Post TRT - Libido is DEAD :(

[Cataceous]

So why do you say you cannot handle higher levels of testosterone. You believe it is because when you went through puberty you had low levels of testosterone to begin with?

I "handled" higher levels for some years, but came to realize the harm they caused was outweighing the good. I loved the boost in athleticism, but the persistent headaches along with impaired libido and sexual function pushed me to keep experimenting. I would guess I had normal testosterone through life until hypogonadism hit in my 50s. What guys like you downplay is that even a TT of 800 ng/dL is unnaturally high for most men, especially when that level is constant 24/7. If my healthy youthful levels entailed a daily peak of 600 ng/dL, then that is not low, but average.

You are now studiously silent on your claim that lower levels didn't work for you. Are they true or a confabulation?

When it did first started I did have lower numbers and they did not work for me as I'm sure you know.

 

[Vince]

I "handled" higher levels for some years, but came to realize the harm they caused was outweighing the good. I loved the boost in athleticism, but the persistent headaches along with impaired libido and sexual function pushed me to keep experimenting. I would guess I had normal testosterone through life until hypogonadism hit in my 50s. What guys like you downplay is that even a TT of 800 ng/dL is unnaturally high for most men, especially when that level is constant 24/7. If my healthy youthful levels entailed a daily peak of 600 ng/dL, then that is not low, but average.

You are now studiously silent on your claim that lower levels didn't work for you. Are they true or a confabulation?

I thought you said you had anxiety issues, are you saying that's not true now? I also thought you said you still have libido issues?

I'm sure you know or should know that cycling raising cortisol and inducing inflammation, which can suppress testosterone levels. Maybe that's why you had to go on trt?

Heart Risks Associated With Extreme Exercise

Exercise is good for you. But extreme athletes can push it past healthy limits and cause heart damage. Here’s what you need to know.

health.clevelandclinic.org

 

[Phil Goodman]

I have always said that if you prioritize musculature over general health then higher doses are the way to go. That's not supporting your case. The average guy would rather just feel good and not risk the side effects. At a minimum, he should experience healthy normal levels so he has a point of reference in case he eventually wants to try higher levels and things go bad.

I don't know how you can dismiss dozens of studies involving hundreds of thousands of men, which support dosing to physiological levels. The burden of proof that non-physiological levels are better overall is on you. The studies already show, and you acknowledge, that the side effects burden increases, which is a de facto indication that higher levels are not better overall. If a hypogonadal guy comes along and says "I want big muscles, health be damned." then let him start high. For everybody else, starting at physiological levels is the rational and evidence-based approach.

Increased Muscle mass within reason is a huge benefit to health - dose dependent
Increased Bone density within reason is a huge benefit to health - dose dependent

Consider the number of elderly who fall and break something due to being weak and frail that end up on their deathbed. Just those two alone are huge benefits, and again are dose dependent

Reduced fat mass is also a huge benefit to health. Also dose dependent

IGF 1 levels… IGF-1 matters beyond muscle — it plays a role in tissue repair, collagen synthesis (supporting joint and connective tissue health), and metabolic regulation. At 50 mg/week, IGF-1 stimulation is modest. At 100 mg/week, it’s meaningfully higher.

Improvements to A1C and other metabolic markers are very beneficial for overall health. Also dose dependent.



So no… it isn’t just “sure if you want to get jacked take larger doses”. I stand by my (repeated) statements that benefits at 100-120 are better for most guys than doses of 50-75 and I also stand by my statements that the safety of those doses is well-established.

 

[Cataceous]

I thought you said you had anxiety issues, are you saying that's not true now? I also thought you said you still have libido issues?
...

I never had anxiety in the context of TRT. If anything, TRT lowers my anxiety, though paradoxically it also impairs sleep at higher levels. Not long ago I did report that in the context of short trials with clascoterone I developed anxiety, leading me to stop using it. The apparent resolution of libido issues is fairly recent. It had been unreliable under TRT, but is now consistent.

