High Testosterone on only 80mg/week

[Systemlord]

so my understanding from this forum is that more frequent injections would be counterproductive.

That's not entirely true, high SHBG men can more easily get away with less frequent injections, but I have seen high SHBG men do well on daily injections in an attempt to control estrogen.

 

[SkyWarn]

Follow-up: Feeling so much better the past week.

1. Donated blood (had not done so in 2 years).
2. Started 5mg of amlopidine daily- I'm not going to play around with guessing at my blood pressure rise and trying to lower it 'naturally', just going to deal with it. I would prefer to try Losartan but due to the recall mess, my PCP wants to wait.
3. Set a baseline of 220 IU HCG/32mg cyptionate 2x a week. I was on 250 IU HCG 2x a week prior but my blood pressure starting going up and I cut it out for a few weeks to see if it was a culprit.

So far, blood pressure is down from 140-150/90 to 125-30/80, better morning erections, more libido, feeling more calm, not feeling the hot flushes, etc. Will retest in probably a month or so to assess.

Does HCG raise blood pressure?

 

[Systemlord]

Does HCG raise blood pressure?

HCG increases estrogen and high estrogen can increase blood pressure.

 

[jdthoosier]

That was my theory - and so I dropped the HCG for a while to see if there any BP benefit. I had my BP under control for the first 3.5+ years but it snuck up on me as I got complacent. I decided to bite the bullet and go with a BP med.

 

[Logan24]

So far, happy with the results as far as how I feel. I'll do labs in about a month and see what the numbers are.

Note that this is my 5th year on TRT and 4th year of injections. I've found it hard to find that "good" range that I can sustain. I know that I feel best with my trough in the 700's and estradiol in the mid to upper 20's. It's been hard to consistently keep it there. Seems like the troughs keep rising higher over time and I have to reduce dosage.

I started with 100 mg/week. Felt great for a while but the troughs kept going up, at one point it was up to 1220, and estradiol hit 49 and I did not feel good. Since then, it's been a gradual reduction of cypionate + adding in HCG to try to maintain a reasonable range.

 

[Logan24]

So far, happy with the results as far as how I feel. I'll do labs in about a month and see what the numbers are.

Note that this is my 5th year on TRT and 4th year of injections. I've found it hard to find that "good" range that I can sustain. I know that I feel best with my trough in the 700's and estradiol in the mid to upper 20's. It's been hard to consistently keep it there. Seems like the troughs keep rising higher over time and I have to reduce dosage.

I started with 100 mg/week. Felt great for a while but the troughs kept going up, at one point it was up to 1220, and estradiol hit 49 and I did not feel good. Since then, it's been a gradual reduction of cypionate + adding in HCG to try to maintain a reasonable range.

Same here. I haven’t been able to consistently make this work more than a few weeks at a time. I too started at 100mg but have deviated much from that. Back in November my e2 went up to 48 and I felt terrible. Lowered my dose to 90mg (45 e3.5 days) and started .25mg AI. felt great for a while but e2 went to low. Been trying to get dialed in ever since. My shbg is 70 so free t is kind of low at 13. I can’t decide if I should increase the dose to optimize free t or reduce the dose to keep e2 in check without an AI. did you ever try an AI as opposed to reducing your dose?

 

[Gman86]

Same here. I haven’t been able to consistently make this work more than a few weeks at a time. I too started at 100mg but have deviated much from that. Back in November my e2 went up to 48 and I felt terrible. Lowered my dose to 90mg (45 e3.5 days) and started .25mg AI. felt great for a while but e2 went to low. Been trying to get dialed in ever since. My shbg is 70 so free t is kind of low at 13. I can’t decide if I should increase the dose to optimize free t or reduce the dose to keep e2 in check without an AI. did you ever try an AI as opposed to reducing your dose?

Sounds like you just need to keep the ai dose consistent, and keep raising your T dose until free T and E2 are where you feel best.

 

[jdthoosier]

Same here. I haven’t been able to consistently make this work more than a few weeks at a time. I too started at 100mg but have deviated much from that. Back in November my e2 went up to 48 and I felt terrible. Lowered my dose to 90mg (45 e3.5 days) and started .25mg AI. felt great for a while but e2 went to low. Been trying to get dialed in ever since. My shbg is 70 so free t is kind of low at 13. I can’t decide if I should increase the dose to optimize free t or reduce the dose to keep e2 in check without an AI. did you ever try an AI as opposed to reducing your dose?

