Post TRT - Libido is DEAD :(

[Phil Goodman]

Prompt using Claude:

I’d like to compare various protocols of trt. For an average 200 lb man, review the literature to make a best guess about what his total testosterone blood levels would be for the following doses.
50 mg testosterone cypionate once per week
25 mg testosterone cypionate twice per week
100 mg testosterone cypionate once per week
50 mg testosterone cypionate twice per week
Take your time and confirm accuracy before responding





Response from Claude:

Good, I now have solid data. Let me synthesize this carefully using the pharmacokinetic literature and the key anchor points from clinical studies.
Here’s a thorough breakdown based on the published literature. I’ll note upfront that the exact numbers in this kind of analysis depend on baseline endogenous production (assumed to be suppressed at steady-state), individual metabolism, SHBG levels, body composition, and whether injections are intramuscular or subcutaneous. The figures below represent reasonable population averages at steady state, with typical ranges reflecting real inter-individual variation.

Key pharmacokinetic anchors from the literature
The half-life of testosterone cypionate when injected intramuscularly is approximately eight days. This means at steady state (roughly 5 half-lives, or 5–6 weeks of consistent dosing), drug accumulates meaningfully between doses. Importantly, intramuscular administration of 200 mg of testosterone cypionate produced a mean supratherapeutic Cmax of 1,122 ng/dL occurring 4–5 days post-injection. That’s a well-established anchor for scaling.
In a clinical study of hypogonadal men treated with IM testosterone cypionate 100 mg weekly, trough total testosterone rose from a baseline of ~314 ng/dL to ~536 ng/dL post-treatment. That trough figure is key for calibrating the 100 mg/week once-weekly protocol.
The pharmacokinetics are essentially linear and dose-proportional at TRT doses, so the numbers below scale accordingly.

Protocol Comparisons (at steady state, average 200 lb man)
1. 50 mg testosterone cypionate once per week
∙ Weekly total dose: 50 mg
∙ Peak (day 2–3): ~400–500 ng/dL
∙ Trough (day 6–7, pre-injection): ~250–350 ng/dL
∙ Average/mid-week: ~350–420 ng/dL
∙ Peak-to-trough swing: moderate (~150–200 ng/dL fluctuation)
This is a low-dose protocol. Many men will land in the low-normal range and may hover near or below the 300 ng/dL threshold by injection day. It’s a reasonable starting/conservative protocol but may leave some men symptomatic near trough.

2. 25 mg testosterone cypionate twice per week (same 50 mg/week total)
∙ Weekly total dose: 50 mg (same as above)
∙ Peak (day 1–2 after each injection): ~350–430 ng/dL
∙ Trough (day 3–4, pre-injection): ~280–360 ng/dL
∙ Average: ~350–420 ng/dL
∙ Peak-to-trough swing: much smaller (~70–100 ng/dL fluctuation)
Because the total weekly dose is identical, the average level is essentially the same as Protocol 1. The key difference is dramatically improved stability — the shorter dosing interval relative to the half-life keeps levels far more consistent. The cypionate half-life of ~8 days means 25 mg every 3.5 days produces very smooth, near-flat kinetics. This is arguably the most physiologically stable low-dose option.

3. 100 mg testosterone cypionate once per week
∙ Weekly total dose: 100 mg
∙ Peak (day 2–3): ~700–900 ng/dL
∙ Trough (day 6–7, pre-injection): ~450–550 ng/dL
∙ Average/mid-week: ~550–700 ng/dL
∙ Peak-to-trough swing: significant (~300–400 ng/dL fluctuation)
This is the most commonly studied standard TRT dose. Clinical data from men on 100 mg IM-TC weekly showed trough levels reaching ~536 ng/dL , which aligns well with this estimate. The Endocrine Society Clinical Practice Guidelines target a therapeutic level of 400–700 ng/dL measured one week after a dose of TC. Once-weekly dosing at this amount produces meaningful peaks and troughs — some men feel the difference.

4. 50 mg testosterone cypionate twice per week (same 100 mg/week total)
∙ Weekly total dose: 100 mg (same as above)
∙ Peak (day 1–2 after each injection): ~600–750 ng/dL
∙ Trough (day 3–4, pre-injection): ~500–650 ng/dL
∙ Average: ~550–700 ng/dL
∙ Peak-to-trough swing: much smaller (~100–150 ng/dL fluctuation)
Again, the average testosterone exposure is identical to Protocol 3, but the curve is dramatically flatter. Splitting doses to 50 mg twice weekly is specifically recommended to avoid the high peaks and troughs seen with less frequent injections. This is widely considered the “gold standard” TRT protocol among endocrinologists for stable symptom management, lower estradiol peaks, and reduced hematocrit elevation.

Important caveats
∙ These are population averages. Individual variation is substantial — SHBG, body fat, metabolic rate, injection site, and whether injection is IM vs. subcutaneous all shift results meaningfully.
∙ Subcutaneous injection of the same dose tends to produce slightly lower, smoother peaks than IM.
∙ Endogenous production is assumed to be largely suppressed at steady state, which typically occurs by weeks 5–6.
∙ A 200 lb man’s weight has a modest effect on distribution volume, but the PK modeling literature suggests weight is not a major driver of average levels at these doses — the effect is smaller than most people assume.
∙ Real blood work is irreplaceable. These estimates are useful for protocol planning but not for replacing lab monitoring.

 

[Phil Goodman]

Not one study saying that it is appropriate to start TRT with supraphysiological levels of testosterone. Many saying to start at mid-physiological levels. End of story. Go away.

Lmfao take the fucking L guy

 

[Cataceous]

Lmfao take the fucking L guy

As if AI vomitus could save the day for you.

