Very high free test at 9mg test per day

[RotnGun]

Hi all! A little background of myself. I started self medicating TRT about 10 months ago. I am 5,10" tall, and weigh 165 ilbs and lean. Im taking a break from bodybuilding for now, but I do a lot of bike riding and walking for exercise. I studied this forum a lot before taking the plunge. My pre TRT levels were very low at about total test of 340 ng/dl. I had the all basic symptoms of testosterone deficiency. I am now using test phenylpropionate at 7mg a day (IM) and I use HCG at 75iu per day. I started this dose about a month ago. My test phenylpropionate is UGL, but I do know for sure that it is 100mg/mL because the lab I use do test their products through Janoshik. When I went in for my lab work a month ago, I was taking 9mg test phenylpropionate a day (but have since than dropped to 7mg a day, IM). Since Im in Canada, the only testing method available for me is 'method of vermeulen' conducted by Lifelabs. Now, my question is,, why is my free test so high? Is it possible the vermeulen method calculated my free test wrong? Here are my lab numbers below. Lifelabs uses a totally different metric system then USA labs, so I converted everything to the USA metric system for simplicity.

Total test, 730 ng/dL (242 - 830 ng/dL)
Free test, 47 ng/dL (9 - 45 ng/dL)
Test bioavailable, 409 ng/dL (78 - 389 ng/dL)
SHBG, 29 nmol/L (19 - 76 nmol/L)
Estradiol, 30 pg/mL (below 44 pg/mL)
Prolactin, 6.4 ug/L (3.8 - 20.6 ug/L)
PSA, 1.0 ug/L (below 3.5 ugL)
Hematocrit, 45% (0.40 - 0.50% )
A1C, 5.6% (4.5 - 5.9%)
WBC, 5.0 (4 - 10)
RBC, 4.76 (4.20 -5.40)

TSH, 1.51 mU/L (.32 - 5.04 mU/L)
Free T3, 1.19 pg/mL (.70 - 1.57 pg/mL)
Free T4, .69 ng/dL (.82 - 1.53 ng/dL)

 

[sammmy]

The free testosterone Vermeulen calculator at

Free & Bioavailable Testosterone calculator

returns free testosterone of 17.7 ng/dL with assumed Albumin = 4.3 g/dL.

 

[Systemlord]

The free testosterone Vermeulen calculator returns free testosterone of 17.7 ng/dL with assumed Albumin = 4.3 g/dL.

I was taking 9mg test phenylpropionate a day (but have since than dropped to 7mg a day, IM).

A Free T of 17.7 ng/dL is perfectly normal. This change in protocol may have been the wrong move and now seems completely unnecessary.

If you had no negative symptoms, stop chasing lab numbers, because lab testing is flawed to some degree as it relates to testosterone.

 

[madman]

Hi all! A little background of myself. I started self medicating TRT about 10 months ago. I am 5,10" tall, and weigh 165 ilbs and lean. Im taking a break from bodybuilding for now, but I do a lot of bike riding and walking for exercise. I studied this forum a lot before taking the plunge. My pre TRT levels were very low at about total test of 340 ng/dl. I had the all basic symptoms of testosterone deficiency. I am now using test phenylpropionate at 7mg a day (IM). I started this dose about a month ago. My test phenylpropionate is UGL, but I do know for sure that it is 100mg/mL because the lab I use do test their products through Janoshik. When I went in for my lab work a month ago, I was taking 9mg test phenylpropionate a day (but have since than dropped to 7mg a day, IM). Since Im in Canada, the only testing method available for me is 'method of vermeulen' conducted by Lifelabs. Now, my question is,, why is my free test so high? Is it possible the vermeulen method calculated my free test wrong? Here are my lab numbers below. Lifelabs uses a totally different metric system then USA labs, so I converted everything to the USA metric system for simplicity.

Total test, 730 ng/dL (242 - 830 ng/dL)
Free test, 47 ng/dL (9 - 45 ng/dL)
Test bioavailable, 409 ng/dL (78 - 389 ng/dL)
SHBG, 29 nmol/L (19 - 76 nmol/L)
Estradiol, 30 pg/mL (below 44 pg/mL)
Prolactin, 6.4 ug/L (3.8 - 20.6 ug/L)
PSA, 1.0 ug/L (below 3.5 ugL)
Hematocrit, 45% (0.40 - 0.50% )
A1C, 5.6% (4.5 - 5.9%)
WBC, 5.0 (4 - 10)
RBC, 4.76 (4.20 -5.40)

TSH, 1.51 mU/L (.32 - 5.04 mU/L)
Free T3, 1.19 pg/mL (.70 - 1.57 pg/mL)
Free T4, .69 ng/dL (.82 - 1.53 ng/dL)

As I stated in my reply to your PM the most accurate assays for free testosterone are the gold standard Equilibrium Dialysis or Ultrafiltration.

