I know, obviously, that lab results will differ guy to guy, but I'm a little concerned that my doctor doesn't care what my levels look like so long as I'm "getting results." I'm 28 weeks+1 day on T, and yesterday I finally asked him if there was a reason he hadn't checked my T levels yet or if he'd just forgotten or something. If he had a good reason, I wouldn't care (he's a doctor at my university and I trust his judgement--that being said, I'm the first guy he's actually prescribed testosterone and I'm something of his guinea pig). He told me that there "has been some controversy since the levels are always higher then [sic] referrence [sic] values" and that it's clinical responses that direct dosage, but how should I know that my responses are what they should be if we're not even looking at my levels? He requested some labwork for me and I went this morning to get blood drawn.

We raised my dose at 14 weeks because I was having some sort of emotional havoc withdrawal going on at the end of my shot cycle, but I don't really have complaints this time except that everything feels like it's going very slowly. I was a hairless guy pre-T (like, people asked if I shaved my legs level of hairlessness) so I'm not expecting to be a bear, but I got a few moustache hairs at just over one month and I expected to be far hairier by now. I have just as much in the way of facial hair as I did six months ago, and from looking at both my mother's brother and his son, even if I'm not growing a full beard by now I should definitely at least have my sideburns lengthening and my moustache coming in thicker. I know levels should be between ~300 and 1000, but I also know that our levels peak right after our shot and trough right before. I did bloodwork this morning, a little over 24 hours after my shot, so what should that look like? How low of a peak is low enough to warrant a dosage increase?

This was really rambly, sorry. Tl;dr, I'm a little worried about what my T levels are and want to know what the normal range should be if my levels are read 24 hours after shot day.

I don't have an answer to your question but I just wanted to chime in and say that my doctor also bases it on what's happening rather than on levels so she doesn't test them. At first I was fine with it but now that I'm 1 year on T and am not quite happy where I'm at, I want to know what my levels are. I'm searching for a new doctor because mine lets me pick my dose essentially (she started me off low but let's me up it now if I want) and I feel too much like I'm self medicating. I'm at an average dose right now because I just don't feel comfortable going higher until I see a doctor who checks my levels. I don't know if I'm unhappy with the changes because i have too much T, too little T, or just genetics.

He should be doing blood work regularly. There are a lot of things besides your T levels that need to be monitored while you're on HRT. My doctor requires quarterly visits in the first year, an annual visits after that as long as there are no other issues.

For reference, my levels have consistently been between 700-800 while on gel and after switching to injections. It hasn't seemed to matter at what point in the cycle I've had blood drawn. I always land somewhere in that range. My doctor says this is not the norm though, and she isn't sure how my body keeps it so regulated. Obviously it's going to affect everyone differently. Someone I know had their dosage increased when their T levels were below 300 for more than 6 months and his masculinization seemed to have peaked.

Thanks for the responses, guys! He sent me a message about my bloodwork, as he did when he first tested me (the day after shot one, to make sure my body was generally healthy enough for T, as he gave me a prescription the first day I saw him). Everything in that labwork came back normal enough for him--it was, I think, a complete blood count, a comprehensive metabolic count, and TSH. The way he phrased the email suggested he's waiting for a few more results to come back, but unless I'm mistaken about TSH tests, this tells me nothing about my actual T levels, right? I'm starting to get a little antsy, 'cause the first results came back about six hours after I actually got my blood drawn, and I've heard nothing since. Maybe it just takes longer for T levels?

Below are two images. The first is my test list with all the names of each test that my doctor has ordered for each visit (most recent at the top), the second is what results from a testosterone test will look like.

If he isn't running something called TTST (Testosterone, Total, Serum) or TTBS (Testosterone, Total and Bioavailable Serum), he isn't testing your T levels. TSH is a thyroid test.

That's what I was thinking, Max, thank you for confirming (and for telling me what the test itself is called, as I hadn't known). I'll email him if he doesn't send TTST or TTBS results in the next few days, then.

So I got my results today, and I'm a little more than concerned about it--both my levels (they're ridiculously high) and my doctor. My results were double what the male reference range says they should've been at highest-- around 340 free and 2260 total. That's absurd. Maddeningly, my doctor used the female reference ranges for my test results, and he used them to basically say "yep they're high as I expected they would be." I don't think he understands exactly how high that is. Doesn't excess testosterone convert to estrogen? Shouldn't my dose be reduced? Even a day after my shot, at peak, I doubt they ?should be nearly that high. At the time I got the blood drawn (and when I first posted and had emailed him), I thought my menstrual cycle had finally ended--but no, it's been back again since Friday, and seven months is more than long enough for it to have ended. Could the ridiculously high levels have something to do with that? Does it seem concerning to you guys (as it does to me) that he didn't think anything of my levels being that high

(I emailed him presenting my concerns and will hopefully hear back soon, but I wanted to hear what you guys think as well, since I'm really his first trans patient.)