The half-life of testosterone cypionate when injected intramuscularly is approximately eight days.​

Garbage-in, garbage out... That figure stems from old research that did not account for the interference of natural production.†

Still waiting for that study that says initial dosing to supraphysiological levels is appropriate. Apparently now you're trying to argue that supraphysiological dosing does not lead to supraphysiological levels. Explain how that works. How does taking an average of 10 mg per day of testosterone result in normal levels in the average guy when average production for healthy young guys is only 6.5 mg?

Basically you're advocating for at least half the guys to experience supraphysiological levels, while most of the rest have levels higher than their healthy natural best. Do you honestly think this is good medical practice? It wouldn't be considered such with any other hormone, More-is-better thinking around testosterone degrades good judgement.

†From smarter AI: The half-life of generic injectable testosterone cypionate formulations is approximately 4.8 days, based on population pharmacokinetic modeling in healthy adult men that mathematically accounts for endogenous testosterone production and its suppression via the HPTA during administration. This estimate comes from a 2018 study that used compartmental analysis to separate exogenous drug kinetics from variable endogenous secretion rates (estimated at 11.9–13 mg/day basally, with dose-dependent suppression). Traditional non-compartmental methods, which do not adjust for endogenous interference, often overestimate the half-life at 6.9–8 days due to flip-flop pharmacokinetics where the slow release from the oil depot is rate-limiting, and residual natural production prolongs the apparent decline in measured levels.​

 

[Phil Goodman]

As if AI vomitus could save the day for you.

The half-life of testosterone cypionate when injected intramuscularly is approximately eight days.​

Garbage-in, garbage out... That figure stems from old research that did not account for the interference of natural production.†

Still waiting for that study that says initial dosing to supraphysiological levels is appropriate. Apparently now you're trying to argue that supraphysiological dosing does not lead to supraphysiological levels. Explain how that works. How does taking an average of 10 mg per day of testosterone result in normal levels in the average guy when average production for healthy young guys is only 6.5 mg?

Basically you're advocating for at least half the guys to experience supraphysiological levels, while most of the rest have levels higher than their healthy natural best. Do you honestly think this is good medical practice? It wouldn't be considered such with any other hormone, More-is-better thinking around testosterone degrades good judgement.

†From smarter AI: The half-life of generic injectable testosterone cypionate formulations is approximately 4.8 days, based on population pharmacokinetic modeling in healthy adult men that mathematically accounts for endogenous testosterone production and its suppression via the HPTA during administration. This estimate comes from a 2018 study that used compartmental analysis to separate exogenous drug kinetics from variable endogenous secretion rates (estimated at 11.9–13 mg/day basally, with dose-dependent suppression). Traditional non-compartmental methods, which do not adjust for endogenous interference, often overestimate the half-life at 6.9–8 days due to flip-flop pharmacokinetics where the slow release from the oil depot is rate-limiting, and residual natural production prolongs the apparent decline in measured levels.​

you’re basing that half life on one study which just used a model to try and estimate it while accounting for endogenous interference, which is a non-factor in a trt patient because their natural production is shut down. The model also didn’t accurately predict what we see in the real world. There’s a reason the 7-8 day half life is used and even acknowledged by the FDA.

From an even smarter AI




KEY POINT HERE:

When the authors assumed endogenous testosterone secretion was zero in their population PK analysis, the median estimated half-life increased to 6.87 days — very close to the traditional non-compartmental estimate.
So your instinct was exactly right, and the answer is clear:
The 4.05-day figure is not really a better half-life estimate — it’s an artifact of the modeling approach. The model mathematically separated exogenous TC kinetics from endogenous production, and in doing so, attributed some of the measured testosterone to endogenous sources rather than the drug. When you strip that out and assume zero endogenous production — which is the correct assumption for an established TRT patient — the half-life reverts to ~6.87 days, nearly identical to the traditional estimate.

The bottom line: the ~6.87–8 day half-life is the correct figure to use for predicting blood levels on TRT, and my original estimates in the first table hold up better than the 4-day recalculation. The “smarter AI” was technically describing a real finding from the paper, but presenting it in a way that overstated its practical relevance for TRT planning.



Like I said, take the L. I’ve shown you all you need to see but for whatever reason(s) you either fail to acknowledge it or fail to admit. And I’m not even trying to convince you anymore, just putting this information out for anyone else who is interested in reading it.


Like I said earlier, you are more than welcome to your own opinion. But when you promote protocols that have been proven to make men weaker, fatter, more frail, and overall less healthy then don’t be surprised if you receive pushback.

 

[Cataceous]

... But when you promote protocols that have been proven to make men weaker, fatter, more frail, and overall less healthy then don’t be surprised if you receive pushback.

You rely on a straw man argument by making the comparison to a protocol that induces hypogonadism; after all this verbiage you still have not cited one study that directly compares our positions. You also don't respond to the assertion that your approach to TRT is out of line with science-based medical practice. What does your AI say about the choice between starting guys on TRT with midrange physiological levels versus putting most of them over-range, which 100 mg TC per week absolutely does?

 

[Phil Goodman]

You rely on a straw man argument by making the comparison to a protocol that induces hypogonadism; after all this verbiage you still have not cited one study that directly compares our positions. You also don't respond to the assertion that your approach to TRT is out of line with science-based medical practice. What does your AI say about the choice between starting guys on TRT with midrange physiological levels versus putting most of them over-range, which 100 mg TC per week absolutely does?

The studies induced hypogonadism in order to more accurately assess long term treatments. By eliminating natural production before starting it more accurately reflects the impact on a body in which endogenous t isn’t a factor(which it won’t be for people on trt).

Meanwhile you share a study that factors in endogenous production to calculate the half life… then come up with an inaccurate number of around 4 days before the authors themselves wrote: “When we assume endogenous testosterone secretion is 0 in the PPK analysis, the median estimated half-life increases to 6.87 days.” And to make it even more hilarious you used that as if it was a counter to my calculations which discredited the levels seen from the various doses.


Similarly, you shared a “study”… that was actually just a review of studies from talking heads in which they concluded that 100 mg/week is a good starting dose… while acting like it supported your narrative and countered mine.


