Heavier Men May Require Higher TRT Doses

[Nelson Vergel]

We finally have a study that looked at this common question.

Effect of Weight on Serum Testosterone Levels with Subcutaneous Testosterone Enanthate in Men with Testosterone Deficiency

Introduction

Obesity is a common issue among men and is often associated with low testosterone (T) levels. This association complicates the management of testosterone deficiency (hypogonadism) in overweight and obese individuals. It is known that men with a higher body mass index (BMI) need higher doses of transdermal testosterone therapy (TTh), like T 2% gel, to get their T levels back to normal. However, not much is known about how body weight affects the pharmacokinetics and dosing of subcutaneous testosterone enanthate (TE) in men who are T deficient. A recent post hoc analysis of a phase 3 trial sheds light on the relationship between body weight and serum T levels achieved with SC TE therapy.

Study Background

A post hoc analysis of data from a 52-week, open-label, single-arm, dose-blinded phase 3 trial (NCT02159469) was used to look into the safety and effectiveness of giving men with low testosterone SC TE once a week. The trial enrolled 150 men, with a primary endpoint of achieving an average serum T concentration (Cavg0-168h) between 300 to 1,100 ng/dL at week 12. This study aimed to assess how different body weights influenced the serum T levels attained with varying doses of SC TE.

Methods

Participants in the study self-administered a starting dose of 75 mg SC TE weekly during the initial titration phase. Subsequently, blinded dose adjustments in increments of 25 mg were made at predefined intervals beyond the sixth dose, based on serum T levels. As a post hoc analysis, a linear regression model was used to look at the effect on mean minimum T concentration (Cmin) and Cavg0-168h at week 12. Body weight and dose were used as independent variables.

Results

A total of 137 men were included in the post hoc analysis. The participants were divided into three dose groups: 50 mg (n=25), 75 mg (n=93), and 100 mg (n=19). The average weights in these groups were 84.4 kg, 102.2 kg, and 112.0 kg, respectively, with a range of 49.9–146.5 kg. The analysis revealed an inverse relationship between body weight and serum T levels. Specifically, the dose-normalized T Cmin and Cavg0-168h decreased as the dose increased:

• 50 mg group: Dose-normalized T Cmin was 9.2 ng/dL, and Cavg0-168h was 12.0 ng/dL per 1 mg of SC TE.
• 75 mg group: Dose-normalized T Cmin was 5.7 ng/dL, and Cavg0-168h was 7.2 ng/dL per 1 mg of SC TE.
• 100 mg group: Dose-normalized T Cmin was 4.3 ng/dL, and Cavg0-168h was 5.7 ng/dL per 1 mg of SC TE.

The linear regression model showed that the weight and dose variables explained 48.2% (P<0.0001) of the total variation in Cmin and 55.0% (P<0.0001) of the total variation in Cavg0-168h.

Conclusion

This analysis highlights an inverse correlation between body weight and T exposure in men undergoing SC TE therapy. Men with higher body weights required higher doses of SC TE to achieve physiological T levels, compared to those with lower body weights. The findings underscore the importance of individualized dosing based on body weight to optimize testosterone therapy outcomes. The study provides valuable insights for clinicians in tailoring SC TE therapy, ensuring effective management of testosterone deficiency in men across different weight categories.

These results add to the growing body of knowledge on how weight impacts the pharmacokinetics of testosterone therapy and suggest that SC TE offers a flexible and effective option for achieving target testosterone levels in men with varying body weights.

SAT-037 Effect of Weight on Serum Testosterone with Subcutaneous Testosterone Enanthate in Men with Testosterone Deficiency

Abstract. BACKGROUND: In men, obesity is often associated with low testosterone (T) levels, but information is limited as to how body weight affects the pharmac

academic.oup.com

 

[madman]

We finally have a study that looked at this common question.

