HELP - Doubts about TRT

[motolele]

Youtuber VitruvianPhysique had good videos discussing T levels of natural bodybuilders.

VigorousSteve measured recently 734 ng/dl half-naturally on 3x 1000 IU HCG / week.

And Bayer used to have good unit converter/calculator on their Nebido info page with sign of normal range close to the normal range coincidentally.

 

[Cataceous]

So what do you think of my potential protocol of 90 mg per week divided in 3 injections and 200 iu of hcg in three injections?

You think this will eventually lead to chronic exposure of high test levels if other factors are in place?

I think that is a perfectly reasonable protocol if blood work looks ok. As you note, there are individual variations. At that dose I would have excessive free testosterone and would experience some side effects. However, others who metabolize testosterone faster would only see upper-normal-range values and could do well. Overall, a low-and-slow approach to dosing is preferred because lowering from an excessive dose is more likely to cause discomfort than raising from a dose that's on the low side.

Regarding possible side effects from either short-term or long-term exposure, I'm more concerned about the range of 120-200 mg TC/week, which is unequivocally non-physiological. It's particularly egregious when hypogonadal men are put on such doses by default. I don't discuss dosing at 200+ mg TC/week because then there's rarely the pretense that it's TRT. In the end, informed individuals should be able to dose how they want. But part of being informed is recognizing that there are known and unknown risks in high dosing. The average risk may not be that high, but that's going to be of little consolation to the guy who finds he's particularly susceptible to heart injury, for example.

 

[Phil Goodman]

A multitude of studies yield the testosterone production figures for healthy young men, as well as serum levels for healthy populations. Obese individuals are excluded from these populations. It's true that there is a skewing of averages in the overall population over time due to factors such as increasing overweight and obesity. If this is creeping into laboratory reference ranges then it's reasonable to rely on earlier research. I frequently refer to this study, which finds a normal range for Vermeulen calculated FT in healthy young men of 7.06-22.6 ng/dL.


The differences in total testosterone in response to injected dose are exaggerated by differences in SHBG, as well as differences in protocols and sampling times. The spread should be considerably less dramatic when free testosterone is examined under controlled conditions.

You would not be so blasé about taking thyroid hormones at triple the healthy normal production rate. Why should testosterone get a free pass? It's only because the side effects aren't quite as severe and the more-is-better perception persists. There are individuals who can take over 100 mg TC per week without apparent negative effects on health. However, let's not pretend that it's TRT when you're taking in more testosterone than the vast majority of the population could make naturally. If you're going to operate outside of physiological ranges then the burden of proof for safety is on you.

Differences in SHBG could explain differences in free t, but wouldn’t necessarily explain differences in total. Also, you seem to imply that differences in protocols explain the rest of the differences with regard to varying measurements(ie measuring the trough of a 3 times/week vs trough of 1 time/week). And I’m sure you are right that it can explain some of the differences, but it very very likely doesn’t explain it all as differences between one person to the next can be vast. So unless you have studies which show people at the same weights on the same protocols got extremely similar readings of total t then it is reasonable to say that differences in people also results in differences of processing exogenous testosterone.



As far as the burden of proof, according to you I’ve been operating at “supra-physiological” ranges for three years with frequent blood tests and my labs are better than ever. I also feel great and am more productive with better well-being than when operating at what you would call “normal” levels. Sure that’s only an N=1 account, but for me that’s the most important N. And there are tons of guys in my same boat. Obviously there are risks involved, just as there are risks with everything(including living with low, what you would call “normal”, testosterone levels). People often try to find a path where they can say “this is the correct path and that’s the incorrect path” so that things are cut and dry. But that’s not how the world, or humans, operate. Instead every decision is a trade off that involves both positives and negatives. So optimizing your path through life really means making decisions with the best tradeoffs. All I’m saying is that for some people, that tradeoff may involve taking what you would call “Supra-physiological” doses of testosterone. Obviously there is a point where the tradeoff becomes a net negative, but again that can be different for different people.

 

[BSS91]

Differences in SHBG could explain differences in free t, but wouldn’t necessarily explain differences in total. Also, you seem to imply that differences in protocols explain the rest of the differences with regard to varying measurements(ie measuring the trough of a 3 times/week vs trough of 1 time/week). And I’m sure you are right that it can explain some of the differences, but it very very likely doesn’t explain it all as differences between one person to the next can be vast. So unless you have studies which show people at the same weights on the same protocols got extremely similar readings of total t then it is reasonable to say that differences in people also results in differences of processing exogenous testosterone.



