Hi All,
52 yo male here new to TRT.
Baseline labs:
Total T = 485ng/dL (264 - 916 ng/dL)
Free T = 7.7pg/mL (7.2 - 24 pg/mL)
Estradiol = 32.5pg/mL (7.6 - 42.6 pg/mL)
Below are labs after 6 weeks on 100mg testosterone enanthate a week split 50mg Sat, 50mg Wed plus 500iu HCG a week split 250iu Sat, 250iu Wed. I took the labs at 3pm on Tuesday and my next injection would have been Wednesday morning so not quit trough but close.
Lab results after 6 weeks:
Total T = >1500ng/dL (264 - 916 ng/dL)
Free T = 40.5pg/mL (7.2 - 24 pg/mL)
Estradiol = 59.8pg/mL (7.6 - 42.6 pg/mL)
LH = <0.3mIU/mL (1.7 - 8.6 mIU/mL)
FSH = <0.3mIU/mL (1.5 - 12.4 mIU/mL)
I was shocked to see my total and free so high since it seems like 100mg test plus 500iu HCG a week is a normal starting dose. Maybe I am a hyper responder or a slow metabolizer. Hematocrit was slightly elevated but well within the normal range but I would imagine that would continue to creep up over time if my test levels remained this high.
I feel great! More energy, better libido, less anxiety, more confidence and I'm actually more calm and patient than I was before. Nice muscle gains in the 6 week period which is nice since at 52 yo I normally can't gain an ounce of muscle no matter how hard I workout. I had a consult with my doctor yesterday to review my labs and his suggestion was to drop the dose to 60mg testosterone enanthate a week split 30mg Sat and 30mg Wed and to keep the HCG the same at 500iu a week. He thinks this would bring me down to 900 - 1000 total t level and maintain most of the positive effects while reducing long term negative effects. He's an internal medicine doctor, not an endocrinologist.
What do you guys think? Is this too dramatic of a reduction in dose or do you think his suggestion is a good one? Thanks very much in advance for your opinion.
Welcome to Nelson's domain!
The most physiological dose being prescribed by most of the endos is 75-100 mg T/week.
Most of them would start younger men on 100 mg T/week and older men on 75 mg T/week!
Yes the most common starting dose by those in the know is 100 mg T/week or better yet 50 mg T split twice-weekly.
Most men on TTh are injecting 100-200 mg T/week whether once weekly or split into ore frequent injections.
The majority of men can easily achieve a healthy/high or in some cases absurdly high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.
Yes there will always be those strays/outliers who may need the higher-end dose 200 mg T/week but its far from common as in rare.
Such dose would have the majority overmedicated on T and unfortunately the more T is better mentality is still being pushed by all those numbskulls stinking up those so called mens health/HRT forums. and to make matters worse still being pushed by this dime a dozen run of the mill T-clinics.
This nonsense needs to be put to rest!
Also keep in mind that there are some men who can achieve stellar levels injecting <100 mg T/week especially when split into more frequent injections.
Always best to start low and go slow on a T-only protocol so you can see how your body reacts to testosterone and where said protocol (dose of T/injection frequency) has your trough TT and more importantly FT and estradiol let alone critical blood markers RBCs, hemoglobin and hematocrit,
There will always be time to increase the dose of T or throw in hCG if need be.
Much harder teasing out any issues that may arise if you throw in hCG or an AI off the hop.
After you have reached steady-state (4-6 weeks) in and blood levels have stabilized labs will be done at true trough (lowest point) before your next injection.
Below are labs after 6 weeks on 100mg testosterone enanthate a week split 50mg Sat, 50mg Wed plus 500iu HCG a week split 250iu Sat, 250iu Wed. I took the labs at 3pm on Tuesday and my next injection would have been Wednesday morning so not quit trough but close.
