Why many lower their dose on ED injections

[eli]

I've been reading online people lower their total weekly dose once they go from 2x or eod to once a day. What's the science behind that?

 

[Cataceous]

Going to more frequent injections reduces the spread between peak and trough serum testosterone. When troughs are too low and/or too long there is some risk of feeling hypogonadal again. Therefore it's typical to dose the testosterone to obtain adequate trough levels. But with infrequent injections the peak levels become unnecessarily high, potentially causing side effects; effectively one is overdosing in part of the injection cycle. This problem is solved by injecting frequently relative to the ester half-life. This raises trough testosterone, which in turn allows lower dosing.

Here's an example with some representative numbers: Suppose a guy injects 100 mg testosterone cypionate once per week, which is the lowest dose he can use without feeling hypogonadal before the next injection. His trough testosterone is 450 ng/dL. His peak testosterone is 1,100 ng/dL. The peak is supraphysiological, pushing up his hematocrit and causing other problems. He switches to daily injections at the same dose rate, about 14 mg cypionate per day. Now he has very little variation in serum testosterone, and his level is about 800 ng/dL all the time. He recognizes that this is higher than necessary for him—after all, his lower threshold for symptoms was 450 ng/dL. So he reduces his dose to 70 mg per week, injected as 10 mg daily. Now he finds his serum testosterone is stable at 600 ng/dL, and it works well for him.

 

[DS3]

Going to more frequent injections reduces the spread between peak and trough serum testosterone. When troughs are too low and/or too long there is some risk of feeling hypogonadal again. Therefore it's typical to dose the testosterone to obtain adequate trough levels. But with infrequent injections the peak levels become unnecessarily high, potentially causing side effects; effectively one is overdosing in part of the injection cycle. This problem is solved by injecting frequently relative to the ester half-life. This raises trough testosterone, which in turn allows lower dosing.

Here's an example with some representative numbers: Suppose a guy injects 100 mg testosterone cypionate once per week, which is the lowest dose he can use without feeling hypogonadal before the next injection. His trough testosterone is 450 ng/dL. His peak testosterone is 1,100 ng/dL. The peak is supraphysiological, pushing up his hematocrit and causing other problems. He switches to daily injections at the same dose rate, about 14 mg cypionate per day. Now he has very little variation in serum testosterone, and his level is about 800 ng/dL all the time. He recognizes that this is higher than necessary for him—after all, his lower threshold for symptoms was 450 ng/dL. So he reduces his dose to 70 mg per week, injected as 10 mg daily. Now he finds his serum testosterone is stable at 600 ng/dL, and it works well for him.

1100 ng/dL of testosterone has already been established as not qualifying as supraphyiological given that it is observed in healthy non-TRT men. Supraphyiological indicates that the TT achieved is one not seen in nature (physiological).

Supraphyiological for one’s idiosyncratic physiology is the counter argument, but lacks merit as nothing substantiates the generalized claim that an individual with a natural peak TT of 450 ng/dL will experience side effects at 1100 ng/dL. This speculation is not generalizable.

 

[eli]

1100 ng/dL of testosterone has already been established as not qualifying as supraphyiological given that it is observed in healthy non-TRT men. Supraphyiological indicates that the TT achieved is one not seen in nature (physiological).

Supraphyiological for one’s idiosyncratic physiology is the counter argument, but lacks merit as nothing substantiates the generalized claim that an individual with a natural peak TT of 450 ng/dL will experience side effects at 1100 ng/dL. This speculation is not generalizable.

He was just giving an example man lol
I'm low shbg and sweet spot is 400-600

 

[DS3]

He was just giving an example man lol
I'm low shbg and sweet spot is 400-600

You have not been privy to previous discussions.

I’m low SHBG and my sweet spot is an oscillation between 800-1200 ng/dL.

 

[eli]

You have not been privy to previous discussions.

I’m low SHBG and my sweet spot is an oscillation between 800-1200 ng/dL.

What's your dose? Shbg? And free T?

 

[bixt]

1100 ng/dL of testosterone has already been established as not qualifying as supraphyiological given that it is observed in healthy non-TRT men

The only times I have seen this kind of TT naturally, they were accompanied by sky high SHBG, leading to measured mid range or even low FT. Almost always also accompanied with a keto type diet\carb restriction.

 

[DS3]

The only times I have seen this kind of TT naturally, they were accompanied by sky high SHBG, leading to measured mid range or even low FT. Almost always also accompanied with a keto type diet\carb restriction.

