Testosterone Levels Too High?

[Johnny5]

I’ve been on TRT for 8 months. Started out at .10 per day and then they increased to .15 per day and then to .20 per day.

My T levels increased moderately at first from
250 total to 500 total. I don’t have the data on free initial T handy. At 500 total I was at 74 free. Then it went up to 1400 total and 300 free. Then from there it went up again to 2772 total and 723 free.

I feel absolutely great. No heart palpitations, no mood swings, no aggression no issues to speak of at all. Get Morning wood every day like I’m 17.

One thing I’ve noticed is that I do have some muscle issues and joint pain - Possibly related? Not sure.

The question is with these numbers so far out of what “they” consider normal - Are these levels of Total and Free safe?

 

[madman]

I’ve been on TRT for 8 months. Started out at .10 per day and then they increased to .15 per day and then to .20 per day.

My T levels increased moderately at first from
250 total to 500 total. I don’t have the data on free initial T handy. At 500 total I was at 74 free. Then it went up to 1400 total and 300 free. Then from there it went up again to 2772 total and 723 free.

I feel absolutely great. No heart palpitations, no mood swings, no aggression no issues to speak of at all. Get Morning wood every day like I’m 17.

One thing I’ve noticed is that I do have some muscle issues and joint pain - Possibly related? Not sure.

The question is with these numbers so far out of what “they” consider normal - Are these levels of Total and Free safe?

Started out at .10 per day and then they increased to .15 per day and then to .20 per day.

My T levels increased moderately at first from
250 total to 500 total. I don’t have the data on free initial T handy. At 500 total I was at 74 free. Then it went up to 1400 total and 300 free. Then from there it went up again to 2772 total and 723 free.

You are clearly overmedicated here!

Who the hell is treating you?

The majority of men on TRT are using the 200 mg/mL strength TC/TE.

.10 ml (10 units) per day would be 20 mg T (140 mg T/week).

.15 mL (15 units) is 30 mg T (210 mg T/week).

200 mg T/week is already a whopping weekly dose for most!

Men on TRT are using therapeutic dose 100-200 mg T whether injected once weekly or split into more frequent injections as in twice-weekly, M/W/F, EOD or daily.

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

.20mL (20 units) is a ridiculous 280 mg T/week!

Well beyond therapeutic as you can clearly see you are hitting an absurdly high TT 2772 ng/dL and more importantly sky f**king high FT 72.3 ng/dL!

Your TT/FT levels are ridiculous as in well beyond therapeutic!

Surefire way to drive your H/H!

Post your full set of labs including RBCs,hemoglobin and hematocrit.

When you were hitting a whopping TT 1400 ng/dL your FT 30 ng/dL was very high!

If you truly felt good there, no sides and overall blood markers were healthy then I see no issue running a very high FT on dailies!

Do what you feel is best for you!

But the running this TT 2700+ ng/dL with FT 70+ng/dL is pure nonsense!

Again this is well beyond therapeutic!

Show me a healthy young natty male walking around with a high-end TT let alone 1000+ with FT through the roof that has low/lowish let alone normal SHBG!

Such does not exist!

This is a short-lived peak we are talking about here not trough!

Hope you understand that a FT 20 ng/dL is high!

A healthy young male has a daily peak/trough, the peak is short-lived, trough is 20-25% lower.

Even if you took the outlier nattys hitting a high-end FT again this is a short-lived daily peak.

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

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

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.

 

[Guided_by_Voices]

I’ve been on TRT for 8 months. Started out at .10 per day and then they increased to .15 per day and then to .20 per day.

My T levels increased moderately at first from
250 total to 500 total. I don’t have the data on free initial T handy. At 500 total I was at 74 free. Then it went up to 1400 total and 300 free. Then from there it went up again to 2772 total and 723 free.

I feel absolutely great. No heart palpitations, no mood swings, no aggression no issues to speak of at all. Get Morning wood every day like I’m 17.

One thing I’ve noticed is that I do have some muscle issues and joint pain - Possibly related? Not sure.

The question is with these numbers so far out of what “they” consider normal - Are these levels of Total and Free safe?

What was the reason for the increase? How did you feel/perform at lower doses? "Safety" has a lot of nuance, but generally going with a dose at which higher doses offer no benefits will be a safer approach than higher doses.

 

[Johnny5]

Started out at .10 per day and then they increased to .15 per day and then to .20 per day.

My T levels increased moderately at first from
250 total to 500 total. I don’t have the data on free initial T handy. At 500 total I was at 74 free. Then it went up to 1400 total and 300 free. Then from there it went up again to 2772 total and 723 free.

You are clearly overmedicated here!

Who the hell is treating you?

The majority of men on TRT are using the 200 mg/mL strength TC/TE.

.10 ml (10 units) per day would be 20 mg T (140 mg T/week).

.15 mL (15 units) is 30 mg T (210 mg T/week).

200 mg T/week is already a whopping weekly dose for most!

