Heavier Men May Require Higher TRT Doses

We finally have a study that looked at this common question.

Effect of Weight on Serum Testosterone Levels with Subcutaneous Testosterone Enanthate in Men with Testosterone Deficiency

Introduction

Obesity is a common issue among men and is often associated with low testosterone (T) levels. This association complicates the management of testosterone deficiency (hypogonadism) in overweight and obese individuals. It is known that men with a higher body mass index (BMI) need higher doses of transdermal testosterone therapy (TTh), like T 2% gel, to get their T levels back to normal. However, not much is known about how body weight affects the pharmacokinetics and dosing of subcutaneous testosterone enanthate (TE) in men who are T deficient. A recent post hoc analysis of a phase 3 trial sheds light on the relationship between body weight and serum T levels achieved with SC TE therapy.

Study Background

A post hoc analysis of data from a 52-week, open-label, single-arm, dose-blinded phase 3 trial (NCT02159469) was used to look into the safety and effectiveness of giving men with low testosterone SC TE once a week. The trial enrolled 150 men, with a primary endpoint of achieving an average serum T concentration (Cavg0-168h) between 300 to 1,100 ng/dL at week 12. This study aimed to assess how different body weights influenced the serum T levels attained with varying doses of SC TE.

Methods

Participants in the study self-administered a starting dose of 75 mg SC TE weekly during the initial titration phase. Subsequently, blinded dose adjustments in increments of 25 mg were made at predefined intervals beyond the sixth dose, based on serum T levels. As a post hoc analysis, a linear regression model was used to look at the effect on mean minimum T concentration (Cmin) and Cavg0-168h at week 12. Body weight and dose were used as independent variables.

Results

A total of 137 men were included in the post hoc analysis. The participants were divided into three dose groups: 50 mg (n=25), 75 mg (n=93), and 100 mg (n=19). The average weights in these groups were 84.4 kg, 102.2 kg, and 112.0 kg, respectively, with a range of 49.9–146.5 kg. The analysis revealed an inverse relationship between body weight and serum T levels. Specifically, the dose-normalized T Cmin and Cavg0-168h decreased as the dose increased:

• 50 mg group: Dose-normalized T Cmin was 9.2 ng/dL, and Cavg0-168h was 12.0 ng/dL per 1 mg of SC TE.
• 75 mg group: Dose-normalized T Cmin was 5.7 ng/dL, and Cavg0-168h was 7.2 ng/dL per 1 mg of SC TE.
• 100 mg group: Dose-normalized T Cmin was 4.3 ng/dL, and Cavg0-168h was 5.7 ng/dL per 1 mg of SC TE.

The linear regression model showed that the weight and dose variables explained 48.2% (P<0.0001) of the total variation in Cmin and 55.0% (P<0.0001) of the total variation in Cavg0-168h.

Conclusion

This analysis highlights an inverse correlation between body weight and T exposure in men undergoing SC TE therapy. Men with higher body weights required higher doses of SC TE to achieve physiological T levels, compared to those with lower body weights. The findings underscore the importance of individualized dosing based on body weight to optimize testosterone therapy outcomes. The study provides valuable insights for clinicians in tailoring SC TE therapy, ensuring effective management of testosterone deficiency in men across different weight categories.

These results add to the growing body of knowledge on how weight impacts the pharmacokinetics of testosterone therapy and suggest that SC TE offers a flexible and effective option for achieving target testosterone levels in men with varying body weights.

SAT-037 Effect of Weight on Serum Testosterone with Subcutaneous Testosterone Enanthate in Men with Testosterone Deficiency

Abstract. BACKGROUND: In men, obesity is often associated with low testosterone (T) levels, but information is limited as to how body weight affects the pharmac

academic.oup.com

 

So in December when I first started on injections the Endocrinologist had me at 0.25ml once a week. I was on this dosage for 3 months. During the 3 months I didn't feel any better, I still did not have clear thought, and great depression. The Endo did a blood test in February and he found that my Testosterone levels where still below 8 nmol/L but the level was slightly higher then the blood test taken in November of 2019. I was not feeling any better in February with a lack of ability to think and was threatened with job dismissal as a result. So I went to my Medical Doctor and told her and she increased my dosage to 0.5ml once a week.

When I got my blood work numbers back the Endo changed the dosage to 0.5ml twice a week because I was still lower than 8.0 nmol/L just before the Lock down in April in Canada. He called me during lock down to inquire on how I was feeling. What I noticed was that the 0.5ml seemed to give me clarity of thought for about 2 days. And then after that my sleep stopped and I had fits of mood swings, depression, foggy mind and I couldn't complete complex tasks which is kind of a problem when you develop software for a industrial advanced automation company. So they put on reduced hours (1 week a month) until I could get my medication fixed.