But it is, in fact, seen in nature. Thus, the level is not considered supraphyiological. Now, the next counter is to discuss free testosterone being above physiological ranges when TT reaches that high in lower SHBG men. That’s a fair point, but we circle back to the dilemma wherein no evidence, anecdotal or clinical, suggests that moderately supraphyiological levels of free T lead to long-term morbidities. We do know, however, that some men feel better in lower physiological ranges, such as @eli and @Cataceous, while others such as @S1W @madman and @Gman86 feel better with larger dosing protocols (myself included).

 

[Charliebizz]

You have not been privy to previous discussions.

I’m low SHBG and my sweet spot is an oscillation between 800-1200 ng/dL.

Yeah what is your dose and free t?

 

[madman]

But it is, in fact, seen in nature. Thus, the level is not considered supraphyiological. Now, the next counter is to discuss free testosterone being above physiological ranges when TT reaches that high in lower SHBG men. That’s a fair point, but we circle back to the dilemma wherein no evidence, anecdotal or clinical, suggests that moderately supraphyiological levels of free T lead to long-term morbidities. We do know, however, that some men feel better in lower physiological ranges, such as @eli and @Cataceous, while others such as @S1W @madman and @Gman86 feel better with larger dosing protocols (myself included).

As I have stated numerous times on the forum men on trt can easily achieve a high-end/high FT running a TT 1000 ng/dL even someone with high/highish SHBG.

Everyone needs to keep in mind that during the 24hr circadian rhythm of a healthy young male testosterone levels will start to increase gradually between 1-2 am reaching a peak around 8 am and this peak is short-lived as levels will start to decline over the following hours well into the afternoon/early evening reaching a trough around 7-8 pm.

Fluctuations from peak--->trough would be around 20-25%

Natural endogenous testosterone secretion is pulsatile and diurnal.

Not only have we shut down the HPG-axis through the use of exogenous T but more importantly many are forcing T levels well beyond what the body could or would ever produce endogenously let alone in their PRIME (early teens/the late 20s).

Top it off that these are steady-state levels 24/7!

No comparison between running a steady-state TT 1000+ ng/dL vs hitting a natty short-lived peak of 1000+ ng/dL.

Gets even nuttier when you have guys running absurd TT 1500+ ng/dL with FT 50-60+ ng/dL on dailies!

I believe many (myself included) do better running higher-end FT levels 20-30 ng/dL but even then we have to keep peak--->trough in mind whether injecting once weekly, twice-weekly (every 3.5 days), M/W/F, EOD, or daily.

Comes down to the individual.

Highly doubt most men need to be running absurd trough FT levels 50-60+ ng/dL to benefit from trt.

I would say many of these men CHOOSE/WANT as opposed to need.

Let alone many have dysfunctional thyroid/adrenals or other underlying issues that have absolutely nothing to do with testosterone.

As we all very well know having healthy T levels is only one piece of the puzzle.

Unfortunately too many are jacked up on T from the get-go let alone have that neanderthal mentality that more T is better.

As we say the best piece of advice is to start low and slow on a T-only protocol as we want to see how your body reacts let alone give the protocol enough time before claiming it was a success or failure.

Invest enough time to see how your body reacts to T let alone how you truly feel overall regarding relief/improvement of low-T symptoms before jacking up your dose.

Lab work is critical.

Always keep peak--->trough levels in mind.

Use accurate assays so you know where your trough TT, FT, and estradiol truly sit.

Although symptom relief is what truly matters lab work is critical as not only do we want to see where said protocol (dose T/injection frequency) has ones trough TT/FT level let alone other hormones but also to keep an eye on the impact it has on overall blood markers as we are not only trying to relieve/improve symptoms of low-t but also to minimize/avoid any potential negative effects on overall health especially long-term.

Regarding reference ranges, they are not set in stone and should be used as a guideline to give us an idea of where hormones/blood markers sit as levels could very well be too high or low resulting in negative effects.

There is nothing wrong with one running TT/FT level above range as long as you feel well overall and your blood markers are healthy.

No one is saying you have to keep your levels in a set range as the goal is to achieve the beneficial effects of having healthy FT levels while making sure overall health is maintained long term.

Do what you feel is best for you!


