First set of Follow Up Labs since Starting TRT. Looking for Feedback

5 mg daily cialis. Started 6 grams of citrine a day this week. It’s libido as much as arousal. That’s the concerning part. Even before therapy, my libido was strong, arousal and erection quality was up and down.
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.
 
I don’t want to take anastrozole, but when I did to alleviate symptoms, it gave me a libido boost some to most of the time in the first two months. I took a very low dose .125. It’s not something I wanna do regularly, but it also tells me that my body doesn’t like where my estrogen is sitting right now, even though for a lot of guys it would be perfect.
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!

If your libido was good before TRT, why did you start? What was your fasted T level measured on two different days?
 
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!

If your libido was good before TRT, why did you start? What was your fasted T level measured on two different days?
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
 
So I just got back my first follow up labs since starting TRT a little over two months ago. I was pretty pleased for the most part, as a lot of my numbers improved from a non-hormone standpoint. I was happy to see the drop in my hematocrit, and a lot of that has to do is me stopping iron supplements for a hemorrhoid bleed that I had. I believe those numbers were just elevated with my initial labs because I have been taking supplements for a long time.

I have been suffering from some mild prostate discomfort and inflammation off and on, and I was happy to see that it was not reflected negatively in my PSA numbers. I had it checked out by my primary care physician a few weeks back, and the digital rectal exam showed some slight swelling, but no other issues. He was not worried and he said it was most likely my body adjusting to TRT.

Now from a hormone standpoint, my numbers were taken at trough last Wednesday. I inject Monday, Wednesday and Friday with a total of 100 mg each week divided up into three shots. I injected Monday morning at 9 AM, and my labs were taken Wednesday morning at 8:30 AM, so almost a 48 hour trough.

Over the past 3 to 4 weeks, I haven’t felt great on my regiment. I’ve been short tempered, been suffering from anxiety and have gotten lightheadedness off and on. I am also showing a lot of sleepiness around dinner time before I eat, especially on the days I inject. My libido has not been very good, and I am suffering from moderate erectile dysfunction and struggling with arousal. My sleep hasn’t been very good, and I wake multiple times at night, with sometimes struggling to fall back asleep.

I also had my DHT tested this time around to see if it was contributing to my prostate issues, and obviously it is not as it is in range. The other thing I noticed is my IGF-1 Numbers went up quite a bit. Honestly, I’m not really sure what that means. I do feel like him a little over medicated, and my estrogen is high based off of my symptoms. The biggest benefits I’ve seen are I have lost about 12 pounds, but the weight loss has plateaued over the last month. I’ve also seen really good body composition changes for it only being two months, as I am lifting weights 3 to 4 days a week.

I would love some feedback from some of you guys, especially @madman. I find you knowledge quite valuable. My labs are posted in the attachment. The document shows my initial labs on April 10, as well as my most recent labs pulled last week.

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.


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.



1752699817265.webp


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!




 
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.


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.



View attachment 52338

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!




Thanks for the in-depth reply. There’s a lot to digest there. A couple things to give a little more context.

My PA told me it didn’t matter when I pulled labs as long as I did it before my next injection. I asked him if he wanted me to wait until Monday to be at a 72 hour trough, and he said it didn’t matter as long as it was at least a 48 hour trough. He said with that he would know how to treat me.

I discussed an every other day injection protocol instead of three times a week when I first started. He said basically that would depend on how I would feel on Sunday without injecting until Monday. Honestly, since I started this whole process, Sunday is usually been one of if not my best days of the week, so I kept it the same.

He did suggest me taking 25 mg of pregnenolone every night to help with my sleep. But since my symptoms were in such flux, I wanted to just wait and have my labs pulled with nothing but straight testosterone in my blood.

I may just write it out with my current protocol. I started feeling some of those same symptoms earlier today, then things settled later on, I had a great workout and I’ve had a great evening at home. That is a first in about three weeks. I’m going give it more of a chance if things continue to improve, and I’m more than willing to be patient about it

My prostate symptoms have dissipated over the last couple weeks, and today was the first injection day where I felt no agitation, not even slight at all.

I am aware that there’s a lot of changing going on in the next couple of months now that my natural production is shut down, and one of the reasons I started the thread was to get feedback from you guys. I’ve been on TRT long term to see if that’s what they thought it was.

