My TRT Odyssey: Lab Results and More

[FunkOdyssey]

I'm back on TRT after recording my lowest ever free T recently and getting super lucky with a last hail mary attempt using a new formula. Briefly, my history is as follows:

• 43 years old with hypogonadal symptoms (all of them) since forever, low free T (6.5 ng/dl)
• Tried testosterone cypionate in doses ranging from 70-105 mg weekly for several months
  • Reached 10-13 ng/dl free T, E2 basically unchanged from baseline (mid 20s pg/ml)
  • Mood and energy improved
  • Worse sexual function
  • Anxiety, overstimulation, sometimes elevated HR and BP
  • Insomnia
  • Brain fog / impaired cognition / memory and word recall problems
  • Worsened laryngopharyngeal reflux symptoms
  • Major hair loss
• Briefly tried testosterone propionate 8-10 mg daily
  • I think cognition was better
  • Everything else the same
• Gave up and went off TRT for months
• Tried 20% testosterone cream, 100 - 150 mg (2-3 clicks) daily
  • Reached 22 ng/dl free T, 53 pg/ml E2, 370 ng/dl DHT
  • Major improvement in libido and sexual function
  • Good / normal cognition
  • Massive deal-breaking indigestion / gastritis / GERD
    • DHT somehow?
• Gave up and went off TRT for months
• Tested Free T at 5 ng/dl and decided to try one last time, testing a hunch about excipients
• 8 weeks ago, started Hikma T enanthate at 40 mg EOD (140 mg weekly)
  • Reached 17 ng/dl Free T, 43 pg/ml E2
  • Mood and energy improved
  • More nocturnal erections, otherwise sexual function unchanged
  • No side effects!!!!!!!!
  • Cognition possibly better than normal
  • Some actual gains in response to exercise

Here are my baseline and 8 week labs:

Test	10/13/2023	12/19/2023	Normal Range
Total Testosterone	606 ng/dL	893 ng/dL	250 - 1100 ng/dL
Free Testosterone (EqD)	51.5 pg/mL	168.8 pg/mL	35 - 155 pg/mL
Free Testosterone (calc)		17.3 ng/dL
SHBG		44 nmol/L	10 - 50 nmol/L
Estradiol (ultrasensitive)	22 pg/mL	43 pg/mL	<= 29 pg/mL
DHT	56 ng/dL	66 ng/dL	12 - 65 ng/dL
Prolactin		5.2 ng/dL	2 - 18 ng/dL
DHEA Sulfate		112 mcg/dL	61 - 442 mcg/dL

IGF-1	93 ng/mL	118 ng/mL	52 - 328 ng/mL
PSA		0.79 ng/mL	<= 4.00 ng/mL
TSH		2.51 mIU/L	0.40 - 4.50 mIU/L
Hematocrit	43.3%	41.8%	38.5 - 50%

First, I am thrilled to have discovered a form of TRT that I actually feel good on. My personal experience, my close friend's experience, and various anecdotes I've seen indicate a DRASTICALLY different experience of TRT using Hikma enanthate versus compounded cypionate. I've explored hypotheses around excipients (benzyl benzoate/benzyl alcohol) and ester differences at length elsewhere.

I am for the first time on TRT feeling overall better and more healthy than when not on TRT, to the point that if this were as good as it gets, I would stay on it indefinitely. However, I suspect this is not as good as it gets. For one, I have only been on a couple months. Second, most of the practitioners I follow aim for higher free T values than I have achieved. For example, some notes I recorded from Dave Lee's TRT 101 book after translating the units to be American-friendly:

• When initiating treatment likes to bring free T to 17 to 29 ng/dl
• Younger men do better with higher levels, older men better with lower levels
• Lowest free T observed in a dialed in man was 16 ng/dl
• Highest free T in dialed in men: 43 ng/dl
• Personally he does best between 38 – 43 ng/dl
• Majority of his clients sit around 26 – 35 ng/dl
• Very few clients do well with free T below 20 ng/dl
• Decent handful of clients start to get negative sides above 32 – 35 ng/dl
• Equal number of clients don't receive much benefit until free T is above 35 ng/dl
• Most men over 60 do best with 17 – 26 ng/dl
• Men under 25 do best with 35 – 43 ng/dl

I seem to be a below-average responder with my 17 ng/dL EOD SC trough value on 140 mg weekly. It would probably take a heroic dose for me to reach some of those ranges listed above. I'm not sure how far Defy will support me increasing the dose should it exceed 200 mg weekly.

At the moment though, Defy's instructions are to increase dose to 50 mg EOD (175 mg weekly). That should result in a free T around 21 ng/dL at trough if things remain proportionate. We'll see what that does for me. I am hoping for some of the libido I had on cream, and more gains in size and strength, without losing the overall feeling of well-being I have currently.

I have already increased from a skinny 6'6" 190 lbs to 200 lbs in the last two months with consistent workouts. I alternate a Stronglifts 5x5 program with HIIT and Zone 2 rides on my Peloton bike. I don't want to talk about the specific weights I'm using because they are still embarrassing but I have added 50 lbs on the major lifts.

I'm wondering if I should do anything about my sad DHEA-S and IGF-1 values. I am open to trying MK-677 and already purchased some. Though I don't want to muddy the waters by adding DHEA while I'm dialing in TRT, it seems like that might be worth trying at some point, especially for libido.

I welcome your thoughts and comments as I proceed on my journey.

 

[Systemlord]

Why is your hematocrit so low?

 

[FunkOdyssey]

Why is your hematocrit so low?

Well, hypogonadism can cause mild anemia - that's one of the signs. I don't have sleep apnea, obesity, I don't smoke, or anything else that would drive it up and obscure the effect of hypogonadism on HCT.

My baseline ferritin is normal, a bit over 100.

