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04-04-2013, 07:51 AM #321
It's been a while, I figured I'd update everybody as to the latest.
A lot has gone on since I last logged. I was able to get my PCP to agree to take over my TRT care and continue with my existing protocol. This is wonderful news for me for many reasons:
1 - he's in my healthcare network. The doc I was seeing wasn't, and I had to pay out of pocket for office visits
2 - he writes me scripts for labs and I just go to Labcorp at my convenience. The last doc drew blood at his office then sent it out. That meant double the number of office visits ($$ and inconvenience) - 1 just to draw blood, and a follow up to review results.
3 - he's in my hometown. I can schedule appts. right after work as his office is on my way home. The last doc was in the same town I work in, and I had to schedule appts during work time. When appts would run late (as they always do), I'd wind up with anxiety worrying about work, etc.
4 - before I started TRT, I called my PCP (obviously) to ask if they dealt with this kind of care. I was told (by the front desk, not the doc) that he only prescribes gel, etc. By having already established a protocol with the other doc, it was pretty easy for me to walk in with recent labs, show my PCP what we've been doing, and ask him to simply 'take over'. He agreed without batting an eyelash.
Now, on to a few issues/questions. With the last doc, I was never asked to fast before they drew blood. This doc told me to, and further, at Labcorp this morning (results posted as soon as I have em' in hand) I was asked if I had eaten. Was the last doc doing me a disservice by not having me fast? Could EVERYTHING potentially have been skewed?
Next - with the last doc, they drew LOTS of blood - I mean upwards of 10 vials. I just figured that was necessary given all the labs I was asking to have done (CBC, Lipids, Metabolic, Cortisol, E2, Prolactin, etc). At Labcorp this morning, only 3 vials were drawn. Was the original doc overdoing it, or did Labcorp fvck up this morning? This has me concerned.
Finally - I've been feeling pretty good lately. I'm VERY curious to see how prolactin comes back, because I haven't really been experiencing the symptoms lately which I believe were related to slightly elevated PRL. I'm also interested to see how test and cortisol come back now that labs were done in the am, fasted.
Currently, I'm still at 200mg/week (100mg every 3.5 days) and HCG at 300iu 3x weekly (Mon-Wed-Fri). Still no AI, no signs of E2 sides as far as I can tell. Hopefully, they'll get the fcking sensitive assay right this time as I gave Labcorp their own codes directly (thanks for the info Kel).
I'll follow up with lab results asap. In the meantime, I very much look forward to any/all feedback!
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04-04-2013, 08:04 AM #322
Cool, looks good. Pretty much the same thing I did.. Well my endo said to start to see my GP
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04-04-2013, 12:57 PM #323Junior Member
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As far as the blood goes my doctor takes 3 vials also, but has never said anything about fasting.
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04-04-2013, 09:28 PM #324
Ditto, 3 vials and not always full vials, and never told to fast. In fact, on my 1st blood draw appointment I asked if I should fast and was told it was not necessary for the testosterone related tests.
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04-05-2013, 08:04 AM #325
Thanks guys, sounds like 3 vials is pretty standard. Maybe the last doc was a fvcking sadist!?!
As for fasting - good to know, doesn't sound like it's necessary. It wasn't a big deal though as I went in the morning, basically just skipped breakfast, which allowed me to eat more later in the day.
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04-05-2013, 12:48 PM #326
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04-10-2013, 08:09 AM #327
Latest Labs (LabCorp). Blood drawn in the am, fasted state:
Note: this was taken from a report that gets emailed to me, so it's not the 'hard copy', hence, you'll see some numbers that only show > vs. the actual number. I'll update with the actual figure when I have the hard copy in my hands.
Testosterone, Free and Total
Free Testosterone (Direct) >50.0 8 (7-25.1)
Testosterone, Serum >1500 (348-1197)
Note: Holy shit! Free test is above 50? Anything to worry about here?
