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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
“High-Normal T”
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<blockquote data-quote="BigTex" data-source="post: 249543" data-attributes="member: 43589"><p>My mistake, [USER=38109]@Cataceous[/USER] and I apologize for the misquote, you did say well over 100mg. However, since I am not a doctor I am not going to second guess some of the reasoning for any doses beyond 100mg without blood work, seeing the patient and being able to ask questions to the doctor. Would I question their decision as a patient, absolutely I would. No, you can't just look at blood work which is why I think we both agree it is best scenario to start low and titrate up. Pharmacogenomic tests could also be run in advance to help determine proper dosing but those are quite expensive.</p><p></p><p>I have seen guys in sport that were vey poor responders and needed quite a bit more mg's than what I ever took to get optimal any results. Genetics in this case are very important. I have also seen in the sport of BB that everyone is very individual in how their body responds to certain drugs, doses and combinations. This all comes into play the night before a show. Cookie cutter applications never get perfection. No doubt their field of medicine is the same way. IMHO, 200mg/7 days is a little high, however if you can handle that much with no side effects and all of your symptoms are gone where is the problem? Have we proven a dose of 200mg/7d to be unhealthy?</p><p></p><p>You are absolutely right [USER=16042]@Blackhawk[/USER] "starting low" is not well defined. Our hormonal system is so individual I just don't believe you can put a static number on it without having some idea how we metabolize drugs. For instance, the metabolism and excretion of many drugs decrease, requiring that doses of some drugs be decreased. Toxicity may develop slowly because concentrations of chronically used drugs increase for 5 to 6 half-lives, until a steady state is achieved. So a 30 year old with low T may in fact be able to handle a larger does and have no negative health effects than say a 65 year old.</p><p></p><p>Further, age-related slowing of gastrointestinal motility can prolong movement of drugs through the stomach to the small intestine, thus there is a delay in the absorption and onset of action and reduce peak drug concentrations and pharmacologic effects. Again, a 30 year old will may not have this problem and may need a higher dose of medication.</p><p></p><p>Serum albumin decreases and alpha 1-acid glycoprotein increases with age. The clinical effect of these changes on serum drug binding varies with different drugs and could effect dosing in older populations.</p><p></p><p>One of the most important pharmacokinetic changes associated with aging is decreased renal elimination of drugs. <em>After age 40, glomerular filtration rate (GFR) decreases an average of 8 mL/min/1.73 m2/decade (0.1 mL/sec/m2/decade)</em>; however, the age-related decrease varies substantially from person to person. One might think this could make dosing kind of challenging.</p><p></p><p>I think we are very critical of TRT doctors who for the most part are delving into a relatively new area with very little research to guide our decisions. Over the last two decades, various guidelines and recommendations for TRT have been developed and have evolved with different points of view, from expert opinions to official statements.</p><p></p><p><a href="https://www.pillcheck.ca/2017/11/15/drug-metabolism-and-aging/" target="_blank">Drug Metabolism and Aging - Pillcheck</a></p><p></p><p><strong>Where do we start? - My guess is <125mg/wk </strong></p><p></p><p><em>The 125-mg dose was associated with high-normal testosterone concentrations and low frequency of adverse events, no serious adverse events, and substantial gains in FFM (+4.2 kg) and leg press strength (+28 kg); thus, this dose provided the best trade-off between anabolic effects and adverse events</em>.</p><p></p><p>[URL unfurl="true"]https://academic.oup.com/jcem/article/90/2/678/2836564[/URL]</p><h2></h2></blockquote><p></p>
[QUOTE="BigTex, post: 249543, member: 43589"] My mistake, [USER=38109]@Cataceous[/USER] and I apologize for the misquote, you did say well over 100mg. However, since I am not a doctor I am not going to second guess some of the reasoning for any doses beyond 100mg without blood work, seeing the patient and being able to ask questions to the doctor. Would I question their decision as a patient, absolutely I would. No, you can't just look at blood work which is why I think we both agree it is best scenario to start low and titrate up. Pharmacogenomic tests could also be run in advance to help determine proper dosing but those are quite expensive. I have seen guys in sport that were vey poor responders and needed quite a bit more mg's than what I ever took to get optimal any results. Genetics in this case are very important. I have also seen in the sport of BB that everyone is very individual in how their body responds to certain drugs, doses and combinations. This all comes into play the night before a show. Cookie cutter applications never get perfection. No doubt their field of medicine is the same way. IMHO, 200mg/7 days is a little high, however if you can handle that much with no side effects and all of your symptoms are gone where is the problem? Have we proven a dose of 200mg/7d to be unhealthy? You are absolutely right [USER=16042]@Blackhawk[/USER] "starting low" is not well defined. Our hormonal system is so individual I just don't believe you can put a static number on it without having some idea how we metabolize drugs. For instance, the metabolism and excretion of many drugs decrease, requiring that doses of some drugs be decreased. Toxicity may develop slowly because concentrations of chronically used drugs increase for 5 to 6 half-lives, until a steady state is achieved. So a 30 year old with low T may in fact be able to handle a larger does and have no negative health effects than say a 65 year old. Further, age-related slowing of gastrointestinal motility can prolong movement of drugs through the stomach to the small intestine, thus there is a delay in the absorption and onset of action and reduce peak drug concentrations and pharmacologic effects. Again, a 30 year old will may not have this problem and may need a higher dose of medication. Serum albumin decreases and alpha 1-acid glycoprotein increases with age. The clinical effect of these changes on serum drug binding varies with different drugs and could effect dosing in older populations. One of the most important pharmacokinetic changes associated with aging is decreased renal elimination of drugs. [I]After age 40, glomerular filtration rate (GFR) decreases an average of 8 mL/min/1.73 m2/decade (0.1 mL/sec/m2/decade)[/I]; however, the age-related decrease varies substantially from person to person. One might think this could make dosing kind of challenging. I think we are very critical of TRT doctors who for the most part are delving into a relatively new area with very little research to guide our decisions. Over the last two decades, various guidelines and recommendations for TRT have been developed and have evolved with different points of view, from expert opinions to official statements. [URL='https://www.pillcheck.ca/2017/11/15/drug-metabolism-and-aging/']Drug Metabolism and Aging - Pillcheck[/URL] [B]Where do we start? - My guess is <125mg/wk [/B] [I]The 125-mg dose was associated with high-normal testosterone concentrations and low frequency of adverse events, no serious adverse events, and substantial gains in FFM (+4.2 kg) and leg press strength (+28 kg); thus, this dose provided the best trade-off between anabolic effects and adverse events[/I]. [URL unfurl="true"]https://academic.oup.com/jcem/article/90/2/678/2836564[/URL] [HEADING=1][/HEADING] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
“High-Normal T”
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