[quote]brentf13 wrote:
Good point and by the way the only labs Crisler uses now are 24 hour urine.[/quote]
Oh, I just saw this, so crisler uses the 24 hour urine test from
Rhein labs ? or does he like the ultrasensative test by quest?
[quote]Get out the Door wrote:
KSman wrote:
Perhaps. The numbers will still be foreign to many. But I still have my doubts about this improving perceived TRT results for those with no comorbidies, unless the numbers and lab ranges for urine testing dictate higher T doses than serum tests would.
The effects of E2 control are a vastly bigger variable for perceived benefits than any “higher accuracy” diagnostic.
Collecting 24 hours of urine might be bothersome. You still need blood work for CBC, cholesterol etc.
A 24 hour sample can be of value for someone not yet on TRT. Again, when on effective TRT, the HPTA is shutdown and there is probably no pulsatile release of T. The T levels will change in response and timing of hCG injections. A 24 hour sample the day of the hCG injection may not be the same as the next 24 hour period. Then which “very accurate” result would be best when they are not the same.
A skilled doctor will be able to do a good job with serum tests and a doctor who is less skilful will not provide better care by using a more accurate test.
And one does not know what lab numbers from any method are optimal for a patient. Would one use the more accurate lab numbers to change a test cyp dose from 100 – 115? Would 1ml of 10 T cream be increased to 1.15ml? Could not serum tests drive the same fine adjustments? I think that the vast majority of T injectors are using 100mg/wk. With this “one shoe size fits most” situation, if the dose does not change what is gained by other testing methods.
As an engineer, I am pragmatic and also look for cost benefit. If a change does not increase benefit, is anything gained at all?
A 24 hour urine test is basically like having a blood draw every hour, on the hour, for 24 hours of the day.
There is no argument for which is superior. Its not even a contest. This has already been established amongst the cutting edge HRT Drs.
Its not a matter of being “slightly” more accurate. I wouldn’t trust labcorp period…nonetheless who or which method is better.
Collecting the urine is painless…You carry a jug around all day for one day. No biggie.
It is 224 bucks, insurance covering the shipping part of it, so 199 flat out the door.
Test might be more stable once someone is on HRT, but still expect estrogens to move all around…[/quote]
what test do I ask my DOC for ? I have free medical…so no probs. ? thanks guys…
PS my last blood estradiol was 28*
[quote]matthewt wrote:
Please explain this too me
Dr Crisler suggest the Ultrasensitive Estradiol from Quest Diagnostics as the coorect test,yest as Wise point out frm LEF’s magazine it states
‘‘Estriol in particular does not last long in the blood. In fact, the half life of estriol has been shown to be between 3.6 and 64 MINUTES!’’
The more accurate way to assess estriol is by collecting what is excreted during a 24 hour urine collection. This form of testing ensures that we have an accurate value that is not affected by the fluctuations of the day, because we are measuring 24 hours worth of hormone production.
I wonder what crisler would say about this test be Rhein labs
[/quote]
For estriol(E3), the more important, probably most important, cancer fighting, antiaging estrogen, we need to test in urines.
For E2, Urines is best…However, if one has to blood test, the quest ultrasensitive test is the only one to use. The ONLY one. Standard estrogen tests are woefully inaccurate.
[quote]Wise Guy wrote:
matthewt wrote:
Please explain this too me
Dr Crisler suggest the Ultrasensitive Estradiol from Quest Diagnostics as the coorect test,yest as Wise point out frm LEF’s magazine it states
‘‘Estriol in particular does not last long in the blood. In fact, the half life of estriol has been shown to be between 3.6 and 64 MINUTES!’’
The more accurate way to assess estriol is by collecting what is excreted during a 24 hour urine collection. This form of testing ensures that we have an accurate value that is not affected by the fluctuations of the day, because we are measuring 24 hours worth of hormone production.
I wonder what crisler would say about this test be Rhein labs
For estriol(E3), the more important, probably most important, cancer fighting, antiaging estrogen, we need to test in urines.