The only way to know where your FT truly sits is to have it tested using an accurate assay especially in cases of altered SHBG.

Although such assays are available in Canada through certain labs the cost is ridiculous and they are not covered by insurance so most would never pay out of pocket to obtain such.

If you do not have access to such than you will need to use/rely upon the calculated method which replaced the older outdated and known to be inaccuarte direct FT immunoassay.

The majority of labs use/rely upon the calculated linear law-of-mass action Vermeulen method and unfortunately they have their own set of reference ranges as there is no harmonized reference range let alone standardization of free testosterone as of yet and is in the works as we speak.

As I stated previously you are better off using the cFTV which is available online for free.

Free & Bioavailable Testosterone calculator

Also keep in mind that when using/relying upon the cFTV as of now it tends to overestimate FT when compared to the gold standard Equilibrium Dialysis so your FT level may very well be lower.

First off when were your labs done as we always want to test at the true trough (lowest point) before your next injection.

If we take your TT, SHBG and Albumin we can calculate your FT.

Looking over the lab results you posted a month ago when you were injecting 9 mg TPP daily you were hitting a robust TT 730 ng/dL, with a normal SHBG 29 nmol/L and seeing as you did not post your Allbumin we can use 4.3 g/dL (default) which would have your FT 17.7 ng/dL on the higher end but far from absurdly high.

Most healthy young males would be peaking around 13-15 ng/dL.

Now the big question is how many hours post-injection were your labs drawn?

Testosterone Therapy in Canada

@Marcel https://www.excelmale.com/forum/threads/the-dea-wants-to-limit-your-access-to-trt-telemedicine.27274/page-6 We have always been far worse off than the US when it comes to the treatment of men for testosterone deficiency. Although there has been some improvement in certain areas we...

www.excelmale.com

 

[madman]

Hi all! A little background of myself. I started self medicating TRT about 10 months ago. I am 5,10" tall, and weigh 165 ilbs and lean. Im taking a break from bodybuilding for now, but I do a lot of bike riding and walking for exercise. I studied this forum a lot before taking the plunge. My pre TRT levels were very low at about total test of 340 ng/dl. I had the all basic symptoms of testosterone deficiency. I am now using test phenylpropionate at 7mg a day (IM) and I use HCG at 75iu per day. I started this dose about a month ago. My test phenylpropionate is UGL, but I do know for sure that it is 100mg/mL because the lab I use do test their products through Janoshik. When I went in for my lab work a month ago, I was taking 9mg test phenylpropionate a day (but have since than dropped to 7mg a day, IM). Since Im in Canada, the only testing method available for me is 'method of vermeulen' conducted by Lifelabs. Now, my question is,, why is my free test so high? Is it possible the vermeulen method calculated my free test wrong? Here are my lab numbers below. Lifelabs uses a totally different metric system then USA labs, so I converted everything to the USA metric system for simplicity.

Total test, 730 ng/dL (242 - 830 ng/dL)
Free test, 47 ng/dL (9 - 45 ng/dL)
Test bioavailable, 409 ng/dL (78 - 389 ng/dL)
SHBG, 29 nmol/L (19 - 76 nmol/L)
Estradiol, 30 pg/mL (below 44 pg/mL)
Prolactin, 6.4 ug/L (3.8 - 20.6 ug/L)
PSA, 1.0 ug/L (below 3.5 ugL)
Hematocrit, 45% (0.40 - 0.50% )
A1C, 5.6% (4.5 - 5.9%)
WBC, 5.0 (4 - 10)
RBC, 4.76 (4.20 -5.40)

TSH, 1.51 mU/L (.32 - 5.04 mU/L)
Free T3, 1.19 pg/mL (.70 - 1.57 pg/mL)
Free T4, .69 ng/dL (.82 - 1.53 ng/dL)

Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods

Only at Excel, are we gonna take you deep! Clinical Utility and Analytical Aspects of Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods (2022) Mark M. Kushnir, Heather A. Nelson, and Kelly Doyle Background The free hormone (FH) hypothesis states that hormone...

www.excelmale.com

 

[RotnGun]

As I stated in my reply to your PM the most accurate assays for free testosterone are the gold standard Equilibrium Dialysis or Ultrafiltration.

