TRT Advice

[Youthful55guy]

So I've been on TRT for 2 weeks now and I'm really feeling a whole lot better. Taking .3ml of 200mg Test C every 3 days and it seems to working well so far. Went back to the doctor a couple of days ago and he said from the previous blood drawl that my Test was already back up 800. However he did not give me any details on stuff like Free Test and Estrogen but did take another blood sample.

I was having some urinary issues and he said it was Prostatitis and gave me some antibiotics and Uroxatral (Alfuzosin) which made a significant difference, I feel back to normal now. Having the vericocile repair done on May 29th because I'm having some pain from it now and hopefully get some extra Test production from that side afterwards. This doctor seems to be pretty good in most aspects but I think I'll take your advice Youthful55guy and use the Private Lab to see what my Free Test and E2 levels are. He asked me if I had started taking the AI yet and I told him I wanted to see what my E2 levels were first. Also the Rx was written for 1mg Anastrozole per day!!! Jeez I would crash the hell out of my E2 and have no libido at all. It really seems to me that the doctors don't take the whole picture in.

Once I get the next blood panel back and hopefully information on Free Test and E2 from him then I will start my HCG. I really think I might have to use the Private Labs for that though because when I mentioned Free Test he looked at me funny. Overall I think I'll be good with this doctor but will have to monitor a few things from my end.

Also found out that I'm going to have to do therapeutic phlebotomy a few times a year because the TRT is thickening up my blood, had no idea that could happen so I'm glad he found that out from the blood work as well.

Good approach, but you are starting at the upper end of what most guys need. You 0.3 mL of 200 mg/mL T-cyp E3D equates to about 140 mg per week. I generally recommend starting at 100 mg/week, test at 6 weeks, and then if the labs indicate, bump it up to about 120 mg/week. After 6 more weeks, repeat the testing and if the labs indicate bump it up to 140 mg/wk.

I suspect that at 140 mg you will find that your E is going to go out of range and you will probably need an AI to take the edge off. I'm guessing that you'll need around 0.5 to 0.75 mg per week of anastrozole, which is about 5 to 7 drops per day using my Vodka/Eye Dropper method.

Same goes for high hemoglobin. This is the most common side-effect of TRT, especially at the higher doses like you are using. T converts to DHT and DHT drives hemoglobin production. Keeping DHT under control can help, but at that high level, you are going to have to donate blood. I usually recommend that you start with standard donations without a script for a therapeutic phlebotomy because once you get on thier list for needing this, they will have records forever. At this time, they allow donations from guys with high hemoglobin due to TRT, but that's new and could change in the future. Then you are stuck with having to pay someone to draw your blood and dump it down the drain.

Your best approach is to start with the minimum amount of T you need to keep you in range. if you do this, your hemoglobin will typically be at the top end of the range, but be controllable with standard blood donations every 8 weeks (the maximum allowed by FDA). If your do this, then you can truthfully answer their last screening question. "Has a doctor told you need to donate blood because you are taking testosterone therapy". The key word here is "told". Since I have never gone out of range, but always run at the high end of the range, my doc "suggested" that I might want to consider putting that blood to good use with donations. There's a difference between being told and having it suggested. I equate a script for a therapeutic phlebotomy as being "told".

[DJMikeT]

Good approach, but you are starting at the upper end of what most guys need. You 0.3 mL of 200 mg/mL T-cyp E3D equates to about 140 mg per week. I generally recommend starting at 100 mg/week, test at 6 weeks, and then if the labs indicate, bump it up to about 120 mg/week. After 6 more weeks, repeat the testing and if the labs indicate bump it up to 140 mg/wk.

I suspect that at 140 mg you will find that your E is going to go out of range and you will probably need an AI to take the edge off. I'm guessing that you'll need around 0.5 to 0.75 mg per week of anastrozole, which is about 5 to 7 drops per day using my Vodka/Eye Dropper method.

Same goes for high hemoglobin. This is the most common side-effect of TRT, especially at the higher doses like you are using. T converts to DHT and DHT drives hemoglobin production. Keeping DHT under control can help, but at that high level, you are going to have to donate blood. I usually recommend that you start with standard donations without a script for a therapeutic phlebotomy because once you get on thier list for needing this, they will have records forever. At this time, they allow donations from guys with high hemoglobin due to TRT, but that's new and could change in the future. Then you are stuck with having to pay someone to draw your blood and dump it down the drain.

Your best approach is to start with the minimum amount of T you need to keep you in range. if you do this, your hemoglobin will typically be at the top end of the range, but be controllable with standard blood donations every 8 weeks (the maximum allowed by FDA). If your do this, then you can truthfully answer their last screening question. "Has a doctor told you need to donate blood because you are taking testosterone therapy". The key word here is "told". Since I have never gone out of range, but always run at the high end of the range, my doc "suggested" that I might want to consider putting that blood to good use with donations. There's a difference between being told and having it suggested. I equate a script for a therapeutic phlebotomy as being "told".

