Just started TRT, recent lab questions

Greetings Everyone, I just started TRT with 200mg/ml compounded test cream (.5ml 2x daily) w/ anastrozole (0.5mg 3x a week). It's been just over a week and even though it seems early, I decided to do some labs. For comparison, my labs before TRT were:


Total Testosterone......392.......348-1197
Free Testosterone ......6.0 ….....8.7-25.1
Estradiol ………………...21.5 ......7.6-42.6

And after just one week:

Total Testosterone……926……...348-1197
Free Testosterone ……20.5 ….....8.7-25.1
Estradiol, sensitive……<3 …….….3-70

This seems to be a huge jump in Total and free T. Is it possible that some of the cream on my arm threw off the reading? I made sure not to apply near the blood draw site and scrubbed and alcohol swabbed the area before. Blood draw was 4 hours after I applied my morning cream.

This time I had the sensitive E2 test. The level is pretty shocking. Is this something I should be worried about? Perhaps cut the anastrozole from 3 to 2 times per week? unfortunately the .5mg dose is in capsules that i can't divide up. Even with such supposedly low E2, i have noticed more nipple sensitivity since starting with the Test and Anastrozole.

Lastly, and most importantly, even with these much higher test and lower e2 levels, I barely feel any different from pre-trt. Just a little bit better. Again its only been a week. Too early to tell?

I have more labs pre-trt if anyone is interested, SHBG, LSH, LH, etc..

Thanks kindly everyone

i am not surprised at your levels being out of whack, you didn't have enough time to convert to e2 and while taking 1.5mgs AI it crashed your e2! yea back off AI a bit, twice a week 0.5 would probably be the right amount! but it is very early to do blood work to make a proper adjustment! usually you need to do it after 4 weeks, thats when your level become more stable.

Quote:

---

Originally Posted by frigger

Greetings Everyone, I just started TRT with 200mg/ml compounded test cream (.5ml 2x daily) w/ anastrozole (0.5mg 3x a week). It's been just over a week and even though it seems early, I decided to do some labs. For comparison, my labs before TRT were:


Total Testosterone......392.......348-1197
Free Testosterone ......6.0 ….....8.7-25.1
Estradiol ………………...21.5 ......7.6-42.6

And after just one week:

Total Testosterone……926……...348-1197
Free Testosterone ……20.5 ….....8.7-25.1
Estradiol, sensitive……<3 …….….3-70

This seems to be a huge jump in Total and free T. Is it possible that some of the cream on my arm threw off the reading? I made sure not to apply near the blood draw site and scrubbed and alcohol swabbed the area before. Blood draw was 4 hours after I applied my morning cream.

This time I had the sensitive E2 test. The level is pretty shocking. Is this something I should be worried about? Perhaps cut the anastrozole from 3 to 2 times per week? unfortunately the .5mg dose is in capsules that i can't divide up. Even with such supposedly low E2, i have noticed more nipple sensitivity since starting with the Test and Anastrozole.

Lastly, and most importantly, even with these much higher test and lower e2 levels, I barely feel any different from pre-trt. Just a little bit better. Again its only been a week. Too early to tell?

I have more labs pre-trt if anyone is interested, SHBG, LSH, LH, etc..

Thanks kindly everyone

---

To answer your question your arm should have NO testosterone on it whatsoever and YES it'ss more then very possible that your panels were compromised. The cream absorbs deeper into layers of the skin where a resivore forms and where washing will have to beneifical effect.

You're taking way to much AI and you have to be exhibiting some of the negative symptoms. Generally speaking, men on a cream or gel don't need an AI so the dosage your taking is too much...try cutting back to just .5 mg per week and get retested in 6 weeks.

You probably don't feel any changes because 1) way to early in your protocol to feel or see any changes yet and 2) your Test assay is most likely compromised and not a true reading.

GD, not questioning your reasoning but i am curious! since they draw blood from the vein, how can that be compromised? are you saying even that little entry through the skin is enough to through things out of whack? BTW, that was my thought as well, drawing blood from the same spot where he applied, but don't know exactly how!

I would say it's unlikely your test level was compromised based on the fact your free:total test ratio is about where it should be. Otherwise the free level would have been super elevated.

Waiting a week to get a test level with transdermal applications is just fine. Actually, waiting longer is a waste of time for dosage adjustments. For E2 it would be best to give it more time for it to stabilize.

Like gd said, you probably don't need to be taking an AI.

