“High-Normal T”

[BigTex]

I would take that bet. There are many posts on here in which Defy newcomers describe starting with doses well over 100 mg/week. What is the justification for supraphysiological dosing right from the start—when it's widely believed that titrating downwards is more difficult than titrating upwards? I'm still a supporter of Defy, but this is one area where our views appear to diverge.

I certainly agree with you that going down, once side effects happen, is much harder than going up. No matter what medication, even peptides I have always been an advocate of starting low and slowly titrating upwards. However, I am not so sure I agree that 100mg/wk is supraphysiological but may be too high for a few people. I sure don't want to second guess their medical opinions based on what they saw with blood work. 200mg+ I would sure agree with being supraphysiological and we do see some guys here and other boards on those kinds of doses. Again, since I have no idea how Defy does their dosing, I can only believe that they are very careful in how they approach this. Most I have met in medicine are very conservative in their administration of medications. I agree, I also support Defy but I will not be one of their customers ONLY because we have plenty of excellent TRT doctors here in Houston who all take insurance. Defy is an excellent choice for someone who does not have this kind of access. I would however love hearing from either a patient or some one at Defy on how they justify their dosing protocols. Would be an interesting conversation. So far we are just guessing.

 

[BigTex]

Dr. Lipshultz started me on 200mg/week and later 1mg anastrozole per week and 20mg tamoxifen per day. I guess they were trying to kill my gyno lol

Did he give you a reason for starting that high? I am assuming the high dose started the gyno?

 

[Fernando Almaguer]

Did he give you a reason for starting that high? I am assuming the high dose started the gyno?

No, I had some gyno from puberty but Im sure that with the HCG prescribed exacerbated it. Also, no reason that's just the dose he gave me he said its ok to go over normal range because the trough would be half that (700 trough total testosterone). I don't know if hes changed his thinking, but I did my own research, and he was fine with me doing what I want with that prescription. He has given me lipo C and some glutathione from empower. I am grateful for Dr. Lipshultz don't get me wrong. It is imperative that patients do their own work when diving into something like TRT.

 

[Fernando Almaguer]

This might imply that his concept of starting low is in relation to AAS use.

"starting low" is not well defined.

Yes only that I wasn't looking for an bodybuilding dose. Just replacement therapy. It is cool though I am still with the clinic and pleased.

 

[BigTex]

No, I had some gyno from puberty but Im sure that with the HCG prescribed exacerbated it. Also, no reason that's just the dose he gave me he said its ok to go over normal range because the trough would be half that (700 trough total testosterone). I don't know if hes changed his thinking, but I did my own research, and he was fine with me doing what I want with that prescription. He has given me lipo C and some glutathione from empower. I am grateful for Dr. Lipshultz don't get me wrong. It is imperative that patients do their own work when diving into something like TRT.

So it sounds like the higher dose did not make your gyno worse and he has been able to treat the problem you already had. Interesting! @Fernando Almaguer, I have been VERY impressed with Dr. Lipshultz from all I have heard about him and read about him. We all trust what science has to say, well Dr, Lipshultz is not only very experienced in his field he is also doing lots of research in the field. He has 21 studies listed on his page, which is certainly not all he has been involved with. Very impressive background.

larryl

BCM

www.bcm.edu

I did another search at viictr.org and he published 406 studies in his field.

LARRY LIPSHULTZ | Profiles RNS

If I didn't live so far from the medical center I would definitely like having him as my doctor. I absolutely hate driving and hate going downtown.

 

[Blackhawk]

If I didn't live so far from the medical center I would definitely like having him as my doctor. I absolutely hate driving and hate going downtown.

Makes two of us. 2000 mile drive for me.

 

[Graham]

It takes 175 mg on eod dosing to get me to 900 ng roughly 24 hours post injection so sometimes doses close to 200 mg are warranted

 

[Cataceous]

... However, I am not so sure I agree that 100mg/wk is supraphysiological but may be too high for a few people. I sure don't want to second guess their medical opinions based on what they saw with blood work. 200mg+ I would sure agree with being supraphysiological and we do see some guys here and other boards on those kinds of doses...