 

[madman]

I'm back on TRT after recording my lowest ever free T recently and getting super lucky with a last hail mary attempt using a new formula. Briefly, my history is as follows:

• 43 years old with hypogonadal symptoms (all of them) since forever, low free T (6.5 ng/dl)
• Tried testosterone cypionate in doses ranging from 70-105 mg weekly for several months
  • Reached 10-13 ng/dl free T, E2 basically unchanged from baseline (mid 20s pg/ml)
  • Mood and energy improved
  • Worse sexual function
  • Anxiety, overstimulation, sometimes elevated HR and BP
  • Insomnia
  • Brain fog / impaired cognition / memory and word recall problems
  • Worsened laryngopharyngeal reflux symptoms
  • Major hair loss
• Briefly tried testosterone propionate 8-10 mg daily
  • I think cognition was better
  • Everything else the same
• Gave up and went off TRT for months
• Tried 20% testosterone cream, 100 - 150 mg (2-3 clicks) daily
  • Reached 22 ng/dl free T, 53 pg/ml E2, 370 ng/dl DHT
  • Major improvement in libido and sexual function
  • Good / normal cognition
  • Massive deal-breaking indigestion / gastritis / GERD
    • DHT somehow?
• Gave up and went off TRT for months
• Tested Free T at 5 ng/dl and decided to try one last time, testing a hunch about excipients
• 8 weeks ago, started Hikma T enanthate at 40 mg EOD (140 mg weekly)
  • Reached 17 ng/dl Free T, 43 pg/ml E2
  • Mood and energy improved
  • More nocturnal erections, otherwise sexual function unchanged
  • No side effects!!!!!!!!
  • Cognition possibly better than normal
  • Some actual gains in response to exercise

Here are my baseline and 8 week labs:

Test	10/13/2023	12/19/2023	Normal Range
Total Testosterone	606 ng/dL	893 ng/dL	250 - 1100 ng/dL
Free Testosterone (EqD)	51.5 pg/mL	168.8 pg/mL	35 - 155 pg/mL
Free Testosterone (calc)		17.3 ng/dL
SHBG		44 nmol/L	10 - 50 nmol/L
Estradiol (ultrasensitive)	22 pg/mL	43 pg/mL	<= 29 pg/mL
DHT	56 ng/dL	66 ng/dL	12 - 65 ng/dL
Prolactin		5.2 ng/dL	2 - 18 ng/dL
DHEA Sulfate		112 mcg/dL	61 - 442 mcg/dL

IGF-1

93 ng/mL

118 ng/mL

52 - 328 ng/mL

PSA

0.79 ng/mL

<= 4.00 ng/mL

TSH

2.51 mIU/L

0.40 - 4.50 mIU/L

Hematocrit

43.3%

41.8%

38.5 - 50%

First, I am thrilled to have discovered a form of TRT that I actually feel good on. My personal experience, my close friend's experience, and various anecdotes I've seen indicate a DRASTICALLY different experience of TRT using Hikma enanthate versus compounded cypionate. I've explored hypotheses around excipients (benzyl benzoate/benzyl alcohol) and ester differences at length elsewhere.





I am for the first time on TRT feeling overall better and more healthy than when not on TRT, to the point that if this were as good as it gets, I would stay on it indefinitely. However, I suspect this is not as good as it gets. For one, I have only been on a couple months. Second, most of the practitioners I follow aim for higher free T values than I have achieved. For example, some notes I recorded from Dave Lee's TRT 101 book after translating the units to be American-friendly:

• When initiating treatment likes to bring free T to 17 to 29 ng/dl
• Younger men do better with higher levels, older men better with lower levels
• Lowest free T observed in a dialed in man was 16 ng/dl
• Highest free T in dialed in men: 43 ng/dl
• Personally he does best between 38 – 43 ng/dl
• Majority of his clients sit around 26 – 35 ng/dl
• Very few clients do well with free T below 20 ng/dl
• Decent handful of clients start to get negative sides above 32 – 35 ng/dl
• Equal number of clients don't receive much benefit until free T is above 35 ng/dl
• Most men over 60 do best with 17 – 26 ng/dl
• Men under 25 do best with 35 – 43 ng/dl

I seem to be a below-average responder with my 17 ng/dL EOD SC trough value on 140 mg weekly. It would probably take a heroic dose for me to reach some of those ranges listed above. I'm not sure how far Defy will support me increasing the dose should it exceed 200 mg weekly.

At the moment though, Defy's instructions are to increase dose to 50 mg EOD (175 mg weekly). That should result in a free T around 21 ng/dL at trough if things remain proportionate. We'll see what that does for me. I am hoping for some of the libido I had on cream, and more gains in size and strength, without losing the overall feeling of well-being I have currently.

I have already increased from a skinny 6'6" 190 lbs to 200 lbs in the last two months with consistent workouts. I alternate a Stronglifts 5x5 program with HIIT and Zone 2 rides on my Peloton bike. I don't want to talk about the specific weights I'm using because they are still embarrassing but I have added 50 lbs on the major lifts.

I'm wondering if I should do anything about my sad DHEA-S and IGF-1 values. I am open to trying MK-677 and already purchased some. Though I don't want to muddy the waters by adding DHEA while I'm dialing in TRT, it seems like that might be worth trying at some point, especially for libido.

I welcome your thoughts and comments as I proceed on my journey.

Would ride it out longer before jumping to any conclusions.

You are only 8 weeks in.

Need to give it a few months after one has reached a steady state to gauge how you truly feel overall let alone whether the protocol was a success or failure.

Takes time for the body to adapt to the new set point.

If you are dead set on increasing your weekly dose 8 weeks in just because you feel that achieving a higher troogh FT may be more effective overall than going from 140 mg T/week (40mg EOD) ---> 175 mg T/week (50 mg EOD) is a big jump.

35 mg T/week is going to give you a big bump in TT/FT.

May end up pushing your high-end trough TT from 893 ng/dL higher than needed and might end up overshooting your trough FT.

If you end up with a very high trough TT of almost 1200 ng/dL that would have your trough (cFTV) at 25.7 ng/dL which would be a huge jump from your current 17.

I can drive up my TT 200 ng/dL by just increasing my dose 20 mg/week.

Would be more sensible to go from 140--->160 mg.

Hate to burst your bubble here but you are not going to notice a big difference in muscle/strength gains going from a trough TT 900--->1100-1200 ng/dL or more importantly a trough FT 17--->21 ng/dL.

Either way do what you feel is best for you.




