Average Dad TRT Bloodwork

Pharma TRT
1

New guy here, new to TRT, just looking to get some input on my blood results from the last several months from people who have been on TRT longer than me. My hematocrit has always been on the high side even without TRT, I have blood tests going back 13 years showing this. The wife unit was no longer impressed with my libido which is how I got started. My blood draws were taken 2 hours after injection.

Mid thirties, could stand to lose 30 pounds(5’10" 220), desk job. I used to hit the gym in the morning and bike 12-20 miles mon-fri, had a kid and lost motivation to do most things outside of work over the last several years.

First lab (No TRT, baseline)

Hematocrit 50.9

Testosterone, Serum 402 ng/dL

LH 2.1 mIU/mL

FSH 4.5 mIU/mL

Estradiol 26.5 pg/mL

Free Testosterone(Direct) 9.2 pg/mL

Sex Horm Binding Glob, Serum 39.9

Second lab (On TRT, Test-C 150mg/week split into 75mg every 3.5 days)

Hematocrit 52.6

Testosterone, Serum 1234 ng/dL

Free Testosterone(Direct) 30.4 pg/mL

Estradiol 64.1 High pg/mL (Doctor had me supplementing DHEA and said this was the reason for the high numbers here, I stopped taking the supplement after this test)

Sex Horm Binding Glob, Serum 31.8 nmol/L

Third lab (TRT dose lowered to 120mg/week split into 60mg every 3.5 days)

Hematocrit 54.9

Testosterone, Serum 1253 ng/dL

Free Testosterone(Direct) 24.4 pg/mL

Estradiol 36.3 pg/mL (Roche ECLIA methodology)

Estradiol, Sensitive 30.0 pg/mL (Liquid chromatography tandem mass spectrometry)

Sex Horm Binding Glob, Serum 38.2 nmol/L

2

Don’t bother with the direct immunoassay for Free T testing, it’s unreliable.

As for testosterone being low, the desk job and having a kid will do it. Typically married men with kids see a noticeable reduction in testosterone.

It’s natures way of making sure you raise the child versus going out searching for multiple partners while there is no one raising the kids.

As for your most recent labs, it’s difficult to critic them because I don’t know how well treatment is progressing.

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3

I wouldn’t be comfortable running my hematocrit that high long term. You’ll find a wide range of opinions from doc’s, some say it’s no problem and others would pull your script.

Do you live at altitude? If not, any chance of sleep apnea? It’s quite common for hematocrit to increase in TRT, varies per the individual. I see you reduced your dose, that should help but you won’t see results instantly. A short term solution would be to donate blood but you can get in a cycle of too many donations, low ferritin, etc. that can cause other issues so may not be the best solution. Cardio has helped some.

If you do have apnea losing the 30 extra pounds would be a good start to reducing or eliminating it before looking into the CPAP route.

Other numbers look good to me.

4

The specific lab is a panel so it’s part of the package, I pay the same amount regardless. I did not know it was unreliable though.

It’s also natures way of ensuring I only have one child ha, ha. I don’t know how people with 3+ kids do it.

Wife is happy, sex drive is through the roof to the point she probably gets annoyed with me. I no longer have to take a nap in the afternoon provided I get enough sleep at night.

I do not live at altitude, I am at sea level. My PCM said if it’s this high again that I will have to get some medical term for having your blood drawn on the regular. In the mean time I am all set for a double red blood donation later this week. The lab tech who drew my blood for the third lab made a comment that I needed to drink more water.

I think I will look into this with my PCM.

5

My hematocrit settles at 56% on Jetazao (lowest possible dosage) and get phlebotomies (52% afterwords) and don’t really feel any different afterwords. Higher hematocrit is one of the benefits of TRT, the appropriate doctor can determine what’s safe for you.

My endo said he would be more concerned about an elevation in hemoglobin than he would be with hematocrit.

6

He neglected to tell you that such a treatment won’t do very much for very long. It’s a bandaid. As long as you’re doing the thing that raises your HCT you will continue to have high HCT. What was the time frame between first baseline blood draw and your third draw?

You’re in the boat I was in, btw. Fought HCT issues for 3.5yrs before giving up. You have three options, two of which are actual options and one of which will not be discussed. But before that’s part of the conversation we need to know the time frame between those blood draws.

