Looking for advice...

[BrysZ]

Hello again,

I am currently prescribed for a TRT dose of 1ml or 200mg per week. I have been prescribed this increased dosage for about a year being a TRT patient for 4 years total. I normally don't inject 1ml a week because I don't need this much but I want to keep my script dosage the same so I have extra test to run small blasts. Over the past 3 years I know if I run .5ml per week I am about right in the middle for free test. If I run .75ml I am flirting with the high limit.

The reason for my post is at my last exam my doctor said my free test was at 1100 and wanted to immediately reduce my script. I convinced her to let me get BW done again but I am not sure if I should skip a week of test or dose at .5ml. I want to lower my free test but I also don't want it so low that she becomes suspicious that I am not following the script before BW. I hope I have made since and I also hope to gain some insightful feedback not unrelated questions and critical criticism.

Thank you
Bryan

[kelkel]

Do you happen to have a copy of your BW?
Do you inject once per week or twice?
When was blood pulled relative to your last injection?

[BrysZ]

Sorry I dont have BW results
I inject once a week
I injected 1 week prior to BW

Thank you

[kelkel]

Ok, I think your doc meant your total test was 1100? If you knew what your free test was and the range we could make a better decision. Can you find out? Maybe ask the doc's office to fax you a copy of your BW? Know that if you're at 1100 a week after your shot then you're probably close to twice as high the day after your shot when test peaks.

[BrysZ]

I just sent my Endo an email asking for Total and Free from my last BW along with the normal ranges. Thank you so much for your help. I will post it as soon as she sends them to me.

[kelkel]

I post similar graphs frequently so the guys can visualize how test metabolizes. Keep in mind we all metabolize differently, some faster, some slower.

[BrysZ]

Here are my results...

Total testosterone (250-836) yours was 1119.0, sex hormone binding(14.5-48.4) yours was 67.6, free testosterone (47-244) yours was 169.4

[kelkel]

Ok. First, the scale your lab is using is old and out-dated. The more modern, accepted range for TT is 348 - 1197. It's been expanded since that range was used years ago. Put's you in range doesn't it? That said, ranges don't mean all that much, they are just guides and you should not be treated as only a number. Treatment should be based on how you feel as well.

Also know that total T is really meaningless. Free T is what matters as it's what works for you. Free is just that, free and useful to us. You could have a TT level of 10K but if your free T is in the toilet, you'll feel like crap. Make sense? Your doc needs to start basing your titrations on your FT, not TT.

Your SHBG level is elevated, which is why your FT is basically mid-range and not higher. SHBG is what transports hormones in your blood stream and it binds testosterone , as does albumin to a little extent. When SHBG rises (as it can for many reasons, including simply aging) it binds more T. There are a few things you can try to lower it (mid-range is best) such as Stinging Nettle Root and or Avenacosides. There are drugs that will do so but it will simply rise when you stop taking them. Referring to Danazol and Proviron , a DHT.

Make sure your Vit D level is optimized as it will help reduce shbg as well. Vit D is a hormone, not a vitamin and one of the most important ones you can take, imho. Step one is to pull BW to test it first. Most in N. America are low and can easily take 5K IU per day without issue. Optimizing DHEA levels can also help reduce it. Be sure to test this as well and to use a micronized product only if implemented.

Now, the quickest way to reduce shbg is to add testosterone. That won't happen here so there are different schools of thought on injection protocols that will help with it. Some say that injecting half the amount twice per week will help to push it down more frequently. Since you inject once per week now it would be worth trying this and seeing if it improves. It's also a solid way to maintain a more steady level of serum T and reduce estrogen conversion. Speaking of which, what is your E2 level?

A personal example. I keep my TT in the 1400's to 1500's to keep my FT at the top of the chart. This is using 60-70 mgs of T twice per week.

To sum up, your doc needs to refocus on your FT, not total T.

Hope it helps.

[BrysZ]

Thank you again. I made these points to my Endo here is our correspondence...

I understand but we must go by what our lab sets as high for their calibration. Each lab sets their own high and low, and there is quite a bit of variation between labs. The free testosterone is well within range, I do agree; just get a little concerned when the total is over the high end due to the effect of increasing red blood cells. With any medication you want to go with the lowest effective dose.

----- Message -----
From: LAVIGNE,BRYAN M
Sent: 9/30/2015 10:40 PM CDT
To: Kathy Ziembo, N.P.
Subject: RE: Non-Urgent Medical Question

Shannon thank you for the quick reply. I posted my results on a TRT internet forum and they had two points of interest that I want to express to you and Kathy. First today's high end of the normal range for total testosterone is 1100. The range you have me is outdated. Second we should be focusing more on the free testosterone rather than total. I was hoping for your thoughts on these comments. Thank you Bryan

[BrysZ]

If I use the chart you posted and considering I was at 1100 one week after the injection then can I assume I was at approximately 1500 the day after the injection?

[BrysZ]

I intend of splitting my dosage up and injecting twice a week...good advice. Also I will up my vitamin D to 5000 IU/day.

Thank you again for all your help!

[kelkel]

We'd be guessing exactly where you were the day after injection but definitely higher!
Your doc doesn't need to go by that range at all. But at least now she knows you are educating yourself. That old range with its lower bottom numbers tends to eliminate people who need TRT and the upper range causes the opposite issue. Case in point, you! Your TT is relatively high yet your FT is not.
She is correct to keep an eye on your H & H. Nice that she's willing to communicate like this as so many will not.

[BrysZ]

Well it looks like she wants me to get the BW redone. I think I will drop down to .5ml/week and wait until they make me go in. I just hope I am not too low then and she suspects that I am varying the dosage in order to keep my script high.