I said "doses well over 100 mg" of TC are superphysiological. I might grudgingly agree that there could be some cases where 120 mg is not excessive. However, I doubt you can look at typical bloodwork to discern in advance who the special ones are. I also won't readily concede that an average of 12 mg per day of testosterone is physiological. This is approaching double the average production of healthy young men.

 

[Simbarn]

Dr. Lipshultz started me on 200mg/week and later 1mg anastrozole per week and 20mg tamoxifen per day. I guess they were trying to kill my gyno lol

He started you on 200 mg per week! Did he keep you this for very long?

 

[BigTex]

I said "doses well over 100 mg" of TC are supraphysiological. I might grudgingly agree that there could be some cases where 120 mg is not excessive. However, I doubt you can look at typical bloodwork to discern in advance who the special ones are. I also won't readily concede that an average of 12 mg per day of testosterone is physiological. This is approaching double the average production of healthy young men.

My mistake, @Cataceous and I apologize for the misquote, you did say well over 100mg. However, since I am not a doctor I am not going to second guess some of the reasoning for any doses beyond 100mg without blood work, seeing the patient and being able to ask questions to the doctor. Would I question their decision as a patient, absolutely I would. No, you can't just look at blood work which is why I think we both agree it is best scenario to start low and titrate up. Pharmacogenomic tests could also be run in advance to help determine proper dosing but those are quite expensive.

I have seen guys in sport that were vey poor responders and needed quite a bit more mg's than what I ever took to get optimal any results. Genetics in this case are very important. I have also seen in the sport of BB that everyone is very individual in how their body responds to certain drugs, doses and combinations. This all comes into play the night before a show. Cookie cutter applications never get perfection. No doubt their field of medicine is the same way. IMHO, 200mg/7 days is a little high, however if you can handle that much with no side effects and all of your symptoms are gone where is the problem? Have we proven a dose of 200mg/7d to be unhealthy?

You are absolutely right @Blackhawk "starting low" is not well defined. Our hormonal system is so individual I just don't believe you can put a static number on it without having some idea how we metabolize drugs. For instance, the metabolism and excretion of many drugs decrease, requiring that doses of some drugs be decreased. Toxicity may develop slowly because concentrations of chronically used drugs increase for 5 to 6 half-lives, until a steady state is achieved. So a 30 year old with low T may in fact be able to handle a larger does and have no negative health effects than say a 65 year old.

Further, age-related slowing of gastrointestinal motility can prolong movement of drugs through the stomach to the small intestine, thus there is a delay in the absorption and onset of action and reduce peak drug concentrations and pharmacologic effects. Again, a 30 year old will may not have this problem and may need a higher dose of medication.

Serum albumin decreases and alpha 1-acid glycoprotein increases with age. The clinical effect of these changes on serum drug binding varies with different drugs and could effect dosing in older populations.

One of the most important pharmacokinetic changes associated with aging is decreased renal elimination of drugs. After age 40, glomerular filtration rate (GFR) decreases an average of 8 mL/min/1.73 m2/decade (0.1 mL/sec/m2/decade); however, the age-related decrease varies substantially from person to person. One might think this could make dosing kind of challenging.

I think we are very critical of TRT doctors who for the most part are delving into a relatively new area with very little research to guide our decisions. Over the last two decades, various guidelines and recommendations for TRT have been developed and have evolved with different points of view, from expert opinions to official statements.

Drug Metabolism and Aging - Pillcheck

Where do we start? - My guess is <125mg/wk

The 125-mg dose was associated with high-normal testosterone concentrations and low frequency of adverse events, no serious adverse events, and substantial gains in FFM (+4.2 kg) and leg press strength (+28 kg); thus, this dose provided the best trade-off between anabolic effects and adverse events.

Older Men Are as Responsive as Young Men to the Anabolic Effects of Graded Doses of Testosterone on the Skeletal Muscle

Although testosterone levels and muscle mass decline with age, many older men have serum testosterone level in the normal range, leading to speculation about wh

academic.oup.com

​

 

[Cataceous]

... IMHO, 200mg/7 days is a little high, however if you can handle that much with no side effects and all of your symptoms are gone where is the problem? Have we proven a dose of 200mg/7d to be unhealthy?
...

