Would love some input on lab results

[madman]

Thanks again for your help!

When I mentioned injections to my doctor he said I would have to come in once a month for an injection. Unless this is test-u, it seems like a very old protocol and a recipe for disaster but regardless, he wanted me to try the Andriol first.

I haven't gotten my prescription for the Andriol filled yet as the pharmacy had to track some down as it isn't prescribed very often. When I get it, I will give it a go for 3 weeks and go back and see him as he requested. Ill be sure to take it with a scoop of coconut oil or something for absorption. At that time I will try and talk him into self administered injections at one or twice per week. My hesitation is that he might not be the most knowledgeable on dosing and side effect management given his current suggestions.

Another thought would be to see if he will refer me to an endo or urologist to manage the therapy. I know on the UBC website it shows endos with a clinical interest in Hypogonadism. Ideally I could get a referral to one of them.

Still amazes me though that any doctor would prescribe Andriol (oral) as most would at least start someone on transdermal (Androgel/Testim/Axiron/Compounded gel/cream) even the STUPID ones!

If you have it now you can either adhere to the 80mg (40mg twice daily) and your levels will come back low or try the proper dose 120-160mg/day (60-80mg twice daily) but even than your levels will more than likely be sub-par.

It would be much better to just avoid starting the Andriol and find someone to treat you that understands what is involved although in Canada it is very difficult.

Many end up finding a doctor who will prescribe injections and than they mange their own protocol of course within doses recommended by doctor.

As far as self injections I would just try to convince the doctor to let you do injections once weekly and than on your own you can split your weekly dose and inject every 3.5 days as trying to convince doctors of twice weekly injections is difficult.

In your case if you are stuck with this doctor for now and you feel you want to try the Andriol first and than convice him to move to injections is your call but it would be much better if you can find someone that is more knowledgeable.....but again I understand that is easier said than done as I am also a fellow Canuck!

 

[mdm14]

Thanks man and thanks for all your input! I really do appreciate it.

 

[1Draw]

Your symptoms may not be all testosterone related. Could be your thyroid. Your FT3 of 3.3 appears to be in middle of range however, optimal ranges are 3.8-4.4 pg/ml. Here is good resource for what is normal ranges and what is optimal:
https://www.restartmed.com/normal-thyroid-levels/

No doubt your free T is very low but, your total T is not that bad. If I remember correctly, Trump's total T was in the 450 range before he took office. Don't know what his free t was. If it were me, I would investigate the thyroid angle with all recommended test. At least you will know then if it is contributing to the symptoms. Low T and low thyroid symptoms are very much alike.

Good luck.

 

[mdm14]

A bit of an update. Did not start the Andriol and continued my search for a doctor. I have found a doctor who seems to be knowledgeable. He looked at my LabCorp labs and agreed Free T was too low. He ordered some additional tests to rule out other items that could be causing my symptoms as well as re-testing T related tests. Results of these tests are below. I have converted a couple of the tests to US units in red.

https://imgur.com/a/QO3PVGf

Looks like the amounts convert to very similar amounts. However, at LifeLabs, the amounts are mid-normal but at LabCorp are out of range low. Seems like the Canadian ranges are low, especially for Free T. I assume this could partially be due to LifeLabs range being from age 13 - 100 while LabCorp is by age.

Don't go back to the doctor for a few weeks as the IGF1 test he ordered will take some time and I am getting a sleep study done next week.

 

[madman]

A bit of an update. Did not start the Andriol and continued my search for a doctor. I have found a doctor who seems to be knowledgeable. He looked at my LabCorp labs and agreed Free T was too low. He ordered some additional tests to rule out other items that could be causing my symptoms as well as re-testing T related tests. Results of these tests are below. I have converted a couple of the tests to US units in red.

https://imgur.com/a/QO3PVGf

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I would not compare Canadian Labcorp TT and free T reference ranges with the US Labcorp reference ranges as the assays used to test TT and Free T may be different.

You would need to make sure that the TT and Free T assays are the same and equilibrium dialysis ( LC/MS-MS ) which is considered the gold standard method for measuring Total T is not available in Canada and Lifelabs uses the direct analog assay for free t.

Your Total T levels are good and your free t is descent.....mind you the shbg reference range is 10-70 so the mean (mid-range) is 40 and your shbg is 49 so some what higher.