For E2, Urines is best…However, if one has to blood test, the quest ultrasensitive test is the only one to use. The ONLY one. Standard estrogen tests are woefully inaccurate.
[/quote]
Tests will guide your dosing so far. After that, you need to adjust your AI dose from there to see what feels best for you. That is called individualized dosing.
I use the LEF male panel that also includes many other tests of value. I pay for all out of pocket. Getting a hormone only panel would only be part of the testing needed. The other tests, unbundled would be added expense.
Questions:
With these urine tests - what are the results - units etc?
Doctors [some] have been using serum levels for diagnostics and achieving results for their patients. If they switch to these methods, will their existing stabilized patients feel better?
Are these expressed as equivalent serum levels?
If so, what serum labs did they use to correlate urine to serum results? They would need to do something approaching a 24 hour blood draw. The urine tests are then related to serum level tests that are by nature suspect?
Are the optimal target numbers for TT, FT and E2 any different then when using serum levels?
Can anyone report what changes they made to AI dosing when serum E from Labcorp or other suspect methods where replaced with Quest high sensitivity E2 or 24 hour urine testing?
When injecting T, levels are all over the map if done once a week. Depending on what 24 period is selected, the results would be more of a function of blood draw timing and issues of testing method accuracy would be the least concern. If one injects EOD, then levels would be steady and blood draw timing would be a minor issue. With EOD injections, TT, FT and E2 levels would be quite steady. The advantage of a 24 urine sample becomes less of an advantage over a blood draw as the serum levels are not changing and any single blood draw is representative. I think that the 24 hour sampling has great merit for those who are not on TRT, thus having pulsatile LH, FST and T production. Yes, one can use the newly developed testosterone creams; that is not an option for me as I pay for all out of pocket and injecting is greatly less costly than T cream - please advise if I have got that wrong, and discuss these other thoughts.
answers in bold.
KSman wrote:
Tests will guide your dosing so far. After that, you need to adjust your AI dose from there to see what feels best for you. That is called individualized dosing.
I use the LEF male panel that also includes many other tests of value. I pay for all out of pocket. Getting a hormone only panel would only be part of the testing needed. The other tests, unbundled would be added expense.
ABSOLUTELY AGREE. MONEY CAN BE AN ISSUE. I LIKE LEF. MOST OF THOSE TESTS ARE GREAT. THE ESTRADIOL AND FREE TESTOSTERONE THOUGH ARE NOT, AND I REPEAT NOT, TO BE RELIED UPON.
Questions:
With these urine tests - what are the results - units etc?
SAMLE TEST http://www.rheinlabs.com/Rhien_Images/05_IL/05_WomResults.pdf
Doctors [some] have been using serum levels for diagnostics and achieving results for their patients. If they switch to these methods, will their existing stabilized patients feel better? THEY BETTER. ITS UP TO US TO ACCEPT BETTER, ADVANCING TECHNOLOGY.
Are these expressed as equivalent serum levels?
If so, what serum labs did they use to correlate urine to serum results? They would need to do something approaching a 24 hour blood draw.
The urine tests are then related to serum level tests that are by nature suspect? NO. THE RANGES ARE CALCULATED THE SAME WAY SERUM RANGES BECAME CALCULATED - BY TESTING THOUSANDS OF HEALTHY VOLUNTEERS, AND BASING RESULTS ON SUCH. THIS HAS NOTHING, I REPEAT NOTHING TO DO WITH PRIOR SERUM LEVELS.
Are the optimal target numbers for TT, FT and E2 any different then when using serum levels? DEPENDS ON THE HORMONE TESTED
Can anyone report what changes they made to AI dosing when serum E from Labcorp or other suspect methods where replaced with Quest high sensitivity E2 or 24 hour urine testing?
When injecting T, levels are all over the map if done once a week. Depending on what 24 period is selected, the results would be more of a function of blood draw timing and issues of testing method accuracy would be the least concern.
If one injects EOD, then levels would be steady and blood draw timing would be a minor issue. With EOD injections, TT, FT and E2 levels would be quite steady. The advantage of a 24 urine sample becomes less of an advantage over a blood draw as the serum levels are not changing and any single blood draw is representative.
