How do you know when to take an AI.

[firefighterinNC]

Still working with a urologist to get dialed in.

My complaints about lack of libido and sensitivity downstairs are still my biggest issues. Energy and sleep quality seemed to be getting better. I was actually saying to myself I felt pretty good lately and at times for 1-2 days infrequently I think libido is getting better, but it's gone just a quick.

My urologist recently upped my dose to 150 mg of test cyp split into two doses weekly, he did mention he has folks take test cypionate eod and they have good success. My sensitive e2 came back in the at 52 and my testosterone was 1128. He suggested checking prolactin which was 9.7 ng/ml, so that was normal.
He also gave me aromatase inhibitor anastrozole and told me to take a quarter. I don't like that the way that makes me feel at all, depressed and irritable. The previous urologist prescribed aromasin and I did not have that depressed irritable feeling when I took it.
The current urologist just didn't have many answers for me. He said I might not be on high enough dose to get my levels to where they need to be. He said some folks sometimes need an ester change and some folks have to get estrogen under control. He said mine was elevated but not bad ( whatever that means). He wanted me to give it 8 weeks and re evaluate.

His response was to take the AI as needed.
I guess i'm dumbfounded here, when and how do I know when this would be needed? I just had a follow up with my pcp and I told her I felt like the increasing of the dose was the wrong way to go but she told me to just stay the course and see how it went at the 8 week follow up. I'm on week 3 of this dose increase and I can feel this inner anxiety creeping up this week that I didn't have the previous two weeks. Financially I don't have the means to get independent labs so i'm trying to work with my pcp and my urologist.
One thing i have noticed is that towards the end of my week if I miss an injection day or go past an injection date my libido increases. That makes me think i'm on to high of a dose, but what do I know.
Regards,

 

[madman]

JERU!


I meet with doctor again on November 26th i'll ask about the oral TU then. I doubt my insurance will cover it as they gave me a fit over just getting injections covered.

Kyzatrex is a cash pay model only.




Jarenzo

*if commercial insurance rejects coverage, you may pay $150

Post in thread 'Oral TU- IT’S GO TIME - HELPING YOU GET STARTED ON JATENZO®'

Jun 7, 2024

*if commercial insurance rejects coverage, you may pay $150

• madman

Tlando

Thread 'Oral TU - TLANDO4YOU CASH PROGRAM'

Jan 20, 2024

Co-Pay Card :: TLANDO

www.tlando.com

• madman
• tlando; oral testosterone; trt; cashpay
• Replies: 0
• Forum: Testosterone and Men's Health Articles

• 

 

[firefighterinNC]

I meet with doctor again on November 26th i'll ask about the oral TU then. I doubt my insurance will cover it as they gave me a fit over just getting injections covered.

Kyzatrex is a cash pay model only.




Jarenzo

*if commercial insurance rejects coverage, you may pay $150





Tlando

Thanks for that! I'll certainly ask.

I don't really understand the urologist comment when he said the oral TU wouldn't give me the results i'm looking for. Sort of strange. My PCP said she would prefer I used the oral TU over injections for whatever reason she didn't mention so maybe if the urologist doesn't agree I can go back to her.

Got my lab work done this morning for SHBG and Free + total testosterone.

 

[t_spacemonkey]

only time I needed an AI, is when i blasted HCG at 10kiu/week in addition to 200mg T. my only symptoms was shitty anxiety, which was resolved by an AI within 8-12h. no clue what my e2 was, but normally I do ok on 60pg/ml so must have been higher

 

[firefighterinNC]

You are clearly overmedicated here!

Certainly agree, I just don't know what dose I should be at or frequency. Urologist upping my dose and he's about as vague as can be on what dose frequency. He tells me I have folks who feel fine on one large shot every two 1-2 weeks and then some folks feel better on higher frequency lower dose. I've done once a week and i've done twice a week for a while now without any improvement. Still patiently waiting on lab results

 

[madman]

Certainly agree, I just don't know what dose I should be at or frequency. Urologist upping my dose and he's about as vague as can be on what dose frequency. He tells me I have folks who feel fine on one large shot every two 1-2 weeks and then some folks feel better on higher frequency lower dose. I've done once a week and i've done twice a week for a while now without any improvement. Still patiently waiting on lab results

You should have never been started on T until your elevated baseline hematocrit was addressed.