7

My hemoglobin is currently elevated according to my third lab.

Hemoglobin 16.5 g/dL (first lab)
Hemoglobin 16.9 g/dL (second lab, 3 months from first lab)
Hemoglobin 18.6 g/dL (Third lab, 6 months from first lab)

I haven’t talked to my TRT doctor about the third lab yet(labcorp post my results before my next appointment), I assume he is going to lower my dose again which I would be okay with.

8

That’s a big move in HCT in just six months. Lowering the dose may help, but don’t assume it will. It didn’t for me and mine increased at a much slower pace than yours. Injection frequency is likely a bigger problem than the dose.

9

Would injecting more than twice a week have any benefit?

10

It would almost certainly make it worse. The one trt preparation that has the lowest incidence of erythrocytosis is test u. That’s the protocol that has the smallest percentage of men with HCT issues. If you look at how test u is administered you see that injections are very infrequent and the release from the ester is very slow.

Here’s a mildly competent write up about it. Towards the bottom you’ll see where they discuss different routes of administration and the corresponding incidence of erythrocytosis.

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11

I’ve heard this a lot, but in my experience it’s not true. I’ve seen a very good correlation between Direct and Dialysis

12

I asked my doctor about this and they said it’s not available through them, cypionate, enanthate, or propionate only. None of this goes through my insurance and I pay $150 per 10ml, which after reading around on this message board it seems insanely priced.

The interval of injection with Test-U compared to Test-C is rather long, wouldn’t this create a roller coaster effect of hormone levels?

On the plus side I donated double red today and set a record for the fastest red blood cell donation. I don’t feel any different after donating.

13

Oh I don’t think test u is a good option through a doctor. The protocol is pretty wonky and the price is insane. I was just using that as an example of how ester weight and dosing frequency are bigger factors in erythrocytosis than dose seems to be (within the spectrum of clinical dosing).

If you have persistently high HCT from testosterone you have two choices:

  1. Use test u and hope that it works
  2. Stop doing the thing that makes your HCT go up

Most people opt for #3 which is a mishmash of blood donations (minimally useful) and OTC meds with dubious results. The only clinical intervention that works well and is easy is an ARB (telmisartan, valsartan, et al). But if you have healthy BP those are not on the table.

14

Yes, that price is crazy high. Always check GoodRx.com. For me, 80% of the time they beat my paid prescription drug insurance.

15

It’s been a couple of months now. My dose is down to 80mg/week which is fine with me but I am stumped with my latest blood test results. My e2 is crashed according to the sensitive e2 result, how did that happen if I don’t take an AI? Lab error? My doctor keeps rescheduling my appointment so I can’t ask him.

Blood work taken 24-26 hours after injection.

Total Test: 799 ng/dL

Free Test: 17.8 pg/mL

Estradiol: 42.2 pg/mL (Roche ECLIA methodology)

Sex Horm Binding Glob, Serum: 29.8 nmol/L

Everything looks good to me at this point until…

Estradiol, Sensitive: <2.5 Low pg/mL

16

What’s your HCT now? Every had any blood pressure issues or pounding heart beat? How do you feel in general?

17

80mg/week is prolly not enough in the long run, 100mg is simply a better route. HCT can depend on how hydrated you are before testing. I dont really concern myself with those numbers, because if I drink plenty of water the night before my test and 3 glasses of water the morning of the test my HCT is high 40s. If I have any drinks the night before or dont drink enough water,
HCT is almost mid 50s. The number that will def require a blood donation is your RBC count, because this where you can run into sluggish flow issues. I would go back up to 100-120mg/wk and allow for more aromatase to take place.

18

This is a lab error or the lab technician botched it, the Roche ECLIA methodology got it right. That’s the problem with the sensitive essay, an accurate result is reliant on technician skill.

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19

It’s within range, 50 on the dot.

Blood pressure has been high my whole life, but otherwise not worried about it, controlled with medication.

My E2 was too high on 100, it is just now within range according to the ECLIA method of testing. As for not being enough in the long run? I am happy with 799 at my peak.

This is what I was thinking too, I am going to see what my options are to get it retested without having to fork over $60 for a new test.

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20

Then it sounds like you have it all under control. You know best.