The Ultimate TRT Guide for Aussies – Part 6

The Ultimate TRT Guide for Aussies – Part 6

Moving on from Part 5, a bit of a hybrid for Part 6. I often notice that those on TRT like to turn things up a notch from time to time—which is totally fine (even awesome) by the way. Essentially, the markers to monitor on TRT are the same as those to monitor on AAS. The only caveat is that while on AAS there are a few markers that are expected to get away from you while on cycle, but are also expected to quickly return to baseline once the cycle has completed.

I am often asked what to monitor while on cycle, post cycle or on TRT. Proper monitoring of men on Testosterone Replacement Therapy or high doses of AAS and/or other PED’s is essential to, well, not screwing up your life basically. You really can die if you screw this **** up and you’re unlucky. Let me chime in on some things you want to know, or at least need to know. The following lists include all important blood tests and health variables for men before they are prescribed testosterone and while on Testosterone Replacement Therapy. For those using higher doses of Testosterone or other AAS/PED, you should aim for these parameters after you finish your cycle at least. Whether that is PCT or back to a cruise/TRT after your cycle is complete, you should allow the body time to reverse any potential damage your body may have incurred while using these supplements. A good rule of thumb is commonly said to be time on = time off and I have to agree that this rule is quite sensible. PS, “time off” should be time off after your PCT, not inclusive of your PCT. Many get the definition to that rule skewed.

Target Blood Test Limits

HCT which stands for Haematocrit. We want to aim to have this under 55. If your HCT is 55 and over, donate blood. High haematocrit (large amount of red blood cells) makes your blood thick which is not good for your cardiovascular health. Many physicians will argue that under 53 is best. Until further notice, HCT is an important bio-marker we must control while using TRT or AAS. There are some physicians that are saying HCT elevations on their own are of no harm unless platelets are elevated also. I am not convinced yet. I still run with the fact that elevated HCT above 55 is a major danger. Although it can be dangerous if left alone, it is easily treated with a therapeutic phlebotomy which is otherwise known as getting rid of blood. We can discuss exactly how to go about this in the comments section below if asked.

PSA ideally under 3 (4 is max since doctors will not prescribe TRT at this number)

Estradiol (LC-MS aka Sensitive Assay) between 70-150 pmol/L. Anastrozole may be needed at 0.25-0.5 mg per week in some men on TRT with sensitive estradiol over 150 pmol/L if breast tenderness is experienced or other side effects that were associated after elevations in estradiol. For those on higher doses than TRT, an aromatise inhibitor is almost always of benefit. The dosages and types vary greatly depending on the context of the individual which have been discussed in older threads. If there is any confusion here, we can discuss in more depth in the comments section. Of course, there will be exceptions to this rule and there will be some who operate best at slightly higher or lower then reference range estradiol levels. It is important to note that the only accurate method of testing for estradiol is the LC-MS which is otherwise known as the sensitive assay.

Blood pressure ideally under 135/85. High blood pressure is undeniably not good for cardiovascular and kidney health. It can and will kill you if left alone long term. If you are on a heavy cycle, a consistent 140/90 is the absolute limit before we need to either cease AAS use, or add in BP medications. Preferably the first, but I understand some people are serious competitors and ceasing AAS use is not an option. We can discuss the best medications/doses or solutions in the comments section below if asked. When it comes to blood pressure and body-builders, please ensure you have a quality at home monitor with a cuff that is appropriate to your arm size. Check first thing in the AM and PM before bed. Find your weekly mean and do not scare yourself from a single score. There are many factors involved in getting an accurate blood pressure score or mean score. 120/80 or below is perfect but let us not get greedy here. Some will be fortunate enough to have perfect blood pressure scores on AAS but I find that to be in the lighter weight lads or the guys on milder cycles. Again, we can discuss this in the comments section below.

Estimated Glomerular (eGFR) (kidney function) over 60. Keeping blood pressure under control and not overloading the body with supplements that may or may not affect your kidneys is a good solution. That includes natural supplements. Just because something is natural, does not mean it is safe. I absolutely feel there is no room to play for this eGFR threshold. Anything lower and one should cease use of AAS immediately.