Quote:

---

Originally Posted by bass

GD, not questioning your reasoning but i am curious! since they draw blood from the vein, how can that be compromised? are you saying even that little entry through the skin is enough to through things out of whack? BTW, that was my thought as well, drawing blood from the same spot where he applied, but don't know exactly how!

---

Yes it can bass.

Not only does my Physician speak to it I have read both Shippen and Crisler state the same.

His total is very high for a transdermal...not saying it can't happen...there are hyper-responders for sure...but not many.

I still say one week is a bit soon but possible I guess.

Quote:

---

Originally Posted by ecdysone

I would say it's unlikely your test level was compromised based on the fact your free:total test ratio is about where it should be. Otherwise the free level would have been super elevated.

Without SHBG and Albumin I think this is hard to substantiate..don't you e?

Waiting a week to get a test level with transdermal applications is just fine. Actually, waiting longer is a waste of time for dosage adjustments.

General rule of thumb is two weeks for gel/creams and 6 for IM...correct?

For E2 it would be best to give it more time for it to stabilize.

Yup!

Like gd said, you probably don't need to be taking an AI.

---

Yup!

Bold.

Quote:

---

Originally Posted by gdevine

Yup!

---

(1) No, that's the entire point. Free test requires SHBG to equilibrate with it. If all of a sudden you 'dumped in' a "contaminating" amount, it wouldn't have time to equilibrate and therefore the free test would be extremely high. In this case the OP's ratios were reasonably close to his pre-treatment ratios.

(2) Back when I used Axiron, the end point studies showed that for transdermal applications, in which peak levels occur within a couple of hours (almost like oral use), the endpoint concentration will be approached (to within 90%) in 3-5 days. After a week you will be very close to the final level, so this is the time to make a dosage adjustment. If you are purist, waiting a few more days might give you that last 5% or so, but it's not necessary for dosage adjustments.

IM/SQ is a totally different animal because of diffusion from the oil reserve. Transdermal is almost like IV with an hour or so buffer. Just for interest, if we did IV then the final predicted level would be reached within 3-5 hours of continuous administration.

Thanks kindly for all the replies everyone. It's a big help. I will ease off the AI, maybe just 0.5 a week. It does feel like I'm having high e2 symptoms, but could tese just be caused by ultra low e2?

Next blood draw I will only apply to the opposite arm as opposed to both.

btw my SHBG is 43.5 on a range of 16.5-55.9

Thanks again!

Quote:

---

Originally Posted by ecdysone

(1) No, that's the entire point. Free test requires SHBG to equilibrate with it. If all of a sudden you 'dumped in' a "contaminating" amount, it wouldn't have time to equilibrate and therefore the free test would be extremely high. In this case the OP's ratios were reasonably close to his pre-treatment ratios.

(2) Back when I used Axiron, the end point studies showed that for transdermal applications, in which peak levels occur within a couple of hours (almost like oral use), the endpoint concentration will be approached (to within 90%) in 3-5 days. After a week you will be very close to the final level, so this is the time to make a dosage adjustment. If you are purist, waiting a few more days might give you that last 5% or so, but it's not necessary for dosage adjustments.

IM/SQ is a totally different animal because of diffusion from the oil reserve. Transdermal is almost like IV with an hour or so buffer. Just for interest, if we did IV then the final predicted level would be reached within 3-5 hours of continuous administration.

---

not trying to argue but want to learn! imho, just the fact that he did not convert to e2 is an indication not much test made it to his bloodstream! i know its too soon to convert but as per your theory that the pump gets in the blood stream fast then where the e2 conversion?! in my conclusion i think the blood test was compromised! but this is just my opinion and GD for that matter, and the doctors he mentioned..... also like to mention the fact his SHBG is high is another indication that he is binding some, and therefor his test shouldn't read that high!

I don't know about compunded creams, but here is what the prescribing information for Androgel 1.62% says about dose adjustments:

To ensure proper dosing, the dose should be titrated based on the pre-dose morning serum testosterone concentration from a single blood draw at approximately 14 days and 28 days after starting treatment or following dose adjustment.

Their recommendation is to titrate up/down based on a 350-750 ng/dl range, so it would be in the gel users' best interest to draw pre-dose if an increase is desired. At least that's how I plan to do it...

Quote:

---

Originally Posted by ecdysone

(1) No, that's the entire point. Free test requires SHBG to equilibrate with it. If all of a sudden you 'dumped in' a "contaminating" amount, it wouldn't have time to equilibrate and therefore the free test would be extremely high. In this case the OP's ratios were reasonably close to his pre-treatment ratios.