...
I'm sure you know or should know that cycling raising cortisol and inducing inflammation, which can suppress testosterone levels. Maybe that's why you had to go on trt?
...

It can't be ruled out as a contributing factor, but other factors seem more likely. There were concussions from bike racing crashes. There's that old scapegoat, environmental toxins. Who knows?

If I had testosterone levels that looks like you do. I would feel terrible. I believe when I was a young man. My levels must have been pretty high. Cuz now for me to feel good. I have to have levels above the normal range.

When it did first started I did have lower numbers and they did not work for me as I'm sure you know.

In the absence of clarification by you I am going to assume these statements of yours have no basis in fact. You apparently started TRT with a very high dose of 70 mg TC E3.5D, and in part to reduce hematocrit, eventually settled on 16 mg ED, still well above what's physiological. Therefore you have no experience with physiological TRT and cannot make the claim that you would feel worse at "normal" levels. For all you know you would feel better.

 

[Cataceous]

Increased Muscle mass within reason is a huge benefit to health - dose dependent
Increased Bone density within reason is a huge benefit to health - dose dependent

Consider the number of elderly who fall and break something due to being weak and frail that end up on their deathbed. Just those two alone are huge benefits, and again are dose dependent

These parameters most likely can be improved sufficiently with the restoration of normal youthful levels. There's no evidence that going above what's physiological improves longevity.

IGF 1 levels… IGF-1 matters beyond muscle — it plays a role in tissue repair, collagen synthesis (supporting joint and connective tissue health), and metabolic regulation. At 50 mg/week, IGF-1 stimulation is modest. At 100 mg/week, it’s meaningfully higher.

IGF-1 is a double-edged sword. It's useful, but also pro-aging. Maximum longevity is linked to levels that are a little below average.

So no… it isn’t just “sure if you want to get jacked take larger doses”. I stand by my (repeated) statements that benefits at 100-120 are better for most guys than doses of 50-75 and I also stand by my statements that the safety of those doses is well-established.

You're entitled to the opinion, and I appreciate that you now don't seem to be outright rejecting the idea of starting TRT at healthy normal levels to establish a baseline.

 

[Vince]

I never had anxiety in the context of TRT. If anything, TRT lowers my anxiety, though paradoxically it also impairs sleep at higher levels. Not long ago I did report that in the context of short trials with clascoterone I developed anxiety, leading me to stop using it. The apparent resolution of libido issues is fairly recent. It had been unreliable under TRT, but is now consistent.



It can't be ruled out as a contributing factor, but other factors seem more likely. There were concussions from bike racing crashes. There's that old scapegoat, environmental toxins. Who knows?




In the absence of clarification by you I am going to assume these statements of yours have no basis in fact. You apparently started TRT with a very high dose of 70 mg TC E3.5D, and in part to reduce hematocrit, eventually settled on 16 mg ED, still well above what's physiological. Therefore you have no experience with physiological TRT and cannot make the claim that you would feel worse at "normal" levels. For all you know you would feel better.

You may want to go easy on your cycle training. As you know it does lead to heart disease or higher CT heart scan. I don't know if you've had one? Also, if you ease up on your cycle training, it may also help to increase your libido.

Here's one of my very old testosterone level. It's all I could find TESTOSTERONE 503 ng/dL

 

[Cataceous]

...
Here's one of my very old testosterone level. It's all I could find TESTOSTERONE 503 ng/dL

Pair that with your low SHBG back then and you still had upper-range free testosterone, presumably at a trough. Peaks would then be over-range on the E3.5D protocol.

 

[Vince]

Pair that with your low SHBG back then and you still had upper-range free testosterone, presumably at a trough. Peaks would then be over-range on the E3.5D protocol.

Too bad I felt so bad, my libido was strong but I had brain fog. Even before TRT I was in good shape. I don't use TRT for muscle. I use it for TRT health.

I do think you should follow my recommendations. Don't over cycle, start weight training and healthy eating.

