Untainted Results Are In - Burning through T Fast

[james2012]

My previous draw is here: https://thinksteroids.com/community/threads/134297928. At the time I was on .25mg Arimidex every third day along with 250IU HCG along with 1.5 tubes of Testim. I did not trust the results - the T was off the charts high. The labs were drawn on the day before my next adex and HCG injection in the am two hours after Testim application. Contamination at the injection site was suspected.

I am not sure if this contamination would affect, for example, direct DHT numbers. If the blood is contaminated I would suspect that somehow during the direct serum measurement the DHT number would be affected.

Here are my new numbers. By this time I had stopped Arimidex and it had been five days. I did a 250IU HCG shot the day before and only 1 tube of Testim. I had been on this protocol for less 7 days.

Blood drawn 2 hours after Testim application. No Testim at the injection site
Testosterone, Total: 417 ng/dL (range 280-800)

Free: 16.6 pg/mL (range 6.8-21.5) I have read not to trust the Free T measurement from Labcorp.

Estradiol, Sensitive: 13 pg/mL(range 3-70 pg/mL). Interesting this number shot down from before when I was doing more T and more Armidex. I had stopped Arimidex as described above, however previous D-3 was 29 and I began to supplement D-3 at 15g/day. See new D3 number below. Is D-3 an AI?

Vitamin D: 59 ng/dL (range 32-100)

DHEA-S: 223.5 ug/dL (range 88.9-427)

Progesterone: .9 ng/mL (range .2-1.4)

Estrone, Serum: 82pg/mL (range 12-72) HIGH

SHBG: 15.1 nmol/L (range 14.5-48.4). Always had low SHBG even when Total was low prior to TRT.

DHT: 87 ng/dL (range: 30-85). Last result were very high but I don't know if I can believe it due to contamination. I don't know if contamination of T will somehow affect a serum measurement of DHT

Pregnenolone, MS: 39ng/dL (range < 151). This appears low but is probably due to my very low cholesterol. I have since stopped Crestor and my LDL and Total have climbed into normal ranges. Since stopping Crestor I have noticed an improvement in mood and energy

Now for the kicker, which points to insulin resistance. I drew labs the next day prior to any Testim:

Total T: 140 ng/dL (very low)
Free T: 5 pl/mL (low)
SHBG 14.6 nmol/L (low normal)

So I am burning through my T and need to dose more often. The question is should I does two tubes of Testim/day? Right now my protocol has changed to level out T deliver to 100IU HCG every day with 1 tube of Testim. I am now thinking I either add another tube of Testim (at what time of day I do not know) OR I dose with HCG in the morning at a higher dose of 250IU and then use 1 tube of Testim later in the day or early evening.

Any thought on what I should try next? I am curious as to what 250IU of HCG will typically deliver in terms of total T and how long it lasts (on the average). Any help would be greatly appreciated.

 

[Kwirion]

Yes, Vit D3 can be antiestrogenic: Vitamin D is only anti-estrogenic where it?s needed

TRT with low SHBG is hard... body metabolize testosterone to quickly. You need to take smaller doses of T more often. Just experiment yourself to find the best solution..

More about low SHBG: http://www.drkarlisullis.com/Karlis_Ullis,_M.D./BLOG/Entries/2010/8/2_ROLE_OF_ESTRADIOL_AND_SEX_HORMONE_BINDING_GLOBULIN_FOR_MALE_FITNESS_AND_HEALTH_%5BPART_I%5D%26LOW_SEX_HORMONE_BINDING_GLOBULINE_%28SHBG%29_POSITIVE_AND_NEGATIVE_EFFECTS_%5BPART_II%5D.html

Sometimes Clomid can help to increase SHBG...

Thread about low SHBG: https://thinksteroids.com/community/threads/134237140

 

[james2012]

Yes, Vit D3 can be antiestrogenic: Vitamin D is only anti-estrogenic where it?s needed

TRT with low SHBG is hard... body metabolize testosterone to quickly. You need to take smaller doses of T more often.

