Surprising blood results . . . so is this it?

[Melody68]

I'm 68 and started TRT on the gel therapy on Dec 20/23. I was on that for 3.5 months before it was finally determined that it wasn't working right. I then went on TE injections on April 6, taking a rate of 10 mgs per day, injecting 40 mgs every 4th day (equivalent to 70mgs per week). Only been on the injections a month. My pre TRT Total Testosterone was 10.9 (range 8.4-28.8).

I'm in Canada; I've been to an Endo, Urologist and my GP. The GP is the best, at least a little open in his thinking; they all still only test Total Testosterone and CBC for hematocrit, a PSA, and that's it. The GP says the Canadian test for Free T is "notoriously inaccurate" and that he can't test for SHBG (he says the Endo might be able to). He thinks our estradiol test also sucks, and says I shouldn't need it anyway on such a small dose of T.

I tested blood yesterday, May 8; the results are a bit of a surprise. My TT was 24.3 (range 8.4-28.8) a BIG increase over the 10.9 prior TRT. My hematocrit was .494 (range .400-.500) and the hemoglobin a bit high at 176 (range 135-175). My PSA was 3.4 (range <4).

So is that it? It certainly will be for my endo; he'll look at 24.3 and give himself a big pat on the back. The problem is that I don't feel markedly different from my pre T self. I originally started because I had fatigue when working or riding my bike. My bike riding is a BIT better. I had hoped to lose weight, have lost a pound or two. I also notice that I get morning wood once in a while, whereas before I didn't. Still need the little blue pill and a million stars to align if I hope to hit a home run. It's really only been a month on injections, do I have better to look forward to? Many thanks for your input . . .

 

[Systemlord]

The problem is that I don't feel markedly different from my pre T self.

Unrealistic expectations will lead to disappointment. Depending on the ester type, cypionate for example will lead to steady blood levels in 42 days. Testosterone isn't like drugs, the effects aren't instant, testosterone causes structural changes within the body and that takes time.

Sadly without a Free T or SHBG value, there's no way to determine the Free T, the active portion of testosterone and its metabolites DHT and estrogen that provides all of the positive effects.

Many doctors are ill prepared and don't know how to manage male hormones, it doesn't matter what country you live in.

Most men notice significant changes in 4-6 months, with continued improvement for years.

TRT is a marathon, not a sprint!

 

[madman]

I'm 68 and started TRT on the gel therapy on Dec 20/23. I was on that for 3.5 months before it was finally determined that it wasn't working right. I then went on TE injections on April 6, taking a rate of 10 mgs per day, injecting 40 mgs every 4th day (equivalent to 70mgs per week). Only been on the injections a month. My pre TRT Total Testosterone was 10.9 (range 8.4-28.8).

I'm in Canada; I've been to an Endo, Urologist and my GP. The GP is the best, at least a little open in his thinking; they all still only test Total Testosterone and CBC for hematocrit, a PSA, and that's it. The GP says the Canadian test for Free T is "notoriously inaccurate" and that he can't test for SHBG (he says the Endo might be able to). He thinks our estradiol test also sucks, and says I shouldn't need it anyway on such a small dose of T.

So I have limited figures, but they're a bit of a surprise. My TT was 24.3 (range 8.4-28.8) a BIG increase over the 10.9 prior TRT. My hematocrit was .494 (range .400-.500) and the hemoglobin a bit high at 176 (range 135-175). My PSA was 3.4 (range <4).

So is that it? It certainly will be for my endo; he'll look at 24.3 and give himself a big pat on the back. The problem is that I don't feel markedly different from my pre T self. I originally started because I had fatigue when working or riding my bike. My bike riding is a BIT better. I had hoped to lose weight, have lost a pound or two. I also notice that I get morning wood once in a while, whereas before I didn't. Still need the little blue pill and a lotta luck if I hope to hit a home run. It's really only been a month on injections, do I have better to look forward to? Many thanks for your input . . .

As I stated in your previous thread although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

I have stated numerous times on the forum you need to have your FT tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration especially in cases of altered SHBG to know where it truly sits.

Unfortunately most doctors in Canada do not test FT using this method as it is too expensive and not routinely available to most.

Yes the older testing method the direct analog immunoassay (RIA/EIA) are known to be inaccurate and should not be used/relied upon when testing FT.

In Canada we no longer use this testing method/assay which has been replaced by the linear law-of-mass action cFTV.

You can use/rely upon the cFTV as it tends to agree well when compared against a standardized Equilibrium Dialysis assay although it tends to overestimate slightly.

All labs in Canada use this method.

Even then as I stated in your previous thread no need to fret over whether your doctor tests FT as you can easily use the online calculator for free but you need to have your TT, SHBG and Albumin.