The only way to know where your FT truly sits is to have it tested using an accurate assay especially in cases of altered SHBG.

Although such assays are available in Canada through certain labs the cost is ridiculous and they are not covered by insurance so most would never pay out of pocket to obtain such.

If you do not have access to such than you will need to use/rely upon the calculated method which replaced the older outdated and known to be inaccuarte direct FT immunoassay.

The majority of labs use/rely upon the calculated linear law-of-mass action Vermeulen method and unfortunately they have their own set of reference ranges as there is no harmonized reference range let alone standardization of free testosterone as of yet and is in the works as we speak.

As I stated previously you are better off using the cFTV which is available online for free.

Free & Bioavailable Testosterone calculator

Also keep in mind that when using/relying upon the cFTV as of now it tends to overestimate FT when compared to the gold standard Equilibrium Dialysis so your FT level may very well be lower.

First off when were your labs done as we always want to test at the true trough (lowest point) before your next injection.

Even though you are on a daily TPP injection protocol T levels will not be as stable throughout the week as a daily TC/TE protocol.

If we take your TT, SHBG and Albumin we can calculate your FT.

Looking over the lab results you posted a month ago when you were injecting 9 mg TPP daily you were hitting a robust TT 730 ng/dL, with a normal SHBG 29 nmol/L and seeing as you did not post your Allbumin we can use 4.3 g/dL (default) which would have your FT 17.7 ng/dL on the higher end but far from absurdly high.

Most healthy young males would be peaking around 13-15 ng/dL.

Now the big question is how many hours post-injection were your labs drawn?

Testosterone Therapy in Canada

@Marcel https://www.excelmale.com/forum/threads/the-dea-wants-to-limit-your-access-to-trt-telemedicine.27274/page-6 We have always been far worse off than the US when it comes to the treatment of men for testosterone deficiency. Although there has been some improvement in certain areas we...

www.excelmale.com

Hey Madman, thanks for the detailed reply. I would of never thought that my free test would of been that low. But anyhow, I always do my blood test 14 hours after injection. I do my injections right before bed so that way my test phenylprop will increase overnight in me. I know very well I should do my blood test at the 24 hour mark, but because I work the same hours everyday,, it just makes it impossible to do my blood test at the 24 hour mark. I fast for 12 hours before the test and I do the test with 3 hours after waking.

Now, as well as my free test being off, would my estradiol number of 30 pg/mL be off too? If so, what do you figure it would be?

Do you figure I should be going back to 9mg per day?

Also, you mentioned something of being in a steady state. Doesn't test phenylprop follow the 24 hour circadian rythym more closely than any other test ester? For me, I want to take an ester that resembles my 24 hour circadian rythym because I figure this is more natural for my body as opposed to a long acting test ester.

 

[RotnGun]

A Free T of 17.7 ng/dL is perfectly normal. This change in protocol may have been the wrong move and now seems completely unnecessary.

If you had no negative symptoms, stop chasing lab numbers, because lab testing is flawed to some degree as it relates to testosterone.

So if I am correct, the free T range should be from 20 to 30 ng/dL,, right?

Also, true, I didn't have any negative symptoms at that dose of 9mg a day. The only thing is that at that dosage, I am still dependent on viagra to last a decent amount of time, like 10 minutes or more.

 

[Forty2]

Hey Madman, thanks for the detailed reply. I would of never thought that my free test would of been that low. But anyhow, I always do my blood test 14 hours after injection. I do my injections right before bed so that way my test phenylprop will increase overnight in me. I know very well I should do my blood test at the 24 hour mark, but because I work the same hours everyday,, it just makes it impossible to do my blood test at the 24 hour mark. I fast for 12 hours before the test and I do the test with 3 hours after waking.

Now, as well as my free test being off, would my estradiol number of 30 pg/mL be off too? If so, what do you figure it would be?

Do you figure I should be going back to 9mg per day?

Also, you mentioned something of being in a steady state. Doesn't test phenylprop follow the 24 hour circadian rythym more closely than any other test ester? For me, I want to take an ester that resembles my 24 hour circadian rythym because I figure this is more natural for my body as opposed to a long acting test ester.