About low SHBG: http://www.drkarlisullis.com/Karlis_Ullis,_M.D./BLOG/Entries/2010/8/2_ROLE_OF_ESTRADIOL_AND_SEX_HORMONE_BINDING_GLOBULIN_FOR_MALE_FITNESS_AND_HEALTH_%5BPART_I%5D%26LOW_SEX_HORMONE_BINDING_GLOBULINE_%28SHBG%29_POSITIVE_AND_NEGATIVE_EFFECTS_%5BPART_II%5D.html

Sometimes Clomid can help to increase SHBG...

I'm thinking of going on the pellets (Testopel). I hear this delivers a more consistent level and is recommended by Dr. Marciano. Since I stopped the Crestor and it has been shown to lead to diabetes in some patients, I am hoping that quitting this drug and losing another 20lbs (which would put me around 10% body fat) I will drive myself away from insulin resistance and see my SHBG increase to mid-normal and then I can go back and try the Testim. Or I just may double dose the Testim and lose the last 20lbs and get from point A to point B that way.

By the way, thanks for the links.

 

[CubbieBlue]

My previous draw is here: https://thinksteroids.com/community/threads/134297928. At the time I was on .25mg Arimidex every third day along with 250IU HCG along with 1.5 tubes of Testim. I did not trust the results - the T was off the charts high. The labs were drawn on the day before my next adex and HCG injection in the am two hours after Testim application. Contamination at the injection site was suspected.

I am not sure if this contamination would affect, for example, direct DHT numbers. If the blood is contaminated I would suspect that somehow during the direct serum measurement the DHT number would be affected.

Here are my new numbers. By this time I had stopped Arimidex and it had been five days. I did a 250IU HCG shot the day before and only 1 tube of Testim. I had been on this protocol for less 7 days.

Blood drawn 2 hours after Testim application. No Testim at the injection site
Testosterone, Total: 417 ng/dL (range 280-800)

Free: 16.6 pg/mL (range 6.8-21.5) I have read not to trust the Free T measurement from Labcorp.

Estradiol, Sensitive: 13 pg/mL(range 3-70 pg/mL). Interesting this number shot down from before when I was doing more T and more Armidex. I had stopped Arimidex as described above, however previous D-3 was 29 and I began to supplement D-3 at 15g/day. See new D3 number below. Is D-3 an AI?

Vitamin D: 59 ng/dL (range 32-100)

DHEA-S: 223.5 ug/dL (range 88.9-427)

Progesterone: .9 ng/mL (range .2-1.4)

Estrone, Serum: 82pg/mL (range 12-72) HIGH

SHBG: 15.1 nmol/L (range 14.5-48.4). Always had low SHBG even when Total was low prior to TRT.

DHT: 87 ng/dL (range: 30-85). Last result were very high but I don't know if I can believe it due to contamination. I don't know if contamination of T will somehow affect a serum measurement of DHT

Pregnenolone, MS: 39ng/dL (range < 151). This appears low but is probably due to my very low cholesterol. I have since stopped Crestor and my LDL and Total have climbed into normal ranges. Since stopping Crestor I have noticed an improvement in mood and energy

Now for the kicker, which points to insulin resistance. I drew labs the next day prior to any Testim:

Total T: 140 ng/dL (very low)
Free T: 5 pl/mL (low)
SHBG 14.6 nmol/L (low normal)

So I am burning through my T and need to dose more often. The question is should I does two tubes of Testim/day? Right now my protocol has changed to level out T deliver to 100IU HCG every day with 1 tube of Testim. I am now thinking I either add another tube of Testim (at what time of day I do not know) OR I dose with HCG in the morning at a higher dose of 250IU and then use 1 tube of Testim later in the day or early evening.

Any thought on what I should try next? I am curious as to what 250IU of HCG will typically deliver in terms of total T and how long it lasts (on the average). Any help would be greatly appreciated.

I do not think your labs point to you "burning through" testosterone unusually quickly. You hit 417 on a range of 280-800, then 24-ish hours later you dropped 277 points. It seems to me you are metabolizing it correctly, your peaks are just a little low. Boost that peak up to 600-700, and then your morning lab before application should be around 300, which would be perfectly fine.

