

I guess next thing is lowering my dose even more to 100mg a week and see how that turns out, and in the mean time drink a lot more. I've also been drinking elektrolytes every morning for about a month or 2 now, which should help to keep me better hydrated. Also added ferritin in the blood work, and it seems fine, despite donating.

Anyone got ideas on why my HCT increased and my testosterone stayed the same, despite the lowered dose and increased frequency? Could it be the dehydration...? How much can it influence? I took blood at the trough (injected Friday, and then got blood work done Monday morning).

 

[Systemlord]

Anyone got ideas on why my HCT increased and my testosterone stayed the same, despite the lowered dose and increased frequency?

It takes approximately a year for your body to adapt and for the hematocrit to find a new level on TRT.

Onset of effects of testosterone treatment and time span until maximum effects are achieved

AbstractObjective. Testosterone has a spectrum of effects on the male organism. This review attempts to determine, from published studies, the time-course

academic.oup.com

Effects on erythropoiesis (red blood cells) are evident at 3 months, peaking at 9–12 months.

 

[mrblonde01]

It takes approximately a year for your body to adapt and for the hematocrit to find a new level on TRT.

Onset of effects of testosterone treatment and time span until maximum effects are achieved

AbstractObjective. Testosterone has a spectrum of effects on the male organism. This review attempts to determine, from published studies, the time-course

academic.oup.com

Thank you. Does that mean it might stabilize back down eventually?

 

[Systemlord]

Thank you. Does that mean it might stabilize back down eventually?

No, this is your new baseline on TRT. The only way to bring it down is to lower your dose and possibly increase your shot frequency.

 

[mrblonde01]

No, this is your new baseline on TRT. The only way to bring it down is to lower your dose and possibly increase your shot frequency.

Thanks. I'm just trying to figure out what is going on here; wouldn't you say it's at least atypical to see my testosterone level stay the same, and my HCT even increase on a lower dose and a higher frequency?

 

[Seagal]

Thanks. I'm just trying to figure out what is going on here; wouldn't you say it's at least atypical to see my testosterone level stay the same, and my HCT even increase on a lower dose and a higher frequency?

You changed the dosis from 175mg to 125mg and kept HCG constant? I would be surprised too if there was no change in TT and i have no explanation.
Did you switch from SC to IM, or any other changes?

 

[mrblonde01]

Thanks for taking the time to reply. It's a mystery, so I appreciate any help in thinking this through.

HCG is the same indeed, 500iu per week, only this time divided over 3.

The only thing changed that I haven't mentioned yet is my tool for injecting - I've went from a normal injection needle to a Lilly Ergo II Humapen injector, using the same size needle. This makes injecting a lot easier, however I can not imagine this has any effect on TT levels. I've always done a shallow IM injection, using a 12mm 29G needle.

The Lilly Humapen is loaded with 3 mL Insulin Cartridges (100 IU/mL), in which I put the 250mg/ml testosteron enanthate. If I'm correct, every click (unit) on the pen equals 0.01ml.

Dose per injection: 125mg / 3 ≈ 41.67mg
Volume per injection:250mg : 1ml = 41.67mg : x mlx = (41.67 * 1) / 250 ≈ 0.1667 ml

If the HumaPen injector operates with 0.01ml per click, this would equate to approximately 17 clicks (0.1667 / 0.01 ≈ 16.67, rounded to 17)

So I've given myself 3x 17 clicks using the injector per week.

 

[Seagal]

Thanks for taking the time to reply. It's a mystery, so I appreciate any help in thinking this through.

HCG is the same indeed, 500iu per week, only this time divided over 3.

The only thing changed that I haven't mentioned yet is my tool for injecting - I've went from a normal injection needle to a Lilly Ergo II Humapen injector, using the same size needle. This makes injecting a lot easier, however I can not imagine this has any effect on TT levels. I've always done a shallow IM injection, using a 12mm 29G needle.

The Lilly Humapen is loaded with 3 mL Insulin Cartridges (100 IU/mL), in which I put the 250mg/ml testosteron enanthate. If I'm correct, every click (unit) on the pen equals 0.01ml.