To make matters worse you were started off on too high a dose from the get-go.

Even then you should have never been started on T until your elevated baseline hematocrit was addressed.

Standard starting dose if 100 mg T/week whether once weekly or split twice-weekly.

Yes some may inject more frequently off the hop but this is far from common.

Again 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, estradiol and critical blood markers RBCs, hemoglobin and hematocrit.

Always good to know where your SHBG sits too.

Whether starting therapy or tweaking a protocol (dose of T/injection frequency) every protocol needs to be given a fighting chance 12 weeks before claiming whether it was a success or failure.

It takes 4-6 weeks just to reach steady-state (TC/TE) meaning for blood levels to stabilize and it will take a few more months after levels have stabilized in order for the body to adapt to its new set-point as 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.

Yes there will always be time to increase the dose or add in hCG if need be.

The goal here is too achieve a healthy trough FT.

You do not want to be hitting too low or too high a trough otherwise you will run into issues.

Trough needs to be high enough so you can maintain the beneficial effects throughout the week.

The body was never meant to be amped up on T 24/7!

As I have stated numerous times on the forum over the years when looking at the bigger picture all that should really matter here is the dose one needs to achieve a healthy trough FT which will result in relief/improvement of low-T symptoms and overall well-being.

Yes symptom relief is what truly matters but when it comes to what FT level is needed one needs to keep in mind the overall goal would be to use the least amount in order to feel well while at the same time minimizing sides and keep blood markers healthy long-term.

 

[firefighterinNC]

You should have never been started on T until your elevated baseline hematocrit was addressed.

To make matters worse you were started off on too high a dose from the get-go.

Even then you should have never been started on T until your elevated baseline hematocrit was addressed.

Standard starting dose if 100 mg T/week whether once weekly or split twice-weekly.

Yes some may inject more frequently off the hop but this is far from common.

Again 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, estradiol and critical blood markers RBCs, hemoglobin and hematocrit.

Always good to know where your SHBG sits too.

Whether starting therapy or tweaking a protocol (dose of T/injection frequency) every protocol needs to be given a fighting chance 12 weeks before claiming whether it was a success or failure.

It takes 4-6 weeks just to reach steady-state (TC/TE) meaning for blood levels to stabilize and it will take a few more months after levels have stabilized in order for the body to adapt to its new set-point as 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.

Yes there will always be time to increase the dose or add in hCG if need be.

The goal here is too achieve a healthy trough FT.

You do not want to be hitting too low or too high a trough otherwise you will run into issues.

Trough needs to be high enough so you can maintain the beneficial effects throughout the week.

The body was never meant to be amped up on T 24/7!

As I have stated numerous times on the forum over the years when looking at the bigger picture all that should really matter here is the dose one needs to achieve a healthy trough FT which will result in relief/improvement of low-T symptoms and overall well-being.

Yes symptom relief is what truly matters but when it comes to what FT level is needed one needs to keep in mind the overall goal would be to use the least amount in order to feel well while at the same time minimizing sides and keep blood markers healthy long-term.

Certainly makes sense, I've a few co-workers who have been on TRT for the better part of a decade and one specifically said he goes no higher than 80 mg a week. He just said it took a lot of trial and error but thats where he feels best. I hate to go against doctors orders on medication but I feel worse on the higher dosage imo.

I wonder if thats my CNS causing the feeling of anxiety and panic from being amped on up to much testosterone. It really didn't happen until I've gone up in dose. My original endocrinologist started me on 140 mg where i stayed for the initial 6-8 weeks. Once he saw my hematocrit and rbc he lowered me down to 100 mg. The new urologist is the one who bumped me back up to 150 mg. It's been sort of a roller coaster ride. Libido to me seems worse on the higher dose, the only time I notice it improving or my desire level increasing is closer towards injection day or even if I were to skip a injection day.

The one thing I recall that the endocrinologist mentioned to me from the beginning was he was a proponent of single doses weekly or even just slightly past the half life of test cypionate which I think was 7-8 days. He said it gives the body's androgen receptors time to sort of cleanse themselves (whatever that meant).

Still waiting on lab work but i'll post it whenever I get it.