How do you feel later in the afternoon and at night before your next shot? Do you have any symptoms of low testosterone then?
Overall, how do you feel now compared with how you felt before your TRT protocol in terms of libido, erection quality and energy?

 

[Cataceous]

So if I am correct, the free T range should be from 20 to 30 ng/dL,, right?
...

No, a healthy normal range for Vermeulen calculated free testosterone is 10-20 ng/dL. Your result of 17.7 ng/dL is above average. In addition, your measurement may be well off of your peak daily levels. At least with testosterone propionate there's pretty good anecdotal evidence that the peaks occur within 2-5 hours of injections. Phenylpropionate isn't necessarily much slower.

Although there's an emphasis on measuring trough testosterone when on TRT, I think the peak levels are more important with daily injections. Healthy men can naturally have testosterone fall each evening to levels that technically qualify as hypogonadal, although they are not. This is because the morning peaks are better correlated with outcomes.

 

[madman]

Hey Madman, thanks for the detailed reply. I would of never thought that my free test would of been that low. But anyhow, I always do my blood test 14 hours after injection. I do my injections right before bed so that way my test phenylprop will increase overnight in me. I know very well I should do my blood test at the 24 hour mark, but because I work the same hours everyday,, it just makes it impossible to do my blood test at the 24 hour mark. I fast for 12 hours before the test and I do the test with 3 hours after waking.

Now, as well as my free test being off, would my estradiol number of 30 pg/mL be off too? If so, what do you figure it would be?

Do you figure I should be going back to 9mg per day?

Also, you mentioned something of being in a steady state. Doesn't test phenylprop follow the 24 hour circadian rythym more closely than any other test ester? For me, I want to take an ester that resembles my 24 hour circadian rythym because I figure this is more natural for my body as opposed to a long acting test ester.

Again it is not low as I stated it is on the high-end of what would be considered the reference range for cFTV.

My reply from post #4

Looking over the lab results you posted a month ago when you were injecting 9 mg TPP daily you were hitting a robust TT 730 ng/dL, with a normal SHBG 29 nmol/L and seeing as you did not post your Albumin we can use 4.3 g/dL (default) which would have your FT 17.7 ng/dL on the higher end but far from absurdly high.

Most healthy young males would be peaking around 13-15 ng/dL.




Again keep in mind that as of now cFTV tends to overestimate when compared against what would be considered the most accurate assay which is the gold standard Equilibrium Dialysis.

So your FT level may very well be lower than 17.7 ng/dL but even than it is still going to be robust and no where close to low/low normal!

Forget getting caught up on needing your trough FT in the 20-30 ng/dL range.




My repy from post #11

Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods

Only at Excel, are we gonna take you deep! Clinical Utility and Analytical Aspects of Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods (2022) Mark M. Kushnir, Heather A. Nelson, and Kelly Doyle Background The free hormone (FH) hypothesis states that hormone...

www.excelmale.com

Regarding labs, FT assays/reference ranges.

For the time being, if you have access to such then stick to testing your FT using what would be considered the most accurate assays such as the gold standard Equilibrium Dialysis or Equilibrium Ultrafiltration (next best), especially in cases of ALTERED SHBG!

Forget getting caught up in the different reference ranges for the same assays (ED, UF) used by different labs.

Let alone trying to compare the results of ED vs UF, or ED/UF vs the cFT methods.

Test using the same lab/same assay (most accurate).

Compare your blood work using the same lab/same assay (most accurate).

Top it all off that the calculated methods even have flaws!

We need accurate and standardized free testosterone assays with harmonized reference ranges!




Take home points:

*Because FHs are present in biological samples in trace concentrations, highly sensitive and specific methods are required for accurate measurement of FH concentrations

*A limitation of calculation-based methods is in the assumption of uniform hormone affinity to binding proteins among individuals. However, binding protein variants, posttranslational modifications, and other factors may alter binding affinity, causing erroneous results and biases (10). Direct immunoassay methods show discrepancy among methods of different manufacturers and often perform poorly when binding protein concentrations are very elevated or decreased, with some methods suffering from biotin interference (9)

*When a binding protein abnormality is suspected (15). Equilibrium dialysis (ED) followed by LC–MS/MS is considered the gold standard methodology, with a number of LC–MS/ MS methods developed and introduced in routine patient testing (12, 16–22)

*FH concentrations measured by UF-based methods often do not agree with ED-based methods because of UF conditions (temperature, time, centrifugation speed), the type of the UF device (MWC membrane material, material of the of the housing, seal around the membrane, etc.), and inconsistencies in the filtration rate. Therefore, reference intervals are typically not interchangeable across methods for measurement of the same FH





CDC STANDARDIZED TOTAL T AND ESTRADIOL TESTS and soon-to-be FREE TESTOSTERONE!

