TRT Dosage advice?

[50BMGdoesitforme]

Hey all - thanks for the continued input. I do have a great PCP and a urologist but after a single day of research when I was diagnosed with low T I knew more about it than them, so I'm in the driver's seat. I do have a script for 200/wk, which is more than I would ever need, but that's great for me because that gives me the freedom to adjust my dosage without the red tape.

I've heard a lot about Defy, not a bad idea - I may well do that.

As for now, I'm going to stick with 150/wk as you all recommend; what's my best course of action? Give it six more weeks and see how things are? Or longer? Is it worth getting labs now or should I wait?

Thanks a lot, guys.

 

[TLawyer]

Hey all - thanks for the continued input. I do have a great PCP and a urologist but after a single day of research when I was diagnosed with low T I knew more about it than them, so I'm in the driver's seat. I do have a script for 200/wk, which is more than I would ever need, but that's great for me because that gives me the freedom to adjust my dosage without the red tape.

I've heard a lot about Defy, not a bad idea - I may well do that.

As for now, I'm going to stick with 150/wk as you all recommend; what's my best course of action? Give it six more weeks and see how things are? Or longer? Is it worth getting labs now or should I wait?

Thanks a lot, guys.

I would wait until at least 6 weeks after changing a protocol to get labs. Some guys take a week or two longer for the numbers to stabilize. At that point, you should have a good sense of what the new protocol will do for your numbers - if the number look good, then stick with it and see how your symptoms do for the next few weeks/months after.

 

[50BMGdoesitforme]

Thanks, TL - so I know numbers don't mean nearly as much as results, but would I be incorrect to be aiming for 800-1000, or even 1100? Basically if I get 675 back, would I be wrong to increase my dose slightly?

I appreciate everyone's patience very much!

 

[TLawyer]

Defy wants me to target for the high "normal range" for total testosterone, which would be in the 800-1000 range. But obviously will also need to look at the other numbers (free testosterone, DHT, etc.) as well, but that's probably a good range for total testosterone.

 

[Jackie Treehorn]

Ok, I'll add DHT to my labs - I think I was already planning the rest. I have an excellent PCP who is very supportive of my TRT but doesn't know anything about it, and my urologist was happy for me to stay on 200mg/wk indefinitely as well as crashing my e2 with AIs. I'm just happy I got a script for TC as I know many guys can't even get that.

I will research all the things you mentioned.

I gotta say I can't help but feel a bit discouraged after reading all this - just seems like it will be impossible to actually arrive at the right dose. I mean waiting a year between? Man, that's just such a long time. Just so many variables - what I wouldn't give to have a doctor who truly understood TRT - it's just so much to try to manage by myself.

50BMG,

Honestly, it seems to me that you are in desperate need of a doctor that understands TRT. I'm sure that your PCP is a real nice guy, but if he doesn't know squat about TRT, then you're driving at night, without headlights. You can pickup a lot of pointers here on this forum, and there are some guys here that are very experienced with TRT. That being said, it's not the same as having a MD that specializes in this field monitoring your progress, and giving you professional advice.

Have you considered Defy Medical? Dr. Saya is an outstanding physician that understands the subject matter thoroughly, where TRT is the main area of his practice. In fact, the very same Dr. Crisler that you talk about used to be affiliated with Defy. IMHO, you really need a professional to evaluate your past TRT history, and come up with a solid plan.

 

[Stylo]

libido is sometimes the last thing to improve. I use 1.25mg of Tadalafil daily and 2.5mg if Im going to have sex. Takes time. But it helps to take tadalafil so that you have random boners awake and asleep. This keeps your dick with a nice healthy flow of blood. Before you know it, months later, you might feel that you dont need tadalafil for boners. And go high. 160-175mg is a good sweet spot for lots of men

 

[50BMGdoesitforme]

All great advice here, gents - thank you very much! I'm going to sleep on all of it. Since I'm in the club for life it's really nice knowing that there's a great amount of collected wisdom in this forum. I'll holler back in a few weeks with some labs! Thanks again, all.

 

[50BMGdoesitforme]

Hey all - still staying the course and waiting a bit more to test. I am trying to plan ahead and get the right tests. There is a Quest quite close by and a LabCorp quite a ways away that I've had some truly crappy service at, but it's looking like LabCorp will have the cheapest tests.

Several testing questions:

Do I really need to test E2? I've seen a lot of research that says high E doesn't really matter, so why bother.

I'm looking at two options currently. Option 1 - LEF.org has a Male Basic Hormone Panel that tests:

Total T
Free T
DHEA-S
E2
PSA

But doesn't say anything about SHBG - don't they need that to calculate free T? Can I calculate SHBG from my total and free T levels? If not I'll add the SHBG test. Also adding DHT because I've never tested it.

