Post TRT - Libido is DEAD :(

[Cataceous]

... proclaiming that 75 mg is not physiological for the vast majority of men. ...

Never said that. You're thinking of 100 mg TC/week, where the 10 mg T/day is more than the vast majority of men would ever make naturally.

With regard to your AI question, what you posted here and what you asked it are two very different things. Why not just ask it if what you said is true instead of re-writing it. Here’s the response I got:

You failed to give the AI the context, which is the distinction between TRT dosing at 5 mg T/day (50 mg TC/week in divided doses) versus dosing that declines to as little as 2-3 mg T/day (50 mg TC/week in one dose). Here is the followup question in my AI thread:

Question to AI:

Given this information, is it reasonable to suggest that a majority of hypogonadal men who start testosterone replacement therapy at a dose of 5 mg/day of testosterone will see a resolution of such symptoms, even if they may not be optimized?​

​

Answer:

Yes, it is reasonable to suggest that a majority of properly diagnosed hypogonadal men (confirmed low morning total T + symptoms) starting a standard dose equivalent to ~5 mg/day systemic testosterone delivery (e.g., typical starting gel regimens like AndroGel 1% 5 g delivering ~50 mg testosterone topically, with ~10% nominal absorption) will experience at least partial resolution or meaningful improvement in threshold-dependent sexual symptoms like low libido/desire and reduced spontaneous/morning erections—even if the dose isn't fully titrated to "optimized" mid-normal levels.​

​

Why This Holds Based on the Threshold Effect​

​

The threshold/saturation model means that restoring T from frankly low levels (<8–12 nmol/L or <230–350 ng/dL) to low-normal range (~300–500+ ng/dL) is often sufficient for libido, sexual thoughts, spontaneous erections, and related function. Standard starting doses frequently achieve this in many men, especially those with moderate-to-severe deficiency.​

• Clinical response rates: In real-world and trial data, ~60–70%+ of symptomatic hypogonadal men report noticeable improvements in libido, sexual desire/motivation, erections (especially spontaneous/morning), and overall sexual satisfaction within weeks to months on TRT. For example:
  • One observational study found ~70% reported benefits in erections, libido, energy, and/or mood by 3 months, with ~63% continuing at 12 months with sustained subjective benefit.
  • Gel studies (starting doses delivering normal-range T) showed rapid improvements in sexual function scores (e.g., within 30 days, sustained), with libido and desire often responding earliest (plateauing by ~3 weeks).
  • Meta-analyses confirm small-to-moderate benefits on desire/libido and erectile function vs. placebo in hypogonadal men, with stronger effects when baseline T is lower.
• Dose relevance: Starting gels (e.g., 50 mg topical testosterone) typically raise levels into the low-to-mid normal range for many, aligning with the threshold. Not everyone normalizes perfectly on the initial dose (absorption varies), but enough do for majority symptom relief without immediate up-titration. Studies often allow adjustment (e.g., to 75–100 mg topical), but initial responses are common at entry doses.

"Majority" is a fair characterization, but individual results vary. Factors favoring better response include:​

• Lower baseline T (clearer deficiency).
• Primarily sexual symptoms tied to T (vs. vascular/neurologic ED, where TRT helps desire more than rigid erections alone).
• No major comorbidities interfering (e.g., uncontrolled diabetes, obesity, medications).

Response is not 100%—some need dose titration, adjuncts (e.g., PDE5i for ED), or don't respond robustly due to other causes. Effects on pure erectile function can be more modest/partial than on desire.​

​

Key Caveats and Clinical Context​

• Not optimized ≠ ineffective: Many see benefits at low-normal T; further increases yield diminishing returns for sexual domains per the threshold data.
• Monitoring is essential: Guidelines recommend confirming low T (two morning totals), assessing symptoms, and titrating based on follow-up levels (~4–6 weeks) and response. Aim for mid-normal range overall, but sexual symptoms often improve earlier.
• Risks/benefits: TRT improves these symptoms in responders but carries risks (e.g., erythrocytosis, prostate monitoring). Not everyone qualifies or benefits.
• "Majority" evidence level: Supported by RCTs, meta-analyses, and observational data, though exact percentages vary by study population, definition of "resolution" (partial improvement vs. full normalization), and duration.

In summary, yes—it's a reasonable, evidence-aligned expectation for most hypogonadal men on a standard starting dose. Consult an experienced clinician for diagnosis, baseline labs, individualized dosing, and monitoring rather than self-management. Lifestyle factors (weight loss, exercise) often amplify benefits.​

 

[Phil Goodman]

Never said that. You're thinking of 100 mg TC/week, where the 10 mg T/day is more than the vast majority of men would ever make naturally.



