Help please ! high free Test - low serum Test

[muslhead]

I need some ideas for trying to figure this all out and was hoping some people smarter on this board could lend a brother a hand

A quick background
I have been self administering HRT for a couple of years. I am 51. My original test levels were in the 200-300 range. My Dr. did not want to help out so I took things into my own hands. I started out at 100mg/wk of test and have been playing with the amount used depending upon the blood test results which were done quarterly. As a result of being on HRT my iron stores went high as well as my HCT/RBC/HG. I dont have hemochromotosis, but I do have androgen induced erythrocytosis. I have been slowly lowering the HRT amount until the out of range tests were back in range.

Fast forward. The latest replacement amounts have been ~40mg/4 days. This has gotten my iron/HCT/RBC/HG at the high end of normal or slightly out of range but my test levels results have come back as
Free = 29.9pg/ml high (7.2-24)
Serum = 347 in range but low (241-927).

The high hct/rbc/HG levels made me very short of breath and tired. So I really wanted to drive them down. At the high end the symptoms are pretty much gone.

What precipitated the lastest round of testing was I have been extremely tired (could sleep forever which is not normal) and a puffy face (around eyes and sinuses).

I prefer not to get into the discussion of which test is best and why. Lets assume for the sake of this discussion the results are accurate. Does anyone have any ideas on why my Free test levels are high and serum on the low end (SBHG?). If I continue with the disparity which should I view as the gold standard? The free?

Thanks, in advance, for your ideas/help/assistance\
If you need any further background let me know.

JANSZ - i would appreciate your thoughts

 

[BigAk]

Everybody; on these boards, says that blood results for Free T are not reliable and invalid. And that they should be measured via the Free Test Calculator using Albumin, SHBG, and Total...

Here it is:

http://www.issam.ch/freetesto.htm

For me, they have been matching everytime... meaning Bloodwork matches calculator... But, the stubborn heads still say "NO."
.

 

[BigAk]

In order to knock down your iron and the rest of your high values due to HRT, you needed to do theraputic phlebotomy or donate blood; not decrease your T intake. That's far more effective and the proper way to go about resolving this issue.
.

 

[The Matrix]

I need some ideas for trying to figure this all out and was hoping some people smarter on this board could lend a brother a hand

A quick background
I have been self administering HRT for a couple of years. I am 51. My original test levels were in the 200-300 range. My Dr. did not want to help out so I took things into my own hands. I started out at 100mg/wk of test and have been playing with the amount used depending upon the blood test results which were done quarterly. As a result of being on HRT my iron stores went high as well as my HCT/RBC/HG. I dont have hemochromotosis, but I do have androgen induced erythrocytosis. I have been slowly lowering the HRT amount until the out of range tests were back in range.



Fast forward. The latest replacement amounts have been ~40mg/4 days. This has gotten my iron/HCT/RBC/HG at the high end of normal or slightly out of range but my test levels results have come back as
Free = 29.9pg/ml high (7.2-24)
Serum = 347 in range but low (241-927).

The high hct/rbc/HG levels made me very short of breath and tired. So I really wanted to drive them down. At the high end the symptoms are pretty much gone.

What precipitated the lastest round of testing was I have been extremely tired (could sleep forever which is not normal) and a puffy face (around eyes and sinuses).

I prefer not to get into the discussion of which test is best and why. Lets assume for the sake of this discussion the results are accurate. Does anyone have any ideas on why my Free test levels are high and serum on the low end (SBHG?). If I continue with the disparity which should I view as the gold standard? The free?

Thanks, in advance, for your ideas/help/assistance\
If you need any further background let me know.

JANSZ - i would appreciate your thoughts

Examine insulin resistance since this is common in this case

 

[JanSz]

I need some ideas for trying to figure this all out and was hoping some people smarter on this board could lend a brother a hand

A quick background
I have been self administering HRT for a couple of years. I am 51. My original test levels were in the 200-300 range. My Dr. did not want to help out so I took things into my own hands. I started out at 100mg/wk of test and have been playing with the amount used depending upon the blood test results which were done quarterly. As a result of being on HRT my iron stores went high as well as my HCT/RBC/HG. I dont have hemochromotosis, but I do have androgen induced erythrocytosis. I have been slowly lowering the HRT amount until the out of range tests were back in range.