The burden of proof must be on those who would state it's safe to take triple the average youthful production. Not all risks are known and even the known risks are not so well quantified. Kudos to @readalot for his detailed explorations of this subject. The U-shaped mortality curve associated with testosterone levels should at least give pause to anyone contemplating long-term use of such high doses. If it takes giant doses of testosterone to resolve symptoms then shouldn't the focus be on why? It's not clear to me if even a relatively high CAG repeat length in the AR gene would need to be offset by such high levels. The natural increase in total testosterone from higher CAG repeat length isn't so pronounced. "The highest (n > 23) vs lowest quartile of CAG repeats (n < 20) associated with a 1.1 nmol/L [32 ng/dL] higher baseline testosterone level (F = 1.94, P = 0.02)."[R]

 

[t_spacemonkey]

my last blood work, where my T was 180mg/week was:
total: 754 ng/dl
free: 22.6 pg/mL

the T dose is irrelevant. what matters is:
a) how you feel
b) do you have any side effects which are due to dose/protocol.

 

[BigTex]

What exactly is a giant dose of testosterone? To me that would be 1-2g/wk. That being said, no one would think about being on that kind of dose for the long term. Didn't Dr. Lipshultz said he has done baseline studies on guys doing large doses and monitored their progress over time and has rarely if any, seen any unhealthy side effects? I have seen studies showing left ventricle hypertrophy, but these studies failed to take into account the effect heavy resistance training has on the heart as and adaptive measure. I do see @readalot study on 500mg of testosterone....yes to me that is a pretty big dose too. But people who do these large doses doing them for a short period of time. I also see @readalot as posting:

Almost 4 years on TRT. Typically 80-120 mg/week of TC (on and off hCG). Played with 1x and 2x per week injections.

Total T between 1500 and 1200 ng/dl (peak) and 500-800 ng/dl (trough). I can get into fT/SHBG and all that if you are interested.

IMHO, 80-120mg/wk is a fairly low dose, yet his serum T levels are certainly not in the Defy average of 800-950 ng/dl range. I this to be considered a giant dose? Seems to me @readalot is a very health man. Again, it seems a healthy dose is very dependent on the individual and obviously the expert opinion of their doctor.

Here is a good study to look at:

Epidemiological studies have found that men with low or low normal endogenous testosterone are at an increased risk of mortality than those with higher levels.

https://onlinelibrary.wiley.com/doi/full/10.1111/cen.12503

What we do see is that low and low normal levels are not so healthy. They didn't really describe what higher levels are but I will assume it is greater than low normal levels. My question is this. If I have low T and go to a doctor, do I want to continue to look and feel like a 66 year old man or like a 26 year old man? I know what I am going to say. Quality of life seems to be a big deal and @madman posted a very nice post on that just today.

Just for the heck of it, Quest changed the normal range for serum testosterone in 2016 at the advice of the CDC from 348 - 1,130 ng/dL to 250-827 ng/dL. This was based off one study. Are those with normal highs or 1130 now unhealthy?

 

[Cataceous]

What exactly is a giant dose of testosterone? To me that would be 1-2g/wk. ...

In the context of TRT, 200 mg TC/week qualifies as a giant dose. That's about double the top physiological production rate. No doubt it's a baby dose in the world of steroid abuse.

In the absence of acute side effects the concern is what happens with integrated exposure. This is what @readalot was exploring. There's nothing definitive, but the animal models hint at the possibility of problems when exposure goes from years to decades. Average guys on TRT should be discouraged from being guinea pigs in such experiments.

The large majority of men on TRT do not have a legitimate medical need to dose more than 100 mg TC/week. The evidence shows that the essential improvements occur when going from hypogonadal to normal. Higher doses do not improve sexual function and libido. While there can be further improvements in musculature and body composition, they may be accompanied by various side effects of excess. The "what if" scenarios about outliers are simply a backdoor way to normalize excessive dosing. "What if it takes 140 mg for John Doe to feel good?" There's this implication that if it takes 140 mg for someone to say he feels better then this dose level should be considered in the normal range. In reality there's something unusual going on when someone actually needs this much testosterone. Hyper-metabolizers? Long CAG repeats? Perhaps—but these few do not define TRT for the majority.

... If I have low T and go to a doctor, do I want to continue to look and feel like a 66 year old man or like a 26 year old man? ...