Dose per injection: 125mg / 3 ≈ 41.67mg
Volume per injection:250mg : 1ml = 41.67mg : x mlx = (41.67 * 1) / 250 ≈ 0.1667 ml

If the HumaPen injector operates with 0.01ml per click, this would equate to approximately 17 clicks (0.1667 / 0.01 ≈ 16.67, rounded to 17)

So I've given myself 3x 17 clicks using the injector per week.

Interesting, the use of the insulin injector.
You lost me there with your calculations.
125mg T is 0.5ml that would be 50 units(3x17)
I would try to validate that by injecting 50 units into a insulin syringe, if that's doable.
If you refilled the cartridge with 3ml and it lasted for 6 weeks, then it should work as supposed.

 

[Seagal]

I did read the pen manual. If it works for oil, it actually seems perfect for accurate microdosing.

 

[mrblonde01]

Interesting, the use of the insulin injector.
You lost me there with your calculations.
125mg T is 0.5ml that would be 50 units(3x17)
I would try to validate that by injecting 50 units into a insulin syringe, if that's doable.
If you refilled the cartridge with 3ml and it lasted for 6 weeks, then it should work as supposed.

I've tested it in a new cartridge with water - 50 clicks corresponds with 0.5ml (maybe slightly less)

 

[mrblonde01]

I did read the pen manual. If it works for oil, it actually seems perfect for accurate microdosing.

I'd say I absolutely recommend it if it weren't for my mysterious t & hct levels...

I am now thinking about doing every other day injections, making sure I have a total of 100mg per week. I'm really at a loss here on how to approach this, or what the implications are exactly - does this for instance mean I'm a hyper responder to testosterone?

 

[mrblonde01]

I've made a clear comparison of both measurements, green being the most recent

 

[Seagal]

I'd say I absolutely recommend it if it weren't for my mysterious t & hct levels...

I am now thinking about doing every other day injections, making sure I have a total of 100mg per week. I'm really at a loss here on how to approach this, or what the implications are exactly - does this for instance mean I'm a hyper responder to testosterone?

Maybd @madman can have a look at your lab results.

 

[Seagal]

I've made a clear comparison of both measurements, green being the most recent
View attachment 45971

Your estradiol and Shbg did reduce. I understand that you are feeling well. The main issue seems to be the high and increasing hematocrit values. Do you know your baseline hematocrit before starting TRT?

 

[mrblonde01]

Your estradiol and Shbg did reduce. I understand that you are feeling well. The main issue seems to be the high and increasing hematocrit values. Do you know your baseline hematocrit before starting TRT?

Unfortunately, no. I should have gotten full bloodwork done before this, but I was stupid enough not to do that, I didn't know everything back then which I know now.

In general - I always drink less than people around me. Also, I go to the toilet pretty fast. It might be that my baseline HCT is pretty high because I'm constantly slightly dehydrated, but that's just me coming up with something that might not have an effect on hematocrit.

I feel fine, however I do notice being tired every now and then. But definitely nothing serious. At night, I'm running pretty hot, I can get a bit sweaty. My blood pressure, taken just now, is 126/82

 

[Seagal]

I noticed that some hematology values got out of range too. I don't know if that is a proper adaptation to the high hematocrit.
My only suggestion would be to get an opinion from a hematologist.
Maybe @Systemlord has some experience to share?

 

[madman]

I've made a clear comparison of both measurements, green being the most recent
View attachment 45971

Would not even waste my time getting caught up on this as all that matters now is where your current trough FT level sits which is absurdly high!

Something to keep in mind here is even though you lowered your dose slightly you changed your injection frequency from 2X/week to 3X/week which will clip the peak--->trough.

You will soften the peak and bring up the trough.

Top it off that your SHBG was driven down from 33-25 nmol/L.

If we calculate your FT using the linear law-of-mass action cFTV with a very high trough TT 1148 ng/dL, lowish SHBG 25.1 nmol/L and Albumin 4.4 g/dL your trough FT 32.2 ng/dL is absurdly high!