As far as the burden of proof, according to you I’ve been operating at “supra-physiological” ranges for three years with frequent blood tests and my labs are better than ever. I also feel great and am more productive with better well-being than when operating at what you would call “normal” levels. Sure that’s only an N=1 account, but for me that’s the most important N. And there are tons of guys in my same boat. Obviously there are risks involved, just as there are risks with everything(including living with low, what you would call “normal”, testosterone levels). People often try to find a path where they can say “this is the correct path and that’s the incorrect path” so that things are cut and dry. But that’s not how the world, or humans, operate. Instead every decision is a trade off that involves both positives and negatives. So optimizing your path through life really means making decisions with the best tradeoffs. All I’m saying is that for some people, that tradeoff may involve taking what you would call “Supra-physiological” doses of testosterone. Obviously there is a point where the tradeoff becomes a net negative, but again that can be different for different people.

Completely agree.

May I know your protocol and frequency of injections and if you are taking hcg?

 

[BSS91]

I think that is a perfectly reasonable protocol if blood work looks ok. As you note, there are individual variations. At that dose I would have excessive free testosterone and would experience some side effects. However, others who metabolize testosterone faster would only see upper-normal-range values and could do well. Overall, a low-and-slow approach to dosing is preferred because lowering from an excessive dose is more likely to cause discomfort than raising from a dose that's on the low side.

Regarding possible side effects from either short-term or long-term exposure, I'm more concerned about the range of 120-200 mg TC/week, which is unequivocally non-physiological. It's particularly egregious when hypogonadal men are put on such doses by default. I don't discuss dosing at 200+ mg TC/week because then there's rarely the pretense that it's TRT. In the end, informed individuals should be able to dose how they want. But part of being informed is recognizing that there are known and unknown risks in high dosing. The average risk may not be that high, but that's going to be of little consolation to the guy who finds he's particularly susceptible to heart injury, for example.

What is your protocol?

Also, what about people that a 100 mg dose put them in the 500s, not much symptom relief, and that hemacrotit stays high and so they can never increase their test dosage because otherwise the trade off is more hemacrotit and more blood donations.

I figured that maybe by increasing frequency, it would be better controlled.

Did you come across this kind of examples before? Is it common in your experience?

 

[madman]

Perfect thanks Madman.

About DHEA and Pregnenolone, I was wondering since they are not available otc in canada, if clinic prescribe if there is a need.

This is another thing I was thinking about, it would be nice to have it available on the canadian market if it becomes a need.

Would not waste your time supplementing DHEA unless your levels are low.

Pregnenolone is a hit or miss as some men feel it benefits them whereas others feel worse off.

Trial and error.

I have been on a T-only protocol for years and eventually added in hCG.

Never touched an AI and I run a high-end trough FT!

 

[Phil Goodman]

Completely agree.

May I know your protocol and frequency of injections and if you are taking hcg?

Started with 120 mg/week spilt into two injections per week. I’d say I started noticing obvious positives around the three week mark. Sometime around weeks five and six I started noticing a little bit of an increase in anxiety. Not much, but I’ve never really had issue with anxiety before and I’d say it was noticeable. Some of that was due to life circumstances, but again I’ve always handled stress well so it was somewhat noticeable. That only lasted about two week, maybe a little less and wasn’t terrible just noticeable. After that energy levels and motivation continued to increase and gym performance got better. Never had issues with libido, but that got even better. And for me a substantial improvement in “brain fog” was one of the areas of biggest improvement.

I’d pretty much planned on adding HCG at some point for various reasons, with the biggest one being that I didn’t want to shut down production just in case I ever needed or wanted to stop trt. I figured having that would improve transition if the time came. I’d say around the 2-3 month mark I noticed a decrease in orgasm intensity. Nothing too bad, but again noticeable. And since I was dialed in on trt plus planned on adding HCG anyway I figured it was a good time. Started that at 500 ius twice/week. Within about four weeks all atrophy was reversed and orgasms were better than ever. I also dropped my test down to 100 mg/week at that point long enough to have it stabilized before my bloodwork to how that addition would affect blood levels. I guess I got lucky because my levels stayed about the same even though I added HCG and dropped test down 20 less mg/week. Stayed on that for a while and got settled in.