Free & Bioavailable Testosterone calculator

Again I told you that you need to get your SHBG tested.

You are injecting 40 mg T every 4 days (70 mg/week).

Labs should be done at the 4-6 week mark (TC/TE) although most would wait 6 weeks.

Labs should always be done at the true trough (lowest point) before your next injection.

You never had your FT, estradiol or SHBG tested for reasons stated by your GP.

Keep in mind that although most labs use the standard estradiol assay it is still a reliable test if you do not have elevated CRP or are using an aromatase inhibitor and end up crashing or driving down your estradiol too low.

If such is the case then yes you would need to use/rely upon the estradiol sensitive (LC/MS-MS) which would be considered the most accurate assay and as I have stated in your previous thread it is available in the province of Ontario but only through Dynacare laboratories.

Seeing as you are injecting every 4 days then your labs should have been done 96 hrs post-injection.

You are injecting 40 mg T every 4 days (70 mg/week).

You stated that you are hitting a TT 24.3 nmol/L which is a robust TT 700.9 ng/dL.

If this is your true trough then your peak TT, FT and estradiol will be much higher!

Now the shitkicker here is even though you are hitting a robust TT 700.9 ng/dl (hopefully your trough) if you have high SHBG with such TT then your FT will not be high enough!

Again TT means nothing without knowing where your FT level sits.

Seeing as your doctor is ignoring the most important bloodmarker and relying upon TT you are in a world of hurt!

You need to test your SHBG then you can calculate your FT to see where it sits on such protocol!

Top it all off that I have clearly stated numerous times on the forum the first 6 weeks means nothing when looking at the bigger picture!

Every protocol needs to be given a fighting chance 12 weeks in order to claim whether it was truly a success or failure.

The only time you dose should be increased at the 6 week mark when first starting therapy or tweaking a protocol is if your trough FT level is too low (highly unlikely) in most cases.

 

[madman]

I'm 68 and started TRT on the gel therapy on Dec 20/23. I was on that for 3.5 months before it was finally determined that it wasn't working right. I then went on TE injections on April 6, taking a rate of 10 mgs per day, injecting 40 mgs every 4th day (equivalent to 70mgs per week). Only been on the injections a month. My pre TRT Total Testosterone was 10.9 (range 8.4-28.8).

I'm in Canada; I've been to an Endo, Urologist and my GP. The GP is the best, at least a little open in his thinking; they all still only test Total Testosterone and CBC for hematocrit, a PSA, and that's it. The GP says the Canadian test for Free T is "notoriously inaccurate" and that he can't test for SHBG (he says the Endo might be able to). He thinks our estradiol test also sucks, and says I shouldn't need it anyway on such a small dose of T.

I tested blood yesterday, May 8; the results are a bit of a surprise. My TT was 24.3 (range 8.4-28.8) a BIG increase over the 10.9 prior TRT. My hematocrit was .494 (range .400-.500) and the hemoglobin a bit high at 176 (range 135-175). My PSA was 3.4 (range <4).

So is that it? It certainly will be for my endo; he'll look at 24.3 and give himself a big pat on the back. The problem is that I don't feel markedly different from my pre T self. I originally started because I had fatigue when working or riding my bike. My bike riding is a BIT better. I had hoped to lose weight, have lost a pound or two. I also notice that I get morning wood once in a while, whereas before I didn't. Still need the little blue pill and a million stars to align if I hope to hit a home run. It's really only been a month on injections, do I have better to look forward to? Many thanks for your input . . .

If it turns out you have high SHBG (60 nmol/L) even with a robust TT 700s your FT would be far from stellar!

Many aiming for a high-end cFTV would be hitting 20 ng/dL.

Free & Bioavailable Testosterone calculator

 

[madman]

I'm 68 and started TRT on the gel therapy on Dec 20/23. I was on that for 3.5 months before it was finally determined that it wasn't working right. I then went on TE injections on April 6, taking a rate of 10 mgs per day, injecting 40 mgs every 4th day (equivalent to 70mgs per week). Only been on the injections a month. My pre TRT Total Testosterone was 10.9 (range 8.4-28.8).

I'm in Canada; I've been to an Endo, Urologist and my GP. The GP is the best, at least a little open in his thinking; they all still only test Total Testosterone and CBC for hematocrit, a PSA, and that's it. The GP says the Canadian test for Free T is "notoriously inaccurate" and that he can't test for SHBG (he says the Endo might be able to). He thinks our estradiol test also sucks, and says I shouldn't need it anyway on such a small dose of T.