Men on TRT are using therapeutic dose 100-200 mg T whether injected once weekly or split into more frequent injections as in twice-weekly, M/W/F, EOD or daily.

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

.20mL (20 units) is a ridiculous 280 mg T/week!

Well beyond therapeutic as you can clearly see you are hitting an absurdly high TT 2772 ng/dL and more importantly sky f**king high FT 72.3 ng/dL!

Your TT/FT levels are ridiculous as in well beyond therapeutic!

Surefire way to drive your H/H!

Post your full set of labs including RBCs,hemoglobin and hematocrit.

When you were hitting a whopping TT 1400 ng/dL your FT 30 ng/dL was very high!

If you truly felt good there, no sides and overall blood markers were healthy then I see no issue running a very high FT on dailies!

Do what you feel is best for you!

But the running this TT 2700+ ng/dL with FT 70+ng/dL is pure nonsense!

Again this is well beyond therapeutic!

Show me a healthy young natty male walking around with a high-end TT let alone 1000+ with FT through the roof that has low/lowish let alone normal SHBG!

Such does not exist!

This is a short-lived peak we are talking about here not trough!

Hope you understand that a FT 20 ng/dL is high!

A healthy young male has a daily peak/trough, the peak is short-lived, trough is 20-25% lower.

Even if you took the outlier nattys hitting a high-end FT again this is a short-lived daily peak.

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

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

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.

Without getting into the who. Let’s just assume it’s an online mail order company.

My Hgb is at 15.7 and my Hct is at 45.2. This has never been an issue at all for me even at these high T levels. It’s very steady. I have to get labs every two weeks for another issue I have so I’m up to date on those numbers. I get T labs every 3 months.

I hear every thing you’re saying and everything I’ve read agrees with what you’re saying. When I was at .10 it made little to no difference for me. When I was at .15 things were marginally improved but I still felt off and there was a bit of a roller coaster effect even with dosing daily. They increased to .20 and everything magically smoothed out.

Thats not to say that there is nothing to be concerned with obviously but I’m struggling to reconcile how I feel at lower levels with what I’ve read and experienced.

Can you offer anything else to educate me other than what is normal in for dosing in the TRT treatment world.

 

[Johnny5]

Started out at .10 per day and then they increased to .15 per day and then to .20 per day.

My T levels increased moderately at first from
250 total to 500 total. I don’t have the data on free initial T handy. At 500 total I was at 74 free. Then it went up to 1400 total and 300 free. Then from there it went up again to 2772 total and 723 free.

You are clearly overmedicated here!

Who the hell is treating you?

The majority of men on TRT are using the 200 mg/mL strength TC/TE.

.10 ml (10 units) per day would be 20 mg T (140 mg T/week).

.15 mL (15 units) is 30 mg T (210 mg T/week).

200 mg T/week is already a whopping weekly dose for most!

Men on TRT are using therapeutic dose 100-200 mg T whether injected once weekly or split into more frequent injections as in twice-weekly, M/W/F, EOD or daily.

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

.20mL (20 units) is a ridiculous 280 mg T/week!

Well beyond therapeutic as you can clearly see you are hitting an absurdly high TT 2772 ng/dL and more importantly sky f**king high FT 72.3 ng/dL!

Your TT/FT levels are ridiculous as in well beyond therapeutic!

Surefire way to drive your H/H!

Post your full set of labs including RBCs,hemoglobin and hematocrit.

When you were hitting a whopping TT 1400 ng/dL your FT 30 ng/dL was very high!

If you truly felt good there, no sides and overall blood markers were healthy then I see no issue running a very high FT on dailies!

Do what you feel is best for you!

But the running this TT 2700+ ng/dL with FT 70+ng/dL is pure nonsense!

Again this is well beyond therapeutic!

Show me a healthy young natty male walking around with a high-end TT let alone 1000+ with FT through the roof that has low/lowish let alone normal SHBG!

Such does not exist!

This is a short-lived peak we are talking about here not trough!

Hope you understand that a FT 20 ng/dL is high!

A healthy young male has a daily peak/trough, the peak is short-lived, trough is 20-25% lower.

Even if you took the outlier nattys hitting a high-end FT again this is a short-lived daily peak.

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

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

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.

Without getting into the who. Let’s just assume it’s an online mail order company.

My Hgb is at 15.7 and my

 

[Johnny5]

Last labs

 

[Johnny5]

What was the reason for the increase? How did you feel/perform at lower doses? "Safety" has a lot of nuance, but generally going with a dose at which higher doses offer no benefits will be a safer approach than higher doses.

Well that’s just it. At .10 it didn’t make any difference at all. .15 slightly better but felt kinda moody. Then .20 feel Incredible…so based on how I felt the lower doses I didn’t feel great.

 

[madman]

Without getting into the who. Let’s just assume it’s an online mail order company.