The big problem with this is the assumption that testosterone alone is going to make you feel like you're 26. Nope. If you're hypogonadal and get back to normal levels—even for a healthy 66-year-old—then you're probably going to feel better. So go a bit further and raise levels to 650 ng/dL, about average for a young guy. There may be some incremental improvements, but nothing like just getting to normal. Go up even higher if you want, but you're still not going to feel 26—and you might start to feel worse as your hormonal balance is upset.

....
Just for the heck of it, Quest changed the normal range for serum testosterone in 2016 at the advice of the CDC from 348 - 1,130 ng/dL to 250-827 ng/dL. This was based off one study. Are those with normal highs or 1130 now unhealthy?

To me this just emphasizes the need to focus on free testosterone. High total testosterone can easily be driven by elevated SHBG. You can divorce yourself from falling standards by using older data and the Vermeulen calculation. As I recall, the range for healthy young men was something like 8-22 ng/dL. If the guy with a total testosterone of 1,130 ng/dL had SHBG of 50 nMol/L then his free testosterone would be around the top of the normal range and not unhealthy.

 

[camygod]

Saying you want to look and feel like a 26 year old at 66 is crazy thinking
What I notice and have experienced with friends too is that many guys want to have their cake and eat it
Most also have over muscled flushed look and are a pain in arse to be around but think that being short tempered is just being a "alpha male"
sadly many of the trt Cliniques sell them a lie that more test the better
My close friend is on high trt dose and still complain being tired and needing different pills for his dick ect and he is lean and shredded his whole life
His face has aged alot since starting trt he really didn't need
I really think running high test for ever will lead to side affects down the line
You might feel good at first due to raise in dopamine but it won't last
But each to their own
Most egos are too high to accept this

 

[BigTex]

Saying you want to look and feel like a 26 year old at 66 is crazy thinking
What I notice and have experienced with friends too is that many guys want to have their cake and eat it
Most also have over muscled flushed look and are a pain in arse to be around but think that being short tempered is just being a "alpha male"
sadly many of the trt Cliniques sell them a lie that more test the better
My close friend is on high trt dose and still complain being tired and needing different pills for his dick ect and he is lean and shredded his whole life
His face has aged alot since starting trt he really didn't need
I really think running high test for ever will lead to side affects down the line
You might feel good at first due to raise in dopamine but it won't last
But each to their own
Most egos are too high to accept this

Wait until you get 66 before you make those judgmental statements. But I do love cake and love to eat it. You ever tried Tres Leche cake, best stuff in the world to put on weight. Anyway, I don't know too many my age and older that would not pay to look and feel younger. Part of growing old, its not so fun. I can easily say that at 66 I would love to feel 26 again, even 36, heck even 46. I set 14 world records in powerlifting around that 46-50. In my case its kind of hard to go in the gym 13 years later from a 950lb squat, 800lb deadlift, and 525 lb bench to not being able to squat or deadlift and struggling to do 225lbs 12 times. Going from a 66" chest to a 50" chest. Having to use a leg press loaded up with 16-45lb plates form 12 reps honestly sucks. But I can't squat an longer and miss the squat bar. Then having to see the muscle size shrink and the skin start sagging and wrinkling up like a old prune kind of bites. Man, that is a dose of reality and will definitely make you want to be 26 again. You know, I have no idea what my T levels were at 26. Most likely pretty high. I started competing in powerlifting then.

But then I kind of fit some of those other comments. I am most definitely still an "alpha male" and old lion, and have always had a very short fuse. Even before I ever took the 1st steroid I was very quite, had a more than ample patients but blew up like an atomic bomb. Probably something I needed to see a shrink about but never liked shrinks. So I chose activities that took all of this toxic masculinity out of me for a few hours. Probably the only reason why I lived beyond 30.

My sole purpose for wanting to be in the 800-900 range is I feel "NORMAL." Ego would put me over 2000 so its not my ego driving this. When I am in the 600's, 500's, 400's and God forbid 300's I don't feel normal, I actually feel like shit. Quality of life seems to come in here some where. I have been using steroids for over 43 years of my life, I don't remember being any other way. When I hear guys talk about how good they feel I laugh, I just feel normal. I recently went up to 900 and felt pretty good because I felt normal. Then reality hit me and I realized I may not be so healthy feeling normal and might need to come down some. Every morning when I wake up now matter where my T live might be, I am still 66 years old and hurt like crap every morning when I get up and it continues during the day. All the steroids in the world won't change this, surgery might. I would much rather put up with pain than feeling like crap from low T.