 

[firefighterinNC]

Just sharing most recent labwork for free t and shbg. Free T was flagged high and my shbg has stayed close to the same from prior to when i started trt at 25.5.
What all that means I have no idea, lol

 

[madman]

Just sharing most recent labwork for free t and shbg. Free T was flagged high and my shbg has stayed close to the same from prior to when i started trt at 25.5.
What all that means I have no idea, lol

This is the wrong FT assay you had it tested using the Equilibrium Ultrafiltration assay which would be considered the next best to the gold standard Equilibrium Dialysis but I and many in the know no longer recommend this assay as it is prone to over/underestimating FT as the assay has a higher level of imprecision


Equilibrium Ultrafiltration

070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS

Labcorp test details for Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS

www.labcorp.com

Equilibrium Dialysis (gold standard reference method)

You need to have your FT tested using the Equilibrium Dialysis assay.

I already posted the links for Quest or Labcorp which offer the assay.

You can throw Mayo Clinic in there too.

500726: Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences)

Labcorp test details for Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences)

www.labcorp.com

https://www.mayocliniclabs.com/test-notifications/attachment.php?id=80379

Quest Diagnostics: Test Directory

testdirectory.questdiagnostics.com

Testosterone, Free (Equilibrium Dialysis) and Total, MS | Discounted Labs

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

www.discountedlabs.com

Again what is your current protocol (dose of T/injection frequency) and how many days post-injection were your labs done.

You doctor just recently changed your dose so as I stated you need to wait 4-6 weeks (TC/TE) until blood levels have stabilized. in order to see where your trough FT truly sits otherwise your results would be skewed.

Always need to test at the true trough (lowest point) before your next injection.

If you waited 4-6 weeks on your new protocol and had blood work done at true trough if we use the go to calculated linear law-of-mass action Vermeulen and plug in your robust TT 586 ng/dL, SHBG 25.5 nmol/L which is far from low and Albumin 4.3 g/dL (default) your trough FT 14.6 ng/dL is sitting in a healthy range and not high.

Free & Bioavailable Testosterone calculator

If anything you would need to retest it using the ED assay to see where it truly sits.

Post in thread 'Impact of TRT and Supraphysiological Testosterone Doses on Biological Aging'

Oct 8, 2025

I personally just go by the range labcorp and quest uses. I personally feel best with a free T higher than average. At least 40 on Labcorp’s range, and at least 400 on quest’s range. Which might seem really high to some, but that’s just where I’ve found that I feel best. And there’s a famous TRT doc that all of us have come across at some point. I’m blanking on his name, but I know throughout all the patients he’s treated, he said on average his patients do best with a free T between 40-60. Which is Labcorp’s range. It would be roughly 400-600 using quest’s range

STILL...

• madman

Thread 'Dr. Shalender Bhasin: Optimizing the Diagnosis and Treatment of Hypogonadism 2025'

Oct 7, 2025

Nelson's house u heard it here first!

Dr. Shalender Bhasin!

* over the past 4 decades he has become a global leader in the biology of androgens, sarcopenia and aging related functional decline, his research has shaped clinical guidelines, its informed public health policy particularly around testosterone therapy, anabolic interventions and then the development of function promoting therapies

The Complete Guide to Low Testosterone: What Every Man Should Know About Diagnosis and Treatment​

Medical Disclaimer: This article is for informational...

• madman
• hypogonadism; diagnosis/treatment; trt
• Replies: 31
• Forum: Testosterone and Men's Health Articles

 

[firefighterinNC]

This is the wrong FT assay you had it tested using the Equilibrium Ultrafiltration assay which would be considered the next best to the gold standard Equilibrium Dialysis but I and many in the know no longer recommend this assay as it is prone to over/underestimating FT as the assay has a higher level of imprecision




You need to have your FT tested using the Equilibrium Dialysis assay.

I already posted the links for Quest or Labcorp which offer the assay.

You can throw Mayo Clinic in there too.

Again what is your current protocol (dose of T/injection frequency) and how many days post-injection were your labs done.

You doctor just recently changed your dose so as I stated you need to wait 4-6 weeks (TC/TE) until blood levels have stabilized. in order to see where your trough FT truly sits otherwise your results would be skewed.

Always need to test at the true trough (lowest point) before your next injection.

