blood work done. Need advice on how to proceed

[cookwg513]

I've ended up here as a first time poster because of the "anti-aging" category. After some time of assuming I was just getting older I finally took Labcorp's comprehensive "aging" test (results attached) and am now reaching out for advice on how to treat my symptons. My major issues are the common "brain fog", irritability, etc. plus a significant loss of strength in the gym but most troubling, starting about two years ago my erections were no longer firm enough to have intercourse. I've spent some time on this site already so a couple of things seem clear. The foundation of my problems is that my free "T" is low but my total "T" is Okay. My SHBG is high enough to cause problems. I'm not clear on how any of these blood tests may reflect on my erection issues. My hope is that some experienced members can offer suggestions for solutions.

Some pertinent information: I'm 68 years old. 5'7" and 150 lbs. A little soft in the middle but not fat. I'm in the gym 3x a week and have been for many years. I'm taking a couple of medications that could be relevant: 50 mcg of Synthroid daily. 10 mg of Simvistatin daily and most importantly 5 mg of Finesteride a day for BPE. I've been taking the Finesteride for 7 years. My urologist doesn't think it's the cause of the impotence but doesn't rule it out either. But it does mean that I cannot give blood to keep my hematocrit in check.

I have experience doing one cycle following the protocol elsewhere on this site exactly. I acquired the gear for that privately and feel that I have a reliable source. I have not been able to find a local physician to work with and am reluctant to try the $200 a month storefront "clinics". Noteworthy also is that my PSA is high. I've been monitered since I was 45 with an annual digital rectal exam. I am cancer free and my PSA level is very stable. It's not a concern.

My goal is to make my remaining years as vital as possible. I would so appreciate any advice members have to offer about starting with the very minimum amount of gear necessary to optimize my search for optimal health. Thank You!

[cookwg513]

Thanks for your response. I am taking your advice about the DHEA (ordered some a few minutes ago) and will get my DHT checked.

[cookwg513]

Thanks for sharing that link. It looks like a low dose of Winstrol could be helpful. Youthful55guy apparently uses it with success but I'm unclear if an oral can be used without cycling off. Thanks!

[Youthful55guy]

I've ended up here as a first time poster because of the "anti-aging" category. After some time of assuming I was just getting older I finally took Labcorp's comprehensive "aging" test (results attached) and am now reaching out for advice on how to treat my symptons. My major issues are the common "brain fog", irritability, etc. plus a significant loss of strength in the gym but most troubling, starting about two years ago my erections were no longer firm enough to have intercourse. I've spent some time on this site already so a couple of things seem clear. The foundation of my problems is that my free "T" is low but my total "T" is Okay. My SHBG is high enough to cause problems. I'm not clear on how any of these blood tests may reflect on my erection issues. My hope is that some experienced members can offer suggestions for solutions.

Some pertinent information: I'm 68 years old. 5'7" and 150 lbs. A little soft in the middle but not fat. I'm in the gym 3x a week and have been for many years. I'm taking a couple of medications that could be relevant: 50 mcg of Synthroid daily. 10 mg of Simvistatin daily and most importantly 5 mg of Finesteride a day for BPE. I've been taking the Finesteride for 7 years. My urologist doesn't think it's the cause of the impotence but doesn't rule it out either. But it does mean that I cannot give blood to keep my hematocrit in check.

I have experience doing one cycle following the protocol elsewhere on this site exactly. I acquired the gear for that privately and feel that I have a reliable source. I have not been able to find a local physician to work with and am reluctant to try the $200 a month storefront "clinics". Noteworthy also is that my PSA is high. I've been monitered since I was 45 with an annual digital rectal exam. I am cancer free and my PSA level is very stable. It's not a concern.

My goal is to make my remaining years as vital as possible. I would so appreciate any advice members have to offer about starting with the very minimum amount of gear necessary to optimize my search for optimal health. Thank You!

A couple of thoughts.