Nope. Never had it recommended to me, and have no interest to complicate the procedure by adding it.

 

[JRos895]

This isn't as unusual as you think. I've been on 63 mg T enanthate per week taken EOD and it gets serum levels to around 800 ng/dL when combined with 250 IU hCG EOD. Typical natural testosterone production is said to be 5-7 mg per day, which would correspond to 50-70 mg T cypionate a week. The better question might be why do some guys need so much, e.g. 200 mg per week to achieve decent serum levels?

Do you have studies regarding 5-7mg per day number?

 

[Cataceous]

Do you have studies regarding 5-7mg per day number?

https://www.em-consulte.com/showarticlefile/75864/pdf_49404.pdf

See also:

How Many Milligrams Of Testosterone Do Men Naturally Produce?

How many milligrams of Testosterone do men naturally produce? The answer is 3-10 milligrams per day, with the average being 6-7 milligrams per day.

moreplatesmoredates.com

The references trace back to work by Nieschlag and Behre.

 

[eli]

Your E2 looks low for that TT to be honest with you

 

[ricky1357]

I'm somewhat confused. I had not been feeling great - as though my levels have been off. My cypionate schedule is 40mg (0.2 ml) on Sundays and Thursdays. So, I went in for a blood test on Thursday before my next injection:

Testosterone - 907 ng/dL
Estradiol (Sensitive) - 18.7 pg/mL
Hematocrit - 50.2

If the trough is that high, I think that would explain why I do not feel well. I do not feel good when my T gets too high and that is the highest hematocrit test I've ever had. I feel much better when my trough hits 600/700. I'm also a high SHBG guy. I'm thinking to go down to 30mg (0.15 ml) 2x a week which seems ridiculous as I don't think I've seen anyone with a dosage this low.

Don't worry, you're not the only one like that. My level get high like that too, so I'm down to 35mg 2x weekly, total 70mg for the week and I'm around 500-700 and I feel great, no side effects and I feel "off" when levels get close to 1000, everyone is different and it's all about the way you feel not about high or low your numbers are. You have to try new things to "fine tune your dose"

 

[Forty2]

Don't worry, you're not the only one like that. My level get high like that too, so I'm down to 35mg 2x weekly, total 70mg for the week and I'm around 500-700 and I feel great, no side effects and I feel "off" when levels get close to 1000, everyone is different and it's all about the way you feel not about high or low your numbers are. You have to try new things to "fine tune your dose"

Are you taking hCG too?

 

[BruceWayne]

I'm somewhat confused. I had not been feeling great - as though my levels have been off. My cypionate schedule is 40mg (0.2 ml) on Sundays and Thursdays. So, I went in for a blood test on Thursday before my next injection:

Testosterone - 907 ng/dL
Estradiol (Sensitive) - 18.7 pg/mL
Hematocrit - 50.2

If the trough is that high, I think that would explain why I do not feel well. I do not feel good when my T gets too high and that is the highest hematocrit test I've ever had. I feel much better when my trough hits 600/700. I'm also a high SHBG guy. I'm thinking to go down to 30mg (0.15 ml) 2x a week which seems ridiculous as I don't think I've seen anyone with a dosage this low.

I would advise you to find a good endocrinologist and listen to them on the dosing. You are on the right track. With TRT more is not better. Will you gain more muscle mass on high doses? Sure! You will also greatly increase your risk of stroke and heart attack with higher Hematocrit. You will also increase your Estradiol. Also, with higher doses sex drive and function will get better for a short while, then it will get worse. This is why so many on high doses are constantly trying to get "dialed in". They are in an unnatural supraphysiological level. You sex drive and function will consistently be better on a lower dose in mid normal range the day before injection.

Forget about all the people telling you to focus on free testosterone, estradiol, and the like. World renowned endocrinologists rely on two things, total testosterone and hematocrit. The reality is that the average healthy young man produces 5 to 7 mg testosterone per day. I will not drop names but have had in depth conversations on this matter with one of the leading endocrinologists in the country when he was with UCLA medical center in Torrance California. Forget about what people are telling you on internet sites loaded with people who have never studied medicine let alone the complex field of endocrinology. Myself included! However, I am confident that if you seek out an endocrinologist at a leading medical center you will find what I am saying is correct.