Dave Lee's TRT 101 book after translating the units to be American-friendly:

• When initiating treatment likes to bring free T to 17 to 29 ng/dl
• Younger men do better with higher levels, older men better with lower levels
• Lowest free T observed in a dialed in man was 16 ng/dl
• Highest free T in dialed in men: 43 ng/dl
• Personally he does best between 38 – 43 ng/dl
• Majority of his clients sit around 26 – 35 ng/dl
• Very few clients do well with free T below 20 ng/dl
• Decent handful of clients start to get negative sides above 32 – 35 ng/dl
• Equal number of clients don't receive much benefit until free T is above 35 ng/dl
• Most men over 60 do best with 17 – 26 ng/dl
• Men under 25 do best with 35 – 43 ng/dl

Would tread lightly on this one!

Could easily blow holes through this.

Big difference between one running an absurdly high trough FT 30 ng/dL on a once weekly vs EOD or daily protocol.

 

[madman]

I'm back on TRT after recording my lowest ever free T recently and getting super lucky with a last hail mary attempt using a new formula. Briefly, my history is as follows:

• 43 years old with hypogonadal symptoms (all of them) since forever, low free T (6.5 ng/dl)
• Tried testosterone cypionate in doses ranging from 70-105 mg weekly for several months
  • Reached 10-13 ng/dl free T, E2 basically unchanged from baseline (mid 20s pg/ml)
  • Mood and energy improved
  • Worse sexual function
  • Anxiety, overstimulation, sometimes elevated HR and BP
  • Insomnia
  • Brain fog / impaired cognition / memory and word recall problems
  • Worsened laryngopharyngeal reflux symptoms
  • Major hair loss
• Briefly tried testosterone propionate 8-10 mg daily
  • I think cognition was better
  • Everything else the same
• Gave up and went off TRT for months
• Tried 20% testosterone cream, 100 - 150 mg (2-3 clicks) daily
  • Reached 22 ng/dl free T, 53 pg/ml E2, 370 ng/dl DHT
  • Major improvement in libido and sexual function
  • Good / normal cognition
  • Massive deal-breaking indigestion / gastritis / GERD
    • DHT somehow?
• Gave up and went off TRT for months
• Tested Free T at 5 ng/dl and decided to try one last time, testing a hunch about excipients
• 8 weeks ago, started Hikma T enanthate at 40 mg EOD (140 mg weekly)
  • Reached 17 ng/dl Free T, 43 pg/ml E2
  • Mood and energy improved
  • More nocturnal erections, otherwise sexual function unchanged
  • No side effects!!!!!!!!
  • Cognition possibly better than normal
  • Some actual gains in response to exercise

Here are my baseline and 8 week labs:

Test	10/13/2023	12/19/2023	Normal Range
Total Testosterone	606 ng/dL	893 ng/dL	250 - 1100 ng/dL
Free Testosterone (EqD)	51.5 pg/mL	168.8 pg/mL	35 - 155 pg/mL
Free Testosterone (calc)		17.3 ng/dL
SHBG		44 nmol/L	10 - 50 nmol/L
Estradiol (ultrasensitive)	22 pg/mL	43 pg/mL	<= 29 pg/mL
DHT	56 ng/dL	66 ng/dL	12 - 65 ng/dL
Prolactin		5.2 ng/dL	2 - 18 ng/dL
DHEA Sulfate		112 mcg/dL	61 - 442 mcg/dL

IGF-1

93 ng/mL

118 ng/mL

52 - 328 ng/mL

PSA

0.79 ng/mL

<= 4.00 ng/mL

TSH

2.51 mIU/L

0.40 - 4.50 mIU/L

Hematocrit

43.3%

41.8%

38.5 - 50%

First, I am thrilled to have discovered a form of TRT that I actually feel good on. My personal experience, my close friend's experience, and various anecdotes I've seen indicate a DRASTICALLY different experience of TRT using Hikma enanthate versus compounded cypionate. I've explored hypotheses around excipients (benzyl benzoate/benzyl alcohol) and ester differences at length elsewhere.




I am for the first time on TRT feeling overall better and more healthy than when not on TRT, to the point that if this were as good as it gets, I would stay on it indefinitely. However, I suspect this is not as good as it gets. For one, I have only been on a couple months. Second, most of the practitioners I follow aim for higher free T values than I have achieved. For example, some notes I recorded from Dave Lee's TRT 101 book after translating the units to be American-friendly:

• When initiating treatment likes to bring free T to 17 to 29 ng/dl
• Younger men do better with higher levels, older men better with lower levels
• Lowest free T observed in a dialed in man was 16 ng/dl
• Highest free T in dialed in men: 43 ng/dl
• Personally he does best between 38 – 43 ng/dl
• Majority of his clients sit around 26 – 35 ng/dl
• Very few clients do well with free T below 20 ng/dl
• Decent handful of clients start to get negative sides above 32 – 35 ng/dl
• Equal number of clients don't receive much benefit until free T is above 35 ng/dl
• Most men over 60 do best with 17 – 26 ng/dl
• Men under 25 do best with 35 – 43 ng/dl

I seem to be a below-average responder with my 17 ng/dL EOD SC trough value on 140 mg weekly. It would probably take a heroic dose for me to reach some of those ranges listed above. I'm not sure how far Defy will support me increasing the dose should it exceed 200 mg weekly.

At the moment though, Defy's instructions are to increase dose to 50 mg EOD (175 mg weekly). That should result in a free T around 21 ng/dL at trough if things remain proportionate. We'll see what that does for me. I am hoping for some of the libido I had on cream, and more gains in size and strength, without losing the overall feeling of well-being I have currently.

I have already increased from a skinny 6'6" 190 lbs to 200 lbs in the last two months with consistent workouts. I alternate a Stronglifts 5x5 program with HIIT and Zone 2 rides on my Peloton bike. I don't want to talk about the specific weights I'm using because they are still embarrassing but I have added 50 lbs on the major lifts.

I'm wondering if I should do anything about my sad DHEA-S and IGF-1 values. I am open to trying MK-677 and already purchased some. Though I don't want to muddy the waters by adding DHEA while I'm dialing in TRT, it seems like that might be worth trying at some point, especially for libido.

I welcome your thoughts and comments as I proceed on my journey.