My Hgb is at 15.7 and my Hct is at 45.2. This has never been an issue at all for me even at these high T levels. It’s very steady. I have to get labs every two weeks for another issue I have so I’m up to date on those numbers. I get T labs every 3 months.

I hear every thing you’re saying and everything I’ve read agrees with what you’re saying. When I was at .10 it made little to no difference for me. When I was at .15 things were marginally improved but I still felt off and there was a bit of a roller coaster effect even with dosing daily. They increased to .20 and everything magically smoothed out.

Thats not to say that there is nothing to be concerned with obviously but I’m struggling to reconcile how I feel at lower levels with what I’ve read and experienced.

Can you offer anything else to educate me other than what is normal in for dosing in the TRT treatment world.

Hope you understand that it is critical to give each protocol a fair shake before claiming whether it was truly a success or failure.

When first starting TTh or tweaking a protocol (increasing/decreasing dose of T, manipulating injection frequency) hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks using TC/TE) and it is common for many to experience ups/down during the transition as the body is trying to adjust to the increasing or decreasing T levels.

Even then once blood levels have stabilized (4-6 weeks using TC/TE) it will still take the body a few months (2-3) 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.

Every protocol needs to be given a fighting chance 3-4 months before claiming whether it was truly a success or failure.

Many make the mistake of increasing their dose too soon!

Judging by your first post my gut instinct tells me you most likely kept increasing your T dose well before the full 3-4 months needed!

Patience is key here.

As we always say start slow and go slow as it is much easier going up than coming down!

The goal is to achieve a healthy trough FT level in order to achieve relief/improvement of low-T symptoms, minimize/avoid sides and more importantly maintain healthy blood markers long-term.

Key here being long-term!

Keep in mind running too high a trough FT level can be just as bad in many ways as running too low a FT level especially when it comes to libido/erectile function let alone mood (hammering dopamine) long-term!

Your TT/FT levels are well beyond therapeutic!

No one would need such in order to reap the beneficial effects of having healthy FT levels in order to experience relief/improvement of low-T symptoms especially long-term.

If the goal was for purely cosmetic purposes (increased muscle/strength) and better recovery most definitely as its would be more advantageous the higher you push your FT level but unfortunately most would be abusing T/AAS to achieve such which has nothing to do with testosterone therapy let alone maintaining long-term health!

Again when you were hitting a whopping TT 1400 ng/dL your FT 30 ng/dL was very high!

If you truly felt good there, no sides and overall blood markers were healthy then I see no issue running a very high FT on dailies!

Do what you feel is best for you.

But the running this TT 2700+ ng/dL with FT 70+ng/dL is pure nonsense!

Again this is well beyond therapeutic!

If anything I would be aiming for a healthy/high-end trough long-term on a daily protocol.

Critical to invest 3-4 months on such in order to truly gauge how you feel overall regarding relief/improvement of low-T symptoms.

Regarding hemoglobin/hematocrit yes your levels are well within normal but I with those freakishly high TT/FT levels you are running I would be suspect of low iron/ferritin as most would see an increase in H/H running much lower TT/FT levels.

More importantly getting back to how much to time you truly invested in each protocol (increased dose of T) hope you understand that when one uses exogenous T RBCs, hemoglobin and hematocrit will increase within the first month after starting and it can take anywhere from 6-9 months or in some cases up to a year to reach peak levels.

Where your hematocrit sits 4 let alone 12 weeks in is not where it will end up 6-9 months from now!

Again your levels are well with range but I would be highly suspect of low iron/ferritin, underlying issue with absorption of iron.

Something not jiving here!



Too many are still caught up in jumping the gun (starting with too high a T dose/increasing T dose to soon) off the hop!


*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.

*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.

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

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.

Androgen modulation of mesoprefrontal dopamine systems and the effects of these actions on the adult male brain

Again would tread lightly on how high you run your trough/steady-state FT level! This can easily backfire in the long-run for many especially when it comes to mood, libido and erectile function! Too high a FT level can be just as bad in many ways as having too low a FT level. Libido starts in...

www.excelmale.com

Everyone is so caught up on the physical yet overlooks long-term brain health!

Again would tread lightly on how high you run your trough/steady-state FT level!

This can easily backfire in the long-run for many especially when it comes to mood, libido and erectile function!

Testosterone Therapy and Erythrocytosis - the most common dose-limiting effect of testosterone therapy

https://www.thebloodproject.com/cases-archive/testosterone-therapy-and-erythrocytosis-2/ Introduction Androgens play a crucial role in the development and maintenance of: Male reproductive and sexual functions Body composition Erythropoiesis Muscle and bone health Cognitive function...

www.excelmale.com

 

[Johnny5]

Appreciate the insight and you’re correct in your assessment of when my dose was increased in conjunction with time on last protocol.