Yes, your TT is in the normal range and your FT is abysmal. I'm pretty sure this is the cause of your brain fog and ED symptoms. Your labs are very similar to mine when I started out on TRT over 7 years ago. I'm just a few years younger than you and in similar physical shape except I carry a bit more muscle mass. The cause of the low Free T is obviously high SHBG. I suspect this is a secondary issue to your use of Synthoid. It would be interesting to see your thyroid labs before you started taking Synthoid and your rationale for using it. Both T3 and T4 are well documented to drive up SHBG. Unless you plan on starting out on TRT, you may wish to reconsider your need for supplemental thyroid hormone treatment.

I do not think the statins have anything to do with the issues you describe. There are some anti-statin people in this forum that would disagree, but my experience (with Lipitor) is that the benefits of statins far outweigh any risks, and the side-effects are generally not as you describe.

I do not suspect E2 is at the root of your issues either, although I'd like to see it a bit higher. Guys need E2 too for normal libido and erections. I suspect this will move to the upper end of the normal range if you proceed with TRT as E2 is made directly from T. Watch out for canned protocols from anti-aging clinics. They usually recklessly prescribe anastrozole proactively and generally do not titrate dose with labs. AIs, and anastrozole in particular, are very difficult to dose for guys.

I do not see any DHT labs. I find this odd since you are on a pretty stout dose of finasteride. I would look into whether that high of a dose is necessary. Guys need DHT to feel like guys. However, you need to balance this with BHP issues. My advice is to rationalize the use of finasteride to get DHT levels in the mid-range of normal. I suspect your optimal dose might be closer to 1 mg per day.

Finally, regarding anti-aging clinics as a source of T, I don't have a lot of good to say about them. They usually have cookie cutter protocols and their protocols are usually decades behind what we know are best practices. They rarely prescribe T for self-injections. This means that they are forced into once per week or (or God forbid) once per 2 week protocols. both of these are a recipe for disaster. Assuming they prescribe T-cyp, you need to be injecting small doses much more frequently. Check out the Sticky I wrote on Best Practices in TRT. I usually recommend that guys start out with a dose of about 100mg broken up into at least 2 injections per week. I much prefer every 3 day dosing (E3D) for a variety of reasons. With an E3D schedule, you should start with a dose of about 0.2mL (of 200 mg/mL) T-cyp E3d. This equates to about 93mg per week. After 6 weeks, pull labs just prior to one of your scheduled injections and adjust the T dose in necessary. It take at least 6 weeks for your hormones to normalize, so don't rush decisions and don't attempt to do it by feel. Do not proactively use an AI. Only consider an AI if the 6 week (or subsequent) labs say you need it. It's highly debated at how high guys on TRT should let their E2 go, good arguments from all sides. I personally use 50 pg/mL using LabCorps Sensitive test (normal range 8-35).

Hope this helps!

[cookwg513]

Thanks for responding! I checked my medical records for synthoid and here they are: TSH Results Range .40-5.00 uIU/ml

12/07 3.5
9/09 3.87
9/11 3.80
1/13 4.44
2/14 4.75
2/15 4.52
synthoid prescribed
4/15 2.61
4/16 2.60
4/17 2.81
5/18 3.17


I'm not quite sure why the Doctor prescribed synthroid. I believe it was simply based on lab values.

I have taken cylon357's and your advice and arranged for a DHT test. The blood draw is scheduled for Tuesday (8-10 days for results)

In regard to the Finesteride. I spoke to my urologists about the possible connection with my impotence. She didn't think so but didn't rule it out. She did say that I could quit taking it if I wanted to see what happened. However it does treat some important medical issues in regard to being able to completely empty the bladder.

My current thinking is that I'll continue to refine my proposed protocol while waiting for the DHT results. My plan now is 100mg of T-cyp and 500 mg of HCG on an E3D schedule. I will also cut my Finesteride dose down to 2.5 mg a day and see how that effects my symptoms. I'm also considering a very small dose of Winstrol but am concerned about never cycling off of it.

What sort of information will the DHT test reveal? I'd like to get a jump on reading up on it. Thanks!