I tested blood yesterday, May 8; the results are a bit of a surprise. My TT was 24.3 (range 8.4-28.8) a BIG increase over the 10.9 prior TRT. My hematocrit was .494 (range .400-.500) and the hemoglobin a bit high at 176 (range 135-175). My PSA was 3.4 (range <4).

So is that it? It certainly will be for my endo; he'll look at 24.3 and give himself a big pat on the back. The problem is that I don't feel markedly different from my pre T self. I originally started because I had fatigue when working or riding my bike. My bike riding is a BIT better. I had hoped to lose weight, have lost a pound or two. I also notice that I get morning wood once in a while, whereas before I didn't. Still need the little blue pill and a million stars to align if I hope to hit a home run. It's really only been a month on injections, do I have better to look forward to? Many thanks for your input . . .

Even then looking over your pre-TT highly doubtful you have high SHBG!

Throw in the increased hemoglobin/hematocrit (pre/post TTh) and it is doubtful your FT would be subpar.

Even then you are only 4 weeks in and although hematocrit will increase within the 1st month it can take anywhere from 6-9 months and in some cases up to a year to reach peak levels so where it sits 4 weeks in is not where it will be 6-9 months from now.

 

[Melody68]

Hello Madman and Systemlord; thank you both very much for your timely input - I suspected as much but needed to hear it yet again.

Madman had kindly sent a link to private blood testing that's available in Ontario through Dynacare. I intend to continue the TRT another couple of months and then explore a more complete set of blood tests.

I'll find out if the Free Testosterone test available in Ontario is, in fact, the "linear law-of-mass action cFTV" as Madman suggests. If so, I think I can twist the GP's arm to test for it. I could ask the Endo for SHBG, but that will likely be pointless - numerous emails and phone calls have gone unanswered.

Easy to get frustrated with all this testing BS in Canada. If I can't get any satisfaction with my doctor requisitions, then I'll go Dynacare in July and at least get estradiol and SHBG (and FT if not available through normal req).

Madman, my blood was tested about 1 hour before my next injection when T levels were completely in the trough. For what it's worth, my Albumin tested at 47 g/L (range 35-52). You guys are a HUGE help, thanks again!

 

[madman]

Hello Madman and Systemlord; thank you both very much for your timely input - I suspected as much but needed to hear it yet again.

Madman had kindly sent a link to private blood testing that's available in Ontario through Dynacare. I intend to continue the TRT another couple of months and then explore a more complete set of blood tests.

I'll find out if the Free Testosterone test available in Ontario is, in fact, the "linear law-of-mass action cFTV" as Madman suggests. If so, I think I can twist the GP's arm to test for it. I could ask the Endo for SHBG, but that will likely be pointless - numerous emails and phone calls have gone unanswered.

Easy to get frustrated with all this testing BS in Canada. If I can't get any satisfaction with my doctor requisitions, then I'll go Dynacare in July and at least get estradiol and SHBG (and FT if not available through normal req).

Madman, my blood was tested about 1 hour before my next injection when T levels were completely in the trough. For what it's worth, my Albumin tested at 47 g/L (range 35-52). You guys are a HUGE help, thanks again!

If you are hitting a robust trough TT 700s 4 days (96 hrs) post-injection then your peak TT would be much higher!

This would also apply to FT and estradiol.

If no doctor is willing to test SHBG then I would just up the $$$ and pay out of pocket to get it done.

The cost is ridiculous but it is what it is as your options for private pay out of pocket testing in Canada are limited.

Sex Hormone Binding Globulin (SHBG)

This Private Blood Test for sex-hormone-binding-globulin-shbg is available in Ontario, Quebec and Manitoba - Simply Order Online, attend a Dynacare Service Centre and get your sex-hormone-binding-globulin-shbg results online. Free phlebotomy and GP referral.

bloodtestscanada.com

Then you can calculate your FT using the cFTV available online for free!

Otherwise you will be shooting in the dark here as again TT means nothing without knowing where your FT sits!

Dynacare - Change in Methodology for Measurement of Free Testosterone Levels

Change in Methodology for Measurement of Free Testosterone Levels

www.dynacare.ca

Dynacare - FREE TESTOSTERONE

FREE TESTOSTERONE

www.dynacare.ca

(1)
Free testosterone is estimated from
measured total testosterone and
sex hormone-binding globulin using
Vermeulen's algorithm
[J Clin Endocrinol Metab 84 (10):3666-3672, 1999]

 

[Melody68]

If you are hitting a robust trough TT 700s 4 days (96 hrs) post-injection then your peak TT would be much higher!
It is hard to believe that I got such a strong response from only 70mgs per week. I have always, however, been quite sensitive to any drugs that I took, so this seems consistent. Because I wasn't really feeling any great symptom relief, I was going to up the dose to 84mgs (!) from 70, but I think I'll stay here for a few months and give it more time. Patience, grasshopper . . .

