3 Months into TRT - Advice on Most Recent Bloodwork

I started TRT about 12 weeks ago and just had my most recent labs done after getting on a good trt schedule. I was wanting to see if anyone could give me any advice on changes or things I may want to look out for based on my most recent labs. My Dr. did agree to bump my dose up to 90mg per week (he's relatively conservative). Here's a little history prior to starting and along the way up until this week.

Went to Dr. in December 2016 checked T again. He only did Total even though I always ask for full T work up. Surprisingly this came back at

Total T - 193 300-1100.

Dr. said he'd treat this time wanted me to do gel but for all the obvious reasons and my 4yr. old daughter and 2 yr old son I asked for injections. To no surprise he originally wanted to do 100mg T cyp every 3 weeks. I told him why this wasn't going to be good for me and he reduced it to every 2 weeks with a recheck at 6 weeks. I started IM injects on his schedule for those 6 weeks and like one would expect there were 5-6 good days after a shot, nothing profound, but then 8 pretty bad days. Rechecked bloods after 6 weeks. I asked for a lot more BW but got full T work up and E2.

Total T - 272 250-1100
Free T - 46.9 46-224
Bio T - 102.6 110-575
SHBG - 21 10-50
Albumin - 4.8 3.6-5.1
E2 <5 0-52

These bloods were taken on day 13 about 30 hours before next inject. Dr. saw these and agreed to start weekly doses at 80mg. which I am doing 40mg 2x a week. Since I started doing the shots altogether, even on a horrible schedule, I have noticed a couple positives, and they seem to be increase in libido and way less irritability. I almost actually feel quite calm all the time in a sense. I am hoping to not have to use an AI and am highly considering HCG. although I don't know when or how much. I would like to see where things are at after 6 weeks of my current regiment but don't know if that feasible or advisable.

Most recent labs taken about 8hrs. before next injection:

Testosterone Total LC/MS/MS 522ng/dl 250-1100 ng/dl
Free T 120 pg/ml 46-224 pg/dl
Bioavialable 267.7 ng/dl 110-575 ng/dl
E2 12pg/ml 0-52 pg/ml
SHBG 15nmol/L 10-50 nmol/L
Albumin 4.9 g/dl 3.6-5.1 g/dl
AST 32 U/L 0-46 U/L
ALT 25 U/L 0-60 U/L
Total Cholesterol 190
Triglycerides 66 (a little higher than pre trt)
HDL 48
LDL 129 (about 30 points higher than pre trt)
RBCC 5.34 m/mm3 4.40-5.80 m/mm3 (up from 4.9 pre trt)
Hemoglobin 16.6 g/dl 13.8-17.2 g/dl (up from 15.10 g/dl pre trt)
Hematocrit 47.7% 41-50% (up from 44.20% pre trt)
PSA 1.00 ng/ml <4.0ml

My very amateur assessment of these number tells me there could be some room to up the T dose some, how much remains to be seen. It would seem that if I am splitting my dose that my T levels would not be that far from peak just 76 hours after my injection. I was also wanting to know if upping to say 100mg ultimately, how much that will continue to move my hemoglobin, hematocrit, red blood cell count. I plan on donating blood but have not yet. The other question is how would I adjust my dose or change my regimen based on what appears to be historically lower SHBG. It also appears I don't aromatize much i.e., lower E2 levels w/o an AI. I also plan on trying HCG to see if it is of a benefit. Not sure yet how much or often. Any advice or discussion is greatly appreciated. Thanks

What is your age? Your Dr might be passing a bit too conservative. You're still at a pretty low dose for most people in their 30s and 40s. I've seen doses that low in 60+ due to the Dr trying to get then normal for their age. You're at 522 total, which isn't terrible, but I would want more around 700 for myself. You're still in a good range from most GPs standpoints, but you could stand more of bloodwork permitted it. As far as hcg, do it. My Dr is way uninformed and I've had to take that into my own hands. Talk to him and be honest. If he's not willing to do what's best for you, move on. Being conservative is not a bad thing, but if it causes one to be regressive in their practice, it is a bad thing.