You failed to give the AI the context, which is the distinction between TRT dosing at 5 mg T/day (50 mg TC/week in divided doses) versus dosing that declines to as little as 2-3 mg T/day (50 mg TC/week in one dose). Here is the followup question in my AI thread:

Question to AI:

Given this information, is it reasonable to suggest that a majority of hypogonadal men who start testosterone replacement therapy at a dose of 5 mg/day of testosterone will see a resolution of such symptoms, even if they may not be optimized?​

​

Answer:

Yes, it is reasonable to suggest that a majority of properly diagnosed hypogonadal men (confirmed low morning total T + symptoms) starting a standard dose equivalent to ~5 mg/day systemic testosterone delivery (e.g., typical starting gel regimens like AndroGel 1% 5 g delivering ~50 mg testosterone topically, with ~10% nominal absorption) will experience at least partial resolution or meaningful improvement in threshold-dependent sexual symptoms like low libido/desire and reduced spontaneous/morning erections—even if the dose isn't fully titrated to "optimized" mid-normal levels.​

​

Why This Holds Based on the Threshold Effect​

​

The threshold/saturation model means that restoring T from frankly low levels (<8–12 nmol/L or <230–350 ng/dL) to low-normal range (~300–500+ ng/dL) is often sufficient for libido, sexual thoughts, spontaneous erections, and related function. Standard starting doses frequently achieve this in many men, especially those with moderate-to-severe deficiency.​

• Clinical response rates: In real-world and trial data, ~60–70%+ of symptomatic hypogonadal men report noticeable improvements in libido, sexual desire/motivation, erections (especially spontaneous/morning), and overall sexual satisfaction within weeks to months on TRT. For example:
  • One observational study found ~70% reported benefits in erections, libido, energy, and/or mood by 3 months, with ~63% continuing at 12 months with sustained subjective benefit.
  • Gel studies (starting doses delivering normal-range T) showed rapid improvements in sexual function scores (e.g., within 30 days, sustained), with libido and desire often responding earliest (plateauing by ~3 weeks).
  • Meta-analyses confirm small-to-moderate benefits on desire/libido and erectile function vs. placebo in hypogonadal men, with stronger effects when baseline T is lower.
• Dose relevance: Starting gels (e.g., 50 mg topical testosterone) typically raise levels into the low-to-mid normal range for many, aligning with the threshold. Not everyone normalizes perfectly on the initial dose (absorption varies), but enough do for majority symptom relief without immediate up-titration. Studies often allow adjustment (e.g., to 75–100 mg topical), but initial responses are common at entry doses.

"Majority" is a fair characterization, but individual results vary. Factors favoring better response include:​

• Lower baseline T (clearer deficiency).
• Primarily sexual symptoms tied to T (vs. vascular/neurologic ED, where TRT helps desire more than rigid erections alone).
• No major comorbidities interfering (e.g., uncontrolled diabetes, obesity, medications).

Response is not 100%—some need dose titration, adjuncts (e.g., PDE5i for ED), or don't respond robustly due to other causes. Effects on pure erectile function can be more modest/partial than on desire.​

​

Key Caveats and Clinical Context​

• Not optimized ≠ ineffective: Many see benefits at low-normal T; further increases yield diminishing returns for sexual domains per the threshold data.
• Monitoring is essential: Guidelines recommend confirming low T (two morning totals), assessing symptoms, and titrating based on follow-up levels (~4–6 weeks) and response. Aim for mid-normal range overall, but sexual symptoms often improve earlier.
• Risks/benefits: TRT improves these symptoms in responders but carries risks (e.g., erythrocytosis, prostate monitoring). Not everyone qualifies or benefits.
• "Majority" evidence level: Supported by RCTs, meta-analyses, and observational data, though exact percentages vary by study population, definition of "resolution" (partial improvement vs. full normalization), and duration.

In summary, yes—it's a reasonable, evidence-aligned expectation for most hypogonadal men on a standard starting dose. Consult an experienced clinician for diagnosis, baseline labs, individualized dosing, and monitoring rather than self-management. Lifestyle factors (weight loss, exercise) often amplify benefits.​

@Cataceous

You still haven’t answered my question. I asked

But actually I don’t think you’ve ever even provided evidence to support that claim. What are you using to make this statement?:

going from 50 mg TC/week in one injection to multiple injections is the difference between a protocol that fails for most men and one that would likely resolve the worst symptoms of hypogonadism for a majority.

I didn’t ask:

Can you an LLM to say something you want to hear?

Also, the output still hasn’t supported your statement. For one, it is still focused solely on libido instead of all symptoms. Secondly, it doesn’t show that 50 mg/week consistently gets the majority of men to the levels needed for symptom resolution. I’m assuming it referenced this study based on statements:

A 6-month observational study of energy, sexual desire, and body proportions in hypogonadal men treated with a testosterone 1% gel - PMC

This was a 6-month, open label, multinational, observational study in hypogonadal men treated with daily titrated dose of 50, 75, or 100 mg 1% testosterone gel (AndroGel®) in community practice. Primary outcome was effect of treatment on hypogonadal ...

pmc.ncbi.nlm.nih.gov

Yet if you look at that and ask follow up questions you’ll get this.


