TRT bloodwork questions

[T-boner]

Doctor put me on 150mg/wk test E.
After 6 months my bloodwork came back all good. Total Test was around 800 and free test around 20. Estrogen was perfect.
I told the doctor I still didn’t feel all that great so he raised my dose to 200mg/wk. Been 6 months later. I feel really good now but bloodwork came back and total test is over 1500. Not sure exactly the number cause this panel won’t read levels higher than 1500. Free test is 67.
My blood count numbers didn’t change. They are all still in the normal range although some are towards the high end of normal. Cholesterol is good.
Estradiol is high at 72.3 and the normal range is 8-35.

Do I need to worry about testosterone being so high if all my other numbers are in line? I feel great so do I need to get estrogen down or is it not high enough to matter? I know a little arimidex will knock it down or I could back off the test to around 150-175mg/wk.
But do I need to do that? Doesn’t estrogen help muscle growth? I read somewhere way back that estrogen is a carcinogen so we shouldn’t let it stay high for long periods of time.

[Youthful55guy]

Doctor put me on 150mg/wk test E.
After 6 months my bloodwork came back all good. Total Test was around 800 and free test around 20. Estrogen was perfect.
I told the doctor I still didn’t feel all that great so he raised my dose to 200mg/wk. Been 6 months later. I feel really good now but bloodwork came back and total test is over 1500. Not sure exactly the number cause this panel won’t read levels higher than 1500. Free test is 67.
My blood count numbers didn’t change. They are all still in the normal range although some are towards the high end of normal. Cholesterol is good.
Estradiol is high at 72.3 and the normal range is 8-35.

Do I need to worry about testosterone being so high if all my other numbers are in line? I feel great so do I need to get estrogen down or is it not high enough to matter? I know a little arimidex will knock it down or I could back off the test to around 150-175mg/wk.
But do I need to do that? Doesn’t estrogen help muscle growth? I read somewhere way back that estrogen is a carcinogen so we shouldn’t let it stay high for long periods of time.

I caution against going that high on the T dose unless your SHBG is high and you need a higher T dose to get Free T within range. Agree with Cylon that we need ranges and units to interpret the results, but assuming this is similar to the LabCorp RIA method, your Free T is way high (normal range with LabCorp varies according to age group, but generally tops out around 26 pg/mL.

This is what is driving your E so high. If you adjust the dose so that your Free T is still within range, your E should follow and there will be no need for an AI. The use of an AI is controversial in TRT as it too has side-effects to consider. You are better off to avoid it unless absolutely necessary.

Regarding using the "Normal" RIA T lab or the LS/MS method, I only use the Normal RIA method because there is no reason to know the exact number if you are above the sensitivity of the test (which is 1500 pg/mL with LabCorp). If you are above 1500, you are too high for a sustainable TRT dose, so why waste the money on the much more expensive LS/MS method to quantify precisely much too high you are? make sense?

[T-boner]

Here’s the ranges.
Total Test >1500ng/dL. Range 264-916ng/dL
Free test 67.35ng/dL. Range 5-21ng/dl
Estradiol 72.3pg/ml. Range 8-35 pg/ml

I can drop my test dose back to 150mg/wk to get estrogen in line. Still wondering if my estrogen is high enough to worry about. The rest of my numbers are pretty good. I feel great. Is there any negative things that could happen if my bloodwork stayed like this long term? Meaning blood count and cholesterol stays good and test and estrogen stay at current levels also.

One more question. I’ve heard conflicting things about test causing prostate cancer. Some say it can and some say it won’t. My initial bloodwork before TRT had my PSA at .5. After 6 months it was .8. This time six months later it’s .9. The range is 0-4.0 no/dL. My doctor said it’s more about the direction it’s heading than how high it is. Should I be concerned that my PSA jumped initially and has crept up a little more since?