[Youthful55guy]

My current thinking is that I'll continue to refine my proposed protocol while waiting for the DHT results. My plan now is 100mg of T-cyp and 500 mg of HCG on an E3D schedule. I will also cut my Finesteride dose down to 2.5 mg a day and see how that effects my symptoms. I'm also considering a very small dose of Winstrol but am concerned about never cycling off of it.

What sort of information will the DHT test reveal? I'd like to get a jump on reading up on it. Thanks!

I can see the rational for considering thyroid medication, but I would never run it based on TSH alone. Your doctor should have checked free T3 and T4 levels (and possible rT3). If they were in range, there would be no need for the Synthoid. I suspect that is driving up your SHBG and lowering your free T. You might want to consider running Free T3 and T4 labs with the synthoid and then backing off and rechecking in about 6 weeks. Continue this until you get to the minimum dose you need to keep T3 and T4 in the normal range.

Your proposed protocol looks good. I'm assuming you mean 100mg and 500IU broken up into and E3D protocol (i.e., 43mg & ~220 IU E3d).

Your DHT levels will tell you whether you are overtreating the BHP, which I suspect you are. Finasteride is a powerful drug and 5mg, while being a standard dose for treating BHP, is more than likely going to crush your DHT levels. Guys need DHT to feel like guys. Also, when you block T to DHT conversion it can increase E levels because T backs up in the steroid cascade and then spills over into E. However, your labs do not indicate this is happening. However, I'd be very cautious at introducing exogenous T while on high doses of finasteride by periodically checking your E levels to ensure this does not happen. If it does, we can discuss options.

Regarding backing off to 2.5 mg to see how symptoms progress. I'd wait to see the DHT labs to understand where you are now. Then back off to 2.5 mg and retest in about 6 weeks. I suspect that even at 2.5 mg you will still be near the bottom end of the normal range for DHT. My experience is that with my current experimental (high T/no Winstrol) protocol that a dose of 1.4mg finasteride with 200mg T per week (E2D dosing) will bring DHT down to about the 75th percentile of the normal range. Currently, I'm lowering my T dose but maintaining Finasteride at 1.4mg/day. I'm hoping that should lower the DHT to about the 50th percentile, which is where I want to maintain it. However, I also need to get my Free T down, as 200mg/week T was WAY too much without suppressing SHBG with Winstrol (stanozolol).

Regarding a long term maintenance dose of Winstrol, I have found that 2.5mg 2X per day worked extremely well and did not overly tax my liver (numerous tests). However, I decided to try an experimental high(er) T/no Winstrol experiment to see how I like it and simply because I don't wish to be a felon to get the medical treatment I need. I may end up going back on Winstrol after the experiment, but I'm look to at least test out alternatives.

[cookwg513]

Hi, thanks for sharing your thoughts. I didn't get right back to you as there was a development i was letting play out first. My PCP is Kaiser (Northern California) and it just so happens I was assigned a new Doctor who happened to be an Osteopath. As I was scheduled to meet him yesterday (regrettably because I'd torn up my rotator cuff) I thought I'd wait and get his input regarding my plans. In particular your suggestion regarding re-evaluating the need for Synthroid.

The good news is that he is very supportive of reducing the synthroid and finesteride to the minimum necessary but felt strongly that to really get things dialed in only one variable should be changed at a time. Either reduce the synthroid or the finesteride but not both. That made sense to me.

Furthermore he thought the finesteride was the place to start as the synthroid dose I'm taking is relatively small. As I read your responses I also see that you suspect I'm taking way too much finesteride as well so my current thinking is to wait for my DHT results (blood was drawn last Tuesday, results 8-10 days) and make a final decision based on what input I receive when I post those numbers. As a practical matter I would like my new physician to feel like I'm taking his advice. Although Kaiser isn't going to support HRT in my case, an individual physician can order any blood test he wants. It would be a real advantage for me compared to paying Labcorp out of pocket to have that kind of support.

I'm finding this whole thing quite complex. Thank you so much for taking the time to help those of us who are struggling our way forward!