(2) Back when I used Axiron, the end point studies showed that for transdermal applications, in which peak levels occur within a couple of hours (almost like oral use), the endpoint concentration will be approached (to within 90%) in 3-5 days. After a week you will be very close to the final level, so this is the time to make a dosage adjustment. If you are purist, waiting a few more days might give you that last 5% or so, but it's not necessary for dosage adjustments.

IM/SQ is a totally different animal because of diffusion from the oil reserve. Transdermal is almost like IV with an hour or so buffer. Just for interest, if we did IV then the final predicted level would be reached within 3-5 hours of continuous administration.

---

How are final levels predicted?

^^^ bad wording, should have said final equilibrium level.

The manufacturer's recommendations for when to measure test after beginning transdermal therapy are all around 2-4 weeks. I'm referring to the actual FDA studies which show near final levels being achieved after 5 days or so. That's because the "half life" for transdermal applications could be thought of as being 2-4 hours in contrast to IM/SQ with their 5-7 day half life.

Quote:

---

Originally Posted by bass

just the fact that he did not convert to e2 is an indication not much test made it to his bloodstream!

---

Not saying your wrong, but for some reason with the Gels, there normally isn't that much E2 conversion. Might just be the amount of AI was enough to drive it to very low values. However, I would say that E2 is produced almost instantly and tracks very closely the test levels, so from that viewpoint it should have been higher.

Not arguing either, only agreeing to disagree :)

frigger: what was you pre-TRT SHBG?

ecdysone,

Pre-TRT SHBG was 43.5 on a range of 16.5-55.9

Thanks!
Brad

Quote:

---

Originally Posted by ecdysone

Not saying your wrong, but for some reason with the Gels, there normally isn't that much E2 conversion. Might just be the amount of AI was enough to drive it to very low values. However, I would say that E2 is produced almost instantly and tracks very closely the test levels, so from that viewpoint it should have been higher.

Not arguing either, only agreeing to disagree :)

frigger: what was you pre-TRT SHBG?

---

Quote:

---

Originally Posted by frigger

ecdysone,

Pre-TRT SHBG was 43.5 on a range of 16.5-55.9

Thanks!
Brad

---

how about the one you posted earlier, was that after TRT, or is it the same test?

same test. did not get SHBG tested again

Quote:

---

Originally Posted by bass

how about the one you posted earlier, was that after TRT, or is it the same test?

---

Great read and topics like this are always helpful, all good info - a quick question;

Why start an AI at all? I would come off the AI until the blood tests show a reason to be on them. I could see if he was jumping on a 500-800mg cycle of injectables, but too early in TRT for an AI (IMHO).

the doc just thought it was a safe bet to start AI with the compounded cream. Even I thought 1.5mg a week was too much based on my own research. glad to hear this is confirmed by all of you. i'm going to go off all AI's for a week or two and see how i feel. Is 30mg of zinc a day still ok? or will this also deplete E2 substantially?

Quote:

---

Originally Posted by Herman Munster

Great read and topics like this are always helpful, all good info - a quick question;

Why start an AI at all? I would come off the AI until the blood tests show a reason to be on them. I could see if he was jumping on a 500-800mg cycle of injectables, but too early in TRT for an AI (IMHO).

---

Quote:

---

Originally Posted by Herman Munster

Great read and topics like this are always helpful, all good info - a quick question;

Why start an AI at all? I would come off the AI until the blood tests show a reason to be on them. I could see if he was jumping on a 500-800mg cycle of injectables, but too early in TRT for an AI (IMHO).

---

conversion starts immediately depending on the individual, for example i was put on 1 mg Adex everyday for teh first week while i was on 200 mgs test, then reduced it to 1 mg each day two days after my shot then 0.5 mg the rest of the week, so you can see thats allot of AIs! four weeks later i did blood work and my e2 was at 31 range 7.5-42. some of us convert allot and very quickly and some don't at all like our members JohhnyVegus and KelKel!

bass

Absolutely agree on the differing rates; is it not safer to assume a slower conversion than a quick conversion? Come in slow on the AI, await testing then react? Was your 200mg of test inject or transdermal? Is 200mg of test cyp injected the same as receiving 200mg via a transdermal?

Frigger - As for feeling different or better, when my test levels were low I had no libido and no morning or nighttime wood. I have the similar issues when my E is off (either low or high), my libido is off and my morning wood is sporadic. When I am in between blood work this is how I gauge my administration of AI. Not exactly a science and may not work for you, but as Bass could probably tell you, you learn to read your bodies signs and symptoms.