Studies have shown that you risk of a stroke greatly increases with a hematocrit over 48 much more over 50. I also don't agree with the frequency of your injections. However, this is a lengthy discussion on its own. With a hematocrit of over 50 at trough, I highly recommend you don't listen to anyone who tells you to increase your dose! Also find it highly irresponsible for anyone to recommend this course of action. First rule of medicine is DO NO HARM!

 

[BruceWayne]

If you want consistency in how you feel over time and want to keep your trough levels as steady as possible, increase your injection frequencies and inject smaller doses.

Bad advice! There is no empirical data to take more frequent doses. In fact, the opposite is true. I would advise dosing no more than once per week and given the half-life of injectable testosterone cypionate even this is a compromise. Question-Why would you recommend this to the OP?

 

[madman]

I would advise you to find a good endocrinologist and listen to them on the dosing. You are on the right track. With TRT more is not better. Will you gain more muscle mass on high doses? Sure! You will also greatly increase your risk of stroke and heart attack with higher Hematocrit. You will also increase your Estradiol. Also, with higher doses sex drive and function will get better for a short while, then it will get worse. This is why so many on high doses are constantly trying to get "dialed in". They are in an unnatural supraphysiological level. You sex drive and function will consistently be better on a lower dose in mid normal range the day before injection.

Forget about all the people telling you to focus on free testosterone, estradiol, and the like. World renowned endocrinologists rely on two things, total testosterone and hematocrit. The reality is that the average healthy young man produces 5 to 7 mg testosterone per day. I will not drop names but have had in depth conversations on this matter with one of the leading endocrinologists in the country when he was with UCLA medical center in Torrance California. Forget about what people are telling you on internet sites loaded with people who have never studied medicine let alone the complex field of endocrinology. Myself included! However, I am confident that if you seek out an endocrinologist at a leading medical center you will find what I am saying is correct.

Studies have shown that you risk of a stroke greatly increases with a hematocrit over 48 much more over 50. I also don't agree with the frequency of your injections. However, this is a lengthy discussion on its own. With a hematocrit of over 50 at trough, I highly recommend you don't listen to anyone who tells you to increase your dose! Also find it highly irresponsible for anyone to recommend this course of action. First rule of medicine is DO NO HARM!

You will also greatly increase your risk of stroke and heart attack with higher Hematocrit.

Forget about all the people telling you to focus on free testosterone, estradiol, and the like. World renowned endocrinologists rely on two things, total testosterone and hematocrit.


Do not get me started on the importance of free testosterone!

As has been stated numerous times on the forum the cut-off for hematocrit is 54% or better yet 55% in Canada as per the CUA (Canadian Urological Association) guidelines for Testosterone Therapy.

Most doctors in the know would recommend donating or reducing your weekly T-dose and bringing down your trough FT once you hit 54%.

Some will be more cautious and take measures once hematocrit hits 52%.

If one has no underlying health issues and is not experiencing any negative sides most in the know specializing in testosterone therapy would not fret if the patient's hematocrit falls within 50-54%.

Need to do your research!

You are out to lunch here!

Those endos in the know are far and few.

Would never waste my time with an endo!

Any of the top uros especially those considered world renowned in the field of testosterone therapy (Morgentaler, Khera) would shit all over this!




post #5 (Go nuts)!

Controversies with Testosterone Replacement Therapy: Lecture by Dr Khera

As usual Nelson's Excel is where it's at! Mohit Khera, MD, MBA, MPH, Professor of Urology, F Brantley Scott Chair in Urology, Medical Director of the Laboratory for Andrology Research, Medical Director for the Scott Department of Urology Baylor College of Medicine.

www.excelmale.com

Testosterone Therapy and Erythrocytosis - the most common dose-limiting effect of testosterone therapy

https://www.thebloodproject.com/cases-archive/testosterone-therapy-and-erythrocytosis-2/ Introduction Androgens play a crucial role in the development and maintenance of: Male reproductive and sexual functions Body composition Erythropoiesis Muscle and bone health Cognitive function...

www.excelmale.com

*hematocrit of ≥54% appears to be consistent threshold to discontinuing or reducing treatment utilized by major urologic governing bodies, while the evidence for this specific cutoff is lacking

*There is no compelling evidence that testosterone therapy or testosterone therapy-associated erythrocytosis are associated with increased risk of cardiovascular events or venous thromboembolism

*However, clinical practice guidelines generally recommend intervention if hematocrit of ≥54% while taking testosterone therapy; interventions include stopping testosterone therapy altogether, changing the dose or route of administration or instituting a phlebotomy regimen

 

[madman]

Bad advice! There is no empirical data to take more frequent doses. In fact, the opposite is true. I would advise dosing no more than once per week and given the half-life of injectable testosterone cypionate even this is a compromise. Question-Why would you recommend this to the OP?