[Youthful55guy]

Hi, thanks for sharing your thoughts. I didn't get right back to you as there was a development i was letting play out first. My PCP is Kaiser (Northern California) and it just so happens I was assigned a new Doctor who happened to be an Osteopath. As I was scheduled to meet him yesterday (regrettably because I'd torn up my rotator cuff) I thought I'd wait and get his input regarding my plans. In particular your suggestion regarding re-evaluating the need for Synthroid.

The good news is that he is very supportive of reducing the synthroid and finesteride to the minimum necessary but felt strongly that to really get things dialed in only one variable should be changed at a time. Either reduce the synthroid or the finesteride but not both. That made sense to me.

Furthermore he thought the finesteride was the place to start as the synthroid dose I'm taking is relatively small. As I read your responses I also see that you suspect I'm taking way too much finesteride as well so my current thinking is to wait for my DHT results (blood was drawn last Tuesday, results 8-10 days) and make a final decision based on what input I receive when I post those numbers. As a practical matter I would like my new physician to feel like I'm taking his advice. Although Kaiser isn't going to support HRT in my case, an individual physician can order any blood test he wants. It would be a real advantage for me compared to paying Labcorp out of pocket to have that kind of support.

I'm finding this whole thing quite complex. Thank you so much for taking the time to help those of us who are struggling our way forward!

My condolences at having to work through Kaiser, a growing cancer in California. They have very regimented TRT protocols and won't let their doctors stray far from them. My PCP is with a medium sized clinic on the Central Cost and they give their docs a much longer leash.

Having said that, I think you ended up with the best possible choice of docs in your situation. To a certain degree, I also agree with him. If you are basing decisions on symptoms, then adjusting one variable at a time is the right decision. However, I think you could work on both to adjust the levels based on labs to get you within the 50th percentile of the normal range both DHT and thyroid hormone. I suspect you are currently at the higher end of the range for both and that both are contributing to your symptoms. So, just because you lower finasteride and don't feel better (because of the high thyroid hormones/SHBG), it doesn't mean it wasn't the right thing to do, as it will contribute to the overall solution once you adjust the thyroid hormones into the normal range.

[cookwg513]

Just received my DHT blood work results from LabCorp.

DHYDROTESTOSTERONE (reference range 30-85) Result: 11

Now that seems extremely low to me. I would appreciate any advice on how to proceed based on that result. Thanks

[cookwg513]

Thanks for your thoughts. Looking around online it seems that a daily dose of 50 mg's of DHEA might help. My lab results from earlier for DHEA were 27.9 on a range from 30.9 to 295.6

Not sure of what to do just yet except get off the 5mg daily of Finesteride,

[Youthful55guy]

Thanks for your thoughts. Looking around online it seems that a daily dose of 50 mg's of DHEA might help. My lab results from earlier for DHEA were 27.9 on a range from 30.9 to 295.6

Not sure of what to do just yet except get off the 5mg daily of Finesteride,

DHEA supplementation is a good idea, but won't help with DHT levels. You do need to dial back the finasteride substantially. My best guess is that 1 mg will be sufficient to keep DHT in the low end of the range, but with PSA issues, you might want to follow your urologist's advice and dial back slowly. I'd also not lose sight of dialing back on the thyroid hormone supplementation to help bring SHBG down.

[cookwg513]

There have been a couple of developments in my health journey.

First, in response to a long email with copies of my blood work my new Kaiser osteopath has responded to my concerns seriously. He wants me to stop the finesteride completely, wait 30 days and then come in for a whole new set of blood tests. Including testosterone, a thyroid panel, DHT, and a hormone panel. He then proposes to dial back on the synthroid based on the new lab results.

Clearly he's making a good faith effort to help me get my situation figured out. Since he's meeting me more than half way I'm going to cooperate with his plan. Consequently I'm putting off starting the T-cyp, HCG, & (maybe) stanzol until he's had a chance to adjust the synthroid. All I've done is start taking 50mg of DHEA daily.

