Bloodwork Questions

[trt]

Hi there.
Been on TRT for a couple of years. I'm having issues keeping my numbers stable. I'll get my weekly shots on Tuesdays, my numbers would then be stable for about 6-12 weeks, as my blood work would come back ok, until following blood work, then my numbers would drop off. Then they would up my dose. This has been going on now since the beginning where every other blood work is a drop.

When I had blood work in the beginning, the pituitary gland and other blood work would be fine. My last blood work total T was 700, free was 21. Just had blood work done last week and total drop to 500 & free dropped to 15. I'm up to 280 mg of Test per week now. The numbers have been up and down much like a roller coaster ride and if I don't get a bump in Test, the numbers just keep dropping.

I take 1/2 mg of Anastrozole two days after my injection and then I take HCG /B12 on Fridays & Sundays. My injections are every Tuesday, I've been super consistent with everything. My lifestyle is pretty clean, not a smoker, not a big drinker, and I do not do drugs.

Any help would be greatly appreciated. Will be making an appointment to see an endocrinologist. Will be providing attachments with blood work findings.

Low T.pdf

Thank you.

[kelkel]

Welcome to the forum TRT.

First, remember that BW is always just a snapshot in time. If you're expecting it to be consistent and stable, even if your dosing stays the same then get used to disappointment. Over time dosing has to be changed. When I started TRT I did not need an AI, now I do while on the same dose of Test.

I'll assume that blood work has been consistently pulled the day of injection but before said injection, correct? To show trough levels? If this is not the case this can be the cause of your concern.

Not sure I understand your comment that your "pituitary gland would be fine." When on exogenous test pituitary function basically shuts down. Did you mean Pre-TRT?

280 mgs of test per week is a boat-load of test. Now, your shbg is low but not sub-normal. Shbg binds hormones and the less you bind the more quickly you can metabolize testosterone . If this (big if) is the causative factor of your issue then you need to stop once per week injections and inject multiple times per week. I'd suggest a minimum of 3 times per week or EOD with obviously small amounts (do the math). This can be done SQ as well. This will lessen the suppression on your shbg and thus slow down the process of metabolization of the injected testosterone. You should be able to reduce the dose as well as not doing so will effect your hematocrit causing frequent blood donations.

Re your anastrozole I'd take it the day after injection at the latest on your current protocol. Arguably the same day. Test peaks in about 24 hrs or so and you may be even quicker if in fact you metabolize that quickly.

Also note that when you test estrogen levels it needs to be a Sensitive E2 Assay. Standard estradiol is wildly inaccurate in men.

If you make changes be sure to back them up with BW in about 4 weeks or so.

[trt]

Thank you so much for your reply, I greatly appreciate it. Yes, blood work is pulled day of injection prior to injection. For pituitary gland, yes it was pre TRT. Yes I do give frequent blood donations. Yes, I'll let them know to give me the sensitive E2. I've asked about multiple injections during the week, but they don't seem to agree with that approach.

Thanks again.

[kelkel]

If you self-inject just do it yourself. Even twice per week would be better. It's abnormal for someone to need such a high amount of Test and they should realize this and look deeper into it. That said, most docs simply don't know hormones as they're not trained in them, yet many seem to expect patients to follow them blindly regardless. You are your best advocate here.

Regarding frequent donations please keep an eye on your iron levels. With aging and frequent donations we raise the risk of anemia.

Setting the numbers aside, how do you feel?

[trt]

Thanks for the response.
I go to a low T center here in IL and they will not let me self inject. I know I might need to go somewhere else though. I'll need to see what the endo says when I go. I'll keep an eye on my iron levels. TRT has really changed my life in many aspects. Definitely made a huge improvement cleared up the adult acne and my wife now likes me more, (LOL). Overall I feel a thousands times better. I seem to feel the best at total T in the 600's and Free T at like 16-18, (approximate).

I definitely notice a mood change when my levels are off and I don't feel myself. My body seems to be ultra sensitive to change.

Just hoping to get this figured out.
Thanks.

[kelkel]

Personally I'd recommend a Uro over and Endo. That said, any doc who understands hormones will do just fine. They don't need a special title. Best bet so as not to waste your time is to call the office, ask them if they'll treat you in the following manner:

Self-injections of test
HCG
AI if needed

Normally one of the nurses will be glad to help if you speak politely. This can save you quite a headache with seeing multiple doctors to no avail.

Also remember that you are not a number so don't hyper-focus on them as they're just a snapshot in time. I really don't think you'll feel the difference between 500 and 700 Test levels so don't be too quick to blame an off day on T levels. We all have off days, TRT or not.

[Youthful55guy]

Thanks for the response.
I go to a low T center here in IL and they will not let me self inject. I know I might need to go somewhere else though. I'll need to see what the endo says when I go. I'll keep an eye on my iron levels. TRT has really changed my life in many aspects. Definitely made a huge improvement cleared up the adult acne and my wife now likes me more, (LOL). Overall I feel a thousands times better. I seem to feel the best at total T in the 600's and Free T at like 16-18, (approximate).

I definitely notice a mood change when my levels are off and I don't feel myself. My body seems to be ultra sensitive to change.

Just hoping to get this figured out.
Thanks.

There in lies the problem. It's a good place to get your feet wet, but their on size fits all approach is too limiting. They make their money billing your insurance company for the office visit, so they have no interest in giving T to go, which is why they disagree with the more frequent injection approach. They have a vested interest in not agreeing with the approach.

I started out in a low T center about 6.5 years ago and stuck it out for several months. Like you, we kept going higher and higher on the weekly dosage because I'd always crash the day or two before the next injection and felt like crap. My hemoglobin too was becoming problematic. I then was faced with an upcoming 14 day vacation in Europe with my family and the thought of going without T for that long was not acceptable to me. That was the kick in the behind I needed to find a doc that would prescribe self-injections. He was a big name in the industry and I trusted him. He got me on my current protocol of about 40 to 50 mg every 3 days (E3D) and that gave me a much smoother ride at about 75% of the 'weekly equivalent' dose that the T center was giving me. My hemoglobin and E also stabilized within normal ranges.

Kel has given good advice. I'd suggest you find an enlightened doc that will take over the protocol and prescribe self-injections.

[trt]

I agree with what you are saying. I actually have a buddy in the same boat as well. Can anyone recommend such a doctor in the Chicago land area?

Thanks everyone for all your help.

[RoxRunner]

I agree with what you are saying. I actually have a buddy in the same boat as well. Can anyone recommend such a doctor in the Chicago land area?

Thanks everyone for all your help.

Sorry, can't help in Chicago. If you have a good family/GP doctor, I'd recommend having the conversation with them first. Some of them are very open minded and if you present your current pro's/con's they may be willing to prescribe Test and oversee your protocol, if not at least give some recommendations that are different than what you're currently using. I agree with Kel that a urologist is probably the best type of doctor to use, but it depends on who you have available.