Yes I know a few guys who cry all day because their hair is falling out. Annoying and seems to be a bit anal. Heck I keep mine buzzed off and could care a less. Most of the people I know are competitive bodybuilders and talk about a narcissistic bunch. They always complain about their sexual problems. Find you a woman that can make you feel 26 again, no pills needed. At least never had problems like that in my life. My last blood work put me in the mid 700's. I did not feel that normal but it was acceptable. Then I cut the cypionate all together and put my own TRT together despite my doctor's objections. He already knows I do what I feel is best for me. I have no idea what my T levels are now, but judging by my perception of normal I am under 600. I will see in 2 months. I wanted to use TU and not cypionate. Never liked cypionate.

According to you guys, running high test (200mg) is going to kill us all. Yet I did that amount plus for the majority of my life, I competed 27 years, usually 250mg test E. Maybe some anadrol and Cheque drops here and there. Other than the pain I endure every day just getting up out of bed I am still pretty damn healthy. My cardiologist sent me home with a clean bill of health. I have had every cardiological test know to man run in the past three years, my regular doctor thinks I am pretty healthy but wonders about my sanity some times. My orthopedic surgeon is fascinated how someone with all the pain I have can still walk into a gym and train as hard as I do and not cry about like the rest of his patients who come in an are younger and not as badly injured. Hey, that's how alpha males are. It part of our toxic masculinity, right. He has said many times that it is amazing to see a guy your age with such dense muscle mass and dedication to keeping your self strong and healthy. Yea, I live the life and it's all I know.

I had a dear friend who lived in California most of his life. He won Mr. Universe in 1966 and appeared in quite a few television shows. Of course he was a steroids user like most in bodybuilding and powerlifting and use over 200mgs for most of his life. I still have pictures of him when we went to visit in maybe 2011. I believe he was 76 years old. At this age he is still working out hard and has the body most 26 year old men would die to have. He still looked like a Greek God. At 76 years old he still could keep up with his young beautiful wife and his active life style. He didn't need any one to take care of him, change his diaper, or feed him like so many people that age. He was also not afraid to jump into a swimsuit, go to the beach and walk around with no shirt and get a tan. He honestly looked like a 40 year old man. My friend Dave Draper died last year at 79. QUALITY OF LIFE, Dave lived the life he wanted to live and never had regrets. When it was time to go he went peacefully and was never a burden on his family. I never forget the impact Dave Draper and his lifestyle had on my and my wife who viewed him as a hero living in Buenos Aires. I learned a valuable lesson from him on how it is much more important to have quality of life as we age. Live the life you want to live and don't let others tell you different.

 

[BigTex]

In the context of TRT, 200 mg TC/week qualifies as a giant dose. That's about double the top physiological production rate. No doubt it's a baby dose in the world of steroid abuse.

In the absence of acute side effects the concern is what happens with integrated exposure. This is what @readalot was exploring. There's nothing definitive, but the animal models hint at the possibility of problems when exposure goes from years to decades. Average guys on TRT should be discouraged from being guinea pigs in such experiments.

The large majority of men on TRT do not have a legitimate medical need to dose more than 100 mg TC/week. The evidence shows that the essential improvements occur when going from hypogonadal to normal. Higher doses do not improve sexual function and libido. While there can be further improvements in musculature and body composition, they may be accompanied by various side effects of excess. The "what if" scenarios about outliers are simply a backdoor way to normalize excessive dosing. "What if it takes 140 mg for John Doe to feel good?" There's this implication that if it takes 140 mg for someone to say he feels better then this dose level should be considered in the normal range. In reality there's something unusual going on when someone actually needs this much testosterone. Hyper-metabolizers? Long CAG repeats? Perhaps—but these few do not define TRT for the majority.


The big problem with this is the assumption that testosterone alone is going to make you feel like you're 26. Nope. If you're hypogonadal and get back to normal levels—even for a healthy 66-year-old—then you're probably going to feel better. So go a bit further and raise levels to 650 ng/dL, about average for a young guy. There may be some incremental improvements, but nothing like just getting to normal. Go up even higher if you want, but you're still not going to feel 26—and you might start to feel worse as your hormonal balance is upset.