Does the study indicate which percentage changed their dose from the initial dosage?

Good question—and this is exactly where the nuance matters.

Short answer​

• In industry-controlled trials (like those behind AndroGel labeling), yes:
  • Roughly ~70–75% of patients had their dose adjusted at least once.
• In observational studies like ESPRIT:
  • They clearly state dose titration was allowed and common
  • But they often do NOT report a single clean percentage of how many changed dose

---

1) The clearest number (~74%)​

From manufacturer-associated clinical data:

• Patients started at ~50 mg/day
• Then titrated based on testosterone levels

Result:

• About 74% required a dose change

That means:

Only ~25–30% actually stayed on the initial starting dose

---

2) ESPRIT study (the one your passage most resembles)​

This large real-world study:

• Started men on 50 mg gel
• Allowed increases to 75 mg or 100 mg
• Adjusted based on lab results

What it reports:

• A substantial proportion did not achieve target levels initially
• Many required upward titration

What it does not cleanly report:

• A single “X% changed dose” number

But reading between the lines:

Dose adjustment was routine, not exceptional

---

3) What this implies (this is the key takeaway)​

Even without a perfect percentage in every paper, the pattern is very consistent:

• Starting dose = just a starting point
• Most patients:
  • Either don’t reach target levels
  • Or overshoot and need reduction
• So clinicians adjust

---

4) Why this matters for your original claim​

If:

• ~70%+ of patients need dose changes

Then:

The improvement rates (~60–70%) cannot be attributed to the initial dose itself

They reflect:

• Final, titrated dosing
• Not fixed low-dose therapy

---

Bottom line​

• Yes, there is a concrete figure (~74%) from clinical datasets
• And across studies, the consistent reality is:
  
  

  Most patients do NOT stay on the starting dose

So using those studies to argue:

“A fixed low dose works for most men”

…doesn’t really hold up under scrutiny.





Thanks for once again providing evidence that supports the claim that the dosage does not work for most men. If you did any type of follow up instead of just repeating it because it said what you want to hear you would catch these key pieces earlier.



So until you can actually provide evidence for your claim that 50 mg/week (or equivalent) split into multiple doses provided symptom resolution for most men then I’ll just assume you aren’t really basing it on real-world data. This is especially true after discovering that, at least upon initial digging, the opposite seems to be true.

 

[Guided_by_Voices]

My point is that you can be healthy and athletic with TT at 600 ng/dL, and that the thus-far unquantified, likely marginal athletic/body composition gains in going to say 1,250 ng/dL are not worth the risks for the average man going on TRT.

Those are my actual numbers, current daily peak versus constant level while using 100 mg TC/week. I did perceive a mild boost in athleticism at higher doses, but it's much better to feel healthy overall. Might I choose differently if I were still actively competing and the side effects weren't so blatant? Perhaps, but my increasing awareness of possible long-term issues would at least give me pause.

I think we're saying fairly similar things but at the risk of splitting hairs I'll say that I think that it's best to accept someone's priorities (as long as they're not directly hurting someone else) and then try to help them achieve those with the best risk/reward possible. Humans have a bad tendency to want to tell everyone else how they should be without a true understanding of the other person's situation. This is why I try to push back on the use of the term "steroid abuse" whenever I see it because people using that term are implying that they have some amazing ability to say what's best for someone else whose situation may be completely different. One of an almost infinite number of possible examples that I've heard multiple times is that for some types of police work, being physically imposing can be a life and death advantage and is far from just cosmetic.

For me, when my peak was around 600 I could not maintain a workout schedule based on a normal week because of the two-day rest that is built into that schedule., I have used a 9-day week before however that just doesn't work for my current situation. Where the overall risk/reward lies I don't know, especially because the rewards are fairly evident and the risks may not be, which is what leads me back to a balance with risk reduction at higher performance levels.

 

[Cataceous]

You still haven’t answered my question.

Notice I didn't say "all symptoms". Now what qualifies as the "worst symptoms" is subjective, but I would say the feeling of emasculation from having low libido and impaired sexual function is about the worst. So let's spell out the answer for you:

1) Many studies show a low threshold for total testosterone to resolve these symptoms, with TT less than 400 ng/dL. (First AI answer)
2) A TRT dose of 5 mg T per day puts most men consistently over the symptom resolution threshold. (Second AI answer)
3) When given in multiple injections, 50 mg TC/week provides 5 mg of T per day. (Basic pharmacokinetics)
4) Therefore, 50 mg TC/week in divided doses resolves these symptoms in most men. QED.
5) Furthermore, if 50 mg TC/week is delivered in single weekly injections then serum levels are below the symptom resolution threshold for nontrivial amounts of time (see your favorite dose-response study) making the protocol likely to fail. QED

Much as I enjoy this sort of thing, it seems to be a diversion from the lack of any serious rebuttal. And then invoking the inconsistency of topical absorption is a diversion from the diversion, and it still doesn't affect the above logic.

