Questions re. finding the optimal dose and testing

[alsi33]

I started TRT 7 days ago. My prescription is for 150 mg (0.75 ml) of Testosterone 20% Gel. I started with a lower dose of 50 mg for the first few days and then increased to 100 mg. I plan to reach the full dose in a few days. I have already noticed improved insulin sensitivity which is very encouraging.

At this point I basically have 2 questions. I am sure the answers are somewhere on the website but I could not find them.

First, for how long do I stay on the dose before having tests done? Which tests are to be done to monitor the progress? (Are Total Test and Test Bio sufficient?).

Second, what is the process of finding the optimal dose? Is it based on test results and symptoms? What is the optimal testosterone test results to shot for?

Just want to add that I also take 30 mg of HC for partial adrenal insufficiency, 37.5 mg of DHEA, 2.5 grain of NDT for hypothyroidism.

Thank you very much.

 

[sammmy]

Were you diagnosed by an endocrinologist for all these deficiencies - adrenal, hypothyroid, and hypogonadal?

The first few weeks of TRT are the honeymoon period, which eventually goes away and does not reflect how you would feel in the long run.

The minimal tests for monitoring are: Total T, SHBG, Estradiol, Comprehensive Metabolic panel (for Albumin and Glucose - Albumin is needed to calculate free Testosterone), CBC (for Hemoglobin, Hematocrit and immune function), Lipid Panel (for cholesterol), Iron panel and Ferritin, and PSA for prostate. It's good to have all those for a baseline before starting TRT.

The standard time to test for monitoring is 6 weeks after you change dose of INJECTABLE testosterone. Transdermal testosterone should reach stable concentrations quicker, since you apply it every day, but it's good to stick to the same time interval - shorter intervals are inadequate for assessing effects and side effects.

 

[Systemlord]

Second, what is the process of finding the optimal dose?

Trial and error. Think of it as an experiment and you’re the guinea pig.

 

[alsi33]

Were you diagnosed by an endocrinologist for all these deficiencies - adrenal, hypothyroid, and hypogonadal?

The first few weeks of TRT are the honeymoon period, which eventually goes away and does not reflect how you would feel in the long run.

The minimal tests for monitoring are: Total T, SHBG, Estradiol, Comprehensive Metabolic panel (for Albumin and Glucose - Albumin is needed to calculate free Testosterone), CBC (for Hemoglobin, Hematocrit and immune function), Lipid Panel (for cholesterol), Iron panel and Ferritin, and PSA for prostate. It's good to have all those for a baseline before starting TRT.

The standard time to test for monitoring is 6 weeks after you change dose of INJECTABLE testosterone. Transdermal testosterone should reach stable concentrations quicker, since you apply it every day, but it's good to stick to the same time interval - shorter intervals are inadequate for assessing effects and side effects.

Yes, all these deficiencies were diagnosed by different doctors at different times (endos and internists). Unfortunately, I have been on HC for the last 15 years and did not take testosterone which was a big mistake. I was not guided properly for many years. Also, I had some major issued tolerating thyroid and DHEA for some time in the past but have been tolerating ok more recent. I now realized that due to not taking testosterone all these years, i developed insulin resistance and a bunch of bad related symptoms. I had significant improvement in insulin resistance while on testosterone.

My lab tests total testosterone and bioavailable testosterone. How does one calculate free testosterone using albumin as you mentioned? Also, when I test, do I do it early in AM before taking testosterone dose, is it ok? Or I should test some hours after the dose to know how it is working?

Because my condition is probably more complicated than most because of multiple hormone deficiencies, I just want to understand how would I know if my dose of testosterone is optimal? My prescription is for 150 mg but, for example, in Dr. Hertoghe’s book “the hormone handbook”, it says that men can take up to 300 mg. I know this question is not for now but just a bit confused what to look for to know if I am on an optimal dose.

 

[sammmy]

All tests should be done in the morning, fasted, before your next dose. You can try one time a few hours after you apply the dose to see if it is absorbed.

You apply 150mg testosterone but not all of it is absorbed. You should follow the instructions for your particular gel, not what some doctor on internet says. Every formulation has different absorption.

Free testosterone can be tested but many of the tests are unreliable, except the equilibrium dialysis tests. When you don't have access to the reliable free testosterone test, you can use the free testosterone calculator:

Free & Bioavailable Testosterone calculator

Normal levels for males are 5-25ng/dL.

 

[alsi33]

Trial and error. Think of it as an experiment and you’re the guinea pig.

My doctor mentioned that i may need to take two doses to achieve stable levels as my levels are quite low. Total T between ~200. I have been using 150 mg in AM only but notice symptoms in PM. I would like to try splitting the dose. Do people usually split 50/50 or i can take higher dose in Am and lower in PM?