 

[madman]

A bit of an update. Did not start the Andriol and continued my search for a doctor. I have found a doctor who seems to be knowledgeable. He looked at my LabCorp labs and agreed Free T was too low. He ordered some additional tests to rule out other items that could be causing my symptoms as well as re-testing T related tests. Results of these tests are below. I have converted a couple of the tests to US units in red.

https://imgur.com/a/QO3

Looks like the amounts convert to very similar amounts. However, at LifeLabs, the amounts are mid-normal but at LabCorp are out of range low. Seems like the Canadian ranges are low, especially for Free T. I assume this could partially be due to LifeLabs range being from age 13 - 100 while LabCorp is by age.

Don't go back to the doctor for a few weeks as the IGF1 test he ordered will take some time and I am getting a sleep study done next week.

Your Labcorp blood test results clearly show a descent Total T but as I said before your free t is really low due to your absurdly high shbg 67.

Any doctor looking at those labs along with the symptoms you are experiencing would treat you.

Now as far as insurance purposes using your Lifelabs results your Total T is descent and your free t is descent and most doctors would not treat you, luckily you found someone so hopefully all works out well!

My pre-trt total t was low 300s and free t was 225 (range 196-636 pmol/L).

 

[mdm14]

Thanks for the quick reply as always madman.

I had a LifeLabs test in the past as well that had very similar results to this most recent test. The LabCorp test is an outlier. I am tempted to go get another test done at LabCorp to see if the test itself was an outlier or if the two lab results are actually that different.

Don't want to go down the road of TRT if it is not required. Although, I suppose a three month trial wouldn't hurt to answer the question of if it will help with my symptoms.

 

[madman]

Thanks for the quick reply as always madman.

I had a LifeLabs test in the past as well that had very similar results to this most recent test. The LabCorp test is an outlier. I am tempted to go get another test done at LabCorp to see if the test itself was an outlier or if the two lab results are actually that different.

Don't want to go down the road of TRT if it is not required. Although, I suppose a three month trial wouldn't hurt to answer the question of if it will help with my symptoms.

Regardless of the Lifelabs results I would say your high shbg is the issue hence why you are experiencing low t symptoms and getting on trt would be beneficial in your situation!

 

[mdm14]

I just purchased a few tests from discounted labs. Will get try and go on Saturday morning and see if there are any differences if the req comes in time.

This is more out of curiosity than anything. After I will summarize for any other Canadians using LifeLabs comparing all 4 sets of bloods all within a few months to see if there are any noticeable trends.

 

[mdm14]

Alright, please see LabCorp test from the weekend to compare to most recent from Life Labs. Shows free at the very bottom of the range (direct) and calculated would be below. Just if anyone is curious showing labs between the 2 countries.

https://imgur.com/a/eRwigrH

In my experience, it would appear that LabCorp has shown a lower free testosterone compared to reference ranges than Life Labs.

 

[madman]

Alright, please see LabCorp test from the weekend to compare to most recent from Life Labs. Shows free at the very bottom of the range (direct) and calculated would be below. Just if anyone is curious showing labs between the 2 countries.

https://imgur.com/a/eRwigrH

In my experience, it would appear that LabCorp has shown a lower free testosterone compared to reference ranges than Life Labs.

Regardless your free t is definitely low due to your higher SHBG and most need to have FT it in the 2-3 % range to feel optimal.

Even when one converts Canadian units for TT or free t to the US units and wants to compare Canadian vs US labs it is not accurate as the testing methods used by different labs for TT and free t are usually different and depending on the testing methods for TT and free t certain assays are more accurate than others.

Regarding Total Testosterone at most labs in Canada they use the automated immunoassay which is not as accurate as the liquid chromatography tandem-mass spectrometry (LC-MS/MS) which is used at certain labs in the US and Labcorp offers it which was used when you had your blood work done.

Regarding free testosterone at most labs in Canada they use the calculated free t as oppose to the direct or equilibrium dialysis which is offered at most US labs mind you calculated free t is also used.

Than to top it off lab reference ranges are different in Canada and the US and there is also variance in reference ranges between labs.

Two of the biggest labs in Ontario are Lifelabs and Dynacare and there is a difference between reference ranges for TT,FT,SHBG,E2 and so on.

Two of the biggest labs in the US are Labcorp and Quest and there is also a difference in reference ranges.

Sad fact of the matter is a lot of doctors in Canada are dead set on only looking at TT and not even concerned with ones free t let alone SHBG.

 

[mdm14]

Thanks man. All makes sense. The issue I’m facing here is the docs dismiss Labcorp tests and rely on Canadian only. Canadian tests are mid range and Docs say I’m fine even though Labcorp shows low free t.