ABSOLUTELY AGREE HERE. SERUM AND URINE SHOULD BE SIMILAR, IN THEORY. TO BE HONEST THOUGH I HAVE NO IDEA - I HAVE YET TO SEE ANYONE COMPARE THESE TWO. BUT YOUR LINE OF THINKING HERE IS SOLID.
I think that the 24 hour sampling has great merit for those who are not on TRT, thus having pulsatile LH, FST and T production. Yes, one can use the newly developed testosterone creams; that is not an option for me as I pay for all out of pocket and injecting is greatly less costly than T cream - please advise if I have got that wrong, and discuss these other thoughts.
ABSOLUTELY. MONEY IS ALWAYS AN ISSUE, ESPECIALLY IN TODAYS ECONOMY. GOOD FOR YOU FOR TAKING THESE ISSUES INTO ACCOUNT - MOST DON’T.
ok… so in the end… whats the better test…and or the best way to test ? that’s what the rest here are thinking…just I asked…lol
thanks for the reply’s guys…great work
Since adex has a half life of approximately 50 hours, and ittakes about 14 days to hit serum maximum, In two days or so your serum level would half of your last dosage, then two days later half of that and so on…
A lot of guys after stopping for two days notice significant positive results, some of course don’t. Patiently remember you didn’t get upside down overnight, and may not get back to normal that fast either.
According to a post made previously about figuring dosage, I was at 69 on 1mg/week and to get to 22 I needed 3.10mg/week to get back down there and stay there. I have been on 3.5mg/week for two plus weeks and my libido is slightly down, so I’m stopping for three day to see if it pops back up. If not, I need more than 3.5mg’s/week but at least I’ll know tomorrow afternoon or so which way to adjust my dosage.
Good luck.
[quote]fightu35 wrote:
ok… so in the end… whats the better test…and or the best way to test ? that’s what the rest here are thinking…just I asked…lol
thanks for the reply’s guys…great work[/quote]
24 hour urines. By far superior. Not even close.
The only issue you will have is getting a Dr to run them.
[quote]Chushin wrote:
Wise Guy wrote:
I LIKE LEF. MOST OF THOSE TESTS ARE GREAT. THE ESTRADIOL AND FREE TESTOSTERONE THOUGH ARE NOT, AND I REPEAT NOT, TO BE RELIED UPON.
Because they are innacurate, or because they don’t have reliability?
Put another way, if I only use the test as a ballpark indicator (not the final word; that would be “how I feel”), can I at least count on the results to be reliable (in the sense that they will always give the same result if T and E levels are unchanged)?[/quote]
The free testosterone is woefully inaccurate, because it is done using “calculated” numbers. They don’t actually test for free testosterone in the blood - They find out albumin/SHBG and calculate it by hand. Only problem with that is SHBG, by nature, is downright next to impossible to test for, it varies by the hour.
However, when using urinary analysis, the free levels of hormones are a piece of cake, because thats all that is present in urine. In fact, thats all they test for - the free, unbound levels of hormones.
I just got word today that Labcorp has now switched over to the ultrasensitive estrogen testing method. This was done recently.
So you should be good there.
Dosing Adex is really difficult. I think it’s would be extremely difficult to hit it right with tablets. I can tell you from experience, and I wouldn’t necessarily recommend this, it’s easier to run your E2 into the ground and adjust back up from there. Slightly increasing the dosage will take weeks and weeks to hit it right. For example take two 1mg doses three days apart and that should run you to low. Believe me if you’re real low you’ll know it. (Joints hurt, general feeling of unwell…) Once you’re to low stop taking it and wait until you pass through the sweet spot.
For me the sweet spot lasts for about a full day. Judge from the time it took you to hit the sweet spot what your ongoing dose should be. If you hit it in two days you need a high ongoing dose (maybe 1.25mg a week.) if it takes you 4 days to pass through then maybe you need a lower dose (.75mg or .50mg a week.). You’d be surprised how fast you can hammer E2 with a couple of high doses of Adex. You could also end up needing a really high dose. Like KNB when I was on 200mg of T cyp I probably needed upwards of 2mg a week.