 

[Phil Goodman]

These parameters most likely can be improved sufficiently with the restoration of normal youthful levels. There's no evidence that going above what's physiological improves longevity.



IGF-1 is a double-edged sword. It's useful, but also pro-aging. Maximum longevity is linked to levels that are a little below average.



You're entitled to the opinion, and I appreciate that you now don't seem to be outright rejecting the idea of starting TRT at healthy normal levels to establish a baseline.

I’ve always been fine with the idea of starting trt at healthy normal levels to establish a baseline, that’s why I recommend people start on a dose ranging from 100-120.

Everything I said in my post was true about all of the benefits of trt as well as those benefits being dose dependent. You didn’t counter anything I said, because again, everything I said was true.

You’re entitled to your opinion as well, and ultimately it probably just comes down to a difference in approach between us. You seem to go with a “if things get a little better then that’s good enough”. My approach is to find the sweet spot on the U-curve where a person can find the best balance of maximized benefits while maintaining very low risks. The data is out there no matter how many times you want to say that it isn’t. You also seem to think a person should always remain within the natural physiological range even though they’re using an unnatural process to get there. I disagree with that for a multitude of reasons that we can get into if you’d like, but either way, disagreeing is fine. It would be pretty boring to live in a world where everyone agreed all the time anyway lol.

 

[Mastodont]

There was this one late great doc who used 60mg of test e as a starting point for all his patients, and he made a name for himself doing that...also i don't think it's wise to use the magical 54% hct as a one size fits all to justify running high levels for decades unless you prefer to have muscles over everything else without hypertrophy-focused smart training.

 

[Mastodont]

It would have been nice if the Shalender Basin study would have had groups who trained, also once weekly is not ideal for smaller amounts like 50mg weekly...still 125mg group maintained muscle without training, is that normal for most of the natural population?
fat gain in the 50mg group was interesting, i believe they were not athletes before the study and diet remained the same. Also the average total levels were very low.

 

[Phil Goodman]

It would have been nice if the Shalender Basin study would have had groups who trained, also once weekly is not ideal for smaller amounts like 50mg weekly...still 125mg group maintained muscle without training, is that normal for most of the natural population?
fat gain in the 50mg group was interesting, i believe they were not athletes before the study and diet remained the same. Also the average total levels were very low.

Once weekly is not ideal for other dosages either… you could also say that splitting the dose in those groups would provide even more benefits and even less risks(though again the risks were already shown to be very low, with the authors explicitly stating that the 120-125 group had the best mix of good benefits/low risk ratio).

Regardless of what percentage of the population can maintain muscle without exercise, the point remains that building and retaining more muscle is healthy. Which means the 125 group had an advantage on that front. Same with fat loss. Regardless of how it occurs in the general population, if there is a patient group losing more fat then their treatment gets a win in that category over others that either don’t show the same rate of fat loss(or even worse, end up gaining fat). Same with bone density and the other factors mentioned above.

 

[Mastodont]

@Cataceous Interested in your opinion on the fat gains of the Forementioned study. Is it all about the administration once weekly, or can there be some endogenous production on small doses if no GnRH agonist is used. Otherwise the levels seem too low to recommend as a starting dose, cant really see twice weekly bringing them significantly higher...personally 7.5mg per day of test e resulted in low levels, total around 430, may be sufficient if shbg is low.

1. Natural testosterone production was intentionally shut down​

In that study, participants were given a GnRH agonist to completely suppress endogenous testosterone before giving the injections.
So the real comparison was:

Condition	Hormone situation
Before study	Normal natural testosterone
During 50 mg/week	Only the injected testosterone

For many participants, 50 mg/week produced lower overall testosterone than their natural baseline.
So metabolically they were effectively in a mild hypogonadal state, which promotes fat gain.

