Ok, there are other things on the ED front like beet root powder for nitric oxide for example, however the libido issue sounds like you've overshot to the upside on some aspect of Testosterone, so letting it come down and then titrating up only if necessary and after libido has returned seems reasonable.
Nothing beats someone's certainty that something works. I have no idea how anyone can cut a tiny 1 mg pill to achieve a dose of 0.125 mg, but I admire your determination. The dose won't harm anything, and the key is that you believe it works. Keep taking it!
I don’t cut the pills, that’s what empower compound them at. When I say my libido was good I mean my mental desire to want to have sex, physically there was nothing there. Struggled with ED and maintaining your erection without Cialis. I guess we all kind of define libido differently. My free T was below 10 at peak and my total testosterone hovered in the 330s to 340s at peak before TRT
journals.lww.com
Thanks for the in-depth reply. There’s a lot to digest there. A couple things to give a little more context.Defy wanted to start you on 150 mg T/week wonder how that would have worked out!
Remeber I stated that the most common starting dose is 100 mg T/week or better yet 50 mg T twice-weekly.
Look at the robust T levels you achived injecting 100 mg T split 3X/week!
As I have been preaching for years on the forum most men can easily achieve a healthy let alone high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.
You also have those outliers who cam still a achieve a robust trough FT injecting <100 mg/week splt into more frequent injections.
Now regarding your current labs/sides.
First off you never even tested at the true trough (lowest point) before your next injection.
You are injecting 100 mg T splt 3X/week (M/W/F).
Your true trough on said injetcion protocol would be Monday morning 72 hrs post-injection.
You had your blood work done Wednesday morning roughly 48 hrs post-injection.
As you can see you are hitting a healthy high-end TT 798 ng/dL and with lowish SHBG 18.8 nmol/L your FT is high but keep in mind you never tested your FT using a accurate assay the gold standard Equilibrium Dialysis.
You had it tested using the direct immunoassay which should not be used/relied upon.
Not sure why you did not just pay out of pocket and test your FT using what would be considerwed the most accuarate assay Quests Equilibrium Dialysis which is offered through Nelson's discounted labs.
Testosterone, Free (Equilibrium Dialysis) and Total, MS | Discounted Labs
Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.
I stressed this point in one of your other threads!
Always need to know where yurn trough FT level truly sits!
This is critical!
Even then if we calculate your FT using the linear law-of-mass action Vermeulen by plugging in your high-, end TT 798 ng/dL, lowish SHBG 18.8 nmol/L and Albumin 4.3 g/dL you would be hitting a top-end FT 24.7 ng/dL.
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The only way to know where FT truly sits is to have it tested using the most accurate methods/assays (ED/UF) especially in cases of altered SHBG.
The gold standard would be Equilibrium Dialysis.
If one did not have access (highly doubtful if you reside in the US) to such then you would need to use/rely upon the go to calculated linear law-of-mass action cFTV which will give a good approximation but keep in mind it tends to overestimate FT.
As I have stated numerous times on the forum you always have the option of using/relying upon calculated FT which would be the linear law-of-mass action cFTV as it has already been validated twice (1st time was done using TT/SHBG assays no longer available) and was then eventually re-validated using current state-of-the-art ED method (higher order reference method) let alone more recently against CDCs standardized Equilibrium Dialysis assay.
Yes it tends to overestimate slightly but it is nothing to fret over!
*Calculated free T using high-quality T and SHBG assays has been considered the most useful for clinical purposes [99]. All algorithms suffer from some inaccuracies, including the variable quality of SHBG IAs [100], not replicating the non-linear nature of T-SHBG binding, different and inaccurate association constants for SHBG and albumin binding [101], and variable agreement with equilibrium dialysis results [99,100]. However, until further developments in the field materialize, the linear model algorithms [in particular, the most used Vermeulen equation [102]] appear to give, despite a small systematic positive bias, acceptable data for the clinical management and research[37,103]
Again you are hitting a top-end cFTV 24.7 ng/dL but chances are your FT would be lower than that if you had it tested using the most accuarate assay ED but it would still be on the higher-end.
Even than this is 48 hrs post-injetion not your true trough 72 hrs post-injection so your true trough would most likely be ilower as in the upper teens!
You are definitely hitting a good FT level 48 hrs post-injecion but keep in mind your peak TT/FT and estradiol would be higher.
I see no issue with running a FT where yours sits and this is not even your true trough but the problem here is unfortunately you have been struggling with numerous sides and you are over 2 months in!
No denying that your FT levels most of the week are going to be high/high-end so of course there would be room to bring it down if need be.
I and many would prefer to run a high-end trough FT but again need to keep in mind your injection frequency as there is a huge diffenece between one hitting a high-end/high trough FT injecting daily vs twice-weekl vs once weekly!