Fast forward. The latest replacement amounts have been ~40mg/4 days. This has gotten my iron/HCT/RBC/HG at the high end of normal or slightly out of range but my test levels results have come back as
Free = 29.9pg/ml high (7.2-24)
Serum = 347 in range but low (241-927).

The high hct/rbc/HG levels made me very short of breath and tired. So I really wanted to drive them down. At the high end the symptoms are pretty much gone.

What precipitated the lastest round of testing was I have been extremely tired (could sleep forever which is not normal) and a puffy face (around eyes and sinuses).

I prefer not to get into the discussion of which test is best and why. Lets assume for the sake of this discussion the results are accurate. Does anyone have any ideas on why my Free test levels are high and serum on the low end (SBHG?). If I continue with the disparity which should I view as the gold standard? The free?

Thanks, in advance, for your ideas/help/assistance\
If you need any further background let me know.

JANSZ - i would appreciate your thoughts

#1 newer ask for FreeT direct test.
For now forget that you ever did the testing of FreeT and do not mention it in the future.
------------------------------------------------------
Post all blood and urine testing that you have.
Organize them by date and laboratory.
Name of analyte, value, units, ranges

Stay on this thread, do not start new threads on your topic,
makes easier to see your whole picture, that way. You will have better chance on getting advice when background info is readily available.
------------------------------------------------------

If you want to do blood testing make your picks from my list on post #44 here:
http://anabolicminds.com/forum/male-anti-aging/66268-jan-s-bloodtest-2.html

If you want to know your FreeT
use chart, post #31 there, or calculator.
When using calculator, always double check using chart, easy to mess up units on calculator.
-----------------------------------------------------
Make sure that you deal with hemochromatosis.
These blood tests, then use advice as per link on the bottom.

31 --------- • Iron and Iron Binding Capacity (7573X) - (356N)
32 --------- • Iron, Total (571X) - (24984P)
33 --------- • Ferritin (457X) - (22764P)
34 --------- • Transferrin (891X) - (30346P)
35 --------- • Folate, RBC & Hematocrit - (1768N)
36 --------- • Hemoglobin A1c (496X) - (45484P)
37 --------- • Hemoglobin, Plasma (514X) - (7211P)

Hemochromatosis Diagnosis: Test to Diagnose - Iron Overload Diseases Assn.
-------------------------------------------------------

As for the TRT, limiting it to the absolute bottom line (there is much more):

Test for:
60 --------- Estradiol, Ultrasensitive, LC/MS/MS (30289X)
62 --------- Testosterone, Free, Bio/Total (LC/MS/MS)
63 --------- Dihydrotestosterone (204X)

if you are not able to use Quest Diagnostics, then do

TotalTestosterone
SHBG
Albumin
Estradiol, Ultrasensitive
Dihydrotestosterone

then calculate your FreeT.

Goals for TRT while on external testosterone:
FreeT~300, you may have to settle at lesser FreeT because of hemochromatosis, but newer less than FreeT=160.
Estradiol, ultrasensitive (15-30) further tweaked by nightly erections
DHT at upper range or slightly above

Transdermal testosterone used only when need to raise DHT
Transdermal T use daily
Injectable T use twice weekly or better EOD, newer less often.
Blood draw for testing 48hrs after T shot when on injections
Blood draw in the morning before aplying transdermal, when on transdermals.
Do not draw blood from the skin area that had transdermal T on it within last month.

Newer use finasteride, duosteride etc.
Use Arimidex=Liquidex=Anastrozole only when test show that it is required.
==============================================
Get education; buy books, buy doctor's presentations.

If you will buy only one book, buy this one.
The Hormone Solution: Stay Younger Longer with Natural Hormone and Nutrition Therapies (Paperback)
by Thierry Dr Hertoghe
Amazon.com: The Hormone Solution: Stay Younger Longer with Natural Hormone and Nutrition Therapies: Thierry Dr Hertoghe: Books
----
A4M :: Conference Library
Thierry Hertoghe, MD
President of the World Society of Anti-Aging Medicine

----
Breakthrough: Eight Steps to Wellness
by Suzanne Somers
Item Catalog Number: 33808
Breakthrough: Eight Steps To Wellness, By Suzanne Somers
==============================================
I have not read this book, wish someone who did make a comment.
Dr John violently does not like dr Lichten, at least in the past.
But he cannot be all bad, well not sure, we all know dr John have excellent expertise on TRT.
He (dr Lichten) recently joined LEF.
LEF is good organization, couple day ago dr John was at LEF owner's birthday party.
http://muscle chat room.com/forum/showpost.php?p=21883&postcount=125

I see that dr Lichten is rewamping TRT at LEF, there is a whole new series of blood tests, packaged into logical sets, they hold his name. I wish that he also started re-writing their TRT protocols, they are dated.

