Testosterone confusing lab results

[Cataceous]

... All I'm saying is that something in low shbg seems to correlate with lower than expected t numbers so one naturally assumes it's associated with shbg in some form or another.

And now we're saying the same thing. If you accept my premise that the exogenous testosterone dose sets free testosterone, then you can use any free T calculator to see that a lower SHBG requires lower total testosterone to maintain a particular free testosterone level.

It's also plausible that low SHBG has a separate effect on underlying metabolism, in the fluid analogy effectively enlarging the hole in the lower tank more than predicted. This effect is not present in my data in the graph above, even with SHBG values ranging from mid-20s nMol/L to mid-40s. But if present maybe it's only significant at even lower levels?

 

[Relar]

And now we're saying the same thing. If you accept my premise that the exogenous testosterone dose sets free testosterone, then you can use any free T calculator to see that a lower SHBG requires lower total testosterone to maintain a particular free testosterone level.

It's also plausible that low SHBG has a separate effect on underlying metabolism, in the fluid analogy effectively enlarging the hole in the lower tank more than predicted. This effect is not present in my data in the graph above, even with SHBG values ranging from mid-20s nMol/L to mid-40s. But if present maybe it's only significant at even lower levels?

After all this discussion, i feel it would help if i ask the lab to check shbg. They have my blood so i can call them and ask more labs. Other than shbg should i ask them anything else? Also should i ask them to test shbg at the first result at 665 total testosterone or the second one at 1031 total testosterone?

 

[Cataceous]

After all this discussion, i feel it would help if i ask the lab to check shbg. They have my blood so i can call them and ask more labs. Other than shbg should i ask them anything else? Also should i ask them to test shbg at the first result at 665 total testosterone or the second one at 1031 total testosterone?

The second result seems as though it should be the more accurate one given the high testosterone dose. So I would use that sample preferentially. Of course, if inexpensive, it would be somewhat interesting to see both results, as SHBG should not change in a day's time. If results were different then it would support the idea of a problem with one of the samples. That big disparity in testosterone measurements is hard to understand without invoking technical problems.

 

[Weasel]

The second result seems as though it should be the more accurate one given the high testosterone dose. So I would use that sample preferentially. Of course, if inexpensive, it would be somewhat interesting to see both results, as SHBG should not change in a day's time. If results were different then it would support the idea of a problem with one of the samples. That big disparity in testosterone measurements is hard to understand without invoking technical problems.

Lots of great food for thought in this thread! Until this thread, I thought it was pretty well accepted that low SHBG guys metabolized T faster than High SHBG guys. The rate of absorption is irrelevant to this discussion IMO. We know that is a given based on Ester. But after that happens, metabolism is no longer affected by the ester as it is no longer attached. Clearance rates are dependent on something besides Ester at this point, SHBG seems to be the big player.

 

[Cataceous]

... Clearance rates are dependent on something besides Ester at this point, SHBG seems to be the big player.

You can't clear testosterone faster than you receive it from the ester, on average. Therefore the ester absorption rate sets the clearance rate. The clearance rate is proportional to free testosterone. Therefore the absorption rate also sets free testosterone. Low SHBG just means that total testosterone is kept lower so free testosterone returns to the level permitted by the absorption rate.

 

[Weasel]

You can't clear testosterone faster than you receive it from the ester, on average. Therefore the ester absorption rate sets the clearance rate. The clearance rate is proportional to free testosterone. Therefore the absorption rate also sets free testosterone. Low SHBG just means that total testosterone is kept lower so free testosterone returns to the level permitted by the absorption rate.

We don't even come close to clearing T faster than absorption. Or we would never get a increase in T levels. But the clearance after is is absorbed IS affected by SHBG.

Here is study that tells us just that.

Differences in the apparent metabolic clearance rate of testosterone in young and older men with gonadotropin suppression receiving graded doses of... - PubMed - NCBI

 

[Cataceous]

We don't even come close to clearing T faster than absorption. Or we would never get a increase in T levels. But the clearance after is is absorbed IS affected by SHBG.

Here is study that tells us just that.