*The goal of trt is to replace physiological levels of testosterone through the use of exogenous testosterone in order to achieve a healthy TT/FT level which will result in the relief/improvement of low-t symptoms while at the same time minimizing/avoiding any potential side effects (cosmetic/overall health) while keeping blood markers healthy long-term

 

[madman]

But it is, in fact, seen in nature. Thus, the level is not considered supraphyiological. Now, the next counter is to discuss free testosterone being above physiological ranges when TT reaches that high in lower SHBG men. That’s a fair point, but we circle back to the dilemma wherein no evidence, anecdotal or clinical, suggests that moderately supraphyiological levels of free T lead to long-term morbidities. We do know, however, that some men feel better in lower physiological ranges, such as @eli and @Cataceous, while others such as @S1W @madman and [B][I][B][I]@Gman86[/I][/B] feel better with larger dosing protocols (myself included).[/I][/B]

He needs to be left out you know the guy running a trough TT 1600-1800 ng/dL on EOD injections.


@Gman86

* I personally need my total T at least 1600, but closer to 1800 to feel best.

*The answer is that as long as u stay on top of everything, while having total T levels around 1500-2500, or even 3000, u’ll be fine. All that happens when u get around 2000+ is that u have to be more strict with ur lifestyle choices to maintain health. But it’s relatively easy as long as u know what ur doing.


Anyone making such statements is clearly out to lunch.

This is the same guy who is claiming it is all about balance yet he has been jacked up on T from the get-go.

Joe was all about scrotal, then comes nandrolone followed by oxandrolone only to top it off with GH.

Should not be dishing out advice on here when it comes to its all about balance let alone testosterone/AAS!


post #118

I found a TRT protocol that works

Thanks for keeping us all in mind. Although I’m not in the near future considering pellets, this thread has been on my radar for some time and I may give it a go at some point down the road. I will say that you can always go back to injections if pellets don't work. You literally can just start...

www.excelmale.com

post #4/5/8/11

I feel best on a protocol that puts me above range... advice?

So ive tried a few dosing protocols and have a journal where I log the side effects after 6-12 weeks. 20mg eod puts me at Total Testosterone 830 ng/dl (250-1100) Free Testosterone (151 pg/mL (35.0-155.0) Sensitive Estradiol 27 pgmL (< or = 29) I feel flat and low energy.. also irritable...

www.excelmale.com

 

[madman]

post #11

Estradiol is an Important Hormone for Men

* read full paper (pdf) MECHANISMS IN ENDOCRINOLOGY Estradiol as a male hormone Nicholas Russell and Mathis Grossmann Abstract Evidence has been accumulating that, in men, some of the biological actions traditionally attributed to testosterone acting via the androgen receptor may...

www.excelmale.com

What does this tell you about the s**t show we call trt!

Everyone is misinformed due to the bulls**t being spewed on those bro forums/gootube let alone dime a dozen T-mills stinking up the game.

We have quite a few from the herd that unfortunately lurk on here.

Everyone thinks they need to be running trough TT well above 1000+ ng/dL with FT through the roof.




Nelson

*I agree. But this change will not be an easy one to convince the field or men on TRT to do. 90 percent of all testosterone tests on DiscountedLabs.com are over 1,000 ng/dL. Most self-pay clinics are keeping men at high T levels. And most men truly believe that more is better. All I can do now is to keep digging more information about T/E2 ratios and how the balance of these two hormones matter more than the actual estradiol value. But we have limited data and a field that has already bought into a deeply ingrained mantra that will take many years to change.

 

[bixt]

But it is, in fact, seen in nature. Thus, the level is not considered supraphyiological.

So by your definition a guy with a prolactinoma secreting 200ng/dl of prolactin is not considered supraphyiological either, as "its seen in nature"

the next counter is to discuss free testosterone being above physiological ranges when TT reaches that high in lower SHBG men.

Now this combination I have not seen in nature. So, that would be fT of 40 or 50 or 60. You are also in the same breath talking infrequent (weekly) dosing, so those levels are at trough!!! How about at day 2, 3 or 4? fT of > 60??

but we circle back to the dilemma wherein no evidence, anecdotal or clinical, suggests that moderately supraphyiological levels of free T lead to long-term morbidities.

Have you paid no attention at all to @readalot in his posts just the other day? Im actually hoping secretly you are right as I run big doses, but I think the evidence points the other way.

 

[Cataceous]

But it is, in fact, seen in nature. ...