 

[Phil Goodman]

Notice I didn't say "all symptoms". Now what qualifies as the "worst symptoms" is subjective, but I would say the feeling of emasculation from having low libido and impaired sexual function is about the worst. So let's spell out the answer for you:

1) Many studies show a low threshold for total testosterone to resolve these symptoms, with TT less than 400 ng/dL. (First AI answer)
2) A TRT dose of 5 mg T per day puts most men consistently over the symptom resolution threshold. (Second AI answer)
3) When given in multiple injections, 50 mg TC/week provides 5 mg of T per day. (Basic pharmacokinetics)
4) Therefore, 50 mg TC/week in divided doses resolves these symptoms in most men. QED.
5) Furthermore, if 50 mg TC/week is delivered in single weekly injections then serum levels are below the symptom resolution threshold for nontrivial amounts of time (see your favorite dose-response study) making the protocol likely to fail. QED

Much as I enjoy this sort of thing, it seems to be a diversion from the lack of any serious rebuttal. And then invoking the inconsistency of topical absorption is a diversion from the diversion, and it still doesn't affect the above logic.

That’s an awful lot of “AI response” and connecting dots. I feel like we’re having two different conversations at this point. I also think there is a difference in the quality of evidence with regard to how it pertains to the topic of trt doses.

You made a claim about symptom resolution. I provided clear evidence that the dosages did not resolve symptoms for most patients. If you’d like to find a study that utilizes injections since that’s your claim then please share it. As is, your evidence is just weakly correlated “studies”… for example I’m guessing the threshold your using is based on a study that didn’t even include guys on trt. It just tried to correlate a good cutoff at which symptoms are less prevalent, so they settled on 400. Or at least that’s the closest study I could find that you might be referring to. Or better yet, instead of making blanket statements like “many studies” just share the studies. Then we can all see them. From my perspective, your argument is a good example of the old saying “numbers will tell you whatever you want to hear as long as you torture them long enough”. You’re taking a vague study about symptoms(not even involving trt), applying a best-case scenario for patient response. So your “evidence” appears to be more hypothetical whereas I’m pointing to actual real-world studies that actually captured the outcome from the doses. Unless, again, there are other studies which you’d like to share. In which case some confusion could be avoided in the future by simply sharing the studies instead of vaguely saying “lots of studies support my theory”.

 

[Cataceous]

That’s an awful lot of “AI response” and connecting dots. I feel like we’re having two different conversations at this point. I also think there is a difference in the quality of evidence with regard to how it pertains to the topic of trt doses.

All the AI is doing is finding the studies I was already aware of.

You made a claim about symptom resolution. I provided clear evidence that the dosages did not resolve symptoms for most patients.

Clear as mud. Absorption of topical testosterone varies greatly, even in the same patient over time. The studies I brought up rigorously demonstrate the threshold effect for symptom resolution. Various dose-response studies then show that 50 mg TC/week yields average TT of 400-500 ng/dL. If the dose is split adequately then levels are stable in this range.

If you’d like to find a study that utilizes injections since that’s your claim then please share it.

You're asking for repetition of very basic stuff that you already know. If you look at the dose-response chart I linked to above you'll see that it incorporates data from various studies. Overall response to 50 mg TC/week is about 500 ng/dL. Even your favorite study allows quick inference of average levels: Average TT ~= 3 * trough / 2 = 410 ng/dL.

As is, your evidence is just weakly correlated “studies”… for example I’m guessing the threshold your using is based on a study that didn’t even include guys on trt.

Instead of guessing, try looking at the AI summary of the studies.

It just tried to correlate a good cutoff at which symptoms are less prevalent, so they settled on 400. Or at least that’s the closest study I could find that you might be referring to. Or better yet, instead of making blanket statements like “many studies” just share the studies.

Now I'll grant you I don't always read your AI-generated material in detail. But I try to at least skim it so I don't end up making requests for information that's already been provided.

So go back and review the summary of the studies, and I'll enter the citations here in case you want check the AI's characterizations:

Conclusion of the first link: "These data indicate that erectile function and sexual activity and feelings are restored by relatively low T levels." There was no appreciable difference in these parameters between men receiving 4 mg T/day and those receiving 8 mg T/day.

Conclusion from the last link: "Our findings add original evidence regarding day-to-day associations between testosterone and desire, and suggest that testosterone above minimum threshold concentrations does not increase sexual desire."