I followed up with my urologist about cylon357's regimen of cialis & flomax as an alternative to the finesteride. She's started me on flomax only(mainly because I have Kaiser's "bargain basement" health plan and my co-pay on cialis would be over $10 a day).

So for the next month I'll be letting the fina clear my system and my hormones return to whatever they actually are. After that I'll let the doctor work on the thyroid issue and then finally decide if HRT would benefit me.

[Youthful55guy]

There have been a couple of developments in my health journey.

First, in response to a long email with copies of my blood work my new Kaiser osteopath has responded to my concerns seriously. He wants me to stop the finesteride completely, wait 30 days and then come in for a whole new set of blood tests. Including testosterone, a thyroid panel, DHT, and a hormone panel. He then proposes to dial back on the synthroid based on the new lab results.

Clearly he's making a good faith effort to help me get my situation figured out. Since he's meeting me more than half way I'm going to cooperate with his plan. Consequently I'm putting off starting the T-cyp, HCG, & (maybe) stanzol until he's had a chance to adjust the synthroid. All I've done is start taking 50mg of DHEA daily.

I followed up with my urologist about cylon357's regimen of cialis & flomax as an alternative to the finesteride. She's started me on flomax only(mainly because I have Kaiser's "bargain basement" health plan and my co-pay on cialis would be over $10 a day).

So for the next month I'll be letting the fina clear my system and my hormones return to whatever they actually are. After that I'll let the doctor work on the thyroid issue and then finally decide if HRT would benefit me.

Make sure the T labs include Free T or Bioavailable T. My experience is that either one is a good measure of T. With high SHBG, you need to adjust dose on Free/bioavailable T, not total T. Oddly, high SHBG falsely inflates Total T labs because it protects T from liver metabolism but does not allow it to pass through the blood-brain barrier where it is needed to feel normal.

A month off of finasteride is probably sufficient. It has a very short half life. I agree with your docs approach to re-baseline and adjust all hormones based on labs.

You can obtain generic Cialis from any of a number of overseas suppliers for a fraction of that cost and my experience is that they work just as well. I pay $1.40 each for 10mg tables and cut them in half for a daily dose of 5mg at $0.70 per day. You can get it less expensive if you purchase 20mg tables and cut them in quarters but I find that too much of a hassle and difficult to cut accurately.

[Youthful55guy]

As an FYI on cialis, I can only do 2.5 mg at a time but I do it twice a day for a total of 5mg/day. My doc prescribes the 5mg and I cut them in half. If I take 5mg at once, I get this minor but annoying cough. Doc says the same thing happens to him, something to do with dilating blood vessels in the lungs, yada yada. Solution for me (and him apparently) is to take 2.5 twice a day.

It's interesting that we all seem to react differently to PDE5 inhibitors. I seem to have no problem with Cialis (tadalafil) at doses up to 20mg as long as I don't drink alcohol. Even just a little alcohol gives me a sever headache. At first when I started taking tadalafil, I also experienced a lot of nasal congestion but over years of taking it, I seem to experience a lot less of this.

Sildenafil (Viagra) on the other hand, I could tolerate several years back but had similar headaches and nasal congestion as tadalafil. I chose tadalafil as my drug of choice because I liked that it had a MUCH MUCH longer half life, hence time of activity and I could do smaller doses on a daily basis. Then a couple years ago, I decided to try sildenafil again and had a really bad rare side effect that is described in the literature. it temporarily effected my eye sight by making colors shift to the blue and my eyes became very light sensitive. It was really scary to have my perception of color so distorted. It lasted a couple hours and then went away. That was the last time I took the drug.

[cookwg513]

I did a little research on taking cialis and flomax at the same time. There's an interesting little article summary on medivizor that show combining the two is far superior than taking either one separately. The combination was effective for both ED and BPH.

Consequently I have ordered the cialis from an overseas supplier and will use the same dosage that cylon357 is using.

[cookwg513]

After 30 days without Finesteride I had some new blood work done and here are the results.