We could pick this apart too!

When it comes to the half-lifes TE/TC are basically interchangeable.

Numerous threads posted on the forum with some studies thrown in there to boot!

Even then many of the top uros are recommending injecting twice-weekly vs once weekly as the main advantage here is clipping the peak--->trough and blood levels will be more stable throughout the week.

Downfall when injecting once weekly is there will be a big difference in the peak--->trough and blood levels will not be as stable throughout the week especially when injecting strictly IM which a common practice.

This will result in what we call the roller coaster type effect where T levels will be very high at the peak (8-12 hrs) post-injection/during the first 2-3 days every week only to be followed by much lower levels come weeks end which can easily have a negative effect on energy,mood, libido and erectile function.

Top it all off that once weekly injections can have a stronger impact on driving up the hematocrit!

 

[Systemlord]

Bad advice! There is no empirical data to take more frequent doses. In fact, the opposite is true. I would advise dosing no more than once per week and given the half-life of injectable testosterone cypionate even this is a compromise. Question-Why would you recommend this to the OP?

Boy, we’re open-minded and not arrogant aren’t we! You’re embarrassing yourself as someone new to ExcelMale. My advice is take some time and do some research before putting your foot in your mouth.

There are many antidotal experiences where someone injecting smaller doses more frequently to resolve symptoms, where lowering the dose has the effect of lowering trough levels too much.

Some men actually feel the difference when their hormone levels start out high in the first part of the week and end up significantly lower on the second part of the week as we all metabolize testosterone at different rates.

This is where injecting twice weekly is beneficial.

@Vince used to have to donate blood, he was able to forgo blood donations by injecting small doses daily to control his hematocrit and hemoglobin levels, something he could not do on less frequent injections.

Maybe @Vince would be better off injecting less frequently, dealing with high hematocrit, which, according to you is dangerous, now has to donate blood frequently and is now dealing with low ferritin.

Because this is the path forward, isn’t it?

Diagnosis and management of testosterone deficiency - PMC

Testosterone supplementation therapy (TST) use has dramatically increased over the past decade, due to the availability of newer agents, aggressive marketing, and an increasing incidence of testosterone deficiency (TD). Despite the increase in TST, ...

www.ncbi.nlm.nih.gov

All of the short-acting agents are plagued by a “roller coaster” effect by achieving supraphysiologic levels within 2–4 days after injection followed by sub-therapeutic levels by 10–14 days. A rapid decline in serum levels around 10–14 days has been called “testosterone crash” and is associated with sudden recurrence of TD symptoms. To minimize these effects, more frequent dosing from once to twice weekly has been suggested as is preferred by these authors.

 

[BruceWayne]

You will also greatly increase your risk of stroke and heart attack with higher Hematocrit.

Forget about all the people telling you to focus on free testosterone, estradiol, and the like. World renowned endocrinologists rely on two things, total testosterone and hematocrit.


Do not get me started on the importance of free testosterone!

As has been stated numerous times on the forum the cut-off for hematocrit is 54% or better yet 55% in Canada as per the CUA (Canadian Urological Association) guidelines for Testosterone Therapy.

Most doctors in the know would recommend donating or reducing your weekly T-dose and bringing down your trough FT once you hit 54%.

Some will be more cautious and take measures once hematocrit hits 52%.

If one has no underlying health issues and is not experiencing any negative sides most in the know specializing in testosterone therapy would not fret if the patient's hematocrit falls within 50-54%.

Need to do your research!

You are out to lunch here!

Those endos in the know are far and few.

Would never waste my time with an endo!

Any of the top uros especially those considered world renowned in the field of testosterone therapy (Morgentaler, Khera) would shit all over this!




post #5 (Go nuts)!