Quote from: veniamviam on September 14, 2015, 11:00:40 AM
My results were double what the male reference range says they should've been at highest-- around 340 free and 2260 total.

What were the units ?

Males  270 - 1100ng/dl  2.4 - 12ng/ml
Conversion factor: 1 ng/ml = 3.47 nmol/l

One thing that sometimes frustrates transgender patients is that measurements for the biologically significant free testosterone are not easily compared between men and women. Labs often state the percentage free for men, but give a measurement in pg/ml for women. Or the male measurements will be in ng/dl requiring a mathematical conversion for direct comparison to the "normal" range of the opposite sex.

It's 340.1 pg/mL (male reference range: 35-155 pg/mL) free and 2267 ng/dL (male reference range: 250-1100 ng/dL) total. The lab they got sent to uses the same units for both male and female ranges, and they have the references easily available online (if you'd like to take a look, they're found here: http://www.questdiagnostics.com/testcenter/testguide.action?dc=TS_Testosterone_LCMSMS)

Ok so they got the units right.

Maybe measurements should be taken in the middle of an injection cycle.

With mtf there are very high values if measured at the beginning of a cycle (and a low at the end if on biweekly injections... thats why many people inject after 10-12 days or use weekly application where there are less high values in the first days).

I don't disagree that a middle-of-injection-cycle measurement would give a more typical reading--as far as I've seen, most people on biweekly shots as I am get their levels checked around 5-7 days after their injection. My doctor (who is a GP at my university medical center, by the way, and not an endo) made no requests as for when after my shot I should get blood drawn, so I've informed him that it was my peak levels. Still, double the highest end of ranges seems absurd, even for peak levels. I don't have a sort of "low" feeling at the end of my shot cycle like I did when my dose was lower, so I doubt that it's getting much lower than mid-range even at the end of my cycle.

With all due respect, Laura, I don't know if you'll have the most relevant information for me--I appreciate your input, of course, but guys on testosterone will have some more experience in this area I think.

Update: he's going to be calling a specialist in Philadelphia (who I'm presuming he met at the trans health conference) to better address these concerns, and in the mean time I'm dropping back to my old dose and taking Aldactone to block estrogen (oddly?) to deal with the cycle problem.

Laura: I don't have enough posts to message you back, but thank you for the link--sorry I doubted you! That, combined with my doctor's response, make me feel a bit better about having such a huge spike.

It's good that he's calling someone else. It doesn't sound like he knows what he needs to be looking for. Is there anyone else in the medical center that may be a more appropriate choice to monitor your HRT? An endocrinologist maybe?

I would ask him for clarification as to the Aldactone. It's an anti-androgen. MTFs take it.

Quote from: ftmax on September 14, 2015, 12:17:14 PM
It's good that he's calling someone else. It doesn't sound like he knows what he needs to be looking for. Is there anyone else in the medical center that may be a more appropriate choice to monitor your HRT? An endocrinologist maybe?

I would ask him for clarification as to the Aldactone. It's an anti-androgen. MTFs take it.

There is a pathway from very excessive testo to estro via aromatase (its one way).

Quote from: Laura_7 on September 14, 2015, 12:27:36 PM
There is a pathway from very excessive testo to estro via aromatase (its one way).

Laura, can you explain? Combining it with a lower testosterone dose seems like a waste to me - like yes, it will lower your T levels back down because the Aldactone is blocking your androgen receptors.

Quote from: ftmax on September 14, 2015, 12:32:28 PM
Laura, can you explain? Combining it with a lower testosterone dose seems like a waste to me - like yes, it will lower your T levels back down because the Aldactone is blocking your androgen receptors.

Since there seems to be a problem with the cycle, maybe from some estro

Quote
I thought my menstrual cycle had finally ended--but no, it's been back again since Friday, and seven months is more than long enough for it to have ended. Could the ridiculously high levels have something to do with that?

QuoteI'm dropping back to my old dose and taking Aldactone to block estrogen (oddly?) to deal with the cycle problem.

Here is a quote showing it might help with this problem:
realself.com/question/aldactone-irregular-periods

Quote from: ftmax on September 14, 2015, 12:17:14 PM
It's good that he's calling someone else. It doesn't sound like he knows what he needs to be looking for. Is there anyone else in the medical center that may be a more appropriate choice to monitor your HRT? An endocrinologist maybe?

I would ask him for clarification as to the Aldactone. It's an anti-androgen. MTFs take it.

I was pretty confused about the Aldactone as well, hence the "oddly?", but turns out he meant Progestim and just said the wrong one. There aren't any endos, as far as I know of, at the medical center. I trust him to listen to any concerns I have, though, and call the specialists in Philly if he has any questions. Apparently he learned something concerning when he called those specialists, though--I have an appointment with him tomorrow because we need to talk in person.