Less than 50 mg of T per week

[Melody68]

That's basically argument from authority. They may simply be responding to the demands of their customers, who by and large have more-is-better thinking. I see that @Willyt has already mentioned Xyosted. Its success dispels the notion that supra-physiological doses are needed to ameliorate symptoms of hypogonadism. The main thing I object to is starting new patients on 100+ mg TC/week when many will be harmed by this practice.

There is an evolution-based argument in favor of targeting average serum levels for healthy young men, which can be the 600-700 ng/dL figure of earlier decades, predating the recent decline. The reasoning is that nature had selected those levels as optimal for reproductive success. Reproductive success is then suggested to be a decent proxy for overall success in life; you have the resources and skills to attract a mate and ensure the survival of the resulting offspring. So in the end this gets you back to those physiological doses of testosterone, around 3-9 mg/day.

I'm one of these layperson guys that does well on a smaller dose, probably around 70mg/week. That puts me in the Cataceous camp of thinking. One concern I've always had is that, acknowledging the ideal of 4-8 mg/day that young men produce and use, it seems likely to me that our pathway of T delivery via injecting into the muscle or subcutaneous fat is no where near as efficient as what nature provides. Perhaps, when we inject IM we have to inject more T into the muscle to finally net out to the same 4-8mg that naturally arrives at the necessary sites for use by the young man. If that were true then higher daily allotments of 10, 12, 14 or more mg/day might be necessary . . .

 

[tropicaldaze1950]

I'm one of these layperson guys that does well on a smaller dose, probably around 70mg/week. That puts me in the Cataceous camp of thinking. One concern I've always had is that, acknowledging the ideal of 4-8 mg/day that young men produce and use, it seems likely to me that our pathway of T delivery via injecting into the muscle or subcutaneous fat is no where near as efficient as what nature provides. Perhaps, when we inject IM we have to inject more T into the muscle to finally net out to the same 4-8mg that naturally arrives at the necessary sites for use by the young man. If that were true then higher daily allotments of 10, 12, 14 or more mg/day might be necessary . . .

I agree. I'm of the opinion that exogenous T cannot be compared to endogenous production, along with endogenous DHEA, pregnenolone, progesterone, DHT, estradiol, etc. Everything was in balance. Of course, I can't explain why many men seem to do well with a dosage of between 100 mg & 200 mg, whether weekly or in divided doses and I'm not talking about clinics that start every man on 200 mg, weekly. But, I'm willing to try low dosing, whether daily or EOD. I hope I'm pleasantly surprised.

 

[Cataceous]

I'm one of these layperson guys that does well on a smaller dose, probably around 70mg/week. That puts me in the Cataceous camp of thinking. One concern I've always had is that, acknowledging the ideal of 4-8 mg/day that young men produce and use, it seems likely to me that our pathway of T delivery via injecting into the muscle or subcutaneous fat is no where near as efficient as what nature provides. Perhaps, when we inject IM we have to inject more T into the muscle to finally net out to the same 4-8mg that naturally arrives at the necessary sites for use by the young man. If that were true then higher daily allotments of 10, 12, 14 or more mg/day might be necessary . . .

Absorption via injection is almost 100%. And once the testosterone gets into circulation your body can't tell if it was injected or manufactured in the testicles. At that point the only differentiation is in the pharmacokinetics—basically the serum concentration and how it changes over time. If your TRT method provides a reasonably natural diurnal variation then you'd have to look at other factors if you're casting about for some reason to justify unnaturally high doses. One such factor is HPTA disruption. However, even if there's something to it, it's akin to fixing a nearly-flat tire by letting air out of the others to match. You restore some balance but degrade the performance of the entire system.

For example, there's a school of thought that says that symptoms of high estradiol should be addressed by increasing the dose of testosterone until the issue resolves. It's somewhat plausible because at higher doses androgenic activity is increasing faster than estrogenic activity. So maybe you do regain relative balance between the two, but you're left with unnaturally high levels of both, which can easily disrupt other systems. The irony is that the original symptoms of high estradiol frequently come about because the starting dose of testosterone was too high.

 

[Vince]

Absorption via injection is almost 100%. And once the testosterone gets into circulation your body can't tell if it was injected or manufactured in the testicles. At that point the only differentiation is in the pharmacokinetics—basically the serum concentration and how it changes over time. If your TRT method provides a reasonably natural diurnal variation then you'd have to look at other factors if you're casting about for some reason to justify unnaturally high doses. One such factor is HPTA disruption. However, even if there's something to it, it's akin to fixing a nearly-flat tire by letting air out of the others to match. You restore some balance but degrade the performance of the entire system.