There is a reason I’m dealing with an online provider. It’s certainly not to avoid doing this the right way. These online providers are obviously in the business of moving as many units of TRT as possible and are not really concerned about the labs. Initially they did run labs and I did have labs done locally by a legitimate TRT clinic. However due to another condition that needed to get under control they would not treat me with TRT until it was under control. Working with the Doc to treat this other condition it was obvious that I was getting it under control. Keep in mind it was 4 months prior to starting TRT that I discovered this other issue. This other issue was discovered through the initial labs that the local TRT clinic did. That was back in Oct of 2023. In Jan of 24 my numbers for this other issue got down in safe range and I went online and found this online TRT clinic. They ran labs and my Testosterone and other numbers really had not changed from the initial labs. They sent the first vial of TRT and I was wrong they actually started me at .15 and I was on that until May 24 and that’s when we did another online visit and I was asked about how I felt, no labs, and I wasn’t feeling great. They increased to .20. Lately I’ve been taking a day or two off every couple weeks. I started doing this because of this latest T lab results. Also keep in mind the T labs I am currently having done are not through the Online Clinic but in conjunction with this other issue. One of the chief concerns was to keep my Hcb and Hct in range which they are. I don’t have current labs for sex binding, just test and my blood labs. Part of the issue may be that in order to keep this other issue under control I had to give a unit of blood every two week which is brutal. Now that it’s fully under control I’m able to wait longer and I’m thinking that it would be smart to cut back on the TRT dose.

If it were you - Would you cut back slowly over time? Would you cut back to the .10 right away. I’m curious as to what one might do to bring the Test numbers down to a more reasonable level.

 

[Vince]

Appreciate the insight and you’re correct in your assessment of when my dose was increased in conjunction with time on last protocol.

There is a reason I’m dealing with an online provider. It’s certainly not to avoid doing this the right way. These online providers are obviously in the business of moving as many units of TRT as possible and are not really concerned about the labs. Initially they did run labs and I did have labs done locally by a legitimate TRT clinic. However due to another condition that needed to get under control they would not treat me with TRT until it was under control. Working with the Doc to treat this other condition it was obvious that I was getting it under control. Keep in mind it was 4 months prior to starting TRT that I discovered this other issue. This other issue was discovered through the initial labs that the local TRT clinic did. That was back in Oct of 2023. In Jan of 24 my numbers for this other issue got down in safe range and I went online and found this online TRT clinic. They ran labs and my Testosterone and other numbers really had not changed from the initial labs. They sent the first vial of TRT and I was wrong they actually started me at .15 and I was on that until May 24 and that’s when we did another online visit and I was asked about how I felt, no labs, and I wasn’t feeling great. They increased to .20. Lately I’ve been taking a day or two off every couple weeks. I started doing this because of this latest T lab results. Also keep in mind the T labs I am currently having done are not through the Online Clinic but in conjunction with this other issue. One of the chief concerns was to keep my Hcb and Hct in range which they are. I don’t have current labs for sex binding, just test and my blood labs. Part of the issue may be that in order to keep this other issue under control I had to give a unit of blood every two week which is brutal. Now that it’s fully under control I’m able to wait longer and I’m thinking that it would be smart to cut back on the TRT dose.

If it were you - Would you cut back slowly over time? Would you cut back to the .10 right away. I’m curious as to what one might do to bring the Test numbers down to a more reasonable level.

What are your estrogen levels?

 

[Systemlord]

I’ve been on TRT for 8 months. Started out at .10 per day and then they increased to .15 per day and then to .20 per day.

My T levels increased moderately at first from
250 total to 500 total. I don’t have the data on free initial T handy. At 500 total I was at 74 free. Then it went up to 1400 total and 300 free. Then from there it went up again to 2772 total and 723 free.

I feel absolutely great. No heart palpitations, no mood swings, no aggression no issues to speak of at all. Get Morning wood every day like I’m 17.

One thing I’ve noticed is that I do have some muscle issues and joint pain - Possibly related? Not sure.

The question is with these numbers so far out of what “they” consider normal - Are these levels of Total and Free safe?

Biotin supplements will interfere with some testosterone lab tests. It will give erroneously high results.

What lab method was used to check your testosterone?

 

[madman]

Appreciate the insight and you’re correct in your assessment of when my dose was increased in conjunction with time on last protocol.

There is a reason I’m dealing with an online provider. It’s certainly not to avoid doing this the right way. These online providers are obviously in the business of moving as many units of TRT as possible and are not really concerned about the labs. Initially they did run labs and I did have labs done locally by a legitimate TRT clinic. However due to another condition that needed to get under control they would not treat me with TRT until it was under control. Working with the Doc to treat this other condition it was obvious that I was getting it under control. Keep in mind it was 4 months prior to starting TRT that I discovered this other issue. This other issue was discovered through the initial labs that the local TRT clinic did. That was back in Oct of 2023. In Jan of 24 my numbers for this other issue got down in safe range and I went online and found this online TRT clinic. They ran labs and my Testosterone and other numbers really had not changed from the initial labs. They sent the first vial of TRT and I was wrong they actually started me at .15 and I was on that until May 24 and that’s when we did another online visit and I was asked about how I felt, no labs, and I wasn’t feeling great. They increased to .20. Lately I’ve been taking a day or two off every couple weeks. I started doing this because of this latest T lab results. Also keep in mind the T labs I am currently having done are not through the Online Clinic but in conjunction with this other issue. One of the chief concerns was to keep my Hcb and Hct in range which they are. I don’t have current labs for sex binding, just test and my blood labs. Part of the issue may be that in order to keep this other issue under control I had to give a unit of blood every two week which is brutal. Now that it’s fully under control I’m able to wait longer and I’m thinking that it would be smart to cut back on the TRT dose.