Again, I’ve shared tons of studies to support my assertions. I’ve also shown the negative effects of starting at your suggested dose of 50 mg/week. And no… splitting the suboptimal dose of 50 per week doesn’t magically fix all of the issues with it as far as muscle, bone, fat, and other effects are concerned.



The more you go on the worse it looks. Like I said, you should’ve taken the L a LONG time ago. Continuing to dig this hole is not getting you anywhere

 

[Cataceous]

The studies induced hypogonadism in order to more accurately assess long term treatments. By eliminating natural production before starting it more accurately reflects the impact on a body in which endogenous t isn’t a factor(which it won’t be for people on trt).

I wasn't even thinking about that aspect—the a priori artificial HPTA suppression—but that makes the comparison even worse. Nonetheless, a sustained protocol of 50 mg TC/week in one injection is still going to be highly suppressive, leading to hypogonadism later in each injection cycle. This is why the dosing pattern is highly relevant. In divided doses the 5 mg/day of testosterone is sufficient to ameliorate hypogonadism in most men, even if it's not optimal. It's even proven that < 5 mg/day of testosterone can resolve hypogonadism when it's delivered appropriately, say as three doses of a fast acting nasal gel.

The point remains: There's no study showing that dosing to midrange testosterone levels is inferior to higher levels for improving overall health. You have also not pointed to any evidence that harm is caused by initial sub-optimal dosing and subsequent titration, whereas tangible negative effects of high doses are common.

Meanwhile you share a study that factors in endogenous production to calculate the half life… then come up with an inaccurate number of around 4 days before the authors themselves wrote: “When we assume endogenous testosterone secretion is 0 in the PPK analysis, the median estimated half-life increases to 6.87 days.” And to make it even more hilarious you used that as if it was a counter to my calculations which discredited the levels seen from the various doses.

The cited numbers fail basic areas-under-the-curves analysis. You keep ignoring the simplified version: most men naturally produce 3-9 mg/day of testosterone at their best. There is no justification for starting TRT with higher amounts. All you have is one study showing that higher amounts are better than hypogonadism. That proves nothing.

Similarly, you shared a “study”… that was actually just a review of studies from talking heads in which they concluded that 100 mg/week is a good starting dose… while acting like it supported your narrative and countered mine.

The science-based recommendations are to start with physiological levels. 100 mg TC/week does not qualify.

Again, I’ve shared tons of studies to support my assertions. I’ve also shown the negative effects of starting at your suggested dose of 50 mg/week.

It's one study and you can't let go of it for some reason. Read my comments above and explain why this study proves your point. I'm getting tired of asking to see a study advocating for above-physiological levels at the start of TRT. You don't have one, so your argument collapses.

...
The more you go on the worse it looks. Like I said, you should’ve taken the L a LONG time ago. Continuing to dig this hole is not getting you anywhere

LOL

 

[Phil Goodman]

I wasn't even thinking about that aspect—the a priori artificial HPTA suppression—but that makes the comparison even worse. Nonetheless, a sustained protocol of 50 mg TC/week in one injection is still going to be highly suppressive, leading to hypogonadism later in each injection cycle. This is why the dosing pattern is highly relevant. In divided doses the 5 mg/day of testosterone is sufficient to ameliorate hypogonadism in most men, even if it's not optimal. It's even proven that < 5 mg/day of testosterone can resolve hypogonadism when it's delivered appropriately, say as three doses of a fast acting nasal gel.

The point remains: There's no study showing that dosing to midrange testosterone levels is inferior to higher levels for improving overall health. You have also not pointed to any evidence that harm is caused by initial sub-optimal dosing and subsequent titration, whereas tangible negative effects of high doses are common.



The cited numbers fail basic areas-under-the-curves analysis. You keep ignoring the simplified version: most men naturally produce 3-9 mg/day of testosterone at their best. There is no justification for starting TRT with higher amounts. All you have is one study showing that higher amounts are better than hypogonadism. That proves nothing.



The science-based recommendations are to start with physiological levels. 100 mg TC/week does not qualify.



It's one study and you can't let go of it for some reason. Read my comments above and explain why this study proves your point. I'm getting tired of asking to see a study advocating for above-physiological levels at the start of TRT. You don't have one, so your argument collapses.



LOL

It proves my point because it shows that a dose of 50 mg/week does not provide benefits for most men on trt. I don’t know how much more plainly I can put it. I know you are an intelligent person, so I assume it isn’t your lack of intellect preventing you from seeing it. To me that means the most likely culprit is that it’s your cognitive dissonance making you blind to something that is sitting right in front of your face.

On top of that, the study shows that the dosage I propose (between 100-120 per week) is the best dosage for maximizing benefits in a way that is safe for the vast majority of patients. Other studies show the same. Recommended guidelines which YOU YOURSELF shared show the same. The clinical experience of thousands of doctors show the same. The personal experience of millions of patients shows the same.

You also shared a study which actually proved the half life calculation I used to clearly show your preferred dosage leaves men at levels which are too low was correct… while pretending the study was a valid counter to my point. You have done that repeatedly in this thread. You share materials which actually make MY case then scream that nothing supports my case. It’s honestly pretty fucking hilarious. Meanwhile you have shared ZERO studies which conclude it’s a good idea to start people off at 50 mg/week. All you have is this fixation on natural production and zero evidence to support your claim while I show repeatedly it can and does cause patients to end up worse off than they would be if taking a dose of 100-120.


Again.. I gave up on convincing you long ago. Your cognitive dissonance makes that impossible and I have a saying that goes “if you’re trying to teach a dog algebra… at some point you have to realize the fault lies not with the dog’s inability to grasp the concepts, but with the fact that you’re still spending time trying to teach it”.

And I’m sure other posters are tired of watching us go round and round in circles(and I’m probably the only one enjoying watching you dig this hole so much) so we can just leave it at that and my only suggestion at this point would be for you to research cognitive dissonance and how to spot it in yourself.