SAT-037 Effect of Weight on Serum Testosterone with Subcutaneous Testosterone Enanthate in Men with Testosterone Deficiency

Abstract. BACKGROUND: In men, obesity is often associated with low testosterone (T) levels, but information is limited as to how body weight affects the pharmac

academic.oup.com

I did post this in an earlier thread but you can delete it if need be.

 

[Nelson Vergel]

Sorry ! Did not see it. I should have known. There is no study that escapes you!! You read every single TRT related study out there before anyone does. That’s for sure !

 

[madman]

So much on here to keep track of and the wealth of information you provide for us is nothing short of amazing, to say the least.

 

[XXY47]

And yet, I have an Endo which continues to drop my Testosterone without taking into regard my weight. He is stressing weight reduction but limits me to the extent of resulting in mood swings so that my free testosterone in the blood matches his scale. And yet, in talking with various XXY men who have worked out and are musclular they say they could only do this with much higher than normal levels of testosterone. But my doctor refuses to allow me to do that.

 

[madman]

And yet, I have an Endo which continues to drop my Testosterone without taking into regard my weight. He is stressing weight reduction but limits me to the extent of resulting in mood swings so that my free testosterone in the blood matches his scale. And yet, in talking with various XXY men who have worked out and are musclular they say they could only do this with much higher than normal levels of testosterone. But my doctor refuses to allow me to do that.

We are on trt here not using testosterone for muscle enhancement.

Sure your TT/FT levels may very well be too low, post labs?

If your current trt dose has your TT 1000-1200 ng/dL then you would easily achieve a healthy FT level.

What is your protocol (dose of T/injection frequency) and where does your TT/FT levels sit at the trough?

 

[madman]

Experiencing mood swing does not mean that your testosterone levels are too low, could easily be many other factors.

Injection protocol resulting in unstable blood levels, e2 out of control and the list would go on.

 

[XXY47]

We are on trt here not using testosterone for muscle enhancement.

Sure your TT/FT levels may very well be too low, post labs?

If your current trt dose has your TT 1000-1200 ng/dL then you would easily achieve a healthy FT level.

What is your protocol (dose of T/injection frequency) and where does your TT/FT levels sit at the trough?

I inject 0.75 ml of 200mg/ml of test 2 times a week. And my latest blood test was at 52 no longer/l. Or 1399.87 ng/nl

I have klinefelter’s syndrome and generally if I am getting mood swings, depression, foggy head and no longer can think it means my testosterone is on the down swing. Also I‘m fat current weight is 303 lbs, and I’m suppose to be 220 lbs.

 

[madman]

I inject 0.75 ml of 200mg/ml of test 2 times a week. And my latest blood test was at 52 no longer/l. Or 1399.87 ng/nl

I have klinefelter’s syndrome and generally if I am getting mood swings, depression, foggy head and no longer can think it means my testosterone is on the down swing. Also I‘m fat current weight is 303 lbs, and I’m suppose to be 220 lbs.

Do you mean 150mg/week (75mg every 3.5 days)

Your TT levels are way too high if this is your TROUGH levels, 52 nmol/L which would be a whopping 1499 ng/dl basically 1500 ng/dL.

What days do you inject and when was blood work done?

How can your T levels be on the downswing when your most recent labs have your TT at a whopping 1500 ng/dL and I bet your FT let alone estradiol levels are sky-high!

No wonder your endo wants to lower your dose.

Hope to god you are not injecting .75ml (150mg twice weekly)?

 

[madman]

I inject 0.75 ml of 200mg/ml of test 2 times a week. And my latest blood test was at 52 no longer/l. Or 1399.87 ng/nl

I have klinefelter’s syndrome and generally if I am getting mood swings, depression, foggy head and no longer can think it means my testosterone is on the down swing. Also I‘m fat current weight is 303 lbs, and I’m suppose to be 220 lbs.

No wonder you feel like shit as your levels are way too high.

 

[XXY47]

Experiencing mood swing does not mean that your testosterone levels are too low, could easily be many other factors.