Thanks for the response. I should have mentioned that I am 42 yrs old. I agree with what you are saying. I've had to be very persistent with my Dr. to get where I am and if I get to a point where I don't have any reasonable input then I will have to move on. The numbers that I find most disappointing are my free and bioavailabe. They seem to be quite pedestrian. As time goes on I will test 24 and 48 hours after injection to find out what my peaks are looking like.

Did your doctor determine the root cause? Primary, secondary, etc or simply age related? 193 total T is quite low and I'd want to see Pituitary function(LH/FSH) to determine where the issue lies and what to check next. It's why full BW is so important.

Always try to base things on your FT level along with how you feel. Total T really doesn't mean that much as FT is what works for us. Lower SHBG is not necessarily a bad thing like so many say. As long as you don't exhibit signs of metabolic syndrome there's really no issues with it. You're in range anyway.

Your doc starting out conservative is fine, although the red flag was his original every three week injection. That shows he really does not know hormones but as long as you can work together and educate him you may be just fine. Sometimes the patient has to teach the doctor when it comes to HRT.

IMHO, I'd probably up your dose to 60 x 2 and see where you land in 4 weeks. Your T will no doubt come up as will your E2. Re E2 try to make sure it's a Sensitive Assay, not standard estradiol.

When it comes to HCG, yes it should be part of your protocol. Nothing wrong with getting dialed in with your T first and then adding the HCG. Once you do you may have to titrate your T dose down slightly. Only labs will reveal the answer.

Quote:

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Originally Posted by kelkel

Did your doctor determine the root cause? Primary, secondary, etc or simply age related? 193 total T is quite low and I'd want to see Pituitary function(LH/FSH) to determine where the issue lies and what to check next. It's why full BW is so important.

Always try to base things on your FT level along with how you feel. Total T really doesn't mean that much as FT is what works for us. Lower SHBG is not necessarily a bad thing like so many say. As long as you don't exhibit signs of metabolic syndrome there's really no issues with it. You're in range anyway.

Your doc starting out conservative is fine, although the red flag was his original every three week injection. That shows he really does not know hormones but as long as you can work together and educate him you may be just fine. Sometimes the patient has to teach the doctor when it comes to HRT.

IMHO, I'd probably up your dose to 60 x 2 and see where you land in 4 weeks. Your T will no doubt come up as will your E2. Re E2 try to make sure it's a Sensitive Assay, not standard estradiol.

When it comes to HCG, yes it should be part of your protocol. Nothing wrong with getting dialed in with your T first and then adding the HCG. Once you do you may have to titrate your T dose down slightly. Only labs will reveal the answer.

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Thanks for taking the time to reply kelkel. I would guess I'm secondary but no idea of the cause. Could be age related too thought. In 2014 I did have FSH and LH tested and they were

FSH 3.7 1.4-18.1
LH 3.1 2-6

I don't believe I exhibit any signs of metabolic syndrome. I'm in decent shape at the moment. Cardio 4x a week 40min and lift 4 days a week. Still have some body fat to get rid of but nothing excessive. Yes I am trying to educate both myself and my Dr. Just recently he wanted me to stay at 80mg a week with these numbers but I asked to increase to 100mg and he came back with 90mg recheck in 6 weeks. Guess I'll have to live with that for now, which is not a big deal since I am feeling better, I'm just trying to figure out optimal. I'm really interested in knowing where my peaks are but may not look at those until I get the troughs where I'm satisfied. I'm curious how quickly I may be metabolizing this T. I also wonder how much more 250iu of hcg will move my numbers. In re: to my e2 lab does that not look like the sensitive test? I always thought it was. I ask for sensitive assay but when my Dr. Is commenting on what check boxes he is checking on the electronic form he says "estradiol for a man". Don't know what that means.

At least your doc is listening to you. That's key. Main thing is you're feeling better. Also remember that you're not a number on a chart. They're just a guide. Really no clue on what type of bump you'll get from the HCG until you add it and pull some BW. I'm not sure on your E2 lab. What I'm used to seeing is a range of 8-35 for a sensitive E2 panel. Standard estradiol is geared to women and can range greatly (be way off) in men.