If no doctor is willing to test SHBG then I would just up the $$$ and pay out of pocket to get it done.
Yup, that's what I'll do. I consider myself fortunate that I have doctors to prescribe the T, I don't pay for the T, and I get some of the testing paid for. I don't mind the occasional fee.

I was also pleased that the GP said he'd prescribe a phlebotomy if need be.

Hopefully I never have to complicate the therapy with a second drug . . .

 

[Systemlord]

Madman had kindly sent a link to private blood testing that's available in Ontario through Dynacare.

Maybe you could work with Dr. Adam Millar at Mount Sinai Hospital in Ontario. A reputable TRT doctor.

I was also pleased that the GP said he'd prescribe a phlebotomy if need be.

Be aware that a slight elevation in hematocrit and hemoglobin is fine as long as there are no symptoms. Many doctors get this wrong and freak out thinking testosterone, hematocrit and hemoglobin above the normal limit to be harmful without any evidence that is the case.

 

[Melody68]

Yet another option that I'll keep tucked away, thanks!

 

[madman]

Hello Madman and Systemlord; thank you both very much for your timely input - I suspected as much but needed to hear it yet again.

Madman had kindly sent a link to private blood testing that's available in Ontario through Dynacare. I intend to continue the TRT another couple of months and then explore a more complete set of blood tests.

I'll find out if the Free Testosterone test available in Ontario is, in fact, the "linear law-of-mass action cFTV" as Madman suggests. If so, I think I can twist the GP's arm to test for it. I could ask the Endo for SHBG, but that will likely be pointless - numerous emails and phone calls have gone unanswered.

Easy to get frustrated with all this testing BS in Canada. If I can't get any satisfaction with my doctor requisitions, then I'll go Dynacare in July and at least get estradiol and SHBG (and FT if not available through normal req).

Madman, my blood was tested about 1 hour before my next injection when T levels were completely in the trough. For what it's worth, my Albumin tested at 47 g/L (range 35-52). You guys are a HUGE help, thanks again!

Dynacare and Lifelabs are the 2 big boys in Ontario.

Dynacare - Change in Methodology for Measurement of Free Testosterone Levels

Change in Methodology for Measurement of Free Testosterone Levels

www.dynacare.ca

*Effective September 29, 2014, Gamma-Dynacare Medical Laboratories will be changing the methodology for free testosterone (FT) measurement. FT results will be calculated using Vermeulen’s equation1, incorporating the levels of serum total testosterone, sex hormone binding globulin (SHBG) and albumin. The current analog based measuring method will be discontinued. For more information, please see the Client Notice below.




Lifelabs

*The reference ranges for free testosterone listed here are calculated via the Vermeulen equation according to the current practice at Lifelabs

 

[madman]

Maybe you could work with Dr. Adam Millar at Mount Sinai Hospital in Ontario. A reputable TRT doctor.


Be aware that a slight elevation in hematocrit and hemoglobin is fine as long as there are no symptoms. Many doctors get this wrong and freak out thinking testosterone, hematocrit and hemoglobin above the normal limit to be harmful without any evidence that is the case.

Typical endo he is a stickler when it comes to numbers!

Would not even waste my time.

 

[madman]

Hello Madman and Systemlord; thank you both very much for your timely input - I suspected as much but needed to hear it yet again.

Madman had kindly sent a link to private blood testing that's available in Ontario through Dynacare. I intend to continue the TRT another couple of months and then explore a more complete set of blood tests.

I'll find out if the Free Testosterone test available in Ontario is, in fact, the "linear law-of-mass action cFTV" as Madman suggests. If so, I think I can twist the GP's arm to test for it. I could ask the Endo for SHBG, but that will likely be pointless - numerous emails and phone calls have gone unanswered.

Easy to get frustrated with all this testing BS in Canada. If I can't get any satisfaction with my doctor requisitions, then I'll go Dynacare in July and at least get estradiol and SHBG (and FT if not available through normal req).

Madman, my blood was tested about 1 hour before my next injection when T levels were completely in the trough. For what it's worth, my Albumin tested at 47 g/L (range 35-52). You guys are a HUGE help, thanks again!

I would not lead you astray, that's a promise!

 

[Melody68]

I would not lead you astray, that's a promise!

Most certainly not! I have great confidence in your words first and then those of a select few others on the forum.

I was checking for a Dynacare in my hometown and discovered, to my shock, that a new one has located in an office building about a stone's throw from where I live (ok, you'd have to have a pretty good arm . . . but it's there). So I think I could work with the GP to provide me with most of the tests, and those that aren't possible I'll just buy (will wait a couple of months to let the T really entrench itself before I retest). Other than that, I'll rely on the expertise here on the forum, so glad I found it!