Key Points:

* Limitations of using free testosterone by equilibrium dialysis and calculated free testosterone concentrations in practice are the lack of assay standardization, an accuracy-based quality control program, and a harmonized reference range. Until these limitations are addressed, free testosterone by equilibrium dialysis and calculated free testosterone should use reference ranges established by individual laboratories or their specific assay method

*Currently, the CDC is developing a harmonized method for free T based on calculated free T using REVISED FORMULAE. This may bring the measurement of free T to a referable standard in clinical laboratories and common reference intervals that all clinicians can use

*Assays that are standardized are designed to provide accurate results, traceable to “true” value-assigned certified reference materials and gold-standard reference methods. Results obtained using standardized methods can be compared across assays, institutions, populations, and past and future test results, thereby improving diagnosis, treatment, and outcomes of patients




The Need to Harmonize Clinical Laboratory Test Results-----

Laboratory test results are a critical component of patient care. These values help physicians diagnose disease and are critical to developing clinical guidelines that direct treatment options and are instrumental in ongoing efforts to improve and measure the quality of patient care. Most tests report a numeric value for healthcare providers to interpret and the range of numbers reported for a test for a certain condition may vary depending on the method used

Different test methods, however, may report different numeric values for the same condition. Although these test results may be accurate within the context of its own method, this variation can create confusion for physicians and patients. Clinical laboratory test results need to be harmonized so that healthcare providers and the public receive the same numeric result regardless of the method or instrument used or the setting where it was performed



No need to fast when testing for TT, FT, or BAT as your hpta is shutdown due to using exogenous testosterone.

Seeing as you had labs drawn 14 hrs post-injection using TPP than your peak levels will be slightly higher.

True trough on dailies would be 24 hrs post-injection so your levels will be lower and the difference in peak--->trough will always come down to the dose of T, injection frequency and ester used (TC/TE/TPP/TP).

Dose of T, injection frequency and ester used will have a big impact on the difference between peak--->trough levels.

If you felt good overall on your previous protocol, no sides and overall blood markers are healthy injecting 9 mg TPP daily than stick with it!

Your RBCs, hemoglobin and hematocrit are fine!

Other than your daily peak--->trough on daily TPP let alone TP neither will mimic the natural 24 hr circadian rhythm of a healthy young male.

No esterfied T will do such!

The only formulation which most closely mimics this would be the T-patch (Androderm) applied before bed!



My reply from post #31

So who is happy with TRT? Who wish they never started?

Testosterone cypionate, eod. I seem to feel best between 7-800. I've been over 1,000, and didn't feel "better".

www.excelmale.com

Many fail to realize that T levels gradually rise overnight reaching peak in the early AM.

*elevated and near peak TT level during nighttime sleep, peak TT level around the time of morning awakening

*T production occurs in the greatest amount during sleep as recurring pulses at approximately 90 min intervals in healthy young males and approximately 140 min in healthy middle-aged males (91).




This is key:

(i) elevated and near peak TT level during nighttime sleep, (ii) peak TT level around the time of morning awakening, (iii) moderately elevated TT level during the initial hours of wakefulness, (iv) reduced TT level in the late afternoon, and (v) lowest TT level in the evening. Based upon these criteria, only the Androderm® transdermal patch (Figure 3D), when applied in the evening (∼22:00 h) as recommended, closely mimics the TT circadian rhythm of normal young adult males.

ANDRODERM® (TDS)

https://www.androderm.com/about-androderm ANDRODERM® (testosterone transdermal system) is designed to deliver testosterone continuously for 24 hours following application to intact, non-scrotal skin (e.g., back, abdomen, thighs, upper arms). Four strengths of ANDRODERM® are available that...

www.excelmale.com

 

[Systemlord]

I am still dependent on viagra to last a decent amount of time, like 10 minutes or more.

This may have more to do with the use of hCG and is the price some men pay for using it.