Textbook Of Bio-Identical Hormones, By Edward M. Lichten .
Dr. Lichten Cardiac Risk Factors
Dr. Lichten Comprehensive Diabetes Testing
Dr. Lichten Hepatitis A,B,C Panel I
Dr. Lichten Comprehensive Thyroid Panel
Dr. Lichten Comprehensive Male Panel
Dr. Lichten Comprehensive Female Panel
Textbook Of Bio-Identical Hormones, By Edward M. Lichten , Md, F.A.C.S.

Textbook of Bio-Identical Hormones
by Edward M. Lichten , MD, F.A.C.S.
Item Catalog Number: 33800

 

[muslhead]

In order to knock down your iron and the rest of your high values due to HRT, you needed to do theraputic phlebotomy or donate blood; not decrease your T intake. That's far more effective and the proper way to go about resolving this issue.
.

BigAK
I do this every 8 weeks as much as allowed.
Thanks for the thoughts. I failed to fill in all the background in my original post otherwise it would have been a small novel.
MH

 

[muslhead]

Examine insulin resistance since this is common in this case

Matrix
Actually this and kidney questions were the first thing that came up in my research as they both had many of the symptoms I have.
I do monitor this and it is right smack in the middle of normal. I dont think this is it but I havent ruled it out completely.
Thanks for your input.
MH

 

[muslhead]

#1 newer ask for FreeT direct test.
For now forget that you ever did the testing of FreeT and do not mention it in the future.
------------------------------------------------------
Post all blood and urine testing that you have.
Organize them by date and laboratory.
Name of analyte, value, units, ranges

Stay on this thread, do not start new threads on your topic,
makes easier to see your whole picture, that way. You will have better chance on getting advice when background info is readily available.
------------------------------------------------------

If you want to do blood testing make your picks from my list on post #44 here:
http://anabolicminds.com/forum/male-anti-aging/66268-jan-s-bloodtest-2.html

If you want to know your FreeT
use chart, post #31 there, or calculator.
When using calculator, always double check using chart, easy to mess up units on calculator.
-----------------------------------------------------
Make sure that you deal with hemochromatosis.
These blood tests, then use advice as per link on the bottom.

31 --------- • Iron and Iron Binding Capacity (7573X) - (356N)
32 --------- • Iron, Total (571X) - (24984P)
33 --------- • Ferritin (457X) - (22764P)
34 --------- • Transferrin (891X) - (30346P)
35 --------- • Folate, RBC & Hematocrit - (1768N)
36 --------- • Hemoglobin A1c (496X) - (45484P)
37 --------- • Hemoglobin, Plasma (514X) - (7211P)

Hemochromatosis Diagnosis: Test to Diagnose - Iron Overload Diseases Assn.
-------------------------------------------------------

As for the TRT, limiting it to the absolute bottom line (there is much more):

Test for:
60 --------- Estradiol, Ultrasensitive, LC/MS/MS (30289X)
62 --------- Testosterone, Free, Bio/Total (LC/MS/MS)
63 --------- Dihydrotestosterone (204X)

if you are not able to use Quest Diagnostics, then do

TotalTestosterone
SHBG
Albumin
Estradiol, Ultrasensitive
Dihydrotestosterone

then calculate your FreeT.

Goals for TRT while on external testosterone:
FreeT~300, you may have to settle at lesser FreeT because of hemochromatosis, but newer less than FreeT=160.
Estradiol, ultrasensitive (15-30) further tweaked by nightly erections
DHT at upper range or slightly above

Transdermal testosterone used only when need to raise DHT
Transdermal T use daily
Injectable T use twice weekly or better EOD, newer less often.
Blood draw for testing 48hrs after T shot when on injections
Blood draw in the morning before aplying transdermal, when on transdermals.
Do not draw blood from the skin area that had transdermal T on it within last month.