 

[madman]

I'm 68 and started TRT on the gel therapy on Dec 20/23. I was on that for 3.5 months before it was finally determined that it wasn't working right. I then went on TE injections on April 6, taking a rate of 10 mgs per day, injecting 40 mgs every 4th day (equivalent to 70mgs per week). Only been on the injections a month. My pre TRT Total Testosterone was 10.9 (range 8.4-28.8).

I'm in Canada; I've been to an Endo, Urologist and my GP. The GP is the best, at least a little open in his thinking; they all still only test Total Testosterone and CBC for hematocrit, a PSA, and that's it. The GP says the Canadian test for Free T is "notoriously inaccurate" and that he can't test for SHBG (he says the Endo might be able to). He thinks our estradiol test also sucks, and says I shouldn't need it anyway on such a small dose of T.

I tested blood yesterday, May 8; the results are a bit of a surprise. My TT was 24.3 (range 8.4-28.8) a BIG increase over the 10.9 prior TRT. My hematocrit was .494 (range .400-.500) and the hemoglobin a bit high at 176 (range 135-175). My PSA was 3.4 (range <4).

So is that it? It certainly will be for my endo; he'll look at 24.3 and give himself a big pat on the back. The problem is that I don't feel markedly different from my pre T self. I originally started because I had fatigue when working or riding my bike. My bike riding is a BIT better. I had hoped to lose weight, have lost a pound or two. I also notice that I get morning wood once in a while, whereas before I didn't. Still need the little blue pill and a million stars to align if I hope to hit a home run. It's really only been a month on injections, do I have better to look forward to? Many thanks for your input . . .

Discouraged with TRT

Ah? You do know what the cervix is attached to, right? Oh, well, crazy rabbit trail. Ya, vagina on one end, uterus on the other. I’m really not trying to bust ur balls man lol. Just do a quick google search. The cervix opening is about the size of an earring hole, and u need special tools to...

www.excelmale.com

post #53

*I think Cataceous made a pretty strong argument supporting the concept that the norm of starting us all at 100mg per week is excessive . . . and then when it doesn't work well most are inclined to take more instead of less. I'm still very new to all of this, but I'm drawn to the "less is more" idea and have now reduced my originally prescribed dose by 15%. Probably worth a try for you, maybe 75mg per week instead of 100?


Hate to be the bearer of bad news here but the most common starting dose is 100 mg T/week.

Most in the know including many of the top uros preach this!

Look up Dr. Morgentaler who would be considered the godfather of testosterone.

Most men on TTh are injecting 100-200 mg T/week whether once weekly or split into more frequent injections as in twice-weekly, 3X/week, EOD or daily.

Even then the majority of men can easily hit a healthy/high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.

Yes there will always be those outliers who need the higher-end dose but this is far from common as in rare!

200 mg T/week is overkill for the majority!

Yes there are some men who can achieve stellar T levels injecting <100 mg T/week especially when split into more frequent injections but it is far from common.

Unfortunately most men especially the ones caught up on those so called men's health forums loaded with all those blast n cruizzzers littered on the internet let alone the nonsense being pushed by those dime a dozen run of the mill T-clinics or so called internet gurus have these men brainwashed into thinking they need to be hitting this so called magical trough FT 30-60 ng/dL in order to reap the beneficial effects of testosterone.

That more T is better mentality bullS**T!

Top it off when using exogenous testosterone for most we are forcing levels well beyond what our body could or would produce and this is at a steady state (24/7).

The shit kicker here is most are running trough levels at the top-end or well beyond!

Most men have blown past their genetic set-point let alone are running around with inflated FT levels well beyond where a healthy young male would sit (peak) and this is inflated trough levels we are talking about here which means that their peak FT levels will be even higher.

Again the average secretion rate of T in the majority of healthy young males is 5-7 mg/day.

10 mg would be those outliers and even then there is not going to be a big difference in how one would feel/function.

Also need to keep in mind that those healthy natty young men running around with those very high T levels have high SHBG and it is not like they are running around with absurdly high FT levels.

Top it off that these TT/FT levels healthy natty young men in their prime are hitting are at peak which is short-lived, their trough/nadir (lowest point)) of the day would be 20-25% lower.

Natural endogenous testosterone secretion is pulsatile and diurnal.

During the natural 24-hour circadian rhythm of a healthy young male T levels will start rising gradually overnight reaching a peak (highest point) in the early AM followed by lower levels in the late afternoon and reaching trough (lowest point) in the evening.