So my Doctor "told me" and sent in an order to the blood collection place. From the information they gave me it says "There will be no charge of therapeutic phlebotomy for patients whose orders state a diagnosis of hereditary hemochromatosis or secondary polycythemia due to TRT replacement."
Hopefully like you stated it stays that way because otherwise there's a $150 charge for it.

Also one question about the link you posted above for the discount labs on the E2 test. That's just for E2 correct, so for Free Test and Test levels I'd have to get a separate blood panel or is that an all in one panel. The information on the site was limited that's why I'm asking.

Thanks again Youthful55guy for all your help, it's truly appreciated!

[Youthful55guy]

So my Doctor "told me" and sent in an order to the blood collection place. From the information they gave me it says "There will be no charge of therapeutic phlebotomy for patients whose orders state a diagnosis of hereditary hemochromatosis or secondary polycythemia due to TRT replacement."
Hopefully like you stated it stays that way because otherwise there's a $150 charge for it.

Also one question about the link you posted above for the discount labs on the E2 test. That's just for E2 correct, so for Free Test and Test levels I'd have to get a separate blood panel or is that an all in one panel. The information on the site was limited that's why I'm asking.

Thanks again Youthful55guy for all your help, it's truly appreciated!

they have a huge number of labs that they offer. Some individuals and some in panels. I don't remember the specific link I posted (probably directly to the E test). You have to back out to the home page and go to the Testosterone Replacement Page to find all of the tests. Start here on the Choose A Test tab: https://www.discountedlabs.com/.

[DJMikeT]

Hey Youthful55guy,

Got my latest blood work results and they are as follows.

TEST - 904 NG/DL
CALC FREE TEST - 170.5 PG/ML
SEX HORMONE BINDING - 47.1 NMOL/L
ESTRADIOL - 17 PG/ML
IGF-1 SOMATOMEDIN-C - 96 NG/ML

My Free Test is within range according to this lab which says the standard ranges are 47.0 - 244.0 PG/ML

This is different from the levels you mentioned above but you did say it varied from lab to lab.

My Estrogen levels look good and I feel great, no bloating or massive water retention or nipple sensitivity. Also my libido is through the roof again. I don't see any reason to take Arimidex unless those levels change.

Also just started the HCG this week, so that may have some impact. I'm not sure about the Sex Hormone Binding or the IGF-1 results but they are within range.

How do these results look in your opinion?

[DJMikeT]

Also my Hematocrit level was 48.8 and when I went in to give blood the other day it was 46 so I guess that's a good thing. The nurse drawing blood said that 44 was the lowest my doctor wanted me to be and I'm already close to that.

[Chrisp83TRT]

Here dude , here’s the TRT panel

https://www.discountedlabs.com/trt-m...p-panel-option

[DJMikeT]

Here dude , here’s the TRT panel

https://www.discountedlabs.com/trt-m...p-panel-option

Why would I want to do that, I just had blood drawn at my doctor's office on May 3rd and can see the results online. That's just extra money to spend. That's a $189 panel when I can get for next to nothing using my insurance.

[Youthful55guy]

Also my Hematocrit level was 48.8 and when I went in to give blood the other day it was 46 so I guess that's a good thing. The nurse drawing blood said that 44 was the lowest my doctor wanted me to be and I'm already close to that.

Hematocrit and hemoglobin results don't vary as much from lab to lab as hormones do. This is due to standardization in the test method. A level of 48.8 is good. The LabCorp range is 37.5 - 51.0 my doc's lab (Pacific Diagnostic) has a normal range of 39-51. I don't understand why your doc's nurse thinks 44 is bad. I'd actually consider that good. High hematocrit/hemoglobin is often the most limiting side-effect of TRT. It is VER IMPORTANT not to let it go out of range due to risk of a life-threatening cardiovascular or cerebrovascular event.

[Youthful55guy]

Hey Youthful55guy,

Got my latest blood work results and they are as follows.

TEST - 904 NG/DL
CALC FREE TEST - 170.5 PG/ML
SEX HORMONE BINDING - 47.1 NMOL/L
ESTRADIOL - 17 PG/ML
IGF-1 SOMATOMEDIN-C - 96 NG/ML

My Free Test is within range according to this lab which says the standard ranges are 47.0 - 244.0 PG/ML

This is different from the levels you mentioned above but you did say it varied from lab to lab.

My Estrogen levels look good and I feel great, no bloating or massive water retention or nipple sensitivity. Also my libido is through the roof again. I don't see any reason to take Arimidex unless those levels change.

Also just started the HCG this week, so that may have some impact. I'm not sure about the Sex Hormone Binding or the IGF-1 results but they are within range.

How do these results look in your opinion?