Lab results after 6 weeks:
Total T = >1500ng/dL (264 - 916 ng/dL)
Free T = 40.5pg/mL (7.2 - 24 pg/mL)
Estradiol = 59.8pg/mL (7.6 - 42.6 pg/mL)
LH = <0.3mIU/mL (1.7 - 8.6 mIU/mL)
FSH = <0.3mIU/mL (1.5 - 12.4 mIU/mL)
I was shocked to see my total and free so high since it seems like 100mg test plus 500iu HCG a week is a normal starting dose. Maybe I am a hyper responder or a slow metabolizer. Hematocrit was slightly elevated but well within the normal range but I would imagine that would continue to creep up over time if my test levels remained this high.
As you can see on 100 mg T/week (50 mg split twice-weekly) + hCG (250IU 2X/week) you are hitting a 16-18 hr just shy of true trough whopping TT >1500 ng/dL, high estradiol and more importantly an absurdly high FT mind you it was not tested using an accurate assay as it was most likely the known to be inaccurate direct immunoassay so you have no idea where it truly sits but regardless with a whopping TT >1500 ng/dL your FT would be high even in cases where one had highish/high SHBG.
What was your SHBG at baseline?
FT <5 ng/dL would be considerd low.
FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.
FT 10-15 ng/dL would be healthy.
FT 20-25 ng/dL would be high-end/high.
The majority of men will do well with a trough FT 15-25 ng/dL depending on the injection frequency.
Even then your TT was not even tested using the most accurate assay (LC-MS/MS) as the direct IA caps out at 1500 ng/dL so your TT is going to be higher.
You would need to retest your TT using the most accurate assay LC-MS/MS and more importantly your FT using the most accurate assay which would be the gold standard Equilibrium Dialysis especially in cases of altered SHBG.
Again you need to retest at the true trough which would be Wednesday morning just before your next injection.
The next best testing method would be the go to calculated. linear law-of-mass action Vermeulen (cFTV) which will give a good approximation but you need to plug in your TT, SHBG and Albumin.
Keep in mind that you would easily have room to lower your weekly dose and bring down your trough FT if need be but again need to retest using accurate assays so you can see where it truly sits.
Also keep in kind that although you luckily feel great off the hop you are only 6 weeks in and things may take a turn for worse in the long run.
Running too high a trough/steady-state FT can be just as bad in many ways as running too low a FT especially when it comes to libido and erectile function.
Hammering the s**t out of your dopamine and CNS is the last thing you want to do here.
The first 6 weeks means nothing when looking at the bigger picture here as hormones will be in flux during the weeks leading up until blood levels have stabilized (4-6 weeks) due to the PK (TC/TE) and it is common for one to experience ups/downs along the way as the body is trying to. adjust to the rising hormones.
Some will feel. great off the hop especially when it comes to mood, libido and erections as you are going to experience what we call the honeymoon phase where one feels euphoric, increased libido and. erections (nocturnal/spontaneous) due to rising hormones, increased dopamine and lighting up of the AR (androgen receptor).
Unfortunately for most this is short-lived and temporary as the body will eventually adapt to its new set-point where things tend to level off more in the norm.
The first 6 weeks. can be misleading because once blood levels have stabilized it will still take the body a few more months to adapt to its new set-point and this is the critical time period where one needs to gauge how they truly feel overall regarding relief/improivement of low-T symptoms.
Many still lack the understanding of how. exogenous works and jump the gun way too early tweaking their dose of T because they do not feel well and others that are amped up on T off the hop make the mistake because they feel stellar off the hop only to be let down months later especially in the libidoo/erectile function department.
Like I said always best to start low and go slow as it is much easier going up then having to come down.
In your situation I would definitely retest at true trough using accurate assays so you can see where your trough TT and more importantly trough FT truly sits but again it will be high.
If you feel great overall so far you can just stick with it and if things turn out for the worse you can back off your dose but also need to keep in mind that where your hematocrit sits 6 weeks in is not where it will end up at the 3-6 month mark.
Chances are it will be high but how high depends on how high your trough/steady-state FT sits and other factors can be at play here too.
When first starting TTh hematocrit needs to be checked at 3 and 6 months then 12 months in as the biggest increase will be seen within the first 3-6 months.
Need to give it 6 months on said protocol (dose of T/injection frequency) to see where it truly ends up!
If you do end up reducing your weekly dose going from 100--->80 mg T/week is the more sensible move instead of making the big jump.
Do what you feel is best for you!
