That's a tremendous amount of verbiage to continue skirting the key points here:
The studies and anecdotes suggest various risks in higher levels of testosterone, even starting within the physiological range. You want to debate the magnitude of these risks all day long to obfuscate this double standard you're applying, where I have to provide rigorous scientific evidence while you repeat your claim ad nauseam with no rigorous support whatsoever. Once again, show me some credible scientific evidence that absorbing 10 mg per day of testosterone provides better results overall than a physiological range of ~5-8 mg per day. Because you are unable to do so the conclusion is obvious: Start TRT with physiological dosing.
I'll still comment on some of your more egregious remarks:
In order to dodge having to formulate a rebuttal you call something "word salad" when clearly it is not. In this case I am explaining the apparent inconsistencies in the medical societies' positions. They try to respect tradition by using 100 mg TC/week as an example starting dose, yet call for titration to the mid-normal range of serum levels. Because this dose puts most men above the normal range it's a prescription for immediate titration downwards. It's also important to note that they still begin their standard dosing range at 50 mg TC/week, and they do not make an explicit recommendation for a particular starting dose.
That's pretty disingenuous coming from someone who previously suggested that 100 mg TC/week might not put most men above the minimal risk levels on many of these U-shaped curves.
This is basically irrelevant when the issue is long-term safety. The evidence points to a linear increase in risk
Let's avoid the silly straw-men extremes for a moment and consider this realistically. In the end what matters is the dose that is physiological for the individual. Ideally this encompasses both average testosterone intake and the pharmacokinetics. Maybe in the future there will be a way to determine this, but right now it is primarily guesswork. What we do know is that 10 mg/day of testosterone is more than the vast majority of men could make naturally, even at their peak. Given the risk of side effects with doses that are excessive
for the individual, the question is how to minimize harm when starting TRT? Obviously extremes in either direction are problematic; clearly some men would be hypogonadal on 3 mg T/day, even if it is ok for a few. On the other hand, there is evidence that for most men the worst symptoms of hypogonadism resolve at pretty modest levels, e.g. >400 ng/dL. I view this data as providing support for a low-and-slow approach. Ideally the initial
TRT dose should take a guy from below the threshold to consistently above it—though free testosterone should be used for guidance rather than total.
You haven't demonstrated otherwise. I continue to concede that being modestly hypergonadal beats being hypogonadal. In this context guys may well accept some "pain" with 100 mg TC/week because they assume that's the price to pay for being on TRT. Unfortunately many—maybe you included—never get the opportunity to discover that lower doses can give better results and/or fewer problems.
For amusement:
Question to AI:
Grok:
Cataceous has the stronger argument overall. His position is more evidence-based, aligned with major clinical guidelines, cautious about risks, and logically consistent with the goal of TRT (restoring physiological function without unnecessary excess). Phil Goodman’s stance, while reflecting common real-world TRT community experiences and some short-term dosing data, leans more on anecdotes, selective interpretations of studies, and optimization assumptions that lack robust long-term support—especially for QoL outcomes like libido.
GPT-5 mini:
Short answer: Cataceous has the stronger argument.
Why (concise):
- Evidence-based framing: Cataceous emphasizes starting with physiological replacement, cites dose-response risks (cardiovascular, hematocrit, metabolic, hormonal imbalances) and points out that many claimed benefits of higher-than-physiologic dosing are anecdotal and biased by forum selection. That aligns with clinical prudence and published concerns about supraphysiologic testosterone.
- Clear, testable recommendation: recommends lowering dose/frequency (e.g., ~40 mg twice weekly or equivalent) to restore physiology and then only escalate if objective/subjective deficits persist — a conservative, reversible approach.
- Phil Goodman's counter is mostly community-anecdote and poll-based (“many feel better at higher levels”), which is weaker as causal evidence and ignores dose-dependent risks and measurement issues (peaks vs troughs, SHBG effects). Cataceous directly addresses those measurement and interpretation problems.
So, on balance, Cataceous presents the more rigorous, safety-oriented, and evidence-aligned position.
Well, we’ve already been around in circles enough… again. I guess we can just wait until another study comes out which supports one side over the other, like we do recently with yet another study showing 100 mg/day was well-tolerated and provided benefits on many fronts for patients.
With regard to those AI overviews… go back into those chats and ask how many pages they reviewed when analyzing for a recap. You’ll notice that they say they only looked at the single page. So pro tip, you should be careful when instructing LLMs and not expect that they are doing exactly what you told them to do. I instructed them (ChatGPT and Grok) to review FULL thread and list the pros and cons of each side.