That being said, the next time you tell someone to try 50 mg/week there’s a decent chance you’ll get called out again.

 

[Cataceous]

It proves my point because it shows that a dose of 50 mg/week does not provide benefits for most men on trt. I don’t know how much more plainly I can put it. I know you are an intelligent person, so I assume it isn’t your lack of intellect preventing you from seeing it. To me that means the most likely culprit is that it’s your cognitive dissonance making you blind to something that is sitting right in front of your face.

The cognitive dissonance lies with the one who acts like he can't distinguish between different dosing patterns for the same amount of testosterone in a given time period. By this way of thinking you can take your 5,200 mg of testosterone cypionate on January 1st and say you're done for the year. If it doesn't work then the dose size must be at fault rather than the pattern, right? Try 10,000 mg next year, yes?

On top of that, the study shows that the dosage I propose (between 100-120 per week) is the best dosage for maximizing benefits in a way that is safe for the vast majority of patients. Other studies show the same.

Repeating an invalid argument a million times doesn't make it right. There's no comparison to physiological dosing, so "best" in this study has reduced value.

That being said, the next time you tell someone to try 50 mg/week there’s a decent chance you’ll get called out again.

Taking 50 mg TC per week in divided doses is a perfectly reasonable starting protocol. Many will want to titrate upwards, but at least few would start out with symptoms of excess. However, I'd be pretty happy if people would even get the starting dose down to 60-70 mg/week. Some would still have symptoms of excess and need to titrate down, but not nearly in the numbers seen with 100+ mg TC/week.

If you continue to insert yourself in these recommendations using the same irrelevant study as a basis for criticism then I will remove those posts. You can cite the study to demonstrate a reasonable short-term safety profile for higher doses, and for demonstrating dose-response characteristics of the higher doses. But if you misrepresent the study as evidence against physiological dosing then such posts will go the way of all spam.

 

[Vince]

The cognitive dissonance lies with the one who acts like he can't distinguish between different dosing patterns for the same amount of testosterone in a given time period. By this way of thinking you can take your 5,200 mg of testosterone cypionate on January 1st and say you're done for the year. If it doesn't work then the dose size must be at fault rather than the pattern, right? Try 10,000 mg next year, yes?



Repeating an invalid argument a million times doesn't make it right. There's no comparison to physiological dosing, so "best" in this study has reduced value.



Taking 50 mg TC per week in divided doses is a perfectly reasonable starting protocol. Many will want to titrate upwards, but at least few would start out with symptoms of excess. However, I'd be pretty happy if people would even get the starting dose down to 60-70 mg/week. Some would still have symptoms of excess and need to titrate down, but not nearly in the numbers seen with 100+ mg TC/week.

If you continue to insert yourself in these recommendations using the same irrelevant study as a basis for criticism then I will remove those posts. You can cite the study to demonstrate a reasonable short-term safety profile for higher doses, and for demonstrating dose-response characteristics of the higher doses. But if you misrepresent the study as evidence against physiological dosing then such posts will go the way of all spam.

When I was at NIH in Maryland an endocrinologist. Told me, on her first day the dean of students told them. Study hard, learn a lot but remember the day of graduation 75% of what you learned this will have been disproven.

 

[Phil Goodman]

The cognitive dissonance lies with the one who acts like he can't distinguish between different dosing patterns for the same amount of testosterone in a given time period. By this way of thinking you can take your 5,200 mg of testosterone cypionate on January 1st and say you're done for the year. If it doesn't work then the dose size must be at fault rather than the pattern, right? Try 10,000 mg next year, yes?



Repeating an invalid argument a million times doesn't make it right. There's no comparison to physiological dosing, so "best" in this study has reduced value.



Taking 50 mg TC per week in divided doses is a perfectly reasonable starting protocol. Many will want to titrate upwards, but at least few would start out with symptoms of excess. However, I'd be pretty happy if people would even get the starting dose down to 60-70 mg/week. Some would still have symptoms of excess and need to titrate down, but not nearly in the numbers seen with 100+ mg TC/week.

If you continue to insert yourself in these recommendations using the same irrelevant study as a basis for criticism then I will remove those posts. You can cite the study to demonstrate a reasonable short-term safety profile for higher doses, and for demonstrating dose-response characteristics of the higher doses. But if you misrepresent the study as evidence against physiological dosing then such posts will go the way of all spam.

1.)

Watch this video

You might learn a few things. Also.., pay attention to sign # 2. Jumping to an absurd absolute. It is one of the strongest signals of cognitive dissonance and just so happens to be exactly what you did when starting your post. “Hurrr durr if you’re saying that 50 mg per week split up into two doses won’t magically fix all of the issues with 50 mg once per week then you’re saying you should just take 5200 mg of test on Jan 1st and be done for the year”. Like… you actually typed that out and thought it was a valid point to make. Which brings me back to your cognitive dissonance. So again, I suggest watching the video.


It’s not a reasonable stating protocol and you’ve shared exactly zero studies to make those claims.


Fuck outta here with your threats of censorship. Just because you keep getting wrecked and have absolutely nothing to fall back on you just resort to threaten to silence the points you don’t want to see. I haven’t broken any forum rules, and have provided extensive materials to support the claims I’m making. Not surprised though… that approach is a convenient tool for people who have no case. Next thing I know you’re gonna threaten to censor me for saying the covid injections are not safe and effective.

 

[Cataceous]

1.)

Watch this video

You might learn a few things. Also.., pay attention to sign # 2. Jumping to an absurd absolute. It is one of the strongest signals of cognitive dissonance and just so happens to be exactly what you did when starting your post. “Hurrr durr if you’re saying that 50 mg per week split up into two doses won’t magically fix all of the issues with 50 mg once per week then you’re saying you should just take 5200 mg of test on Jan 1st and be done for the year”. Like… you actually typed that out and thought it was a valid point to make. Which brings me back to your cognitive dissonance. So again, I suggest watching the video.


