First set of Follow Up Labs since Starting TRT. Looking for Feedback

[FunkOdyssey]

 

[Cataceous]

True. However, when you dig into mechanisms for higher testosterone to reduce reproductive success in an ancestral hunter-gatherer scenario, you realize that some are no longer relevant, while others are easily mitigated or monitored to avoid. You could even argue that higher levels would be more adaptive and increase reproductive fitness in our current environment. From GPT on why we evolved to have the physiologic levels that we do:

Some interesting stuff there, but I suspect it's far from complete. More discussion of testosterone's link to antisocial effects is needed.

A small point, but I have to somewhat question the statement that "even modest increases in lethal cancer late in life would select against chronically high T." Why would lethal cancers after childbearing/childrearing years produce significant evolutionary pressure? I have heard of an argument in favor of a grandparent effect. It tries to answer the question of what favored increasing longevity in hominids. According to this, having grandparents involved in childrearing confers an evolutionary advantage.

...
In today’s environment, pharmacologic testosterone can be subjectively beneficial for some men if hematocrit, cardiovascular status, and fertility goals are monitored.

I would attach more conditions to this, most prominently that the disruption of other hormones doesn't eventually cause you harm in other ways. Of course you'd want to avoid the side effects of diminished libido and sexual function that some men experience at higher doses. Are you willing to potentially sacrifice some longevity for the subjective benefits? Maybe monitor IGF-1? Would the dose be lowered when a relationship is entered to better ensure its survival?

 

[Phil Goodman]

Cite at least three of the "numerous studies" showing people doing "really well" long-term at these doses. A few months of dose-response testing doesn't count. What is really telling is the high churn rates for the standard forms of TRT, including injections, which at least prior to Xyosted were heavily skewed towards the higher doses you favor. For example, one study found that even after a year from treatment start, 69% of men using TE/TC dropped out in a three month period. This does not suggest a high rate of doing "really well".

I love how you make all these demands for burden of proof for my statements while earlier in the thread you were completely pulling numbers out your ass as if they were proven fact. Secondly, the study analyzing adherence doesn’t even factor in or include the dosing for each patient that continued or discontinued. For all we know, the patients who stuck with it were all on 120 mg/week and all the ones who discontinued treatment were on lower doses. Not saying that’s the case, just pointing out that the study you linked doesn’t show what you think it does. Likewise for the xyosted studies, it doesn’t specify which percentage went up to 100 mg and which went down to 50. Also, the entire criteria for adjustments during those assessments was total testosterone levels so that isn’t a great way to treat patients anyway.


Snyder et al. (2016) – The Testosterone Trials


• Study Details: A series of coordinated, double-blind, placebo-controlled trials involving 790 men aged ≥65 with hypogonadism (testosterone <275 ng/dL). Participants received testosterone gel (initially 5 g/day, adjusted to achieve 500–800 ng/dL, equivalent to ~100–150 mg/week of injectable testosterone) or placebo for 1 year.


• Adherence Findings: Adherence was high, with 85% of participants completing the 1-year protocol. The study monitored adherence through clinic visits and serum testosterone levels, noting that most men maintained target levels with dose adjustments (mean dose ~75–100 mg/week equivalent). Dropout rates were low (10–15%), primarily due to adverse events (e.g., erythrocytosis) rather than non-adherence to dosing.


• Outcomes: Testosterone therapy improved sexual function, mood, and physical function compared to placebo, with benefits sustained over 1 year. Adherence was supported by regular monitoring and dose titration.


• Relevance: While the study used gel, the equivalent injectable dose (~100 mg/week) aligns with your specified range. High completion rates suggest good adherence to a similar protocol over 1 year, likely due to clinical oversight and symptom improvement.


2. Basaria et al. (2015) – Long-Term Safety and Efficacy of TRT


• Study Details: A 3-year observational follow-up of men with hypogonadism receiving testosterone undecanoate (1000 mg every 10–12 weeks, equivalent to ~100–120 mg/week of cypionate/enanthate) in a multicenter study (n=149).


• Adherence Findings: Approximately 70% of participants continued therapy for the full 3 years, indicating reasonable long-term adherence. Reasons for discontinuation included adverse events (e.g., polycythemia, prostate issues) or personal choice, but most dropouts occurred in the first year. Adherence was assessed via injection records and clinic visits, with stable serum testosterone levels (400–700 ng/dL) maintained in most participants.


• Outcomes: Sustained improvements in libido, erectile function, mood, and body composition were observed, with no significant increase in cardiovascular or prostate-related adverse events compared to baseline.


• Relevance: The equivalent weekly dose (~100–120 mg) matches your query, and the 70% continuation rate over 3 years suggests good adherence in a real-world setting, particularly for patients who tolerate therapy well after the first year.


3. Hackett et al. (2014) – BLAST Study (Long-Term Outcomes)


• Study Details: The BLAST (Blast Long-Term Androgen Study) was a 30-month open-label study in the UK involving 199 men with hypogonadism receiving testosterone undecanoate (1000 mg every 10–12 weeks, ~100–120 mg/week equivalent).


• Adherence Findings: Approximately 65% of participants completed the 30-month study. Adherence was monitored through injection records and patient self-reports, with dropouts attributed to adverse events (e.g., elevated hematocrit, 10%) or logistical issues (e.g., missed appointments, 15%). Patients with better symptom improvement (e.g., improved erectile function, energy) were more likely to adhere.


• Outcomes: Significant improvements in metabolic parameters (e.g., HbA1c, waist circumference) and quality of life were sustained over 30 months, with stable testosterone levels in the therapeutic range (400–600 ng/dL).


• Relevance: The dose equivalence and long duration provide strong evidence for adherence to a protocol similar to 100–120 mg/week, with adherence linked to symptom relief and regular clinical follow-up.


4. Morgentaler et al. (2016) – Long-Term TRT Registry


• Study Details: A 5-year observational registry of 656 men with hypogonadism receiving testosterone cypionate or enanthate (mean dose 100–150 mg/week, typically 100 mg/week initially) in a clinical setting.


• Adherence Findings: Approximately 60% of men continued TRT for 5 years, with adherence assessed via clinic visits and prescription refills. Discontinuation was higher in the first year (25%) due to side effects (e.g., gynecomastia, mood changes) or lack of perceived benefit but stabilized thereafter. Patients with regular follow-ups and dose adjustments (e.g., 100–120 mg/week to maintain 400–700 ng/dL) showed higher continuation rates.


• Outcomes: Sustained improvements in sexual function, mood, and muscle mass were reported, with no significant increase in prostate cancer or cardiovascular events.


• Relevance: Directly addresses 100–120 mg/week of injectable testosterone, with 60% adherence over 5 years, highlighting the importance of monitoring and patient education for long-term compliance.


5. Clinical Practice Insights (Real-World Data)


• Source Details: Clinics like Regenx Health and Defy Medical report on TRT outcomes in large patient cohorts, often using 100–200 mg/week of testosterone cypionate/enanthate (commonly 100–120 mg/week) for long-term therapy (1–10 years).


• Adherence Findings: These sources note that ~70–80% of patients continue TRT beyond 1 year when managed with regular blood tests and dose adjustments (e.g., splitting 100–120 mg/week into twice-weekly injections). Adherence is higher in patients who experience symptom relief (e.g., improved energy, libido) and lower in those with side effects (e.g., erythrocytosis) or logistical barriers (e.g., cost, access to care).


• Outcomes: Stable testosterone levels (400–700 ng/dL) and sustained symptom improvement are common, with adherence supported by patient education and telemedicine follow-ups.


• Relevance: These real-world data align with your dose range and suggest that adherence over years is feasible for many patients with proper clinical support.



And many of those studies included protocols that could’ve been further improved even while maintaining the same or higher doses. So maybe the people at Defy actually do know what they’re talking about based on the thousands(if not tens of thousands) of patients they’ve treated.


Now I’m sure you’ll return the favor and provide numerous studies which show long term adherence to protocols equivalent to 50-70 mg/week. Don’t worry, take your time… I’ll wait.

Your words: "However, tons of studies show that excessive amounts of vitamin c can have lots of benefits..."

If don't like the interpretation then don't make vague pronouncements. Regardless, you still overstate the benefits.

I used excessive because that is the terminology you started with during this discussion. According to you, anything above symptom resolution doses and/or over what is naturally produced by the body is “excessive”. So yes, those are the words I used to describe it, but I was using your definition to point out the flaw in your reasoning. And no, I’m not overstating the benefits regardless of how many times you decide to repeat that line.

The differences in clearances are already encompassed in the normal reference ranges. You have provided no evidence that exogenous testosterone is different in this respect.