CBC/Diff Ambiguous Default
Neutrophils 65 % (40-74)
Baso (Absolute) 0.0 x10E3/uL (0.0-0.2)
Lymphs 24 % (14-46)
Immature Granulocytes 0 % (0-2)
Hematocrit 48.3 % (37.5-51.0)
RBC 5.20 x10E6/uL (4.14-5.80)
MCH 30.6 pg (26.6-33.0)
MCHC 32.9 g/dL (31.5-35.7)
MCV 93 fL (79-97)
Monocytes 8 % (4-13)
Hemoglobin 15.9 g/dL (12.6-17.7)
Lymphs (Absolute) 1.6 x10E3/uL (0.7-4.5)
Immature Grans (Abs) 0.0 x10E3/uL (0.0-0.1)
Eos (Absolute) 0.1 x10E3/uL (0.0-0.4)
WBC 6.4 x10E3/uL (4.0-10.5)
RDW 14.6 % (12.3-15.4)
Platelets 201 x10E3/uL (140-415)
Eos 2 % (0-7)
Neutrophils (Absolute) 4.2 x10E3/uL (1.8-7.8)
Basos 1 % (0-3)
Monocytes(Absolute) 0.5 x10E3/uL (0.1-1.0)
Estradiol, Sensitive
Estradiol, Sensitive 39 pg/mL (3-70)
Sex Horm Binding Glob, Serum
Sex Horm Binding Glob, Serum 40.4 nmol/L (16.5-55.9)
Note: Not thrilled with this number. Stopped taking nettle root a while ago (simply ran out)... looks like I need to restock.
Prolactin
Prolactin 9.3 ng/mL (4.0-15.2)
Note: VERY happy with this. As some of you may remember, mine was (slightly) elevated the last couple of labs.
Comp. Metabolic Panel
BUN 26 mg/dL (6-20) Flagged High
Sodium, Serum 136 mmol/L (134-144)
Glucose, Serum 82 mg/dL (65-99)
Creatinine, Serum 1.19 mg/dL (0.76-1.27)
Albumin, Serum 4.3 g/dL (3.5-5.5)
Carbon Dioxide, Total 23 mmol/L (20-32)
Potassium, Serum 4.2 mmol/L (3.5-5.2)
Calcium, Serum 9.0 mg/dL (8.7-10.2)
eGFR If Africn Am 90 mL/min/1.73 (>59)
A/G Ratio 2.0 1 (1.1-2.5)
Globulin, Total 2.1 g/dL (1.5-4.5)
ALT (SGPT) 34 IU/L (0-44)
AST (SGOT) 34 IU/L (0-40)
eGFR If NonAfricn Am 78 mL/min/1.73 ( >59)
Alkaline Phosphatase, S 45 IU/L (25-150)
Bilirubin, Total 0.9 mg/dL (0.0-1.2)
Chloride, Serum 100 mmol/L (97-108)
Protein, Total, Serum 6.4 g/dL (6.0-8.5)
BUN/Creatinine Ratio 22 1 (8-19) Flagged as high
Cortisol
Cortisol 12.6 ug/dL (2.3-19.4)
Lipid Panel
Cholesterol, Total 128 mg/dL (100-199)
HDL Cholesterol 41 mg/dL (>39)
Triglycerides 55 mg/dL (0-149)
LDL Cholesterol Calc 76 mg/dL (0-99)
VLDL Cholesterol Cal 11 mg/dL (5-40)
Note: Argh.... forgot to ask for a Thyroid panel!! Opted not to have DHEA tested for since I already supplement with it regardless, and there's nothing more I can do (to my knowledge) to bring it up. Figured why bother paying for an additional test...
Anyway, feedback!?!Last edited by gbrice75; 04-10-2013 at 08:29 AM.
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04-10-2013, 08:50 AM #328Banned
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GB, on the fly with my phone, so can't post that much. Your free test is just relative to your high serum score. Get your serum reduced to a normal range and your free test will follow suit.
I'll try to post more later ...
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04-10-2013, 09:12 AM #329
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04-10-2013, 10:22 AM #330Member
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shbg doesn't mean a thing if your free is at 50! Lower your dosage and get that serum down, your free will drop as vette said as well as estrogen which in turn should lower shbg ( add some vitamin d3 to lower it as well)... Having a free testosterone level twice the top of the range is not healthy long term
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04-10-2013, 10:37 AM #331
Re: dropping estrogen - I'm pretty happy with where it's at currently - do you/any of you feel it's too high?
Already supplementing 50,000iu D3/week. Gotta restock nettle root as it seemed to help while I was using it.
This is what my main concern was/is, but are you certain about this? I'm under the impression (and could easily be wrong) that total test being too high is the bigger concern vs. free test. Also, I would have expected to see higher E2 considering I'm not currently running any AI (but do have adex on hand).