 

[Systemlord]

My doctor mentioned that i may need to take two doses to achieve stable levels as my levels are quite low. Total T between ~200. I have been using 150 mg in AM only but notice symptoms in PM.

I don't think testosterone gel is going to work out for you, for the fact you're already dealing with poor absorption, which is very common.

If you do the math, you're only getting 200 ng/dL at 150 mg on the T-gel, so double the dosage and you can expect 400 ng/dL, which is still subtherapeutic for the majority of men.

At this stage in the game, ditch the gel and move on to another delivery method.

Do people usually split 50/50 or i can take higher dose in Am and lower in PM?

Twice daily dosing is common and prefered. I'm surprised you didn't start out with twice daily dosing.

 

[alsi33]

I don't think testosterone gel is going to work out for you, for the fact you're already dealing with poor absorption, which is very common.

If you do the math, you're only getting 200 ng/dL at 150 mg on the T-gel, so double the dosage and you can expect 400 ng/dL, which is still subtherapeutic for the majority of men.

At this stage in the game, ditch the gel and move on to another delivery method.


Twice daily dosing is common and prefered. I'm surprised you didn't start out with twice daily dosing.

Sorry, i did not myself clear. Total T of 200 was prior to starting TRT. I have been on TRT for about 2 weeks only. I will do my first labs while on TRT soon.

You mentioned that the preferred and common dosing regimen is twice daily. Just wanted to know if most do half in AM and half in PM, or take a higher dosage in Am and lower in PM. From what i understand, we produce more T in Am, and it would make sense at least to try to split that way.

 

[Systemlord]

From what i understand, we produce more T in Am, and it would make sense at least to try to split that way.

Naturally you produce more testosterone in the morning hours, but not on TRT.

 

[Seagal]

For Androgel it is once daily dosing. With Androgel one can take a blood test after the morning dose in order to measure the daily peak.
However, the gel you described (Testosterone 20% Gel, 150mg) must be something different.?

 

[alsi33]

Were you diagnosed by an endocrinologist for all these deficiencies - adrenal, hypothyroid, and hypogonadal?

The first few weeks of TRT are the honeymoon period, which eventually goes away and does not reflect how you would feel in the long run.

The minimal tests for monitoring are: Total T, SHBG, Estradiol, Comprehensive Metabolic panel (for Albumin and Glucose - Albumin is needed to calculate free Testosterone), CBC (for Hemoglobin, Hematocrit and immune function), Lipid Panel (for cholesterol), Iron panel and Ferritin, and PSA for prostate. It's good to have all those for a baseline before starting TRT.

The standard time to test for monitoring is 6 weeks after you change dose of INJECTABLE testosterone. Transdermal testosterone should reach stable concentrations quicker, since you apply it every day, but it's good to stick to the same time interval - shorter intervals are inadequate for assessing effects and side effects.

Besides the tests you mentioned, my doctor wants me to have DHT test done. Do men on TRT usually measure DHT? I am in Canada and DHT is quite expensive, done only in private labs and sent to USA for analysis, so trying to determine if it is really necessary at this point. Thanks

 

[sammmy]

DHT is measured when you have emerging side effects of TRT (acne, balding, increased prostate PSA test) or lack of the expected sexual boost on TRT. It's not necessary as an initial test and can be skipped, if its expensive or hard to do.

DHT (Dihydrotestosterone): What It Is, Side Effects & Levels

Dihydrotestosterone (DHT) is a hormone and androgen that plays a key role in the sexual development of people assigned male at birth (AMAB).

my.clevelandclinic.org

 

[alsi33]

DHT is measured when you have emerging side effects of TRT (acne, balding, increased prostate PSA test) or lack of the expected sexual boost on TRT. It's not necessary as an initial test and can be skipped, if its expensive or hard to do.

DHT (Dihydrotestosterone): What It Is, Side Effects & Levels

Dihydrotestosterone (DHT) is a hormone and androgen that plays a key role in the sexual development of people assigned male at birth (AMAB).

my.clevelandclinic.org

My doctor suggested that i try to take the gel 2 times per day because my levels were quite low in the bottom of the range. Being cautious and sometimes sensitive to changes in meds, i decided to start with once per day in AM but notice symptoms in the evening. I would like to try to introduce PM dose and would like to know if people split the total dose equally between AM and PM dose or take a higher dose in AM and less in PM which i would prefer to try. I am on 150 mg of gel at the moment and i would try 100 mg in Am and 50 in PM. Is this reasonable?

 

[Systemlord]

I am on 150 mg of gel at the moment and i would try 100 mg in Am and 50 in PM. Is this reasonable?

I would keep the dosage at 150 mg. The body likes consistency.