After some time(not sure of exact timeline) I thought it would probably be better to go to three times/week. Mainly because I think avoiding higher peaks and lower troughs is generally a better approach. Eventually thought that same approach would be better for HCG so went to 300 ius three times/week. Felt like that was a little much so dropped further to 250 three times/week and that seems to be a good spot. Been on that protocol for over a year and don’t plan to change anything. Its seems to be a good balance of bumping my levels to the top of the range without negative side effects other than occasional acne. Also just ftr I also take about 5 mg DHEA per day. I must be pretty sensitive to it because if I take more than I get too amped up and a lot more acne.

Let me know if you have any questions.

 

[madman]

Okay Madman, so now my question is:

What is the solution then? Besides Natesto?

Because from the sound of it, TRT is not a viable option, better stay low T for life (considering everything is done to raise it but the balls just don’t seem to work as they should).

For example, would injecting twice per week a 80-100 mg dose (so 40-50 mg twice per week) would be closest to having at least peaks and downward levels that most closely ressemble natural healthy levels?

In my case I honestly don t care about levels. If i get symptom relief in the 500-600s I ll take it with open arms.

Again forget worrying about where your trough TT/FT will end up!

Start low and go slow.

100 mg T split into twice-weekly (50mg T every 3.5 days) injections is a sensible starting protocol.

If you want to start a little lower let alone throw in hCG off the hop go nuts!

No need to jump into injecting 3X/week off the hop.

Do what you feel is best for you.

Key when first starting TRT is to start low and go slow as in 100 mg T/week no AI or hCG.

T only protocol as we want to see how your body reacts to testosterone without mucking up the waters along the way.

Blood work will be done 6 weeks in once blood levels have stabilized (steady-state) so we can see where said protocol (dose T/injection frequency) has your trough TT, FT, estradiol, DHT, prolactin, SHBG let alone other important blood markers such as RBCs, hemoglobin and hematocrit.

The only time the dose of T should be increased at the 6 week mark is if you truly feel unwell due to achieving low trough FT levels (highly unlikely) in most cases.

Otherwise every protocol needs to be given 12 weeks to truly gauge the outcome/effectiveness.....THIS IS CRITICAL!

The protocol chosen (dose T/injection frequency) needs to be followed week in and week out.

When first starting therapy or tweaking a protocol (increasing/decreasing dose T) hormones will be in FLUX during the weeks leading up until blood levels have stabilized (4-6 weeks using TC/TE) and it is common for many to experience ups/downs during the transition as T levels are increasing or decreasing (when lowering T dose) and the body is trying to adjust.

Even then once blood levels have stabilized (4-6 weeks) it will still take the body a few months to adapt to the new set-point and this is the critical time period when one needs to gauge how they truly feel overall regarding relief/improvement of low-T symptoms.

Every protocol needs to be given a fighting chance to claim whether it was a success or failure.

Many make the mistake of tweaking their protocol every 6 weeks because they do
not feel good.

The first 6 weeks means nothing when looking at the bigger picture.

Patience is key otherwise you will end up chasing your tail indefinitely.

It is a common theme when starting TRT or tweaking a protocol (increasing dose T) to experience what we call the honeymoon period (euphoric like state, increased libido/erections, overall well-being) due to increasing T levels, dopamine, lighting up ARs (androgen receptors).

Unfortunately this is short-lived and temporary as the body will eventually adapt and things will level out and this will become the new norm.

Many lack the understanding of how this works and end up on that never ending merry go round chasing the honeymoon period.

After you put in the time 12 weeks to gauge how you truly feel regarding relief/improvement of low-T symptoms and overall well-being on your current protocol then you can decide if it needs to be tweaked (increase dose of T/manipulate injection frequency).

No one can say where you will end up or what protocol (dose of T/injection frequency) will be best for you!

 

[madman]

Okay Madman, so now my question is:

What is the solution then? Besides Natesto?

Because from the sound of it, TRT is not a viable option, better stay low T for life (considering everything is done to raise it but the balls just don’t seem to work as they should).

For example, would injecting twice per week a 80-100 mg dose (so 40-50 mg twice per week) would be closest to having at least peaks and downward levels that most closely ressemble natural healthy levels?

In my case I honestly don t care about levels. If i get symptom relief in the 500-600s I ll take it with open arms.

Again need to stress this here.

Every protocol needs to be given a fighting chance before claiming whether it was truly a success or failure!