LabCorp (5/19) Kaiser (7/19)

PSA 3.0 (0-4.0) 3.6 (0-4.5)

Estradiol, sensitive 15.1 (8.0-35.0) <50 (<50)

LH 7.5 (1.7-8.6) 8 (1.0=12.0)

FSH 7.8 (1.5-12.4) 10.9 (1.4-18.1)

DHT 11 (30-85) 339.3 (106-719)

T4 1.34 (.82-1.77) 1.3 (.8-1.7)

TSH 2.4 (.45-4.5) 3.31 (.40-5.0)

Prolactin 9.5 (4.0-15.2) 10 (2.0-18.0)

Total T 581 (264-916) 465 (>240)

Free T 5.8 (6.6-18.1) Not Tested


In the follow up meeting with the Doctor he thinks I should leave the dose of the synthroid as is. Thought that midrange was fine. He told me that the reason the free T was not tested is that Kaiser doesn't allow it to be tested if the total T is above 240. Apparently Kaiser is very determined not to be in the HRT business. There was nothing he could do about that. Looking over the lab work I was struck by the great improvement in my DHT score. Besides stopping the Fina I've also started taking 200mg of DHEA daily. I'm really not sure how to interpret the scores from two different labs. Obviously they have different standards so...I guess they're pretty much the same. Kaiser didn't run a "sensitive" Estradiol test though.

That still leaves my free T too low for my liking so I decided to go ahead on my own following Youthful55guy's protocol. So last Friday I gave myself my first injections of Test C and HCG and plan to continue E3D for the next six weeks and get retested and see how I feel. I've also received my shipment of Tadalafil(Cialis) and have started taking an everyday dose. So far I haven't noticed any troubling symptoms from stopping the Fina and switching over to the Flomax and Cialis combination. Although overall I find myself very hopeful of greatly improving the quality of my remaining years I have to say I find the idea of a lifetime of injections daunting. That is a serious commitment.

[cookwg513]

I completely eliminated the Fina. I started the DHEA at the same time in the hope of raising the DHT score. I'm not committed to the 200mg by any means. Would you recommend dialing back? I'm completely willing to retest in another 5 weeks when I have my free T, T, and estradiol blood work done.

[cookwg513]

Correction: I double checked the DHEA container and I'm actually taking a total of 50mg per day.

[Youthful55guy]

After 30 days without Finesteride I had some new blood work done and here are the results.

LabCorp (5/19) Kaiser (7/19)

PSA 3.0 (0-4.0) 3.6 (0-4.5)

Estradiol, sensitive 15.1 (8.0-35.0) <50 (<50)

LH 7.5 (1.7-8.6) 8 (1.0=12.0)

FSH 7.8 (1.5-12.4) 10.9 (1.4-18.1)

DHT 11 (30-85) 339.3 (106-719)

T4 1.34 (.82-1.77) 1.3 (.8-1.7)

TSH 2.4 (.45-4.5) 3.31 (.40-5.0)

Prolactin 9.5 (4.0-15.2) 10 (2.0-18.0)

Total T 581 (264-916) 465 (>240)

Free T 5.8 (6.6-18.1) Not Tested


In the follow up meeting with the Doctor he thinks I should leave the dose of the synthroid as is. Thought that midrange was fine. He told me that the reason the free T was not tested is that Kaiser doesn't allow it to be tested if the total T is above 240. Apparently Kaiser is very determined not to be in the HRT business. There was nothing he could do about that. Looking over the lab work I was struck by the great improvement in my DHT score. Besides stopping the Fina I've also started taking 200mg of DHEA daily. I'm really not sure how to interpret the scores from two different labs. Obviously they have different standards so...I guess they're pretty much the same. Kaiser didn't run a "sensitive" Estradiol test though.

That still leaves my free T too low for my liking so I decided to go ahead on my own following Youthful55guy's protocol. So last Friday I gave myself my first injections of Test C and HCG and plan to continue E3D for the next six weeks and get retested and see how I feel. I've also received my shipment of Tadalafil(Cialis) and have started taking an everyday dose. So far I haven't noticed any troubling symptoms from stopping the Fina and switching over to the Flomax and Cialis combination. Although overall I find myself very hopeful of greatly improving the quality of my remaining years I have to say I find the idea of a lifetime of injections daunting. That is a serious commitment.