For example, there's a school of thought that says that symptoms of high estradiol should be addressed by increasing the dose of testosterone until the issue resolves. It's somewhat plausible because at higher doses androgenic activity is increasing faster than estrogenic activity. So maybe you do regain relative balance between the two, but you're left with unnaturally high levels of both, which can easily disrupt other systems. The irony is that the original symptoms of high estradiol frequently come about because the starting dose of testosterone was too high.

Interested. Who said to increase testosterone to lower the effect of estrogen? I've never heard that one before.

 

[Cataceous]

Interested. Who said to increase testosterone to lower the effect of estrogen? I've never heard that one before.

Dr. Nichols and presumably some others in the TOT crowd. ChatGPT says "Some of his discussions of TRT, while emphasizing a holistic approach, have included mentions that, in specific cases, higher T doses may be needed to optimize the ratio of T to E."

 

[Vince]

Dr. Nichols and presumably some others in the TOT crowd. ChatGPT says "Some of his discussions of TRT, while emphasizing a holistic approach, have included mentions that, in specific cases, higher T doses may be needed to optimize the ratio of T to E."

When someone is not on TRT. Doctors do recommend increasing your testosterone by exercise, better diet + weight loss. Which in turn will will lower your estrogen.

But I never heard of someone increasing their dose of T to lower symptoms of e2.

 

[Vince]

@Cataceous You mean this doctor?

Keith Nichols, M.D. - Tier 1 Health & Wellness

One of American's top doctors in bio-idential hormone replacement therapy, J. Keith Nichols, M.D. is the Medical Director and CEO of Tier 1 Health and Wellness, a preventive medicine clinic headquartered the Chatanooga, TN.

tier1hw.com

 

[Cataceous]

@Cataceous You mean this doctor?

Keith Nichols, M.D. - Tier 1 Health & Wellness

One of American's top doctors in bio-idential hormone replacement therapy, J. Keith Nichols, M.D. is the Medical Director and CEO of Tier 1 Health and Wellness, a preventive medicine clinic headquartered the Chatanooga, TN.

tier1hw.com

Yes. You should know him. He has posted here as "RobRoy" and previously as "J. Keith Nichols MD". He has quite an ego, and a temper that flares whenever he is questioned.

 

[Vince]

Yes. You should know him. He has posted here as "RobRoy" and previously as "J. Keith Nichols MD". He has quite an ego, and a temper that flares whenever he is questioned.

"Needing" 300mg a week

I have been following this guy for a while because he seems to chant constantly experiment on himself and I do find it interesting He does come across as someone who knows less than he thinks but now he seems to think he needs trt at 300mg to feel best for him and that it's not a a cycle Is this...

www.excelmale.com

 

[Belekas]

Yes. You should know him. He has posted here as "RobRoy" and previously as "J. Keith Nichols MD". He has quite an ego, and a temper that flares whenever he is questioned.

I've seen how he replies to serious questions and to be fair he is a clown as he can't handle any discussion politely and seems can't handle his ego as well. Nobody in their right set of mind would talk to other people like that esp when one is a doctor. Probably needs to lower his androgens and get a proper "treatment" instead talking like a little guy who has no idea what time it is. Just another keyboard warrior who happens to be a doctor. Not sure who can go to him after reading his menstruation posts. Smh

 

[Vince]

I've seen how he replies to serious questions and to be fair he is a clown as he can't handle any discussion politely and seems can't handle his ego as well. Nobody in their right set of mind would talk to other people like that esp when one is a doctor. Probably needs to lower his androgens and get a proper "treatment" instead talking like a little guy who has no idea what time it is. Just another keyboard warrior who happens to be a doctor. Not sure who can go to him after reading his menstruation posts. Smh

Apparently it does work for him. But as we all know what works for one doesn't mean it will work for the next person.

 

[itsme]

Your results aren’t typical, you’re an outlier.

my at 7,5mgdaily =52.5 mg week ,T.T 490 ,FT 90,E51 and Hematocrit 53......I lowered the t dose from 60mg to 52.5 and also switched to daily,hoping to lower the E and Hemat. . When i was at 60mg Week-30mgx2 Mon-Thu,the T.T was 650 and the FT 155 and E at 52 and Hemat. at 53..... The lower T.T and FT was expected but not the E&Hemat,which stayed the same,why? Wondering why..getting so confusing and tired with this adjustments.Do not not want Phleb nor AL.. Can you or anyone here has a reasonable explanation? Thanks

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[Cataceous]

my at 7,5mgdaily =52.5 mg week ,T.T 490 ,FT 90,E51 and Hematocrit 53......I lowered the t dose from 60mg to 52.5 and also switched to daily,hoping to lower the E and Hemat. . When i was at 60mg Week-30mgx2 Mon-Thu,the T.T was 650 and the FT 155 and E at 52 and Hemat. at 53..... The lower T.T and FT was expected but not the E&Hemat,which stayed the same,why? Wondering why..getting so confusing and tired with this adjustments.Do not not want Phleb nor AL.. Can you or anyone here has a reasonable explanation? Thanks
...