Fluctuations from peak--->trough would be around 20-25%

One daily peak/trough.

What percentile of healthy young men would even be hitting a peak not trough FT 17.1 ng/dL!

LMFAO!

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

Age category (years)	Median mFT (ng/dl)	95% mFT reference range (ng/dl)
25-29 (n=148)	10.3	5.6 - 17.1

A pill that could outsell Viagra: New testosterone Rx drug

https://www.americanbazaaronline.com/2022/10/11/testosterone-drug-kyzatrex-hits-market-451261/ Kyzatrex could be a potential blockbuster to treat testosterone deficiency, a severely undertreated disease. Testosterone has been historically perceived as a lifestyle issue for men who want to...

www.excelmale.com

Testosterone Therapy (TTh) - How To Treat - Abraham Morgentaler

Have every lecture! Link to some of them. Excel is littered with AM! https://vimeo.com/user19492999

www.excelmale.com

Dose T/week

The starting dose is about 100 mg/week.

If they're going to be giving it to themselves or coming into the office every week we start with 100 mg but you can move up.

Rarely do we go lower but some people will.

100 mg is 0.5 CC each CC is 200 mg per CC or per mL.

So we start at 0.5 and if that's not good enough we go to 0.6 (120 mg) and 0.7 (140 mg) and occasionally but not very often we go above that

 

[madman]

I'm 68 and started TRT on the gel therapy on Dec 20/23. I was on that for 3.5 months before it was finally determined that it wasn't working right. I then went on TE injections on April 6, taking a rate of 10 mgs per day, injecting 40 mgs every 4th day (equivalent to 70mgs per week). Only been on the injections a month. My pre TRT Total Testosterone was 10.9 (range 8.4-28.8).

I'm in Canada; I've been to an Endo, Urologist and my GP. The GP is the best, at least a little open in his thinking; they all still only test Total Testosterone and CBC for hematocrit, a PSA, and that's it. The GP says the Canadian test for Free T is "notoriously inaccurate" and that he can't test for SHBG (he says the Endo might be able to). He thinks our estradiol test also sucks, and says I shouldn't need it anyway on such a small dose of T.

I tested blood yesterday, May 8; the results are a bit of a surprise. My TT was 24.3 (range 8.4-28.8) a BIG increase over the 10.9 prior TRT. My hematocrit was .494 (range .400-.500) and the hemoglobin a bit high at 176 (range 135-175). My PSA was 3.4 (range <4).

So is that it? It certainly will be for my endo; he'll look at 24.3 and give himself a big pat on the back. The problem is that I don't feel markedly different from my pre T self. I originally started because I had fatigue when working or riding my bike. My bike riding is a BIT better. I had hoped to lose weight, have lost a pound or two. I also notice that I get morning wood once in a while, whereas before I didn't. Still need the little blue pill and a million stars to align if I hope to hit a home run. It's really only been a month on injections, do I have better to look forward to? Many thanks for your input . . .

Discouraged with TRT

Ah? You do know what the cervix is attached to, right? Oh, well, crazy rabbit trail. Ya, vagina on one end, uterus on the other. I’m really not trying to bust ur balls man lol. Just do a quick google search. The cervix opening is about the size of an earring hole, and u need special tools to...

www.excelmale.com

post #53

*I think Cataceous made a pretty strong argument supporting the concept that the norm of starting us all at 100mg per week is excessive . . . and then when it doesn't work well most are inclined to take more instead of less. I'm still very new to all of this, but I'm drawn to the "less is more" idea and have now reduced my originally prescribed dose by 15%. Probably worth a try for you, maybe 75mg per week instead of 100?


You just made a huge mistake here!

Never even gave your protocol a fighting chance.

First off you have no clue where your trough FT level sat on such protocol 70mg T/week (40mg every 4 days) as you only tested your TT.

Again although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

You stated in your first post that you were hitting a trough TT low 700s yet you have no clue where your SHBG sits or more importantly your trough FT.

Top it all off that every protocol needs to be given a fighting chance 12 weeks to claim whether it was truly as success or failure.

As I have preached numerous times on the forum over the years whether starting TTh or tweaking a protocol (increasing/decreasing T dose) hormone will be in FLUX during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE) and it is common for most to experience ups/downs during the transition as the body is trying to ADJUST.

Even then once blood levels have stabilized (4-6 weeks TC/TE) it will still take time as in a few more months for the body to ADAPT to its new set-point and this is the critical time period when one needs to gauge how they truly feel overall regarding relief/improvement of low-t symptoms and overall well-being.

The first 6 weeks means nothing when looking at the bigger picture here!

Again every protocol needs to be given 12 weeks before claiming whether it was truly a success or failure.