It’s not a reasonable stating protocol and you’ve shared exactly zero studies to make those claims.


Fuck outta here with your threats of censorship. Just because you keep getting wrecked and have absolutely nothing to fall back on you just resort to threaten to silence the points you don’t want to see. I haven’t broken any forum rules, and have provided extensive materials to support the claims I’m making. Not surprised though… that approach is a convenient tool for people who have no case. Next thing I know you’re gonna threaten to censor me for saying the covid injections are not safe and effective.

"Jumping to an absurd absolute."
You mean like saying "And it is CLEARLY superior to 50 mg/week… no matter how you split the dosing."

There is a significant cohort, myself included, that does much better on 50 mg TC per week split appropriately than at the excessive 100+ mg/week level you propose to start everyone at.

You've had ample opportunity to make your case and failed miserably from my point of view. You ignored multiple requests to explain how your flagship study pertains to physiological dosing. With your threat to re-litigate this every time I'm offering science-based guidance to others you are crossing the line into harassment. Even that isn't necessarily grounds for action, but combining it with continued misrepresentation is problematic. I see that some abusive language is creeping in now too. Don't keep claiming that a study on one dosing pattern applies equally well to all patterns. That's what I illustrated with an extreme example: cramming all of the doses into the first day of each year and claiming that's representative of all other patterns that involve getting that much testosterone in a year.

 

[Phil Goodman]

"Jumping to an absurd absolute."
You mean like saying "And it is CLEARLY superior to 50 mg/week… no matter how you split the dosing."

There is a significant cohort, myself included, that does much better on 50 mg TC per week split appropriately than at the excessive 100+ mg/week level you propose to start everyone at.

You've had ample opportunity to make your case and failed miserably from my point of view. You ignored multiple requests to explain how your flagship study pertains to physiological dosing. With your threat to re-litigate this every time I'm offering science-based guidance to others you are crossing the line into harassment. Even that isn't necessarily grounds for action, but combining it with continued misrepresentation is problematic. I see that some abusive language is creeping in now too. Don't keep claiming that a study on one dosing pattern applies equally well to all patterns. That's what I illustrated with an extreme example: cramming all of the doses into the first day of each year and claiming that's representative of all other patterns that involve getting that much testosterone in a year.

I don’t have to make the case for physiological dosing… you’re the one that is hung up on that. Again, now for the 7,000th time: My claim is that 100-120 mg of testosterone per week will provide more benefits for men than 50-75 mg of testosterone per week. That is my first claim which I have supported. My second claim is that dose is safe for the vast majority of men(also supported) I have no desire to jump through your physiological hoops because again you’re the one hung up on that point.

I have shared multiple studies which clearly illustrated those doses (100-125/week) performed better in the subjects. The authors even explicitly stated that the doses I recommend were the sweet spot for maximizing benefits without introducing unnecessary risks. In other words, that dose is the best risk/reward ratio.

You tried yet again to hide behind the claim that splitting the dose of 50 mg per week would somehow solve the problem of the dose being too low. I showed the accurate pharmacokinetic calculations for where the various doses would put patients, clearly illustrating that even when splitting 50 mg into two doses it still leaves most patients at levels too low to see good benefits. You countered by sharing a BS study about how the half life of test cyp is really 4 days when factoring in endogenous production… when the authors themselves even said that when factored by itself(as is the case for people on trt) the half life is right around 7 days. And you’re ignoring that it is readily accepted that the half life is around 7 days for trt patients. You were grasping for straws so desperately you actually decided to go with “nah man, the half life of cypionate is only four days…” Cognitive dissonance anyone? So again, the calculations showing that the dose of 50 mg per week are too low for most people were accurate, and another example of evidence for my case and against your case.



Meanwhile you say you’re offering “science based guidance”… then the first link you share has 100 mg per week as a recommended starting dose. So you can share links which support it, but others can’t?

You’ve shared no studies that compare various doses and found 50 mg per week to be superior to doses around 100-125.

You’ve shared no studies which show that 50 mg per week can provide the same benefits as 100 mg per week.

You’ve shared multiple things which don’t provide recommended doses at all, but rather recommended total t levels to reach…. While ignoring the fact that for the vast majority of men it would take more than 50 mg/week to reach the levels they suggest. My claim that they wouldn’t reach those levels is supported by many many studies which show blood levels of various doses as well as the calculations I shared earlier… which you were so adamant about discrediting(possibly due to realizing how much it damaged your argument), that you resorted to telling us the half life of cypionate is 4 days.




All the while, you say that I’M the one misrepresenting things and threatening to delete my posts for misrepresenting things(which you have done both with my posts and studies), when I haven’t misrepresented them and stand by my earlier claims about the effectiveness and safety of the dose. You say you’re offering science-based advice when you haven’t done any such thing yet I’ve done it countless times throughout this thread and others.


And yes, if you tell people that 50 mg is a great dose for starting trt it’s possible that I’ll respond again with tons of evidence that counter your point. If you feel the need to censor me for that then go ahead.

 

[Cataceous]

...
My claim is that 100-120 mg of testosterone per week will provide more benefits for men than 50-75 mg of testosterone per week. That is my first claim which I have supported.

You have offered very little to support this claim. You continue to point to the fact that taking 50 mg TC once per week yields poor results. This says nothing about how achieving physiological levels via divided doses of 50-75 mg per week compares to the above-physiological doses that you advocate.

My second claim is that dose is safe for the vast majority of men(also supported) I have no desire to jump through your physiological hoops because again you’re the one hung up on that point.

The studies indicate reasonable short-term safety. However, you cannot say for sure that those experiencing elevated hematocrit would not face more severe consequences with long-term exposure. As has been discussed in these pages at length, the higher blood viscosity does lead to the potential for increased wear and tear on the vasculature in susceptible individuals. Cardiotoxicity through integrated exposure is a possibility, though hopefully a very small one at these doses.