I notice you've gone from men doing "really well" to the treatment being "safe and effective". It's an arguably vague, but important distinction. Depo-Testosterone, the granddaddy of TRT, was shown to be safe and effective. It is 200 mg TC given once every two weeks. I think we might agree that while this protocol usually resolves some of the more overt symptoms of hypogonadism, the fraction of men doing "really well" on it is more limited. This protocol is also used to provide cover for the trend of excessive dosing via injections. Overlooked is the fact that when the protocol originated it was generally expected that injections would be performed at a medical clinic. Therefore the dose frequency had to be minimized, and in turn the dose itself had to be maximized to avoid hypogonadism at the end of each injection cycle.



Repeating this tripe doesn't make it any more accurate or less disingenuous. The natural progression of your straw man argument is that I'm supposedly saying any xenobiotic substance should not be used. Aspirin, for example. Are you unable to address the specific comments I made about hCG in the previous post?

Aspirin is not made naturally in the body. HCG is. Surely you can understand this difference.

You missed it.

Can you repeat your response? I’d like to know why so many people take excessive(based on YOUR definition) amounts of creatine and are over-medicated yet they enjoy tons of benefits while experiencing no adverse side effects.

A list of xenobiotic peptides and typical doses is not meaningful unless you provide equivalencies to native peptides. But that takes work, so you didn't do it. I wrote about this subject in the context of bremelanotide (PT-141). The standard doses were found to be safe and effective according to the FDA, yet they are probably enormous relative to native α-MSH production. Anecdotally, I found that the pharmacological doses yielded poor results, whereas the doses more in line with endogenous production gave good results.



See above. 200 mg TC every two weeks is "safe and effective".

Just more bobbing and weaving from you, as usual.

The other end of the spectrum is that everybody should be at 10-40 mg TC per week. I'm in the middle. While I think 40-80 mg would be fine for 99+% of the population, all I'm requesting is that men start TRT in this range and slowly adjust from there as needed. I believe this is a position of moderation, whereas yours is the more extreme that leads to unnecessary suffering. However, I am not dogmatic about. While there are prominent TRT doctors who are in my camp, there are others who are clearly in yours. I would really like to see someone from Defy Medical come on here to defend starting with such high doses. While you have not said anything remotely persuasive on the subject, perhaps they could do better.

But you are dogmatic about it, because you instantly attacked me and said I was helping cause people to suffer needlessly based on my line of thought and suggestions. And you’re still just pulling numbers out your ass saying 99+% of men would do well on a dose no higher than 80 mg/week. Yet let me make a claim that is much more reasonable and you’ll demand numerous studies to support my statements. Also, the fact that I’ve provided numerous studies and showed multiple examples of the flaw in your logic with regard to sticking to what is made naturally in the while you say I’ve offered nothing that is even remotely persuasive is clear evidence that you are dogmatic, so it’s quite ironic you’d choose that word (almost like you know you are being dogmatic). And to make it even worse you share studies to support your case when they don’t even include data to support at all.

 

[Cataceous]

I love how you make all these demands for burden of proof for my statements while earlier in the thread you were completely pulling numbers out your ass as if they were proven fact.

That's patently false. I called the 60-70% figure a rough guess initially and then provided the statistics to back it up, showing a more accurate number was only 5% outside of my estimated range. And speaking of prevarication, as long as we're letting AI do the heavy lifting for us:

- However, none of the listed studies directly evaluated this specific dosage, so the evidence is based on general clinical guidelines and practice rather than direct study results.​

It's actually worse than that, as none of the references is a study on testosterone cypionate, as opposed to gels (2/5), undecanoate (1/5), not specified or not a study (2/5). Furthermore, those attempts to set an equivalent in testosterone cypionate are inaccurate. There's a disparity on the Morgentaler registry "While Morgentaler’s work supports TRT in general, including doses within the 50-200 mg per week range, there is no specific study or registry data directly addressing 100-120 mg of testosterone cypionate." Ok, your AI is hallucinating. It can't be a coincidence that this study has 656 men with 360 on testosterone undecanoate, 1000 mg/12 weeks.

Apparently your AI can't do math or it misunderstood the TC equivalence. "(1000 mg [TU] every 10–12 weeks, ~100–120 mg/week equivalent)". TU is 63.2% testosterone. Therefore, the TC equivalent is 75-90 mg/week.

Goes to show the risks of overly trusting AI.

... Not saying that’s the case, just pointing out that the study you linked doesn’t show what you think it does. Likewise for the xyosted studies, it doesn’t specify which percentage went up to 100 mg and which went down to 50. Also, the entire criteria for adjustments during those assessments was total testosterone levels so that isn’t a great way to treat patients anyway.

Since we're already letting AI do a lot of the research why didn't you ask it?

In a key clinical trial involving 150 men, doses were adjusted after 6 weeks to achieve target testosterone levels, and by Week 12, the distribution was approximately:​

• 50 mg: 18.2% of men
• 75 mg: 67.9% of men
• 100 mg: 13.9% of men

These numbers reflect the initial stabilization after dose adjustments, based on a study of 137 men who completed the 12-week treatment phase with pharmacokinetic data. ​

Unsurprisingly, most men achieve physiological levels on 75 mg TE/week. I'd prefer to see it based on free testosterone, but it's still way more intelligent than starting everybody at 100+ mg.

...
Now I’m sure you’ll return the favor and provide numerous studies which show long term adherence to protocols equivalent to 50-70 mg/week. Don’t worry, take your time… I’ll wait.

And therein lies the problem. Injecting to attain more physiological levels is relatively recent. Fortunately the Xyosted trials are helping to break the dated thinking, as are the forum pioneers who buck the high-dose pressure and feel better in doing so.

Aspirin is not made naturally in the body. HCG is. Surely you can understand this difference.

Aspirin is made naturally in the body. Ok, so it's not synthesized by human cells, but by gut bacteria, which also happen to manufacture compounds important to our health. Now what's your point? A slightly different perspective is that in order to treat medical conditions we take pharmacological doses of drugs/hormones that may or may not occur naturally. HCG is taken to combat the LH deficiency caused by TRT. Even so, you don't usually start out with thousands of IU per week, likely inducing new side effects. As with testosterone, you're looking to replace the missing LH, which is best done with a low-and-slow approach. Or is it your view that men should start with a dose equivalent to more LH than could ever be made naturally?

...
But you are dogmatic about it, because you instantly attacked me and said I was helping cause people to suffer needlessly based on my line of thought and suggestions. ...

The part about men suffering from high starting doses is unequivocal. The evidence is paraded through the forums on a regular basis, and even in this thread that we have so completely hijacked. There's my collection of anecdotes as well, where men do better after dropping to more physiological doses.

Let's look at the logic: High starting doses—100+ mg TC/week—cause some men to suffer. You are encouraging the use of such doses, therefore some of the men you influence may suffer as a result. QED.

So what is the defense for you and Defy Medical and anyone else encouraging high initial dosing? Is it a lesser evil defense? Will more men suffer by starting everyone at a mid-range dose than by starting everyone at a high dose? That seems laughable in the general context of medicine, but have at it. Or is there some better argument out there?

And you’re still just pulling numbers out your ass saying 99+% of men would do well on a dose no higher than 80 mg/week. ...

You'll note that this particular comment was preceded by "I think", which is normally interpreted as signaling that an opinion is about to be rendered, not a claim of fact. I believe it's likely to be true, but it is a hypothesis.

Yet let me make a claim that is much more reasonable and you’ll demand numerous studies to support my statements. Also, the fact that I’ve provided numerous studies and showed multiple examples of the flaw in your logic with regard to sticking to what is made naturally in the while you say I’ve offered nothing that is even remotely persuasive is clear evidence that you are dogmatic, so it’s quite ironic you’d choose that word (almost like you know you are being dogmatic). And to make it even worse you share studies to support your case when they don’t even include data to support at all.

You made a claim about men doing "really well" on 100-120 mg TC/week and then backed it up with nothing of relevance—studies on gels and lower doses of testosterone undecanoate. My reference clearly demonstrates a high rate of discontinuance for injections of TE/TC. The only necessary inference is that doses were what I consider to be on the high side, ~100 mg/week, which historically have been the most common due to the precedent set by the afore-mentioned Depo-Testosterone.

 

[Phil Goodman]

That's patently false. I called the 60-70% figure a rough guess initially and then provided the statistics to back it up, showing a more accurate number was only 5% outside of my estimated range.

That’s a fair callout. You did admit that it was just a guess so I shouldn’t have said you state it as fact. I should give credit for you admitting you’re providing rough guesses.