I am willing to try doing some IM injections instead of sub Q. I ordered some 29 gauge half inch syringes on Amazon today to give me that option. I have been using 27 gauge, and I know I can use those for a IM as well, but I’d like something a little less hefty if I go that route.

I’m just gonna play it day by day right now and see how my body adjusts. Thank you guys for the feedback.
 
First off, I want to thank everybody giving feedback on this thread. I appreciate it all of your views, and I agree with a lot of what all of you were saying. I know I’m definitely overmedicated on some level for me, but it might not be for other people. Having all the sexual side effects, along with no nocturnal erections or morning wood, as well as the anxiety and short temper.

Even today, I injected my normal .17 Wednesday injection at 6:30 in the morning, and by midday that light headed dizzy feeling and mild fatigue have already kicked in. I haven’t had my follow up from my lab scheduled yet, but it should be sometime next week.

I’m pretty much gonna be at the point where I’m going to drop my dose regardless. I feel like just experimenting and dropping it on my own to see how I feel on a lower dosage. The choice to go 100 a week was mine, as my PA wanted to go 150 a week. I can’t even imagine how messed up I would’ve been if I would’ve stuck to the protocol that they wanted. I have no ill will or am mad, but I know how my body has reacted to other types of therapy in the past, and knew I needed to start lower.

I feel like I’m close to where I need to be, and all I ever hear is that your trough free T should be over 20. I feel like a free T trough in the high teens would probably be best for me based on how I feel with a 23.7 trough currently. My question for some of you guys is, why does everybody feel like the 20 free T trough is what has to be done to feel good? Again, thanks for all the feedback. This forum is great.


It's a myth that one needs to attain a high trough FT in order to experience relief/improvement of low-T symptoms let alone to feel great!

More T is better sheep mentality bulls**t at it's finest!

Most would easily do well hitting a trough 15-25 ng/dL.

Yes many may tend to aim for higher-end/high trough FT but again you need to keep in mind that there is a big difference between one hitting a high-end/high FT injecting daily vs twice-weekly vs once weekly!

Trial and error need to find what level suits you best and more importantly a level that will allow you to reap the beneficial effects of having a healthy FT while at the same time preventing/minimizing sides and keeping blood markers healthy long-term!

The last thing you want to do is drive up your trough FT too high!

Trust me on this one!

Take a look at all the men doing well on oral TU!

Morgentaler hits the nail on the head here!


Pros/Cons oral TU (51:24-57:12)

*one of the things that the orals have transformed is the concept that you have to have a continually high level of testosterone to get the benefits and clearly that's not true and the safety profile seems to be improved by having levels that fluctuate some during the day returning to close to or even baseline
















Put the nail in the coffin here!

This is coming from the man who would be considered the father of testosterone who has made huge contributions regarding testosterone therapy and men's health let alone has treated 1000s of men over decades!

Would be considered one of the top heavyweights when it comes to (research/clinical experience) in the field of hormone replacement therapy!

Puts most endos to shame when it comes to treating symptoms vs numbers!

Even then one of the main points he always stresses:


Dr.Abraham Morgentaler

* what's important to understand though is that the concept of testosterone therapy in theory is designed to replicate youthful levels of testosterone to help people who are deficient in this hormone, the goal isn't to make them into supermen and the real question is why do people want to go above normal if at all, much of the concept of treating up lets say a 1000 let's say our normal upper limit, in the anti-aging community or age management community there are some people who believe the there's an optimal level of testosterone that may be 1200 or 1500 or even I've heard 1800 and the basis for that is WEAK!
 
The main problem I have with this is that you have no idea what physiological doses are like.
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.

What you haven't demonstrated is that one can compensate for the differences between endogenous and exogenous testosterone simply by giving more exogenous testosterone. I would argue that such compensation is making things worse overall—promoting side effects and further interfering with other hormones. I'd also argue that the main difference between endogenous and—long-lasting—exogenous testosterone is the HTPA shutdown that accompanies the latter. HCG helps many to compensate, but I feel there is much more going on.

Give that the exogenous testosterone here is bioidentical, if we discount the effects on other hormones, and dose to achieve a diurnal rhythm, then it's hard to argue that 5 mg T per day injected is significantly different from 5 mg per day made by the testicles.