Most do not understand how exogenous T works and start tweaking their protocols 6 weeks in because they do not feel good!

Again the only way one would even consider tweaking the dose of T 6 weeks in is if your trough FT level was too low which would be highly unlikely in most cases.

If anything many end up being overmedicated from the get go especially the ones being treated by those run of the mill T-clinics or so called HRT internet gurus (you know who you are)!

This needing 200 mg T/week or hitting this so called magical trough FT 30-60 ng in order to reap the beneficial effects of T is pure nonsense.

Again yes there are those outliers who may need the higher-end dose 200 mg T/week but it is far from common as in RARE!

Again one needs to keep injection frequency/true trough in mind and tread lightly when it comes to speaking on needing this so called high-end/absurdly high trough FT level!

Big difference between one hitting a very high trough FT 30 ng/dL injecting once weekly vs every 3.5 days vs EOD or daily!

 

[Cataceous]

...
Hate to be the bearer of bad news here but the most common starting dose is 100 mg T/week.
...

Just because it's common doesn't mean it's a good idea. Such dosing came about because of infrequent injections, once every week or even every two weeks. The larger doses keep serum-level troughs close to physiological. But ignored are the excessive peaks, which are responsible for many of the side effects.

@Melody68: There is further evidence that lower dosing is preferred in the relatively new XYOSTED product. This is testosterone enanthate without any additives. As a result it has a half-life that is about double that of typical formulations of TE/TC. This in turn means that it can be injected once-weekly without causing such extreme variation in serum testosterone. It only comes in three doses: 50 mg, 75 mg, and 100 mg. Patients are started at 75 mg/week. If serum testosterone is too high then they are lowered to 50 mg. If serum testosterone is too low then they are raised to 100 mg. It's that simple, and the 50-100 mg/week of TE aligns well with youthful physiological production of testosterone. Given that XYOSTED is a commercial product, you'd assume its developers would want to cover as much of the TRT market as possible. Thus it is telling that it maxes out at 100 mg/week.

If you are hitting a robust trough TT 700s 4 days (96 hrs) post-injection then your peak TT would be much higher!
It is hard to believe that I got such a strong response from only 70mgs per week. I have always, however, been quite sensitive to any drugs that I took, so this seems consistent. Because I wasn't really feeling any great symptom relief, I was going to up the dose to 84mgs (!) from 70, but I think ...

There's probably nothing unusual about your response to the dose. As @madman suggests, you need to know free testosterone to be sure about what's going on, since unusual SHBG affects total testosterone. In contrast, free testosterone is likely to be proportional to the dose rate.

For comparison, my average total testosterone was over 1,200 ng/dL when I was started out on 100 mg TC/week, split into EOD doses. Another factor is that older men metabolize testosterone more slowly than younger men. This in turn increases our serum testosterone at the same dose rate.

...
I'll stay here for a few months and give it more time. Patience, grasshopper . . .
...

Good plan.

 

[Melody68]

Hello Madman, thanks for your considerations, your words as always are very wise. I was thinking about them, especially your minimum 12 week time frame to determine the success of a given protocol.

I certainly may have acted with a little haste in reducing my dosage from 70mg to 60mg per week. As we all know this is a very low dose, yet I have a history of being super sensitive to medications; the TT of 24.3, taken at trough after 4 weeks on injections didn't surprise me. I had noticed in the couple of weeks before my switch that morning erections were appearing only on the last day or two before my trough, as well as some increased difficulties in maintaining erections. I made the switch only 5-6 days ago, but it seems to be better. Again, I'm aware that the short time frame makes reactions largely inconsequential in the big scheme of things; rest assured that at this point I'll let things run out until I (finally) get a full set of tests in July.

 

[Melody68]

Hello Cataceous, thanks for your input with regard to my dosing change - I certainly didn't think that a minor change would create such a stir. It's pleasant to know that moderators such as you and Madman are there and available for help; it's a nice change from doctors that don't return your messages. Really, I've always preferred to be on the lower side of any dosage and will stay here at 60mg/week until I get confirmation of what's happening with some proper bloodwork, planned for July. If I'm light on my weekly dosage, I can always increase, and in the meantime it should put me on the right side of Hematocrit for the time being . . .

 

[madman]

Just because it's common doesn't mean it's a good idea. Such dosing came about because of infrequent injections, once every week or even every two weeks. The larger doses keep serum-level troughs close to physiological. But ignored are the excessive peaks, which are responsible for many of the side effects.