[Youthful55guy]

Here’s the ranges.
Total Test >1500ng/dL. Range 264-916ng/dL
Free test 67.35ng/dL. Range 5-21ng/dl
Estradiol 72.3pg/ml. Range 8-35 pg/ml

I can drop my test dose back to 150mg/wk to get estrogen in line. Still wondering if my estrogen is high enough to worry about. The rest of my numbers are pretty good. I feel great. Is there any negative things that could happen if my bloodwork stayed like this long term? Meaning blood count and cholesterol stays good and test and estrogen stay at current levels also.

One more question. I’ve heard conflicting things about test causing prostate cancer. Some say it can and some say it won’t. My initial bloodwork before TRT had my PSA at .5. After 6 months it was .8. This time six months later it’s .9. The range is 0-4.0 no/dL. My doctor said it’s more about the direction it’s heading than how high it is. Should I be concerned that my PSA jumped initially and has crept up a little more since?

Your ranges look like standard LabCorp ranges. Correct, that where the tests were conducted? Also, your Free T ranges look like the "Normal" (Direct) method. When we post results here, it is VERY IMPORTANT to post ranges and/or the test method. Normal ranges can vary between laboratories and the methods they use. For example, the LabCorp MS/Equilibrium Dialysis (Test 500726) has a Free T range of 52-280 pg/mL, which is similar to a test for Bioavailable T offered by Pacific Diagnostic, which has a normal range of 48-317 ng/DL. And then there's the LabCorp Testosterone Free, Profile I (Test 140226), which provides age-adjusted ranges that vary from 47-174 pg/mL to 21-97 pg/mL. I have no idea what method they use. BOTTOM LINE: Your test range makes me believe it is the LabCorp Direct (Normal) method (Test 144980) using an age-adjusted range of 40 to 49.

I highly support dropping your T dose down until you get your Free T to within the normal range for your lab. If my above assumptions are correct (LabCorp Direct method), then you can probably push the results to around 25-26 pg/mL, which is the upper end of the range for guys in their 20's and 30's.

Regarding Estrogen (Estradiol, E2). It should come down closer to range if you drop T. I would not add in an AI until you first adjust the T dose down. AIs are difficult to dose in men and guys usually end up crushing their E2 levels and feel like $#!^ with a bad case of ED.

I would be worried more about DHT and hemoglobin production. At 200 mg/week, I can pretty much guarantee that your DHT will be out of range and this drives hemoglobin production, hair loss, and BHP. Hemoglobin production takes about 6-12 months to show up in labs. My advice is to lower T and monitor DHT. If after 6 or so weeks at your lower dose your DHT levels are out of range, you might want to consider layering in a small dose of finasteride. I'd recommend a starting dose of 0.5mg/day.

The link between TRT and prostate cancer is a fallacy. Don't fall for it. The old DHT/prostate cancer research is flawed on so many levels. Yet, the medical profession can't seem to move on. Prostate cancer may (and I emphasize may) have a correlation to high E, but not to DHT. High DHT, on the other hand is definitely linked to BHP, but that is not prostate cancer. It is possible that if you have a latent cancer, that TRT may accelerate it's growth, but this has never been proven. I would continue to monitor your PSA levels, but given that your levels are less than 1, you are in the very low risk category. Over the past 11 years (last 7.5 on TRT), my PSA levels have varied from 0.5 to 0.87 with no discernable trend.

[Youthful55guy]

I think those concerns are both a bit overblown and a pretty strong leap from A to B. That is, DHT seems to be the larger concern with prostate issues, not test. Somebody correct me if I'm wrong about that. I think it would be beneficial to pull DHT levels as well (just so you have it, if nothing else), but looking at your PSA score, I can kind of see why the doc hasn't ordered it yet. Less than 1.0 and you are in your 40s?? How awesome is that! Anyhow, maybe pull DHT on your next labs just to know what is what. If it is high (I would be kind of surprised if it isn't), dialing back the test should help and finasteride can get it in line, too.

Didn't read your reply before posting mine, but it seems we are telling the same story.