If you waited 4-6 weeks on your new protocol and had blood work done at true trough if we use the go to calculated linear law-of-mass action Vermeulen and plug in your robust TT 586 ng/dL, SHBG 25.5 nmol/L which is far from low and Albumin 4.3 g/dL (default) your FT 14.6 ng/dL is sitting in a healthy range and not high.




If anything you would need to retest it using the ED assay to see where

These labs were done at the 4 week mark since dose increase. I injected Thursday night around 9pm and had labs done Tuesday morning at 8am. Thats about close to true trough as i can get.
Dose is 150 mg split twice a week Monday morning and Thursday night as I mentioned in the beginning of the thread. Thats probably well past my trough because i would have injected Monday at 8am. So 24hrs past my true trough.

I didn't choose the type of test that was ordered. I asked my doc to have my free test and SHBG tested and thats what was given to me. I don't have the excess funds to go around ordering labs at places i've never heard of or trust, I can have it tested under insurance and it covers every single lab I need as long as my doctor writes it. Thats just where the doctor sent me and what it
came back as. Thanks for the feedback I feel like you're pushing me to get labs done from the lab linked to the website and I just can't do that.

Thanks for the help, ill ask the doc about oral TU. In my mind 4 weeks on the upped dose I should have noticed some form of improvement or change by now, but its gotten worse.

 

[madman]

Nothing showing up in your reply?

 

[firefighterinNC]

Nothing showing up in your reply?

Some reason it doesn’t allow me permissions to quote whenever you have embed links.

I did respond once it let me edit it.

 

[madman]

These labs were done at the 4 week mark since dose increase. I injected Thursday night around 9pm and had labs done Tuesday morning at 8am. Thats about close to true trough as i can get.
Dose is 150 mg split twice a week Monday morning and Thursday night as I mentioned in the beginning of the thread. Thats probably well past my trough because i would have injected Monday at 8am. So 24hrs past my true trough.

I didn't choose the type of test that was ordered. I asked my doc to have my free test and SHBG tested and thats what was given to me. I don't have the excess funds to go around ordering labs at places i've never heard of or trust, I can have it tested under insurance and it covers every single lab I need as long as my doctor writes it. Thats just where the doctor sent me and what it
came back as. Thanks for the feedback I feel like you're pushing me to get labs done from the lab linked to the website and I just can't do that.

Thanks for the help, ill ask the doc about oral TU. In my mind 4 weeks on the upped dose I should have noticed some form of improvement or change by now, but its gotten worse.

I didn't choose the type of test that was ordered. I asked my doc to have my free test and SHBG tested and thats what was given to me. I don't have the excess funds to go around ordering labs at places i've never heard of or trust, I can have it tested under insurance and it covers every single lab I need as long as my doctor writes it. Thats just where the doctor sent me and what it came back as.


All the links I posted for labs are the big boys used by the majority of doctors which would be Labcorp and Quest Diagnostics.

Unfortunately your doctor ordered the wrong FT assay which was Equilibrium Ultrafiltration.

You need to have your FT tested using the gold standard Equilibrium Dialysis which is offered by numerous labs especially the most reputable ones Labcorp and Quest Diagnostics.

Otherwise do not waste your time getting your FT tested and use the calculated linear law-of-mass action Vermeulen (cFTV).

I already posted the link as it is available online to the general public for free.

As I stated you just plug in your TT, SHBG and Albumin and if you have no clue where your Albumin sits then you can use the default 4.3 g/dL.

I already calculated your FT in my previous reply seeing as you retested your SHBG.

You were hitting a robust TT 586 ng/dL with an SHBG 25.5 nmol/L which is not even low so your cFTV 14.6 ng/dL is healthy but far from high.

I let you know in one of my previous replies that since you are injecting twice-weekly (every 3.5 days) which you stated is Monday am and Thursday pm then your true trough would be Monday morning before your next shot or Thursday. evening before your next shot.

As I stated get your blood work done Monday morning before your next shot.

Not sure why you waited until Tuesday morning especially seeing as you went and injected Monday morning which throws everything off as your TT/FT levels will start rising again within the first 24 hrs post-injection.




I injected Thursday night around 9pm and had labs done Tuesday morning at 8am. Thats about close to true trough as i can get.