And speaking of prevarication, as long as we're letting AI do the heavy lifting for us:

- However, none of the listed studies directly evaluated this specific dosage, so the evidence is based on general clinical guidelines and practice rather than direct study results.​

It's actually worse than that, as none of the references is a study on testosterone cypionate, as opposed to gels (2/5), undecanoate (1/5), not specified or not a study (2/5). Furthermore, those attempts to set an equivalent in testosterone cypionate are inaccurate. There's a disparity on the Morgentaler registry "While Morgentaler’s work supports TRT in general, including doses within the 50-200 mg per week range, there is no specific study or registry data directly addressing 100-120 mg of testosterone cypionate." Ok, your AI is hallucinating. It can't be a coincidence that this study has 656 men with 360 on testosterone undecanoate, 1000 mg/12 weeks.

Apparently your AI can't do math or it misunderstood the TC equivalence. "(1000 mg [TU] every 10–12 weeks, ~100–120 mg/week equivalent)". TU is 63.2% testosterone. Therefore, the TC equivalent is 75-90 mg/week.

Goes to show the risks of overly trusting AI.

Again, a good callout and it shows the importance of reviewing output from various platforms. Kind of lazy on my part and I didn’t feel like reviewing or diving into the results on a nice Saturday in the south when I could be spending time at the gym and in the pool.

Since we're already letting AI do a lot of the research why didn't you ask it?

In a key clinical trial involving 150 men, doses were adjusted after 6 weeks to achieve target testosterone levels, and by Week 12, the distribution was approximately:​

• 50 mg: 18.2% of men
• 75 mg: 67.9% of men
• 100 mg: 13.9% of men

These numbers reflect the initial stabilization after dose adjustments, based on a study of 137 men who completed the 12-week treatment phase with pharmacokinetic data. ​

Unsurprisingly, most men achieve physiological levels on 75 mg TE/week. I'd prefer to see it based on free testosterone, but it's still way more intelligent than starting everybody at 100+ mg.

Do you have a link to those studies which provide the dosage adjustments? Also, as I already mentioned, treating numbers instead of symptoms isn’t optimal. I’d also argue that it isn’t “way more intelligent that starting everyone at 100+ mg/week”. But if you can provide studies that show a majority of men experience adverse side effects at 100-120 mg/week I’d be interested to see them.

And therein lies the problem. Injecting to attain more physiological levels is relatively recent. Fortunately the Xyosted trials are helping to break the dated thinking, as are the forum pioneers who buck the high-dose pressure and feel better in doing so.

Thats pretty convenient for your argument… “I don’t have to provide studies to support my claims because it’s a new approach”. Doesn’t automatically mean you’re wrong, but it does mean you don’t have as much data to support your claims.

Aspirin is made naturally in the body. Ok, so it's not synthesized by human cells, but by gut bacteria, which also happen to manufacture compounds important to our health. Now what's your point? A slightly different perspective is that in order to treat medical conditions we take pharmacological doses of drugs/hormones that may or may not occur naturally. HCG is taken to combat the LH deficiency caused by TRT. Even so, you don't usually start out with thousands of IU per week, likely inducing new side effects. As with testosterone, you're looking to replace the missing LH, which is best done with a low-and-slow approach. Or is it your view that men should start with a dose equivalent to more LH than could ever be made naturally?

Can you share some sources to support your claim that aspirin is made naturally in the body?

The part about men suffering from high starting doses is unequivocal. The evidence is paraded through the forums on a regular basis, and even in this thread that we have so completely hijacked. There's my collection of anecdotes as well, where men do better after dropping to more physiological doses.

Let's look at the logic: High starting doses—100+ mg TC/week—cause some men to suffer. You are encouraging the use of such doses, therefore some of the men you influence may suffer as a result. QED.

Ok, and the flip side of that coin would be that men would suffer at low doses that you suggest. The dose of 100-120 has been settled on and well tolerated by the majority of men in lots of studies with minimal adverse effects, even over prolonged periods of time.

So what is the defense for you and Defy Medical and anyone else encouraging high initial dosing? Is it a lesser evil defense? Will more men suffer by starting everyone at a mid-range dose than by starting everyone at a high dose? That seems laughable in the general context of medicine, but have at it. Or is there some better argument out there?

It’s laughable to you, but to most people it’s perfectly reasonable. To be fair, that doesn’t automatically make it the correct assumption, but even you admit that in your opinion most men would need more than 50 mg/week to get a positive outcome. If that won’t work for most, then most men should start higher. How much higher?? That’s where the split in opinion comes in. You say it should be as low as possible, whereas I say you should do a risk/reward ratio analysis and dose accordingly. But as I’ve stated repeatedly, I think the “more is better” is a bad approach to take… so even though I say starting with 100-120 is perfectly reasonable based on the data we have available, I do think that if issues are encountered then dropping the dose should be considered as heavily or even heavier depending on other information.

You'll note that this particular comment was preceded by "I think", which is normally interpreted as signaling that an opinion is about to be rendered, not a claim of fact. I believe it's likely to be true, but it is a hypothesis.

Again, good callout. At least you admit when you’re guessing so I shouldn’t say you’re stating it as fact.

You made a claim about men doing "really well" on 100-120 mg TC/week and then backed it up with nothing of relevance—studies on gels and lower doses of testosterone undecanoate. My reference clearly demonstrates a high rate of discontinuance for injections of TE/TC. The only necessary inference is that doses were what I consider to be on the high side, ~100 mg/week, which historically have been the most common due to the precedent set by the afore-mentioned Depo-Testosterone.

Again, your reference says nothing about which doses lead to discontinuation and which resulted in success, so they are meaningless in this context.







Perhaps at least you can realize now that humans can supplement with exogenous compounds at doses higher than exogenous production would ever result in, and see many benefits with minimal risks. Not to say that is the case with testosterone, but the flaw in your logic of applying that view to all compounds should be apparent, unless you can tell me how it’s possible with creatine and many other substances.

 

[Cataceous]

...
Do you have a link to those studies which provide the dosage adjustments? ...

https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/209863Orig1s000SumR.pdf

Also, as I already mentioned, treating numbers instead of symptoms isn’t optimal.

Nonetheless, it makes sense to titrate to the center of the healthy normal distribution for initial dosing.

... But if you can provide studies that show a majority of men experience adverse side effects at 100-120 mg/week I’d be interested to see them.

That's not a claim I have made, though it would undoubtedly be true if out-of-range free testosterone were considered an adverse effect. I would claim that the incidence of side effects is considerably higher in this range than at 60-80 mg TC/week.

Thats pretty convenient for your argument… “I don’t have to provide studies to support my claims because it’s a new approach”.

You were asking about the long-term adherence to a relatively new dosing pattern. Though preliminary, the success of Xyosted is a reasonable indicator.

...
Can you share some sources to support your claim that aspirin is made naturally in the body?

Admittedly this is a little overstated. First, it's salicylic acid, and we're not talking about significant or even necessarily measurable amounts. "... indirect evidence from studies like Zhang et al. (2017) suggests that gut microbiota could produce salicylic acid or related phenolic acids through the metabolism of dietary polyphenols or aromatic precursors. "

Zhang, Z., Peng, X., Li, S., Zhang, N., Wang, Y., & Wei, H. (2017). "Bacterial Metabolism of Dietary Polyphenols and Their Metabolites by Gut Microbiota." Frontiers in Microbiology, 8, 729. DOI: 10.3389/fmicb.2017.00729

And a particular bacterial species, Pseudomonas aeruginosa, is observed to create salicylic acid de novo. "Given the gut’s vast bacterial population (trillions of microbes), if even a rare species like P. aeruginosa is present and active, it could produce trace amounts of salicylic acid. In individuals where this bacterium resides this production likely occurs."

Ok, and the flip side of that coin would be that men would suffer at low doses that you suggest. The dose of 100-120 has been settled on and well tolerated by the majority of men in lots of studies with minimal adverse effects, even over prolonged periods of time.

The dose I suggest starting at, 50 mg TC/week, is only 10-23% below average production for healthy young men. A starting dose of 100 mg TC/week is 54-82% above. Except for the name of the hormone there would be no debate about which is more likely to cause problems.

You have yet to cite a single study in which doses above 100 mg TC/week are examined in the context of TRT, let alone are "tolerated by the majority of men". In any case, "toleration" is a pretty low bar. It's not like there's acute toxicity. I was able to tolerate higher doses, but they did degrade quality of life, and more so as time went on.

... To be fair, that doesn’t automatically make it the correct assumption, but even you admit that in your opinion most men would need more than 50 mg/week to get a positive outcome.

That is based on the assumption that men need doses that give serum levels close to their healthy young values. But you obviously don't subscribe to that anyway since you're pushing for much higher, non-physiological levels. In reality I'm suspecting that lower levels are more easily tolerated. This is based on the threshold effect seen with sexual function, and my own experience.