Then there are anecdotal reports of problems with higher testosterone levels, including issues with libido and sexual function. I have collected some of those documenting how lower doses led to significant improvements. These occur with such frequency that they are not easily dismissed. The primary argument against them is that they do not give a good idea of the actual frequency of these problems; men doing well are less likely to be asking for help in the forums. On the other hand, some studies have suggested significant "churn" and drop rates for some forms of TRT, hinting at more widespread problems and lack of satisfaction with results.

I have shared multiple studies which clearly illustrated those doses (100-125/week) performed better in the subjects. The authors even explicitly stated that the doses I recommend were the sweet spot for maximizing benefits without introducing unnecessary risks. In other words, that dose is the best risk/reward ratio.

"Multiple" is an exaggeration when all were based on the same underlying dataset that does not look at physiological levels. You have yet to offer specific quotes from the study or explain how they are relevant to your position. The fact that hypogonadism sucks says nothing about how normal levels compare to unnaturally high levels.

I showed the accurate pharmacokinetic calculations for where the various doses would put patients, clearly illustrating that even when splitting 50 mg into two doses it still leaves most patients at levels too low to see good benefits.

Those numbers are at best misleading and you offer no evidence that 50 mg TC/week in divided doses cannot produce "good benefits". I am a counterexample, and there's nothing particularly unusual about my case. I've conceded that 50 mg TC /week is not optimum for most men, but it will resolve the most blatant side effects of hypogonadism if dosed appropriately. Starting at 50 mg TC/week is superior to starting at 100+ mg/week because it avoids the side effects of higher doses, along with the withdrawal-type symptoms seen when titrating down.

Now about the numbers. Let's go by free testosterone because that's the primary driver of effects. Official recommendations would be based on healthy population averages, but I'll be more generous and say that healthy youthful levels are the preferred target. The healthy youthful range for Vermeulen calculated free testosterone (cFTV) is about 7.0-22.5 ng/dL. This is the morning peak value. The range for average values is about 25% lower to account for diurnal variation: 5.3-16.9 ng/dL. The overall average cFTV level is thus about 11 ng/dL. This is driven by average healthy youthful production of about 6.5 mg T/day. A protocol using 50 mg TC/week gives 5 mg T/day, a 23% decrease from the average. Free testosterone scales with dose, so the drop leads to average cFTV of 8.7 ng/dL, which is still comfortably in the second quartile.

It's worth mentioning that older men, who are more likely to be the ones on TRT, have lower clearance rates than young men and therefore require less testosterone to achieve the same levels as young men. This cohort will suffer more as a result of high initial TRT dosing. For example, my starting dose of 98 mg TC/week gave me an average cFTV of 26 ng/dL. That's more than double the youthful average level of 11, and shows that a divided dose of 50 mg TC/week would have been an appropriate starting point. @readalot's chart suggests that my clearance rate is not that much lower than average, meaning that this is not an uncommon occurrence. Indeed, there are plenty of anecdotal reports of 100 mg TC/week putting men's total testosterone over 1,200 ng/dL, about double the healthy average.

Meanwhile you say you’re offering “science based guidance”… then the first link you share has 100 mg per week as a recommended starting dose. So you can share links which support it, but others can’t?

I shared two direct quotes advocating dosing to achieve mid-range serum testosterone levels in TRT, with said guidance based on dozens of peer-reviewed studies and thousands of patients. You have yet to share a single quote based on peer-reviewed work that advocates starting TRT at above-physiological levels. These facts hurt your credibility considerably.

... And yes, if you tell people that 50 mg is a great dose for starting trt it’s possible that I’ll respond again with tons of evidence that counter your point. If you feel the need to censor me for that then go ahead.

I do have a few conciliatory words: For 10 years I have been reading accounts of men being harmed in various way by starting and often continuing TRT with excessive doses. As a result I approach this subject with passion, and sometimes this passion impinges on my professionalism. I acknowledge that your position is less extreme than many, and your advice is less injurious than when actual doctors are starting patients at higher doses than even you suggest.

I believe my criticisms of your arguments are sound, but I acknowledge that we should avoid becoming like the political parties, who often end up energetically defending even the more marginal positions. That fact is that I do typically advocate for starting TRT with 60-80 mg TC/week. I still believe that 50 mg/week is reasonable, but it does entail more injections and a higher probably of needing to titrate upwards. I suspect that for the average man taking 50 mg TC/week would be something like using Androgel, with its notorious absorption issues; it's better than nothing, but there's room for improvement.

Let me also reiterate that I am not opposed to men exploring higher doses after they have sufficient experience with the physiological range. This prior reference period allows for the recognition of dose-related side effects. Starting high immediately means that new patients might think that problems are naturally part of TRT, or worse—and common—they think that an already high dose is not high enough.

In any case, with respect to other threads where you feel the urge to contradict the principle of starting TRT with mid-physiological levels, I think it's reasonable to require direct evidence from you. You're in a bind there, because if there were any peer reviewed articles advocating your position—to initially dose in a way that almost guarantees above-physiological levels—then you would have quoted them many times already.

Meanwhile, I demonstrated that 50 mg TC/week can be physiological when split appropriately. This was done in a transparent fashion, and I can provide references if you want to question the underlying figures: average testosterone production, normal range for cFTV and peak testosterone variance from average.

 

[FunkOdyssey]

I acknowledge that your position is less extreme than many, and your advice is less injurious than when actual doctors are starting patients at higher doses than even you suggest.

We need someone to come on here arguing for everyone to start at 200 mg weekly to put things in perspective. You guys aren't really that far apart in the end.

Where's Keith Nichols when you need him?

 

[Phil Goodman]

You have offered very little to support this claim. You continue to point to the fact that taking 50 mg TC once per week yields poor results. This says nothing about how achieving physiological levels via divided doses of 50-75 mg per week compares to the above-physiological doses that you advocate.