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https://www.sciencedirect.com/science/article/pii/S001502821655938X

https://journals.sagepub.com/doi/10.1089/andro.2021.0034

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https://academic.oup.com/jcem/article/90/7/3838/2837203

https://onlinelibrary.wiley.com/doi/full/10.2164/jandrol.05157

https://royalsocietypublishing.org/rspb/article/291/2035/20241508/116500/Day-to-day-associations-between-testosterone

 

[Phil Goodman]

All the AI is doing is finding the studies I was already aware of.

Ok, but you agree that it is better to provide the studies you’re referencing, correct?

Clear as mud. Absorption of topical testosterone varies greatly, even in the same patient over time. The studies I brought up rigorously demonstrate the threshold effect for symptom resolution. Various dose-response studies then show that 50 mg TC/week yields average TT of 400-500 ng/dL. If the dose is split adequately then levels are stable in this range.

You didn’t bring up studies, you just made claims about them. But you linked them below so we can dive into those.

You're asking for repetition of very basic stuff that you already know. If you look at the dose-response chart I linked to above you'll see that it incorporates data from various studies. Overall response to 50 mg TC/week is about 500 ng/dL. Even your favorite study allows quick inference of average levels: Average TT ~= 3 * trough / 2 = 410 ng/dL.



Instead of guessing, try looking at the AI summary of the studies.

For one, LLMs can hallucinate and get stuff wrong. Again, it would be better to just share the studies directly. I think we can both agree on that front.

Now I'll grant you I don't always read your AI-generated material in detail. But I try to at least skim it so I don't end up making requests for information that's already been provided.

So go back and review the summary of the studies, and I'll enter the citations here in case you want check the AI's characterizations:

Conclusion of the first link: "These data indicate that erectile function and sexual activity and feelings are restored by relatively low T levels." There was no appreciable difference in these parameters between men receiving 4 mg T/day and those receiving 8 mg T/day.

Conclusion from the last link: "Our findings add original evidence regarding day-to-day associations between testosterone and desire, and suggest that testosterone above minimum threshold concentrations does not increase sexual desire."

https://www.sciencedirect.com/science/article/pii/S001502821655938X

Well there are clear issues with the strength of the study, but kudos for starting to share links for things you’re referring to. Obviously a sample size of 11 and duration of 9 weeks are both huge weaknesses. I also find it funny that when I share studies where they artificially suppress healthy young men for a study it’s a disqualifying approach, yet this is the one you start off with. But again thanks for sharing something that at least appears to support your case. Another thing I find interesting is that they used an application method that resulted in pretty much constant levels. Some men need the swings to get benefits on the libido front, but at least in this small sample size it does suggest that decent levels can provide similar benefits. It also supports your claim that more frequent doses could provide benefits in some men since participants here would’ve been very stable. But again, it’s a very small group for a very short time frame… and a group that doesn’t really represent the types of guys who would be on trt. But it is a signal supporting your claim so kudos for that.

https://journals.sagepub.com/doi/10.1089/andro.2021.0034

This isn’t an actual study, but rather a review of multiple studies. One of which is the study I referenced earlier that showed higher doses provided better outcomes with regard to libido. They also didn’t include injectable testosterone studies in the review.

Seftel et al (n=406, hypogonadal men, T ≤ 300 ng/dL)
100 mg/day T gel was the clear winner at both measured timepoints:
• At day 30: “a significant increase from baseline sexual desire was noted for those on 100 mg/day T gel compared with those on 50 mg/day T gel (increase by 1.2 vs. 0.4, p < 0.001), T patch (1.2 vs. 0.7, p < 0.0013), and placebo (1.2 vs. 0.4, p < 0.001)”
• At day 90: the 100 mg/day T gel advantage held vs. 50 mg/day gel (1.0 vs. 0.5, p = 0.0165), T patch (1.0 vs. 0.6, p = 0.0317), and placebo (1.0 vs. 0.5, p = 0.0035)

Steidle et al (n=406, hypogonadal men)
Only the highest dose showed significant benefit:
• “Men who received 100 mg/day T gel showed a significant improvement for…sexual desire (p < 0.01)”
• “This same effect was not seen in men who received 50 mg/day of T gel or T patch versus placebo, suggesting a dose-dependent effect and superior efficacy with 100 mg/day T gel”

Finkelstein et al (n=400, healthy men with induced hypogonadism)
Clearest dose-response relationship:
• “Sexual desire decreased progressively with declining testosterone doses”
• In cohort 2, “sexual desire declined significantly in men who received placebo compared with men in the three highest dose groups and declined more in men who received 1.25 g of T daily versus men in the two highest dose groups”

Summary
Across all four studies, the pattern is consistent — higher T gel doses (particularly 100 mg/day) produced greater libido improvements than lower doses or patch delivery. The 50 mg/day dose showed mixed results, significant in some studies (Wang) but not others (Steidle). The patch consistently underperformed gel at equivalent doses.