Do not be too eager to increase your strength so quickly as it is hard on the tendons and joints, especially at your age.

 

[madman]

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.

 

[FunkOdyssey]

Would ride it out longer before jumping to any conclusions.

You are only 8 weeks in.

Need to give it a few months after one has reached a steady state to gauge how you truly feel overall let alone whether the protocol was a success or failure.

Takes time for the body to adapt to the new set point.

If you are dead set on increasing your weekly dose 8 weeks in just because you feel that achieving a higher troogh FT may be more effective overall than going from 140 mg T/week (40mg EOD) ---> 175 mg T/week (50 mg EOD) is a big jump.

35 mg T/week is going to give you a big bump in TT/FT.

May end up pushing your high-end trough TT from 893 ng/dL higher than needed and might end up overshooting your trough FT.

If you end up with a very high trough TT of almost 1200 ng/dL that would have your trough (cFTV) at 25.7 ng/dL which would be a huge jump from your current 17.

I can drive up my TT 200 ng/dL by just increasing my dose 20 mg/week.

Would be more sensible to go from 140--->160 mg.

Hate to burst your bubble here but you are not going to notice a big difference in muscle/strength gains going from a trough TT 900--->1100-1200 ng/dL or more importantly a trough FT 17--->21 ng/dL.

Either way do what you feel is best for you.




Dave Lee's TRT 101 book after translating the units to be American-friendly:

• When initiating treatment likes to bring free T to 17 to 29 ng/dl
• Younger men do better with higher levels, older men better with lower levels
• Lowest free T observed in a dialed in man was 16 ng/dl
• Highest free T in dialed in men: 43 ng/dl
• Personally he does best between 38 – 43 ng/dl
• Majority of his clients sit around 26 – 35 ng/dl
• Very few clients do well with free T below 20 ng/dl
• Decent handful of clients start to get negative sides above 32 – 35 ng/dl
• Equal number of clients don't receive much benefit until free T is above 35 ng/dl
• Most men over 60 do best with 17 – 26 ng/dl
• Men under 25 do best with 35 – 43 ng/dl

Would tread lightly on this one!

Could easily blow holes through this.

Big difference between one running an absurdly high trough FT 30 ng/dL on a once weekly vs EOD or daily protocol.

Thank you madman for taking the time to give me some sage advice. Much appreciated.

Assuming my response is proportional to dose, increasing from 140 to 175 mg should only move my free T from 17 to 21 ng/dL. With EOD SC injections, that trough value shouldn't be too far off my average value either. My friend hits 27 ng/dL trough with 160 mg a week EOD, so I think I'm just a below average responder. According to my calculations, I would predict needing a dose of 222 mg weekly (!!) to reach my buddy's 27 ng/dL trough free T on this EOD protocol.

35 mg a week sounds like a big jump, but does 4 ng/dL free T sound like a huge jump? I don't think it's too crazy and neither did Ben at Defy. Yes, my total T is going to be high, but I have high SHBG so I ignore total T. I just recorded a robust total T of 606 ng/dL with 5 ng/dL free T -- in my opinion, Total T is worthless for this process of diagnosing and treating low T. I probably wouldn't even order it if it wasn't bundled with the Free T test. Total T is the noise that distracts from the signal.

About the range of Free T that different practitioners prefer, I have been following this TRT space closely for two years now and I still don't know who to believe. We have the seeming voices of reason that advocate for staying within reference ranges and we have the TOT practitioners who have collectively many, many thousands of men that by their account are thriving in supraphysiologic territory. You know who they are and what ranges they like, but just as an example, I took the data highpull from t-nation posted on his patients' labs and calculated a simple average of the values. Here they are, keeping in mind these are a mix of E3.5D and E7D protocols when you see these trough values:

Total T: 1029 ng/dL
Free T (EqD): 242 pg/mL
SHBG: 25 nmol/L
Free T (calc): 29 ng/dL
E2: 57 pg/mL

Highpull states that these men are "all happy with their results" and I believe him, just like I believe Dave Lee and others when they share details of their TRT practices. I also believe the men who have negative side effects at high doses and fix all their woes by reducing their dose to 100 mg or less weekly.

It is difficult to reconcile these two camps by reading and analysis alone or I would have by now. I am going to have to experience these things for myself, and for me, I think that looks like gradually raising the dose until things start getting worse. I have literally no side effects right now as I stated earlier, so naturally, I want to explore in the direction of more.

Your point about the benefits of TRT taking 3-6 months to manifest is well taken. I am not so much trying to rush that process as I am trying to reach free T levels that will be maximally beneficial and discovering what levels and doses I can comfortably tolerate. At what point would it start negatively affecting things like sleep, BP, heart rate, skin, etc? There's only one way to find out.

 

[madman]

Thank you madman for taking the time to give me some sage advice. Much appreciated.

Assuming my response is proportional to dose, increasing from 140 to 175 mg should only move my free T from 17 to 21 ng/dL. With EOD SC injections, that trough value shouldn't be too far off my average value either. My friend hits 27 ng/dL trough with 160 mg a week EOD, so I think I'm just a below average responder. According to my calculations, I would predict needing a dose of 222 mg weekly (!!) to reach my buddy's 27 ng/dL trough free T on this EOD protocol.

35 mg a week sounds like a big jump, but does 4 ng/dL free T sound like a huge jump? I don't think it's too crazy and neither did Ben at Defy. Yes, my total T is going to be high, but I have high SHBG so I ignore total T. I just recorded a robust total T of 606 ng/dL with 5 ng/dL free T -- in my opinion, Total T is worthless for this process of diagnosing and treating low T. I probably wouldn't even order it if it wasn't bundled with the Free T test. Total T is the noise that distracts from the signal.

About the range of Free T that different practitioners prefer, I have been following this TRT space closely for two years now and I still don't know who to believe. We have the seeming voices of reason that advocate for staying within reference ranges and we have the TOT practitioners who have collectively many, many thousands of men that by their account are thriving in supraphysiologic territory. You know who they are and what ranges they like, but just as an example, I took the data highpull from t-nation posted on his patients' labs and calculated a simple average of the values. Here they are, keeping in mind these are a mix of E3.5D and E7D protocols when you see these trough values:

Total T: 1029 ng/dL
Free T (EqD): 242 pg/mL
SHBG: 25 nmol/L
Free T (calc): 29 ng/dL
E2: 57 pg/mL

Highpull states that these men are "all happy with their results" and I believe him, just like I believe Dave Lee and others when they share details of their TRT practices. I also believe the men who have negative side effects at high doses and fix all their woes by reducing their dose to 100 mg or less weekly.