If it were you - Would you cut back slowly over time? Would you cut back to the .10 right away. I’m curious as to what one might do to bring the Test numbers down to a more reasonable level.

These online providers are obviously in the business of moving as many units of TRT as possible and are not really concerned about the labs.


Most definitely and you can blame those run of the mill dime a dozen T mills pushing that more T is better mentality let alone those blast n cruizzers polluting those so called men's health forums and you can throw in those snakey so called GURUS polluting the steroid forums and GOOTUBE!

These clinics love jacking everyone up on T from the get go!

Many may feel like superman when first starting but it will eventually bite them in the ass in the long run.

Most struggling on TTh are running way too high a trough/steady state FT level!




Initially they did run labs and I did have labs done locally by a legitimate TRT clinic. However due to another condition that needed to get under control they would not treat me with TRT until it was under control. Working with the Doc to treat this other condition it was obvious that I was getting it under control. Keep in mind it was 4 months prior to starting TRT that I discovered this other issue. This other issue was discovered through the initial labs that the local TRT clinic did. That was back in Oct of 2023.

Also keep in mind the T labs I am currently having done are not through the Online Clinic but in conjunction with this other issue. One of the chief concerns was to keep my Hcb and Hct in range which they are. I don’t have current labs for sex binding, just test and my blood labs. Part of the issue may be that in order to keep this other issue under control I had to give a unit of blood every two week which is brutal. Now that it’s fully under control I’m able to wait longer and I’m thinking that it would be smart to cut back on the TRT dose.


Sounds like you had elevated hematocrit pre-TRT which needed to be addressed before hopping on exogenous T as it is a given that RBCs, hemoglobin and hematocrit will be driven up due to driving up your FT!

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.

Were you diagnosed with sleep apnea or another underlying condition?

Most likely had you donating blood frequently let alone it sounds like you have been donating the whole time to keep things in check.

Surefire way to crash your iron/ferritin

Unfortunately in many cases this can lead to crashed iron/ferritin which can open up another can of worms in the long-run.

You are clearly overdosed on T and your TT and more importantly FT levels are way too high!




In Jan of 24 my numbers for this other issue got down in safe range and I went online and found this online TRT clinic. They ran labs and my Testosterone and other numbers really had not changed from the initial labs. They sent the first vial of TRT and I was wrong they actually started me at .15 and I was on that until May 24 and that’s when we did another online visit and I was asked about how I felt, no labs, and I wasn’t feeling great. They increased to .20. Lately I’ve been taking a day or two off every couple weeks. I started doing this because of this latest T lab results. Also keep in mind the T labs I am currently having done are not through the Online Clinic but in conjunction with this other issue. One of the chief concerns was to keep my Hcb and Hct in range which they are. I don’t have current labs for sex binding, just test and my blood labs. Part of the issue may be that in order to keep this other issue under control I had to give a unit of blood every two week which is brutal. Now that it’s fully under control I’m able to wait longer and I’m thinking that it would be smart to cut back on the TRT dose.


They started you on a whopping 30 mg T daily (210 mg T/week).

Most men would never even need such in order to achieve a healthy/high trough FT.

Hard to believe that you were already hitting a whopping TT 1400 ng/dL with a very high FT 30 ng/dL and they still increased your dose and we are talking an extra 70 mg T/week which is well beyond therapeutic let alone a huge jump.

When tweaking a TTh protocol (increase in/decreasing dose of T) adjusting the dose by 20-30 mg T/week would be more than enough.

Talk about complete f**king overkill going from a starting whopping dose 210 mg--->an absurd 280 mg T/week which skyrocketed your TT 1400--->2700 ng/dL and more importantly your FT 30--->72 ng/dL!

That is barring your dose adjustments are even correct.




My T levels increased moderately at first from
250 total to 500 total. I don’t have the data on free initial T handy. At 500 total I was at 74 free. Then it went up to 1400 total and 300 free. Then from there it went up again to 2772 total and 723 free.

Pure madness especially for someone who was most likely already struggling with elevated hematocrit pre-TRT!

Not sure how the dose adjustment played out over the 8 months you have been on therapy.

Did you even reach steady-state each protocol before getting your blood work done?