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04-10-2013, 11:02 AM #332Member
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04-10-2013, 11:04 AM #333Banned
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GB, it will be near impossible to sustain a healthy balance, or call it homeostasis for the long-haul when testosterone levels are this elevated (as noted by Jomamma). Your testosterone serum is calculated at slightly over 1,900ng/dl, which puts your free testosterone at 2.64%. Regardless of your total serum level, your free and bio-available testosterone is what your body is using, and it will usually be in the 2% to 3% range, which is ideal. This is contingent on SHBG, and weakly on albumin. IMO, I wouldn't put too much focus on your SHBG at this point, and would look more at reducing your serum to a more sustainable level. Again, if you're in the 2.6% range right now, you can easily figure out where that will put you relative to your serum (e.g., 1,000ng/dl = 26.0ng/dl).
Can you briefly tell me your protocol again, and when you took your last injection relative to your labs?
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04-10-2013, 11:31 AM #334
Understood Vette, and appreciate your attempt to explain to a mathematical retard (me) how to calculate. However, you state that 2-3% range is ideal for free test, and I'm at around 2.64% - so what exactly is the concern?
My protocol is currently 200mg cyp/week (100mg every 3.5 days). I know this is high and do plan to lower it... just wanted to get these labs over with first.
300iu HCG 3x weekly (Mon-Wed-Fri). AI on hand but not currently using it. This lab was done fasted, 8am Thursday morning - roughly 12 hours after my last injection. I've been told this isn't ideal, but that also confuses me as with cyp being a long/slow ester, I can't make the connection as to how an injection would affect blood being drawn only 12 hours later.
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04-10-2013, 12:03 PM #335Banned
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GB, the concern is the amount of free testosterone that is unbound in the body. The percentage is constant, and in most men will be 2% to 3% of the total serum level. If it's higher/lower than that, then that's where the focus on SHBG will be directed. So, you could have a total serum of 300ng/dl, or it could be 3,000ng/dl, the amount in your case (right now) would be 2.64%. Again, it's not the % percentage % that is the concern, but the ACTUAL amount of testosterone in your system, which is calculated (TS * %) or (1900 x 2.64 = 50ng/dl of free test). The range is 7 - to -25ng, so you're double the max on the LabCorp reference range. Me personally, I think 18ng to 26ng/dl of free test is a long-term, sustainable range for TRT, but that's just my .02 on that. The ONLY way you will get in that 26ng/dl bracket for free testosterone is to reduce your total serum to the 1,000ng/dl or lower, which will require an adjustment to your exogenous protocol.
Hopefully this isn't confusing the matter.Last edited by Vettester; 04-10-2013 at 12:06 PM.
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04-10-2013, 12:10 PM #336
Also looks like he did BW early correct?
If he waited wouldn't those numbers improved
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04-10-2013, 12:41 PM #337
I think I got it now Vette... the bold did it. I'll probably start with a small adjustment... 160g/week and then take it from there. I assume i'll probably wind up at around 120g/week though in the long run.
Early as in the time of day? Yes. I assume test numbers would have decreased later in the day, as well as cortisol.
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04-10-2013, 01:04 PM #338
It's possible the numbers would have improved. Just depends on how GB metabolizes his testosterone . Vettes on the money (love the calculations) as expected. I would add the stinging nettle back in as well as titrate back to 75mg x 2 per week and re-do bloods (abbreviated) in 4 weeks or so. Now, I'm not saying your E2 is elevated as we are all different, but when E rises so does shbg. LEF recommends between 20-30 but we are all different. The opposite would be increasing test suppresses shbg. Catch 22 huh! Also remember that nettle can possibly lower dht levels too. So.....
The Testosterone Controversy - 2 - Life Extension
It's all about how you feel GB. Well, that and long term health, building muscle, erectile ability, hair loss, healthy H & H levels, etc. But I digress....
Also. If you still aren't happy with your shbg level then you may consider injecting one time per week (gasp) as it will suppress it more with the larger dose as opposed to the twice per week smaller dosing schedule. It remains to be seen what will happen after reducing your injection amount.Last edited by kelkel; 04-10-2013 at 01:07 PM.
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04-10-2013, 01:32 PM #339
Thanks Kel. Definitely adding the nettle back in, especially considering the potential to lower DHT (I wasn't aware of that).
Aside from that, I'm wondering if I should start up adex again (I was running it for a very brief period, but discontinued... for no good reason honestly)... my dosage was already relatively low at .25mg 2x weekly (day after my injections).
We can cross hair loss off the list... that concern has LONG since been a non-issue!
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04-10-2013, 01:34 PM #340
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It's pretty obvious you're taking just way way too much testosterone . That's really the low hanging fruit that needs to be addressed first.
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04-10-2013, 02:38 PM #342
Noted, thx Kel.