Dose is 150 mg split twice a week Monday morning and Thursday night as I mentioned in the beginning of the thread. Thats probably well past my trough because i would have injected Monday at 8am. So 24hrs past my true trough.


Unfortunately you missed the true trough which should have been Monday morning before your shot and since you injected Monday morning and waited until Tuesday morning to test then this would be 24 hrs post-dose which should be closer to the true peak which seems odd as your true peak TT/FT would be achieved within 24 hrs post-dose.

You are only hitting a TT 586 ng/dL 24 hrs post-dose which means your true trough Monday morning before your injection would have been lower than 586 ng/dL yet in your opening post when you had your blood work done Thursday morning roughly 12 hrs shy of your true trough which would have been Thursday night before your injection you were hitting a high TT 1128 ng/dL.

Something is way off here!

Look over your replies from your opening post/post #7.


Post #1

My urologist recently upped my dose to 150 mg of test cyp split into two doses weekly, he did mention he has folks take test cypionate eod and they have good success. My sensitive e2 came back in the at 52 and my testosterone was 1128.


Post #7

So I inject monday morning and thursday night or as reasonably close to that as I can. Labs were done Thursday morning of injection day, which i felt like was as close to my trough as I can get.

 

[firefighterinNC]

I didn't choose the type of test that was ordered. I asked my doc to have my free test and SHBG tested and thats what was given to me. I don't have the excess funds to go around ordering labs at places i've never heard of or trust, I can have it tested under insurance and it covers every single lab I need as long as my doctor writes it. Thats just where the doctor sent me and what it came back as.


All the links I posted for labs are the big boys used by the majority of doctors which would be Labcorp and Quest Diagnostics.

Unfortunately your doctor ordered the wrong FT assay which was Equilibrium Ultrafiltration.

You need to have your FT tested using the gold standard Equilibrium Dialysis which is offered by numerous labs especially the most reputable ones Labcorp and Quest Diagnostics.

Otherwise do not waste your time getting your FT tested and use the calculated linear law-of-mass action Vermeulen (cFTV).

I already posted the link as it is available online to the general public for free.

As I stated you just plug in your TT, SHBG and Albumin and if you have no clue where your Albumin sits then you can use the default 4.3 g/dL.

I already calculated your FT in my previous reply seeing as you retested your SHBG.

You were hitting a robust TT 586 ng/dL with an SHBG 25.5 nmol/L which is not even low so your cFTV 14.6 ng/dL is healthy but far from high.

I let you know in one of my previous replies that since you are injecting twice-weekly (every 3.5 days) which you stated is Monday am and Thursday pm then your true trough would be Monday morning before your next shot or Thursday. evening before your next shot.

As I stated get your blood work done Monday morning before your next shot.

Not sure why you waited until Tuesday morning especially seeing as you went and injected Monday morning which throws everything off as your TT/FT levels will start rising again within the first 24 hrs post-injection.




I injected Thursday night around 9pm and had labs done Tuesday morning at 8am. Thats about close to true trough as i can get.

Dose is 150 mg split twice a week Monday morning and Thursday night as I mentioned in the beginning of the thread. Thats probably well past my trough because i would have injected Monday at 8am. So 24hrs past my true trough.


Unfortunately you missed the true trough which should have been Monday morning before your shot and since you injected Monday morning and waited until Tuesday morning to test then this would be 24 hrs post-dose which should be closer to the true peak which seems odd as your true peak TT/FT would be achieved within 24 hrs post-dose.

You are only hitting a TT 586 ng/dL 24 hrs post-dose which means your true trough Monday morning before your injection would have been lower than 586 ng/dL yet in your opening post when you had your blood work done Thursday morning roughly 12 hrs shy of your true trough which would have been Thursday night before your injection you were hitting a high TT 1128 ng/dL.

Something is way off here!

Look over your replies from your opening post/post #7.


Post #1

My urologist recently upped my dose to 150 mg of test cyp split into two doses weekly, he did mention he has folks take test cypionate eod and they have good success. My sensitive e2 came back in the at 52 and my testosterone was 1128.


Post #7

So I inject monday morning and thursday night or as reasonably close to that as I can. Labs were done Thursday morning of injection day, which i felt like was as close to my trough as I can get.