Ensure Liver enzymes are not elevated 3 x over the reference ranges while on cycle and ideally no more than 20% above the reference ranges long term. Look, this is a generalisation but also one should not fret if their ALT or AST is a little over the reference range, even double. GGT is of concern if it is 3 x the reference range and should be monitored every 30 days until levels return to baseline. It is important to realise that not all liver values if elevated are indicative of liver damage. It is also important to realise that on cycle if liver values are elevated, they will return to normal on their own after you finish your cycle. If you have stopped AAS and began taking supposed supplements that will “heal” your liver, how do you know they did not just return to baseline on their own? To my knowledge, in the context of AAS use, there is not a great deal of research to support the use of liver supplements while using AAS in humans. Until a solid comparative study is complete in humans within this context, I suggest you spend your money on more healthy food and cycle sensibly. Liver issues on AAS are over-hyped and are rare if you cycle sensibly which includes regular lab work. Many don’t do this and there are prices to pay.

TSH under 2.5. Higher numbers can point at low thyroid function, which causes a lot of the same symptoms low testosterone can cause. As we will sometimes see, AAS use can affect thyroid function. Unless you are symptomatic, perhaps not worth investigating any further than TSH. If you are symptomatic or would like a more detailed insight into your thyroid, it is worth getting a comprehensive thyroid test which includes TSH, FT3, FT4, Thyroglobulin ab (T Gab), Thyroid Receptor ab (TRab), Thyroperoxidase a (TPO). These extensive tests are not often covered by Medicare so beware of the cost. We can discuss what each marker may be useful for in the comments section if asked.

Lipid values. As far as lipid values are concerned, the medical community is currently re-evaluating where they stand with lipids values as an indicator of cardiovascular health. The question is whether or not they are accurate indicators of cardiovascular health or not, except for LDL. There is a divide in the medical community and from what I have read up on, it seems to me the only accurate indicator to monitor would be LDL. I look to have LDL within normal reference ranges. If you are on AAS cycles and LDL is affected, I like to see equal time where LDL has returned to baseline either with PCT or cruising at a dosage of AAS that allows for LDL to stay at baseline so that any damage incurred can hopefully be reversed. The issue is long term deviations of LDL outside of reference ranges, not for brief periods of time. When on AAS, we must learn to push the limitations within healthy bounds, not to stay perfect. To ask for perfect blood work all the time while on AAS is greedy. There is also research into LDL testing and whether or not there are more accurate ways to test for. It all goes beyond my head for the moment so until then, I stick to testing for LDL only with the regular method and look to stay within reference ranges. I know this lipid value testing controversy will rustle some feathers and I am sure it will spark some healthy discussion.

Total Testosterone over 15 nmol/L (many men feel better above 20-25 nmol/L). If you’ve finished your PCT and you want to see if you’ve recovered, these are some good ways to know. Of course, if you are on cycle you are going to see much higher scores than that.

Free Testosterone equal or above 400 pmol/L. Free Testosterone is important to check as it is unbound and “usable” if you will, but we can get a fair indication of what your Free Test will be from your Total Test scores unless there is a major SHBG issue.

LH and FSH within reference ranges if you have completed your PCT and have cleared all medications from your system. Do not bother to test on AAS as they are for the vast majority going to be undetectable.

Before I conclude, of course, there are many other serum markers, screens and bio-markers we could add to this list, but where does it all end? Before your blood work costs more than the cycle itself, I believe the above markers to monitor will provide you with a peace of mind and longevity you may not see if you did not monitor, which you can have done at a reasonably affordable price quite instantaneously. If you are symptomatic or feel generally unwell after all of these markers came back okay, we can look deeper also. For the super serious athletes who wish to stay on high doses of AAS year-round, we can perhaps delve into a more in depth look at other markers, thresholds and medications that can be used to mitigate some of these issues that can and will often occur with chronic (long term) use of high dose AAS and other PED’s. A story for another time though. To be continued.