ChatGPT
The actual disagreement (properly framed)
This is
not “high dose vs low dose.”
It’s:
What is the best starting strategy for TRT under uncertainty?
- Cataceous: Start physiological, then titrate up if needed
- Phil Goodman: Start at a clinically effective dose, then titrate down or up based on response
Both allow adjustment. The disagreement is about
where you begin and why.
Cataceous — strongest version of his argument
1. TRT should approximate natural physiology first
- Endogenous production roughly translates to:
- ~50–70 mg/week equivalent
- Many standard starting doses (e.g., 100 mg/week):
- Already produce supraphysiological exposure, especially at peak
Core idea:
You don’t start above normal and then “back into” normal—you start at normal.
2. Pharmacokinetics matter more than people think
- Injections ≠ steady levels
- Even “moderate” weekly doses can create:
- High peaks + lower troughs
- These peaks may drive:
- Hematocrit increases
- Estradiol fluctuations
- Neurological/libido issues
This is one of his most technically grounded points.
3. Free testosterone and SHBG are central
- TRT often lowers SHBG
- Result:
- Disproportionately high free T, even when total T looks “normal”
Implication:
You can be supraphysiological without realizing it if you only look at total T.
4. Evidence plateau argument
- Benefits like:
- Libido
- Mood
- Cognition
tend to improve into the normal range, then flatten
- Beyond that:
- More testosterone ≠ reliably better outcomes
5. Risk management is the default in medicine
Analogy:
- You don’t treat hypothyroidism by inducing hyperthyroidism first
So:
Starting high and titrating down is backwards from standard medical logic
Strengths
- Mechanistically rigorous
- Consistent with endocrine guidelines
- Correctly emphasizes:
- Peaks
- Free T
- Long-term risk markers
Weaknesses
- Assumes “physiological = optimal” for all patients
- Underestimates how often:
- Patients remain symptomatic at mid-range levels
- Doesn’t fully grapple with:
- Real-world heterogeneity in response
Phil Goodman — strongest version of his argument
1. Start where efficacy is likely, not where theory says
- Typical starting point:
- ~100 mg/week (not extreme, but often effective)
- Rationale:
- Many patients are significantly symptomatic
- Starting too low:
- Delays relief
- Leads to prolonged under-treatment
2. Titrate in both directions
This is critical (and often misrepresented):
- If markers worsen → lower dose
- If symptoms persist → adjust upward or modify protocol
So his model is:
Find the minimum effective dose, not blindly push high levels
3. Outcomes include more than symptom relief
Phil’s argument isn’t just “feel better.”
He implicitly values:
- Body composition improvements
Which connect to:
- Insulin sensitivity
- Metabolic health
So the goal becomes:
Symptom relief plus anabolic/metabolic benefit
4. Individual variability is real and large
- SHBG varies widely
- Androgen sensitivity varies
- Neurosteroid response varies
Implication:
A rigid “mid-range total T target” will fail a subset of patients
5. Guidelines are conservative starting points
- Designed for safety across populations
- Not optimized for:
- Individual symptom resolution
- Performance or physique outcomes
Strengths
- Reflects real clinical variability
- More practical for symptom resolution
- Recognizes meaningful non-symptom benefits (body composition)
- Flexible, not dogmatic
Weaknesses
- Less precise about:
- Peak exposure
- Free T overshoot
- Assumes starting higher is “efficient,” but:
- Doesn’t fully quantify added risk
- Leans partly on observational experience vs controlled data
Direct comparison on key issues
1. Starting dose philosophy
- Cataceous: Start low/physiological → move up
- Phil: Start effective → move down or up
This is the
core divide
2. Body composition
- Phil: Central benefit, clinically meaningful
- Cataceous: Secondary / not justification for higher dosing
This is a real point in Phil’s favor
3. Pharmacokinetics (peaks/troughs)
- Cataceous: Major concern, foundational to argument
- Phil: Acknowledged indirectly, but not emphasized
Edge: Cataceous
4. Free T / SHBG dynamics
- Cataceous: Central
- Phil: De-emphasized
Edge: Cataceous
5. Symptom resolution speed
- Phil: Faster path to relief
- Cataceous: Slower but more controlled
Edge: Phil
6. Risk management
- Cataceous: Front-loaded (avoid excess early)
- Phil: Back-loaded (correct if issues arise)
Philosophical difference, not outright right/wrong
What the thread itself reveals (important)
Across multiple users in that discussion:
- Many have:
- Normal or high testosterone
- Yet poor libido
This observation:
- Weakens a simplistic “more T = better libido” model
- Supports the idea that:
- Neurobiology, estradiol balance, or receptor effects matter more than total T alone
This indirectly supports
Cataceous’ caution, even if it doesn’t fully validate his dosing strategy.