 

[james2012]

I do not think your labs point to you "burning through" testosterone unusually quickly. You hit 417 on a range of 280-800, then 24-ish hours later you dropped 277 points. It seems to me you are metabolizing it correctly, your peaks are just a little low. Boost that peak up to 600-700, and then your morning lab before application should be around 300, which would be perfectly fine.

How CubbieBlue? Should I increase my HCG dose or go to a tube and a half of Testim? I am still staying off the AI. I was surprised my Estrone was high and my Estradiol so low. Five days after my last adex the number 13 was pretty shocking. However, D3 can boost the effectiveness of adex and I have been on 15g/day for over 1 month.

I did take your suggestion to use a lufah (sp?) to scrub the arms prior to using Testim. So I guess my next step is to boost the Testim.

Is there a way to control Estadiol and Estrone? I think adex just targets E2. Or perhaps I should just lose my last 20lbs and see where I am and quit looking for a quick fix.

So for now - boost to 600-700 and don't worry about Etradiol and Estrone. The question now is - how to boost - higher HCG dose or another 1/2 tube of Testim?

Thanks for the great advice. You have been very instrumental in pointing me in the right direction. I can only imagine where my E2 levels would be if I had not taken your advice to drop the adex. Somewhere around 2 I suspect.

 

[CubbieBlue]

How CubbieBlue? Should I increase my HCG dose or go to a tube and a half of Testim? I am still staying off the AI. I was surprised my Estrone was high and my Estradiol so low. Five days after my last adex the number 13 was pretty shocking. However, D3 can boost the effectiveness of adex and I have been on 15g/day for over 1 month.

I did take your suggestion to use a lufah (sp?) to scrub the arms prior to using Testim. So I guess my next step is to boost the Testim.

Is there a way to control Estadiol and Estrone? I think adex just targets E2. Or perhaps I should just lose my last 20lbs and see where I am and quit looking for a quick fix.

So for now - boost to 600-700 and don't worry about Etradiol and Estrone. The question now is - how to boost - higher HCG dose or another 1/2 tube of Testim?

Thanks for the great advice. You have been very instrumental in pointing me in the right direction. I can only imagine where my E2 levels would be if I had not taken your advice to drop the adex. Somewhere around 2 I suspect.

I would keep the hCG low and bump the testim up. Didn't you already try the 1.5 tubes of testim and test high? I can't remember. Maybe you can do 1.25 tubes a day?

 

[maracatu]

Let's face it: Low SHBG => no response to TRT
Why ? Nobody Knows.

 

[james2012]

I would keep the hCG low and bump the testim up. Didn't you already try the 1.5 tubes of testim and test high? I can't remember. Maybe you can do 1.25 tubes a day?

I think that test was tainted by testim at the injection site and why I retested, although there were changes prior to the second test (dropped adex and tested five days - probably still had adex in the system from 1.5 months of use - and the second test results above was with 250IU HCG the day before while the previous test where TT was 1400ng/dL was done two days after 250IU HCG). That is why the results look tainted to me on the previous run.

 

[james2012]

Let's face it: Low SHBG => no response to TRT
Why ? Nobody Knows.

I don't necessarily agree with this. The response to TRT is difficult but not impossible which you are implying. I have responded to TRT in the past and even now I am noticing an improvement but not to the level I expected.

 

[James23]

TRT absolutely will not work if you have low SHBG. It is impossible.

If you have low SHBG, and you are secondary, your testosterone is low because your body is already making the maximum amount of testosterone that it can handle in lieu of the low SHBG. Pardon me for exploding for a moment: but if you add testosterone in this scenario then you are a fucking moron. Adding testosterone when your body cannot handle it makes absolutely no sense.

Notice, however, that I said TRT and not HRT. Solutions for this scenario are to be found in repairing SHBG expression by alleviating the causes through lowering cortisol, correcting insulin resistance and correcting any adrenal abnormality (excess, in particular.) You may be absolutely screwed, however, as low SHBG can be congenital. It's the male version of PCOS. Luckily, all women have to do is take anti-androgens. We currently have no idea what males should do.