Injection protocol resulting in unstable blood levels, e2 out of control and the list would go on.

but for klinefelter people generally untreated you get mood swings, foggy brain, depression, get really fat, completely messed up. But then we do not produce enough testosterone. Me without TRT I produce 5.7 nmol/l. Testosterone. And I feel like I want to die.

 

[XXY47]

Do you mean 150mg/week (75mg every 3.5 days)

Your TT levels are way too high if this is your TROUGH levels, 52 nmol/L which would be a whopping 1499 ng/dl basically 1500 ng/dL.

What days do you inject and when was blood work done?

How can your T levels be on the downswing when your most recent labs have your TT at a whopping 1500 ng/dL and I bet your FT let alone estradiol levels are sky-high!

No wonder your endo wants to lower your dose.

Hope to god you are not injecting .75ml (150mg twice weekly)?

yep. But was at 0.5 ml and within 2 days I was crying and depressed. Having issue with mood swings and fog. Like I said, I have klinefelter’s syndrome.

 

[XXY47]

No wonder you feel like shit as your levels are way too high.

i feel awesome, I don’t feel like shit with high levels. I generally feel bad with low levels.

 

[madman]

i feel awesome, I don’t feel like shit with high levels. I generally feel bad with low levels.

You have no clue what you are doing!

 

[XXY47]

You have no clue what you are doing!

So I am XXY47 Mosaic, I m genetically more female then male. I have my medication monitored by an Endocrinologist and he had my blood work done July 9th. At that time he said my levels where at 52 nmol/l. We could not get any blood work done for the past 4 months because of lock down.

So I was on Androgel last year in November and it had stopped working. When I had last saw my Endocrinologist in October of 2018 I weighed 220 lbs, when I saw my Endo last year in November I weighed 330 lbs and my blood work said that my Testosterone was at 5.2 nmol/l. At the time the Endo figured the Androgel had stopped working. And we switched to injections at 0.5 ml Delatestryl (200mg/ml) injected once a week. I did this for 4 months and when we tested my testosterone in Feburary it was at 7.9 nmol/l so the Endocrinologist changed the dosage from once a week to twice a week. And then we went into lockdown.

But each time the Endo called while we where in lockdown he asked me how I was doing. And I would get a spike of testosterone and within a day I would feel worse and worse until finally, all I did was sleep for the next two days. Without doing any bloodwork we had no idea what was happening.

But when my testosterone in the past has been on a down swing I get foggy, and moody and have no energy.

 

[XXY47]

yep. But was at 0.5 ml and within 2 days I was crying and depressed. Having issue with mood swings and fog. Like I said, I have klinefelter’s syndrome.

So I am XXY47 Mosaic, I m genetically more female then male. I have my medication monitored by an Endocrinologist and he had my blood work done July 9th. At that time he said my levels where at 52 nmol/l. We could not get any blood work done for the past 4 months because of lock down.

So I was on Androgel last year in November and it had stopped working. When I had last saw my Endocrinologist in October of 2018 I weighed 220 lbs, when I saw my Endo last year in November I weighed 330 lbs and my blood work said that my Testosterone was at 5.2 nmol/l. At the time the Endo figured the Androgel had stopped working. And we switched to injections at 0.5 ml Delatestryl (200mg/ml) injected once a week. I did this for 4 months and when we tested my testosterone in Feburary it was at 7.9 nmol/l so the Endocrinologist changed the dosage from once a week to twice a week. And then we went into lockdown.

But each time the Endo called while we where in lockdown he asked me how I was doing. And I would get a spike of testosterone and within a day I would feel worse and worse until finally, all I did was sleep for the next two days. Without doing any bloodwork we had no idea what was happening.

But when my testosterone in the past has been on a down swing I get foggy, and moody and have no energy.

Oh, yes. When my testosterone was correct while I was taking Androgel I did attempt to build muscle but never could. I took Androgel for 15 year and have taken testosterone ever since I was diagnosed at age 25, I'm now 54. I have been on injections before but moved off them due to issues with the needles. When I was on injections in the past, I was injected at 0.5 ml once a week I would see about 4 days of good mental attention to detail and 3 days of depression, mood swings, and anger. I never could develop any muscle then and had very little energy.