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2. 50 mg/week produced low serum testosterone levels​

In the study the approximate testosterone levels were:

Dose	Avg serum T
25 mg	~253 ng/dL
50 mg	~306 ng/dL
125 mg	~542 ng/dL
300 mg	~1345 ng/dL

For reference:

• Normal healthy male range: ~300–1000 ng/dL
• Many young men naturally sit 500–800+

So 50 mg/week ≈ borderline low testosterone for many subjects.
Low testosterone is associated with:

• Increased fat mass
• Reduced insulin sensitivity
• Reduced energy expenditure

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3. Muscle-building threshold wasn’t reached​

The study showed fat-free mass only increased meaningfully at ≥125 mg/week.
Below that:

• anabolic signaling is weak
• muscle mass doesn’t increase
• metabolic rate doesn’t rise

Without the anabolic effect, the hormonal environment favors fat storage rather than lean mass gain.

---

4. Estrogen also dropped​

Because aromatization depends on testosterone levels:

• Low testosterone → low estradiol
• Low estradiol in men can increase fat accumulation and worsen body composition.

This is another reason the low-dose groups gained fat.

---

5. The key takeaway​

The study doesn’t mean testosterone causes fat gain. It shows something more nuanced:
Replacing normal testosterone with a dose that produces lower levels worsens body composition.
In simplified terms:
Natural T (600 ng/dL) → good body composition
Suppress T + 50 mg/week (300 ng/dL) → worse body composition
125+ mg/week (normal-high levels) → improved body composition
So the fat gain happened because the dose was effectively under-replacement.

 

[Cataceous]

@Cataceous Interested in your opinion on the fat gains of the Forementioned study. Is it all about the administration once weekly, or can there be some endogenous production on small doses if no GnRH agonist is used. Otherwise the levels seem too low to recommend as a starting dose, cant really see twice weekly bringing them significantly higher...personally 7.5mg per day of test e resulted in low levels, total around 430, may be sufficient if shbg is low.

The big problem is that once-weekly dosing of 50 mg TC leaves most men hypogonadal later in each injection cycle—so the pattern is not remotely physiological. Obviously this causes problems. As a starting dose 50 mg must be divided, probably into at least EOD injections, even though some might be fine with 25 mg twice a week.

For most men with secondary hypogonadism, 50 mg TC per week is enough to significantly or fully suppress the HPTA. Recall that in some ways secondary might be thought of as a hypersensitivity of the hypothalamus to estrogens and androgens; the negative feedback is much higher than it should be.

As you imply, free testosterone is what counts. With low SHBG a total testosterone of 430 ng/dL could mean a healthy free level. In truth, while 5 mg of testosterone per day certainly isn't optimal for everyone, it is sufficient to prevent hypogonadism when it's delivered appropriately.

 

[Willyt]

Interesting that Xyosted auto-injector (enanthate) targets a TT trough of 350 - 650. Xyosted injected once per week so that is 7 day trough. However, Xyosted appears to maintain more stable levels as evidenced by fact that its peak is 1.8x trough.

So Xyosted's recommended trough equates to TT peak of 630 to 1170, but that is presumably a short-lived peak (versus steady state).

Overall, this would seem to more conservative than your typical Low T clinic.

Efficacy

XYOSTED® is a virtually pain-free testosterone replacement for adult males who have low or no testosterone due to certain medical conditions. See Boxed Warning, Important Safety Information, and Full Prescribing Information.

www.xyosted.com

 

[Cataceous]

Interesting that Xyosted auto-injector (enanthate) targets a TT trough of 350 - 650. Xyosted injected once per week so that is 7 day trough. However, Xyosted appears to maintain more stable levels as evidenced by fact that its peak is 1.8x trough.

So Xyosted's recommended trough equates to TT peak of 630 to 1170, but that is presumably a short-lived peak (versus steady state).

Overall, this would seem to more conservative than your typical Low T clinic.

It's presumed that the lack of excipients gives Xyosted its relatively long have-life of 10 days. This is around double that of typical enanthate and cypionate formulations, and makes once-weekly injections feasible. I also like to call attention to the fact that the starting dose is 75 mg/week, which is only modestly above average production for healthy young men. Of course I still think this is a little high for starting out, but it's a huge improvement over the non-physiological 100+ mg/week starting doses of many clinics.