The studies indicate reasonable short-term safety. However, you cannot say for sure that those experiencing elevated hematocrit would not face more severe consequences with long-term exposure. As has been discussed in these pages at length, the higher blood viscosity does lead to the potential for increased wear and tear on the vasculature in susceptible individuals. Cardiotoxicity through integrated exposure is a possibility, though hopefully a very small one at these doses.

Then there are anecdotal reports of problems with higher testosterone levels, including issues with libido and sexual function. I have collected some of those documenting how lower doses led to significant improvements. These occur with such frequency that they are not easily dismissed. The primary argument against them is that they do not give a good idea of the actual frequency of these problems; men doing well are less likely to be asking for help in the forums. On the other hand, some studies have suggested significant "churn" and drop rates for some forms of TRT, hinting at more widespread problems and lack of satisfaction with results.



"Multiple" is an exaggeration when all were based on the same underlying dataset that does not look at physiological levels. You have yet to offer specific quotes from the study or explain how they are relevant to your position. The fact that hypogonadism sucks says nothing about how normal levels compare to unnaturally high levels.



Those numbers are at best misleading and you offer no evidence that 50 mg TC/week in divided doses cannot produce "good benefits". I am a counterexample, and there's nothing particularly unusual about my case. I've conceded that 50 mg TC /week is not optimum for most men, but it will resolve the most blatant side effects of hypogonadism if dosed appropriately. Starting at 50 mg TC/week is superior to starting at 100+ mg/week because it avoids the side effects of higher doses, along with the withdrawal-type symptoms seen when titrating down.

Now about the numbers. Let's go by free testosterone because that's the primary driver of effects. Official recommendations would be based on healthy population averages, but I'll be more generous and say that healthy youthful levels are the preferred target. The healthy youthful range for Vermeulen calculated free testosterone (cFTV) is about 7.0-22.5 ng/dL. This is the morning peak value. The range for average values is about 25% lower to account for diurnal variation: 5.3-16.9 ng/dL. The overall average cFTV level is thus about 11 ng/dL. This is driven by average healthy youthful production of about 6.5 mg T/day. A protocol using 50 mg TC/week gives 5 mg T/day, a 23% decrease from the average. Free testosterone scales with dose, so the drop leads to average cFTV of 8.7 ng/dL, which is still comfortably in the second quartile.

It's worth mentioning that older men, who are more likely to be the ones on TRT, have lower clearance rates than young men and therefore require less testosterone to achieve the same levels as young men. This cohort will suffer more as a result of high initial TRT dosing. For example, my starting dose of 98 mg TC/week gave me an average cFTV of 26 ng/dL. That's more than double the youthful average level of 11, and shows that a divided dose of 50 mg TC/week would have been an appropriate starting point. @readalot's chart suggests that my clearance rate is not that much lower than average, meaning that this is not an uncommon occurrence. Indeed, there are plenty of anecdotal reports of 100 mg TC/week putting men's total testosterone over 1,200 ng/dL, about double the healthy average.



I shared two direct quotes advocating dosing to achieve mid-range serum testosterone levels in TRT, with said guidance based on dozens of peer-reviewed studies and thousands of patients. You have yet to share a single quote based on peer-reviewed work that advocates starting TRT at above-physiological levels. These facts hurt your credibility considerably.



I do have a few conciliatory words: For 10 years I have been reading accounts of men being harmed in various way by starting and often continuing TRT with excessive doses. As a result I approach this subject with passion, and sometimes this passion impinges on my professionalism. I acknowledge that your position is less extreme than many, and your advice is less injurious than when actual doctors are starting patients at higher doses than even you suggest.

I believe my criticisms of your arguments are sound, but I acknowledge that we should avoid becoming like the political parties, who often end up energetically defending even the more marginal positions. That fact is that I do typically advocate for starting TRT with 60-80 mg TC/week. I still believe that 50 mg/week is reasonable, but it does entail more injections and a higher probably of needing to titrate upwards. I suspect that for the average man taking 50 mg TC/week would be something like using Androgel, with its notorious absorption issues; it's better than nothing, but there's room for improvement.

Let me also reiterate that I am not opposed to men exploring higher doses after they have sufficient experience with the physiological range. This prior reference period allows for the recognition of dose-related side effects. Starting high immediately means that new patients might think that problems are naturally part of TRT, or worse—and common—they think that an already high dose is not high enough.

In any case, with respect to other threads where you feel the urge to contradict the principle of starting TRT with mid-physiological levels, I think it's reasonable to require direct evidence from you. You're in a bind there, because if there were any peer reviewed articles advocating your position—to initially dose in a way that almost guarantees above-physiological levels—then you would have quoted them many times already.

Meanwhile, I demonstrated that 50 mg TC/week can be physiological when split appropriately. This was done in a transparent fashion, and I can provide references if you want to question the underlying figures: average testosterone production, normal range for cFTV and peak testosterone variance from average.

Still plenty that I disagree with, but I think you make a good point that neither of us should dig in and become dogmatic about our approaches. I will say more on this front when I conclude this post, but wanted to make sure I start off on that foot and state that I appreciate you pointing that out. Sometimes in debates it easy for the posts to build off of each other and end up at a destination that doesn’t really serve either side and becomes counterproductive.

You have offered very little to support this claim. You continue to point to the fact that taking 50 mg TC once per week yields poor results. This says nothing about how achieving physiological levels via divided doses of 50-75 mg per week compares to the above-physiological doses that you advocate.

Again, I already showed that dosing at 25 mg twice/week does little to take care of the issue of the dose being too low. I didn’t say nothing… I said plenty of things. If you’d like to show some studies that show what blood levels would look like on those doses then feel free to share them. Otherwise YOU are the one who has said nothing about how splitting the dose resolves the issue of the dose being too low.