I genuinely don’t know, I asked the doctor if skipping my Monday injection and getting my labs done Tuesday was ok and she said that was fine but this is my primary care doc, she’s at least attempting to help me get dialed in.
My urologist on the other hand wants lab work done 48hrs post injection instead of at a true trough which i think skews my test numbers.

Taking 150mg a week just seems like to much dose to me regardless of what the lab numbers were saying.
You mentioned before you thought i was over medicated and I do sort of agree with that.
How are you calculating my free test with that Vermeulen method? Edited- I see the calculator now and know how to calculate it. Just need shbg and total testoserone and albumin.
I’ve not seen that before.
Trying to figure all this stuff out and then it not being correct is a bit deflating. Not having libido/energy/drive etc is even worse. Just doesn’t feel like the test cypionate does much for me in that area at all.

 

[firefighterinNC]

Really the only protocol I haven’t tried is lowering the dose per injection and doing eod or daily. Seems there is quite a bit of positive reviews for that. The video shared above the doctor was pro micro dosing it seems.
I guess I can ask urologist about it at next meet.

 

[madman]

I genuinely don’t know, I asked the doctor if skipping my Monday injection and getting my labs done Tuesday was ok and she said that was fine but this is my primary care doc, she’s at least attempting to help me get dialed in.
My urologist on the other hand wants lab work done 48hrs post injection instead of at a true trough which i think skews my test numbers.

Taking 150mg a week just seems like to much dose to me regardless of what the lab numbers were saying.
You mentioned before you thought i was over medicated and I do sort of agree with that.
How are you calculating my free test with that Vermeulen method? Edited- I see the calculator now and know how to calculate it. Just need shbg and total testoserone and albumin.
I’ve not seen that before.
Trying to figure all this stuff out and then it not being correct is a bit deflating. Not having libido/energy/drive etc is even worse. Just doesn’t feel like the test cypionate does much for me in that area at all.

I genuinely don’t know, I asked the doctor if skipping my Monday injection and getting my labs done Tuesday was ok and she said that was fine but this is my primary care doc, she’s at least attempting to help me get dialed in.


Yes if you skipped your Monday am injection and tested Tuesday am which would be 24 hrs after your true trough (Monday morning) it would still be okay but not ideal and unfortunately you still injected Monday morning then had your blood work done 24 hrs later which would not be a trough as your TT/FT levels would start rising again within the first 24 hrs which would be during the peak.




My urologist on the other hand wants lab work done 48hrs post injection instead of at a true trough which i think skews my test numbers.


This guy is out to lunch as he does not understand the PK or the importance of testing the true trough (lowest point) before your next injection.

Top it off that he should have never started you on testosterone as your baseline hematocrit was already high before you jumped on T which is a big no no!

To make matters worse he started you off on too high a dose of T from the get-go.

The standard starting dose across the board by those in the know is 100 mg T/week or better yet 50 mg T split twice-weekly.

Some may even choose to start some patients on <100 mg T/week but it is far from common.

I would have kicked this guy to the curb!

As I have been preaching for years on the forum the majority of men on T-therapy can easily hit a healthy let alone high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.

Some can even achieve stellar levels injecting <100 mg T/week especially when split into more frequent injections.

Again if anything I would look into giving one of the newer oral TU formulations (Jatenzo, Tlando or Kyzatrex) a go as you may very well fare better with daily fluctuations as such formulation would allow you to achieve 2 short-lived daily peaks (high-end/high TT/FT) and 2 daily troughs ( TT/FT close to/back to baseline) which would allow you to avoid the high/absudly high TT and more importantly high FT 24/7 steady-state many are unfortunately running when using medium acting (TC/TE), or in many case short-acting (TP) protocols.

Due to the PK of the newer oral TU formulations achieving 2 daily short-lived peaks with troughs (close to/back to baseline) would minimize/prevent elevated hematocrit and estradiol let alone have minimal impact on hammering the s**t out of your CNS and dopamine which can have a positive impact on libido/erectile function and mood.

Most running a daily TP protocol are injecting way too high a dose of T and have no clue what the f**k they are doing as they are still hitting high/very high troughs 24 hrs post-dose and ridiculous peak levels which means they are still hammering the s**t out of their CNS and dopamine 24/7!