On it guys... agreed, blatantly obvious at this point. I was waiting for this labwork (big gap due to switching providers, etc) to confirm that which I already was expecting... going to knock it down to 75g/week as suggested, then retest. Probably won't be in 4 weeks (out of pocket expense more or less), but next labs will be at that dosage.
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04-10-2013, 03:29 PM #343
For the sake of me not knowing, what is all that extra Free Test doing...? I'm surprised your Hematocrit and Hemoglobin isnt much higher.. Do you give blood?
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04-10-2013, 08:06 PM #344~ PLEASE DO NOT ASK FOR SOURCE CHECKS ~
"It's human nature in a 'more is better' society full of a younger generation that expects instant gratification, then complain when they don't get it. The problem will get far worse before it gets better". ~ kelkel
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04-11-2013, 08:04 AM #345
Hopefully building muscle!
Re: Hema and Hemo - I just gave blood about 6 weeks ago. Both were JUST over the high end of the range. Will be donating again in a couple months.
I can't say for sure Austin... only because I always have a slight fatigue lol. The time I have to sleep isn't great to begin with (roughly 6 hours) and to make matters worse, I don't sleep very well more often than not. :\
Curious though - why do you ask?
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04-11-2013, 08:07 AM #346
I asked because my cortisol levels were similar to yours. For everyone, cortisol levels drop around 2 to 3 pm, this was causing me to crash, even though I was still in range. Medication fixed that. Since you took this in the AM, your PM number is probably around 7 or 8. But I was just curious, it's possible that it doesn't have the same effect on you.
~ PLEASE DO NOT ASK FOR SOURCE CHECKS ~
"It's human nature in a 'more is better' society full of a younger generation that expects instant gratification, then complain when they don't get it. The problem will get far worse before it gets better". ~ kelkel
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04-12-2013, 07:51 AM #347
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07-08-2013, 09:08 AM #348
Just a brief update - lowered dosage from 200mg/week to 160/week a few months ago. Just got back current labs (test only) and it's still pretty high:
Total Test - 1477 (348 - 1197)
Free Test - 33.8 (8.7 - 25.1)
I'd like to get total down in the 900 range but keep free somewhere in the 25-30 range. What would you suggest? I can lower dosage again to 120mg/wk and see how that goes.
Btw - re: keeping free test up, I am supplementing with nettle root extract and D3.
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07-08-2013, 09:10 AM #349
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07-10-2013, 12:15 AM #350Associate Member
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Gb do u feel any better after lowering your dose?
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07-10-2013, 11:03 AM #351
are you on once a week protocol? if not you may want to consider twice a week protocol.
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07-12-2013, 08:31 AM #352
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10-03-2013, 02:43 PM #353
Latest labs, tests done on 9/20. Appreciate any and all feedback.
Current regimen is 60mg cyp every 3.5 days. 300iu HCG M/W/F. No AI (but have arimidex on hand just in case)
CBC With Differential/Platelet
WBC 6.0 x10E3/uL (3.4 − 10.8)
RBC 5.53 x10E6/uL (4.14 − 5.80)
Hemoglobin 17.1 g/dL (12.6 − 17.7)
Hematocrit 49.5 % (37.5 − 51.0)
MCV 90 fL (79 − 97)
MCH 30.9 pg (26.6 − 33.0)
MCHC 34.5 g/dL (31.5 − 35.7)
RDW 12.8 % (12.3 − 15.4)
Platelets 178 x10E3/uL (155 − 379)
Neutrophils 62 % (40 − 74)
Lymphs 27 % (14 − 46)
Monocytes 7 % (4 − 12)
Eos 3 % (0 − 5)
Basos 1 % (0 − 3)
Neutrophils (Absolute) 3.8 x10E3/uL (1.4 − 7.0)
Lymphs (Absolute) 1.6 x10E3/uL (0.7 − 3.1)
Monocytes(Absolute) 0.4 x10E3/uL (0.1 − 0.9)
Eos (Absolute) 0.2 x10E3/uL (0.0 − 0.4)
Baso (Absolute) 0.0 x10E3/uL (0.0 − 0.2)
Immature Granulocytes 0 % (0 − 2)
