Help Interpreting Recent Labs

Pharma / TRT Testosterone Replacement
1

Hello All!

I have another thread going, but figured i would start a new one since this is not really on the topic of the first thread. If i need to post this to my original thread let me know and i will. I have attached my most recent labs (done 12/30/2019) to this thread below. I am moving my care over to a telemed clinic that many on here use and these are the labs that they did for me. I have a consult with them on the 15th. I am posting these labs to get some feedback from you all on what questions i should be asking the new doc when i talk to them in a couple weeks. See at bottom for my questions.

My current protocol:

190mg test IM every monday.
.5mg of AI day after injection. another .5mg (when needed) on Fridays. I have attempted to stay off the AI, but could not tolerate the high E2 symptoms. I have significant water weight gain and become SUPER bitchy when my E2 is elevated. The water weight gain made my entire body hurt, especially my joints. very uncomfortable. I know this was high E2 and not low E2 because of the previous labs below.

I am going to a new doc because my current doc only does weekly shots in his office. In an attempt to keep my E2 down, i thought it would be a good idea to go with more frequent injections.

Here are my most recent labs:

page 1
page 11314Ă—996 151 KB

page 2
page 21281Ă—1402 204 KB

page 3
page 31258Ă—625 140 KB

Here are the results of previous labs. These are the only things that i was tested for by my current (about to be former) doc…

Notes: E2 test for the tests below are NON Sensitive test. Also, reference ranges listed on the first set of labs are the same for all the labs listed below…I just didnt want to type them over and over.

Date 7/11/2019-PRE TRT LABS
SHBG 70.9 (18.5-55.9)
TT 373 (350-1000)
E2 14.9 (7.6-42.6)
Free Test 4.31

Protocol: 140mg 1x per week. 1MG of AI 24 hours post injection

Date 8/26/2019
SHBG 66.9
TT 716
E2 41.3
Free Test 9.56

Date 10/21/2019
SHBG 47.5
TT 597
E2 66.4
Free Test 9.94
Protocol: Increased test to 190mg 1x per week. told to increase AI to 2MG weekly…1mg 24 hours after shot, 1mg 3 days later

Date 11/18/2019
SHBG 28.6
TT 416
E2 <5
Free Test 12.95
Protocol: Increased test to 190mg 1x per week. told to stop AI for 2 weeks (because of low E2) then continue with 1mg 24 hours after shot. my desire is to not take the AI so i stopped the AI for 4 weeks. could tell my E2 had shot back up as i was feeling terrible again. complained to doc on 12/16 and they ran a E2 test. Those results were…

Date 12/16/2019
E2 70.4
Started with .5mg of AI 2 times a week. this week is the first week i didnt feel l needed the second .5mg so i havent taken it.

Questions: Is there a signficant difference between the sensitive E2 and non sensitive (or whatever its called). What is DHEA?

I am just asking for those of you who have been on TRT long enough and know what these labs mean to comment on anything you see that i need to make sure i bring up. Overall, i feel pretty dang good. I seem to convert test to E2 pretty easily and feel absolutely terrible when my E2 gets higher than 65. almost not worth the trouble of shooting myself every week. When my E2 tanked, i honestly didnt feel that bad at all. I know alot of you have a terrible experience with low E2, i did not.

Thanks!

2

You could definitely benefit from more frequent injections which will lower E2 and decrease the dependence on AI’s. Too bad your current doctor is unwilling to be flexible and allow you to inject at home so that you may optimize treatment.

I have seen high SHBG guys do well on daily dosing, but some just don’t feel right and these men usually always do better on an EOD protocol. I believe it’s that they need the larger spikes in hormones to suppress SHBG creating a surge in androgens.

There was one member who I’m referring to who witnessed an increase in SHBG going from an EOD to a daily protocol without so much as a change in dosage, free testosterone was lower and total testosterone was higher.