I wanted catch up my original post here as I am still getting things figured out and I wanted to get some advice. Here are posts from my last two dose/ protocol adjustments:


From May 2017

Okay, so I am still I the process of getting my dose dialed in and wanted some opinions. Since my last appt. and blood work I have been doing 50mg every 3.5 days along with 250iu 24 hrs prior to T dose. I'm feeling better than pre trt but don't feel like I'm exactly where I need to be. Still have some lingering pre trt symptoms such as fatigue, libido not completely right etc. my most recent bloods are:
Total T 732 250-1100
Free T 145.7 46-224
Bioavailable T 306 110-575
SHBG 22 10-50
E2 19 0-52
Seems like there is room for me to bump up to 120mg a week or even 140mg per week. I hate having to ask my Dr. For an increase because he feels like I should be fine where I'm at. I appreciate and welcome any opinions or comments.


After this my Dr. Agreed to bump me up to 120mg

This is where I am now and I have an appt. with the Dr. Tomorrow for bloodwork and hopefully the last time I have to see him for 3 months rather than every 6 weeks like I've been doing since January of this year. As my last post stated, I have been doing 120mg of test cypionate a week, split into .6 2x a week. Previously when I was doing 100mg a week split, I was also taking 250iu hcg 2x a week as well, but I stopped that about 7 weeks ago so I was only working with 1 variable and I wanted to see where that put everything. Also I was worried about coming in high on this next set of bloodwork and it freaking my dr. and him wanting to dial me back, even if I felt best at 120mg a week. To summarize the last 6 weeks on 120mg, it has been okay but I think I may have felt better before at 100mg + hcg and maybe even 80mg + hcg. I was thinking that 120mg my have been pushing my e2 to the limits because I was more moody/ irritable, a little anxious at times and just not as relaxed. I also noticed less morning wood on the 2 days after my inject, but by the day of inject, I felt better and the morning wood returned. I also was not very interested in lifting or getting my workouts in although I did, and other days I was just dog tired. In addition I felt I was not sleeping as well. So I'm thinking this could be from lack of hcg, too high dose of T, or e2 creeping up. Last week I had private labs done to see where I was at peak, so I would know what to expect at the Dr. office this week and I also tested sensitive e2 (because I don't think my dr. is running the correct test, as well has hematocrit because he failed to check that on my last bw) Here are my numbers from that draw:
Total T 941 348-1197
free T 38.77 High 5-21
% free 4.12 1.5-4.20
e2 34.1 8-35
Hematacrit 45.5 37-51%
Again, this was about 32 hours after my last inject which should have represented a peak. I had been testing on day of inject with my Dr. My questions are:

why is free so high on this test? On the lc/ms/ms test my dr. runs for total, bio, and free, my free and bio are barely in the middle of the range. That's why I increased dose to 120mg a week. (see previous posts). I am lower shbg and think I could be burning through my exo T pretty quickly. Can any comparisons be made between this test and the one my dr. runs? I have bw this Wednesday and again it will be on day of inject and actually just about 8 hours prior to inject.

my e2 is at the top of the range and I believe my e2 generally runs low, but my dr. may not have been running an lc/ms test that is not sensitive, but regardless on the e2 tests he has run, it has always come up low in the range. And I have never taken an AI. So what inferences can be made between this test and the test my dr. has been running for e2? Could I be correct in that I have not felt as good on this dose because of e2 getting high, where mine is normally rather low? in other words could I have a lower threshold for the effects of e2 because I normally run low?

I plan on starting hcg and may very well dial my dose back to 100mg or even 80mg a week after my next set of bloods. My Dr. shouldn't want to see me for at least 3 months as I have been going every 6 weeks since January. I am reluctant to try hcg at my current dose even if that's whats missing because I fear it causing e2 to go up more. When I dial dial back the dose, should I wait a period for e2 and T to lower/ stabilize before I start hcg? I'm really anxious to start it again, because I do believe it has value for me in the way I feel.

I apologize if this post is disjointed, I'm typing in a hurry and may have forgot somethings. As always I appreciate the time anyone takes to read and reply to my post.