Forgive me but the people running that clinic treating you are f**king idiots!

Taking a day or two off every week is not the way to approach this here.

You need to lower your weekly dose and bring down your FT level big time!




If it were you - Would you cut back slowly over time? Would you cut back to the .10 right away. I’m curious as to what one might do to bring the Test numbers down to a more reasonable level.

You could bite the bullet and do a 360 and start of on a more sensible weekly dose 100-120 mg T/week but you will most likely have a bumpy ride over the following weeks going from an absurdly high FT to a more sensible level.

It would be more sensible if you lower your dose gradually over the following weeks which will soften the blow and minimize the downs you may experience along the way.

Do what you feel is best for you.

 

[Steve78]

Madman, in general, what’s highest TT and free T that would yield a good balance between muscle gains and long term sides? I know prob dose that doesn’t increase HCT etc but would bring 1000-1100 long term be ok generally speaking even if phlebotomy is done anyway (I like donating blood to help others too)…. Thoughts?

 

[Johnny5]

Biotin supplements will interfere with some testosterone lab tests. It will give erroneously high results.

What lab method was used to check your testosterone?

I’m not taking any supplements.

It’s through Quest Diagnostics. I tried to look it up on their site and could not find any info. The results I have online through my Doc don’t tell me what lab method either.

 

[madman]

Biotin supplements will interfere with some testosterone lab tests. It will give erroneously high results.

What lab method was used to check your testosterone?

Far from common anyone would be taking a high enough dose of biotin to skew the results of a standardized immunoassay.

He is injecting a whopping 40mg T daily (280 mg T/week)!

 

[Johnny5]

These online providers are obviously in the business of moving as many units of TRT as possible and are not really concerned about the labs.


Most definitely and you can blame those run of the mill dime a dozen T mills pushing that more T is better mentality let alone those blast n cruizzers polluting those so called men's health forums and you can throw in those snakey so called GURUS polluting the steroid forums and GOOTUBE!

These clinics love jacking everyone up on T from the get go!

Many may feel like superman when first starting but it will eventually bite them in the ass in the long run.

Most struggling on TTh are running way too high a trough/steady state FT level!




Initially they did run labs and I did have labs done locally by a legitimate TRT clinic. However due to another condition that needed to get under control they would not treat me with TRT until it was under control. Working with the Doc to treat this other condition it was obvious that I was getting it under control. Keep in mind it was 4 months prior to starting TRT that I discovered this other issue. This other issue was discovered through the initial labs that the local TRT clinic did. That was back in Oct of 2023.

Also keep in mind the T labs I am currently having done are not through the Online Clinic but in conjunction with this other issue. One of the chief concerns was to keep my Hcb and Hct in range which they are. I don’t have current labs for sex binding, just test and my blood labs. Part of the issue may be that in order to keep this other issue under control I had to give a unit of blood every two week which is brutal. Now that it’s fully under control I’m able to wait longer and I’m thinking that it would be smart to cut back on the TRT dose.


Sounds like you had elevated hematocrit pre-TRT which needed to be addressed before hopping on exogenous T as it is a given that RBCs, hemoglobin and hematocrit will be driven up due to driving up your FT!

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.

Were you diagnosed with sleep apnea or another underlying condition?

Most likely had you donating blood frequently let alone it sounds like you have been donating the whole time to keep things in check.

Surefire way to crash your iron/ferritin

Unfortunately in many cases this can lead to crashed iron/ferritin which can open up another can of worms in the long-run.

You are clearly overdosed on T and your TT and more importantly FT levels are way too high!




In Jan of 24 my numbers for this other issue got down in safe range and I went online and found this online TRT clinic. They ran labs and my Testosterone and other numbers really had not changed from the initial labs. They sent the first vial of TRT and I was wrong they actually started me at .15 and I was on that until May 24 and that’s when we did another online visit and I was asked about how I felt, no labs, and I wasn’t feeling great. They increased to .20. Lately I’ve been taking a day or two off every couple weeks. I started doing this because of this latest T lab results. Also keep in mind the T labs I am currently having done are not through the Online Clinic but in conjunction with this other issue. One of the chief concerns was to keep my Hcb and Hct in range which they are. I don’t have current labs for sex binding, just test and my blood labs. Part of the issue may be that in order to keep this other issue under control I had to give a unit of blood every two week which is brutal. Now that it’s fully under control I’m able to wait longer and I’m thinking that it would be smart to cut back on the TRT dose.


They started you on a whopping 30 mg T daily (210 mg T/week).

Most men would never even need such in order to achieve a healthy/high trough FT.

Hard to believe that you were already hitting a whopping TT 1400 ng/dL with a very high FT 30 ng/dL and they still increased your dose and we are talking an extra 70 mg T/week which is well beyond therapeutic let alone a huge jump.

When tweaking a TTh protocol (increase in/decreasing dose of T) adjusting the dose by 20-30 mg T/week would be more than enough.

