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The improved DHT:T ratio has been below my radar. It's a selling point for me, given my general preference for staying in the confines of normal physiology. There may not be much specific evidence of harm in an elevated ratio, but I'd say the burden of proof should be on those defending the...

Let's ask a different question then. Aside from the possible GI link, have any clinically significant differences been found? If not then the whole "native T" thing still seems like marketing obfuscation to me.

Free testosterone is what's relevant here, not total. His is considered to be healthy and normal for an adult male, and further indicates that the chance of being overtly hypogonadal is quite small. You can argue that statistically it's likely to be somewhat below the average for his age...

@madman has some excellent posts explaining the mechanics of honeymoon periods. When you read men's accounts of these periods you might think TRT is a panacea. The problem is that often the post-honeymoon let-downs are reported in different threads, so you might miss the reality of TRT. The...

Me: Grok, rewrite this sentence so that even a child can understand it: "Without an age-stratified reference range there's no evidence that your testosterone is particularly low for your age." Grok: We don't have a special chart for this test that shows the normal amounts of testosterone for...

It's challenging to give advice while the story is shifting. The return of morning erections is significant and suggests you should continue with the oral testosterone. You're unlikely to do much better with propionate, although you might enjoy a short-lived honeymoon period. With respect to...

The lab work you posted earlier and the lack of improvements from oral testosterone are suggesting that low testosterone is not your problem. It's not impossible that your elevated E2/T ratio is contributing to issues. If you can lose more weight then that is the preferred way to reduce the...

Unfortunately you are getting some dubious advice from Vince. Without an age-stratified reference range there's no evidence that your testosterone is particularly low for your age. TRT clinics have an inherent conflict of interest, so just because they might prescribe TRT doesn't mean it's...

Solution: A quick-and-dirty auto-loader. https://www.excelmale.com/threads/need-help-with-t-cypionate-vials-single-vs-multiple-what-do-you-guys-use.27794/post-255297 Yes. I had originally found that getting roughly the same amount of testosterone from each ester led to a diurnal variation in...

Not sure what you're looking for. Your doctor had previously prescribed the obvious solution: lowering your dose to a more physiological level. It sounds like you felt some withdrawal symptoms and gave up too quickly. Apparently you also donate blood without telling your doctor. I think you are...

You're being too charitable. His statement is just ignorance delivered with an air of authority. In the context of the overall hormonal disruption caused by starting TRT, the relatively low dose of hCG is a ways down the list of potential primary causes of sexual dysfunction. @radman: The main...

Unfortunately the DIY approach is likely the only option for getting a propionate blend with a higher fraction of propionate. Discussed in detail here: https://www.excelmale.com/threads/tips-on-how-to-blend-propionate-with-enanthate-or-cypionate.23485/ Obtaining pharma-grade propionate may be...

Though I can't be definitive, I suspect low and steady exogenous testosterone may provide better results in these cases. The idea is to provide a fixed base level of testosterone and then let the HPTA do the fine-tuning. Faster-acting testosterone such as oral or nasal products produce high...

There were two guys with primary hypogonadism on the old PeakTestosterone forum using this kind of treatment. I thought I might have discussed it with a different guy here as well. Consider the relative rarity of guys with primary hypogonadism—I recall Dr. Saya commenting on how infrequent these...

I was defining suppression as being below normal baseline levels. It's just semantics. If you want to say that hyper LH/FSH levels are being suppressed back to normal that's fine. But while that's happening serum testosterone is rising to normal levels—before suppression of endogenous...

From the Grok AI: The premise—that low-dose exogenous testosterone, titrated gradually, can normalize serum testosterone levels in primary hypogonadism while reducing initially elevated LH and FSH back to normal ranges without full suppression—aligns with physiological reasoning rooted in the...

This study applied to men who had natural testosterone production completely suppressed by a GnRH agonist. It's an apples-to-oranges comparison. The OP's doctor has probably forgotten more about TRT than you'll ever know. You are thinking about secondary hypogonadism. With primary the...

Some guys do experience a loss of sensitivity under TRT. I've had that myself and suspect it's from excessive dosing of testosterone and/or disruption of other hormones. If this is the case then the goal should be to restore realistic healthy levels of testosterone and other hormones. Bear in...

Nebido—testosterone undecanoate—is viable, but it's not ideal when you are still planning to make dose adjustments. Either testosterone cypionate or testosterone enanthate would be better, although these should be injected at least three times a week or every other day to smooth out levels. Once...

Yes, it is fine to do that. Other guys have reported following this protocol. It should lead to very stable levels, for better or worse.

You have a wise doctor. It's not common for guys with primary hypogonadism to get such good advice. All I would add is that dividing the dose into 2-3 injections per week is a good idea—if he didn't already suggest that. It is correct that with primary hypogonadism, exogenous testosterone adds...

Some very rough numbers: Twice-weekly injections might give a 50% drop from peak to trough. EOD probably cuts that to 5-10%. Average serum testosterone levels stay about the same at the same dose. For example: suppose with twice weekly injections total testosterone is dropping from a peak of...

Assuming this is morning testosterone: Your cFTV result of 8 ng/dL is borderline. Some men do have symptoms at this level, even though it is considered to be within the normal range. I would be hesitant to start conventional TRT without more information. If you have access to short-acting...

That title is for those who don't provide proper attribution and quoting. It means there are studies demonstrating correlation, which may hint at causality, but are not definitive. I included one of several at the bottom. If you are truly interested then I can provide more of the references...

There is some evidence for such mental health issues, including anxiety. Per Grok: There is emerging evidence from psychology and related fields supporting the hypothesis that a lack of challenges or adversity—sometimes framed as excessive comfort, overprotection, or "coddling"—can contribute...

Setting aside strictly biochemical dysfunction, I think in some ways it's the opposite. We evolved to face challenges and overcome them. When everything is handed to you and you can't feel a sense of purpose or accomplishment then you get mental health issues.

Don't rely on the so-called direct free testosterone tests. They are useless, and the dose linearity might not be reflected in them. Instead either use equilibrium dialysis or Vermeulen calculated free testosterone. For the latter, measure SHBG and ideally albumin in addition to total...

It's human nature to strive for better. If we settled for "good enough" then we'd still be cave dwellers.

You can estimate the peak-trough ratio based on the half-life of the testosterone ester. The estimate I use for weekly injections of testosterone cypionate is 2.5, which stems from a five-day half-life. This would put your peak at over 1,500 ng/dL. However, half-lives vary among individuals, so...

The week-long stabilization period is reasonable unless you're converting from a long-lived injected testosterone ester. Then the influence could last a few weeks leading to uncertainty about levels. Waiting a full three months would be good, but maybe not necessary. If you've already been on...

If anything it would be about the half-life rather than the SHBG "charge" time. A good rule of thumb is to allow five half-lives for stabilization. Xyosted is somewhat unusual because the lack of excipients extends its half-life to 10 days, about double that of conventional formulations of...