Too many are still caught up in jumping the gun off the hop!


*As such, patients should be counseled that symptom response will not be immediate. Expectations for treatment response should be established with each patient. Patients can anticipate improvements in many of the common symptoms of TD (libido, energy levels, sexual function) after 3 months of treatment or longer. Metabolic and structural (body composition, muscle mass, bone density) changes may take upwards of 6 months.

*Following the initiation of testosterone therapy, serum concentrations of testosterone are known to correct earlier than the SYMPTOMATIC, STRUCTURAL, and METABOLIC SIGNS associated with TD.

Canadian Urology Guideline on Testosterone Replacement

Canadian Urological Association clinical practice guideline on testosterone deficiency in men: Evidence-based Q&A (2021) Ethan D. Grober, MD; Yonah Krakowsky, MD; Mohit Khera, MD; Daniel T. Holmes, MD; Jay C. Lee, MD; John E. Grantmyre, MD; Premal Patel, MD; Richard A. Bebb, MD; Ryan...

www.excelmale.com

26. What is a reasonable timeline to begin to observe improvements in the signs and symptoms of testosterone deficiency?

*Following the initiation of testosterone therapy, serum concentrations of testosterone are known to correct earlier than the symptomatic, structural, and metabolic signs associated with TD.76,77 As such, patients should be counseled that symptom response will not be immediate. Expectations for treatment response should be established with each patient. Patients can anticipate improvements in many of the common symptoms of TD (libido, energy levels, sexual function) after 3 months of treatment or longer. Metabolic and structural (body composition, muscle mass, bone density) changes may take upwards of 6 months. 77 In addition, patients should be counseled that diet and exercise in combination with testosterone therapy are recommended for body composition changes.

*Appreciating this pattern of response to testosterone therapy is fundamental when determining the impact of treatment and the appropriate timing of follow-up evaluations while on therapy. For example, if patients undergo a symptom review and measurement of testosterone levels too early (< 3 months), it may lead both physicians and patients to conclude that the treatment has not been impactful (i.e. normal levels of testosterone without symptomatic/structural/metabolic benefit). However, if the same assessment was scheduled 3-6 months after the initiation of therapy, the clinical response tends to be more reflective of normalized levels of serum testosterone.

 

[BSS91]

Started with 120 mg/week spilt into two injections per week. I’d say I started noticing obvious positives around the three week mark. Sometime around weeks five and six I started noticing a little bit of an increase in anxiety. Not much, but I’ve never really had issue with anxiety before and I’d say it was noticeable. Some of that was due to life circumstances, but again I’ve always handled stress well so it was somewhat noticeable. That only lasted about two week, maybe a little less and wasn’t terrible just noticeable. After that energy levels and motivation continued to increase and gym performance got better. Never had issues with libido, but that got even better. And for me a substantial improvement in “brain fog” was one of the areas of biggest improvement.

I’d pretty much planned on adding HCG at some point for various reasons, with the biggest one being that I didn’t want to shut down production just in case I ever needed or wanted to stop trt. I figured having that would improve transition if the time came. I’d say around the 2-3 month mark I noticed a decrease in orgasm intensity. Nothing too bad, but again noticeable. And since I was dialed in on trt plus planned on adding HCG anyway I figured it was a good time. Started that at 500 ius twice/week. Within about four weeks all atrophy was reversed and orgasms were better than ever. I also dropped my test down to 100 mg/week at that point long enough to have it stabilized before my bloodwork to how that addition would affect blood levels. I guess I got lucky because my levels stayed about the same even though I added HCG and dropped test down 20 less mg/week. Stayed on that for a while and got settled in.

After some time(not sure of exact timeline) I thought it would probably be better to go to three times/week. Mainly because I think avoiding higher peaks and lower troughs is generally a better approach. Eventually thought that same approach would be better for HCG so went to 300 ius three times/week. Felt like that was a little much so dropped further to 250 three times/week and that seems to be a good spot. Been on that protocol for over a year and don’t plan to change anything. Its seems to be a good balance of bumping my levels to the top of the range without negative side effects other than occasional acne. Also just ftr I also take about 5 mg DHEA per day. I must be pretty sensitive to it because if I take more than I get too amped up and a lot more acne.

Let me know if you have any questions.