It is difficult to reconcile these two camps by reading and analysis alone or I would have by now. I am going to have to experience these things for myself, and for me, I think that looks like gradually raising the dose until things start getting worse. I have literally no side effects right now as I stated earlier, so naturally, I want to explore in the direction of more.

Your point about the benefits of TRT taking 3-6 months to manifest is well taken. I am not so much trying to rush that process as I am trying to reach free T levels that will be maximally beneficial and discovering what levels and doses I can comfortably tolerate. At what point would it start negatively affecting things like sleep, BP, heart rate, skin, etc? There's only one way to find out.

Assuming my response is proportional to dose, increasing from 140 to 175 mg should only move my free T from 17 to 21 ng/dL. With EOD SC injections, that trough value shouldn't be too far off my average value either. My friend hits 27 ng/dL trough with 160 mg a week EOD, so I think I'm just a below average responder. According to my calculations, I would predict needing a dose of 222 mg weekly (!!) to reach my buddy's 27 ng/dL trough free T on this EOD protocol.


May very well be but I would still go with a 20-25 mg T/week increase in dose.

Yes, you still have room to bring up your FT but keep in mind pushing your trough up towards the 30s is very high.

No natty healthy young male is running around with a trough FT 30 ng/dL.

Look up where the 50-97.5 TH percentile sits!




35 mg a week sounds like a big jump, but does 4 ng/dL free T sound like a huge jump? I don't think it's too crazy and neither did Ben at Defy. Yes, my total T is going to be high, but I have high SHBG so I ignore total T. I just recorded a robust total T of 606 ng/dL with 5 ng/dL free T -- in my opinion, Total T is worthless for this process of diagnosing and treating low T. I probably wouldn't even order it if it wasn't bundled with the Free T test. Total T is the noise that distracts from the signal.


So your pre-trt SHBG was absurdly high when you were hitting a robust TT 606 ng/dL?

On your most recent labs, your SHBG 44 nmol/L is highish but far from very high, and with a very high trough TT 893 ng/dL, you are still hitting a healthy/higher-end trough FT 17 ng/dL which is higher than where a healthy young male would sit and this it at the peak!

Even then the natty peak is short-lived!

If you end up with a trough FT 21 ng/dL on your new protocol then you would be on the top-end (cFTV).

No need to tell me when it comes to looking at TT/FT, altered SHBG, SHBG: T binding let alone assays/reference ranges as I was the one preaching the importance of FT since I came on the forum.

Many are still clueless when it comes to assays, reference ranges, and so on.




About the range of Free T that different practitioners prefer, I have been following this TRT space closely for two years now and I still don't know who to believe. We have the seeming voices of reason that advocate for staying within reference ranges and we have the TOT practitioners who have collectively many, many thousands of men that by their account are thriving in supraphysiologic territory. You know who they are and what ranges they like, but just as an example, I took the data highpull from t-nation posted on his patients' labs and calculated a simple average of the values. Here they are, keeping in mind these are a mix of E3.5D and E7D protocols when you see these trough values:

Total T: 1029 ng/dL
Free T (EqD): 242 pg/mL
SHBG: 25 nmol/L
Free T (calc): 29 ng/dL
E2: 57 pg/mL

Highpull states that these men are "all happy with their results" and I believe him, just like I believe Dave Lee and others when they share details of their TRT practices. I also believe the men who have negative side effects at high doses and fix all their woes by reducing their dose to 100 mg or less weekly.


Would not get too caught up on all these so-called HRT gurus let alone forums on the internet as they represent a small slice of the HRT pie.

I know numerous top uros and many outside of the net that have 100s and 100s of patients that do well with trough FT 16-31 ng/dL range keeping in mind the troughs/injection frequency of the protocol.

Far from common that everyone needs to be hitting this absurd trough 30+ ng/dL to experience relief/improvement of low-T symptoms and feel great overall.

Just to be clear hitting a trough FT 30 ng/dL is absurd on a once-weekly protocol.

Even when injecting twice weekly (every 3.5 days) is very high.

Pure nonsense pushed by the so-called optimal is where it's at clan!

My doctor is one of the top uros in Canada and has been treating men for low-T since the early 2000s.

Considered a pioneer when it comes to subcutaneous injections as he was one of the first in Canada to use this method almost 2 decades ago!

He has treated 100s of men and you would be hard-pressed to find many running those absurdly high trough FT levels.

He would agree that many tend to do better on the higher end but within reason.

Comes down to the individual.

Too many are caught up on those forums which are loaded with misinformation let alone many of those blast-n cruizerzzz preaching that more T is better mentality.

Complete shit show!




It is difficult to reconcile these two camps by reading and analysis alone or I would have by now. I am going to have to experience these things for myself, and for me, I think that looks like gradually raising the dose until things start getting worse. I have literally no side effects right now as I stated earlier, so naturally, I want to explore in the direction of more.
Your point about the benefits of TRT taking 3-6 months to manifest is well taken. I am not so much trying to rush that process as I am trying to reach free T levels that will be maximally beneficial and discovering what levels and doses I can comfortably tolerate. At what point would it start negatively affecting things like sleep, BP, heart rate, skin, etc? There's only one way to find out.


Agree and yes this is the only way you would know.

As long as one has given the protocol a fighting chance (12 weeks) blood markers remain healthy, minus any sides and they feel there may be room for improvement then it would make sense to bring up your trough FT further.

Shitkicker here is you and most have never even given the protocol a fighting chance.

You are already eager to bump up your dose 8 weeks in.

You have been on here long enough to know that this is a big mistake.

If your trough FT level was too low 6 weeks in I would say go nuts and increase your dose.

Again hormones are in flux during the weeks leading up until blood levels have stabilized and it is common to experience ups/downs during the transition as the body is trying to adjust.