As highlighted by @bixt, this is not the definition of "physiological" we use in science and medicine. Rather, the standard for "normal" is having your numbers within two standard deviations of the mean, plus or minus. The situation I described, with normal SHBG and total testosterone of 1,100 ng/dL, results in free testosterone that's more than three standard deviations above the mean. Statistically speaking, we're talking about one in a thousand men possibly at such a level, and even that's dubious. In any case, if the level of testosterone is supraphysiological for 99.9% of all men then it's supraphysiological, period.

 

[Jurek Kletsy]

I notice that on this forum there is a tendency by some members - moderators at that - to attack other members who share their experiences with a higher dose, even though their intention is not to encourage others to use the same doses. I understand we all have our beliefs and some of these are more substantiated than other, but let’s not be too dogmatic: HRT is a new science.

As far as I am aware there is no offical definition (and even so, definitions can change over time) of what TRT entails except that you replace a hormone that is naturally not being produced in a quantity that allows general wellbeing and a good health.

I trust that this discussion can just be had among adults without fear of this forum turning into a place for steroid abusers.

 

[DS3]

So by your definition a guy with a prolactinoma secreting 200ng/dl of prolactin is not considered supraphyiological either, as "its seen in nature"



Now this combination I have not seen in nature. So, that would be fT of 40 or 50 or 60. You are also in the same breath talking infrequent (weekly) dosing, so those levels are at trough!!! How about at day 2, 3 or 4? fT of > 60??




Have you paid no attention at all to @readalot in his posts just the other day? Im actually hoping secretly you are right as I run big doses, but I think the evidence points the other way.

As far as @readalot post, there were counter arguments providing that cast doubt on the transferability of the research.

To his credit, he did a kick ass job in compiling this data.

 

[DS3]

Now this combination I have not seen in nature. So, that would be fT of 40 or 50 or 60. You are also in the same breath talking infrequent (weekly) dosing, so those levels are at trough!!! How about at day 2, 3 or 4? fT of > 60??

To clarify, this statement was made in reference to men on TRT as the counter argument is always that men on TRT tend to have lower SHBG and higher free T.

 

[DS3]

As highlighted by @bixt, this is not the definition of "physiological" we use in science and medicine. Rather, the standard for "normal" is having your numbers within two standard deviations of the mean, plus or minus. The situation I described, with normal SHBG and total testosterone of 1,100 ng/dL, results in free testosterone that's more than three standard deviations above the mean. Statistically speaking, we're talking about one in a thousand men possibly at such a level, and even that's dubious. In any case, if the level of testosterone is supraphysiological for 99.9% of all men then it's supraphysiological, period.

Indeed, the men reaching these TTs naturally would be considered outliers. However, normal being within two SDs from the mean does not inherently preclude individuals more than two SDs more being considered physiological. Rather, these individuals are considered outliers. After all, statistical means are derived from humans across the spectrum, meaning outliers at both tail ends are included in determining this mean.

 

[Cataceous]

Indeed, the men reaching these TTs naturally would be considered outliers. However, normal being within two SDs from the mean does not inherently preclude individuals more than two SDs more being considered physiological. Rather, these individuals are considered outliers. After all, statistical means are derived from humans across the spectrum, meaning outliers at both tail ends are included in determining this mean.

If it were any other hormone then discussions of one-in-a-thousand outliers would focus on the possible pathologies. We wouldn't a priori be trying to rationalize the condition as normal and healthy. But because it's testosterone it gets a pass, is that right?

 

[tareload]

No need to try and rationalize your permacruise or high end TRT dosing (lets say you are diligent and dial it in between 800 and 1200 trough to peak). Run your trough to 1200 ng/dl if you want. Understand what that means (hint: I made it easy for you to understand).

But if shit goes south don't say we didn't try to give you food for thought. If it doesn't go south then great. With informed consent everyone wins or at least loses with no surprises.

Regarding outliers, there are accepted treatments to handle those and no they aren't always included in the computation of statistically mean.

7.1.6. What are outliers in the data?

I'll just leave this here.....

To Remove or not to Remove: the Impact of Outlier Handling on Significance Testing in Testosterone Data - Adaptive Human Behavior and Physiology

Outlier removal is common in hormonal research. Here we investigated to what extent removing outliers in hormonal data leads to divergent statistical conclusions. We first show that the most common outlier detection rule is based on a number of standard deviations (SD) from the mean. Next, we...

link.springer.com

Topic looks familiar.