You are injecting 125 mg T split 3x/week and as you can see you are still hitting a very high trough TT 1148 ng/dL and more importantly your trough FT is still very high as in 32.2 ng/dL!

You drove your trough FT from 27.8---> a whopping 32.2 ng/dL on your new protocol which also means that your peak will be even higher!

This is not going to do you any favors when it comes to lowering your H/H and even then you most likely had a high-end/high hematocrit pre-trt and unfortunately you have no idea where it truly sat pre-trt as you never had these critical blood markers tested before hopping on exogenous testosterone.

Big mistake here.

Again although other factors such as dehydration, sleep apnea, smoking, asthma, COPD can cause elevated hematocrit this is a common side-effect when using exogenous testosterone especially from running too high a trough FT level.

Your trough cFTV is a whopping 32.2 ng/dL.

My reply from a previous thread regarding FT levels.

Just to be clear here the only way to know where your FT level truly sits is to have it tested using what would be considered the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG!

If you do not have access to such (highly doubtful) if you live in the US then you would need to use/rely upon the linear law-of-mass action cFTV.

Keep in mind as of now cFTV tends to slightly overestimate when compared against a standardized ED assay.

Just to put this in perspective most healthy young males would be hitting a FT 10-12 ng/dL tested using the gold standard Equilibrium Dialysis assay (most accurate) or a cFTV 13-15 ng/dL and this is a short-lived peak to boot!

Trough would be 20-25% lower.

More importantly a FT in the low-mid 20s whether cFTV or standardized ED assay would be very high!

Everyone needs to hammerit in their heads that a trough FT 30 ng/dL is absurdly high.

We are talking f**king TROUGH here not peak!

Again you EASILY have room to lower your weekly dose and bring down your TROUGH FT!

Plain and simple!

Age-stratified reference ranges for directly measured (ED LC-MS/MS) serum free testosterone in healthy men

Just to be clear up any confusion this is Fiers camps data for mFT reference ranges not the harmonized reference range being worked on by the CDC. *Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies * mFT...

www.excelmale.com

*We established mFT reference ranges for healthy men aged 18 to 69 years




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

*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





*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).


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

In the current study, we used a state-of-the-art direct ED method to reassess FT in sets of representative serum samples. This method takes advantage of the ability of a highly sensitive and accurate measurement of T by liquid chromatography–tandem mass spectrometry (LC-MS/MS) to reliably measure the low FT concentration directly in the dialysate after ED. This more straightforward method avoids potential sources of inaccuracy in indirect ED, such as those resulting from tracer impurities or from measures to limit their impact (e.g., sample dilution). We then used the measured FT results to re-evaluate some characteristics of two more established and a more recently proposed calculations for estimation of FT.

 

[mrblonde01]

Would not even waste my time getting caught up on this as all that matters now is where your current trough FT level sits which is absurdly high!

Something to keep in mind here is even though you lowered your dose slightly you changed your injection frequency from 2X/week to 3X/week which will clip the peak--->trough.

You will soften the peak and bring up the trough.

Top it off that your SHBG was driven down from 33-25 nmol/L.

If we calculate your FT using the linear law-of-mass action cFTV with a very high trough TT 1148 ng/dL, lowish SHBG 25.1 nmol/L and Albumin 4.4 g/dL your trough FT 32.2 ng/dL is absurdly high!

View attachment 45990

You are injecting 125 mg T split 3x/week and as you can see you are still hitting a very high trough TT 1148 ng/dL and more importantly your trough FT is still very high as in 32.2 ng/dL!

You drove your trough FT from 27.8---> a whopping 32.2 ng/dL on your new protocol which also means that your peak will be even higher!

This is not going to do you any favors when it comes to lowering your H/H and even then you most likely had a high-end/high hematocrit pre-trt and unfortunately you have no idea where it truly sat pre-trt as you never had these critical blood markers tested before hopping on exogenous testosterone.

Big mistake here.

Again although other factors such as dehydration, sleep apnea, smoking, asthma, COPD can cause elevated hematocrit this is a common side-effect when using exogenous testosterone especially from running too high a trough FT level.