A couple of comments. Given that you are stuck with Kaiser, I'm assuming you are in California (perhaps you've mentioned that previously). If so, it is easy and relatively inexpensive to get your own labs done and all the work is done through LabCorp, so you know the labs are good. I've also found that the results correlate well with Pacific Diagnostic Labs, which is what my local doc uses for my annual check ups. Here's a link to where you can purchase the labs al a carta: https://www.discountedlabs.com/. They are very professional and everything is done via email.

Regarding lifetime injections, once you get the volume down to where you can use an insulin syringe for E3D dosing (I use a 28G 1/2 inch needle), you will find that it is a very sustainable protocol. I've been doing it for about 7 years. The alternative is feeling like $#!^ all the time, so choose your poison.

[Tim1985]

Youthful, what is the max volume of test you inject sub-q with your insulin needle? Currently I inject IM every 3.5 days but switching over to sub-q would be nice even at EOD to get volume down. What was the smallest gauge you have been able to use? I use 30 gauge for HCG but imagine that would be tough with test.

[Youthful55guy]

Youthful, what is the max volume of test you inject sub-q with your insulin needle? Currently I inject IM every 3.5 days but switching over to sub-q would be nice even at EOD to get volume down. What was the smallest gauge you have been able to use? I use 30 gauge for HCG but imagine that would be tough with test.

I use a 28G one-piece insulin syringe with a 1/2 inch needle. I find that anything smaller than this (e.g., 30G) is too slow and difficult to draw up. I inject straight into my quad muscle. It's a shallow IM injection. Usually the volume is around 0.2 to 0.25 mL, depending on my exact protocol. Right now, I'm on an experimental protocol of 0.2 mL E2D.

I do not like subcutaneous injections (i.e., belly fat) because I always bruise from even very small volumes.

[cookwg513]

I received my first test results back since starting TRT and I have a couple of questions. The first is on calculating dosage. My assumption was that 1ml=100iu. Is that correct for Test Cypionate? My calculations were:

Test C vial has 250mg/ml. 250mg/100iu=2.5mg/iu. In order to get a dose of 43mg would require 43/2.5=17.2iu.

So I've been dosing approx. 18iu's every third day. That's in order to get approx. 100 mg per week. Did I have that figured out correctly?

Here are the results after 7 weeks (all tests from LabCorp)

Original: Total T 581 (264-916)
Free T 5.8 (6.6-18.1)

Current: Total T 1082 (264-916)
Free T 22.6 (6.6-18.1)

I noticed although my total T has slightly less than doubled my free T has almost quadrupled. Since I'm above the ranges in both category's shouldn't I be reducing my dosage? I'm thinking of dropping them by about 20%. Does that seem about right?

Finally I'm planning on more extensive blood tests at the end of my first 90 days. Other than checking T, estradiol, hematocrit, are there others that would be useful at this time?

Thanks.

[HoldMyBeer]

I received my first test results back since starting TRT and I have a couple of questions. The first is on calculating dosage. My assumption was that 1ml=100iu. Is that correct for Test Cypionate? My calculations were:

Test C vial has 250mg/ml. 250mg/100iu=2.5mg/iu. In order to get a dose of 43mg would require 43/2.5=17.2iu.

So I've been dosing approx. 18iu's every third day. That's in order to get approx. 100 mg per week. Did I have that figured out correctly?

Here are the results after 7 weeks (all tests from LabCorp)

Original: Total T 581 (264-916)
Free T 5.8 (6.6-18.1)

Current: Total T 1082 (264-916)
Free T 22.6 (6.6-18.1)

I noticed although my total T has slightly less than doubled my free T has almost quadrupled. Since I'm above the ranges in both category's shouldn't I be reducing my dosage? I'm thinking of dropping them by about 20%. Does that seem about right?

