timing of bloodwork

[caira1074]

I have been pinning once a week on sun mornings and usually would get bloodwork drawn on wed morning, is this correct for once a week pinning, and if I go to twice a week pinning sun mornings and wed afternoon what day would be the best for blood draw.

[bass]

its best to draw toward the end or the same day of your next shot. I would change from Sunday to working week days so you can do BW the same day of your next shot, prior to your shot of course!

[LowT Mike]

I have been pinning once a week on sun mornings and usually would get bloodwork drawn on wed morning, is this correct for once a week pinning, and if I go to twice a week pinning sun mornings and wed afternoon what day would be the best for blood draw.

Yes caira this is correct. Generally on day 3 or 4 is best. You want to catch your levels right after peak. If you draw on injection day your levels are close to baseline and this actually is the worst time to draw because it will reflect the lowest levels throughout the week. Generally it will take 24-48 hours to reach peak after you inject. See graph.

It is most important to get your blood draw on the same day (3 or 4) post injection every time you get a blood draw throughout treatment. This is called TRT restaging. This is the only way to truly pin point test levels during the week and find what your "optimal" dose is. It is done by analyzing the data under identical circumstances and comparing these data sets to each other over time

[bass]

^^^ Mike, just curious, what's is the purpose of knowing what the peak is? isn't more important to know what your lowest level is? I thought the idea was to avoid valleys not peaks. basically if at day 6-7 you're back to your base you'll know to either split your dose to twice a week and increase your dose if you want to stay on once a week.

[LowT Mike]

"Relative T Serum Peak" is very important to know for many reasons.

What you are suggesting is not correct at all. Your lowest level is baseline. Which is the T level you started with when beginning TRT. On TRT in most cases men are below baseline by the end of the week (using the 1x per week injection protocol) because the body in no longer producing natural testosterone without HCG so lower than when you started TRT. Measuring this value is not relevant at all. Yes you want to avoid valleys of course but no reason to know what these valley's level are over peak. Way more important to know "relative T serum peak" for many reason and identifying general peak is the whole premise of treatment.

When a patient starts TRT and has been on for months and still has strong symptoms of andropause you absolutly need to know "relative T serum peak". Men are generally symptom free using labcorp between the optimal "relative peak" range of TT 650-1100 ng/dl and free T 20-30 pg/ml. This is bar none the best tool you have when restaging the patient and trying to find a tailored protocol to which they are symptom free.

If the patient's "relative T serum peak" is still 300-400ng/dl then we can use this as a guide when treating men to titrate up there dose into that optimal "relative T serum peak" range and keep pushing them to the top of that range if symptoms pursist. If symptoms still persist we eventually have to stop increasing dose because we dont want to create superphysiological doses which can occur within the "relative T serum peak" range over 1300 ng/dl. Levels north of that have side effects such as polychthemia, acne, hyper aromatase. At which point the practitioner needs to look at other pathologies causing these symptoms such as Hypothyroid/DHEA deficiency/adrenal fatigue/depleted neurotransmitters. The whole premise of treatment is based around measuring general peak levels. This is the only guide we have when staging patients to find there sweet spots and is all done by targeting "relative serum T peak". How else would you find an ideal protocol by measuring the bottom of a valley or baseline T and correctly keep the patient within the confines of safe T levels. Do you know what your peak is? How do you know your T levels arnt 6000 and you have a whole host of side effects occurring.

[2Sox]

Yes caira this is correct. Generally on day 3 or 4 is best. You want to catch your levels right after peak. If you draw on injection day your levels are close to baseline and this actually is the worst time to draw because it will reflect the lowest levels throughout the week. Generally it will take 24-48 hours to reach peak after you inject. See graph.

It is most important to get your blood draw on the same day (3 or 4) post injection every time you get a blood draw throughout treatment. This is called TRT restaging. This is the only way to truly pin point test levels during the week and find what your "optimal" dose is. It is done by analyzing the data under identical circumstances and comparing these data sets to each other over time

Mike,

To clarify: Are you saying to get a blood draw on the same day of your injection after your injection - not before??

I've gone down to pinning 30mg EOD and 250iu hCG on the off days. I went for BW on the off days so far - once a month. Is that right? My last two bloods had my total in the 1300s - coming off of 40mg EOD.

If my bw comes back high again, how long should I wait to titrate down?

EDIT: Re: Your graph. The labels of the X and Y axis are?

[jay adams]

Damn Mike! You just flipped over the way I was seeing things from what I've been taught on this site. Thanks for clearing that up. I have a better introspect on how to handle my treatment.

[bass]

Mike, this is the first I've heard doing BW at the peak, I see your point about avoiding other sides, but to be honest and in my opinion (I'm not a doctor ) I would think hitting valleys can have allot worse results that the predicted sides of high peak levels. I end up at 650-850 when I do BW toward the end, I doubt my peak would be in the 6000!

[LowT Mike]

Always do lab draws on day 3 or 4 post injection day. If you are a hyper excretor and wait until day 7 past injection looking at the graph above your levels are going to be back at baseline. So if one of our patients did this then we would get low readings and keep titrating him upward where the first few days he would be superphysiologic. not good. Bass if your baseline is 650-850 on day 7 doing 1 time per week injection your levels are way north of 1500 most likely. Labcorp cant even measure that high just says >1500. Also not good. More DHT conversion, more E2 conversion bad for the prostate and much higher hematocrit. Its probably why so many guys on this site Ive noticed have to do blood draws because their hematocrit is going sky high. Thats I sign you are dosing way too much. I would say probably 2-3% of LT.com patients have to do a blood draw for high hematocirt. They feel great because dosing is on par and labs are drawn at the right times consistently. If you are doing 2x per week injections of T it dosent matter really when you do your blood draw. Just make sure you continue to get the draw at the same time for every blood work. Looking for consistency here.

[LowT Mike]

Just another reason to go see a board certified anti-aging doctor or a LT.com doctor. Dont self medicate guys. I see guys everyday that have wreaked their whole endocrine system going at this blind by what the guy at the gym told him. These guys usually end up andropausal much earlier in life or have much worse complications.

[bass]

Always do lab draws on day 3 or 4 post injection day. If you are a hyper excretor and wait until day 7 past injection looking at the graph above your levels are going to be back at baseline. So if one of our patients did this then we would get low readings and keep titrating him upward where the first few days he would be superphysiologic. not good. Bass if your baseline is 650-850 on day 7 doing 1 time per week injection your levels are way north of 1500 most likely. Labcorp cant even measure that high just says >1500. Also not good. More DHT conversion, more E2 conversion bad for the prostate and much higher hematocrit. Its probably why so many guys on this site Ive noticed have to do blood draws because their hematocrit is going sky high. Thats I sign you are dosing way too much. I would say probably 2-3% of LT.com patients have to do a blood draw for high hematocirt. They feel great because dosing is on par and labs are drawn at the right times consistently. If you are doing 2x per week injections of T it dosent matter really when you do your blood draw. Just make sure you continue to get the draw at the same time for every blood work. Looking for consistency here.

ahhhh, I see what you're saying regarding peaks on once a week shot, I am on twice a week, so in reality I draw BW at peak day as you are suggesting! I knew i'd see your logic sooner or later thanks for taking the time to explain, good info as usual.