I never said a person could compensate for shutdown of natural production by simply adding more testosterone. Not sure why I’d need to demonstrate support for claims I’ve never made.
Using the norms of any other medication you are overmedicated. At least the risks from excessive testosterone use aren't as immediately severe as those from adrenal/thyroid/etc. meds. The main objection is that you don't even know how you'd feel with physiological doses. In any case, I'm not trying to change your mind. If you have good lipids, good HCT, etc., then your risks aren't bad, and you're free to make that choice.



I agree that 50 mg TC/week is likely to be too low for most men. However, if you start there as a matter of course then you help the ones that do best there. Others simply continue to titrate up as needed. With Xyosted you start at 75 mg TE/week and either drop to 50 mg or go up to 100 mg. This might be a little harsh on those who are titrating downward. But you save time for the others. It's a tradeoff.
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.


With regard to OP, he started feeling bad after natural production shut down. When his production was still functional and he was at 5+ weeks in his test levels were higher than they are now because he had reached a steady state of exogenous while still having some endogenous to use as well. So either it’s all due to natural shutdown and its effects on other hormones making him feel worse, having a lower test level now than when he felt best, or a combination of both. Lowering his dose won’t bring back natural production and it obviously won’t raise his test levels. It’s possible he’ll feel better after a dosage decrease, but if I was a gambling man I wouldn’t put money on it. Like I said earlier, I think the best thing at this point would be to switch to IM and give his body more time to find homeostasis. I also think he may benefit from HCG, but that should be done down the road if at all.


As far as my personal journey, I still ended up at a good place and had a pretty easy and enjoyable road to be here the past five years. And while there’s no way to know, I’d say my path was probably easier than if I’d started out at 50 mg/week (which you agree probably isn’t best for most men anyway). And we agree on others things as well, mainly that finding a point where you feel good with good health and bloodwork is the main objective.
 
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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.
...
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.

...
I never said a person could compensate for shutdown of natural production by simply adding more testosterone. Not sure why I’d need to demonstrate support for claims I’ve never made.
...

You are implying as much when you say that endogenous and exogenous testosterone are different in the context of defending above-physiological dosing.

...
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. ...

The key point here is that "most" in this context means a modest majority, say 60-70% as a rough guess. It's not like you'd be catering to a few outliers.

... 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.
...

The honeymoon period is common with any dose that's on the order of natural production or greater. There are apocryphal tales of men spending their entire time on TRT trying to recreate the feeling of those first couple weeks. If you want to avoid being mislead by it then start with 10 mg TC/week and only increase by 10 mg per week.

There's nothing wrong with 50 mg/TC per week if it's comparable to your healthy natural production, which it is for a large minority. The more-is-better mentality is so ingrained that you can't believe this is a perfectly reasonable dose. Remember, this is one of only three standard doses for Xyosted.

The point of the low-and-slow approach is that you stop raising the dose as soon as true symptoms of hypogonadism resolve. You don't keep raising it in the hope that it will cure all that ails you or turn you into superman.

With respect to the OP, it's a classic case of starting too high. We see it all the time because of this ill-considered use of 100+ mg TC/week as a starting dose.
 
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.

You are implying as much when you say that endogenous and exogenous testosterone are different in the context of defending above-physiological dosing.



The key point here is that "most" in this context means a modest majority, say 60-70% as a rough guess. It's not like you'd be catering to a few outliers.



The honeymoon period is common with any dose that's on the order of natural production or greater. There are apocryphal tales of men spending their entire time on TRT trying to recreate the feeling of those first couple weeks. If you want to avoid being mislead by it then start with 10 mg TC/week and only increase by 10 mg per week.

There's nothing wrong with 50 mg/TC per week if it's comparable to your healthy natural production, which it is for a large minority. The more-is-better mentality is so ingrained that you can't believe this is a perfectly reasonable dose. Remember, this is one of only three standard doses for Xyosted.

The point of the low-and-slow approach is that you stop raising the dose as soon as true symptoms of hypogonadism resolve. You don't keep raising it in the hope that it will cure all that ails you or turn you into superman.