Immature Grans (Abs) 0.0 x10E3/uL (0.0 − 0.1)
Comp. Metabolic Panel (14)
Glucose, Serum 96 mg/dL (65 − 99)
BUN 26 High mg/dL (6 − 20)
Creatinine, Serum 1.14 mg/dL (0.76 − 1.27)
eGFR If NonAfricn Am 82 mL/min/1.73 >59
eGFR If Africn Am 94 mL/min/1.73 >59
BUN/Creatinine Ratio 23 High (8 − 19)
Sodium, Serum 140 mmol/L (134 − 144)
Potassium, Serum 4.1 mmol/L (3.5 − 5.2)
Chloride, Serum 105 mmol/L (97 − 108)
Carbon Dioxide, Total 24 mmol/L (19 − 28)
Calcium, Serum 9.1 mg/dL (8.7 − 10.2)
Protein, Total, Serum 6.9 g/dL (6.0 − 8.5)
Albumin, Serum 4.5 g/dL (3.5 − 5.5)
Globulin, Total 2.4 g/dL (1.5 − 4.5)
A/G Ratio 1.9 (1.1 − 2.5)
Bilirubin, Total 0.7 mg/dL (0.0 − 1.2)
Alkaline Phosphatase, S 49 IU/L (44 − 102)
AST (SGOT) 34 IU/L (0 − 40)
ALT (SGPT) 37 IU/L (0 − 44)
Lipid Panel
Cholesterol, Total 156 mg/dL (100 − 199)
Triglycerides 47 mg/dL (0 − 149)
HDL Cholesterol 48 mg/dL (>39 )
VLDL Cholesterol Cal 9 mg/dL (5 − 40)
LDL Cholesterol Calc 99 mg/dL (0 − 99) (SHOULD I BE CONCERNED??)
Testosterone,Free and Total
Testosterone , Serum 1186 ng/dL (348 − 1197) (FINALLY WITHIN RANGE!!!)
Free Testosterone(Direct) 29.6 High pg/mL (8.7 − 25.1) (AWESOME!)
Cortisol 16.6 ug/dL (2.3 − 19.4) (THIS WAS AM, FASTED - SHOULD I BE CONCERNED??)
(Cortisol AM 6.2 − 19.4
Cortisol PM 2.3 − 11.9)
Prolactin 4.3 ng/mL (4.0 − 15.2) (*VERY* HAPPY TO SEE THIS DOWN)
Estradiol, Sensitive 23 pg/mL (3 − 70)
Sex Horm Binding Glob, Serum 47.6 nmol/L (16.5 − 55.9) (I'M SUPPLEMENTING WITH NETTLE ROOT EXTRACT AND VIT D3, AND STILL THIS HIGH!? ANY SUGGESTIONS?)
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10-03-2013, 03:03 PM #354
BUN may just be dehydration.
LDL. Not really concerned as your overall picture is good. Consider Slo-Niacin at bed time. Using Niacin to Improve Cardiovascular Health - Life Extension
T levels look great.
Couple thoughts on your shbg: Quickest way to suppress shbg is to increase test. You've done that, so, either just give it more time on your current protocol and see if the D/Nettle works over time. Knowing your currend D level would have been good (don't see a DHEA-S either.) Danazol will help with shbg but it's not a means to an end, unless the D & nettle help to hold it down. Other than that you could slightly increase your T if possible to help suppress it for a brief period of time and then return to your protocol and see if it holds. The last part, along with implementing D and Nettle at the same time is what worked for me.
Regardless, your BW looks good GB. Way to go!
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10-03-2013, 03:20 PM #355
looking good GB! wini and var can lower SHBG quickly, but compared to the rest of your levels I wouldn't worry about it. how you feeling?
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10-04-2013, 07:17 AM #356
Thanks Kel. That makes sense (BUN); I'm *extremely* guilty of not drinking enough water, not nearly enough. It's one of my biggest flaws with regard to health. I'm sure a lot more than BUN is being affected too.
If you recall, I've actually *lowered* my T dosage over the past 6 months. I was prescribed 200mg/week and that sent my test through the roof, >1500. Reduced to 160mg/week and was still high (but under 1500). This is my first lab at the 120mg/week dosage and it's looking good, at the high end of the range.
Honestly, I guess I shouldn't be overly concerned with SHBG considering free test is looking really good without total test being super high. That's pretty much the goal, right?
Thanks brother. I'm feeling about the same... going through a stressful time right now so it's hard to get a real real, i.e. my life at the present time isn't comparable to my 'usual' life/day to day routines.
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10-04-2013, 09:23 AM #357
^^^ sorry to heat bro, I hope things will workout for you. stay healthy.
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10-04-2013, 12:43 PM #358
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10-04-2013, 01:04 PM #359
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10-04-2013, 02:27 PM #360
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