Have a follow up with my current doc in a few weeks. Will keep my fingers crossed!

 

[mdm14]

Had my followup appointment today with a full workup and physical and reviewed blood results in detail as well as TRT protocols, pros & cons, etc.

I was prescribed a 3 month trial of TRT. Protocol is 100 mg Test E (Delatestryl) per week. No AI, no HCG for trial period to see how I respond to test only. He said to start at once per week injections but if I feel a slump at the end of the week, I should move to twice per week. He told me to use 25g one inch needles using z-track and I gave myself a practice injection of water with him.

From what I have read, this is a very reasonable trial. I have a couple questions though.

Should start with two injections per week rather than try one first? I have read that Test E has a bit shorter of a half life than Test C but given my high SHBG (50ish) maybe 1 is better?

Can I use a 28g 1/2" 1/2 CC insulin needle instead of the 25g one inch? Seems like the answer is yes to this.

As I am 29 and could be on this a long time if things go well, thinking I could try SC rather than IM? Again high SHBG so maybe quicker delivery of IM is better.

My wife and I still want kids and the Dr said he is open to adding HCG after the 3 month trial but typically has his guys come off T to conceive. Should this be fine if I add HCG later or should I be including right from the start? I do have really good benefits and FSH/HMG is fully covered so I could always see if he would add those later. I do like the idea of keeping the trial simple though.

I realize these are all very subjective questions and no one knows what is right for sure, just looking for some discussion.

Thanks!

 

[madman]

Had my followup appointment today with a full workup and physical and reviewed blood results in detail as well as TRT protocols, pros & cons, etc.

I was prescribed a 3 month trial of TRT. Protocol is 100 mg Test E (Delatestryl) per week. No AI, no HCG for trial period to see how I respond to test only. He said to start at once per week injections but if I feel a slump at the end of the week, I should move to twice per week. He told me to use 25g one inch needles using z-track and I gave myself a practice injection of water with him.

From what I have read, this is a very reasonable trial. I have a couple questions though.

Should start with two injections per week rather than try one first? I have read that Test E has a bit shorter of a half life than Test C but given my high SHBG (50ish) maybe 1 is better?

Can I use a 28g 1/2" 1/2 CC insulin needle instead of the 25g one inch? Seems like the answer is yes to this.

As I am 29 and could be on this a long time if things go well, thinking I could try SC rather than IM? Again high SHBG so maybe quicker delivery of IM is better.

My wife and I still want kids and the Dr said he is open to adding HCG after the 3 month trial but typically has his guys come off T to conceive. Should this be fine if I add HCG later or should I be including right from the start? I do have really good benefits and FSH/HMG is fully covered so I could always see if he would add those later. I do like the idea of keeping the trial simple though.

I realize these are all very subjective questions and no one knows what is right for sure, just looking for some discussion.

Thanks!

Great news!

I would definitely stick to injecting once weekly for now especially with your higher SHBG.

Definitely stick with just testosterone for the first 6 weeks to see how it affects your TT, FT and e2 numbers.

With a higher SHBG it is highly unlikely you will feel a slump before your next injection unless 100mg/week is not enough to bring your TT/FT to where it needs to be and even than it is better to stay with the once weekly injection for the full 6 weeks, gauge how you feel along the way and than have blood work done and it will be decided from there if you need a slight dose increase or may need to switch to injecting twice weekly (every 3.5 days).

Just understand that the first 6 weeks you may experience ups/downs and in the beginning you may feel well due to the exogenous testosterone and the fact that your body will still be producing endogenous testosterone until your hpga shuts down which can happen 2-6 weeks in and once shutdown happens sometimes the dose you started on is not always enough and your TT/FT levels may not be ideal.

The increase in libido is common and may seem intense but is is temporary and short lived (honeymoon period) or when one increases testosterone dose (due to tweaking protocol) and libido will eventually level off and in some cases seem worse if your T levels are not optimal or if e2 get too high.

Tough it out as once you are on the protocol and blood levels stabilize you can make any adjustments that may be needed after you have blood work.

As far as syringes it is best to use insulin syringe with a fixed needle as they have virtually no dead space so you do not waste any medication and 27-29 gauge 1/2 needle length are common.

You will draw/inject with the same syringe.....just make sure to always wipe the neoprene rubber stopper on top of vial every time you draw and of course wipe area where you are injecting.