With respect to the OP, it's a classic case of starting too high. We see it all the time because of this ill-considered use of 100+ mg TC/week as a starting dose.
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).

With regard to your statement about stopping right at the point of symptom resolution…. To reiterate the vitamin C analogy, stopping at a dose that gets rid of symptoms doesn’t necessarily mean you are getting the full benefits. You can take enough vitamin c to not get sick while not having a dose that optimizes your immune system and provides lots of other benefits.


Lastly… you have no way of knowing that OP started too high, you’re just making up claims as a best guess based on your views. You would’ve said the same thing to me, yet I’ve done great for five years now. And again, I could say most men doing well on trt are running doses that you consider “over-medicated”… while at the same time you say most men should start out under-medicated. I don’t agree with your approach and have pointed out what I see as flaws. I’ve also shown through my own experience that my approach worked great for me (and also works for many many other men).
 
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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

"The golden mean, or golden middle way, is a philosophical concept, primarily associated with Aristotle's ethics, that emphasizes finding a virtuous middle ground between two extremes, one of excess and one of deficiency. It suggests that true virtue lies in moderation, avoiding both extremes in any given situation. "
 
Would you say that anything over 70 mg/week is a supra-physiological dose? ...

I noted that one reference range for daily testosterone production is about 3-9 mg. That translates to 30-90 mg TC per week.

... 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
...

If you want to go by anecdotes then there are a "TON" of guys who suffer from supraphysiological and even high-normal dosing. I've already linked to the list twice in this thread.

The use of the word "optimal" is colored by more-is-better thinking—even if not yours—and presents a false-dichotomy on top of that. If you want optimal muscle growth then sure, the sky is the limit for testosterone. But if you want optimal health then what's physiological is usually the best. More technically, physiological levels are what nature has come up with for maximum reproductive success. I have argued that the latter is a pretty good proxy for success in life. At least historically you had to be relatively healthy and successful to win a mate, have healthy offspring and provide for them and protect them.

To be clear, I'm not defining hypogonadism via some arbitrary level of (free) testosterone. And furthermore, if you want to make a vitamin C analogy then it should be to a modest deficiency and not scurvy. Successfully treating hypogonadism implies that the deficiency is resolved, clearing the symptoms. The false dichotomy is that there is this one magical optimal level. The reality is that there's a level or pattern of levels that represent a good compromise among competing parameters. I've mentioned the most obvious one: body composition, for which more testosterone is better, at least to a point that's much above normal physiology. Then there's longevity, which is linked to mid-range levels. Better lipids are also linked to moderate levels, i.e. TT of 300-700 ng/dL. Research shows that sexual function depends on a threshold that is not all that high, TT around 300-400 ng/dL. Below that threshold you have problems, but going significantly above confers no additional benefit. In the case of aggression, which depends on various factors including testosterone, some is good but too much is bad; being in jail is not optimal. And of course they are various other parameters influenced by testosterone.

So we essentially agree that proper balance is necessary. Then perhaps we can also agree that starting with a supraphysiological dose is not in line with this principle.

...
By “rough guess” you really mean you’re just making up numbers. ...

Not made up, but an educated guess based on the statistics. Somewhat off, but not wildly so. It looks like 75% is more accurate, arrived at by two different approaches, both with some backing in the literature. For a normal distribution of production you can use either 5.5 ± 0.75 mg or 6 ± 1.5 mg.

From a practical standpoint, the 67% implied by the Xyosted dosing presumably accounts for the older population comprising more of the market.

...
With regard to your statement about stopping right at the point of symptom resolution…. To reiterate the vitamin C analogy, stopping at a dose that gets rid of symptoms doesn’t necessarily mean you are getting the full benefits. You can take enough vitamin c to not get sick while not having a dose that optimizes your immune system and provides lots of other benefits.
...

If you have an objectively deficient immune system because of low vitamin C then you have obviously not resolved the deficiency. Similarly, if you have an objective measurement you can link to low testosterone then the hypogonadism is not resolved. But typically such talk is just used as an excuse for ever higher doses rather than relating to a real phenomenon.

...
Lastly… you have no way of knowing that OP started too high, you’re just making up claims as a best guess based on your views. ...