More importantly, once levels have stabilized it will still take time (a few months or longer) for the body 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 and overall well-being.

Otherwise, you will never know whether the protocol was truly a success or failure.

This is the main reason why many struggle in the long run.

Many lack the understanding of how exogenous T works.

Misinformed and brainwashed.

I do not feel well 6-8 weeks in time to increase my dose.

My libido/erectile function is not where it is at 6-8 weeks in time to increase my dose.

My trough TT needs to be 1000+ ng/dL.

My trough FT is only 20 ng/dL I need to get to that magical 30 ng/dL.

You get the point!

As I have stated previously do what you feel is best for YOU!

 

[Guided_by_Voices]

I'm back on TRT after recording my lowest ever free T recently and getting super lucky with a last hail mary attempt using a new formula. Briefly, my history is as follows:

• 43 years old with hypogonadal symptoms (all of them) since forever, low free T (6.5 ng/dl)
• Tried testosterone cypionate in doses ranging from 70-105 mg weekly for several months
  • Reached 10-13 ng/dl free T, E2 basically unchanged from baseline (mid 20s pg/ml)
  • Mood and energy improved
  • Worse sexual function
  • Anxiety, overstimulation, sometimes elevated HR and BP
  • Insomnia
  • Brain fog / impaired cognition / memory and word recall problems
  • Worsened laryngopharyngeal reflux symptoms
  • Major hair loss
• Briefly tried testosterone propionate 8-10 mg daily
  • I think cognition was better
  • Everything else the same
• Gave up and went off TRT for months
• Tried 20% testosterone cream, 100 - 150 mg (2-3 clicks) daily
  • Reached 22 ng/dl free T, 53 pg/ml E2, 370 ng/dl DHT
  • Major improvement in libido and sexual function
  • Good / normal cognition
  • Massive deal-breaking indigestion / gastritis / GERD
    • DHT somehow?
• Gave up and went off TRT for months
• Tested Free T at 5 ng/dl and decided to try one last time, testing a hunch about excipients
• 8 weeks ago, started Hikma T enanthate at 40 mg EOD (140 mg weekly)
  • Reached 17 ng/dl Free T, 43 pg/ml E2
  • Mood and energy improved
  • More nocturnal erections, otherwise sexual function unchanged
  • No side effects!!!!!!!!
  • Cognition possibly better than normal
  • Some actual gains in response to exercise

Here are my baseline and 8 week labs:

Test	10/13/2023	12/19/2023	Normal Range
Total Testosterone	606 ng/dL	893 ng/dL	250 - 1100 ng/dL
Free Testosterone (EqD)	51.5 pg/mL	168.8 pg/mL	35 - 155 pg/mL
Free Testosterone (calc)		17.3 ng/dL
SHBG		44 nmol/L	10 - 50 nmol/L
Estradiol (ultrasensitive)	22 pg/mL	43 pg/mL	<= 29 pg/mL
DHT	56 ng/dL	66 ng/dL	12 - 65 ng/dL
Prolactin		5.2 ng/dL	2 - 18 ng/dL
DHEA Sulfate		112 mcg/dL	61 - 442 mcg/dL

IGF-1	93 ng/mL	118 ng/mL	52 - 328 ng/mL
PSA		0.79 ng/mL	<= 4.00 ng/mL
TSH		2.51 mIU/L	0.40 - 4.50 mIU/L
Hematocrit	43.3%	41.8%	38.5 - 50%

First, I am thrilled to have discovered a form of TRT that I actually feel good on. My personal experience, my close friend's experience, and various anecdotes I've seen indicate a DRASTICALLY different experience of TRT using Hikma enanthate versus compounded cypionate. I've explored hypotheses around excipients (benzyl benzoate/benzyl alcohol) and ester differences at length elsewhere.


I am for the first time on TRT feeling overall better and more healthy than when not on TRT, to the point that if this were as good as it gets, I would stay on it indefinitely. However, I suspect this is not as good as it gets. For one, I have only been on a couple months. Second, most of the practitioners I follow aim for higher free T values than I have achieved. For example, some notes I recorded from Dave Lee's TRT 101 book after translating the units to be American-friendly:

• When initiating treatment likes to bring free T to 17 to 29 ng/dl
• Younger men do better with higher levels, older men better with lower levels
• Lowest free T observed in a dialed in man was 16 ng/dl
• Highest free T in dialed in men: 43 ng/dl
• Personally he does best between 38 – 43 ng/dl
• Majority of his clients sit around 26 – 35 ng/dl
• Very few clients do well with free T below 20 ng/dl
• Decent handful of clients start to get negative sides above 32 – 35 ng/dl
• Equal number of clients don't receive much benefit until free T is above 35 ng/dl
• Most men over 60 do best with 17 – 26 ng/dl
• Men under 25 do best with 35 – 43 ng/dl

I seem to be a below-average responder with my 17 ng/dL EOD SC trough value on 140 mg weekly. It would probably take a heroic dose for me to reach some of those ranges listed above. I'm not sure how far Defy will support me increasing the dose should it exceed 200 mg weekly.

At the moment though, Defy's instructions are to increase dose to 50 mg EOD (175 mg weekly). That should result in a free T around 21 ng/dL at trough if things remain proportionate. We'll see what that does for me. I am hoping for some of the libido I had on cream, and more gains in size and strength, without losing the overall feeling of well-being I have currently.

I have already increased from a skinny 6'6" 190 lbs to 200 lbs in the last two months with consistent workouts. I alternate a Stronglifts 5x5 program with HIIT and Zone 2 rides on my Peloton bike. I don't want to talk about the specific weights I'm using because they are still embarrassing but I have added 50 lbs on the major lifts.

I'm wondering if I should do anything about my sad DHEA-S and IGF-1 values. I am open to trying MK-677 and already purchased some. Though I don't want to muddy the waters by adding DHEA while I'm dialing in TRT, it seems like that might be worth trying at some point, especially for libido.

I welcome your thoughts and comments as I proceed on my journey.