Regarding injecting i.m or sub-q it will not matter to the absorption/effectiveness of the testosterone.....mind you some men do not do well injecting sub-q due to a bad reaction and developea lump/swelling/pain at injection site but it is not common in everyone.

I have been injecting 150mg/week Delatestryl sub-q (abdominal fat) 75mg every 3.5 days for 15 months.....never used hcg or an aromatase inhibitor.

Where is your doctor located?

 

[mdm14]

Thanks for the reply! Noted all of the above and will do! I think I will start IM for now to keep things simple. Although I don't get labs and see him again for 3 months, I plan on going down to the States to get some bloodwork done at 6-8 weeks as most people seem to do.

The doctor is in Vancouver. It is at an anti-aging clinic. He said I am his youngest patient and he normally turns away anyone under 40 or refers them to an endo as his specialty is in age-related hypogonadism. However, he said my case intrigued him when I filled out the application to go see him so I consider myself lucky in that regard.

 

[madman]

Thanks for the reply! Noted all of the above and will do! I think I will start IM for now to keep things simple. Although I don't get labs and see him again for 3 months, I plan on going down to the States to get some bloodwork done at 6-8 weeks as most people seem to do.

The doctor is in Vancouver. It is at an anti-aging clinic. He said I am his youngest patient and he normally turns away anyone under 40 or refers them to an endo as his specialty is in age-related hypogonadism. However, he said my case intrigued him when I filled out the application to go see him so I consider myself lucky in that regard.

Definitely get bloods at 6 weeks.....8 is ok but do not wait 3 months as the quicker you know how your testosterone dose affects your TT, FT and e2 among other health markers the better in case protocol adjustment are needed.....mind you you will not be able to increase your dose if needed as you need to wait 3 months until your follow-up but you could tweak injection frequency if need be.

Also keep an eye on your hemoglobin/hematocrit as it will increase in the first 3 months of trt and can take up to 9-12 months to reach peak levels.....mind you if one had any issues early into trt most would donate blood along with monitoring ferritin/serum iron as many end up donating too frquently and end up crashing their ferritin which can have a negative impact on thyroid function among other things.

Only time will tell, glad you found a doctor to treat you.....best of luck and keep us posted!

 

[mdm14]

Will do! Thanks man and thanks for all your help along the way.

 

[mdm14]

Took my first shot last Friday evening 100mg test e. The pharmacy had to order in needles so I used what was given to me by the dr's office which was a 18g 1" to draw and 25g 1" to inject. Injected in my thigh, no issues and no pain to my surprise. The barrel was 3 CC so it did take a long time to inject. I now have 28g insulin needles going forward.

Saturday to Tuesday night I felt amazing. My brain fog lifted, I had lots of energy and just felt genuinely happy for the first time in a long time. I basically was feeling like myself again is the only way I can explain it. Starting Wednesday, the brain fog and fatigue slowly started coming back although still better than before. Today (Friday) I feel like I am back to where I was before.

I realize it will take 6 weeks for blood levels to stabilize and there will be plenty of ups and downs during this time. Also, will have about half of the last dose still in my system plus this next full dose tonight.

Overall, I am very happy with this start and am looking forward to my 2nd shot tonight! Thanks again, this community is awesome!

 

[MarkM]

Good to hear you doing well. Remember, you are in the "honeymoon" phase where the exogenous testosterone you are injecting is adding to your natural testosterone giving you a boost. It won't take long for your HPTA to shut down because of the exogenous testosterone so you may feel a little decline. Let the exogenous test build up and reach a steady state to see how you are going to truly feel on the initial protocol. Good choice moving over to the insulin syringes. Keep us posted.

 

[mdm14]

Another update. Still taking 100mg once a week. Don't see my doctor for another 6 weeks so I decided to get some bloods done. These were done at trough week 7.

Been really feeling great! Clear mind, energy up, libido way up, gym and sport performance is finally improving. I do find the good feelings tend to slip a bit later in the week coming up to my next injection

I have attached my most recent blood work. I was surprised to see Total T and free T so low. However, my SHBG has dropped to 43 when it has historically been between 50ish and 70.

My guess is numbers are much better closer to injection and fall down throughout the week. I would imagine increasing the dose and/or frequency could help. However this wont be an option for 6 weeks.

All in all though, i feel amazing 4-5 days a week. A great improvement from feeling like crap 7 days a week. Just very surprised by blood work as Total T is lowest I have ever had and Free T is about the same.