Final verdict (revised and more accurate)
Cataceous makes the stronger case on:
- Physiology
- Pharmacology
- Risk modeling
Phil makes the stronger case on:
- Practical treatment
- Patient variability
- Inclusion of body composition as a real outcome
Who actually “wins”?
If forced to choose:
Cataceous has the stronger theoretical and medical foundation
Phil has the stronger clinical pragmatism
The synthesis (most defensible overall approach)
The best interpretation of the debate is not choosing a side:
1. Start reasonably (bridging both views)
- Not ultra-low (pure Cataceous)
- Not aggressively high
- Somewhere in:
2. Monitor the right things
- Total T and free T
- SHBG
- Hematocrit
- Lipids
- Estradiol
3. Adjust deliberately
- Down if:
- Markers worsen
- Libido paradox appears
- Up if:
4. Recognize diminishing returns
- Body composition improves with higher T
- But:
- Gains taper
- Risks continue to accumulate
Bottom line
With the improved interpretation:
- Phil is more nuanced and defensible
- Cataceous is still more complete mechanistically
But neither fully solves the problem highlighted in the thread:
Libido on TRT often fails for reasons that aren’t fixed by simply adjusting testosterone dose up or down
Grok
Thread Overview (Full Read Confirmed)
The thread (“Post TRT - Libido is DEAD
”) on
ExcelMale.com totals ~120–130 posts across 6 active pages of discussion (pages 7–9 contain no additional user posts or are pagination artifacts with zero content). I reviewed every post in full via direct page fetches. The core debate between Cataceous (pages 1–6) and Phil Goodman (primarily pages 1–6, with heavy back-and-forth) centers on TRT starting/ongoing dosing philosophy in the context of the OP’s post-Androgel libido crash, recovery labs, enclomiphene use, and mildly elevated prolactin.
Cataceous argues for physiological restoration first (targeting mid-normal levels ~400–700 ng/dL via modest doses equivalent to natural production). Phil Goodman argues for 100–125 mg/week TC as the evidence-based, practical sweet spot for most men. Both cite studies, guidelines, PK data, AI summaries, and real-world outcomes. The exchange is civil but pointed, with repeated references to prior threads. Below is a neutral, balanced outline of pros and cons for each side, drawn strictly from their posts and the cited evidence in the thread.
Cataceous’s Argument: Prioritize Physiological Dosing (~50–75 mg/week TC equivalent, frequent splits, mid-normal troughs)
Core Claim: Healthy young men produce ~3–7 mg/day endogenous T (top ~9 mg/day in some data) → injectable equivalent ~30–90 mg/week max. Anything routinely pushing beyond (e.g., 100+ mg/week) is supraphysiological for most, creating unnecessary peaks/troughs, SHBG suppression, E2 imbalances, and risks—without proven superior QoL/libido benefits. Start modest, titrate to symptoms + mid-normal labs. Frequent small doses (e.g., 25–40 mg 2x/week or daily) or gels are preferred for stability. In the OP’s case: address prolactin first, stop enclomiphene if blocking brain E2 signaling.
Pros
• Strongly mechanistic and risk-minimizing: Directly ties to natural production data and explains OP’s libido crash via imbalances (low SHBG reducing E2 buffering, enclomiphene’s brain ER blockade, prolactin at 15.3 ng/mL).
• Aligns with guideline language: AUA/Endocrine Society emphasize “mid-normal range,” “minimal effective dose,” and “smaller/more frequent dosing” to stay in-range and limit time outside normal. Cites Crisler’s low-and-slow approach.
• Highlights study limitations: Many trials compare doses vs. placebo/hypogonadal baselines (not true physiological arms), so “higher wins” is often vs. severe deficiency, not optimized mid-normal.
• Practical for troubleshooting: Urges trying physiological levels first so patients have a true baseline before escalating; avoids committing men to lifelong supraphysiology unnecessarily.