Option #2 - Do SHBG and DHT at Labcorp and do the Female Hormone Panel at Quest, which tests:
Estradiol, serum;
Follicle-Stimulating Hormone (FSH);
Luteinizing Hormone (LH);
Testosterone, Serum (Total Only);
Complete Blood Count (CBC) with Differential:
Comprehensive Metabolic Profile (CMP) (includes eGFR):

These tests can get expensive REALLY fast, but I do want the information I need. Which of these, or none, do you all recommend?

Thank you VERY much.

 

[fifty]

Option 1 does not have SHBG. You cannot calculate SHBG based off direct Free T.

Do:
Option 1
add SHBG test
add CBC test
(optional) add DHT test

OR (for Quest):

TRT Basic Monitoring Panel

TRT Basic Monitoring Panel This TRT basic panel includes essential tests (CBC, CMP, ultrasensitive estradiol, total and free testosterone) to monitor treatment in men on that have been testosterone replacement therapy for a few months. You can add PSA, DH

www.discountedlabs.com

Do NOT do your option 2. LH and FSH tests are worthless on TRT because they will be hovering around 0.

 

[50BMGdoesitforme]

That's a plan then. So how the crap do they calculate free T without also calculating SHBG?? I thought that was a necessary part - but I of course have plenty to learn.

 

[fifty]

Note that I added info to my post above. Direct Free T is just a bad test.

 

[50BMGdoesitforme]

Yeah, I somewhat panicked the first time I saw LH and FSH near zero, then had it explained that that was normal.

Okay, so thinking I'll do that TRT monitoring panel at Quest and then drive to LabCorp for SHBG and DHT.

So I definitely understand why SHBG is important - would you mind schooling me on DHT and what the number will tell me?

Thanks all!

 

[Cataceous]

That's a plan then. So how the crap do they calculate free T without also calculating SHBG?? I thought that was a necessary part - but I of course have plenty to learn.

You must measure SHBG along with total T to calculate free testosterone. Ideally you measure albumin too, but you can use the default of 4.3 for that.

For me at least the Tru-T free testosterone calculator has proved to be the most useful. The healthy normal range for this is 16-31 ng/dL.

For economy and to avoid using results from two different labs I would just add CBC/CMP to the male basic panel that's on sale.

 

[50BMGdoesitforme]

Thanks, Cataceous - sorry which basic male panel are you referring to?

 

[TLawyer]

Hey all - still staying the course and waiting a bit more to test. I am trying to plan ahead and get the right tests. There is a Quest quite close by and a LabCorp quite a ways away that I've had some truly crappy service at, but it's looking like LabCorp will have the cheapest tests.

Several testing questions:

Do I really need to test E2? I've seen a lot of research that says high E doesn't really matter, so why bother.

I'm looking at two options currently. Option 1 - LEF.org has a Male Basic Hormone Panel that tests:

Total T
Free T
DHEA-S
E2
PSA

But doesn't say anything about SHBG - don't they need that to calculate free T? Can I calculate SHBG from my total and free T levels? If not I'll add the SHBG test. Also adding DHT because I've never tested it.

Option #2 - Do SHBG and DHT at Labcorp and do the Female Hormone Panel at Quest, which tests:
Estradiol, serum;
Follicle-Stimulating Hormone (FSH);
Luteinizing Hormone (LH);
Testosterone, Serum (Total Only);
Complete Blood Count (CBC) with Differential:
Comprehensive Metabolic Profile (CMP) (includes eGFR):

These tests can get expensive REALLY fast, but I do want the information I need. Which of these, or none, do you all recommend?

Thank you VERY much.

I would go with the following if you're looking for bare minimum:

Total Testosterone
Free Testosterone (Direct)
DHT
DHEA - Sulfate
TSH (if you're taking HCG)
Prolactin
PSA
Estradiol (Sensitive)
SHBG

 

[Cataceous]

Thanks, Cataceous - sorry which basic male panel are you referring to?

This one, and CBC/CMP. The sensitive estradiol test is not essential. The standard test is more repeatable but may have a positive bias.

 

[50BMGdoesitforme]

OK - trying to cover all the bases here - Male Basic Hormone is $56, CBC is $26, SHBG is $25, and DHT is $38 - I think that also covers everything on your list TLawyer except Prolactin. That's $145 but seems like a year or so into TRT would be nice to get a good look at everything. Surely you all don't spend $145 every time you test - am I right that some of these are occasional, dialing-in tests and not things you all test regularly?

 

[Cataceous]

Here's Defy Medical's TRT followup panel: CBC, CMP-14, Lipid Panel, Testosterone free and total, Estradiol Sensitive, DHEA-Sulfate, TSH, PSA, SHBG

These are the things they want regularly.

 

[TLawyer]

Here's Defy Medical's TRT followup panel: CBC, CMP-14, Lipid Panel, Testosterone free and total, Estradiol Sensitive, DHEA-Sulfate, TSH, PSA, SHBG

These are the things they want regularly.

They suggest adding DHT and Prolactin to the above if there are any libido issues.

 

[50BMGdoesitforme]

OK, added Prolactin into the mix just because why not. Checking out of LEF.org and now it's talking about shipping everything to me? Are these tests not done at a LabCorp site?