You have to understand that your low testosterone is a SIDE EFFECT OF ANOTHER PROBLEM. It is NOT the problem you should be aiming to solve. Your body has no problem producing testosterone. Your body has no problem expressing LH to "ask" the testes for testosterone. Your body does not WANT any extra, because it cannot properly metabolize any extra.

You will not find a single member of this board who successfully treated a low SHBG by using extra testosterone. Any "relief" will be transient. There are a number of doctors that will be clueless about this, including Dr. Scally, so beware.

If you did experience some benefit, it could be that your low SHBG is simply a side effect of driving your estrogen so low and that you do not have naturally low SHBG. In that case, you're one of the lucky ones.

 

[CubbieBlue]

TRT absolutely will not work if you have low SHBG. It is impossible.

If you have low SHBG, and you are secondary, your testosterone is low because your body is already making the maximum amount of testosterone that it can handle in lieu of the low SHBG. Pardon me for exploding for a moment: but if you add testosterone in this scenario then you are a fucking moron. Adding testosterone when your body cannot handle it makes absolutely no sense.

Notice, however, that I said TRT and not HRT. Solutions for this scenario are to be found in repairing SHBG expression by alleviating the causes through lowering cortisol, correcting insulin resistance and correcting any adrenal abnormality (excess, in particular.) You may be absolutely screwed, however, as low SHBG can be congenital. It's the male version of PCOS. Luckily, all women have to do is take anti-androgens. We currently have no idea what males should do.

You have to understand that your low testosterone is a SIDE EFFECT OF ANOTHER PROBLEM. It is NOT the problem you should be aiming to solve. Your body has no problem producing testosterone. Your body has no problem expressing LH to "ask" the testes for testosterone. Your body does not WANT any extra, because it cannot properly metabolize any extra.

You will not find a single member of this board who successfully treated a low SHBG by using extra testosterone. Any "relief" will be transient. There are a number of doctors that will be clueless about this, including Dr. Scally, so beware.

If you did experience some benefit, it could be that your low SHBG is simply a side effect of driving your estrogen so low and that you do not have naturally low SHBG. In that case, you're one of the lucky ones.

Here's a good question for you:
What is a "low" SHBG?

Edit: Here is the paper James is drawing from
http://pmr.cuni.cz/Data/files/PragueMedicalReport/PMR_01-2006_Duskova.pdf

and the thread:
https://thinksteroids.com/community/threads/134294681

Interesting (but over my head)

 

[Kwirion]

Here's a good question for you:
What is a "low" SHBG?

One (or more) standard deviation below average value for given age.
What are Normal Testosterone Levels in Men by Age | Male Average Healthy Testosterone Ranges

 

[BBC3]

"burning through it", or pissing it out??

 

[zkt]

Ref ranges dont address the issue of the degree of healthiness. +/- 2 SD is the point where the majority of people start complaining of Sx. Depends on what is being measured too. K or Na at +/-2SD is quite serious. A 300 T is much less so. Yea I agree the ref ranges need to be taken with a grain of reason.

"Reference ranges aren’t typically set by what is healthy and what is not. They are set by where 95% of the population lies. Do you honestly think 95% of the population is healthy? I didn’t think so. Unfortunately many doctors fall in to this line of thinking. "

One (or more) standard deviation below average value for given age.
What are Normal Testosterone Levels in Men by Age | Male Average Healthy Testosterone Ranges

 

[james2012]

TRT absolutely will not work if you have low SHBG. It is impossible.

If you have low SHBG, and you are secondary, your testosterone is low because your body is already making the maximum amount of testosterone that it can handle in lieu of the low SHBG. Pardon me for exploding for a moment: but if you add testosterone in this scenario then you are a fucking moron. Adding testosterone when your body cannot handle it makes absolutely no sense.

Notice, however, that I said TRT and not HRT. Solutions for this scenario are to be found in repairing SHBG expression by alleviating the causes through lowering cortisol, correcting insulin resistance and correcting any adrenal abnormality (excess, in particular.) You may be absolutely screwed, however, as low SHBG can be congenital. It's the male version of PCOS. Luckily, all women have to do is take anti-androgens. We currently have no idea what males should do.