Distilling this down...it sounds like more strength/athleticism and libido are your short- term goals? If so, I would try PT-141 and/or a micro-dose of cream before anything else. Altheticism is a longer discussion, but without knowing what your current progression/trend is, it is impossible to comment specifically. 5x5 could mean a lot of different things, but quality protein and mild over-feeding is a good place to start first. I prefer IPAM/MGF over MK677 but that is more for injury issues. I would judge progress over at least a year to start with before making changes, especially for an ectomorph.

 

[FunkOdyssey]

Assuming my response is proportional to dose, increasing from 140 to 175 mg should only move my free T from 17 to 21 ng/dL. With EOD SC injections, that trough value shouldn't be too far off my average value either. My friend hits 27 ng/dL trough with 160 mg a week EOD, so I think I'm just a below average responder. According to my calculations, I would predict needing a dose of 222 mg weekly (!!) to reach my buddy's 27 ng/dL trough free T on this EOD protocol.


May very well be but I would still go with a 20-25 mg T/week increase in dose.

Yes, you still have room to bring up your FT but keep in mind pushing your trough up towards the 30s is very high.

No natty healthy young male is running around with a trough FT 30 ng/dL.

Look up where the 50-97.5 TH percentile sits!




35 mg a week sounds like a big jump, but does 4 ng/dL free T sound like a huge jump? I don't think it's too crazy and neither did Ben at Defy. Yes, my total T is going to be high, but I have high SHBG so I ignore total T. I just recorded a robust total T of 606 ng/dL with 5 ng/dL free T -- in my opinion, Total T is worthless for this process of diagnosing and treating low T. I probably wouldn't even order it if it wasn't bundled with the Free T test. Total T is the noise that distracts from the signal.


So your pre-trt SHBG was absurdly high when you were hitting a robust TT 606 ng/dL?

View attachment 40413


On your most recent labs, your SHBG 44 nmol/L is highish but far from very high, and with a very high trough TT 893 ng/dL, you are still hitting a healthy/higher-end trough FT 17 ng/dL which is higher than where a healthy young male would sit and this it at the peak!

Even then the natty peak is short-lived!

If you end up with a trough FT 21 ng/dL on your new protocol then you would be on the top-end (cFTV).

No need to tell me when it comes to looking at TT/FT, altered SHBG, SHBG: T binding let alone assays/reference ranges as I was the one preaching the importance of FT since I came on the forum.

Many are still clueless when it comes to assays, reference ranges, and so on.




About the range of Free T that different practitioners prefer, I have been following this TRT space closely for two years now and I still don't know who to believe. We have the seeming voices of reason that advocate for staying within reference ranges and we have the TOT practitioners who have collectively many, many thousands of men that by their account are thriving in supraphysiologic territory. You know who they are and what ranges they like, but just as an example, I took the data highpull from t-nation posted on his patients' labs and calculated a simple average of the values. Here they are, keeping in mind these are a mix of E3.5D and E7D protocols when you see these trough values:

Total T: 1029 ng/dL
Free T (EqD): 242 pg/mL
SHBG: 25 nmol/L
Free T (calc): 29 ng/dL
E2: 57 pg/mL

Highpull states that these men are "all happy with their results" and I believe him, just like I believe Dave Lee and others when they share details of their TRT practices. I also believe the men who have negative side effects at high doses and fix all their woes by reducing their dose to 100 mg or less weekly.


Would not get too caught up on all these so-called HRT gurus let alone forums on the internet as they represent a small slice of the HRT pie.

I know numerous top uros and many outside of the net that have 100s and 100s of patients that do well with trough FT 16-31 ng/dL range keeping in mind the troughs/injection frequency of the protocol.

Far from common that everyone needs to be hitting this absurd trough 30+ ng/dL to experience relief/improvement of low-T symptoms and feel great overall.

Just to be clear hitting a trough FT 30 ng/dL is absurd on a once-weekly protocol.

Even when injecting twice weekly (every 3.5 days) is very high.

Pure nonsense pushed by the so-called optimal is where it's at clan!

My doctor is one of the top uros in Canada and has been treating men for low-T since the early 2000s.

Considered a pioneer when it comes to subcutaneous injections as he was one of the first in Canada to use this method almost 2 decades ago!

He has treated 100s of men and you would be hard-pressed to find many running those absurdly high trough FT levels.

He would agree that many tend to do better on the higher end but within reason.

Comes down to the individual.

Too many are caught up on those forums which are loaded with misinformation let alone many of those blast-n cruizerzzz preaching that more T is better mentality.

Complete shit show!




It is difficult to reconcile these two camps by reading and analysis alone or I would have by now. I am going to have to experience these things for myself, and for me, I think that looks like gradually raising the dose until things start getting worse. I have literally no side effects right now as I stated earlier, so naturally, I want to explore in the direction of more.
Your point about the benefits of TRT taking 3-6 months to manifest is well taken. I am not so much trying to rush that process as I am trying to reach free T levels that will be maximally beneficial and discovering what levels and doses I can comfortably tolerate. At what point would it start negatively affecting things like sleep, BP, heart rate, skin, etc? There's only one way to find out.


Agree and yes this is the only way you would know.

As long as one has given the protocol a fighting chance (12 weeks) blood markers remain healthy, minus any sides and they feel there may be room for improvement then it would make sense to bring up your trough FT further.

Shitkicker here is you and most have never even given the protocol a fighting chance.

You are already eager to bump up your dose 8 weeks in.

You have been on here long enough to know that this is a big mistake.

If your trough FT level was too low 6 weeks in I would say go nuts and increase your dose.

Again hormones are in flux during the weeks leading up until blood levels have stabilized and it is common to experience ups/downs during the transition as the body is trying to adjust.

More importantly, once levels have stabilized it will still take time (a few months or longer) for the body 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 and overall well-being.

Otherwise, you will never know whether the protocol was truly a success or failure.

This is the main reason why many struggle in the long run.

Many lack the understanding of how exogenous T works.

Misinformed and brainwashed.

I do not feel well 6-8 weeks in time to increase my dose.

My libido/erectile function is not where it is at 6-8 weeks in time to increase my dose.

My trough TT needs to be 1000+ ng/dL.

My trough FT is only 20 ng/dL I need to get to that magical 30 ng/dL.

You get the point!

As I have stated previously do what you feel is best for YOU!