• Supported by some PK/QoL data: Physiological TRT improves libido/sexual function, mood, and body comp without the dose-dependent sides (HCT, lipids) that rise beyond mid-normal.
Cons
• Can appear overly rigid or dismissive of variability: Acknowledges individual differences but still frames 100 mg/week as “already supraphysiological for most” and 75 mg/week as “higher than ideal.” Some men (per studies Phil cites) feel suboptimal or even worse at true low-physiological doses due to clearance rates/SHBG.
• Underplays real-world starting regimens: Guidelines list 75–100 mg/week (or 100 mg weekly) as common/practical examples; Cataceous calls these excessive without always addressing why they became standard.
• Relies heavily on critique rather than head-to-head superiority: No large trials directly prove physiological-first yields better long-term QoL/libido than titrated 100–125 mg for the average patient.
• Anecdotal counter-risk: Forum users (including some in-thread) report persistent symptoms until reaching higher-normal levels; Cataceous attributes this to bias/self-selection but doesn’t fully refute it with patient-level data.
Phil Goodman’s Argument: 100–125 mg/week TC Is the Evidence-Based Sweet Spot (Practical, Well-Tolerated, Maximizes Benefits)
Core Claim: Literature, PK studies, and “tons of patients” show 100–125 mg/week (split preferred) reliably hits mid-to-high normal (often 500–900+ ng/dL trough/average), delivers superior symptom relief (libido, energy, muscle, bone, metabolic markers), and has minimal risks when monitored. Physiological mimicry (~50 mg/week) is often insufficient or leaves men worse off (e.g., fat gain in some trials). Guidelines and FDA labeling support 75–100+ mg as starting examples. Higher doses are not “excessive” but optimized for most men.
Pros
• Grounded in multiple direct dose-comparison studies: Bhasin 2001/2006, Kaminetsky 2015, Xyosted data, etc., show 100–125 mg/week produces better body-comp, IGF-1, A1C, muscle, and bone outcomes than 50 mg/week—dose-dependently, with libido/sexual function often improving more reliably at higher-normal levels.
• Practical and matches real-world guidelines: AUA table and Endocrine Society list 75–100 mg/week (or 100 mg weekly) as standard starting options; 100 mg is preferred over 200 mg/2 weeks for stability. Phil repeatedly quotes these exactly.
• Strong safety data at this dose: Hematocrit >54% is rare (<1% in monitored cohorts per his citations); sides are manageable with splitting/monitoring. Many men tolerate and thrive long-term.
• Addresses under-dosing risk head-on: Provides PK tables showing 50 mg/week often lands low-normal or sub-therapeutic for many (especially older men), leading to incomplete relief—exactly why 100–125 became common.
• Patient-centered: Emphasizes real-world outcomes and polls (e.g., members feeling better slightly above normal) alongside studies; argues physiological-first can delay optimal symptom relief.
Cons
• Over-relies on studies without perfect comparators: Many trials use suppressed/hypogonadal controls or don’t test optimized frequent physiological protocols (daily micro or gel) head-to-head against 100–125 mg. “Higher wins” is sometimes vs. very low, not vs. stable mid-normal.
• Downplays supraphysiological exposure: 100 mg/week does push many men (especially younger/faster clearers) above natural peaks on average/peak; Phil acknowledges this but argues it’s not harmful and often beneficial.
• Guidelines are not a full endorsement: While examples include 100 mg, the overarching directive is “titrate to mid-normal” with minimal necessary dose—not “start at 100–125 as optimal.”
• Anecdotal weight: Cites forum experience and “tons of patients,” but these are self-selecting; doesn’t fully address mechanisms Cataceous raises (SHBG/E2 dynamics, prolactin, brain aromatization) that can kill libido even at “good” levels.
Neutral Bottom Line
Both arguments are evidence-informed and reasonable within the TRT community’s ongoing divide. Cataceous’s strength is mechanistic prudence and strict guideline alignment for risk avoidance, especially relevant to the OP’s libido-recovery scenario. Phil Goodman’s strength is pragmatic, study-backed optimization that reflects how most clinicians actually dose and what many patients report as effective. Neither is “wrong”—individual response, labs, and monitoring ultimately decide. The thread itself shows no clear “winner”; it ends with mutual respect for differing opinions while each sticks to their data. If applying to the OP: trial prolactin management + enclomiphene pause first (both agree on this), then titrate dosing based on symptoms and trough labs rather than ideology. This is not medical advice—consult a qualified clinician.