If that won’t work for most, then most men should start higher. How much higher?? That’s where the split in opinion comes in. You say it should be as low as possible, whereas I say you should do a risk/reward ratio analysis and dose accordingly. But as I’ve stated repeatedly, I think the “more is better” is a bad approach to take… so even though I say starting with 100-120 is perfectly reasonable based on the data we have available, ...

This is not a mainstream opinion.

Research suggests that the general principle for HRT across various hormones is to start with the lowest effective dose to achieve symptom relief and physiological levels while minimizing risks. This approach, often described as “low-and-slow,” is supported by guidelines from major medical organizations like the North American Menopause Society (NAMS), the NHS, and the American Thyroid Association. The focus is on clinical response, with serum levels used as a guide where applicable, such as TSH for thyroid hormones or estradiol for sex hormones. However, for hormones like cortisol, where levels fluctuate naturally, the emphasis is more on clinical symptoms due to the circadian rhythm.​

So a fair question is, why do so many respected doctors ignore this? I suggest part of it is about pleasing the customers. In the case of testosterone, more-is-better thinking is so widespread that a lot of the Internet is thoroughly contaminated. Hypogonadal men doing initial research stand a good chance of being influenced. Then they go to clinics with expectations about dosing, and clinics are forced to oblige. The historical context is a contributing factor. As I mentioned above, relatively infrequent injections of testosterone cypionate require high doses to maintain a physiological trough. But these days we know you can easily inject twice a week at a much lower dose rate, e.g. 40-80 mg per week. The half-life of Xyosted is double that of standard TC, so it can still be dosed weekly at the lower rates.

...
Again, your reference says nothing about which doses lead to discontinuation and which resulted in success, so they are meaningless in this context. ...

We'll just have to disagree. This was back in 2014, when 100 mg/week or 200 mg/2 weeks was closer to the standard.

Perhaps at least you can realize now that humans can supplement with exogenous compounds at doses higher than exogenous production would ever result in, and see many benefits with minimal risks. Not to say that is the case with testosterone, but the flaw in your logic of applying that view to all compounds should be apparent, unless you can tell me how it’s possible with creatine and many other substances.

This is still a straw man argument, as I'm primarily speaking of starting doses. That said, I remain skeptical of supraphysiological doses in general. It seems like, as in your case, many don't even bother to see what lower levels are like. To informed men who know the potential risks I say have at it. To clinics doing this to newbies I say WTH!

 

[Phil Goodman]

https://www.accessdata.fda.gov/drugsatfda_docs/nda/2019/209863Orig1s000SumR.pdf

Nonetheless, it makes sense to titrate to the center of the healthy normal distribution for initial dosing.



That's not a claim I have made, though it would undoubtedly be true if out-of-range free testosterone were considered an adverse effect. I would claim that the incidence of side effects is considerably higher in this range than at 60-80 mg TC/week.

You said people suggesting that 100 mg/week isn’t a high dose are causing lots of people to suffer.

“Considerably higher” is a very vague term. Do you have any data to support your claim that people taking 100 mg/week experience adverse effects at considerably higher rates than those taking 80/week?

You were asking about the long-term adherence to a relatively new dosing pattern. Though preliminary, the success of Xyosted is a reasonable indicator.

Again, that’s very convenient of you to not have to provide any evidence for your claims because long term data isn’t out. There are many studies which show success at the 100-120 mg/week doses for similar timeframes as the xyosted studies you use to support your statement. But when those are shared you say it doesn’t mean anything about long term success metrics…. while at the same time saying the studies you share offer every valid support for your claims. We also know that most of the people who discontinue a protocol will stop it within the first year, so the closer a study gets to hitting the 12 month+ window the more likely it is to be applicable to long term adherence. But again, there are plenty of studies which show high adherence to protocols of 100 mg/week or higher, and they are of varying timeframes.

Admittedly this is a little overstated. First, it's salicylic acid, and we're not talking about significant or even necessarily measurable amounts. "... indirect evidence from studies like Zhang et al. (2017) suggests that gut microbiota could produce salicylic acid or related phenolic acids through the metabolism of dietary polyphenols or aromatic precursors. "

Zhang, Z., Peng, X., Li, S., Zhang, N., Wang, Y., & Wei, H. (2017). "Bacterial Metabolism of Dietary Polyphenols and Their Metabolites by Gut Microbiota." Frontiers in Microbiology, 8, 729. DOI: 10.3389/fmicb.2017.00729

And a particular bacterial species, Pseudomonas aeruginosa, is observed to create salicylic acid de novo. "Given the gut’s vast bacterial population (trillions of microbes), if even a rare species like P. aeruginosa is present and active, it could produce trace amounts of salicylic acid. In individuals where this bacterium resides this production likely occurs."

That’s a lot of words to say “no, the body does not create aspirin”. It isn’t aspirin, and it isn’t created by the human body. It isn’t “a little overstated”. It’s outright false.

The dose I suggest starting at, 50 mg TC/week, is only 10-23% below average production for healthy young men. A starting dose of 100 mg TC/week is 54-82% above. Except for the name of the hormone there would be no debate about which is more likely to cause problems.

Yes, we already know you suggest men start at a dose that even you admit probably won’t work for them.

Again, I’ve already pointed out plenty of examples where humans take compounds at levels exceeding what the body naturally produces and seeing many benefits with little to no negative effects. And certainly at a rate where the risk/reward ratio greatly supports taking them at levels higher than seen occurring naturally in the body. No need to keep going round and round in circles, but if you’d like to keep bringing up this flawed view then let’s start with creatine before moving on to all the others I’ve already mentioned

You have yet to cite a single study in which doses above 100 mg TC/week are examined in the context of TRT, let alone are "tolerated by the majority of men". In any case, "toleration" is a pretty low bar. It's not like there's acute toxicity. I was able to tolerate higher doses, but they did degrade quality of life, and more so as time went on.

AI warning… but did some verification and all statements seem legit. So once again, yes, there are plenty of studies(many more than just the ones I’m providing below) which show that doses around 100 mg/week provide many benefits for men with little to no negative effects


Bhasin et al. (2010) - Testosterone Therapy in Men with Androgen Deficiency Syndromes


• Source: J Clin Endocrinol Metab, 95(6):2536-2559


• Re-analysis:


• Dosing: Confirmed TE 100 mg/week IM in 209 hypogonadal men (aged 18–65 years) over 6 months.


• Benefits: Verified significant improvements in sexual function (International Index of Erectile Function [IIEF] scores increased by ~15%), lean body mass (+2.7 kg via DEXA), and strength (leg press strength +10–15%). Mood improvements were statistically significant (P<0.05) vs. placebo.


• Adherence: Confirmed ~87% completion rate; 5% discontinued due to mild adverse effects (acne, injection site discomfort). No major safety concerns (e.g., erythrocytosis rates <5%).


• Key Findings: TE 100 mg/week maintained serum testosterone in the 400–700 ng/dL range, with consistent benefits and high adherence. The study emphasized dose-dependent efficacy.


• Accuracy: Statements are accurate. The study used 100 mg/week TE IM, with clear evidence of benefits and high adherence.


2. Wang et al. (2000) - Effects of Testosterone Enanthate in Hypogonadal Men


• Source: J Clin Endocrinol Metab, 85(8):2839-2853


• Re-analysis:


• Dosing: Confirmed TE 100 mg/week or 200 mg every 2 weeks (~100 mg/week equivalent) IM in 227 hypogonadal men (aged 19–68 years) over 6 months.


• Benefits: Verified improvements in sexual function (libido scores +30–40%), lean body mass (+3.1 kg at 100 mg/week), and lumbar spine bone mineral density (+1.5–2%). The 100 mg/week group had more stable testosterone levels (400–700 ng/dL) than the 200 mg/2 weeks group.


• Adherence: Confirmed 89% completion rate; ~3% discontinued due to mild erythrocytosis or injection site issues.


• Key Findings: Weekly 100 mg TE injections were effective, with stable pharmacokinetics and minimal side effects, supporting high adherence.


• Accuracy: Statements are accurate. Both dosing regimens were correctly described, and benefits/adherence align with study results.


3. Schubert et al. (2004) - Long-Term Testosterone Undecanoate in Hypogonadal Men


• Source: J Urol, 172(6 Pt 1):2333-2337


• Re-analysis:


• Dosing: Confirmed TU 1000 mg every 10–12 weeks (~83–100 mg/week equivalent) IM in 130 hypogonadal men over 12 months. Pharmacokinetic data support the ~100 mg/week equivalent based on TU’s long half-life.


• Benefits: Verified improvements in sexual function (IIEF scores improved), quality of life (SF-36 questionnaire), and body composition (lean mass +2 kg, fat mass -1.5 kg). PSA levels remained stable (<4 ng/mL).


