islandtime50 said:
Alright, it was a wild week, but I figured I'd come back and post an update here in case anyone else is thinking about starting TRT and wants to know how to handle it when things go sideways.
Here's what my labs came back as:
Total testosterone: 32.6nmol/L, which converts to 940 ng/dL — on the high side, though not absurdly so for the top end of TRT.
Free testosterone: 678 pmol/L, or 19.6 ng/dL — fairly high.
Estradiol (E2): 170 pmol/L, equal to 46.3 pg/ml — clearly elevated given this testosterone level. When total T sits at 940, the target zone is roughly 25-35 pg/mL. Hitting 46 tells me aromatization is happening.
Hematocrit: 0.52L/L (52%) — this one worries me the most. 54 is the upper limit.
Hemoglobin: 173g/L, i.e. 17.3 g/dL — raised, consistent with the HCT and not unexpected.
RBC: 5.77 — high, a classic picture of testosterone-driven erythrocytosis.
SHBG: 43.1 — squarely within range.
Remainder of CBC: WBC, platelets and differentials all came back unremarkable.
Now, what I think this adds up to. My current protocol is 15mg of pharma testosterone cypionate every day, totaling 105mg per week. Back when the tingly nipple sensation started, I was running 20mg ED, which added up to 140mg/week.
To start with, that isn't a large dose, and the sides showed up around the 8 week mark — well inside the full saturation window.
Second, that particular week I was staying in a hotel and everything fell apart. I was waking at 3am for early flights, sleeping badly in the hotel bed, eating poorly (relative, sure, but since my December cancer surgery removed most of my colon, eating away from home is genuinely hard for me now), getting no exercise, and I also ended up fairly dehydrated (staying hydrated is something I have to actively manage — I watch my coffee intake, I suspect my absorption isn't what it once was, and tirz is still hitting me hard). I dropped 4.1 kg across that week.
Third, I couldn't get labs drawn right away because I was switching TRT providers, work was slammed, and I simply had no plan for getting a requisition. Where I live in BC, you need a requisition from someone before you can get blood work, and then you have to squeeze into LifeLabs around your job (booking an appointment was impossible, so I ended up going Saturday morning). The takeaway is that the timing distorts the results you're reading. The tingly nipples were definitely there Friday night, I flew home Saturday, and I cut my dose from 20mg/ED down to 15mg/ED on Monday (relief came almost immediately) — but the earliest blood draw I could get was the following Saturday.
Finally, hindsight being 20/20, I made some plain dumb calls.
1. I might have kept an AI on hand — UpGuys and Teletest both seem stingy about handing out AIs. I'm in a few TG groups now and some guys using those same providers did get AIs. I didn't. It appears to hinge on whichever doctor handles your assessment through the online TRT provider. I'm going to source my own, but I could have sorted that out before any of this happened, and that's what I'd tell anyone else to do. Even if it takes some pushing.
2. I used to make my living in hotel rooms as a utility arborist and I was pretty decent at it. I knew restaurant food wasn't happening, so I upgraded to a kitchenette room and hit the grocery store on day one. Still, I misjudged what I'd need and it went badly with those long days. I also had no rental car, so during 10 hour training days I was stuck and couldn't get back to my room.
3. Someone advised me not to drink much before the blood draw, the reasoning being you want a true baseline without skewing results (especially HCT) so you can see where you genuinely stand. Makes sense on paper, fails in reality. I sat around the clinic for ages, TRT blood work is fasted so there's no food either, and the plain truth is I was dehydrated again when they drew. Don't repeat this — your HCT will read high like mine did. Normally I'm up at 4:45am to fit workouts or a run in before breakfast and then rush to work. Being stuck at the clinic until 11am for a draw is far too long to go without fluids.
The numbers above are at least partly shaped by the higher dose I was on before I lowered it.
One more red herring I had to ask about was my nipples in general. Funny story: about 25 years ago, drunk and bored, I pierced my nipples with a sewing needle. All I had to put in were some earring hoops (curved, not straight), and getting the piercing done and then the hoops in took some effort. Soon after, they started reacting far more than my earlobes ever did, so a few days later I swapped in the proper hardware before they'd healed, which again took some doing. Long story short, my nips are quite sensitive. I feel the faintest breeze, any drop in temperature, and any kind of rubbing is strictly off limits. Whether I'm outfitted with extremely long-range early-warning gyno tits is anyone's guess.
Even with the rough week and my sensitive nips ... I got gyno, lowered my dose, and it cleared up immediately — pretty clear-cut evidence that my estradiol had climbed too high.
So ...
Here's how I understand it (the Rick bot at Anabolic Atlas helped me with this):
My testosterone figures are probably trustworthy — the gap between lowering my dose and the test is likely long enough for the change to show up. I'm probably at the top of the range for TRT. Honestly, I'm fine with that. I was only trying to dial in TRT with an eye toward TRT+ down the road, but I arrived there much sooner than planned because I respond well to exogenous test.
My raised estradiol probably isn't accurate at this moment, since those levels shift more slowly. E2 at 46 is a lagging indicator from before the dose change, plus travel stress and dehydration. Even if it were accurate, my nipples quit hurting right away, and side effects matter more than the number anyway. That figure could easily fall into the 30s by the next draw.
HCT is probably not accurate either. Dehydration by itself is a factor, plus the tirz weight dump and travel. I need to retest in a couple of weeks to find out where it truly sits.
Tirz genuinely matters. Dropping 9lb in a week is aggressive. That pulls fluid out, concentrates blood markers, piles on metabolic stress and lifts cortisol. This panel could easily be a badly timed snapshot.
Recovering from colon cancer plays in too. I'm 9 months out from very poor health and probably nowhere near decent homeostasis. My ferritin was also in single digits, which meant a blood transfusion right before surgery. So I may be over-responding on erythropoiesis and my HCT tolerance could be lower than most people's.
All of the above might read like a pile of cope. If you disagree, say so. Like I said, I had some help with it. Discourse breeds understanding, and even just reading chips away at ignorance. I've got no real reason to want to harm my own health.
What I'm doing: nothing to my dose for now. I'll get ancillaries and some aromasin (though I don't expect to need it anytime soon). I already take a lot of the right vitamins (omega 3, magnesium, zinc, k2+d3, berberine and coq10), but I'm going to quiz the bot on whether these specific ones are good and whether my amounts are right. I also already take daily low-level Tylenol since that's a post colon surgery thing. I've already got some suggestions for others to add.
Additional notes: I'm now on TRT through Teletest. The $49 referral fee covers basic blood work, a doctor reviewing the results, and you get your 12 week test prescription. The included blood work package probably isn't sufficient. I had to pay LifeLabs $90 extra just to add SHBG to the panel. There's a test prescription waiting at my pharmacy, but I haven't finished the original vials from UpGuys. Teletest offers an AAS 'harm reduction' panel that looks far more complete (though it still lacks igf-1 and other markers I might want). I worried they'd frown on me being on TRT and asking for an AAS panel simultaneously, but other Canadians reassured me they'll just take my money. Big caveat: the AAS panel still carries plenty of user-pay portions on top of the $79 sticker price. I'll update when it's actually time for more blood work. Apparently if a Dynacare lab were available, their pricing is far more competitive than LifeLabs. There isn't a single Dynacare clinic even in the lower mainland, never mind the island.
TL;DR disaster averted, TRT good, blood work good-ish, lessons learned