Differences in the apparent metabolic clearance rate of testosterone in young and older men with gonadotropin suppression receiving graded doses of... - PubMed - NCBI

The study does not contradict what I've said. What you're not getting is that lower SHBG creates a higher clearance rate only if total testosterone is kept constant. So using the analogy, low SHBG means you make the tank's outlet hole twice as big, but to maintain a constant fluid level (total testosterone) you must now pour in water twice as fast (inject double the testosterone). Flow out (MCR) is now also doubled. But if the input flow wasn't doubled then the water level (total testosterone) must drop to half its former level.

Serum testosterone goes up after an injection analogously to how the water level in a tank rises if I suddenly increase the rate of flow into it.

 

[Weasel]

All that and we're saying the same thing....I think

 

[Relar]

The second result seems as though it should be the more accurate one given the high testosterone dose. So I would use that sample preferentially. Of course, if inexpensive, it would be somewhat interesting to see both results, as SHBG should not change in a day's time. If results were different then it would support the idea of a problem with one of the samples. That big disparity in testosterone measurements is hard to understand without invoking technical problems.

Its Saturday today , monday morning i will call them to check both samples. Monday noon i will got the results and i will post them !

 

[Relar]

@Cataceous hello! Ive just received both of the results.
At the first sample with 645 total testosterone SHBG was 13.4
At the second sample (1day after the first one) with 1037 total testosterone SHBG was at 12.2

I hope that helped

 

[Cataceous]

@Cataceous hello! Ive just received both of the results.
At the first sample with 645 total testosterone SHBG was 13.4
At the second sample (1day after the first one) with 1037 total testosterone SHBG was at 12.2
...

They are close enough that I would consider them mutually consistent, so it doesn't seem as though the earlier blood sample itself was the problem, though the testosterone test could have been botched.

The important information is that SHBG is low. Probably it was somewhat higher before TRT and has been suppressed by the excess androgens. For a total testosterone of 665 ng/dL, Tru-T calculated free testosterone is about 25 ng/dL, which would put it in the middle of the healthy normal range of 16-31. A total testosterone of 1,037 puts free testosterone around 40 ng/dL, on the high side, and more likely given the testosterone dose.

 

[Relar]

They are close enough that I would consider them mutually consistent, so it doesn't seem as though the earlier blood sample itself was the problem, though the testosterone test could have been botched.

The important information is that SHBG is low. Probably it was somewhat higher before TRT and has been suppressed by the excess androgens. For a total testosterone of 665 ng/dL, Tru-T calculated free testosterone is about 25 ng/dL, which would put it in the middle of the healthy normal range of 16-31. A total testosterone of 1,037 puts free testosterone around 40 ng/dL, on the high side, and more likely given the testosterone dose.

yes you are correct it was about 33 if i recal correctly.
i would like to ask 2 more things before we end the thread conversation which to be honest was insanly educative and thank you a lot for that , i realy apriciate it.
Lets agree that the first sample was botched.
The second one is normal result for 250mg enathate per week(35mg daily injections)?
and switching from daily to lets say 3 times per week will elevate SHBG ?

 

[Cataceous]

...
The second one is normal result for 250mg enathate per week(35mg daily injections)?
and switching from daily to lets say 3 times per week will elevate SHBG ?

Side note: It's still a pretty low response for the amount of testosterone. I doubt that switching to somewhat less frequent injections will change SHBG much—it could even lower it further. We don't know if SHBG is more responsive to peak or average testosterone levels. And in any case, injecting three times a week probably would create only modest variations in serum testosterone.

 

[Relar]

Side note: It's still a pretty low response for the amount of testosterone. I doubt that switching to somewhat less frequent injections will change SHBG much—it could even lower it further. We don't know if SHBG is more responsive to peak or average testosterone levels. And in any case, injecting three times a week probably would create only modest variations in serum testosterone.

The strangest thing for me is that 1 month after starting trt i did bloodwork. I was doing 100mg enathate per week (25mg everyother day ) and also i was on 100mg of masterolone (proviron) and blood works came back with 600 total testosterone 18.5 shbg.. after that i stoped masterolone and changed to this protocol with dailys 35mg injections without nothing else.anyway i guess my testosterone vial its lost its potency so i will just buy from another local pharmacy and recheck 1 month later. Last thing , i promise Any way to increase shbg?