Basically you are what I hope for for myself and dream about actually. Everything you said, about the specific symptoms that got relieved, the amount of hcg, how it affected you, how you modifed it with time, etc etc etc is what TRT should be like in my head (changing things slowly, even side effects would be occasional and if they arise they shouldn`t make you feel like crap but be there enough to be noticed and fixed without much of your mental and physical health being impacted.

 

[Cataceous]

Differences in SHBG could explain differences in free t, but wouldn’t necessarily explain differences in total. ...

We've been discussing this old myth for several years now. Changes in SHBG do not affect free testosterone once steady state is achieved. The production rate or dose rate of testosterone directly and proportionally drive free testosterone. Total testosterone is a dependent variable, basically a function of free testosterone, SHBG and albumin. Think of SHBG as a storage reservoir for testosterone; add more and before long the reservoir fills, increasing total testosterone. Free testosterone is only altered transiently, but must return to its original value that is determined by the rate of testosterone entering the blood.

... Also, you seem to imply that differences in protocols explain the rest of the differences with regard to varying measurements(ie measuring the trough of a 3 times/week vs trough of 1 time/week). And I’m sure you are right that it can explain some of the differences, but it very very likely doesn’t explain it all as differences between one person to the next can be vast. So unless you have studies which show people at the same weights on the same protocols got extremely similar readings of total t then it is reasonable to say that differences in people also results in differences of processing exogenous testosterone.
...

Surprisingly there's more complexity on the protocol side. Metabolism occurs mainly in the liver at a rate proportional to free testosterone. The constant of proportionality determines the level of free testosterone seen in response to a given production rate. Variations in this constant are what drive differences in dose-response between individuals who are otherwise identical. As this constant is a physiological parameter with connections to liver function there are not going to be extreme variations among individuals in good heath.

On the protocol side you have to account for the area under the curve, which is difficult to do if your protocol leads to variations in serum levels. The simplest was around this is to inject a long testosterone ester frequently so that variation is minimal. Otherwise you have to consider the decay characteristics, which depend on things like the ester, IM/SC, injection site, activity level, etc.

... As far as the burden of proof, according to you I’ve been operating at “supra-physiological” ranges for three years with frequent blood tests and my labs are better than ever. I also feel great and am more productive with better well-being than when operating at what you would call “normal” levels. Sure that’s only an N=1 account, but for me that’s the most important N. And there are tons of guys in my same boat. Obviously there are risks involved, just as there are risks with everything(including living with low, what you would call “normal”, testosterone levels). People often try to find a path where they can say “this is the correct path and that’s the incorrect path” so that things are cut and dry. But that’s not how the world, or humans, operate. Instead every decision is a trade off that involves both positives and negatives. So optimizing your path through life really means making decisions with the best tradeoffs. All I’m saying is that for some people, that tradeoff may involve taking what you would call “Supra-physiological” doses of testosterone. Obviously there is a point where the tradeoff becomes a net negative, but again that can be different for different people.

In taking 120 mg TC/week you were averaging 12 mg of testosterone a day, which is objectively supra-physiological. This is according to published research, not my opinion. How you feel on the protocol does not alter the fact. Why not just acknowledge it without being defensive? If you accept the risks then no problem. There's little doubt you had high levels of free testosterone on the protocol. Leave it at that and don't try to redefine what is physiological. Doing otherwise harms men new to TRT who are not as tolerant of high levels as you are.

 

[BSS91]

Again forget worrying about where your trough TT/FT will end up!

Start low and go slow.

100 mg T split into twice-weekly (50mg T every 3.5 days) injections is a sensible starting protocol.

If you want to start a little lower let alone throw in hCG off the hop go nuts!

No need to jump into injecting 3X/week off the hop.

Do what you feel is best for you.

Key when first starting TRT is to start low and go slow as in 100 mg T/week no AI or hCG.

T only protocol as we want to see how your body reacts to testosterone without mucking up the waters along the way.

Blood work will be done 6 weeks in once blood levels have stabilized (steady-state) so we can see where said protocol (dose T/injection frequency) has your trough TT, FT, estradiol, DHT, prolactin, SHBG let alone other important blood markers such as RBCs, hemoglobin and hematocrit.

The only time the dose of T should be increased at the 6 week mark is if you truly feel unwell due to achieving low trough FT levels (highly unlikely) in most cases.

Otherwise every protocol needs to be given 12 weeks to truly gauge the outcome/effectiveness.....THIS IS CRITICAL!

The protocol chosen (dose T/injection frequency) needs to be followed week in and week out.