Your trough cFTV is a whopping 32.2 ng/dL.

My reply from a previous thread regarding FT levels.

Just to be clear here the only way to know where your FT level truly sits is to have it tested using what would be considered the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG!

If you do not have access to such (highly doubtful) if you live in the US then you would need to use/rely upon the linear law-of-mass action cFTV.

Keep in mind as of now cFTV tends to slightly overestimate when compared against a standardized ED assay.

Just to put this in perspective most healthy young males would be hitting a FT 10 ng/dL tested using the gold standard Equilibrium Dialysis assay (most accurate) or a cFTV 13-15 ng/dL and this is a short-lived peak to boot!

Trough would be 20-25% lower.

More importantly a FT in the low 20s whether cFTV or standardized ED assay would be very high!

Everyone needs to hammerit in their heads that a trough FT 30 ng/dL is absurdly high.

We are talking f**king TROUGH here not peak!

Again you EASILY have room to lower your weekly dose and bring down your TROUGH FT!

Plain and simple!

Age-stratified reference ranges for directly measured (ED LC-MS/MS) serum free testosterone in healthy men

Just to be clear up any confusion this is Fiers camps data for mFT reference ranges not the harmonized reference range being worked on by the CDC. *Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies * mFT...

www.excelmale.com

*We established mFT reference ranges for healthy men aged 18 to 69 years




We present 95% mFT age-stratified reference ranges

Age category (years)	Median mFT (ng/dl)	95% mFT reference range (ng/dl)
25-29 (n=148)	10.3	5.6 - 17.1
30-39 (n=252)	9.7	4.9 - 18.1
40-49 (n=207)	8.0	4.3 - 13.5
50-59 (n=146)	7.0	3.8 - 12.6
60-69 (n=114)	5.9	3.3 - 11.9

*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






*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).


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

In the current study, we used a state-of-the-art direct ED method to reassess FT in sets of representative serum samples. This method takes advantage of the ability of a highly sensitive and accurate measurement of T by liquid chromatography–tandem mass spectrometry (LC-MS/MS) to reliably measure the low FT concentration directly in the dialysate after ED. This more straightforward method avoids potential sources of inaccuracy in indirect ED, such as those resulting from tracer impurities or from measures to limit their impact (e.g., sample dilution). We then used the measured FT results to re-evaluate some characteristics of two more established and a more recently proposed calculations for estimation of FT.

Thanks again for the thorough reply!

I do have asthma and generally I'm not very well hydrated. I just hope this blood test caught me at a dehydrated point.

That my FT is so high is also puzzling to me. I also have no idea why my SHBG is lower this time, or what that even implies.

Maybe it might even be useful to lower to 80mg instead of 100, considering the virtually non existent decline in relevant levels since implementing the new protocol. I need to drop these values ASAP...

 

[mrblonde01]

Hey everyone,

I just got my blood report back after 3 months on 80mg EOD subq injections. Overall, I wasn’t feeling as great as before—lower libido, less energy—but no major symptoms either. After my blood work, I decided to increase my dose to 100mg EOD subq, and wow... I felt a huge improvement almost immediately.

BUT, the lab messed up and forgot to include the basic blood panel and Gamma-GT. Super frustrating, especially since I was most concerned about my hematocrit. After several back-and-forth emails with the lab, they sent me a kit for the missing blood markers. However, by the time I got the kit, I’d already been on the 100mg dose for a couple of weeks. I probably should have waited to adjust the dose, but didn’t expect the lab to mess up.

Here’s the new data (right side: green for 3 months on 80mg, light green for 2 weeks on 100mg):

(they forgot to include the RDW-CV somehow)​

• Hematocrit has improved a bit but could still be lower.
• My total and free testosterone levels look much better now, so that’s reassuring.
• I’ve been working out consistently for the last 3 months and really trying to push my progress. Also, I’ve been taking a naringin supplement for about 2 months.

Would love your input—do you see anything that stands out or have any advice based on the results? Curious to hear your thoughts!