It's difficult to comment without 'normal' ranges for each of the tests. You did provide the range for Free T and that's in the upper 87th percentile of your normal range but still in range, which is good. That is, assuming these are nadir values (taken just prior to the next scheduled injection).

Just as an example of why you must have ranges for the lab where you got the results, my lab (LabCorp) using the direct Free T test method has a normal range of 7.2 to 24 pg/mL (for my age group). If you applied my range to your lab's results, you would be so far out of range you'd be in the anabolic steroid misuse category, but of course we know you're not.

[DJMikeT]

It's difficult to comment without 'normal' ranges for each of the tests. You did provide the range for Free T and that's in the upper 87th percentile of your normal range but still in range, which is good. That is, assuming these are nadir values (taken just prior to the next scheduled injection).

Just as an example of why you must have ranges for the lab where you got the results, my lab (LabCorp) using the direct Free T test method has a normal range of 7.2 to 24 pg/mL (for my age group). If you applied my range to your lab's results, you would be so far out of range you'd be in the anabolic steroid misuse category, but of course we know you're not.

Here's the results with the ranges added.

IGF-1 Somatomedin-C - 96 NG/ML Standard Range is 55-168 NG/ML

Testosterone - 904 NG/DL Standard Range is 300-890 NG/DL

Sex Hormone Globulin - 47.1 NMOL/L Standard Range is 16.5-55.9 NMOL/L

Calc Free Test - 170.5 PG/ML Standard Range is 47-244.0 PG/ML

Estradiol Level - <17 PG/ML Standard Range is <=60.7 PG/ML

Clinical Pathology Labs is the Lab running the tests for my doctor.

I agree that with LabCorps ranges I would be way out of range on the free test. Seems like this Lab uses a different scale on the ranges.

Looks like my total Test is just over the top of the scale and that's with me using less than the dosage my doctor recommended. I feel really good where I am at right now, in your opinion should I maintain what I have or make an adjustment??

[Youthful55guy]

Looks like my total Test is just over the top of the scale and that's with me using less than the dosage my doctor recommended. I feel really good where I am at right now, in your opinion should I maintain what I have or make an adjustment??

IGF-1 Somatomedin-C - 96 NG/ML Standard Range is 55-168 NG/ML
Not great but not bad either. I can't recall from this long thread, are you using an AI? I'm not sure if that's the right E test. Most male sensitive labs are designed with an upper range of around 40 pg/mL. You need sufficient E to make GH and that in turn drives IGF-1 levels. Low E = Low GH = Low IGF-1.

Testosterone - 904 NG/DL Standard Range is 300-890 NG/DL
On the high side, probably because your SHBG is on the high side (but not out of range). SHBG binds T and protects it from liver metabolism, so it drives Total T up, even though Free T suffers. Only Free T crosses the blood brain barrier to 'make you feel normal'. However, I definitely would not consider a dose increase. Even though the T is bound to SHBG, it still has peripheral effects such as raising hemoglobin levels.

Sex Hormone Globulin - 47.1 NMOL/L Standard Range is 16.5-55.9 NMOL/L
On the high side but not out of range. You may benefit from lowering it slightly. This will have a net effect of lowering your Total T and raising your Free T. You may actually be able to lower your T dose by lowering your SHBG slightly. You do not want to go too low, because then you will metabolize T too quickly and your Free T will drop like a rock. It's a delicate balance. I would shoot for about 30 to 35 nmol/L with your test range. The difficulty here is that you need either a very open minded doc to get the drugs prescribed, or go off the reservation and obtain them through alternate channels (my approach). There are basically 3 choices in the USA for prescription drugs: Anavar (Oxandrolone), Danazol (Danocrine), and Proviron. In the EU and elsewhere you also have the choice of Winstrol (Oral Stanozolol). I only have experience with Anavar and Winstrol, and both are EXTREMELY effective at very low dosages so there are minimal side-effects. With Anavar, I've found that 5mg 2X per day is optimal for me. For Winstrol, the dose is lower at 5mg 2X per day. I recommend 2X per day dosing because they both have very short half lives. Winstrol is much less expensive than Anavar, so there is less counterfeiting if you obtain it through alternate channels. I do not have personal experience with Danazol, but I did see two posts where guys found it effective at 20-30 mg per day. It is about as expensive as Anavar, so I see no real reason to use it unless you can get it prescribed and covered by insurance (not likely). There is very little information out there in Proviron and the stuff that's out there is mixed information.

Calc Free Test - 170.5 PG/ML Standard Range is 47-244.0 PG/ML
About perfect. I see no reason to increase your dose. If anything, consider lowering your dose by lowering SHBG. See above discussion.

Estradiol Level - <17 PG/ML Standard Range is <=60.7 PG/ML
I question whether this is the correct lab. I'd consider getting it done myself with the best lab out there for guys for about $53 + $6 lab fee (https://www.discountedlabs.com/estra...itive-lc-ms-ms).