To this I say if you gave it more time, your thoughts would change because some guys don’t feel the effects of suppressed estrogen right away.

DHEA is an adrenal hormone helps produce other hormones including testosterone and estrogen. Your DHEA is very low, supplementing DHEA may very well increase estrogen and suggest supplementing 25-50mg daily. You might start out low and see how everything goes.

You’ll hear differences reported by many, but both have pros and cons. The sensitive method is more accurate but is dependant on tech skill, the other less sensitive method can pick up on other steroids (C-reactive protein) falsely elevating estrogen, but can be just as accurate.

If really trying to gain accurate information and are dealing with E2 problems, run both tests if financially stable and compare the two different results and choose one which best describes how you feel.

1 Like
3

The ECLIA test (aka immunoassay or IA) for E2 management is commonly used for those on TRT. It is not an incorrect test or a test for women, but simply one way to check estradiol levels. The other commonly utilized test is the LC/MS/MS method (aka liquid chromatography dual mass spectrometry, sensitive or ultrasensitive). It is the more expensive of the two. There are inherent advantages and disadvantages to each of these two methods. I have been fortunate to be able to speak with professionals who work with both methods. One is a PhD researcher for Pfizer and the other is a medical doctor at Quest. I’ll summarize their comments.

The ECLIA method is the more reliable of the two in terms of consistent results. The equipment is easier to operate thus accuracy is less reliant on the skill of the operator. If the same sample were to be tested twenty times, there would be very little, if any, difference in the results.

The ECLIA method is not as “sensitive” in that it will not pick up E2 levels below 15pg/mL. If your E2 level with this test is 1-14pg/mL, the reported result will be “<15”. Because of this, it is not recommended for menopausal women, men in whom very low levels of E2 are suspected, or children. In other words, if your levels are below 15pg/mL, and it is important to know if the level is 1 or 14pg/mL, you do not want this test. For us, this is likely moot, since if you are experiencing low E2 symptoms and your test comes back at <15, you have your answer. For a woman being treated with anti-estrogen therapy for breast cancer, it may be necessary to know if the E2 level is zero or fourteen because therapeutically, they want zero estrogen.

A disadvantage to IA testing is that it may pick up other steroid metabolites, which in men would be very low levels, but still could alter the result. Another potential disadvantage is that elevated levels of C-reactive protein (CRP) may elevate the result. CRP is elevated in serious infections, cancer, auto-immune diseases, like rheumatoid arthritis and other rheumatoid diseases, cardiovascular disease and morbid obesity. Even birth control pills could increase CRP. A normal CRP level is 0-5 to 10mg/L. In the referenced illnesses, CRP can go over 100, or even over 200mg/L. Unless battling one of these serious conditions, CRP interference is unlikely.

The LC/MS/MS method will pick up lower E2 levels and would be indicated in menopausal women and some men if very low E2 levels are suspected and it is desired to know exactly how low, children and the previously mentioned women on anti-estrogen therapy. It will not be influenced by elevated CRP levels or other steroid metabolites.

While some may believe the ECLIA test is for women, on the contrary, as it pertains to women on anti-estrogen therapy, such as breast cancer patients, the LC/MS/MS is the test for women as CRP levels are a consideration and it is necessary to know if the treatment has achieved an estrogen level of zero.

On the other side of the coin, LC/MS/MS equipment is “temperamental” (as stated by the PhD who operates both) and results are more likely to be inconsistent. Because of this, researchers will often run the same sample multiple times.

It is not clear if FDA approval is significant, but this appears on Quest’s lab reports: This test was developed, and its analytical performance characteristics have been determined by Quest Diagnostics Nichols Institute San Juan Capistrano. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes. This statement is on LabCorp’s results: This test was developed and its performance characteristics determined by LabCorp. It has not been cleared by the Food and Drug Administration.