Unless you have some other health issue this is suggesting that your dose is still too high for you. Although having total testosterone of 500 ng/dL may not seem excessive, with your daily injections you are probably maintaining this level 24 hours a day. This is an unnatural pattern, as normally our testosterone goes down as the day progresses. The constant level could be keeping hematocrit elevated. Ideally you would test this proposition by switching to faster acting testosterone, which would allow you to reduce the dose while maintaining a robust daily peak level. Since you're already injecting daily you could add in some testosterone propionate while cutting back the enanthate. For example, you might start with 2.5 mg propionate and 3 mg of enanthate daily to see if you can reduce hematocrit without becoming hypogonadal.

More dramatic would be a switch to testosterone nasal gel. The principle is the same, and it has the added advantage of allowing natural HPTA function.

Do not let anyone tell you that some arbitrary amount of testosterone is already too low. The pharmacokinetics (how serum testosterone changes over time) must be taken into account. I'm currently taking 3 mg of testosterone per day—equivalent to 30 mg of testosterone cypionate/week—in divided doses and doing better than at any higher doses. The key is that it is fast acting, leading to healthy peaks and low troughs. This intake is similar to what men using Natesto attain.

By the way, do you have a measurement for SHBG? It would be useful for estimating free testosterone. You didn't specify which test gave your free T measurements. Unless it was equilibrium dialysis it may not be trustworthy. Reference ranges and units are also needed.

 

[GreenMachineX]

my at 7,5mgdaily =52.5 mg week ,T.T 490 ,FT 90,E51 and Hematocrit 53......I lowered the t dose from 60mg to 52.5 and also switched to daily,hoping to lower the E and Hemat. . When i was at 60mg Week-30mgx2 Mon-Thu,the T.T was 650 and the FT 155 and E at 52 and Hemat. at 53..... The lower T.T and FT was expected but not the E&Hemat,which stayed the same,why? Wondering why..getting so confusing and tired with this adjustments.Do not not want Phleb nor AL.. Can you or anyone here has a reasonable explanation? Thanks

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Are you sure you tested both at trough?

 

[Willyt]

my at 7,5mgdaily =52.5 mg week ,T.T 490 ,FT 90,E51 and Hematocrit 53......I lowered the t dose from 60mg to 52.5 and also switched to daily,hoping to lower the E and Hemat. . When i was at 60mg Week-30mgx2 Mon-Thu,the T.T was 650 and the FT 155 and E at 52 and Hemat. at 53..... The lower T.T and FT was expected but not the E&Hemat,which stayed the same,why? Wondering why..getting so confusing and tired with this adjustments.Do not not want Phleb nor AL.. Can you or anyone here has a reasonable explanation? Thanks

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are you on HCG or any other supplement? That E2 seems high compared to TT.

 

[itsme]

are you on HCG or any other supplement? That E2 seems high compared to TT.

No never been on this HCG .I take the Bcomplex--omega3 fish oil-D3-pregnenolone +dhea-Nac Been on TRT for about 3 years that E and Hematocrit have been sitted there ever since.
I lowered the T dose i changed Frequency but no change ,i cannot understand it.Maybe its genetic,dont know.

 

[itsme]

Are you sure you tested both at trough?

Of course

 

[itsme]

Unless you have some other health issue this is suggesting that your dose is still too high for you. Although having total testosterone of 500 ng/dL may not seem excessive, with your daily injections you are probably maintaining this level 24 hours a day. This is an unnatural pattern, as normally our testosterone goes down as the day progresses. The constant level could be keeping hematocrit elevated. Ideally you would test this proposition by switching to faster acting testosterone, which would allow you to reduce the dose while maintaining a robust daily peak level. Since you're already injecting daily you could add in some testosterone propionate while cutting back the enanthate. For example, you might start with 2.5 mg propionate and 3 mg of enanthate daily to see if you can reduce hematocrit without becoming hypogonadal.

More dramatic would be a switch to testosterone nasal gel. The principle is the same, and it has the added advantage of allowing natural HPTA function.

Do not let anyone tell you that some arbitrary amount of testosterone is already too low. The pharmacokinetics (how serum testosterone changes over time) must be taken into account. I'm currently taking 3 mg of testosterone per day—equivalent to 30 mg of testosterone cypionate/week—in divided doses and doing better than at any higher doses. The key is that it is fast acting, leading to healthy peaks and low troughs. This intake is similar to what men using Natesto attain.

By the way, do you have a measurement for SHBG? It would be useful for estimating free testosterone. You didn't specify which test gave your free T measurements. Unless it was equilibrium dialysis it may not be trustworthy. Reference ranges and units are also needed.