Talk about complete f**king overkill going from a starting whopping dose 210 mg--->an absurd 280 mg T/week which skyrocketed your TT 1400--->2700 ng/dL and more importantly your FT 30--->72 ng/dL!

That is barring your dose adjustments are even correct.

My T levels increased moderately at first from
250 total to 500 total. I don’t have the data on free initial T handy. At 500 total I was at 74 free. Then it went up to 1400 total and 300 free. Then from there it went up again to 2772 total and 723 free.

Pure madness especially for someone who was most likely already struggling with elevated hematocrit pre-TRT!

Not sure how the dose adjustment played out over the 8 months you have been on therapy.

Did you even reach steady-state each protocol before getting your blood work done?

Forgive me but the people running that clinic treating you are f**king idiots!

Taking a day or two off every week is not the way to approach this here.

You need to lower your weekly dose and bring down your FT level big time!




If it were you - Would you cut back slowly over time? Would you cut back to the .10 right away. I’m curious as to what one might do to bring the Test numbers down to a more reasonable level.

You could bite the bullet and do a 360 and start of on a more sensible weekly dose 100-120 mg T/week but you will most likely have a bumpy ride over the following weeks going from an absurdly high FT to a more sensible level.

It would be more sensible if you lower your dose gradually over the following weeks which will soften the blow and minimize the downs you may experience along the way.

Do what you feel is best for you.

So my hemoglobin and hematocrit have always been in range on every lab since day one. No issue there. My iron and ferritin were sky high which is why the local TRT clinic would not treat me back in Oct of 23.
My iron and ferritin climb all on their own to massive levels without phlebotomy. I’m good right now and those levels are good so I’ve not been having to give blood every two weeks for about a month.
So when I said I skip a day or two per week I meant to say that since I am on a daily protocol I am not taking those doses. So instead of doing .20 per day 7 days a week. I’m doing .20 5 days a week. Taking me from .20X7= 1.4 to .20X5 = 1 per week. Essentially I’m at .15 daily over 7 days now that I’ve made this very recent adjustment. Therefore lowering my weekly.
I’m a pretty sharp guy. Very in tune with my body. I have to be for a few reasons. I notice everything.

I think I’m going to slowly get down to .10 daily.

Any other thoughts would be appreciated. I may seek out a local TRT doc and get on a more comprehensive plan that is not feeding these crazy online TRT pushers - I knew this was a risk going into it. Just want to find a better way to manage things that’s not in la la land!

 

[madman]

So my hemoglobin and hematocrit have always been in range on every lab since day one. No issue there. My iron and ferritin were sky high which is why the local TRT clinic would not treat me back in Oct of 23.
My iron and ferritin climb all on their own to massive levels without phlebotomy. I’m good right now and those levels are good so I’ve not been having to give blood every two weeks for about a month.
So when I said I skip a day or two per week I meant to say that since I am on a daily protocol I am not taking those doses. So instead of doing .20 per day 7 days a week. I’m doing .20 5 days a week. Taking me from .20X7= 1.4 to .20X5 = 1 per week. Essentially I’m at .15 daily over 7 days now that I’ve made this very recent adjustment. Therefore lowering my weekly.
I’m a pretty sharp guy. Very in tune with my body. I have to be for a few reasons. I notice everything.

I think I’m going to slowly get down to .10 daily.

Any other thoughts would be appreciated. I may seek out a local TRT doc and get on a more comprehensive plan that is not feeding these crazy online TRT pushers - I knew this was a risk going into it. Just want to find a better way to manage things that’s not in la la land!

My iron and ferritin were sky high which is why the local TRT clinic would not treat me back in Oct of 23.
My iron and ferritin climb all on their own to massive levels without phlebotomy. I’m good right now and those levels are good so I’ve not been having to give blood every two weeks for about a month.

So when I said I skip a day or two per week I meant to say that since I am on a daily protocol I am not taking those doses. So instead of doing .20 per day 7 days a week. I’m doing .20 5 days a week. Taking me from .20X7= 1.4 to .20X5 = 1 per week. Essentially I’m at .15 daily over 7 days now that I’ve made this very recent adjustment.


Okay I see now.

200-210 mg T/week is still a high dose and will most likely have your trough FT high but it would be in a more sensible range compared to the sky-high FT you were hitting on that absurd dose 40 mg T daily (280 mg T/week).

Seeing as you just recently lowered your dose I would give it 4-6 weeks until blood levels stabilize then have your blood work done to see where your TT/FT level sits.

Also keep in mind that we always want to test at the true trough so there will be a difference when injecting daily vs 5 days/week with the weekends off!

Even then you would need to hang there for a few months as it will take time for the body to adapt to it's new set-point as this would be the critical time period when one needs to gauge how they truly feel overall regarding relief/improvement of low-T symptoms.

Again you will most likely experience ups and downs along the way as you are bringing down your FT level and hormones will be in flux.

