Worried After 6 Months on TRT

[bigrack]

Age:58 , Been weight training in the gym for 35 yrs. I train 5 days a week and eat a high protein diet . 5'7 200lbs.
I'm stumped and want to understand what happened before going back to the urologist with my questions. Been reading, but this is all too new to me. All help is appreciated.

I was diagnosed with a level of 260ng. Started with just Test. cyp. 100mg. every 14 days. 6 mo. ago. (no hcg or anything else.) Dr. changed dose to 5 days 100mg. about 2 mo. ago. and recent testosterone level dropped from 391ng./dl. to now 336ng./dl. since.
I did donate blood the day before lab (3/18/17) work because of high hematocrit level from my primary care physician lab work weeks prior to this.

As of 3/19/17 Dose 100mg. average every 5 days.
Testosterone 336 ng/dL 250 - 1100 ng/dL
Free Testosterone 74.2 pg/mL 46.0 - 224.0 pg/mL
Testosterone, Bioavailable 159.0 ng/dL 110.0 - 575.0 ng/dL
Sex Hormone Binding Globulin 15 nmol/L 22 - 77 nmol/L
Albumin, Serum 4.7 g/dL 3.6 - 5.1 g/dL
TSH 0.75 uIU/ML 0.35 - 4.9 uIU/ML
CBC as of 3/19/17
WBC 16.9 K/UL 4.0 - 11.0 K/UL
RBC 5.65 M/UL 4.40 - 5.60 M/UL
HGB 17.1 G/DL 13.5 - 17.5 G/DL
HCT 49.7 % 40.0 - 51.0 %
MCV 88 FL 80 - 97 FL
MCH 30.3 PG 27.0 - 33.0 PG
MCHC 34.4 G/DL 32.0 - 36.0 G/DL
Platelet 188 K/UL 150 - 400 K/UL
RBC Dist Width 13.2 % 12.0 - 14.5 %

Labs into therapy as of 10/27/16 Test. cyp. 100mg. every 14 days.

Testosterone 391 ng/dL 250 - 1100 ng/
Free Testosterone 75.2 pg/mL 46.0 - 224.0 pg/mL
Testosterone, Bioavailable 164.4 ng/dL 110.0 - 575.0 ng/dL
Sex Hormone Binding Globulin 19 nmol/L 22 - 77 nmol/L
Albumin, Serum 4.8 g/dL 3.6 - 5.1 g/dL
Estradiol 17 PG/ML 11 - 44 PG/ML
CBC
WBC 8.0 K/UL 4.0 - 11.0 K/UL
RBC 5.41 M/UL 4.40 - 5.60 M/UL
HGB 16.2 G/DL 13.5 - 17.5 G/DL
HCT 47.5 % 40.0 - 51.0 %
MCV 88 FL 80 - 97 FL
MCH 29.9 PG 27.0 - 33.0 PG
MCHC 34.1 G/DL 32.0 - 36.0 G/DL
Platelet 165 K/UL 150 - 400 K/UL
RBC Dist Width 13.2 % 12.0 - 14.5 %

[kelkel]

Doesn't seem to make sense to me bigrack. On 100 mgs every 14 days, switch to every 5 days and the level goes down slightly. Odd. Test peaks in 24 hrs or so post injection and has a half life of 5-7 days metabolism dependent.

Was blood work pulled just before injection for both blood draws for consistency? Regardless, it appears you need to elevate your dose slightly and retest in a month. If the tests were consistent you may just be a fast metabolizer. Remember to judge by your FT, not your TT. Your SHBG runs low which is why you have decent FT levels even with a lower TT level. It's a good thing as long as you don't have signs of metabolic syndrome.

[bigrack]

Doesn't seem to make sense to me bigrack. On 100 mgs every 14 days, switch to every 5 days and the level goes down slightly. Odd. Test peaks in 24 hrs or so post injection and has a half life of 5-7 days metabolism dependent.

Was blood work pulled just before injection for both blood draws for consistency? Regardless, it appears you need to elevate your dose slightly and retest in a month. If the tests were consistent you may just be a fast metabolizer. Remember to judge by your FT, not your TT. Your SHBG runs low which is why you have decent FT levels even with a lower TT level. It's a good thing as long as you don't have signs of metabolic syndrome.

Yes both labs done right before injection. I just don't know if I have a major concern here or just need an increase in dosage. Can being a fast metabolizer be corrected? Metabolic syndrome?
Thanks!

[kelkel]

No major concern that I'm seeing. Just increase the dose slightly and recheck labs. You'll be fine. How you metabolize is not in your control, if in fact that's even really an issue.

Google metabolic syndrome. Quick read.

[lntense]

Possible that your dose is just too low. I wouldn't settle for anything less than 150mg/week. But I like to be in the 900-1000 range, so long as my BP, cholesterol, and RBC are in check.


Would think your levels would be at least 700-800 at 100mg every 5 days. You must metabolize it at a faster rate, also you said you're injecting right before labs are taken? So 5 days post injection then pulling labs?

[bigrack]

No major concern that I'm seeing. Just increase the dose slightly and recheck labs. You'll be fine. How you metabolize is not in your control, if in fact that's even really an issue.

Google metabolic syndrome. Quick read.

I googled it. I do have Low HDL of 33mg/gl. and take Lisinopril for hypertension for the last 10 years. Other than that everything is fine.

One thing that came to mind, I did get a cortisone shot the day before in my wrist. Don't know if it would mess with my lab work?