You have to understand that your low testosterone is a SIDE EFFECT OF ANOTHER PROBLEM. It is NOT the problem you should be aiming to solve. Your body has no problem producing testosterone. Your body has no problem expressing LH to "ask" the testes for testosterone. Your body does not WANT any extra, because it cannot properly metabolize any extra.

You will not find a single member of this board who successfully treated a low SHBG by using extra testosterone. Any "relief" will be transient. There are a number of doctors that will be clueless about this, including Dr. Scally, so beware.

If you did experience some benefit, it could be that your low SHBG is simply a side effect of driving your estrogen so low and that you do not have naturally low SHBG. In that case, you're one of the lucky ones.

I am idiopathic, not secondary. All endocrine systems crashed AFTER a four day run \with Prinzide - a blood pressure med with a diuretic. Happened about 10 years ago. Everything was fine until that day. Six months later I had a spontaneous recovery but was already on T therapy. I am insulin resistant and don't believe I have the genetic component you speak of for low SHBG. I would think if that were true then I would have libido and erection problems for a very long time (I am 43 now).

My thinking is that a run a metaformin should prove whether SHBG is low due to insulin resistance. It's worth a shot, but I don't know how long it will take. I do believe I have low T labs prior to TRT that show low SHGB and low-normal Free-T but I don't trust Labcorp's free-T measurements.

I did well on Dr. Scally's PCT in the past so that shows I am neither primary nor secondary. Number got up to 560, then dropped to 390. A four month binge eating and gaining 25lbs the number dropped low enough for me to restart TRT. So yes, I agree that low SHBG makes TRT difficult. I seems libido is improved when TT and FT are normal under TRT. If you note my lab results when my TT is 400 my free-T is normal. So I should dose more often or as CubbieBlue notes, I could increase my does and see what happens.

What is low SHBG? Mine is low normal. I have a lab on shots with TT at 686 and SHBG at 16.2, then a lab with TT on Testim of 417 with SHBG at 16.6 and the next day with no Testim a TT of 140, FT of 5.0 and SHBG of 14.6. Not a great deal of change in SHBG with various levels of TT, which is why, besides reading not to trust Labcorp's FT numbers, I have also decided not to trust them.

What I need is a good BMI measurement and a euglycermic clamp test - I am seeing an endo next Friday and hopefully he will do this. If I am insulin resistant with high BMI (I think I have about 20% bodyfat) then a run of metaformin should raise my SHBG which after some amount of time (what I don't know) I can stop the metaformin once I prove to myself the SHBG is due to insulin resistance or is genetic. If insulin resistance is the culprit then I just lose the weight while changing my TRT from level dosing (such as pellets) back to Testim when my body fat reaches about 10%.

So I disagree it is impossible. If you have a genetic component that lead to low SHBG then maybe pellets that deliver around a constant level of, for example, 500 TT. Then you have to worry about libido and ED. That is where the issue needs to be addressed by a specialist and perhaps require some backfilling of other hormones. I don't think genetic SHBG issues equate to no TRT. I believe it is TRT and HRT or, if you are lucky, just HRT.

I should state I have no issue with building muscle mass. I should also say this: YOU ARE WRONG in my case. TRT with low SHBG is not helping my libido and ED but it does stop my exercise induced angina so it is helping my heart health. Never write off an approach entirely. That is not good medicine either. I have advance heart disease with 25 stents - not a typo. If I pass my stress test this December then two years from now, my cardiologist is thinking of taking me off the Plavix. Also, if you look at my other posts, my cholesterol was VERY low (89 total, LDL of 17). I have since quit the crestor. Maybe with the building blocks for preg, the cascade will fill in and my SHBG will climb. Also note that the Jupiter study indicated that Crestor can cause insulin resistance and ultimately diabetes in patients - something not often reported but born out on many diabetes boards.

 

[CubbieBlue]

I did well on Dr. Scally's PCT in the past so that shows I am neither primary nor secondary.

This is false. I bet every secondary guy here would respond exactly the way you did. Get a decent number (56) then crash back down. Every guy on these boards I have read about with idiopathic hypogonadism has responded exactly how you described.