When first starting therapy or tweaking a protocol (increasing/decreasing dose T) hormones will be in FLUX during the weeks leading up until blood levels have stabilized (4-6 weeks using TC/TE) and it is common for many to experience ups/downs during the transition as T levels are increasing or decreasing (when lowering T dose) and the body is trying to adjust.

Even then once blood levels have stabilized (4-6 weeks) it will still take the body a few months to adapt to the new set-point and this is the critical time period when one needs to gauge how they truly feel overall regarding relief/improvement of low-T symptoms.

Every protocol needs to be given a fighting chance to claim whether it was a success or failure.

Many make the mistake of tweaking their protocol every 6 weeks because they do
not feel good.

The first 6 weeks means nothing when looking at the bigger picture.

Patience is key otherwise you will end up chasing your tail indefinitely.

It is a common theme when starting TRT or tweaking a protocol (increasing dose T) to experience what we call the honeymoon period (euphoric like state, increased libido/erections, overall well-being) due to increasing T levels, dopamine, lighting up ARs (androgen receptors).

Unfortunately this is short-lived and temporary as the body will eventually adapt and things will level out and this will become the new norm.

Many lack the understanding of how this works and end up on that never ending merry go round chasing the honeymoon period.

After you put in the time 12 weeks to gauge how you truly feel regarding relief/improvement of low-T symptoms and overall well-being on your current protocol then you can decide if it needs to be tweaked (increase dose of T/manipulate injection frequency).

No one can say where you will end up or what protocol (dose of T/injection frequency) will be best for you!

The thing is, for me, I cannot do TRT without hcg because i need the fertility in the mid term and I don`t want to wonder for the first few months of only T ``Is my body going to accept the HCG, what if it doesn`t?'' For me, the response from T is equal in importance than the response from HCG.

I don't want to go off TRT because I don't tolerate HCG.

My dream experience would be to have a light transition to the new state of more hormones, without side effects or slight at best and feel symptom relief gradual in time.

I don't want the honeymoon period, for once in my life, I want to experience things slow.

That is why my potential initial protocol has HCG in it.

 

[Cataceous]

What is your protocol?
...

The basics: I take 2.4 mg of testosterone propionate and 3.2 mg of testosterone enanthate each morning. I also use gonadorelin and enclomiphine to maintain pituitary and testicular function. I inject 0.6 mg of progesterone at night.

...
Also, what about people that a 100 mg dose put them in the 500s, not much symptom relief, and that hemacrotit stays high and so they can never increase their test dosage because otherwise the trade off is more hemacrotit and more blood donations.

I figured that maybe by increasing frequency, it would be better controlled.

Did you come across this kind of examples before? Is it common in your experience?

With once-a-week dosing that trough level of 500 ng/dL can easily translate to a peak of 1,300+ ng/dL. No surprise that HCT would be a problem. The likely solution is to both reduce and divide the dose.

It is unfortunately very common for men to be started on an inappropriately high dose of testosterone and end up with high HCT and/or symptoms of high estradiol. The problem is sometimes compounded when doctors then prescribe bloodletting and AIs. This unpleasantness could be avoided if a low-and-slow approach were adopted.

 

[BSS91]

The basics: I take 2.4 mg of testosterone propionate and 3.2 mg of testosterone enanthate each morning. I also use gonadorelin and enclomiphine to maintain pituitary and testicular function. I inject 0.6 mg of progesterone at night.


With once-a-week dosing that trough level of 500 ng/dL can easily translate to a peak of 1,300+ ng/dL. No surprise that HCT would be a problem. The likely solution is to both reduce and divide the dose.

It is unfortunately very common for men to be started on an inappropriately high dose of testosterone and end up with high HCT and/or symptoms of high estradiol. The problem is sometimes compounded when doctors then prescribe bloodletting and AIs. This unpleasantness could be avoided if a low-and-slow approach were adopted.

In what form do you take them, why those dosages and why not cypionate?

How do you use enclomiphene at what dosage and frequency, and what is your reasoning using it with gonadorelin and why not HCG then.

Haha as you can see, you are a very interesting case for me because I thought of enclomiphene as an alternative to HCG.

 

[Phil Goodman]

We've been discussing this old myth for several years now. Changes in SHBG do not affect free testosterone once steady state is achieved. The production rate or dose rate of testosterone directly and proportionally drive free testosterone. Total testosterone is a dependent variable, basically a function of free testosterone, SHBG and albumin. Think of SHBG as a storage reservoir for testosterone; add more and before long the reservoir fills, increasing total testosterone. Free testosterone is only altered transiently, but must return to its original value that is determined by the rate of testosterone entering the blood.


