Very confusing. Looks like there are two camps. The one that says go as high as possible with testosterone to relieve symptoms. Even if this means total t of 1200-1600 or above and free t 30-50 ng/dl with just letting the estrogen go even if its 100 pg/ml. And never use an AI. (dr nichols, neil rouzier etc)
And the other that says lower dosages for lower total t, free t and lower estrogen. Use an AI if needed to lower estrogen.
No one is saying you have to stay in the reference range for TT/FT as there is nothing wrong with one running a higher TT 1200+ or FT level in the 30-50 ng/dL as long as one is not experiencing any side effects and blood markers are in a healthy range.....but again depending on ones SHBG whether high/normal/low it comes down to what
TT does one need to achieve a healthy FT in order to experience relief/improvement of low-t symptoms while minimizing side effects and keeping blood markers in a healthy range.
Most men would do well with a FT in the 20-30 ng/dL range where as others may need levels higher.
Not everyone can handle running higher TT/FT levels and in cases of low SHBG running too high a FT level would result in high e2/free estradiol which can end up putting a damper on running an effective protocol unless an aromatase inhibitor is used sensibly.....although it would be preferable if one could get away without having to use an a.i.
Do understand that one with a higher SHBG would need to run a higher TT in order to achieve the same FT levels compared to one with low SHBG.
As I stated previously:
If we use the
TruT Free Testosterone Calculator by FPT
Taking your
TT 779 ng/dL,
SHBG 14.4 nmol/L and
Albumin 4.3 g/dL (mean)
than your
FT 29.31 ng/dL would be in top of the
reference range 16-31 ng/dL
Now your FT levels are near the top of the reference range at trough.....again most likely your e2/free estradiol is high but again we have no idea where your e2/free estradiol truly sits due to not having access to the proper testing method.
Can you try running higher FT levels.....sure but do understand that not only will your e2/free estradiol increase but it will result in an increased hemoglobin/hematocrit level and possibly have a negative effect on lipids (decrease HDL).
I would tread lightly trying to push your TT/FT levels really high seeing as you have low SHBG.
As an example if you wanted to push your
FT levels close to the upper end
50 ng/dl (well over the
reference range of 16-31 ng/dL -
TruT Free Testosterone Calculator by FPT
Than with your
SHBG of 14.4 nmol/L you would need to run a
TT of 1300 ng/dL to achieve a
FT of 49.86 ng/dL
Looking at one with
high SHBG 70 nmol/L they would need to run a
TT of roughly 1500 ng/dL to achieve a
FT of 50.28 ng/dL
The one that says go as high as possible with testosterone to relieve symptoms. Even if this means total t of 1200-1600 or above and free t 30-50 ng/dl with just letting the estrogen go even if its 100 pg/ml. And never use an AI. (dr nichols, neil rouzier etc)
Both solely prefer the transdermal method and one is notorious for transdermal cream scrotal application (twice daily am/pm) and one of the main benefits is a large increase in DHT which may negate the effects of high e2.
Doubtful many using injectable could tolerate running TT 1500+.....let alone 1200+ without experiencing negative effects due to very high FT levels.
Even than using transdermal whether standard body application or scrotally some would not be able to handle running such high TT/FT levels.
If anything one would have to run TT levels of 1300-1500+ to achieve FT levels in the 50 ng/dL range and only in cases of absurdly high SHBG levels 100 nmol/L (or higher) or possible AR resistance (older men or previous steroid users) would one need to run TT levels of 1600+ ng/dL.
Regarding these doctors stating running FT levels in the 30-50 ng/dL range are you sure their patients FT levels are all tested using the
gold standard equilibrium dialysis or taking their
TT,SHBG,Albumin and using the:
TruT™ by FPT
The novel, FDA-registered TruT™ algorithm uses modern understanding of molecular interactions to improve the accuracy of free-T calculations.
* For all we know these patients FT levels whether 30-60 ng/dL are done using flawed FT testing methods!