To me this just emphasizes the need to focus on free testosterone. High total testosterone can easily be driven by elevated SHBG. You can divorce yourself from falling standards by using older data and the Vermeulen calculation. As I recall, the range for healthy young men was something like 8-22 ng/dL. If the guy with a total testosterone of 1,130 ng/dL had SHBG of 50 nMol/L then his free testosterone would be around the top of the normal range and not unhealthy.

I wanted to post this but never got around to it yesterday:

This comes from an old Farmington Study Mean 723.8 SD 221.1

99th percentile - 1322

Reference Ranges for Testosterone in Men Generated Using Liquid Chromatography Tandem Mass Spectrometry in a Community-Based Sample of Healthy Nonobese Young Men in the Framingham Heart Study and Applied to Three Geographically Distinct Cohorts

The composite outcome indicates the following: in FHS, one or more of slow walking speed (walking speed in the lowest 20th percentile), self-reported mobility limitation, or diabetes; in EMAS, one or more of low frequency of morning erections, erectile dysfunction, low frequency of sexual thoughts, difficulty in climbing several stairs, limited in walking more than 1 km, slow walking speed (walking speed in the lowest 20th percentile), or diabetes; in MrOS, one or more of frailty, slow walking speed (walking speed in the lowest 20th percentile), or diabetes.

In general, men with low total or free testosterone were more likely to have low walking speed, frailty, or physical symptoms than those with normal levels (Fig. 3). Thus, EMAS participants with low total or free testosterone were more likely to report difficulty climbing stairs or have low walking speed (in the lowest 20th percentile). In MrOS, men with low total or free testosterone were more likely to have slow walking speed than those with normal testosterone; men with low free testosterone were also more likely to have frailty. As reported previously (20), the FHS participants with low free testosterone were at higher risk of self-reported mobility limitation.

In all three cohorts, the men with low total and free testosterone levels were nearly twice as likely to have DM as those with normal levels (Fig. 3). Similarly, in all three cohorts, men with low total and free testosterone were more likely to have at least one of the following: sexual symptoms (EMAS only), a marker of physical dysfunction, or diabetes (Fig. 3). Sensitivity analyses (not shown) considering the 1st and 5th percentiles, as opposed to the 2.5th, as the threshold value for low testosterone, yielded qualitatively concordant results.


Yet another paper I spent some time looking at:

At present (2004) there are no satisfactory evidence based, generally accepted norms for testosterone levels recognised for the aging male.

[Testosterone deficiency and the problem of normal values] - PubMed

Wait, here is one more:

What is normal?

Of the 25 labs, there were 17 and 13 different sets of reference values for total and free testosterone, respectively. The low reference value for total testosterone ranged from 130 to 450 ng/dL (350% difference), and the upper value ranged from 486 to 1,593 ng/dL (325% difference).

Wide variability in laboratory reference values for serum testosterone - PubMed

Since everyone has a different opinion and labs tend to have different reference norms, make it kind of difficult to tell what normal really is. This is a very new field maybe doctors like Lipshultz are right.

If you are say John Doe and you are taking 100mg and still have lot T symptoms, they what was the purpose going to the Low T clinic in the 1st place? I personally think this is a relatively new field that seem to be constantly clanging like most thing in science. I cold possibly be that we are all guinea pigs. Anyway, I would love to see one of the Doctors from Defy or even Dr. Lipshultz debate this as they are truly more expert in the field that anyone here. Yet we tell them they are wrong.

As a world class powerlifter and strength coach , I use to get so fed up with the guys in the lab coats telling us how to do our jobs. Most of them never lifted a weight in their lives. But they had no problem telling us how we can't be getting the results we get because their data shows we are wrong. Years later, the men in the white lab coats figured it all out. I use to argue with the Copper Clinic guys all the time about how weight lifters are in better cardiovascular shape that these aerobic people. No way right. They laughed, years later they are all eating some crow. Sometimes science needs to take at look at what those in the trenches are doing and try to figure out why they are getting the results they get.

 

[Cataceous]

I wanted to post this but never got around to it yesterday:

This comes from an old Farmington Study Mean 723.8 SD 221.1
...

That's probably the data I was thinking of, with the range for Vermeulen free testosterone being 7-23 ng/dL, and the average about 14.