It is unlikely that any difference in the same sample run through both methods will be clinically significant. Estradiol must be evaluated, and it should be checked initially and ongoing after starting TRT. It obviously makes sense to use the same method throughout. Most important are previous history and symptoms related to low or high E2. Those are correlated with before and after lab results. Any estradiol management should not be utilized without symptoms confirmed by lab results.

Dihydroepiandrosterone, a neurosteriod, precursor hormone which converts to many steroids downstream. It is a mild anabolic steroid. Any adrenal stress? I’d get it up to 400.

4

Adrenal stress? I’d say no since I’ve got no idea what that is. I’ll look into DHEA supps

5

It is not uncommon to acquire illnesses or conditions that are unfamiliar to you. Unfortunately, we are not limited to only diseases which we know about.

Here are some common causes of adrenal stress, or adrenal fatigue:

  • Poor diet
  • Poor sleep
  • Emotional trauma
  • Stressful relationships
  • Employment/work stress
  • Lack of exercise
  • Too much exercise
  • Mold exposure

All of these things stress you out and tax your adrenals. Low DHEA levels can be a sign. If any of the above apply, it may be worthwhile to have cortisol levels evaluated.

6

My job is super stressful, so this maybe something for me to dig further into. Plus I’m married to a woman so that’s not exactly easy either…

1 Like
7

A man’s testosterone levels drop significantly when holding an infant. Married men have markedly lower testosterone levels than single males. So there is another reason.

8

Being married to a man would not likely make a difference…

I’d love to see the study that proved this. There is nothing more peaceful than a baby sleeping on your shoulder, it’s a feeling that makes life worthwhile.

9
11

A man’s testosterone levels drop significantly when he holds an infant. Even holding a baby doll can decrease levels of the male virility hormone.

It says this, and then provides zero backup for the statement. Which makes sense. They would have to be drawing blood, then handing the guy a baby, then drawing blood, to get data that doesn’t actually help anyone.

12

There are tons of other studies showing the same outcome. I our primary purpose is to procreate, have a child, raise that child and that will only happen if the males aren’t going around screwing every female in the vicinity.

13

You should change your screen name to DB Cooper.

14

:sunglasses:
As long as none of the passengers are injured I guess.

15

UPDATE (for those who care to know):

I talked with my new doc (Defy) and they have recommended some significant changes (significant for me). I will now be doing shots M, W, F every week subQ at a rate equivalent to 168mg per week. This is a sizable drop in test as i am currently at 190mg/week. It was explained that i wont need as much test since my peaks and valleys will be less significant (more steady levels).

It was also recommended that i take .25mg of AI with each shot (so a total of .75mg per week, which is down from my 1mg a week). I was somewhat surprised that they recommended the AI since it seems that most people are against it completely. The rationale that i was given is that the long term effects of high E2 are unknown and its not worth the risk of having high E2 if we find out there is a neg consequence of high E2 down the road. The goal is to keep my E2 at around 40. I know many of you feel E2 is irrelevant, but i feel terrible if my E2 raises.

It was recommended that i take 25mg of DHEA once a day to raise that level since i am low there.

It was recommended that i take 200mg a day of CoQ10 to combat the effects of the statin i take for high cholesterol.

Overall i feel very good about this advice. My intent is to switch to more frequent dosing and then try to slowly decrease the AI and eventually get off it all together to see if there is a difference in the way i feel with the more frequent shots compared to just shooting 1 time a week. I know this is against docs orders, but there are just too many people that feel that an AI is not necessary for me not to give it a try.

as always, i recommend any feedback any of you have!

16

This was going to be my recommendation, at least you can remove or reduce the dependence on AI’s. Defy Medical doesn’t immediately recommended daily dosing to newbies because it might scare them away from TRT, they want to slowly allow you to get used to injecting before recommending very frequent shots.

You start a guy on daily shots right away and he’ll most like quit before he has a chance to build confidence in injecting himself. It’s not often I see newcomers wanting daily shots right away, it does happen, but not often.