A new AI issue:
I hope that this is understandable. Its almost 3AM and my brain is shutting down.
Discussed:
-daily changes of TT, FT and E levels; TD and injected
-how that effects serum blood tests; timing affects results
-how anastrozole dose-response may not be linear
-two mechanisms that drive E2 daily variations with TD TRT
-how a TD need for anastrozole might affect the brain
-how 24 hour urine tests solve the TD timing error issue
-how TD anastrozole dose changes can be bases on faulty data
-how TD serum lab results can be all over the place
When on injections, the T levels that feed aromatization are probably the same every where in the body. One exception is the testes when hCG is used. One can find the correct amount of anastrozole to get E2 to a given target level. With frequent T injections, twice a week, E3D or EDO, T and E levels are not varying much. One should test between injections. The time of day for the draw should not matter much.
hCG has a long half life. EOD dosing probably does not create significant swings in testicular T&E production.
When using transdermals, TD, the TT and FT levels are varying greatly. E2 will change as well. The levels change with time and the time of the lab may have a great influence over the results.
Should one put off their daily TD application until after the lab. I think this would be a good idea. However, 24 urine based tests would eliminate the effects of time of day for the blood draws and there would not be any need to defer a TD application.
When on transdermals, there are two different aromatase processes going on. One is the same as above, with equal T levels in “internal tissues”. Typically one adjusts anastrozole dosing to balance that aromatization to achieve a target E2 level.
The second process is the aromatization of T in the dermal layers. What are the factors? The T levels in the dermal layers are very high peaks after application, which fade down over hours, I don’t have numbers for that, but that does not matter for the sake of the situation that I am describing.
With TD having very high T level spikes and fades, there will never be a balance of the competitive effects of T and anastrozole determining aromatization rates. E2 production will be all over the map. This second process could have a needed anastrozle dose to create a favourable average E2 production rate that is a lot higher that for for the internal tissues.
The amount of anastrozole to control dermal aromatization will not be the same as the amount needed to control aromatization in the rest of the body. More will be needed.
One would easily assume that this all averages out and you just adjust the dose to get the desired serum levels, simple and done.
With dermal T levels changing greatly, when T is high, E production in the dermis is probably very high. As T levels fall, anastrozole levels will become more effective. Serum E levels may be varying to a greater amount than one would expect.
One does have the issue of T&E levels changing by the hour. That places lab results at the mercy of blood draw timing. But that is not where I am going. But do not lose sight of this.
When on TD with a given dose of arimidex, if you get lab numbers that are too high [assume that the numbers are correct time of day wise for the sake of argument]. With injections, you get a result of 35. The dose response is reasonably linear.
If you have an E2=22 target [0-54pg/ml] and were on 1.2mg of anastrozole per week doses EOD, then your dose can be increased as follows: 35/22*1.2mg/wk=1.9mg/wk. But that does not work for TDs. The dermal situation may need more that that increase to achieve the target E2 level because the dermal T levels are so high.
One may have to use more anastrozole than expected with TD TRT. The dose corrections may not fit the linear level.
There was a post here where the linear anastrozole dose correction seems to be quite inadequate. What does this mean to a guy on TD? It may take a a few labs and adjustment to get the results that you need.
Some who absorb TDs well have reported lab results that are all over the map. I think that this be a blood draw timing issue and T&E levels that are changing all of the time. What to do? 24 hour urine based labs can eliminate the time of lab draw problem. Note that doing one’s AM TD application the day of the draw may reduce these timing based errors. FT numbers are probably the most time of day volatile.
With TDs, one may be taking longer to find the right anastrozole dose. The results of dose changes and basic med checks when nothing changes may be all over the map. This can be from dose changes based on faulty data from the time of day problem. Basing dose changes on fault data is not going to go well.
TD TT and FT levels are varying and anastrozole levels are steady. This is a mismatch. With injections, the situation is well behaved.