Many tend to overlook this which can backfire on you in the long-run!
Downfall here is there are numerous things to look at.
Would not put the sole blame on estradiol let alone injecting strictly sub-q for the side-effects you are experiencing.
Some of the sides you mention (mood, libido and erectile function) can be negatively impacted by lack of quality sleep.
Hard to gauge a protocol when you are not sleeping well!
Could you be one of those who does not fare well running higher-end/high FT levels most definitely but you would need to lower your weekly dose to bring down your FT.
Could you be one of those outliers that falls into the not faring so well when injecting strictyly sub-q.....sure!
The only way you woild know is to try injecting IM.
Could you be one of those who may need to inject more frequently in order to clip the peak--->trough and achieve more stable blood levels throughout the week sure but you would need to manipulate your injection frequency.
I never liked the 3X/week protocol and would have rather injected EOD.
With all that being said remember when I told you the first 6 weeks means nothing when looking at the bigger picture.
Hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks TE/TC) and it is common to experience ups/downs along the way as the body is trying to adjust.
Even then once blood levels have stabilized it will still take a few months for the body to fully adapt to it's new set-point and this is the critical time period when one needs to gauge how they truly feel overall regarding relief/improvement of low-T symptoms and overall well-being.
Every protocol whether first starting TTh or tweaking (increasing/decreasing dose) needs to be given a fighting chance 12 weeks before claiming it was a success or failure.
Could even say 3-4 months.
The only time a protocol should be tweaked 6 weeks in is if your trough FT is too low (highly unlikely) in most cases or if your trough FT is absurdly high and you are experiencing bad sides.
If you are hitting a healthy or high-end trough FT 6-8 weeks in and stil experiencing some issues I would stil give it some time before throwing in the towel.
If it were me I would just bite the bullet but for many they would tend to jump the gun as they lack the understanding of how exogenous T works.
I had a bumpy ride when I first started especially with mood, libido and erections but I stuck with it and as time went on things improved greatly.
Took a while for my body (mentally/physically) to settle in.
I can inject before bed and sleep like a baby.
You have numerous options here but I would not be so dead set on needing to lower your dose just yet.
You know your body best so do what you feel is the most sensible move!
Look over my replies again!
Use of calculated free testosterone in men: advantages and... : Current Opinion in Endocrinology, Diabetes and Obesity
hting its relevance in preventing misdiagnosis and overtreatment of male hypogonadism. Recent findings While there is consensus on measuring total T – comprising sex hormone-binding globulin (SHBG)-bound, albumin-bound, and free T – as a first step in diagnosing male hypogonadism, evidence...
INTRODUCTION
Clinical practice guidelines on the diagnosis of male hypogonadism focus on clinical signs and symptoms of androgen deficiency, as well as biochemical assessment of low circulating testosterone (T). However, there is a longstanding debate, as well as a persisting controversy concerning biochemical assessment of serum T and in particular the use (and misuse) of free T. Free T, as advocated by the free hormone hypothesis, represents...
Ok, which according to you, the top end of the physiological dose would be 50 mg/week. So you have a problem with the fact I’ve never tried 50 mg/week or lower.
On the one hand you have an issue with the fact I’ve never been on a dose of 50 mg/week or lower, and on the other hand you agree that dose is too low for most men. I agree that it is more common for men to start out over-medicated than under. I also tend to agree that for most it’s probably easier to go up instead of down, but we’ve heard from lots of guys here who’ve lowered their dose and felt better pretty quickly, so I’m not too confident in that assertion. I think it’s possible that it’s just been repeated so much people just generally agree with it. Either way, I don’t see the logic in saying most men should start out at a dose that won’t work for them. It’s possible the issues from that approach just aren’t as apparent because it isn’t as common. If everyone started at 50 mg/week we’d almost certainly hear all types of complaints from patients on that protocol. This would be particularly true after natural production shut down and they were left with just the 50 mg/week as their only source of test. It’s also possible that approach would actually have the opposite effect, and men would start too low then feel good after increasing dose which could result in them viewing an increase in dose as a good solution any time they run into issues. Surely they’d hit a wall at some point, but that may be at a dose much higher than if they just started out at 100-120 and stayed there the whole time.
No, according to me, 50 mg TC/week (5 mg T/day) is a mid-level physiological dose. This is in the context of typical production for healthy young men of 6-7 mg/day, and an overall reference range of something like 3-9 mg/day. I have used as little as 3.7 mg T/day in the form of a TP/TE blend and was nowhere close to being hypogonadal. Before you claim I'm an outlier, note that according to @readalot's dose-response graph I am fairly close to average.