 

[madman]

So I am XXY47 Mosaic, I m genetically more female then male. I have my medication monitored by an Endocrinologist and he had my blood work done July 9th. At that time he said my levels where at 52 nmol/l. We could not get any blood work done for the past 4 months because of lock down.

So I was on Androgel last year in November and it had stopped working. When I had last saw my Endocrinologist in October of 2018 I weighed 220 lbs, when I saw my Endo last year in November I weighed 330 lbs and my blood work said that my Testosterone was at 5.2 nmol/l. At the time the Endo figured the Androgel had stopped working. And we switched to injections at 0.5 ml Delatestryl (200mg/ml) injected once a week. I did this for 4 months and when we tested my testosterone in Feburary it was at 7.9 nmol/l so the Endocrinologist changed the dosage from once a week to twice a week. And then we went into lockdown.

But each time the Endo called while we where in lockdown he asked me how I was doing. And I would get a spike of testosterone and within a day I would feel worse and worse until finally, all I did was sleep for the next two days. Without doing any bloodwork we had no idea what was happening.

But when my testosterone in the past has been on a down swing I get foggy, and moody and have no energy.

You most likely encountered absorption issues with the transdermal.

So on 100mg once weekly your T levels ended up way too low.

Gaining a large amount of body fat does not help either as more of the T will be aromatized into estrogen.

You eventually went to injecting 100mg twice weekly but unfortunately, we have no idea where your TT/FT/e2 levels sat on such protocol.

For all we know your TT/FT/e2 levels were too high on such dose but again would need lab work.

Again what is your current protocol 150mg/week (75mg twice weekly) or 300mg/week (150mg twice weekly) and what days of the week are you injecting and when was bloodwork done?

Either way, if your trough TT levels are 1500ng/dL than your FT let alone your e2 will be sky high!

 

[XXY47]

So I inject on Monday morning and Thursday evening at 0.75ml of 200mg/ml testosterone, this is what the Endocrinologist has requested to drop my dosage to from 0.8ml. But my Endocrinologist said he is puzzled, he said it would have been better if we had more blood tests. This is the first test we have been able to do since coming out of lock down. In Canada they seem to only test for free available testosterone and i can not get an appointment closer to when i would inject again on Thursday because they are not open. It seems the Endocrinologist does not ever check Estrogen levels. I never see that on the test sheets.

 

[XXY47]

Oh, I have requested another print out of my blood work from the last test. I always have to ask for it because generally the Endocrinologist will not give you them. All I really want is to get my Test into a level that I feel good in, can make muscle and work on getting this weight down. My Endo says he thinks the reason my weight jumped by 100 lbs within a year was due to my Androgel failing.

 

[madman]

So I inject on Monday morning and Thursday evening at 0.75ml of 200mg/ml testosterone, this is what the Endocrinologist has requested to drop my dosage to from 0.8ml. But my Endocrinologist said he is puzzled, he said it would have been better if we had more blood tests. This is the first test we have been able to do since coming out of lock down. In Canada they seem to only test for free available testosterone and i can not get an appointment closer to when i would inject again on Thursday because they are not open. It seems the Endocrinologist does not ever check Estrogen levels. I never see that on the test sheets.

300mg/week (150mg every 3.5 days) is a whopping dose of testosterone and in no way needed for trt.

Most men on trt even obese men are injecting on average 100-200mg/week and even then many would never need the high-end trt dose of 200mg/week to achieve a healthy TT/FT level.

Sure there may be some outliers who need slightly more than 200mg/week but that would be far and few.

Not only should he be testing your TT/FT level but more importantly estradiol and SHBG let alone CBC which would include RBCs/hemoglobin/hematocrit.

Would bet your RBCs/hemoglobin/hematocrit is high due to your very high TT level.