TESTOSTERONE, FREE (DIALYSIS) AND TOTAL,MS

TESTOSTERONE, TOTAL, MS

491
Reference Range: 250-1100 ng/dL



TESTOSTERONE, FREE (Dialysis)

90.3
Reference Range: 30.0-135.0 pg/m

The SHBG dont have but i Know its low, tested once,was 11.


Lowering more the T dose. Its an idea but am afraid it would be underdose and bad feeling may creep up.

When i first started on TRT was doing 50mgx2 Mon-Thu=100mg and felt better with T.T at 900 But the hematocrit and the E stayed always the same 53-52 respectively. Because of that i went to 30mg x2 Mon-Thu=60mg.But like i said the E and the hematocrit stayed the same. Then i lowered more to 52.5mg and switched also to daily injection at 7.5mg and the E and Hemat. still the same. I just dont get it.
Maybe its just genetic and should leave it alone.
The only bad thing is a little fatigue and that maybe be also for the lower ferritin which was at 17 last time.

 

[Cataceous]

TESTOSTERONE, FREE (DIALYSIS) AND TOTAL,MS
TESTOSTERONE, TOTAL, MS
491
Reference Range: 250-1100 ng/dL
TESTOSTERONE, FREE (Dialysis)

90.3
Reference Range: 30.0-135.0 pg/m

The SHBG dont have but i Know its low, tested once,was 11.
Lowering more the T dose. Its an idea but am afraid it would be underdose and bad feeling may creep up.

When i first started on TRT was doing 50mgx2 Mon-Thu=100mg and felt better with T.T at 900 But the hematocrit and the E stayed always the same 53-52 respectively. Because of that i went to 30mg x2 Mon-Thu=60mg.But like i said the E and the hematocrit stayed the same. Then i lowered more to 52.5mg and switched also to daily injection at 7.5mg and the E and Hemat. still the same. I just dont get it.
Maybe its just genetic and should leave it alone.
The only bad thing is a little fatigue and that maybe be also for the lower ferritin which was at 17 last time.

Those are the gold-standard tests. Did you happen to have SHBG measured prior to TRT? It it used to be higher then it's another sign that this testosterone dosing is high for you, as androgens drive down SHBG. However, it's also possible that you are genetically predisposed to low SHBG. Such individuals seem to have a harder time with TRT, on average.

It's very common to feel exceptional when starting TRT, the so-called honeymoon period. This rarely lasts, unfortunately, and it can be very misleading with respect to what dose is actually going to be best for the long-term.

There is increasing evidence that daily peak levels of testosterone are providing a lot of the benefits. Under this principle you could potentially decrease your dose by 30-40% and still be ok as long as you still have one or more daily peaks in the 500-600 ng/dL range. This can only be accomplished with faster acting testosterone. Except for the hassle, there's little to lose with experimentation, and much to gain. In recent experimentation I did fall back into hypogonadal territory. After recognizing that I increased the dose and was fine again within a matter of days. You're not going to get into much trouble as long you don't let low levels persist for months.

 

[itsme]

Those are the gold-standard tests. Did you happen to have SHBG measured prior to TRT? It it used to be higher then it's another sign that this testosterone dosing is high for you, as androgens drive down SHBG. However, it's also possible that you are genetically predisposed to low SHBG. Such individuals seem to have a harder time with TRT, on average.

It's very common to feel exceptional when starting TRT, the so-called honeymoon period. This rarely lasts, unfortunately, and it can be very misleading with respect to what dose is actually going to be best for the long-term.

There is increasing evidence that daily peak levels of testosterone are providing a lot of the benefits. Under this principle you could potentially decrease your dose by 30-40% and still be ok as long as you still have one or more daily peaks in the 500-600 ng/dL range. This can only be accomplished with faster acting testosterone. Except for the hassle, there's little to lose with experimentation, and much to gain. In recent experimentation I did fall back into hypogonadal territory. After recognizing that I increased the dose and was fine again within a matter of days. You're not going to get into much trouble as long you don't let low levels persist for months.

I had the SHBG measurement after TRT.
I see you are very knowledgeable and expert in TRT.
For me it's too much hassle, I just looking for simple thing.
Just doing daily inject it's becoming too much. It was nice on 2x week, if wasn't for the high Hemat. and E i would have stayed on that frequency. Thinking maybe EOD a middle ground.
looking at present lab result seems the FT 90.3 pg/lm its sited at a pretty good level. Isn't this FT more important to chase number of High normal T.T? ..Maybe to notch dow this stubborn E at least in the 30s i could use like 0.125mg AL every 7-10 days and see if fatigue would resolve.?
Unless this symptom is from low ferritin which is 17 now.
They say not to supplement with iron because it could fuel more Hemat. But doing phlebotomy would lower ferritin even more. It's all a complex situation with this TRT.
I thought it was easy but it's not. TRT has its good positive things but there are a lot of frustration in finding the right individual protocol that works subjectively.
Anyway thanks for your responses.