 

[Vince]

Hi all! A little background of myself. I started self medicating TRT about 10 months ago. I am 5,10" tall, and weigh 165 ilbs and lean. Im taking a break from bodybuilding for now, but I do a lot of bike riding and walking for exercise. I studied this forum a lot before taking the plunge. My pre TRT levels were very low at about total test of 340 ng/dl. I had the all basic symptoms of testosterone deficiency. I am now using test phenylpropionate at 7mg a day (IM) and I use HCG at 75iu per day. I started this dose about a month ago. My test phenylpropionate is UGL, but I do know for sure that it is 100mg/mL because the lab I use do test their products through Janoshik. When I went in for my lab work a month ago, I was taking 9mg test phenylpropionate a day (but have since than dropped to 7mg a day, IM). Since Im in Canada, the only testing method available for me is 'method of vermeulen' conducted by Lifelabs. Now, my question is,, why is my free test so high? Is it possible the vermeulen method calculated my free test wrong? Here are my lab numbers below. Lifelabs uses a totally different metric system then USA labs, so I converted everything to the USA metric system for simplicity.

Total test, 730 ng/dL (242 - 830 ng/dL)
Free test, 47 ng/dL (9 - 45 ng/dL)
Test bioavailable, 409 ng/dL (78 - 389 ng/dL)
SHBG, 29 nmol/L (19 - 76 nmol/L)
Estradiol, 30 pg/mL (below 44 pg/mL)
Prolactin, 6.4 ug/L (3.8 - 20.6 ug/L)
PSA, 1.0 ug/L (below 3.5 ugL)
Hematocrit, 45% (0.40 - 0.50% )
A1C, 5.6% (4.5 - 5.9%)
WBC, 5.0 (4 - 10)
RBC, 4.76 (4.20 -5.40)

TSH, 1.51 mU/L (.32 - 5.04 mU/L)
Free T3, 1.19 pg/mL (.70 - 1.57 pg/mL)
Free T4, .69 ng/dL (.82 - 1.53 ng/dL)

As others have said your levels will be higher because you inject at night and do labs after 12 hours.

My two cents is I would increase my daily dose to 10 mg daily and inject HCG 500 IU twice a week. I think you would feel your best at this dose.

What is the best dose of HCG? Dr Saya presents two case studies.

Community - I am sharing and have attached the write-up of a recent small case study I have conducted on quantitative serum beta hCG concentrations relating to hCG injections. This study is limited to dosages of 150iu and 500iu, although I hope to obtain more data in the near future. P.S...

www.excelmale.com

 

[RotnGun]

How do you feel later in the afternoon and at night before your next shot? Do you have any symptoms of low testosterone then?
Overall, how do you feel now compared with how you felt before your TRT protocol in terms of libido, erection quality and energy?

I feel good throughout the day until evening time. From there, I get very tired. Especially afer having a meal at 5:30pm. I definitely sleep good at night.
I definitely feel better now on TRT by a long shot. My A1C used to be higher at 5.9, but now its 5.6. I heard on various TRT forums that TRT helps regulate blood suger levels. So it seems that TRT is preventing me from becoming diabetic. And before TRT, I was always so much more tired and I had IBS. I am more wakeful now, except evening time. And I don't have IBS anymore. TRT has solved my ED problem, for the most part anyways. I still can't last a long time like I once used too. It starts to go limp after 10 minutes or so,, or maybe after 15 minutes. I have to depend on using viagra or levitra to last a long time. I was originally assuming that my test levels were too high on 9 mg a day, and that may of been influencing my sex drive on a negative matter. Thats one reason I dropped down to 7mg a day. But so far, it has made no difference. It seemed like my sex drive was maybe somewhat better on 12mg a day. I was at this dosage level 3 months ago.

 

[RotnGun]

No, a healthy normal range for Vermeulen calculated free testosterone is 10-20 ng/dL. Your result of 17.7 ng/dL is above average. In addition, your measurement may be well off of your peak daily levels. At least with testosterone propionate there's pretty good anecdotal evidence that the peaks occur within 2-5 hours of injections. Phenylpropionate isn't necessarily much slower.

Although there's an emphasis on measuring trough testosterone when on TRT, I think the peak levels are more important with daily injections. Healthy men can naturally have testosterone fall each evening to levels that technically qualify as hypogonadal, although they are not. This is because the morning peaks are better correlated with outcomes.

Would you estimate that the peak on TPP comes around 10 hours or so? There also seems to be considerable debate about the half life of TPP. I've heard if it being 1.5 days, and also heard of it being 4.5 days. Would you think the half life of TPP is closer to 1.5 days, or shorter than that?