My cautionary words are intended more for the broader audience, and we are on the same page with respect to low-and-slow on the TRT dosing. You have a lot of experience and know your own body much better than most. I don't presume to know what's best for you. I also don't in general object to guys experimenting with upper-normal levels if they have thoroughly evaluated normal and ideally lower-normal levels first.

If you are say John Doe and you are taking 100mg and still have lot T symptoms, they what was the purpose going to the Low T clinic in the 1st place? ...

... Sometimes science needs to take at look at what those in the trenches are doing and try to figure out why they are getting the results they get.

I'm wondering how often such cases receive a thorough investigation. And how common are they? What are the "T" symptoms, and how can we be sure they are exclusive to testosterone? A more prosaic problem than excessive CAG repeats or hyper-metabolizing would be an imbalance of androgenic and estrogenic activity. In this case there's a hypothesis linked to the TOT crowd, which is that the ratio of androgenic to estrogenic activity can be increased by pushing testosterone above what's physiological. The aromatase enzyme starts to saturate, reducing the incremental increases in estradiol. Then you get into the argument over whether high-doses of testosterone are better than micro-doses of an aromatase inhibitor.

... Every morning when I wake up now matter where my T live might be, I am still 66 years old and hurt like crap every morning when I get up and it continues during the day. All the steroids in the world won't change this, surgery might. I would much rather put up with pain than feeling like crap from low T.
...

I don't want to give any false hope, because there are a lot of factors going into pain perception. If the damage is too great then what helped me may be too subtle. Over the past decade I had sustained periods in which it seemed like overall pain sensitivity increased, causing any body part with wear or tear to hurt more than seemed justified. At its worst I felt like a decrepit old man, though I'm five years younger than you. I feel very fortunate to have had this problem fade over the last two to three years. Unfortunately I can't be sure why. Some possibilities:

• palmitoylethanolamide—I did notice improvements within weeks of beginning this supplement
• shifting hormone levels—I've been tweaking testosterone, estradiol and progesterone in this period. There is interplay between hormones and pain perception
• peptides—speculative, and not the ones generally associated with healing. Oxytocin is a candidate, having some research behind it. GHK-Cu is also in the mix
• fixing trashed hip—The theory behind it is stated here: "Chronic illnesses that cause pain may also lead to a type of hypersensitivity. People with chronic pain may become very sensitive to that type of pain, effectively reducing their pain tolerance." If you have one particularly bad area then it may increase your sensitivity in all areas. For me it can only be part of the story, as I was improving some even before surgery last year.

 

[Fernando Almaguer]

He started you on 200 mg per week! Did he keep you this for very long?

Yes he was ok with it. I decided to lower it on my own. Only inject what i want to inject and test my numbers.

 

[BigTex]

That's probably the data I was thinking of, with the range for Vermeulen free testosterone being 7-23 ng/dL, and the average about 14.

My cautionary words are intended more for the broader audience, and we are on the same page with respect to low-and-slow on the TRT dosing. You have a lot of experience and know your own body much better than most. I don't presume to know what's best for you. I also don't in general object to guys experimenting with upper-normal levels if they have thoroughly evaluated normal and ideally lower-normal levels first.


I'm wondering how often such cases receive a thorough investigation. And how common are they? What are the "T" symptoms, and how can we be sure they are exclusive to testosterone? A more prosaic problem than excessive CAG repeats or hyper-metabolizing would be an imbalance of androgenic and estrogenic activity. In this case there's a hypothesis linked to the TOT crowd, which is that the ratio of androgenic to estrogenic activity can be increased by pushing testosterone above what's physiological. The aromatase enzyme starts to saturate, reducing the incremental increases in estradiol. Then you get into the argument over whether high-doses of testosterone are better than micro-doses of an aromatase inhibitor.