Newer use finasteride, duosteride etc.
Use Arimidex=Liquidex=Anastrozole only when test show that it is required.
==============================================
Get education; buy books, buy doctor's presentations.

If you will buy only one book, buy this one.
The Hormone Solution: Stay Younger Longer with Natural Hormone and Nutrition Therapies (Paperback)
by Thierry Dr Hertoghe
Amazon.com: The Hormone Solution: Stay Younger Longer with Natural Hormone and Nutrition Therapies: Thierry Dr Hertoghe: Books
----
A4M :: Conference Library
Thierry Hertoghe, MD
President of the World Society of Anti-Aging Medicine

----
Breakthrough: Eight Steps to Wellness
by Suzanne Somers
Item Catalog Number: 33808
Breakthrough: Eight Steps To Wellness, By Suzanne Somers
==============================================
I have not read this book, wish someone who did make a comment.
Dr John violently does not like dr Lichten, at least in the past.
But he cannot be all bad, well not sure, we all know dr John have excellent expertise on TRT.
He (dr Lichten) recently joined LEF.
LEF is good organization, couple day ago dr John was at LEF owner's birthday party.
http://muscle chat room.com/forum/showpost.php?p=21883&postcount=125

I see that dr Lichten is rewamping TRT at LEF, there is a whole new series of blood tests, packaged into logical sets, they hold his name. I wish that he also started re-writing their TRT protocols, they are dated.

Textbook Of Bio-Identical Hormones, By Edward M. Lichten .
Dr. Lichten Cardiac Risk Factors
Dr. Lichten Comprehensive Diabetes Testing
Dr. Lichten Hepatitis A,B,C Panel I
Dr. Lichten Comprehensive Thyroid Panel
Dr. Lichten Comprehensive Male Panel
Dr. Lichten Comprehensive Female Panel
Textbook Of Bio-Identical Hormones, By Edward M. Lichten , Md, F.A.C.S.

Textbook of Bio-Identical Hormones
by Edward M. Lichten , MD, F.A.C.S.
Item Catalog Number: 33800

Jansz -
Yah, I have read your standard cut and paste to everyones posts. Because I did not put all the info down in my post you are covering all bases.

I dont have Hemocromotosis. I have been tested.
My iron stores are kept in check because I have blood drawn every 8 weeks or if I get my serum test levels down to 300 range.

In the past all these came back as normal
SHBG
Albumin
Estradiol, Ultrasensitive
Dihydrotestosterone
This time i did not test them other than albumin and test. I wish i had tested SHBG as I think that is the problem.

The only way I can see having high free and low serum is when there is not enough SHBG to bind to the test, correct?

MH

 

[BigAk]

Jansz -
Yah, I have read your standard cut and paste to everyones posts. Because I did not put all the info down in my post you are covering all bases.

I dont have Hemocromotosis. I have been tested.MH

LOL.. :clap2: :rofl:

 

[BigAk]

muslhead.... Go post your case on this board --->

http://******chatroom.com/forum/forumdisplay.php?f=2

replace the stars with muscle

Hopefully you can get some professional insight from Dr. John Crisler himself.. That's your best bet.

 

[muslhead]

muslhead.... Go post your case on this board --->

http://******chatroom.com/forum/forumdisplay.php?f=2

replace the stars with muscle

Hopefully you can get some professional insight from Dr. John Crisler himself.. That's your best bet.

Big AK
Thanks again.
I will go there.
I only posted the relevant info. All other tests that I have done have come back as normal regardless of the test levels used. The higher the test levels the higher my iron, rbc, hct, hb get (indicative of erythrocytosis). I just dont get why this time my free test came back so high. In the past the results were always proportional to serum levels.
Maybe just a bad test result so I should throw out the data point.
MH

 

[JanSz]

Jansz -
Yah, I have read your standard cut and paste to everyones posts. Because I did not put all the info down in my post you are covering all bases.

I dont have Hemocromotosis. I have been tested.
My iron stores are kept in check because I have blood drawn every 8 weeks or if I get my serum test levels down to 300 range.

In the past all these came back as normal
SHBG
Albumin
Estradiol, Ultrasensitive
Dihydrotestosterone
This time i did not test them other than albumin and test. I wish i had tested SHBG as I think that is the problem.