 

[Cataceous]

Would you estimate that the peak on TPP comes around 10 hours or so? There also seems to be considerable debate about the half life of TPP. I've heard if it being 1.5 days, and also heard of it being 4.5 days. Would you think the half life of TPP is closer to 1.5 days, or shorter than that?

My guess is that the serum T peak for TPP occurs no more than 5-7 hours post-injection with a daily schedule. My guess for the half-life is somewhere in the range of 1.5-3 days.

 

[RotnGun]

Again it is not low as I stated it is on the high-end of what would be considered the reference range for cFTV.

My reply from post #4

Looking over the lab results you posted a month ago when you were injecting 9 mg TPP daily you were hitting a robust TT 730 ng/dL, with a normal SHBG 29 nmol/L and seeing as you did not post your Albumin we can use 4.3 g/dL (default) which would have your FT 17.7 ng/dL on the higher end but far from absurdly high.

Most healthy young males would be peaking around 13-15 ng/dL.




Again keep in mind that as of now cFTV tends to overestimate when compared against what would be considered the most accurate assay which is the gold standard Equilibrium Dialysis.

So your FT level may very well be lower than 17.7 ng/dL but even than it is still going to be robust and no where close to low/low normal!

Forget getting caught up on needing your trough FT in the 20-30 ng/dL range.




My repy from post #11

Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods

Only at Excel, are we gonna take you deep! Clinical Utility and Analytical Aspects of Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods (2022) Mark M. Kushnir, Heather A. Nelson, and Kelly Doyle Background The free hormone (FH) hypothesis states that hormone...

www.excelmale.com

Regarding labs, FT assays/reference ranges.

For the time being, if you have access to such then stick to testing your FT using what would be considered the most accurate assays such as the gold standard Equilibrium Dialysis or Equilibrium Ultrafiltration (next best), especially in cases of ALTERED SHBG!

Forget getting caught up in the different reference ranges for the same assays (ED, UF) used by different labs.

Let alone trying to compare the results of ED vs UF, or ED/UF vs the cFT methods.

Test using the same lab/same assay (most accurate).

Compare your blood work using the same lab/same assay (most accurate).

Top it all off that the calculated methods even have flaws!

We need accurate and standardized free testosterone assays with harmonized reference ranges!




Take home points:

*Because FHs are present in biological samples in trace concentrations, highly sensitive and specific methods are required for accurate measurement of FH concentrations

*A limitation of calculation-based methods is in the assumption of uniform hormone affinity to binding proteins among individuals. However, binding protein variants, posttranslational modifications, and other factors may alter binding affinity, causing erroneous results and biases (10). Direct immunoassay methods show discrepancy among methods of different manufacturers and often perform poorly when binding protein concentrations are very elevated or decreased, with some methods suffering from biotin interference (9)

*When a binding protein abnormality is suspected (15). Equilibrium dialysis (ED) followed by LC–MS/MS is considered the gold standard methodology, with a number of LC–MS/ MS methods developed and introduced in routine patient testing (12, 16–22)

*FH concentrations measured by UF-based methods often do not agree with ED-based methods because of UF conditions (temperature, time, centrifugation speed), the type of the UF device (MWC membrane material, material of the of the housing, seal around the membrane, etc.), and inconsistencies in the filtration rate. Therefore, reference intervals are typically not interchangeable across methods for measurement of the same FH





CDC STANDARDIZED TOTAL T AND ESTRADIOL TESTS and soon-to-be FREE TESTOSTERONE!

Key Points:

* Limitations of using free testosterone by equilibrium dialysis and calculated free testosterone concentrations in practice are the lack of assay standardization, an accuracy-based quality control program, and a harmonized reference range. Until these limitations are addressed, free testosterone by equilibrium dialysis and calculated free testosterone should use reference ranges established by individual laboratories or their specific assay method

*Currently, the CDC is developing a harmonized method for free T based on calculated free T using REVISED FORMULAE. This may bring the measurement of free T to a referable standard in clinical laboratories and common reference intervals that all clinicians can use

*Assays that are standardized are designed to provide accurate results, traceable to “true” value-assigned certified reference materials and gold-standard reference methods. Results obtained using standardized methods can be compared across assays, institutions, populations, and past and future test results, thereby improving diagnosis, treatment, and outcomes of patients




The Need to Harmonize Clinical Laboratory Test Results-----

Laboratory test results are a critical component of patient care. These values help physicians diagnose disease and are critical to developing clinical guidelines that direct treatment options and are instrumental in ongoing efforts to improve and measure the quality of patient care. Most tests report a numeric value for healthcare providers to interpret and the range of numbers reported for a test for a certain condition may vary depending on the method used

Different test methods, however, may report different numeric values for the same condition. Although these test results may be accurate within the context of its own method, this variation can create confusion for physicians and patients. Clinical laboratory test results need to be harmonized so that healthcare providers and the public receive the same numeric result regardless of the method or instrument used or the setting where it was performed



No need to fast when testing for TT, FT, or BAT as your hpta is shutdown due to using exogenous testosterone.