So the second link you provided had a lot more studies(and stronger studies than the one from your first link) that support my position over yours. So thanks again for supporting my case I guess.

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Again, not a standalone study but rather a review of other studies. Also, it seems more focused on ED and not libido, plus it doesnt compare various doses. If I’m missing something please feel free to point it out. And yes I understand that lower t levels in men will result in lower libido a lot of times, which I’m guessing maybe that’s what you’re going for with that one?? Don’t want to guess though, so again if I’m missing something feel free to point it out.

https://academic.oup.com/jcem/article/90/7/3838/2837203

Unless I’m missing something, this one doesn’t specify how the doses compared with regard to libido change. Not sure how that supports your case.

https://onlinelibrary.wiley.com/doi/full/10.2164/jandrol.05157

A study in castrated rodents that researched erection strength and not libido. Wrong variable and wrong species so not sure how that supports your case. Thanks for sharing the study though I guess…

https://royalsocietypublishing.org/rspb/article/291/2035/20241508/116500/Day-to-day-associations-between-testosterone

Participants weren’t on trt. It was a small size (41 men), lasted 31 days, and used daily saliva samples to test t levels and look for correlations between their levels and courtship efforts. At least it’s the right species though… but not sure how it’s applicable to our discussion.





So you’ve shared a very limited study that supports your claim, an analysis that shows numerous studies more aligned with the claims I’m making about dosages, and the rest aren’t applicable to the conversation(with one even being done in the wrong species and not even attempting to measure changes in libido).


But again, kudos for at least sharing the materials.

 

[Mastodont]

and above which extra T adds little for these domains.

Now that the conversation went to the threshold i can provide my personal anecdotes, having been on 50mg/week daily enanthate and supraphysiological doses of the same ester and others as well...the add with higher dosing has always been anything but little...were talking mandatory masturbation minimum twice daily with no "material" needed. That by itself can be considered a downside, but the tendency for premature ejaculation on higher doses sure is one. Orgasms are still great.
I am aware that the threshold theory probably applies to some...still i know from talking to people on testosterone that there are plenty of men to whom it does not.

 

[Cataceous]

Ok, but you agree that it is better to provide the studies you’re referencing, correct?

While no science is ever truly settled, this threshold effect is well-established. That doesn't mean there's one number that applies to everyone, but the statistical results make it safe for me to use the word "majority" when TT above 350 ng/dL is not found to be low with respect to sexual symptoms. The AI text cited Buena et al., 1993 and EMAS directly in the text. EMAS confirmed these general ranges:

• < 8 nmol/L (~230 ng/dL): classified as low (hypogonadal) and associated with higher likelihood of sexual symptoms.​

• 8–12 nmol/L (~230–350 ng/dL): intermediate/borderline range where symptoms may occur and free/bioavailable T or SHBG should be assessed.​

• > 12 nmol/L (> ~350 ng/dL): generally not considered low in that study's analyses.​

EMAS supported those practical ranges (commonly reported as <8 nmol/L = low, 8–12 nmol/L = borderline, >12 nmol/L = unlikely to be the main cause) but did not establish a single hard biochemical cutoff; it showed a continuous association and highlighted free/bioavailable T and clinical context as important modifiers.​

You didn’t bring up studies, you just made claims about them.

Two studies directly named in the text. More available. Are you suggesting they got it wrong?

For one, LLMs can hallucinate and get stuff wrong.

Trust but verify, yes?

I also find it funny that when I share studies where they artificially suppress healthy young men for a study it’s a disqualifying approach...

Where? I would usually be the one arguing for suppression when practical. Otherwise the study might either mix endogenous and exogenous activity or else be purely observational of endogenous activity. You can infer causality from quality observational studies, but there's more room for doubt.

This isn’t an actual study, but rather a review of multiple studies. One of which is the study I referenced earlier that showed higher doses provided better outcomes with regard to libido. ...

Studies of topical testosterone that do not measure and correlate levels cannot quantify the threshold effect, given the highly variable absorption. It's no surprise that a lot of low-concentration gel must be applied to get the average guy absorbing even 4-5 mg T/day. This uncertainty around gel absorption doesn't make your case when studies with known and/or carefully-controlled levels support and quantify the threshold effect.

... And yes I understand that lower t levels in men will result in lower libido a lot of times, which I’m guessing maybe that’s what you’re going for with that one?? Don’t want to guess though, so again if I’m missing something feel free to point it out.

This diversion is because you questioned the assertion that 5 mg/day of testosterone can resolve the worst side effects of hypogonadism in most men. The only thing you can seriously challenge is whether libido and sexual side effects are the worst, given that the characterization is subjective. But granting that, the evidence strongly supports the assertion.