Would you say that anything over 70 mg/week is a supra-physiological dose? There a TON of guys are running supra-physiological doses with no issues and lots of benefits. Also, not being hypogonadal != being optimal. You don’t say “I take enough vitamin C to not have scurvy so that’s a good dose”. I agree lowest effective dose is often a good mindset to take, but if there are extra benefits to be had with little to no additional risks then taking that approach makes sense to me. People can take the “lowest dose” mentality too far, just like people can take the “more is better” mentality too far. As with pretty much everything else, a balanced view with good risk/reward ratio is a good approach to take.
By “rough guess” you really mean you’re just making up numbers. I could just as easily say the majority of guys doing well on trt are running Supra-physiological doses… and I have a lot more data and anecdotal reports to support it. I’d also say there is something wrong with starting at 50 mg/week if the odds are stacked against you with regard to whether it would be effective for you(much less optimal). Not to say I tell someone to never try it, but I would tell them that it likely won’t provide them with the best possible outcome(which you agree with).
Would you say that any dose over 90 mg/week is supraphysiological?
If your symptom is that you frequently get sick, then you take a minimal amount of vitamin c daily which causes less illnesses then according to you, you’ve reached your ideal dose. However, tons of studies show that excessive amounts of vitamin c can have lots of benefits, yes even at levels. higher than would ever be obtained from a natural diet. Same with vitamin d. Same with melatonin. Basically anyone who’s ever taken melatonin was “over-medicated” by your definition because they take way more than their body can naturally produce. Yet there are lots of studies showing that can offer a lot benefits. Same with HCG. Again according to your logic any male taking HCG is drastically “over-medicated” because they are taking a LOT more than their body would ever produce naturally. Yet many men experience lots of great benefits from it. Same with creatine. On non-gym days I take 5 g on top of what I get from my diet, and on gym days I take 10 mg. WAY more than my body would ever get or produce naturally. According to you anyone who does this is drastically over-medicated, yet there are literally thousands of studies showing the benefits of doing so. Same with insulin for diabetics. Same with basically of the peptides people use for the wide range of benefits they provide. So no… I don’t agree at all with your view that anyone taking a dose of something above what their body naturally produces is starting too high and “over-medicated”.
If having intelligent meaningful discussions on an Internet forum is the worst side effect of my protocol which has allowed me to feel great, look great, perform great at work, among numerous other benefits then I’d say my protocol must be pretty damn good. But if you’re only at 1.5 mg/day it’s starting to make sense… you argue like a woman.
Agreed, but again we just disagree on what is considered “excessive”.
I’m not talking about insanely high doses of insulin that could kill people. I simply pointed out that a ton of diabetics have a dose which is higher than what a healthy counterpart would produce naturally.
I’m not exaggerating at all, and I made no claims about the benefits shown from the various studies. All I said is that many many studies did show benefits with little to no risks(and again certainly for most people the benefits clearly outweigh the risks) of taking a dose that, as you would define it, is an excessive amount and an example of being over-medicated.
| Potential downside | Evidence most consistent with risk at higher T or TRT peaks |
|---|---|
| Erythrocytosis / polycythemia (↑Hct, blood viscosity) | 13 % of men on TRT developed polycythemia; odds doubled if OSA co-existed. PubMed |
| CV & thrombotic events | Large RCTs with careful monitoring show neutral CV outcomes,TIME but real-world registries link high peaks & hematocrit >54 % to higher stroke/MI risk. |
| Sleep-apnea exacerbation | Mechanistically tied to the erythrocytosis/OSA finding above. |
| Prostate biology | Modern data no longer support a linear T→prostate-cancer link, yet older prospective work did find higher endogenous T linked to PCa risk. PubMed PubMed Evolutionary pressures tend to act on all-cause survival; even modest increases in lethal cancer late in life would select against chronically high T. |
| Injury & risk-taking | Men prescribed TRT already show a high baseline rate of serious injury; testosterone amplifies dominance and impulsivity, raising extrinsic mortality in ancestral contexts. PubMed |
It’s a high end dose according to you. Yet there are numerous studies that show people can do really well at 100-120 mg/week with little to no issues. In fact it’s probably the most studied range with the most data to back up the fact that it is safe while resolving issues in most men.
Again, you’re going to the extreme and talking about mega doses. My point is that even if you’re only taking 3 mg/day you would be taking far more than your body naturally produces, and this is even after factoring in the reduction of bioavailability. So once again we have yet another example of established science showing safe and beneficial doses that exceed what the body naturally creates.
Growth Hormone-Releasing Hormone (GHRH) (e.g., Sermorelin)
You can keep saying that, but as I stated at the beginning of this post, 100-120 is probably the most studied dose for injectable test and has been shown to be safe and effective for the majority of patients.