Seeing as you had labs drawn 14 hrs post-injection using TPP than your peak levels will be slightly higher.

True trough on dailies would be 24 hrs post-injection so your levels will be lower and the difference in peak--->trough will always come down to the dose of T, injection frequency and ester used (TC/TE/TPP/TP).

Dose of T, injection frequency and ester used will have a big impact on the difference between peak--->trough levels.

If you felt good overall on your previous protocol, no sides and overall blood markers are healthy injecting 9 mg TPP daily than stick with it!

Your RBCs, hemoglobin and hematocrit are fine!

Other than your daily peak--->trough on daily TPP let alone TP neither will mimic the natural 24 hr circadian rhythm of a healthy young male.

No esterfied T will do such!

The only formulation which most closely mimics this would be the T-patch (Androderm) applied before bed!



My reply from post #31

So who is happy with TRT? Who wish they never started?

Testosterone cypionate, eod. I seem to feel best between 7-800. I've been over 1,000, and didn't feel "better".

www.excelmale.com

Many fail to realize that T levels gradually rise overnight reaching peak in the early AM.

*elevated and near peak TT level during nighttime sleep, peak TT level around the time of morning awakening

*T production occurs in the greatest amount during sleep as recurring pulses at approximately 90 min intervals in healthy young males and approximately 140 min in healthy middle-aged males (91).




This is key:

(i) elevated and near peak TT level during nighttime sleep, (ii) peak TT level around the time of morning awakening, (iii) moderately elevated TT level during the initial hours of wakefulness, (iv) reduced TT level in the late afternoon, and (v) lowest TT level in the evening. Based upon these criteria, only the Androderm® transdermal patch (Figure 3D), when applied in the evening (∼22:00 h) as recommended, closely mimics the TT circadian rhythm of normal young adult males.

ANDRODERM® (TDS)

https://www.androderm.com/about-androderm ANDRODERM® (testosterone transdermal system) is designed to deliver testosterone continuously for 24 hours following application to intact, non-scrotal skin (e.g., back, abdomen, thighs, upper arms). Four strengths of ANDRODERM® are available that...

www.excelmale.com

Thanks for all the info Madman! Something that is off with my lab results is the T4. Its under range, (and has come under range like 4 blood test in a row now within one year) which may indicate secondary hypothyroidism. I do have a legitimate prescription for synthroid that a doctor gave to me a couple months ago. (They are 25mcg tablets and to be taken once a day). But I haven't used it yet. In your opinion Madman, do you think it would be worthwhile for me to start using the synthroid? I mean, would it improve my over well being, improve my sex drive, make me less tired in the evening and so forth? @Cataceous @Systemlord or anyone else like to share their input on this?

 

[Systemlord]

Something that is off with my lab results is the T4.

Where does your TSH, Free T3 currently sit?

Did you recently come off an anabolic steroid?

 

[RotnGun]

TSH, 1.51 mU/L (.32 - 5.04 mU/L)
Free T3, 1.19 pg/mL (.70 - 1.57 pg/mL)
Free T4, .69 ng/dL (.82 - 1.53 ng/dL)

I haven't been on any AAS for 2 years now.
The above test were done 4 weeks ago.
When I did my reverse T3 about 6 weeks ago, it was 11 ng/dL (range is 8 - 25 ng/dL).

 

[RotnGun]

@Systemlord I forgot to mention I had about 4 thyroid lab test done over the course of one year and each test yielded similar results as the lab test I posted above (post 18).

 

[bixt]

Other than your daily peak--->trough on daily TPP let alone TP neither will mimic the natural 24 hr circadian rhythm of a healthy young male.

Out of curiosity, why? Will the trough at 24 hr be too low or too high?

No esterfied T will do such!

@Cataceous mixture of test C + test P as detailed in many other posts does, doesn't it? (mimic natural diurnal rhythm).