During lock down we could not do any blood work so all the Endo had to go on was how I felt which is how I ended up getting up to 0.8ml. Not until July 9th was I able to do blood work again. And this was when my testosterone was up at 52 nmol/L.

You had mentioned E2 in the testing, now I have no idea if this test is conducted but on my Blood work requisition it appears. So it is probably done, yet the Endo has not requested it.

For those that are in Alberta maybe it could help to know that Alberta Precision Labs does test for Estradiol

 

So in December when I first started on injections the Endocrinologist had me at 0.25ml once a week. I was on this dosage for 3 months. During the 3 months I didn't feel any better, I still did not have clear thought, and great depression. The Endo did a blood test in February and he found that my Testosterone levels where still below 8 nmol/L but the level was slightly higher then the blood test taken in November of 2019. I was not feeling any better in February with a lack of ability to think and was threatened with job dismissal as a result. So I went to my Medical Doctor and told her and she increased my dosage to 0.5ml once a week.

When I got my blood work numbers back the Endo changed the dosage to 0.5ml twice a week because I was still lower than 8.0 nmol/L just before the Lock down in April in Canada. He called me during lock down to inquire on how I was feeling. What I noticed was that the 0.5ml seemed to give me clarity of thought for about 2 days. And then after that my sleep stopped and I had fits of mood swings, depression, foggy mind and I couldn't complete complex tasks which is kind of a problem when you develop software for a industrial advanced automation company. So they put on reduced hours (1 week a month) until I could get my medication fixed.

During lock down we could not do any blood work so all the Endo had to go on was how I felt which is how I ended up getting up to 0.8ml. Not until July 9th was I able to do blood work again. And this was when my testosterone was up at 52 nmol/L.

You had mentioned E2 in the testing, now I have no idea if this test is conducted but on my Blood work requisition it appears. So it is probably done, yet the Endo has not requested it.

For those that are in Alberta maybe it could help to know that Alberta Precision Labs does test for Estradiol

You are being over-medicated and you need to find a new doctor who specializes in trt.

Your TT levels are >52 nmol/L (>1500 ng/dL) and that is at the trough.

The dose of T you are injecting 300mg/week (150mg every 3.5 days) is not a trt dose.

Let alone your doctor is only testing your TT level/CBC/ALP (requisition you posted) and again he should be testing FT and estradiol.

FT is what matters as it is the active unbound fraction responsible for the positive effects.

Patients with Kleinfelter's syndrome would in no way need doses higher than what is commonly prescribed (100-200mg/week) in men with hypogonadism to achieve a healthy FT level which will result in relief/improvement of low-t symptoms and overall well-being.

I will agree that FT testing is poor in Canada and unfortunately, we do not have access to the most accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best) but if anything at least the direct analog immunoassay has been replaced with the calculated linear law-of-mass action Vermuelen (mind you it is flawed).

Most labs across Canada should at least be using the calculated Vermeulen and even then it is available online as you just need to know your TT/SHBG/Albumin levels mind you if you do not know where your Albumin sits than you can just you the mean 4.3 g/dL.

Unfortunately, your SHBG was never tested.

You can get a better idea of where your FT sits by using the newer calculated TruT which is available online for free TruT Free Testosterone Calculator by FPT

If you are willing to drive across the border and have your bloodwork done at a Quest Diagnostics location in the US which is close to the Canadian border where you reside (Alberta) then you have the option to order the most accurate assays for TT (LC/MS-MS), FT (Equilibrium Dialysis or Ultrafiltration), estradiol sensitive (LC/MS-MS) from Nelson's Discounted Labs Most Popular Blood Tests | Discounted Labs.

The only way you could have the estradiol sensitive (LC/MS-MS) done in Canada would be through Dynacare in the province of Ontario as unfortunately, it is not available in any of the other provinces yet.

You need to take a step back and think this through.

 

If you are willing to drive across the border and have your bloodwork done at a LabCorp location

Quest Diagnostics now

 

When ever the border happens to open. You have given me a lot to think about and look into. I knew Canada was bad at medical but I just didn't know how bad. But I should have clued in when my father died at age 45 and they did an autopsy and found that his Doctor was not telling him he had Heart Disease. I need to read Nelson's books too, I am assuming all these things are explained in them?

 

I did some digging and found this: Home - The Mas Clinic

I have inquire with them to see what they can do. They say they are a TRT clinic. But I really need to read more and then I can ask more intelligent questions. Thank you @madman for the help and the information. It is just staggering how poor the medical system is in Canada.

