I got my 2nd round of blood work done since switching from gels to test cyp injections. Current protocol is 80mg once a week. I’ve been on injections for 10 weeks and have my next doc visit coming up in a couple days.
Prior labs at trough were:
TT: 428 (250 - 827 pg/mL)
SHBG: 48 (10 - 50 nmol/L)
Estradiol: 22 (<= 39 pg/Ml)
Albumin: 4.5 (3.6-5.1 g/dl)
This time around, doc wanted to test at peak to see how high my levels were.
TT: 671(250 - 827 pg/mL)
SHBG: 55 (10 - 50 nmol/L)
Estradiol: <15 (<= 39 pg/Ml)
Albumin: 4.6 (3.6-5.1 g/dl)
I’ve got two questions.
-
What could have caused my E2 to drop so much? All other tests have been 22 and 25. Is this something I should be concerned about?
-
I’ve been thinking about changing my protocol to twice weekly injections. Based on these numbers, would this be a good idea?
I feel much better since switching to injections. Some morning wood, libido is back, ED is hit and miss (but I read it takes time). Gym performance has been very good. Downside is that I’ve gained 15 pounds (diet is 80-90% clean). Thanks for the help.
If going through insurance, you may need to seek private care (cash pay) for your TRT, managed healthcare doctors cannot allow Total T levels 800> do to insurance guidelines. When you surpass 800 ng/dL your dosage will be decreased or TRT stopped by your doctor.
Sadly the insurance institutes who wrote these guidelines had a poor understanding of sex hormones and have caused more headaches for us men seeking care under insurance.
I see your doctor is only testing the inactive portion of testosterone and not the free portion. Men who have SHBG on the higher end tend to have low Free T and low E2, when Total T increases, Free T increases and E2 increases as a result.
I can tell you given your Total T and SHBG levels, Free T levels are probably lower on trough which is why ED is hit and miss and have never really been optimal.
Your dosage is unusually low and this suggests your doctor is trying to keep levels <800 which is bad for you because you’ll need higher Total T levels do in part to your slightly elevated SHBG which will see Free T suboptimal.
Sadly your doctor doesn’t understand how to play this game very well because he/she has no sex hormone education and that’s what guidelines are for, your doctor is just keeping levels in range and failing to understand the implications of elevated SHBG.
This is not a bad idea, but your doctor might pull your script if levels are close to or 800> which is more than likely what you need to have sufficient Free T and E2 levels.
Your dose is way too low, and peak levels are not too relevant. You need more T to have more E2. You should be over 100 mg for certain. More androgens (more test) will lower the SHBG over time.
Appreciate the feedback. Lets assume my dosage stays the same, will it help or hurt me to switch to twice weekly injections?
I don’t think this blanket statement is true. I go to a urologist for my TRT and it’s all through insurance…my last TT value during my last appointment was 1080. Granted, I’m injecting EOD, so there isn’t much of a trough… But he was fine with the number and re-upped my script at the same 200mg a week for another 6 months.
1 Like
Not at all, if anything it will provide better results because levels will not decline as much and trough will likely be higher.
Perhaps not, but is true for the majority who don’t have infomed doctors have no good judgement since knowledge is lacking. The reference ranges were never meant to be the main deciding factor in treatment, your doctor has good judgement and has the ability to decide based on experience if levels over ranges are healthy for that particular patient.
Had my Dr appointment yesterday. He’s upping my does to 100mg once a week. We will be testing only at trough. He’s open to changing my protocol to twice weekly. Should I just make the switch now?
Twice weekly is a better bet than once weekly, your levels will be higher at trough and this can only be a good thing,