This presents a number of challenges for those on TD. 24 hour urine based labs are the best solution for TD based TRT. Dose changes may take more labs to achieve.
For those who inject frequently, the time of lab draw probably does not create any problems. Blood draws should be 1/2 way between injections. Anastrozole linear dose corrections calculations should work well. Serum blood tests should work well and there is not the same need for 24 hour labs to manage basic TRT. The situation is well behaved. The use of 24 hour urine labs to evaluate other hormone systems has great merit.
Another related topic: The brain needs E2 to function and there is a significant amount of T–>E aromatization occurring in the brain. If one does need more anastrozole to control E2 levels while on TDs, the E2 levels in the brain could be lower than a comparable injected TRT situation. TDs might create unexpected low E2 symptoms with some E2 levels that do not cause this for those who are injecting.
1 Like
[quote]KSman wrote:
A new AI issue:
I hope that this is understandable. Its almost 3AM and my brain is shutting down.
…
When on transdermals, there are two different aromatase processes going on. One is the same as above, with equal T levels in “internal tissues”. Typically one adjusts anastrozole dosing to balance that aromatization to achieve a target E2 level.
{/quote]
*Well…this may not fit your understanding, but T dosing does not determine AI dosing; they are not competitive at binding site. But yes, tissues have different levels of activity, that changes over time and with conditions, and…
*Yes, but…
*Not if one takes a “high enough dose…” But yes…
*Yes!
At last. The brain is only my second favorite organ.
But what goes on in there, in men, may have little to do with measured circulating E2.
Hence my comment, pages ago on “paracrine” function of aromatase activity.
Respect to you, KSMan, I agree: measuring E2 serves as a surrogate measure only–a parameteric to an engineer–of what tissues–brain, peripheral, bone, fat, skin–are doing with aromatase, AI, T and E2.
[quote]DrSkeptix wrote:
T dosing does not determine AI dosing; they are not competitive at binding site. But yes, tissues have different levels of activity, that changes over time and with conditions, and…
[/quote]
But, doesn’t T dosage effect aromatase and thus E2? Also, do we know if E2 levels are more sensitive to changes in total or free T?
[quote]
At last. The brain is only my second favorite organ.
But what goes on in there, in men, may have little to do with measured circulating E2.
Hence my comment, pages ago on “paracrine” function of aromatase activity.
Respect to you, KSMan, I agree: measuring E2 serves as a surrogate measure only–a parameteric to an engineer–of what tissues–brain, peripheral, bone, fat, skin–are doing with aromatase, AI, T and E2. [/quote]
Dr. Skeptix, very interesting - are you willing to expand on this a little bit pleeeeeaaase? 
[quote]katzenjammer wrote:
DrSkeptix wrote:
T dosing does not determine AI dosing; they are not competitive at binding site. But yes, tissues have different levels of activity, that changes over time and with conditions, and…
But, doesn’t T dosage effect aromatase and thus E2? Also, do we know if E2 levels are more sensitive to changes in total or free T?
[/quote]
No. Exogenously administered T doses do not effect “aromatase activity” (as we are discussing it here), but E levels, of course, are effected, in men; more substrate, more E. Once blocked, the enzyme doesn’t convert little doses of T or big doses of T.
(Good question about free and total T. I will bullshit here, and guess that all T becomes free T before binding to receptors or aromatase–but I do not know that for sure. Does SHBG act as a delivery protein as well? Don’t know.)
But what does effect aromatase activity in tissues is wonderful: obesity, age, diabetes, shock, infection, wounds, even cyclooxygenase (a pro-inflammatory enzyme) in breast tissue. Does weight training? HIT? Is it part of DOMS?
Who knows? Does someone care to look?
What I cannot fathom is why the geniuses have not yet discovered different isoforms of aromatase in different tissues…
But I do not have enough “street cred” here.
Well, maybe if you are a real good boy, Katzenjammer Kind…
One month alter, sorry for the delay, thanks Wise.
Ignorant question here…what is hmg?