@Melody68: There is further evidence that lower dosing is preferred in the relatively new XYOSTED product. This is testosterone enanthate without any additives. As a result it has a half-life that is about double that of typical formulations of TE/TC. This in turn means that it can be injected once-weekly without causing such extreme variation in serum testosterone. It only comes in three doses: 50 mg, 75 mg, and 100 mg. Patients are started at 75 mg/week. If serum testosterone is too high then they are lowered to 50 mg. If serum testosterone is too low then they are raised to 100 mg. It's that simple, and the 50-100 mg/week of TE aligns well with youthful physiological production of testosterone. Given that XYOSTED is a commercial product, you'd assume its developers would want to cover as much of the TRT market as possible. Thus it is telling that it maxes out at 100 mg/week.


There's probably nothing unusual about your response to the dose. As @madman suggests, you need to know free testosterone to be sure about what's going on, since unusual SHBG affects total testosterone. In contrast, free testosterone is likely to be proportional to the dose rate.

For comparison, my average total testosterone was over 1,200 ng/dL when I was started out on 100 mg TC/week, split into EOD doses. Another factor is that older men metabolize testosterone more slowly than younger men. This in turn increases our serum testosterone at the same dose rate.


Good plan.

Just to be clear here no one is stating that using let alone starting on <100 mg T/week is a bad idea!

The common starting dose across the board is 100 mg T/week.

You should know this.

The majority of uros including the top ones well versed in the field (Morgentaler, Khera) to name a few are prescribing such.

Better yet this is standard practice in Canada.

My uro is considered one of the top and this is his starting protocol for all patients using injectable esterified TC/TE.

He is considered the pioneer when it comes to subcutaneous T therapy and has treated 1000s of men for almost 2 decades.

Far from common anyone is starting someone on <100 mg T/week.

The big issue here is not only did he never give his previous protocol a fighting chance but had no clue where his SHBG and more importantly trough FT level sat.

He lowered his dose 6 weeks in!

He clearly does not understand how this works.

Again the first 6 weeks means nothing when looking at the bigger picture!

Every protocol needs to be given a fighting chance let alone you need a full set of labs which would include the most important blood marker free testosterone.

One needs to know where their trough FT let alone other blood markers sit once blood levels have stabilized (4-6 weeks TC/TE) on such protocol.

No one should be tweaking their dose 6 weeks in unless they felt horrible due to having too low a trough FT (highly unlikely in most cases) or the other scenario which would be too high a trough FT level which will be unfortunately more in the norm as many are over medicated on T from the get go!

You clearly know where I stand!




I already put the link Canadian Urology Guideline on Testosterone Replacement in his previous thread (post #9).

Got Test results after 3 months 1% T-Gel . . . very rattled!

I'm 68 and was diagnosed in December with lower T at 314, hematocrit at 47. I decided together with the Endocrinologist to go with his suggestion of 5gms 1% T Gel, the regular starting dose. Fast forward to my first blood test taken yesterday after applying the gel regularly for 3 months. And...

www.excelmale.com

post #3

Canadian Urology Guideline on Testosterone Replacement

Canadian Urological Association clinical practice guideline on testosterone deficiency in men: Evidence-based Q&A (2021) Ethan D. Grober, MD; Yonah Krakowsky, MD; Mohit Khera, MD; Daniel T. Holmes, MD; Jay C. Lee, MD; John E. Grantmyre, MD; Premal Patel, MD; Richard A. Bebb, MD; Ryan...

www.excelmale.com

Critical point that needs to be stressed here!

*Following the initiation of testosterone therapy, serum concentrations of testosterone are known to correct earlier than the symptomatic, structural, and metabolic signs associated with TD





26. What is a reasonable timeline to begin to observe improvements in the signs and symptoms of testosterone deficiency?


*Following the initiation of testosterone therapy, serum concentrations of testosterone are known to correct earlier than the symptomatic, structural, and metabolic signs associated with TD.76,77 As such, patients should be counseled that symptom response will not be immediate. Expectations for treatment response should be established with each patient. Patients can anticipate improvements in many of the common symptoms of TD (libido, energy levels, sexual function) after 3 months of treatment or longer. Metabolic and structural (body composition, muscle mass, bone density) changes may take upwards of 6 months. 77 In addition, patients should be counseled that diet and exercise in combination with testosterone therapy are recommended for body composition changes.

*Appreciating this pattern of response to testosterone therapy is fundamental when determining the impact of treatment and the appropriate timing of follow-up evaluations while on therapy. For example, if patients undergo a symptom review and measurement of testosterone levels too early (< 3 months), it may lead both physicians and patients to conclude that the treatment has not been impactful (i.e. normal levels of testosterone without symptomatic/structural/metabolic benefit). However, if the same assessment was scheduled 3-6 months after the initiation of therapy, the clinical response tends to be more reflective of normalized levels of serum testosterone.