"Multiple" is an exaggeration when all were based on the same underlying dataset that does not look at physiological levels. You have yet to offer specific quotes from the study or explain how they are relevant to your position. The fact that hypogonadism sucks says nothing about how normal levels compare to unnaturally high levels.

If 50 mg once per week results in hypogonadism then it is very likely that 25 mg twice per week does the same in those patients. If you’d like to provide studies which show that isn’t the case then again, feel free to share them. As best I can tell your “calculations” above are just a good example of the saying “if you torture numbers long enough they’ll tell you whatever you want to hear”. I don’t want your calculations, I want real-world studies that conclusively show where those doses put the levels of patients.

The studies are relevant to my position because they clearly show that 125 mg/week produced much better results in the participants than 50 mg/week did. I’m not sure how much more obvious it could be as the why that’s relevant to my point.

Now about the numbers. Let's go by free testosterone because that's the primary driver of effects.

With all due respect, this is just bobbing and weaving on your part. Earlier in the thread when you shared the links you said using total testosterone was perfectly fine, and then when I pointed out where the total testosterone levels would be for people on your preferred starting dose(and how they would leave patients too low) you pivot and switch to free t. But fine, I do agree that free t is more important. Since that’s the case, please provide studies which show what the free t results are for people on 50 mg/week. Again, I’m not interested in your calculations because you’ve already tried to pass off a calculation to tell us the half life of cyp is 4 days… I want actual real-world evidence.

It's worth mentioning that older men, who are more likely to be the ones on TRT, have lower clearance rates than young men and therefore require less testosterone to achieve the same levels as young men. This cohort will suffer more as a result of high initial TRT dosing. For example, my starting dose of 98 mg TC/week gave me an average cFTV of 26 ng/dL. That's more than double the youthful average level of 11, and shows that a divided dose of 50 mg TC/week would have been an appropriate starting point.

Tons of studies which look into the safety and results of men on trt are done with subjects that are older… actually the vast majority of them are. And one of the ones I referenced was actually carried out with an entirely older test group. Yet the results were the same… 125 mg per week provided the best results and blend of positive effects with minimized risks. If anything your point here only supports the case that younger people may be able to tolerate even higher doses.. not that I’m advocating for that, just highlighting that the numerous studies on trt don’t support your point there.

With regard to your personal experience, based on the dose you landed on I think we can all agree you are clearly an outlier and you yourself have even said your dose won’t work for most people. Hell, you’re the only person I’ve ever heard of successfully treating themselves with such a low dose.

I shared two direct quotes advocating dosing to achieve mid-range serum testosterone levels in TRT, with said guidance based on dozens of peer-reviewed studies and thousands of patients. You have yet to share a single quote based on peer-reviewed work that advocates starting TRT at above-physiological levels. These facts hurt your credibility considerably.

The direct quotes you shared regarding where to aim for total t levels advocate hitting those levels at trough on a weekly injection protocol. To get to those levels at trough, the patient would have to spend substantial time at what you would call supraphysiological levels. So this is yet another example of you sharing things that support my case while hilariously saying it hurts my credibility. You shared this study first - https://academic.oup.com/jcem/article/103/5/1715/4939465?login=false

The recommended dose here is 150-200 mg every two weeks or 75-100 once per week. Tell me how much time the guy injecting 200 mg every two weeks will spend at supraphysiological levels. Also, they established those after reviewing lots of studies and deciding on does that would put patients in the “mid-normal” range.

This is the 2nd link you shared

Testosterone Deficiency Guideline - American Urological Association

Testosterone testing and prescriptions have nearly tripled in recent years; however, it is clear from clinical practice that there are many men using testosterone without a clear indication. AUA identified a need to produce an evidence-based document that informs clinicians on the proper...

www.auanet.org

This is from that link

Confirmed from Table 2 of the AUA guideline:
For testosterone cypionate and testosterone enanthate, the starting dose is 100 mg, with a dose range of 50–200 mg every 7–14 days, administered into the gluteal muscle or lateral upper thigh. Monitoring of testosterone levels is recommended after cycle 4.

The rest of your links were similar with regards to blood levels aimed for but didn’t provide specific dosages as far as I could tell. So out of all the links you shared, you actually just supported MY case.

Do you honestly not realize you are sharing materials which support my view? If so I don’t understand how because I’ve pointed it out repeatedly throughout this thread.

Meanwhile, I demonstrated that 50 mg TC/week can be physiological when split appropriately. This was done in a transparent fashion, and I can provide references if you want to question the underlying figures: average testosterone production, normal range for cFTV and peak testosterone variance from average.

Yes, share this again because I don’t remember seeing it. I’ve seen your constant calculations about what a person naturally produces, but I don’t remember seeing any studies shred by you which showed the levels that 50 mg per week split into doses resulted in. I’m not interested in your calculations, I’m interested in real-world data.





To close, I’ll say that I know you come from a position of wanting to help others and that should be recognized. I put myself in that boat as well so we should probably focus more on our similarities than differences. I think that is true of most posters here and one of the things that makes this site great. I’ve seen you give lots of good advice on here over the years, and honestly, all things said, it’s probably likely that we agree on more than we disagree on. We may disagree on this front in some ways, but honestly it isn’t as rabidly as it appears from this conversation. I mean, it’s not like you’re a hardline “people have to start at 50!” And I’m not hardcore about starting at 125. All things said(and I don’t want to put words in your mouth)…I don’t think you would have a huge problem with someone starting at 75 then going up to 100 if symptoms and bloodwork dictated. Likewise, I’d be fine with that as well, or if someone started at 125 and levels looked fine but they wanted to adjust dosing I’d likely suggest they go down instead of up. So again, I’d say we’re probably closer in thinking than most would imagine, and certainly closer than this conversation makes it appear.

 

[Mastodont]

One thing worth considering is even if a low weekly dose divided in small frequent doses lands testosterone numbers in range, it is often the case that men just don't feel good enough or lack libido. Is it not so that even Cat himself was not satisfied with only test?