Finally I'm planning on more extensive blood tests at the end of my first 90 days. Other than checking T, estradiol, hematocrit, are there others that would be useful at this time?

Thanks.

How soon after pinning did you get your bloodwork?

[cookwg513]

The next day. About 16 hours or so.

[Youthful55guy]

I received my first test results back since starting TRT and I have a couple of questions. The first is on calculating dosage. My assumption was that 1ml=100iu. Is that correct for Test Cypionate? My calculations were:

Test C vial has 250mg/ml. 250mg/100iu=2.5mg/iu. In order to get a dose of 43mg would require 43/2.5=17.2iu.

So I've been dosing approx. 18iu's every third day. That's in order to get approx. 100 mg per week. Did I have that figured out correctly?

Here are the results after 7 weeks (all tests from LabCorp)

Original: Total T 581 (264-916)
Free T 5.8 (6.6-18.1)

Current: Total T 1082 (264-916)
Free T 22.6 (6.6-18.1)

I noticed although my total T has slightly less than doubled my free T has almost quadrupled. Since I'm above the ranges in both category's shouldn't I be reducing my dosage? I'm thinking of dropping them by about 20%. Does that seem about right?

Finally I'm planning on more extensive blood tests at the end of my first 90 days. Other than checking T, estradiol, hematocrit, are there others that would be useful at this time?

Thanks.

Yes, 100 units on an insulin syringe = 1.0mL.
Your calculations are correct.

Given your original Total T was well into the "normal" range and your original Free T was very low, I suspect your problem is with high SHBG. You may want to have that measured in your next set of labs. I'd bet it's way high and probably over 70 nmol/L. It's common for guys with high SHBG to have inflated Total T levels because SHBG protects T from liver metabolism. On the downside, SHBG also tightly binds T and T cannot pass through the blood-brain barrier when it is bound, so you feel like $%^# even when you're swimming in T.

Bottom line is that when treating low Free T, you should pretty much ignore Total T for dosing and focus on adjusting the dose to optimize Free T. The challenge is that the Free T "normal" ranges are age-adjusted. As we age, SHBG normally increases and since they calculate normal ranges based on a sampling of people in that age range, the "normal" values they give you decline as you get older. I'm in my 60's and when I look around me at my peers, there's no way I want the "normal" Free T levels of a typical out of shape guy in his 60's!

My approach to handling high SHBG (mine is in the 90 nmol/L range) is to adjust the T dose so that my free T is in the upper 75th percentile for a 30 year old male. Difficulty is that they don't give those values when they report the labs, just the range for your age group. It took some digging around on the internet, but I finally found them for LabCorp (where I get my tests done).

* 20-29 years 9.3-26.5 picogram/mL
* 30-39 years 8.7-25.1 picogram/mL
* 40-49 years 6.8-21.5 picogram/mL
* 50-59 years 7.2-24.0 picogram/mL
* 60+ years 6.6-18.1 picogram/mL

Upper 75th% for ~25 Y/O = ~22.2
Upper 75th% for ~35 Y/O = ~21.0
Goal = 75th% for 30 Y/O = >21 to <22 pg/mL

Since you are in my age group according to your original post, I think your dose is right on target and would not adjust it unless you are having side-effects (high DHT, BPH, E2, hemoglobin/hematocrite production are the most common). At some point you will want to have DHT and E2 (sensitive test only) done. I highly recommend running all labs immediately before your scheduled injection (morning of day 3 on your E3D protocol). That way labs are comparable from one lab draw to the next.

Regarding labs, Yes, my standard monitoring labs when adjusting the dose are a full T panel (Total T, Free T, SHBG), DHT, E2. I usually also run CBC (to monitor hemoglobin/hematocrit) 2-3 times per year. PSA and CMP (liver) once per year at my annual check up.

[Youthful55guy]

Oh, I didn't see your last post. See my prior post. I strongly recommend testing on day 3 of your E3D protocol, just prior to your scheduled injection (nadir values) and to always maintain the same 72hour post-injection lab draw schedule for all your labs. That way you can compare one lab to another.