...
A study in castrated rodents that researched erection strength and not libido.

Recall that the claim was about libido and sexual function.

...
But again, kudos for at least sharing the materials.

Happy to help.

 

[Cataceous]

Now that the conversation went to the threshold i can provide my personal anecdotes, having been on 50mg/week daily enanthate and supraphysiological doses of the same ester and others as well...the add with higher dosing has always been anything but little...were talking mandatory masturbation minimum twice daily with no "material" needed. That by itself can be considered a downside, but the tendency for premature ejaculation on higher doses sure is one. Orgasms are still great.
I am aware that the threshold theory probably applies to some...still i know from talking to people on testosterone that there are plenty of men to whom it does not.

Out of curiosity, what time periods were involved with these high libido episodes? What doses? PE might be a deterrent, but if it were typical to get the other results with higher dosing alone then it would be beyond commonplace. Unfortunately anecdotes also link higher doses to reduced libido and other dysfunction; there are outliers in both directions.

 

[Phil Goodman]

While no science is ever truly settled, this threshold effect is well-established. That doesn't mean there's one number that applies to everyone, but the statistical results make it safe for me to use the word "majority" when TT above 350 ng/dL is not found to be low with respect to sexual symptoms. The AI text cited Buena et al., 1993 and EMAS directly in the text. EMAS confirmed these general ranges:

• < 8 nmol/L (~230 ng/dL): classified as low (hypogonadal) and associated with higher likelihood of sexual symptoms.​

• 8–12 nmol/L (~230–350 ng/dL): intermediate/borderline range where symptoms may occur and free/bioavailable T or SHBG should be assessed.​

• > 12 nmol/L (> ~350 ng/dL): generally not considered low in that study's analyses.​

EMAS supported those practical ranges (commonly reported as <8 nmol/L = low, 8–12 nmol/L = borderline, >12 nmol/L = unlikely to be the main cause) but did not establish a single hard biochemical cutoff; it showed a continuous association and highlighted free/bioavailable T and clinical context as important modifiers.​

Two studies directly named in the text. More available. Are you suggesting they got it wrong?



Trust but verify, yes?



Where? I would usually be the one arguing for suppression when practical. Otherwise the study might either mix endogenous and exogenous activity or else be purely observational of endogenous activity. You can infer causality from quality observational studies, but there's more room for doubt.



Studies of topical testosterone that do not measure and correlate levels cannot quantify the threshold effect, given the highly variable absorption. It's no surprise that a lot of low-concentration gel must be applied to get the average guy absorbing even 4-5 mg T/day. This uncertainty around gel absorption doesn't make your case when studies with known and/or carefully-controlled levels support and quantify the threshold effect.

Then why did you share the link as evidence for your case if all of the studies use gel?? Or are you just dismissing it now because I pointed out that it doesn’t support your case. Additionally, your statement doesn’t appear to be correct. At least one of the studies did pull bloodwork, and even 25 mg gel/day group got close to the 350 mark you say is the cutoff but didn’t see as much of an improvement as the higher groups. Also the highest group still had benefits. Possibly the most but that level of details isn’t… either way the higher levels didn't diminish returns in this study. So they would get more benefits on other fronts without losing any ground with regard to libido. At least as far as that goes, that’s a good risk/reward calculation that supports the higher dose.

Gonadal Steroids and Body Composition, Strength, and Sexual Function in Men​

Link: Gonadal steroids and body composition, strength, and sexual function in men - PubMed

Dose groups → Serum T​

• 0 g → ~44 ng/dL
• 1.25 g → ~191 ng/dL
• 2.5 g → ~337 ng/dL
• 5 g → ~470 ng/dL
• 10 g → ~805 ng/dL

---

Quotes (direct + relevant)​

• “Sexual desire decreased significantly as testosterone concentrations decreased.”
• “Decreases in testosterone concentrations were associated with decreases in sexual activity and desire.”
• (From subgroup analysis, often cited):
  “Sexual desire declined significantly in men who received placebo… and declined more in men who received 1.25 g… versus men in the two highest dose groups.”

---

What is actually supported​

• 0 g and 1.25 g (very low T):
  • Clearly worse libido
• 2.5 g (~337 ng/dL):
  • Substantial recovery vs low groups
• 5 g vs 10 g:
  • Both maintain/improve libido

This diversion is because you questioned the assertion that 5 mg/day of testosterone can resolve the worst side effects of hypogonadism in most men. The only thing you can seriously challenge is whether libido and sexual side effects are the worst, given that the characterization is subjective. But granting that, the evidence strongly supports the assertion.

How is asking for clarification to better understand your position “diversion”?



Also, why did you gloss over the part where I mentioned that the other links you provided didnt compare doses and therefore didn’t support your case??

Recall that the claim was about libido and sexual function.