[lntense]

I don't know of any studies, but if you google it. Cortisone injections are known to cause a significant decrease in sex drive, and possibly lower natural testosterone levels . I know personally they effect my libido and erection quality, and make me grumpy.



I'm unsure if that would have affected the lab work though. I could see it being possible.

[bigrack]

Possible that your dose is just too low. I wouldn't settle for anything less than 150mg/week. But I like to be in the 900-1000 range, so long as my BP, cholesterol, and RBC are in check.


Would think your levels would be at least 700-800 at 100mg every 5 days. You must metabolize it at a faster rate, also you said you're injecting right before labs are taken? So 5 days post injection then pulling labs?

No, Lab work 5 days after the injection .
One problem I had recently with 5 day 100mg. was the high levels HCT and HGB, so how can I increase the dose now ?

CBC as of 2/7/17 before Phlebotomy

WBC 7.0 K/UL 4.0 - 11.0 K/UL

RBC 5.91 M/UL 4.40 - 5.60 M/UL

HGB 17.5 G/DL 13.5 - 17.5 G/DL

HCT 52.3 % 40.0 - 51.0 %

MCV 88.5 FL 80 - 97 FL

MCH 33.8 PG 27.0 - 33.0 PG

MCHC 33.5 G/DL 32.0 - 36.0 G/DL

Platelet 164 K/UL 150 - 400 K/UL

Thanks for your much needed help.

[Mr.BB]

Title says you are worried? About the hematocrit or the 391ng/dl total T?

IMO more important than T number is how do you feel. I suspect total T numbers will still rise, you inject IM, right?

But if you feel OK (no low T symptoms) I dont see a reason to increase dosage, more important is to maintain health and increasing dosage would rise even further hematocrit. Maybe if you can control hematocrit you can raise then.

Things you can do to control polycythemia: Split T in smaller dosages, make sure your O2 levels are good (smoking, sleep apnea, etc), increase cardio, better hydration, stop drinking alcohol, reduce fat and protein intake, etc.

Another thing you can do is look into Aveed, as it doesnt have such great effect on RBCs.

[bigrack]

Title says you are worried? About the hematocrit or the 391ng/dl total T?

IMO more important than T number is how do you feel. I suspect total T numbers will still rise, you inject IM, right?

But if you feel OK (no low T symptoms) I dont see a reason to increase dosage, more important is to maintain health and increasing dosage would rise even further hematocrit. Maybe if you can control hematocrit you can raise then.

Things you can do to control polycythemia: Split T in smaller dosages, make sure your O2 levels are good (smoking, sleep apnea, etc), increase cardio, better hydration, stop drinking alcohol, reduce fat and protein intake, etc.

Another thing you can do is look into Aveed, as it doesnt have such great effect on RBCs.

Increase in dose lowered my T level. I don't feel great.
Dr. changed dose to 5 days 100mg. about 2 mo. ago. and recent testosterone level dropped from 391ng./dl. to "now 336ng./dl. since. "
Everything else you mention is in check. Did you mean "reduce protein intake"?

[kelkel]

Part of what BB is referring to is your hematocrit level. It's over the top which can get dangerous. Thick blood isn't good and will impact how you feel. Consider a DRBC donation asap.

[bigrack]

Part of what BB is referring to is your hematocrit level. It's over the top which can get dangerous. Thick blood isn't good and will impact how you feel. Consider a DRBC donation asap.

I did a regular blood donation, on 3/18/17. ( I was scheduled for a DRBC they screwed up.)
I brought it down. Do you think this is going to stay? how long?
I also notice the WBC high, maybe the cortisone shot brought it up?

CBC as of 3/19/17 day after Phlebotomy.
WBC 16.9 K/UL 4.0 - 11.0 K/UL
RBC 5.65 M/UL 4.40 - 5.60 M/UL
HGB 17.1 G/DL 13.5 - 17.5 G/DL
HCT 49.7 % 40.0 - 51.0 %

[Mr.BB]

Increase in dose lowered my T level. I don't feel great.
Dr. changed dose to 5 days 100mg. about 2 mo. ago. and recent testosterone level dropped from 391ng./dl. to "now 336ng./dl. since. "
Everything else you mention is in check. Did you mean "reduce protein intake"?

Sorry, but its impossible for you numbers to have lowered when you increase the dosage. I would repeat labs, it could be lab mistake, or you could have changed lab. Different labs (and analysis process) will give different values.

But even if the values are correct a minimal difference from 391 to 336 ng/dl is something that its impossible to notice. Its much more likely for you to feel worse on 100mg every 2weeks than every 5 days..

Like many, seems you suffer from the psychological effect of thinking your testosterone numbers are low, if the lab has a high margin of error and it present you with 436ng/dl values you would probably be happy with it... Serum testosterone numbers while important for diagnosing are not the end of the world, it doesnt account for tissue testosterone levels .

Find it hard to believe you have everything "in check" and still your hematocrit was elevated. And yes, high protein and high fat will promote polycythemia and lower free T (due to high SHBG).

[Mr.BB]

Part of what BB is referring to is your hematocrit level. It's over the top which can get dangerous. Thick blood isn't good and will impact how you feel. Consider a DRBC donation asap.

Kel, around here max age for donation is 60 years old. Is it same over there?

I feel donation is a quick fix, that yes, many times is necessary, but specially in a TRT situation should not be an absolute necessity. Added to the fact the older one get its normal for iron absorption to get worse. If by one side we are trying to avoid high hematocrit problems, we are potentially putting ourselves into iron deficiency problems, which i'm not entirely sure which one is worse...