 

@madman I emailed DynaLife Medical labs in Edmonton and asked if they could prepare the gambit of tests you had recommended within this thread. And they responded by saying they could prepare those tests and all they required was a doctor to request them.

This is specifically what she said:


Dear Cameron,

Good morning.

We do the run all the tests here at DynaLIFE if the Physician orders them.

However, For the last two or three tests TT = total testosterone and FT = free testosterone or estradiol we do measure these analytes by alternative methodologies (immunoassay in our case) and not LC/MS-MS.
It should be noted that, while LC/MS-Ms may be more sensitive, most testosterone immunoassays compare well with LC/MS-MS. The issue might be at low levels of testosterone where LC/MS-MS is a more sensitive and specific methodology.

We do take part in CAP proficiency testing and our methods align well with other laboratories both in Canada and the United states.

Furthermore, currently in Canada, most medical laboratories use immunoassay for measurement of these analytes.

We will require a physician's order request (requisition) to collect and run these tests.

Sincerely,



Kate Fawcett
Client Relations Specialist/Privacy Advisor, Client Relations and Privacy

P 780.451.3702 ext. 8183
TF 1.800.661.9876

DynaLIFE Medical Labs
#200, 10150 102 Street
Edmonton AB T5J 5E2

dynalife.ca

 

Been working with Dr. Brown out of Edmonton for a while. Now they are prescribing higher dosages of Arimidex which I think may be responsible for the completely aimless feeling I feel now. They say my Estradiol is high but I am also overweight. I really don't want to be taking all the vitamins they are recommending. It seems at every turn the doctors prescribe something and I get to put on report by my Work for not completing tasks because I am sick. I still have to eat.

I will see if I can pull my bloodwork numbers today to post.

 

Your doctor should read this

Testosterone Needs to Be Converted into Estradiol to Prevent Fat Accumulation

How Targeting Fat Cells’ Estrogen Receptors Could Fight Obesity Tracy Hampton, PhD In adipocytes, fat cells, a particular estrogen-receptor appears critical for energy supplying mitochondria to function properly. The discovery points to a potential drug target for boosting fat tissue...

www.excelmale.com

Blocking estradiol will make it harder to lose fat.

 

Your doctor should read this

Testosterone Needs to Be Converted into Estradiol to Prevent Fat Accumulation

How Targeting Fat Cells’ Estrogen Receptors Could Fight Obesity Tracy Hampton, PhD In adipocytes, fat cells, a particular estrogen-receptor appears critical for energy supplying mitochondria to function properly. The discovery points to a potential drug target for boosting fat tissue...

www.excelmale.com

Blocking estradiol will make it harder to lose fat.

I can send it to her, I sent her the forum address and your books. But I suspect she is treating my hormones like what they think happens. Thank you for posting.

 

I have posted my current lab work. I still do not feel my doctors know what the hell they are doing and it is still hit and miss. It is very apparent based on how I have felt over the past 2 weeks that they seem to be trying to make me like a male but I do not think my genetics is like that they are using Arimidex to drive my estrogen down.

 

We finally have a study that looked at this common question.

SAT-037 Effect of Weight on Serum Testosterone with Subcutaneous Testosterone Enanthate in Men with Testosterone Deficiency

Abstract. BACKGROUND: In men, obesity is often associated with low testosterone (T) levels, but information is limited as to how body weight affects the pharmac

academic.oup.com

Good study Nelson but I honestly think there are many more factors involved like genetics, sex and age that play a huge part in how much you need to be effective, perhaps even lean tissue to bodyfat ratios. I am 6'1" and 245 and need far less than many guys I know smaller than me. Could be genetics, definitely age as we metabolize drugs slower as we age.

 

300mg/week (150mg every 3.5 days) is a whopping dose of testosterone and in no way needed for trt.

Most men on trt even obese men are injecting on average 100-200mg/week and even then many would never need the high-end trt dose of 200mg/week to achieve a healthy TT/FT level.

Sure there may be some outliers who need slightly more than 200mg/week but that would be far and few.

Not only should he be testing your TT/FT level but more importantly estradiol and SHBG let alone CBC which would include RBCs/hemoglobin/hematocrit.

Would bet your RBCs/hemoglobin/hematocrit is high due to your very high TT level.

Madman, I thought you would get a kick out of this posting from a very good board.

"the most-recent suggested TRT/HRT cycle from one of the larger multi-state clinics."

250mg test e or test c per week
25mg winny per day
500iu hcg twice per week
1.2mg Anastrazole two days per week (one 24 hrs after test injection, one 48 hours after test injection)
2iu gh per day, five days per week

Can you believe that a clinic would push this as TRT? There was another posting that said there was a TRT doctor that had no problem signing off on scrips that would cover 800mg of test/week.