• Adherence: Confirmed 92% adherence; ~4% discontinued due to injection site pain or mild side effects (e.g., acne). The long-acting nature of TU reduced dosing frequency, enhancing compliance.


• Key Findings: TU at ~100 mg/week was effective and well-tolerated, with high adherence due to infrequent injections.


• Accuracy: Statements are accurate. The dose equivalence (~83–100 mg/week) was correctly estimated, and benefits/adherence align with the study.


4. Jockenhövel et al. (1997) - Comparison of Testosterone Esters in Hypogonadal Men


• Source: Clin Endocrinol (Oxf), 47(4):461-468


• Re-analysis:


• Dosing: Confirmed TE or TC 250 mg every 2 weeks (~125 mg/week) IM in 66 hypogonadal men over 9 months.


• Benefits: Verified improvements in sexual function (libido scores +40% via patient-reported outcomes), mood (depression scores reduced), and hematocrit (+3–5%). Lean body mass increased by ~2.5 kg (DEXA).


• Adherence: Confirmed 85% completion rate; ~6% discontinued due to injection site pain or mild erythrocytosis.


• Key Findings: TC/TE at ~125 mg/week was effective and well-tolerated, with high adherence despite biweekly dosing.


• Accuracy: Statements are accurate. Dosing, benefits, and adherence rates align with the study’s findings.


5. Dobs et al. (1999) - Pharmacokinetics and Clinical Response to Testosterone Cypionate


• Source: J Clin Endocrinol Metab, 84(10):3469-3478


• Re-analysis:


• Dosing: Confirmed TC 100 mg/week or 200 mg every 2 weeks (~100 mg/week equivalent) IM in 73 hypogonadal men over 12 months.


• Benefits: Verified normalization of testosterone levels (400–700 ng/dL), with improvements in sexual function (IIEF scores +20–30%), energy (patient-reported), and muscle strength (handgrip strength +10%). Bone density increased by 1.5–2% (lumbar spine).


• Adherence: Confirmed 88% completion rate; ~5% discontinued due to mild erythrocytosis or injection site reactions.


• Key Findings: TC at 100 mg/week was effective, safe, and well-adhered to, with stable serum levels and consistent benefits.

That is based on the assumption that men need doses that give serum levels close to their healthy young values. But you obviously don't subscribe to that anyway since you're pushing for much higher, non-physiological levels. In reality I'm suspecting that lower levels are more easily tolerated. This is based on the threshold effect seen with sexual function, and my own experience.

They may be more easily tolerated, I’d say that is probably a reasonable statement to make. However, I’d also say that they may trade off some of the benefits. Just like with everything else in life, there is a risk/reward ratio to consider and find an approach that provides the most benefits while also introducing and acceptable amount of risk. You seem to take an extremely conservative approach and that’s ok, you’re the one making the decision for your own health. From my own personal experience I have greatly benefited from a dose of 100-120/week and the reward was WELL worth any of the bumps along the way. Lots of studies(and real-world evidence of the number of men who stay on these protocols over extended periods of time) suggest that I am far from alone.

This is not a mainstream opinion.

Research suggests that the general principle for HRT across various hormones is to start with the lowest effective dose to achieve symptom relief and physiological levels while minimizing risks. This approach, often described as “low-and-slow,” is supported by guidelines from major medical organizations like the North American Menopause Society (NAMS), the NHS, and the American Thyroid Association. The focus is on clinical response, with serum levels used as a guide where applicable, such as TSH for thyroid hormones or estradiol for sex hormones. However, for hormones like cortisol, where levels fluctuate naturally, the emphasis is more on clinical symptoms due to the circadian rhythm.​

So a fair question is, why do so many respected doctors ignore this? I suggest part of it is about pleasing the customers. In the case of testosterone, more-is-better thinking is so widespread that a lot of the Internet is thoroughly contaminated. Hypogonadal men doing initial research stand a good chance of being influenced. Then they go to clinics with expectations about dosing, and clinics are forced to oblige. The historical context is a contributing factor. As I mentioned above, relatively infrequent injections of testosterone cypionate require high doses to maintain a physiological trough. But these days we know you can easily inject twice a week at a much lower dose rate, e.g. 40-80 mg per week. The half-life of Xyosted is double that of standard TC, so it can still be dosed weekly at the lower rates.

You keep saying this, but again, tons of those patients stay on those protocols. And if anything… we’re learning that the risks of trt were OVER stated in the past, not under. Millions of men aren’t gonna keep spending all of that money to feel like crap and be less healthy. And if doctors are losing patients then they’ll adjust their treatment plan’s accordingly. That being said, I do think there are plenty who start out their patients too high, but by that I mean at the 150-200/week range. The vast majority of people wouldn’t see a doctor start a patient off at 100 mg/week and call the doctor irresponsible and say he’s “needlessly making people suffer”.

We'll just have to disagree. This was back in 2014, when 100 mg/week or 200 mg/2 weeks was closer to the standard.



This is still a straw man argument, as I'm primarily speaking of starting doses. That said, I remain skeptical of supraphysiological doses in general. It seems like, as in your case, many don't even bother to see what lower levels are like. To informed men who know the potential risks I say have at it. To clinics doing this to newbies I say WTH!

Ok, but I also feel great and am in great health. I don’t chase some Superman feeling all the time, and that applies to going higher or lower. I’ve learned that if something isn’t broke don’t fix it. I’d say the vast majority of users on this forum would agree with that statement, so I’m not sure why you’re so adamant about me changing my protocol, or why you have a problem with the fact that I’ve never gone below 100 mg/week. And if you’re being honest with yourself I think you’d realize that at least part of it is because it goes against your statements. On the other hand, I have no problem with you taking 1.5 mg/day. If that works for you then by all means continue doing what you’re doing. After all, that’s the whole goal of this stuff. And honestly, I think you and I agree on more things than anyone would think by reading our exchange in this thread(maybe even more than you realize). I agree that the more is better approach is harmful, we just disagree on where to draw the line of what constitutes “excessive”. And honestly you could be correct that 80 mg/week is a great dose for most men. If more studies emerge to support that then I’ll be the first to accept the findings. And I’d also be glad if it prevents more people from staring off closer to 200/week. I don’t think it would change my protocol because again I tend to take the “don’t fix what ain’t broke” approach, but with that being said if I do run into issues in the future my first plan would be to lower the dose instead of raise it. So we also agree on that front. I’d also say that I’m glad there are people countering the “more is better approach”. A piece of advice I would give though as you try to spread your views, it tends to rub people the wrong way when you say they’re causing people to needlessly suffer.

 

[Vince]

Post in thread 'TRT in men in their Nineties'

Mar 14, 2025

I truly appreciate all the comments, I could have been more forthcoming with details. I had been injecting 3 times per week for a total of 200 mg. As mad man suggested older people may get “more bang for the buck”.

• Bremster

• 

 

[joetown2001]

On Thursday around dinner, I decided to take a .125 anastrozole to see if it would relieve any of my fatigue, anxiety, and libido issues. I injected Friday like I normally do, and had a pretty good day. Both Thursday and Friday evening I did have some OK nocturnal erections and morning wood. They weren’t robust but better than anything I’ve had in the prior week and a half or so. Saturday was good, had pretty good libido and erections. I did by the evening feel extremely tired again. Sunday has been the opposite, very little libido and have been fatigued most of the day even with a pretty decent night sleep last night. Got through my weight workout fine, even though I felt tired through half of it.

Really can’t say if estrogen would need to be pushed lower, or really that is not the issue. Just trying a couple things out until my follow up on July 30. I am a little frustrated about that, as when I want to schedule it if I told me that my PA is booked until the end of August. The response was, yeah he is really popular, we usually schedule his follow ups right away. When I asked why nobody told me that, they didn’t have an answer. So the cost more, but I now have my follow up with Dr. Calkins. Hopefully he can look at my labs and with my detailed journal I’ve kept on this journey, he can hopefully find a solution to help me.

I travel to Colorado this week to visit family, so I’m just going to continue my same regiment and wait until my follow up.

 

[Cataceous]

You said people suggesting that 100 mg/week isn’t a high dose are causing lots of people to suffer.

They are, but that should read "high starting dose". You added a "majority of men" qualifier. I'm not claiming to have quantified the rate at which men have problems at this dose. My point is that a midrange dose, say 50-80 mg TC/week, is less likely to cause side effects.

“Considerably higher” is a very vague term. Do you have any data to support your claim that people taking 100 mg/week experience adverse effects at considerably higher rates than those taking 80/week?

While the general principle is accepted in medicine, there do not appear to be studies making this specific comparison.