Again, I don't really understand what you are trying to do. It seems like you are trying to get yourself all tuned up just to try and see if another restart will stick.

If you are going to do the restart why not just do it now?

 

[james2012]

This is false. I bet every secondary guy here would respond exactly the way you did. Get a decent number (56) then crash back down. Every guy on these boards I have read about with idiopathic hypogonadism has responded exactly how you described.

Again, I don't really understand what you are trying to do. It seems like you are trying to get yourself all tuned up just to try and see if another restart will stick.

If you are going to do the restart why not just do it now?

I am not trying another restart. I am probably too old now. It was a dream of mine, but I am giving up on that. So are you saying I could be secondary? There is nothing from my MRI to indicate so and if I was secondary why would my pituitary output LH and FSH and my hypothalmus output GnRH just because I took Clomiphene Citrate and Tamoxifen? If I was secondary then I never would have seen a budge in LH and FSH and I certainly saw something. So I think it is still accurate to say idiopathic but not primary or secondary (I also respond to HCG).

My real question is this: What is low SHGB? How low is low? If it is due to insulin resistance then losing weight and possibly taking metaformin should raise SHBG and move me away from the issues related to TRT and low SHBG. I have noted that libido and ED are seen to return to normal when TT and FT are normal and the TT to E2 ratio is 20:1. I don't know why, but this seems to be the magic number with E2 around 25 nominal.

 

[sako]

Your shbg is definitely low.

Do you have thyroid labs?

 

[saru]

...So are you saying I could be secondary? There is nothing from my MRI to indicate so and if I was secondary why would my pituitary output LH and FSH and my hypothalmus output GnRH just because I took Clomiphene Citrate and Tamoxifen? If I was secondary then I never would have seen a budge in LH and FSH and I certainly saw something. So I think it is still accurate to say idiopathic but not primary or secondary (I also respond to HCG)...

You are Secondary if your gonads respond to addition LH (and FSH). If they don't, then you are primary.

You may have low LH/FSH due to (at least) two reason: Pituitary damage or Insulin Resistance.

If your GnRH is also low, then you are probably producing too much of Estrogen and/or have Insulin Resistance (this will, obviously, not show in the MRI). If your GnRH is high, but the LH & FSH are not, then you are pituitary is the suspect (this may be visible in the MRI).

 

[james2012]

You are Secondary if your gonads respond to addition LH (and FSH). If they don't, then you are primary.

You may have low LH/FSH due to (at least) two reason: Pituitary damage or Insulin Resistance.

If your GnRH is also low, then you are probably producing too much of Estrogen and/or have Insulin Resistance (this will, obviously, not show in the MRI). If your GnRH is high, but the LH & FSH are not, then you are pituitary is the suspect (this may be visible in the MRI).

I have insulin resistance and my pituitary MRI is normal. I was labeled as idiopathic by more than 1 doctor. Nobody has told me I am secondary or primary and the reason for my "issues" are truly a mystery to every doctor I have seen. It happened when I had my "collapse" after taking an ACE inhibitor called Prinzide. All my endocrine systems crashed and then recovered spontaneously after 6 months. Unfortunately at the time they picked the one thing they could pick on - TRT. They wanted to do thyroids but I refused. My thyroids are now normal and energy is great. I was on TRT for 5 years before attempting the PCT. I still don't believe I am secondary or primary. Adrenal and pituitary MRIs are normal. If hypothalmus is shot or pituitary is shot then I would not respond to Tamoxifen or Clomiphene Citrate.

Here's a theory: I am insulin resistance. I crashed because my SHGB drew down my T when I ended PCT. From 560 to 390 (held 390) then only dropped to low when I added even more weight. It all adds up.

Scally asked me to go back on TRT for 1 year. Many people double their TT numbers - possibly due to addition ARs being created. Long term TRT does create additional ARs - at least anecdotal evidence exists for this. Dr. Scally did not tell me at the time why the TT may double after an additional year of TRT and then repeat PCT. I don't think now it would have worked. I think I have to control insulin resistance first, get my SHBG up, and then maybe try again.