This is farcical. A guy is taking more testosterone than just about any male makes naturally and has symptoms and you think it's not starting too high. Insert just about any other hormone in there and it sounds nutty. The only reason it doesn't is immersion in more-is-better thinking about testosterone.

... I’ve also shown through my own experience that my approach worked great for me (and also works for many many other men).

In the absence of experience with normal levels you cannot say with certainty that your current situation is better. Maybe with a lower dose you'd be less inclined to burn time debating on the forum. Then again, I'm at 1.5 mg T/day, so it must be an independent trait.
 
Case in point - my last blood panel on 7.5 mg daily = TT 755 / FT Verm 15.6.

There is a 100+ thread on another forum about guys on TC/TE 10mg daily (70mg per week). The majority of them are top end of physiologic range or over. And these are bodybuilder types...
 
I noted that one reference range for daily testosterone production is about 3-9 mg. That translates to 30-90 mg TC per week.
Would you say that any dose over 90 mg/week is supraphysiological?

If you want to go by anecdotes then there are a "TON" of guys who suffer from supraphysiological and even high-normal dosing. I've already linked to the list twice in this thread.

The use of the word "optimal" is colored by more-is-better thinking—even if not yours—and presents a false-dichotomy on top of that. If you want optimal muscle growth then sure, the sky is the limit for testosterone. But if you want optimal health then what's physiological is usually the best. More technically, physiological levels are what nature has come up with for maximum reproductive success. I have argued that the latter is a pretty good proxy for success in life. At least historically you had to be relatively healthy and successful to win a mate, have healthy offspring and provide for them and protect them.

To be clear, I'm not defining hypogonadism via some arbitrary level of (free) testosterone. And furthermore, if you want to make a vitamin C analogy then it should be to a modest deficiency and not scurvy. Successfully treating hypogonadism implies that the deficiency is resolved, clearing the symptoms. The false dichotomy is that there is this one magical optimal level. The reality is that there's a level or pattern of levels that represent a good compromise among competing parameters. I've mentioned the most obvious one: body composition, for which more testosterone is better, at least to a point that's much above normal physiology. Then there's longevity, which is linked to mid-range levels. Better lipids are also linked to moderate levels, i.e. TT of 300-700 ng/dL. Research shows that sexual function depends on a threshold that is not all that high, TT around 300-400 ng/dL. Below that threshold you have problems, but going significantly above confers no additional benefit. In the case of aggression, which depends on various factors including testosterone, some is good but too much is bad; being in jail is not optimal. And of course they are various other parameters influenced by testosterone.

So we essentially agree that proper balance is necessary. Then perhaps we can also agree that starting with a supraphysiological dose is not in line with this principle.

Yes, we agree that balance is necessary. I think we just disagree with regard on where to start. And perhaps I’m just lucky and am able to run higher doses(relatively speaking of course… because many would not call my dose of 100-120 high at all) while getting tons of benefits. My total and free t also stay near the top of the range… but again maybe I’m just lucky. Though I would say there are tons of guys who run similar protocols and do great even though you consider us “over-medicated”.
Not made up, but an educated guess based on the statistics. Somewhat off, but not wildly so. It looks like 75% is more accurate, arrived at by two different approaches, both with some backing in the literature. For a normal distribution of production you can use either 5.5 ± 0.75 mg or 6 ± 1.5 mg.

From a practical standpoint, the 67% implied by the Xyosted dosing presumably accounts for the older population comprising more of the market.



If you have an objectively deficient immune system because of low vitamin C then you have obviously not resolved the deficiency. Similarly, if you have an objective measurement you can link to low testosterone then the hypogonadism is not resolved. But typically such talk is just used as an excuse for ever higher doses rather than relating to a real phenomenon.



This is farcical. A guy is taking more testosterone than just about any male makes naturally and has symptoms and you think it's not starting too high. Insert just about any other hormone in there and it sounds nutty. The only reason it doesn't is immersion in more-is-better thinking about testosterone.
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”.

In the absence of experience with normal levels you cannot say with certainty that your current situation is better. Maybe with a lower dose you'd be less inclined to burn time debating on the forum. Then again, I'm at 1.5 mg T/day, so it must be an independent trait.
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.







And obviously the last line was a joke. You’re way more rational and logical than a woman, even if I don’t agree with your logic I can see it in there.
 
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