I can only imagine the amount of crap you’d give me if I tried to pass of a rodent study for my evidence. But yes… we can both agree on this front. Giving castrated rodents testosterone will probably improve their boners.

Happy to help.

At this point I think we are REALLY in the weeds. I mean… we’ve veered way off from reasonable starting doses all the way to you making a case that getting hypogonadal men up to around 400 will improve their libido. Which sure, I agree that is probably true for a lot of men assuming that testosterone is a key factor in their libido problems.

 

[Mastodont]

Out of curiosity, what time periods were involved with these high libido episodes? What doses? PE might be a deterrent, but if it were typical to get the other results with higher dosing alone then it would be beyond commonplace. Unfortunately anecdotes also link higher doses to reduced libido and other dysfunction; there are outliers in both directions.

Weeks to months, when these effects took place injections were typically on the higher side, 250mg in a single injection, never less than 125. Funny thing is it's not reliable, when i have tried adjustments after thinking it is not sustainable, and ended up messing the libido, i may have not gone straight back to the test only bolus dosing but when i did it did not provide the same results. Staying off of testosterone and reintroducing later usually gave the same results.
Enanthate usually gave most long lasting results during the injection interval, a full dose of sustanon for example has this effect at first, then there is a few days of lower libido and then a reactivation.
Of course with anything this effect on libido somewhat diminish as time passes after injection. It would be nice if you could have this middle ground by injecting less but does not seem to work that way.
Clearly there is some unique cocktail going on...further evidence for this is that i once introduced hcg after being in this horndog-state with bolus dose enanthate(i was uncomfortable with tight testicles) and sure enough libido went out the window. Took about a week and libido reappeared, even though i had not injected more t...dose interval for 250mg enanthate was 14 days.
Now that i am using undecanoate weekly at lower doses, once a week hcg does not kill my libido...it is still at times disturbingly high...hence why i decided to try 80mg instead of 100mg...just hope it's not another hit or miss where a small reduction makes a big impact in that department.
It has now kind of settled to be test u on thursday night and 1000iu hcg on monday night. I have a shitload of gel so i have been messing with it also, but i'm beginning to think that the swing it provides is way too much compared to what men would naturally have, especially during daytime(also have low shbg).
I do also get the elevated hematocrit which is another reason i stay off these kinds of protocols, but being a horndog is not all that fun, sure if you had a partner with endless desire it might be ok but still timeconsuming and distracting.

 

[Vince]

I thought this was interesting because how we tease each other about each other's brain issues

China has launched a comprehensive national campaign against Alzheimer’s, as projections warn the degenerative brain disease could affect nearly 10 percent of citizens by 2050. With the world’s fastest-growing dementia caseload set to sharply grow by mid-century, China is mobilizing top scientific institutions, major biotech firms and dozens of experts to accelerate the development of original treatments

 

[Cataceous]

Then why did you share the link as evidence for your case if all of the studies use gel?? ...
Also, why did you gloss over the part where I mentioned that the other links you provided didnt compare doses and therefore didn’t support your case??

If you recall, I didn't share additional links until you asked for them, at which point I supplied all of the ones the AI relied on. The two references in the text originally make the point just fine on their own.

Or are you just dismissing it now because I pointed out that it doesn’t support your case. Additionally, your statement doesn’t appear to be correct. At least one of the studies did pull bloodwork, and even 25 mg gel/day group got close to the 350 mark you say is the cutoff but didn’t see as much of an improvement as the higher groups.

Now we see why the meta study was included.

Dose groups → Serum T​

• 1.25 g → ~191 ng/dL
• 2.5 g → ~337 ng/dL
• 5 g → ~470 ng/dL
• 10 g → ~805 ng/d

---

Quotes (direct + relevant)​

• (From subgroup analysis, often cited):
  “Sexual desire declined significantly in men who received placebo… and declined more in men who received 1.25 g… versus men in the two highest dose groups.”

---

What is actually supported​

...

• 5 g vs 10 g:
  • Both maintain/improve libido

Thanks for this. The result mirrors that in Buena et al.

How is asking for clarification to better understand your position “diversion”? ...
...
At this point I think we are REALLY in the weeds.

Yep.

I can only imagine the amount of crap you’d give me if I tried to pass of a rodent study for my evidence.

That should depend on how representative the model is with regard to humans.

But yes… we can both agree on this front. Giving castrated rodents testosterone will probably improve their boners.

This ignores the relevant aspect of the research: The existence of a very low testosterone threshold for erectile function.

... I mean… we’ve veered way off from reasonable starting doses all the way to you making a case that getting hypogonadal men up to around 400 will improve their libido. Which sure, I agree that is probably true for a lot of men assuming that testosterone is a key factor in their libido problems.

The assertion provides evidence for my argument in the original debate and is a little stronger than this, but I'll happily take your agreement on something.