If your ultimate goal is to start over again from scratch and get down to .10 mL (10 units) which would be 20mg T daily (140 mg T/week) then you can just gradually decrease your dose over the following weeks.

Critical to use the most accurate assays TT (LC/MS-MS) and FT (Equilibrium Dialysis)especially in cases of altered SHBG in order to know where your trough FT level truly sits.

Find out what testing methods are being used by your doctor for your TT, FT and estradiol.

You always have the option of paying out of pocket and the most cost effective route would be using Nelson's discounted labs as he offers the most accurate assays for TT, FT and estradiol.




$45.15 -most accurate assays for TT/FT

Testosterone, Free (Equilibrium Dialysis) and Total, MS - Most Affordable and Accurate Test

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

www.discountedlabs.com

$84.00 - most accurate assays for TT/FT/E2

Estradiol Ultra Sensitive (LC/MS) and Testosterone, Free (Dialysis) and Total, MS

This best-priced lab test panel includes the two gold standard tests for estradiol and testosterone (Total and Free) that use mass spectrometry for the best accuracy and no interactions.

www.discountedlabs.com

 

[madman]

I’m not taking any supplements.

It’s through Quest Diagnostics. I tried to look it up on their site and could not find any info. The results I have online through my Doc don’t tell me what lab method either.

Post the reference ranges!

Always best to post the methods used/reference ranges when speaking in terms of lab results.

Even then it is easy to figure out the method if you post the reference ranges as the 2 most common labs used are Labcorp and Quest!

 

[Johnny5]

My iron and ferritin were sky high which is why the local TRT clinic would not treat me back in Oct of 23.
My iron and ferritin climb all on their own to massive levels without phlebotomy. I’m good right now and those levels are good so I’ve not been having to give blood every two weeks for about a month.

So when I said I skip a day or two per week I meant to say that since I am on a daily protocol I am not taking those doses. So instead of doing .20 per day 7 days a week. I’m doing .20 5 days a week. Taking me from .20X7= 1.4 to .20X5 = 1 per week. Essentially I’m at .15 daily over 7 days now that I’ve made this very recent adjustment.


Okay I see now.

200-210 mg T/week is still a high dose and will most likely have your trough FT high but it would be in a more sensible range compared to the sky-high FT you were hitting on that absurd dose 40 mg T daily (280 mg T/week).

Seeing as you just recently lowered your dose I would give it 4-6 weeks until blood levels stabilize then have your blood work done to see where your TT/FT level sits.

Also keep in mind that we always want to test at the true trough so there will be a difference when injecting daily vs 5 days/week with the weekends off!

Even then you would need to hang there for a few months as it will take time for the body to adapt to it's new set-point as this would be the critical time period when one needs to gauge how they truly feel overall regarding relief/improvement of low-T symptoms.

Again you will most likely experience ups and downs along the way as you are bringing down your FT level and hormones will be in flux.

If your ultimate goal is to start over again from scratch and get down to .10 mL (10 units) which would be 20mg T daily (140 mg T/week) then you can just gradually decrease your dose over the following weeks.

Critical to use the most accurate assays TT (LC/MS-MS) and FT (Equilibrium Dialysis)especially in cases of altered SHBG in order to know where your trough FT level truly sits.

Find out what testing methods are being used by your doctor for your TT, FT and estradiol.

You always have the option of paying out of pocket and the most cost effective route would be using Nelson's discounted labs as he offers the most accurate assays for TT, FT and estradiol.




$45.15 -most accurate assays for TT/FT

Testosterone, Free (Equilibrium Dialysis) and Total, MS - Most Affordable and Accurate Test

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

www.discountedlabs.com

$84.00 - most accurate assays for TT/FT/E2

Estradiol Ultra Sensitive (LC/MS) and Testosterone, Free (Dialysis) and Total, MS

This best-priced lab test panel includes the two gold standard tests for estradiol and testosterone (Total and Free) that use mass spectrometry for the best accuracy and no interactions.

www.discountedlabs.com

I want to thank you again for your thorough responses.
It’s rare for people these days to give up their time and be willing to offer solid feedback and advice.
I will get the labs done through the links you sent. I really would like better Intel so I can make good decisions.
Really appreciate you and the time you’ve invested today!

I’ll keep you posted in this thread as I make this journey back to reality.

 

[madman]

Madman, in general, what’s highest TT and free T that would yield a good balance between muscle gains and long term sides? I know prob dose that doesn’t increase HCT etc but would bring 1000-1100 long term be ok generally speaking even if phlebotomy is done anyway (I like donating blood to help others too)…. Thoughts?

A higher-end steady-state/trough FT level would be more advantageous but one would need to keep trough/injection frequency in mind.

Even then as I stated in a previous thread there are many other factors at play here.

Brand vs generic testosterone

So for me, I see a difference in my labs using compounded testosterone vs branded depot testosterone, but is there a difference between brand and generic testosterone cyp?

www.excelmale.com