 

[Phil Goodman]

The big problem is that once-weekly dosing of 50 mg TC leaves most men hypogonadal later in each injection cycle—so the pattern is not remotely physiological. Obviously this causes problems. As a starting dose 50 mg must be divided, probably into at least EOD injections, even though some might be fine with 25 mg twice a week.

For most men with secondary hypogonadism, 50 mg TC per week is enough to significantly or fully suppress the HPTA. Recall that in some ways secondary might be thought of as a hypersensitivity of the hypothalamus to estrogens and androgens; the negative feedback is much higher than it should be.

As you imply, free testosterone is what counts. With low SHBG a total testosterone of 430 ng/dL could mean a healthy free level. In truth, while 5 mg of testosterone per day certainly isn't optimal for everyone, it is sufficient to prevent hypogonadism when it's delivered appropriately.

We’ve also been over this aspect as well… and anyone here is free to go check out the steroid plotter to see the results for your recommended dosing.

You say 50 mg is clearly a problem because patients spend too much time at a low point. Below is the comparison for 50 mg once/week, 25 mg twice/week, and your preferred protocol of 14.3 mg every other day


50 mg once/week - peak around 325 and bottom out around 250

25 mg twice/week - peak around 300 and bottom out around 280… for some reason you seem to think this will make a meaningful difference on the muscle-building and fat loss fronts.

14.3 mg every other day(what you say, if I’ve interpreted you correctly, is the dose almost everyone should start with) - bounces back and forth between around 295 to 285.


Tell me how having someone peak at under 300 is getting them to healthy levels, much less allowing them to get maximum benefits from treatment.


Sure those are just estimates, but as it was pointed out above there are studies which support those types of levels being experienced by patients on those doses… which is why they don’t get muscle gaining benefits, don’t get bone density increase benefits, don’t get fat loss benefits(or worse, actually gain fat), and while it wasn’t studied specifically I’d say it’s safe to say they aren’t getting the full range of benefits on other fronts either(like metabolic advantages, psychological advantages, etc.). It makes sense that if they aren’t even returning to their healthy baseline by taking a dose of 50 mg/week then their health would get worse, which is what is seen in the studies. Splitting the dose up does not fix the issue of lower levels like you insist that it does, and the level estimates support my claim on that front.


So I still stand by my claim that 100-125 is the best starting point for patients. And it is CLEARLY superior to 50 mg/week… no matter how you split the dosing.

 

[Cataceous]

...
50 mg once/week - peak around 325 and bottom out around 250

25 mg twice/week - peak around 300 and bottom out around 280… for some reason you seem to think this will make a meaningful difference on the muscle-building and fat loss fronts.

14.3 mg every other day(what you say, if I’ve interpreted you correctly, is the dose almost everyone should start with) - bounces back and forth between around 295 to 285.


Tell me how having someone peak at under 300 is getting them to healthy levels, much less allowing them to get maximum benefits from treatment.


Sure those are just estimates,...

These numbers are not estimates: they are a complete joke, and have no relationship to the real world,—except perhaps that 250 ng/dL as a trough for 50 mg TC/week. The peak for weekly TC injection is going to be two to three times the trough level. This falls out from the half-life alone and totally discredits these numbers.

If you want to see real-world measurements then dig up the dose-response graph that @readalot put together in a forum post.

...
So I still stand by my claim that 100-125 is the best starting point for patients. And it is CLEARLY superior to 50 mg/week… no matter how you split the dosing.

Completely false and thoroughly discredited. The guidelines based on studies of huge numbers of men all say to aim for mid-range levels, which are greatly exceeded with 100-125 mg TC/week—no matter how you split the dosing.

Without having the science behind you, you are relying on anecdotes from the likes of Vince, where unsurprisingly we find out he never even tried physiological dosing, yet somehow knows it doesn't work.