Yes if you prefer to stick with injections then a low dose daily or EOD protocol may be key here but even then as I stated in my reply (post #25):

The goal here is too achieve a healthy trough FT.

You do not want to be hitting too low or too high a trough otherwise you will run into issues.

Trough needs to be high enough so you can maintain the beneficial effects throughout the week.

The body was never meant to be amped up on T 24/7!

As I have stated numerous times on the forum over the years when looking at the bigger picture all that should really matter here is the dose one needs to achieve a healthy trough FT which will result in relief/improvement of low-T symptoms and overall well-being.

Yes symptom relief is what truly matters but when it comes to what FT level is needed one needs to keep in mind the overall goal would be to use the least amount in order to feel well while at the same time minimizing sides and keep blood markers healthy long-term.

 

[firefighterinNC]

I genuinely don’t know, I asked the doctor if skipping my Monday injection and getting my labs done Tuesday was ok and she said that was fine but this is my primary care doc, she’s at least attempting to help me get dialed in.


Yes if you skipped your Monday am injection and tested Tuesday am which would be 24 hrs after your true trough (Monday morning) it would still be okay but not ideal and unfortunately you still injected Monday morning then had your blood work done 24 hrs later which would not be a trough as your TT/FT levels would start rising again within the first 24 hrs which would be during the peak.




My urologist on the other hand wants lab work done 48hrs post injection instead of at a true trough which i think skews my test numbers.


This guy is out to lunch as he does not understand the PK or the importance of testing the true trough (lowest point) before your next injection.

Top it off that he should have never started you on testosterone as your baseline hematocrit was already high before you jumped on T which is a big no no!

To make matters worse he started you off on too high a dose of T from the get-go.

The standard starting dose across the board by those in the know is 100 mg T/week or better yet 50 mg T split twice-weekly.

Some may even choose to start some patients on <100 mg T/week but it is far from common.

I would have kicked this guy to the curb!

As I have been preaching for years on the forum the majority of men on T-therapy can easily hit a healthy let alone high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.

Some can even achieve stellar levels injecting <100 mg T/week especially when split into more frequent injections.

Again if anything I would look into giving one of the newer oral TU formulations (Jatenzo, Tlando or Kyzatrex) a go as you may very well fare better with daily fluctuations as such formulation would allow you to achieve 2 short-lived daily peaks (high-end/high TT/FT) and 2 daily troughs ( TT/FT close to/back to baseline) which would allow you to avoid the high/absudly high TT and more importantly high FT 24/7 steady-state many are unfortunately running when using medium acting (TC/TE), or in many case short-acting (TP) protocols.

Due to the PK of the newer oral TU formulations achieving 2 daily short-lived peaks with troughs (close to/back to baseline) would minimize/prevent elevated hematocrit and estradiol let alone have minimal impact on hammering the s**t out of your CNS and dopamine which can have a positive impact on libido/erectile function and mood.

Most running a daily TP protocol are injecting way too high a dose of T and have no clue what the f**k they are doing as they are still hitting high/very high troughs 24 hrs post-dose and ridiculous peak levels which means they are still hammering the s**t out of their CNS and dopamine 24/7!

Yes if you prefer to stick with injections then a low dose daily or EOD protocol may be key here but even then as I stated in my reply (post #25):

The goal here is too achieve a healthy trough FT.

You do not want to be hitting too low or too high a trough otherwise you will run into issues.

Trough needs to be high enough so you can maintain the beneficial effects throughout the week.

The body was never meant to be amped up on T 24/7!

As I have stated numerous times on the forum over the years when looking at the bigger picture all that should really matter here is the dose one needs to achieve a healthy trough FT which will result in relief/improvement of low-T symptoms and overall well-being.

Yes symptom relief is what truly matters but when it comes to what FT level is needed one needs to keep in mind the overall goal would be to use the least amount in order to feel well while at the same time minimizing sides and keep blood markers healthy long-term.

I didn't inject Monday on my injection day. I held my injection day until Tuesday after labs were
done. I just want to clear that up, my doctor responded to my message Monday morning in response to getting SHBG + FT labs done and by time i saw them she responded back and said to wait till the following morning. So i withheld my injection until Tuesday after labs were done.