The only way I can see having high free and low serum is when there is not enough SHBG to bind to the test, correct?

MH

Well, so far we know that your Totaltestosterone = 347 rather very low.
There is no surprise about this low TT levels, because you said that you have lowered your weekly testosterone dose because of androgen induced erythrocytosis.
Now you are saying that:
quote:
"I dont have Hemocromotosis. I have been tested."

Why do not you use proper dose of testosterone,
establish proper FreeT, E2 & DHT levels.
Then keep them stable, and do not change anything there.

And deal with any other problems that you may have, as a separate issue.
.
.

 

[muslhead]

Well, so far we know that your Totaltestosterone = 347 rather very low.
There is no surprise about this low TT levels, because you said that you have lowered your weekly testosterone dose because of androgen induced erythrocytosis.
Now you are saying that:
quote:
"I dont have Hemocromotosis. I have been tested."

Why do not you use proper dose of testosterone,
establish proper FreeT, E2 & DHT levels.
Then keep them stable, and do not change anything there.

And deal with any other problems that you may have, as a separate issue.
.
.

Jansz
Thanks for the thoughts

Per your comment
:Why do not you use proper dose of testosterone, establish proper FreeT, E2 & DHT levels. Then keep them stable, and do not change anything there."

I have. Keeping them stable causes my hct, rgb and hb to go out of range. The side effects of this is i have no wind. I am sucking for air even at the slightest bit of exertion. I am 51, 6'2" and 210 lbs with less than 10% bodyfat. So my lack of wind is not because I am a fat.out of shape pig.

The comment on iron stores was background only. I had the iron problem before hrt. I have been tested up and down for an answer for that but the Dr could not explain it. The iron stores issue is under control via phlebotomy.

HRT only exacerbates the iron stores.

The issue I was trying to have people toss ideas on was two fold
1) any ideas on controlling androgen induced erythrocytosis. For me, regardless of the dose, my blood levels of hct, hb, rbc get out of whack. When at a normal test dose where my test levels are in the 600-800 range my hct, hb, rbc are out of range. As I lower the test dose not until it gets down to where my test levels were before hrt (200) do i see normal, inrange blood levels. I am trying to find a solution without having to give up my hrt.
I have tried other compounds (primo), gels, more frequent dosing, lower concentration compounds, combos of gels and injects ... virtually every possible thing I can vary I have tried.
2) why (assuming the test results are correct which they may not be) or how could total test be low and the free test be out of range high (my conclusion, again assuming the results are correct, is that my shbg is out of whack)

MH

 

[JanSz]

Jansz
Thanks for the thoughts

Per your comment
:Why do not you use proper dose of testosterone, establish proper FreeT, E2 & DHT levels. Then keep them stable, and do not change anything there."

I have. Keeping them stable causes my hct, rgb and hb to go out of range. The side effects of this is i have no wind. I am sucking for air even at the slightest bit of exertion. I am 51, 6'2" and 210 lbs with less than 10% bodyfat. So my lack of wind is not because I am a fat.out of shape pig.

The comment on iron stores was background only. I had the iron problem before hrt. I have been tested up and down for an answer for that but the Dr could not explain it. The iron stores issue is under control via phlebotomy.

HRT only exacerbates the iron stores.

The issue I was trying to have people toss ideas on was two fold
1) any ideas on controlling androgen induced erythrocytosis. For me, regardless of the dose, my blood levels of hct, hb, rbc get out of whack. When at a normal test dose where my test levels are in the 600-800 range my hct, hb, rbc are out of range. As I lower the test dose not until it gets down to where my test levels were before hrt (200) do i see normal, inrange blood levels. I am trying to find a solution without having to give up my hrt.
I have tried other compounds (primo), gels, more frequent dosing, lower concentration compounds, combos of gels and injects ... virtually every possible thing I can vary I have tried.
2) why (assuming the test results are correct which they may not be) or how could total test be low and the free test be out of range high (my conclusion, again assuming the results are correct, is that my shbg is out of whack)

MH

You are wrestling with bad FreeT number, easier, just forget about it.

androgen induced erythrocytosis;

doubt that you get much of usefull help on this topic here,
I suggest that you contact dr John

you may also PM to BigAk, not exactly sure what is his problem, but he is going thru number of phlebotomies, he is working with dr John.