 

[antelopers]

The strangest thing for me is that 1 month after starting trt i did bloodwork. I was doing 100mg enathate per week (25mg everyother day ) and also i was on 100mg of masterolone (proviron) and blood works came back with 600 total testosterone 18.5 shbg.. after that i stoped masterolone and changed to this protocol with dailys 35mg injections without nothing else.anyway i guess my testosterone vial its lost its potency so i will just buy from another local pharmacy and recheck 1 month later. Last thing , i promise Any way to increase shbg?

I don't think it would have lost potency that drastically. Testosterone is good for a few years at least.

 

[Cataceous]

... Any way to increase shbg?

No panaceas, but take a look: SHBG: Causes and Natural Solutions for Low SHBG

 

[Relar]

Hello again! i am here to update aaand i have a small issue , and any advice it would be appriciated.

My Shbg after 6 weeks of the last check went to 19.4 nmol/l (previous was at 12.2)
also did check
total testosteron :825
free testosterone:244
shbg:19.4
prl :28.39
e2: 76.5

My protocol is 300mg enathate per week 3x100mg (every 56hours)
and 1000iu of hcg , 500iux2 (every 84 hours)
no AI

My issue is that prl keep elevating , before TRT (at november 2019 was 12.15 ng/ml ranges are 2.1 -17.7)
1 month later (december) went to 19
almost 5 months later (Now) went to 28.39
in the past without any prescription i ve checked it many times but never was over 14, TSH is in the middle range checked it too but now after trt it start and keep rising. Any suggestion?

Thanks everyone in advance!

 

[Cataceous]

It's pretty mind boggling that you and I have about the same total serum testosterone, but your average daily testosterone dose is six times greater! Either your testosterone enanthate is under-dosed or you have an incredibly high underlying metabolic clearance rate.

Regarding prolactin, I believe it is somewhat stimulated by estradiol. Are you seeing a correlation with those numbers? I would continue monitoring it. If it keeps rising you may need to have an MRI. If the high levels are mainly a response to estrogen then they could be brought down directly with cabergoline or similar drug, or maybe indirectly with an aromatase inhibitor.

Overall it's better to directly measure the thyroid hormones, in particular free T3 and free T4. TSH is just an indirect marker. But like prolactin it's a pituitary hormone, so there may be a common theme here. It may be a good idea to consult a doctor if you have access to one who knows hormones well.

 

[Relar]

It's pretty mind boggling that you and I have about the same total serum testosterone, but your average daily testosterone dose is six times greater! Either your testosterone enanthate is under-dosed or you have an incredibly high underlying metabolic clearance rate.

Regarding prolactin, I believe it is somewhat stimulated by estradiol. Are you seeing a correlation with those numbers? I would continue monitoring it. If it keeps rising you may need to have an MRI. If the high levels are mainly a response to estrogen then they could be brought down directly with cabergoline or similar drug, or maybe indirectly with an aromatase inhibitor.

Overall it's better to directly measure the thyroid hormones, in particular free T3 and free T4. TSH is just an indirect marker. But like prolactin it's a pituitary hormone, so there may be a common theme here. It may be a good idea to consult a doctor if you have access to one who knows hormones well.

I think its underdosed , i had to change pharmacy cause i moved out. I ve started with 100mg weekly 25mgx4 and had total testosterone 600. After that i moved to other place and changed pharmacy ,i took the same product but it doesnt work like the previous one from the first pharmacy thats why i use bigger dose. I dont care about muscles or something i just want to be healthy. We are in lock down and i cant go to other one cause we have 1 pharmacy here where i live.

I see that there is a correlation with e2 and prolactin. i will post you some blood works :
Before TRT:
E2: 18
Prl: 13

1 Month later in TRT:
E2: 44
Prl: 19

Current results:
E2: 76
Prl: 28

Also about thyroid i have to wait 1 month to do more bloodworks cause they are expensive without insurance . But i will do them next month with the typical hormone check.
I am consulting a doctor , he said its nothing to worry about yet.

But still any advice is welcome! , you here help too much with the knowledge you have.

Thank you again!

 

[Cataceous]

That is a strong correlation between estradiol and prolactin, even if it doesn't establish causality. Those recent numbers would make me uneasy; I seemed to start getting side effects when prolactin got over 10 ng/mL. But if you're not having problems then maybe you don't need to be immediately aggressive about it.