 

[firefighterinNC]

I genuinely don’t know, I asked the doctor if skipping my Monday injection and getting my labs done Tuesday was ok and she said that was fine but this is my primary care doc, she’s at least attempting to help me get dialed in.


Yes if you skipped your Monday am injection and tested Tuesday am which would be 24 hrs after your true trough (Monday morning) it would still be okay but not ideal and unfortunately you still injected Monday morning then had your blood work done 24 hrs later which would not be a trough as your TT/FT levels would start rising again within the first 24 hrs which would be during the peak.




My urologist on the other hand wants lab work done 48hrs post injection instead of at a true trough which i think skews my test numbers.


This guy is out to lunch as he does not understand the PK or the importance of testing the true trough (lowest point) before your next injection.

Top it off that he should have never started you on testosterone as your baseline hematocrit was already high before you jumped on T which is a big no no!

To make matters worse he started you off on too high a dose of T from the get-go.

The standard starting dose across the board by those in the know is 100 mg T/week or better yet 50 mg T split twice-weekly.

Some may even choose to start some patients on <100 mg T/week but it is far from common.

I would have kicked this guy to the curb!

As I have been preaching for years on the forum the majority of men on T-therapy can easily hit a healthy let alone high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.

Some can even achieve stellar levels injecting <100 mg T/week especially when split into more frequent injections.

Again if anything I would look into giving one of the newer oral TU formulations (Jatenzo, Tlando or Kyzatrex) a go as you may very well fare better with daily fluctuations as such formulation would allow you to achieve 2 short-lived daily peaks (high-end/high TT/FT) and 2 daily troughs ( TT/FT close to/back to baseline) which would allow you to avoid the high/absudly high TT and more importantly high FT 24/7 steady-state many are unfortunately running when using medium acting (TC/TE), or in many case short-acting (TP) protocols.

Due to the PK of the newer oral TU formulations achieving 2 daily short-lived peaks with troughs (close to/back to baseline) would minimize/prevent elevated hematocrit and estradiol let alone have minimal impact on hammering the s**t out of your CNS and dopamine which can have a positive impact on libido/erectile function and mood.

Most running a daily TP protocol are injecting way too high a dose of T and have no clue what the f**k they are doing as they are still hitting high/very high troughs 24 hrs post-dose and ridiculous peak levels which means they are still hammering the s**t out of their CNS and dopamine 24/7!

Yes if you prefer to stick with injections then a low dose daily or EOD protocol may be key here but even then as I stated in my reply (post #25):

The goal here is too achieve a healthy trough FT.

You do not want to be hitting too low or too high a trough otherwise you will run into issues.

Trough needs to be high enough so you can maintain the beneficial effects throughout the week.

The body was never meant to be amped up on T 24/7!

As I have stated numerous times on the forum over the years when looking at the bigger picture all that should really matter here is the dose one needs to achieve a healthy trough FT which will result in relief/improvement of low-T symptoms and overall well-being.

Yes symptom relief is what truly matters but when it comes to what FT level is needed one needs to keep in mind the overall goal would be to use the least amount in order to feel well while at the same time minimizing sides and keep blood markers healthy long-term.

Yeah I'm not terribly pleased with the new urologist. I don't agree with increasing the dose and providing a bandaid fix of donating blood every quarter to address high hematocrit issues. I'd rather run a lesser dose that is right for me or try a different form of testosterone all together. There's to many medications to be stuck with just one if its not performing and giving good results imo.
My PCP made the suggestion in her follow up on the lab recent lab results that she would like to see me return to the original endocrinologist as he was the one who suggest going down in dose and not up.

 

[madman]

I didn't inject Monday on my injection day. I held my injection day until Tuesday after labs were
done. I just want to clear that up, my doctor responded to my message Monday morning in response to getting SHBG + FT labs done and by time i saw them she responded back and said to wait till the following morning. So i withheld my injection until Tuesday after labs were done.

Okay glad you cleared that up.

So you had your blood work done 24 hrs after true trough (Monday am) which means your TT/FT levels would be lower than your true trough as you were still hitting a robust TT 586 ng/dL 4.5 days post-injection.

Next time around if you stick with injections make sure you test at the true trough so you know where your FT truly sits at its lowest point during your weekly injection cycle.