Conclusion and Support for the User’s Position​

​

While there are no direct studies comparing 60-80 mg vs. 100 mg per week of testosterone cypionate in divided doses, the literature supports the user’s position through:​

• The alignment of 60-80 mg per week with natural testosterone production, suggesting lower risk of side effects.
• General TRT guidelines recommending lower starting doses (50-75 mg per week) to minimize risks like elevated hematocrit and estradiol.
• Evidence that divided doses reduce peaks and troughs, potentially lowering side effects, but higher total doses (100 mg vs. 60-80 mg) may still increase average levels and associated risks.

Thus, there is substantial support for the idea that starting with 60-80 mg per week may lead to fewer side effects than 100 mg per week, especially when considering divided dosing to maintain stability.​

That’s a lot of words to say “no, the body does not create aspirin”. It isn’t aspirin, and it isn’t created by the human body. It isn’t “a little overstated”. It’s outright false.

Your wording was that it wasn't made "in the body", not "by the human body". I took advantage of that technicality. Salicylic acid can be made naturally in the human body under the right circumstances. But yes, it is a word game that's a tangential distraction from my attempts to have you discuss the specifics of hCG use in the context of physiological dosing.

Yes, we already know you suggest men start at a dose that even you admit probably won’t work for them.

"Won't work" is too strong of a statement. Research shows that if this dose puts TT levels above ~400 ng/dL then sexual side effects of hypogonadism should largely resolve. Additionally, I would hypothesize that a testosterone cypionate/testosterone propionate blend administered daily to provide that 5 mg of testosterone would resolve symptoms of hypogonadism in a majority of men. That said, I suspect that 50 mg of TC in divided doses would not be optimal for a significant fraction. Even so, after starting at this dose you probably haven't trashed your lipids or jacked up HCT and estradiol. If the dose seems insufficient then all you need to do is raise it by 10 mg TC/week, enjoy the transient boost, and then wait a couple months to reevaluate.

Again, I’ve already pointed out plenty of examples where humans take compounds at levels exceeding what the body naturally produces and seeing many benefits with little to no negative effects.

Actually, you didn't. Not saying there aren't cases, but you just gave a list of peptides and common doses.

And certainly at a rate where the risk/reward ratio greatly supports taking them at levels higher than seen occurring naturally in the body. No need to keep going round and round in circles, but if you’d like to keep bringing up this flawed view then let’s start with creatine before moving on to all the others I’ve already mentioned

Creatine is analogous to testosterone. Supraphysiological amounts provide very specific benefits while creating dose-dependent risks.

AI warning… but did some verification and all statements seem legit. So once again, yes, there are plenty of studies(many more than just the ones I’m providing below) which show that doses around 100 mg/week provide many benefits for men with little to no negative effects

Your 100-120 mg TC per week claim has morphed into the generic 100 mg/week that passes muster as safe and effective, and exists due to the historical low injection frequency. In essence the studies are saying that 100 mg TC/week is better than being hypogonadal. No argument there. Even the current dosing instructions for Depo-Testosterone call for 50-400 mg TC to be injected once every two to four weeks. If you're going to insist on this dosing schedule then I'll concede that the higher starting doses might be justified. But with two or more weekly doses, definitely not.

... You seem to take an extremely conservative approach and that’s ok, you’re the one making the decision for your own health. From my own personal experience I have greatly benefited from a dose of 100-120/week and the reward was WELL worth any of the bumps along the way. Lots of studies(and real-world evidence of the number of men who stay on these protocols over extended periods of time) suggest that I am far from alone.

You have yet to find studies showing benefits to overall health in taking >100 mg TC versus less than that. And critically, you still have provided no justification for starting with such doses, rather than beginning low and titrating according to levels and symptoms. Your personal anecdotal evidence has limited value because there's been no experimentation with physiological doses.

You keep saying this, but again, tons of those patients stay on those protocols. And if anything… we’re learning that the risks of trt were OVER stated in the past, not under. Millions of men aren’t gonna keep spending all of that money to feel like crap and be less healthy. And if doctors are losing patients then they’ll adjust their treatment plan’s accordingly. That being said, I do think there are plenty who start out their patients too high, but by that I mean at the 150-200/week range. The vast majority of people wouldn’t see a doctor start a patient off at 100 mg/week and call the doctor irresponsible and say he’s “needlessly making people suffer”.

Certain risks of TRT were overstated, as in the link to prostate cancer. It's still possible that other risks are underappreciated. Regarding what the vast majority of people might think: if they were told that a doctor was going to start patients on a dose of a hormone that is on the order of double their healthy natural production, in contravention of standard medical practice, then they would call it malpractice. Any irrational carve-out for testosterone exists only due to historical precedent and more-is-better thinking. Some men do suffer when they are needlessly started at high-end doses.

Ok, but I also feel great and am in great health. I don’t chase some Superman feeling all the time, and that applies to going higher or lower. I’ve learned that if something isn’t broke don’t fix it. I’d say the vast majority of users on this forum would agree with that statement, so I’m not sure why you’re so adamant about me changing my protocol, or why you have a problem with the fact that I’ve never gone below 100 mg/week.

I'm not asking you to change your protocol. I'm simply observing that you have no personal basis for saying that dosing at 60-80 mg TC/week would not be equally good or better. Instead, in my opinion, you are potentially doing damage by encouraging others to skip the low-and-slow approach.

And if you’re being honest with yourself I think you’d realize that at least part of it is because it goes against your statements. On the other hand, I have no problem with you taking 1.5 mg/day. ...

In fact this low dose is part of ongoing experimentation, and there is definitely concurrent endogenous production. Such low doses should only be used when the exogenous testosterone is fast-acting. Otherwise they would be counterproductive.

... And honestly, I think you and I agree on more things than anyone would think by reading our exchange in this thread(maybe even more than you realize). I agree that the more is better approach is harmful, we just disagree on where to draw the line of what constitutes “excessive”. And honestly you could be correct that 80 mg/week is a great dose for most men. If more studies emerge to support that then I’ll be the first to accept the findings. And I’d also be glad if it prevents more people from staring off closer to 200/week. I don’t think it would change my protocol because again I tend to take the “don’t fix what ain’t broke” approach, but with that being said if I do run into issues in the future my first plan would be to lower the dose instead of raise it. So we also agree on that front. I’d also say that I’m glad there are people countering the “more is better approach”. A piece of advice I would give though as you try to spread your views, it tends to rub people the wrong way when you say they’re causing people to needlessly suffer.

I agree we have some commonality in our views. All I'm asking for is a softening of your views on a starting dose. Let's tell guys to start at midrange, do more homework in the transition months, and then increase slowly if you think there's room for improvement.

I'm sorry if my statements about men suffering seem harsh and off-putting. I don't make them frivolously:

Then, a day or so after my next injection when levels hit > 1000 ng/dl, erections and libido would disappear again, water retention would go up and brain fog would return. As I moved to a higher injection frequency and higher levels were kept more constant, my sexual function was lost outright.​

...​

Years of time and energy wasted due to that mindset.​

----

So nearly 7 weeks ago I dropped my dose down to 52 mg per week. I now feel completely normal in every single aspect including libido. I feel like I have wasted over 12 years listening to what I should do, instead of doing what’s right for me. I feel absolutely normal now and I feel exactly the way I did before ever needing TRT.​

...​

The moral of the story is, I think a lot of men would be better served by substantially lowering their dose. I would not put this post on here if I if I didn’t feel passionate about it and thought it was a fleeting moment. Again I can tell you for absolute certain, that I feel fantastic finally, in every single aspect.​

----

I experienced this "dead wood" penis insensitivity on and off for a long time while on dosages around 100 mgs per week of T. When I lowered the dose down to 60-70 mgs, sexual sensitivity improved considerably. Erectile function is also more responsive and reliable.​

...​

Too much testosterone is not a good thing, especially for your penis.​

----

” Would have saved me those 8 years of countless blood donations, countless nights of frustration for the wife, countless bouts of insomnia, and countless episodes of “dude, why is your face so red”.​

----

Same experience here.​

Keeping my total testosterone above 34 nmol/l (1000 ng/dl) causes erectile dysfunction, absent libido, severe physical anxiety, hairloss, bloat, cognitive impairment, high blood pressure, elevated prolactin + estradiol + HCT, reduced HDL - the list could go on.​

 

[Phil Goodman]

They are, but that should read "high starting dose". You added a "majority of men" qualifier. I'm not claiming to have quantified the rate at which men have problems at this dose. My point is that a midrange dose, say 50-80 mg TC/week, is less likely to cause side effects.

And I’ve already shared lots of evidence that shows 100-120 mg/week provides many benefits for men with little to no adverse effects, and the effects are seen at a rate so low it results in the vast majority of men sticking with their trt for the duration of the studies and beyond.

