Female on TRT, high Free T

Pharma
1

My wife is on doctor prescribed TRT for general health benefits (in USA).

Info:She is mid 40s, overweight, PCOS, gluten/soy/peanut intolerant, and prediabetic (A1C was 6.2 this last check).

Was initially prescribed to take 0.25ml testosterone cyp once every 2 weeks. After 6 weeks she had blood test to check in on things and free testosterone was very high. Everything else (SHBG included) was in the normal range.

Total testosterone: 128 ng/dL
Free testosterone: 18.6 pg/mL

We talked to the doctor and decided to switch dosing to 0.125ml once per week to even things out and hopefully bring the free testosterone down. 4 weeks later she just did bloodwork again to see if it changed anything. Both values actually went up, but of course there is always day-to-day variation.

Total testosterone: 160 ng/dL
Free testosterone: 25.6 pg/mL

Any ideas on what is causing such a high free testosterone? SHBG was in normal range. We are ok with the total T being this high, but something weird is going on with the Free T and I can’t find any reports with similar numbers. Her doctor is supportive but not very well educated on TRT in females.

Thanks

2

Female response to test is quite significant compared to male response.

We need to know the potency of her testosterone.
Is it 50mg/mL?
100?
200?
It will say it on the vial.

Can you check and let us know?

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3

Exactly. OP gave a volume not a dose. Should be 50mg/ml but if not I’m concerned

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4

Long odds but is she taking biotin by any chance?

More importantly, what were her levels pre trt?

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Sorry, I should have included that info. It is 200mg/ml vial.

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Yes, she takes a daily multi b vitamin, but not a biotin specific one.

Hormone levels pre-trt were normal

7

4char

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8

Correct, she is taking 25 mg per week. We are scheduled to talk to doctor for follow-up appointment on bloodwork but I wanted to get this community’s input first as this doctor doesn’t seem hugely experienced with prescribing TRT for a woman

9

I can’t imagine trusting a doctor whose competence I find questionable to prescribe me something as potentially altering as TRT.

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Wow as @Andrewgen_Receptors stated this is way too high. Women’s T doses range from 5-15mg per week depending on response rate with most being somewhere in the middle. A proper protocol starts you lower end, adjusting up with labs, to avoid virilization issues. Deepening voice, increased body hair, changes in private parts can be permanent.

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So her pre trt levels were normal with existing PCOS?

And she’s on for “general heath”.
I can’t believe this is Dr prescribed.

You need to find another “clinic” as there are too many red flags.

12

Yep.

10mg is usually the starting dose, if the female is clinically low…which she wasn’t.

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My wife is on 8mgs a week. Her free T is around 4.5 pg/ml and total T 140. She is also on Estrogen both through defy.

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My wife does well on 8mg. Even 10 caused increased body hair. I can’t imagine what 25mg would have done.

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15

Same for my wife. Above 8mgs was too much. But her being on T has been incredibly beneficial for me! :smirking_face:

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I thought this was relevant to the conversation.