I don't want to give any false hope, because there are a lot of factors going into pain perception. If the damage is too great then what helped me may be too subtle. Over the past decade I had sustained periods in which it seemed like overall pain sensitivity increased, causing any body part with wear or tear to hurt more than seemed justified. At its worst I felt like a decrepit old man, though I'm five years younger than you. I feel very fortunate to have had this problem fade over the last two to three years. Unfortunately I can't be sure why. Some possibilities:

• palmitoylethanolamide—I did notice improvements within weeks of beginning this supplement
• shifting hormone levels—I've been tweaking testosterone, estradiol and progesterone in this period. There is interplay between hormones and pain perception
• peptides—speculative, and not the ones generally associated with healing. Oxytocin is a candidate, having some research behind it. GHK-Cu is also in the mix
• fixing trashed hip—The theory behind it is stated here: "Chronic illnesses that cause pain may also lead to a type of hypersensitivity. People with chronic pain may become very sensitive to that type of pain, effectively reducing their pain tolerance." If you have one particularly bad area then it may increase your sensitivity in all areas. For me it can only be part of the story, as I was improving some even before surgery last year.

@Cataceous, we do agree on more than we disagree on. While I am not a doctor, but I would never start myself on a high dose of anything. As we agreed, side effects are very hard to shake after they get started. Especially as we get into our late 50-60+. Why take the chance. I honestly think that some of the guys here are quite a bit younger and they for the most part will be able to handle some of the bigger doses. Can they maintain that as they age, I rather doubt it. The biggest concern is getting a baseline mapped out and frequently monitoring all of these factors to catch problem before they are very hard to get rid of. Most of these side effects can be reversed unless we continue to ignore them.

Guys like me, I guess there are very few of us. I have surely had a very high normal testosterone level until I started using high does of AAS for sport. I never managed to get through PCT more that 2-3 weeks because it was like deflating a big balloon. Size, gone, body weight gone and strength was pathetic. Strength athletes panic when this happens because you spend so much time and money gaining it all. So I got right back in the game. Probably why in the end I was able to take it to such a high level. I have backed off the weight and eventually the drugs. Like so many top level athletes it becomes a do or die situation at some point, especially when you get close to the top. I never wanted to be one of those who later on says "what if." But that seemed to be one of my problems with any sport I took up, I was always very competitve and was very obsessive/compulsive. I competed in football, baseball, track, kick boxing (PKA), competitive water skiing. So I am a very different case and certainly have a much different views on this stuff than guys who are truly androgen deficient. I was taking TU and my source didn't bother testing a batch he got before the last Olympics when we all stocked up expecting a shortage. I finally notice I was gradually starting to feel low T, 4 months later. I believe I tested at ~350, so I doubled the dose. Three months later ~320 so off I go to the doctor. Granted this 320 was still well within the elimination half-life of the good TU I had done 7 months earlier. So I can only imagine how low mine would have been after a year. Possibly ZERO? So I am here for a totally different reason, but still well within the TRT guidelines. As much as I would like to be in the 3000-4000 range, my day in the game is over and I have to find a way to deal with that. At my age I admit that would be silly thinking. But yest I think most of us old guys often wonder what it would be like to be 26 again.

As for the pain, arthritis runs in both sides of my family As we age connective tissue and disk start getting thin and brittle. My mother has arthritis in the hands, my father had degenerative disk disease as well as my younger brother (RIP). Lucky me, I also have osteoarthritis in both shoulders, the left knee + no meniscus, and the low back. Did years of competitive powerlifing make it worse? Not even my doctor can answer that one. My ortho keeps looking at the damage and doesn't understand how I can handle the pain. The knee is under control as is the left shoulder, but the low back and right shoulder are pretty far gone, I usually have to throw in the Naprosyn on the last month after a 4 month cortisone injection Luckily the cortisol goes systemic over night after the injection and I also get some relief in the back. I just keep fighting through this and hopefully when my times comes, I go out like my friend Dave Draper. Neither me or my wife wants to be a burden on the other having to be cared for. She is a former National Champion and IFBB Pro bodybuilder and has been lifting about as long as I have as well as taking very large doses of anabolic steroids when she competed. When it comes to women being guided with HRT, I promise it is VERY had to find advice worth listening to. Much less a doctor who will even talk to you about it. The drugs female builders do to win would surely scare most of us to death and is rarely talked about. But she is in GREAT health. None of the physiological structural issues I have and have had for many years.

Any way, @Cataceous thank you very much for the civil/professional debate. I has been very mentally stimulating. Not sure anything changed but I do believe as I said that we agree on much more than we disagree. I do completely understand that I am very different and probably very many of my views controversial, but then so many don't know the truth about highly competitive athletes.