Surprisingly there's more complexity on the protocol side. Metabolism occurs mainly in the liver at a rate proportional to free testosterone. The constant of proportionality determines the level of free testosterone seen in response to a given production rate. Variations in this constant are what drive differences in dose-response between individuals who are otherwise identical. As this constant is a physiological parameter with connections to liver function there are not going to be extreme variations among individuals in good heath.

On the protocol side you have to account for the area under the curve, which is difficult to do if your protocol leads to variations in serum levels. The simplest was around this is to inject a long testosterone ester frequently so that variation is minimal. Otherwise you have to consider the decay characteristics, which depend on things like the ester, IM/SC, injection site, activity level, etc.


In taking 120 mg TC/week you were averaging 12 mg of testosterone a day, which is objectively supra-physiological. This is according to published research, not my opinion. How you feel on the protocol does not alter the fact. Why not just acknowledge it without being defensive? If you accept the risks then no problem. There's little doubt you had high levels of free testosterone on the protocol. Leave it at that and don't try to redefine what is physiological. Doing otherwise harms men new to TRT who are not as tolerant of high levels as you are.

The most obvious thing is that you are ignoring weights. What 120 puts me at will be different than what 120 puts a person at if they’re 270 pounds. And that’s even assuming you are correct that there are very little variations between people when it comes to exogenous testosterone metabolism, which you didn’t provide studies for but rather just restated what you said earlier. I’ve seen people on the same dose and frequency of a similar weight have substantially different levels than me on similar or same doses. So we can either say that the my tests, their tests, or both tests were inaccurate….or we can say that it is very likely that different people process injections differently. There are tons of various factors and we don’t think it’s odd if people metabolize food or other substances differently. And another aspect we didn’t bring up is that the body may adjust and process it differently over extended periods. And as far as the variability in tests go that I mentioned earlier, even the study you posted earlier showed there are large variations between the formulas used. When you claim “young men produce x amount each day”, which formula are you basing that on?

 

[madman]

The thing is, for me, I cannot do TRT without hcg because i need the fertility in the mid term and I don`t want to wonder for the first few months of only T ``Is my body going to accept the HCG, what if it doesn`t?'' For me, the response from T is equal in importance than the response from HCG.

I don't want to go off TRT because I don't tolerate HCG.

My dream experience would be to have a light transition to the new state of more hormones, without side effects or slight at best and feel symptom relief gradual in time.

I don't want the honeymoon period, for once in my life, I want to experience things slow.

That is why my potential initial protocol has HCG in it.

If you are not in any rush to have kids holding out on the hCG for 2-3 months is not going to be a big deal when looking at the bigger picture!

If you are dead set on feeling the need to maintain fertility from the get-go then go nuts but just understand that the downfall of this approach is if you run into any issues you will have no idea if its the T or hCG!

Adding in hCG can easily drive up your TT and estradiol.

The main reason for the addition of hCG is to preserve ITT (intra-testicular testosterone) which will help preserve/maintain fertility and minimize/prevent testicular atrophy.

Yes, it can help improve mood and libido but this is not a given as some men will benefit whereas others will be worse off.

Trial and error is the only way to find out.

Tips to Dial In Test C + HCG Protocol

I just had bloodwork done after 4 months on this protocol: 1) 45mg of test cypionate 2x weekly (90mg total per week) 2) 500IU of Pregnyl 2x weekly (1,000IU total per week) My labs are attached. The free T didn't show up on the PDF but it's 823 pmol/L, which is well above the reference range of...

www.excelmale.com

My reply from a previous thread where the poster asked if hCG was needed:


Depends on the individual.....Is hCG needed?

*To preserve/maintain fertility then yes.

*To prevent/minimize testicular atrophy then yes.

*To enhance mood/libido it is not a given as some may experience such effects whereas others may feel worse off.

*To maintain upstream hormones and possibly prevent long-term consequences for health/wellbeing.....you be the judge!

Effect of TRT vs hCG/FSH on upstream hormone pathways.