 

1.2mg Anastrazole two days per week

Crazy dose.

By the way, Winstrol (stanozolol) is FDA approved (like oxandrolone) and some compounding pharmacies make it.

 

Knowing what 25mg/d did to my lipid values I would would not go that route. 250mg of test/week and I would be ready to go back into competition.

Here is another version they give out:

250mg Sustanon per week
200mg Deca per week
500iu hcg three times per week
1.2mg Anastrazole three days per week (one 24 hrs after test injection, one 48 hours after test injection, one 72 hours after test injection)
2iu gh per day, five days per week

 

"the most-recent suggested TRT/HRT cycle from one of the larger multi-state clinics."

250mg test e or test c per week
25mg winny per day
500iu hcg twice per week
1.2mg Anastrazole two days per week (one 24 hrs after test injection, one 48 hours after test injection)
2iu gh per day, five days per week

Here is another version they give out:

250mg Sustanon per week
200mg Deca per week
500iu hcg three times per week
1.2mg Anastrazole three days per week (one 24 hrs after test injection, one 48 hours after test injection, one 72 hours after test injection)
2iu gh per day, five days per week

LMAO. Not hatin'. Here you go in case anyone wants to know what's on the table according to the FDA orange book:

Professor Hulk Cycle Log

I am sorry you had to experience that. Are you in the US or is this Costa Rica? This is a “TRT clinic” with a physical address or a table set up with a tablecloth at a local weight training facility? Genuinely interested. @unreal24278 FYI, “primobolan aka Metenolone” and “trenbolone aka...

forums.t-nation.com

Knowledge is power .

Thanks @BigTex

Also, this "trend" of clinics moving UGL product at their clinics is just nuts to me.

 

Good study Nelson but I honestly think there are many more factors involved like genetics, sex and age that play a huge part in how much you need to be effective, perhaps even lean tissue to bodyfat ratios.

In case anyone interested:

What kind of levels to expect from 100mg weekly

I'm a new to this entire scene, started with levels of around 320, age 40, doctor started me on 100mg once a week. Curious on what type of levels I should expect to see from this? Thanks

www.excelmale.com

Also, the baby "growth chart" equivalent curves for weekly dose vs mean serum TT levels:

Tool to Assess your TT Dose Response -- Percentile Curves

Summary: Tools to estimate your individual dose response for injectable testosterone ester in comparison to a normal distribution (95 percentile confidence estimate) of adult males (Ref). Plot below shows a summary of data from (1) clinical trials gathered from the literature + (2)...

forums.t-nation.com

 

Knowing what 25mg/d did to my lipid values I would would not go that route. 250mg of test/week and I would be ready to go back into competition.

Here is another version they give out:

250mg Sustanon per week
200mg Deca per week
500iu hcg three times per week
1.2mg Anastrazole three days per week (one 24 hrs after test injection, one 48 hours after test injection, one 72 hours after test injection)
2iu gh per day, five days per week

There’s a clinic in SF that gives a cookie cutter protocol to everyone where you get 200mg of test or more a week with Anastrazole actually mixed in with it. I’m glad a friend steered me clear of them. They come to you for blood tests which is nice, but if they’re mixing an AI in with the test itself, they don’t know what they’re doing. For what you get the price was high too. My doc’s pretty much in line with everything here and offers AI’s but doesn’t take one himself or usually recommend them. He actually stopped testing people’s E2 recently since it mostly scared people into taking AI’s by default. For his own protocol he’s only on 100mgish of Test-C a week, formerly Test-E, and nightly HGH peptides. Sometimes he’ll throw on Oxandrolone. He offers most things you could want and more but his base protocol’s just the basics. He competes on that protocol too.

 

Madman, I thought you would get a kick out of this posting from a very good board.

"the most-recent suggested TRT/HRT cycle from one of the larger multi-state clinics."

250mg test e or test c per week
25mg winny per day
500iu hcg twice per week
1.2mg Anastrazole two days per week (one 24 hrs after test injection, one 48 hours after test injection)
2iu gh per day, five days per week

Can you believe that a clinic would push this as TRT? There was another posting that said there was a TRT doctor that had no problem signing off on scrips that would cover 800mg of test/week.

Wow BigTex, that's just silly.
Who would prescribe dosages that high?
Seriously who?
It's a rhetorical question. I ask only in reference to science and you can DM me if you prefer, not open posted please.‍

 

Regarding the original subject of body weight versus total testosterone with TRT, I believe it was @readalot who in another thread astutely posited that the study is probably just demonstrating an inverse relationship between weight and SHBG. The bet is that the correlation would not exist with free testosterone. Lower SHBG at a fixed free testosterone leads to reduced total testosterone.