I could just as easily take your approach even further and say people taking 40 mg would be less likely to experience negative side effects. 20 mg even lower, 10 even lower. And refusing trt altogether would prevent the negative side effects. So by encouraging men to start at 50 mg/week you are causing people to needlessly suffer.

While the general principle is accepted in medicine, there do not appear to be studies making this specific comparison.

Conclusion and Support for the User’s Position​

​

While there are no direct studies comparing 60-80 mg vs. 100 mg per week of testosterone cypionate in divided doses, the literature supports the user’s position through:​

• The alignment of 60-80 mg per week with natural testosterone production, suggesting lower risk of side effects.
• General TRT guidelines recommending lower starting doses (50-75 mg per week) to minimize risks like elevated hematocrit and estradiol.
• Evidence that divided doses reduce peaks and troughs, potentially lowering side effects, but higher total doses (100 mg vs. 60-80 mg) may still increase average levels and associated risks.

Thus, there is substantial support for the idea that starting with 60-80 mg per week may lead to fewer side effects than 100 mg per week, especially when considering divided dosing to maintain stability.​

I used AI to provide lots of studies illustrating the doses I support show many many benefits and very little risk of adverse effects, which results in the vast majority of patients in the studies sticking with the protocols. This is further supported by real world evidence and the number of men staying on trt at those doses. You used AI to spit out “yeah you’re probably right”.

Your wording was that it wasn't made "in the body", not "by the human body". I took advantage of that technicality. Salicylic acid can be made naturally in the human body under the right circumstances. But yes, it is a word game that's a tangential distraction from my attempts to have you discuss the specifics of hCG use in the context of physiological dosing.

The specifics are that HCG is administered at doses far higher than what is created by the body. Yet it is done safely and provides lots of benefits for many people at those doses.

"Won't work" is too strong of a statement. Research shows that if this dose puts TT levels above ~400 ng/dL then sexual side effects of hypogonadism should largely resolve. Additionally, I would hypothesize that a testosterone cypionate/testosterone propionate blend administered daily to provide that 5 mg of testosterone would resolve symptoms of hypogonadism in a majority of men. That said, I suspect that 50 mg of TC in divided doses would not be optimal for a significant fraction. Even so, after starting at this dose you probably haven't trashed your lipids or jacked up HCT and estradiol. If the dose seems insufficient then all you need to do is raise it by 10 mg TC/week, enjoy the transient boost, and then wait a couple months to reevaluate.

But there are many other benefits that trt can provide beyond just improved libido. And a lot of those benefits are dose-dependent. I’ve shared many studies that showed these benefits were experienced by very large percentages of the study groups while subjecting them to little or no adverse effects. Benefits like improved libido, improved sexual function, increased muscle mass, improved metabolic levels, improved motivation, reduced brain fog, higher self confidence, improved well-being, reduced depression, improved bone mass, etc. And at rates that make the dose well worth it for the majority of men. Meanwhile you even admit that the dose you suggest won’t work for most people.

We could also extend your logic even further, and say that any dose which puts a guy above physiological range at PEAK is excessive. And if we take that stance then the dose being given would have to be rather low… too low to get the most benefits from the treatment.

Actually, you didn't. Not saying there aren't cases, but you just gave a list of peptides and common doses.



Creatine is analogous to testosterone. Supraphysiological amounts provide very specific benefits while creating dose-dependent risks.

Not sure why you’re dancing around this topic… well, actually I do know. Creatine is taken at levels higher than is created and acquired naturally via diet while providing many great health benefits with little to no risks… and again at rates that make the benefits well worth the risk. That’s why it has been taken at those levels by literally millions of people for decades. And again, there are plenty of other examples but we should stay here until you acknowledge this fact with regard to creatine.

Your 100-120 mg TC per week claim has morphed into the generic 100 mg/week that passes muster as safe and effective, and exists due to the historical low injection frequency. In essence the studies are saying that 100 mg TC/week is better than being hypogonadal. No argument there. Even the current dosing instructions for Depo-Testosterone call for 50-400 mg TC to be injected once every two to four weeks. If you're going to insist on this dosing schedule then I'll concede that the higher starting doses might be justified. But with two or more weekly doses, definitely not.

I don’t insist on any particular protocol with regard to frequency. My statement is that whatever frequency you’re at, if you’re averaging around 100 mg/week it isn’t automatically excessive, and that saying so isn’t causing people to needlessly suffer.

You have yet to find studies showing benefits to overall health in taking >100 mg TC versus less than that.

You have yet to find studies showing benefits to overall health in taking <100 mg TC versus more than that.

And critically, you still have provided no justification for starting with such doses, rather than beginning low and titrating according to levels and symptoms. Your personal anecdotal evidence has limited value because there's been no experimentation with physiological doses.

Not sure if you’re just being obtuse or honestly are incapable of analyzing the things I’ve shared. There are numerous studies which show the risk/reward ratio of taking 100 mg/week is well tolerated and provides many benefits for the majority of men in the studies. This is supported by the percentage that completed the study. I’m also in that boat. It’s also supported by the real world metrics regarding doses…because again millions of men are not going to spend all that money to feel worse and be less healthy. I’ve shared TONS of evidence while you have made rough guesses, gotten AI to say your rough guesses are good, and failed to provide studies which support your case.

Certain risks of TRT were overstated, as in the link to prostate cancer. It's still possible that other risks are underappreciated. Regarding what the vast majority of people might think: if they were told that a doctor was going to start patients on a dose of a hormone that is on the order of double their healthy natural production, in contravention of standard medical practice, then they would call it malpractice. Any irrational carve-out for testosterone exists only due to historical precedent and more-is-better thinking. Some men do suffer when they are needlessly started at high-end doses.

Testosterone

HCG (for both men and women)

Practically every hormone-related birth control ever prescribed

DHEA

Pregnenolone

Progesterone

Vitamin D

And those are just some hormonal examples. I’ve already given plenty of other examples of non-hormonal compounds(like creatine) that are administered safely at supraphysiological doses which result in many health benefits with little to no negative effects. And certainly with a risk/reward ratio that makes the doses well worth it.

I'm not asking you to change your protocol. I'm simply observing that you have no personal basis for saying that dosing at 60-80 mg TC/week would not be equally good or better. Instead, in my opinion, you are potentially doing damage by encouraging others to skip the low-and-slow approach.

You’re potentially doing damage by even recommending someone consider trt at all. If they don’t do it then they are at zero risk of that damage from trt. But you’ve already agreed that it’s better to be on trt than to be hypogonadal. I’m basing my views on numerous studies, personal experience, and the real world experience of millions of other men.

In fact this low dose is part of ongoing experimentation, and there is definitely concurrent endogenous production. Such low doses should only be used when the exogenous testosterone is fast-acting. Otherwise they would be counterproductive.



I agree we have some commonality in our views. All I'm asking for is a softening of your views on a starting dose. Let's tell guys to start at midrange, do more homework in the transition months, and then increase slowly if you think there's room for improvement.

I'm sorry if my statements about men suffering seem harsh and off-putting. I don't make them frivolously:

Then, a day or so after my next injection when levels hit > 1000 ng/dl, erections and libido would disappear again, water retention would go up and brain fog would return. As I moved to a higher injection frequency and higher levels were kept more constant, my sexual function was lost outright.​

...​

Years of time and energy wasted due to that mindset.​

----

So nearly 7 weeks ago I dropped my dose down to 52 mg per week. I now feel completely normal in every single aspect including libido. I feel like I have wasted over 12 years listening to what I should do, instead of doing what’s right for me. I feel absolutely normal now and I feel exactly the way I did before ever needing TRT.​

...​

The moral of the story is, I think a lot of men would be better served by substantially lowering their dose. I would not put this post on here if I if I didn’t feel passionate about it and thought it was a fleeting moment. Again I can tell you for absolute certain, that I feel fantastic finally, in every single aspect.​

----

I experienced this "dead wood" penis insensitivity on and off for a long time while on dosages around 100 mgs per week of T. When I lowered the dose down to 60-70 mgs, sexual sensitivity improved considerably. Erectile function is also more responsive and reliable.​

...​

Too much testosterone is not a good thing, especially for your penis.​

----

” Would have saved me those 8 years of countless blood donations, countless nights of frustration for the wife, countless bouts of insomnia, and countless episodes of “dude, why is your face so red”.​

----

Same experience here.​

Keeping my total testosterone above 34 nmol/l (1000 ng/dl) causes erectile dysfunction, absent libido, severe physical anxiety, hairloss, bloat, cognitive impairment, high blood pressure, elevated prolactin + estradiol + HCT, reduced HDL - the list could go on.​

Again, I already agree that if someone is feeling bad on a dose of around 100-120 they should reduce it instead of raise it. I’ve said as much to other users on this forum. So we’re on the same page there. However, I could go out and also pull tons of input from users at 100-120 that are doing great (myself included).