Controversies with Testosterone Replacement Therapy: Lecture by Dr Khera

As usual Nelson's Excel is where it's at! Mohit Khera, MD, MBA, MPH, Professor of Urology, F Brantley Scott Chair in Urology, Medical Director of the Laboratory for Andrology Research, Medical Director for the Scott Department of Urology Baylor College of Medicine.

www.excelmale.com

Testosterone Therapy and Erythrocytosis - the most common dose-limiting effect of testosterone therapy

https://www.thebloodproject.com/cases-archive/testosterone-therapy-and-erythrocytosis-2/ Introduction Androgens play a crucial role in the development and maintenance of: Male reproductive and sexual functions Body composition Erythropoiesis Muscle and bone health Cognitive function...

www.excelmale.com

*hematocrit of ≥54% appears to be consistent threshold to discontinuing or reducing treatment utilized by major urologic governing bodies, while the evidence for this specific cutoff is lacking

*There is no compelling evidence that testosterone therapy or testosterone therapy-associated erythrocytosis are associated with increased risk of cardiovascular events or venous thromboembolism

*However, clinical practice guidelines generally recommend intervention if hematocrit of ≥54% while taking testosterone therapy; interventions include stopping testosterone therapy altogether, changing the dose or route of administration or instituting a phlebotomy regimen

Based on the comments you made here about a hematocrit of below 54 being safe are you willing to stand liable for giving out this false information if the OP has a stroke or heart attack?

Also please enlighten us on where you attended medical school and where you got your degree in endocrinology?

If you are having to give blood to reduce the hematocrit, you are not on "TRT" you are taking a small steroid cycle and calling it TRT.

As for my advice to the poster, I know personally of two people I have given similar advice to, both had strokes under the age of fifty. One with a hematocrit of 50 and one with a 51!!!!!

https:www.researchgate.net/publication/317572206 Hematocrit and Stroke A Forgotten and Neglected Link.

I have personally met Abraham Morgentaler, and greatly respect his work. The endocrinologist that I spoke of in my previous post is greatly respected by Dr. Morgentaler. This person was the main influence on the current guidelines set by the Endocrine Society for TRT.

Dr Morgentaler would be appalled that you use his name to reinforce your ridiculous comments.

First of all, Dr Morgentaler preferred method of treatment is gels! He aims to always maintain a treatment response in the 500 to 600 range! Does not recommend TRT to men with a hematocrit over 50. He would laugh you out of his office if you told him you maintain a total testosterone of 1600!

Please do keep your testosterone over 1000 and use 54 percent hematocrit as a cut off and let us know how this works for you over the years!

 

[BruceWayne]

Boy, we’re open-minded and not arrogant aren’t we! You’re embarrassing yourself as someone new to ExcelMale. My advice is take some time and do some research before putting your foot in your mouth.

There are many antidotal experiences where someone injecting smaller doses more frequently to resolve symptoms, where lowering the dose has the effect of lowering trough levels too much.

Some men actually feel the difference when their hormone levels start out high in the first part of the week and end up significantly lower on the second part of the week as we all metabolize testosterone at different rates.

This is where injecting twice weekly is beneficial.

@Vince used to have to donate blood, he was able to forgo blood donations by injecting small doses daily to control his hematocrit and hemoglobin levels, something he could not do on less frequent injections.

Maybe @Vince would be better off injecting less frequently, dealing with high hematocrit, which, according to you is dangerous, now has to donate blood frequently and is now dealing with low ferritin.

Because this is the path forward, isn’t it?

Diagnosis and management of testosterone deficiency - PMC

Testosterone supplementation therapy (TST) use has dramatically increased over the past decade, due to the availability of newer agents, aggressive marketing, and an increasing incidence of testosterone deficiency (TD). Despite the increase in TST, ...

www.ncbi.nlm.nih.gov

I love to read where someone with no training whatsoever says the medical community does not know what they are doing. For someone to take your advice they might as well get on a 747 with their best buddy at the wheel!

If you must donate blood your dose is too high! The answer is not to increase dose frequency. These drugs have a half-life of around 7 to 10 days. When you take smaller doses more frequently it is great at first, then the half-lives start to add up. Hence, the reason that hematocrit goes up not down on more frequent doses in every objective study done.

I did not post to this site to make friends and influence people. Only to try to prevent potential harm in someone.

Taking testosterone by injection is not an ideal method. This is because of the highs and lows. It would be ideal to take a pill. However, testosterone taken in this manner is toxic to the liver. I assure the OP the people who set the guidelines are experts in this field. They still today prefer if giving injections to first start with 150 to 200mg every two weeks. Yes, you have highs and lows, but the half-lives don't start to add up with this treatment method.

It kills me to see people who practice terms like "pinned today" as opposed to injection today, get on these forums and cause much harm and have NO medical training at all. Again, I ask, are you willing to stand liable is the poster is harmed by taking your advice? I am confident he will not be harmed by mine!