Phil Goodman
Well-Known Member
I’ve already provided evidence that being out of range is better as shown by the studies that directly compared various doses. The group on the dose of 100-125 saw more benefits. Their risk was minimal. The risk would be even lower if they split the dose further (into 2-3 injections per week).
You have not provided any evidence that contradicts that. You’ve simply provided general guidelines of a range to land in…. guidelines that the medical association themselves label as being low priority as well as admitting there is weak evidence for the guideline provided. And even then they (a very conservative organization with regard to trt) suggest not falling below around 400. Which your recommended dose of 25 mg twice per week leaves patients under 400 for lots of time.
Secondly, the response can vary widely between patients. You are basing your entire argument on general (weak I might add) guidelines about where patients should fall without any supporting evidence. But since you refuse to provide studies, I went ahead and asked Grok. Let’s see where patients land on various doses, then let’s see if we can find a common ground to put this to bed. We both agree (I think) that 75 mg/week is ok for a starting dose. I tend to think many (perhaps most) patients would probably titrate up slightly from that dose whereas you may think they would probably go down. Either way, let’s just say 75 is a reasonable starting dose if we can agree on that.
AI warning below (Grok)… feel free to highlight any inaccuracies if you see any.
Here is a clear, evidence-based summary of serum testosterone levels achieved at various TRT doses, drawn from multiple peer-reviewed dose-response and pharmacokinetic (PK) studies. I analyzed key papers (Bhasin 2001 & 2006, Kaminetsky 2015, Xyosted phase 3 data/FDA label, and pharmacology reviews) plus supporting data on traditional IM injections and gels for context.
Important caveats before the data:
• Measurement timing matters: “Nadir” or “trough” = lowest level just before next dose (most relevant for weekly dosing). “Cavg” = time-averaged over the week. Peaks occur 1–2 days post-injection.
• Population differences: Fully suppressed young men (GnRH agonist + exogenous T) achieve lower levels than real hypogonadal TRT patients (partial endogenous production remains). Older men achieve higher levels at the same dose due to slower clearance.
• Route/frequency: Weekly split or SC injections produce flatter curves (less fluctuation) than biweekly IM. Individual factors (SHBG, body weight, metabolism, injection site) cause wide variability (±100–300 ng/dL common).
• Normal reference range: ~300–1,100 ng/dL (most labs). Guidelines (AUA/Endocrine Society) target mid-normal (~450–600 or 400–700 ng/dL) via titration.
• 50 mg/week is often borderline low; 75–100 mg/week reliably hits the target for most men; higher doses frequently exceed it.
Summary Table: Typical Serum Total Testosterone Levels by Weekly Dose
| Weekly Dose (TE or TC) | Study / Population | Typical Serum Total T (ng/dL) | Type | Notes |
|------------------------|-------------------------------------|----------------------------------------|---------------|-------|
| 50 mg | Bhasin 2001 (young suppressed men) | 306 (nadir) | IM weekly | Borderline low; often insufficient |
| 50 mg | Kaminetsky 2015 (hypogonadal men) | 422 (steady-state average) | SC weekly | Low-normal; many need titration up |
| 50 mg | Xyosted PK data | 458–598 (Cavg); trough ~458 | SC weekly | On low end for many men |
| 75 mg | Xyosted (starting dose) | 431–538 (Cavg); trough target 350–650 | SC weekly | Designed for physiologic range |
| 75–100 mg | General IM/SC reviews + real-world | 500–800 (trough/avg) | Weekly (split preferred) | Reliably mid-normal for most |
| 100 mg | Kaminetsky 2015 | 895 (steady-state average) | SC weekly | Solid mid-to-high normal |
| 100 mg | Xyosted pooled data | 553 (Cavg); trough ~436 | SC weekly | Within normal range |
| 125 mg | Bhasin 2001 (young) | 542 (nadir) | IM weekly | Mid-normal; anabolic benefits begin |
| 125 mg | Bhasin 2006 (older) | 852 (nadir) | IM weekly | High-normal in older men |
| 150–200 mg (or 200 mg every 2 weeks) | Traditional IM reviews | Peaks >1
Gel examples (for completeness, daily topical):
• 50 mg/day (≈5 g 1% gel): Cavg often 400–600 ng/dL (variable absorption).
• 100 mg/day: Cavg up to ~800–1,000+ ng/dL in some studies.
Key Analysis & Takeaways
• 50 mg/week consistently lands in the low-normal or borderline range (250–450 ng/dL average/trough) across studies — often too low for optimal symptom relief in real hypogonadal men (exactly as the fat-gain study referenced in prior discussion showed).
• 75–100 mg/week (the Endocrine Society/AUA practical starting range) reliably produces mid-normal levels (roughly 450–700 ng/dL trough or average) for the majority of men when dosed weekly or split 2–3×. This is the “sweet spot” for most: physiologic restoration without routine supraphysiologic exposure.
• Higher doses (125+ mg/week) push many men into high-normal or supra territory, especially older men or with frequent dosing. Benefits (muscle, IGF-1) continue dose-dependently, but so do risks (hematocrit rise, lipids, etc.).
• SC vs IM: SC (e.g., Xyosted) gives flatter curves and more predictable troughs in the 350–650 ng/dL target with less fluctuation than traditional biweekly IM.
• Variability is the rule: Some men need only 50–60 mg split; others need 120–150 mg to hit the same mid-normal bloodwork. Always measure trough (day 7 for weekly) at steady state (week 4–6), not random or peak levels.
This data strongly supports the guidelines: Start at 75–100 mg/week (split for stability), titrate based on actual bloodwork and symptoms to mid-normal range, and avoid blanket high dosing.