So like I said, we agree on a lot of things and have gotten hung up on whether 100 mg/week is a reasonable starting dose. I think so and you don’t. And I’m not really concerned with whether you change your mind or not. The point of a discussion should not be to win, it should be to learn. I’ve shared information that leads me to my view and based on everything I said I think it’s well-informed. I haven’t seen you share anything to make me think that 100 is too much for the majority of men, but like I said if new evidence emerges or if you have anything else you think I’d be interested in then pass it along.

 

[Cataceous]

So like I said, we agree on a lot of things and have gotten hung up on whether 100 mg/week is a reasonable starting dose....

As the point-by-point rebuttal has gotten repetitive, I'll skip to this, which I agree is the crux of the matter. In the end you've provided no evidence that there are advantages to starting TRT with this higher, non-physiological dose. In contrast, I have shown that lower starting doses can be equally effective, offer reduced side effects, and are more in line with general medical practice.

 

[Phil Goodman]

As the point-by-point rebuttal has gotten repetitive, I'll skip to this, which I agree is the crux of the matter. In the end you've provided no evidence that there are advantages to starting TRT with this higher, non-physiological dose. In contrast, I have shown that lower starting doses can be equally effective, offer reduced side effects, and are more in line with general medical practice.

Lolwut??

You haven’t shown any of those things.

I’ve shown that the doses I’ve supported are very beneficial for the majority of men with minimal adverse effects.

 

[FunkOdyssey]

If I may insert a thought here, I don't think starting everyone either higher (100-120+ mg) or lower (50-75 mg) makes sense. I think with some baseline testing and information gathering, you can predict with pretty good accuracy (not perfect accuracy, but reasonable accuracy) who is going to respond like these anecdotes:

Then, a day or so after my next injection when levels hit > 1000 ng/dl, erections and libido would disappear again, water retention would go up and brain fog would return. As I moved to a higher injection frequency and higher levels were kept more constant, my sexual function was lost outright.
...
Years of time and energy wasted due to that mindset.
----
So nearly 7 weeks ago I dropped my dose down to 52 mg per week. I now feel completely normal in every single aspect including libido. I feel like I have wasted over 12 years listening to what I should do, instead of doing what’s right for me. I feel absolutely normal now and I feel exactly the way I did before ever needing TRT.
...
The moral of the story is, I think a lot of men would be better served by substantially lowering their dose. I would not put this post on here if I if I didn’t feel passionate about it and thought it was a fleeting moment. Again I can tell you for absolute certain, that I feel fantastic finally, in every single aspect.
----
I experienced this "dead wood" penis insensitivity on and off for a long time while on dosages around 100 mgs per week of T. When I lowered the dose down to 60-70 mgs, sexual sensitivity improved considerably. Erectile function is also more responsive and reliable.
...
Too much testosterone is not a good thing, especially for your penis.
----
” Would have saved me those 8 years of countless blood donations, countless nights of frustration for the wife, countless bouts of insomnia, and countless episodes of “dude, why is your face so red”.
----
Same experience here.
Keeping my total testosterone above 34 nmol/l (1000 ng/dl) causes erectile dysfunction, absent libido, severe physical anxiety, hairloss, bloat, cognitive impairment, high blood pressure, elevated prolactin + estradiol + HCT, reduced HDL - the list could go on.

Who is it going to be, that requires lower doses to avoid all of these side effects? We have a very good idea who it is going to be. Cataceous can cite himself as an exception (the exception that proves the rule).

If you walk into my hypothetical TRT clinic and you are overweight or insulin resistant, you're getting 50-75 mg. If you walk in and you are lean and metabolically healthy, you're getting 100-120+ mg. We avoid causing "needless suffering" without holding back the rest of the class for the slow kids. Everyone wins!

Precision medicine is the future.

 

[Vince]

Thread 'What is the Optimum TRT Dose for Muscle Growth? : Nelson Vergel Reviews the Data'

Yesterday at 10:42 AM

Landmark Study Reveals How Different Testosterone Doses Affect Muscle, Fat, and Health Markers in Young Men

A deep dive into one of the most influential studies on testosterone dosing reveals key takeaways for anyone interested in hormone optimization—a topic of persistent debate in men's health communities and clinics alike.

Background and Study Design

In 2001, a seminal paper was published in the American Journal of Physiology, Endocrinology and Metabolism. Dr. Shalender Bhasin and colleagues—considered among the...

• Nelson Vergel
• best testosterone dose best trt dose for muscle
• Replies: 3
• Forum: Testosterone Basics & Questions

• 

 

[FunkOdyssey]

Vince makes a good example patient. If lean and mean, low-aromatizing Vince rolls into your TRT clinic on his Harley, and you give him 50-75 mg a week, he's going to have single digit E2, hate his life, and hate you. Needless suffering indeed!

 

[Seagal]

If I may insert a thought here, I don't think starting everyone either higher (100-120+ mg) or lower (50-75 mg) makes sense. I think with some baseline testing and information gathering, you can predict with pretty good accuracy (not perfect accuracy, but reasonable accuracy) who is going to respond like these anecdotes:




Who is it going to be, that requires lower doses to avoid all of these side effects? We have a very good idea who it is going to be. Cataceous can cite himself as an exception (the exception that proves the rule).

If you walk into my hypothetical TRT clinic and you are overweight or insulin resistant, you're getting 50-75 mg. If you walk in and you are lean and metabolically healthy, you're getting 100-120+ mg. We avoid causing "needless suffering" without holding back the rest of the class for the slow kids. Everyone wins!

Precision medicine is the future.

Yes, a personalized approach.

If we look at the normal distribution and taking TRT literally, I agree with @Cataceous though.

The aim of TRT isn't 'supraphysiological' muscle growth.

 

[Vince]

Serum Testosterone Levels

25 mg/week: Levels dropped well below baseline; insufficient for replacement.

50 mg/week: Some increase, but still suboptimal.

125 mg/week: Returned testosterone to baseline (pre-suppression) levels for these young men.

300–600 mg/week: Produced supraphysiological levels—common in bodybuilding circles[1].

Thread 'What is the Optimum TRT Dose for Muscle Growth? : Nelson Vergel Reviews the Data'

Yesterday at 10:42 AM

Landmark Study Reveals How Different Testosterone Doses Affect Muscle, Fat, and Health Markers in Young Men

A deep dive into one of the most influential studies on testosterone dosing reveals key takeaways for anyone interested in hormone optimization—a topic of persistent debate in men's health communities and clinics alike.

Background and Study Design

In 2001, a seminal paper was published in the American Journal of Physiology, Endocrinology and Metabolism. Dr. Shalender Bhasin and colleagues—considered among the...

• Nelson Vergel
• best testosterone dose best trt dose for muscle
• Replies: 3
• Forum: Testosterone Basics & Questions

• 

 

[Phil Goodman]

If I may insert a thought here, I don't think starting everyone either higher (100-120+ mg) or lower (50-75 mg) makes sense. I think with some baseline testing and information gathering, you can predict with pretty good accuracy (not perfect accuracy, but reasonable accuracy) who is going to respond like these anecdotes:




Who is it going to be, that requires lower doses to avoid all of these side effects? We have a very good idea who it is going to be. Cataceous can cite himself as an exception (the exception that proves the rule).

If you walk into my hypothetical TRT clinic and you are overweight or insulin resistant, you're getting 50-75 mg. If you walk in and you are lean and metabolically healthy, you're getting 100-120+ mg. We avoid causing "needless suffering" without holding back the rest of the class for the slow kids. Everyone wins!

Precision medicine is the future.

Agreed, care should be customized to increase number of patients who start off at the correct(or at least closer to the) correct dose for them.

And based on your assessment you would’ve been correct for me. I’m 6’1” and stay between 170-175 with great muscle mass and low body fat. And I’ve always been on a dose somewhere between 100-120/week. There were a few bumps along the way but nothing serious and my journey has been overwhelmingly positive. So even if someone does start out on the correct dose we should also reiterate the aspect of allowing your body to settle into whatever protocol your on so you have adequate time to accurately assess. Patients shouldn’t be so eager to make adjustments any time anything negative happens, and that goes for people who want to raise OR lower the dose.

 

[Phil Goodman]

Yes, a personalized approach.

If we look at the normal distribution and taking TRT literally, I agree with @Cataceous though.

The aim of TRT isn't 'supraphysiological' muscle growth.

But there are lots of other dose-dependent benefits from trt beyond just the anabolic ones.