The role of gonadotropins in testicular and adrenal androgen biosynthesis pathways -insights from males with congenital hypogonadotropic hypogonadism on hCG/rFSH and on testosterone replacement SUMMARY Objective: To delineate the role of gonadotropins in male androgen biosynthesis pathways...

www.excelmale.com

*Take-home point:

A replacement regimen with combined hCG/rFSH mimics physiologic steroid hormone profiles better than a substitution with exogenous testosterone. The documented differences in steroid profiles on testosterone replacement in hypogonadal males with absent or severely reduced endogenous LH and FSH secretion may have long-term consequences for health and well-being. Specifically, body composition, bone health, glucose, and lipid metabolism, salt and water balance, cognition, mood, sleep, and sexual function could be affected. The steroidogenic differences could also be relevant for gonadotropin-suppressive treatments with long-acting testosterone preparations in males with primary hypogonadism. To what extent this hypothesis is true, should be addressed in future clinical studies.

 

[BSS91]

yea but the thing is, that combination is a necessity at this point.

Imagine if I start only with test and everything goes well until I add hcg. If I feel less good and can’t dial it , I will have to stop therapy because that would mean that for me, hcg will be a nono,because as I said, fertility and test have equal priorities for me.

If it wasn t for that, I honeslty prefer to start with only T because it will be easier to assess but I have to know as quick as possible i tolerate hcg. I say as quick as possible because i know it can take some time.

 

[Cataceous]

The most obvious thing is that you are ignoring weights. What 120 puts me at will be different than what 120 puts a person at if they’re 270 pounds. ...

Please cite some research showing a significant positive correlation between body mass and testosterone metabolism. If you can't then we'll leave this idea in the myth column.

I’ve seen people on the same dose and frequency of a similar weight have substantially different levels than me on similar or same doses. So we can either say that the my tests, their tests, or both tests were inaccurate….or we can say that it is very likely that different people process injections differently. There are tons of various factors and we don’t think it’s odd if people metabolize food or other substances differently. ...

As I said previously, when you account for areas-under-the-curves and differing SHBG levels then the differences are confined to the rate of metabolism in the liver. So it's one constant, which is considerably more simple than you are suggesting. No amount of handwaving can obscure the fact that we all "process injections" with the same basic biology, and normal variations in this do not lead to requirements for non-physiological amounts of testosterone.

... When you claim “young men produce x amount each day”, which formula are you basing that on?

No formula, and I don't just claim it. These numbers are from various studies. I can't find the post at the moment, but I did previously list several that measured testosterone production in healthy young men. Here's one to get you started.

 

[Mastodont]

Just my two cents. Start around 50 mg/wk. Keep that for 12 weeks and then evaluate again. I started around 80 to 90 and have moved down to 53 mg/wk. It's done wonders for my anxiety. For me, too high and too low feel very similiar. Some differences but in many ways very similiar

Hi, what is your injection frequency?

 

[Phil Goodman]

Please cite some research showing a significant positive correlation between body mass and testosterone metabolism. If you can't then we'll leave this idea in the myth column.


As I said previously, when you account for areas-under-the-curves and differing SHBG levels then the differences are confined to the rate of metabolism in the liver. So it's one constant, which is considerably more simple than you are suggesting. No amount of handwaving can obscure the fact that we all "process injections" with the same basic biology, and normal variations in this do not lead to requirements for non-physiological amounts of testosterone.


No formula, and I don't just claim it. These numbers are from various studies. I can't find the post at the moment, but I did previously list several that measured testosterone production in healthy young men. Here's one to get you started.

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

BACKGROUND: In men, obesity is often associated with low testosterone (T) levels, but information is limited as to how body weight affects the pharmacokinetic profile or dosing of testosterone therapy (TTh) in men with T deficiency. Historically, ...

www.ncbi.nlm.nih.gov

From that page:

“Conclusion: Our results show an inverse relationship between body weight and T exposure. Men with higher mean body weights required higher doses of SC TE to achieve physiologic T levels compared with men with lower mean body weights. The available doses provide effective options to reach target exposures. These findings highlight the impact of weight and dose selection on SC TE exposure.”



For your second statement, we also all process food with the same basic biology. However there are vast differences between people when it comes to food metabolism.


For your third statement, I asked which formula because the link you posted earlier did not show how much testosterone a healthy young person produces each day. It showed four different formulas that are used to calculate levels, and there were substantial differences in the outcomes between the formulas. Likewise the study you posted above simply compares DHT conversion in white men in PA to Chinese men living in China. It does nothing to show how much testosterone a healthy young person creates each day.