Appreciate the tough love madman. I'll tell you what: I already bumped up to the 50 mg EOD, but I will try my damnedest to stay here for the full 12 weeks as a concession to your wisdom. I just wanted to lock in a free T of 20+ ng/dL before playing the waiting game in earnest.

 

[FunkOdyssey]

Distilling this down...it sounds like more strength/athleticism and libido are your short- term goals? If so, I would try PT-141 and/or a micro-dose of cream before anything else. Altheticism is a longer discussion, but without knowing what your current progression/trend is, it is impossible to comment specifically. 5x5 could mean a lot of different things, but quality protein and mild over-feeding is a good place to start first. I prefer IPAM/MGF over MK677 but that is more for injury issues. I would judge progress over at least a year to start with before making changes, especially for an ectomorph.

Thank you for sharing some good suggestions. Yes, more strength/size and better libido and erections are the unmet goals. Better mood, energy, confidence are benefits I am already enjoying so those aspects are largely satisfied. I may even be mentally sharper than before starting TRT, which is great too.

I do have some PT-141 which I have only played with a little bit at small doses that were ineffective. I was nervous to try larger (read: normal) doses because of all the stories about nausea and vomiting. I should revisit that though.

Microdose of cream is not a bad idea either. The trouble is that even one click of my 200 mg/ml cream will now cause me severe indigestion for the better part of a day (at the same time that it noticeably boosts libido). It is the weirdest thing, almost like a gastrointestinal allergy to it. I've assumed somehow DHT is responsible because the crazy supraphysiologic DHT levels are the most obvious difference between cream and injections. I could possibly try a smaller dose of cream than the 50 mg single click.

What do I mean by 5x5? I guess I'm going to share some actual numbers then. I only started in the beginning of November so go easy on me.

The Stronglifts guy says most people can bench 220 lbs, squat 300 lbs and deadlift 400 lbs after a year of training and that is my goal. My father came in 2nd place in the world arm wrestling championship in the late 1970s and could bench 450 lbs at my current age so it has been difficult being so skinny and weak in comparison. Until just recently on TRT, my response to strength training has been terrible which led to discouragement and long periods without exercise.

 

[FunkOdyssey]

Just had my physical exam today per Defy's requirement. BP 110/70, all systems normal. Let's go boys.

 

[Guided_by_Voices]

Thank you for sharing some good suggestions. Yes, more strength/size and better libido and erections are the unmet goals. Better mood, energy, confidence are benefits I am already enjoying so those aspects are largely satisfied. I may even be mentally sharper than before starting TRT, which is great too.

I do have some PT-141 which I have only played with a little bit at small doses that were ineffective. I was nervous to try larger (read: normal) doses because of all the stories about nausea and vomiting. I should revisit that though.

Microdose of cream is not a bad idea either. The trouble is that even one click of my 200 mg/ml cream will now cause me severe indigestion for the better part of a day (at the same time that it noticeably boosts libido). It is the weirdest thing, almost like a gastrointestinal allergy to it. I've assumed somehow DHT is responsible because the crazy supraphysiologic DHT levels are the most obvious difference between cream and injections. I could possibly try a smaller dose of cream than the 50 mg single click.

What do I mean by 5x5? I guess I'm going to share some actual numbers then. I only started in the beginning of November so go easy on me.

View attachment 40429

The Stronglifts guy says most people can bench 220 lbs, squat 300 lbs and deadlift 400 lbs after a year of training and that is my goal. My father came in 2nd place in the world arm wrestling championship in the late 1970s and could bench 450 lbs at my current age so it has been difficult being so skinny and weak in comparison. Until just recently on TRT, my response to strength training has been terrible which led to discouragement and long periods without exercise.

On the libido front, there is no shame in using somethign from the viagra family, and the beetroot/nitric oxide pills may help as well. DHEA helps me as does vitamin C. The indigestion is strange, but yes, try a lower dose and maybe try at night after your daily digestion should be done. Trying GHRP6 to speed intestinal motility is another possibility, but only if nothing else works. Also, over-training will absolutely hurt erections and libido so I would avoid all max-effort lifts and be mindful of any signs of over-training.

On the lifting front, some thoughtlets:

- If you have access to a trap bar, I would do your deadlifts with that as it should be much more spine-friendly, especially for your body type.
- I would not adopt the goals of others or compare yourself to others as that is a sure path to frustration. If you can add 20lbs per year to each of your major movements, you will be up 100lbs in 5 years which should equate to good strength. By progression I mean that you might add 5 lbs to one set every other week and that would equate to 5lbs every 10 weeks which is fine too if maintained over multiple years. You can also adapt you can also adapt you program to add sets which creates an undulating load pattern, such as working from 4 sets of three up to eights sets adding a set every two weeks, for example. Anything that creates gradual volume progression which will eventually lead to strength progression.
- I would also add an explosive movement or two such as cleans and/or box jumps. Maintaining the ability to sprint is also key as is basketball for agility work and fine motor skills.
- For all movements I would be hyper-attentive to form (e.g. dead stop at the bottom for bench presses and learning to "coil" during the descent.)
- Something I have repeatedly found is that your body will tell you when you are reaching a point where you need to maintain at a strength level instead of gain and add in other things instead. For example. my flat bench tends to follow my decline bench up, and pec deck/loaded stretches also seem to help, but the key is to not train thru cumulative joint trauma. The numbers will be what they will be. Become a student of training and let the numbers take care of themselves.
- Also, you don't have to go to failure to know when you are stronger. You will feel it. If you have to grind out a rep and your form is at risk, then you are risking increased recovery time.
- You didn't say what style of quats you are doing, but if they are back squats, I would devote the time to developing a form that allows you at maintain a fairly vertical back posture which usually means using a slightly wider stance that what initially seems natural. If you can front squat comfortably and/or have access to a safety squat bar, those are both preferable movements IMO.

Above all, develop a long-term mindset and let consistency, learning, safety and form be your goals, and let the weights take care of themselves. You will be lifting (hopefully) for the next 60 years at least so develop a long-term mentality.

 

[RotnGun]

• When initiating treatment likes to bring free T to 17 to 29 ng/dl
• Younger men do better with higher levels, older men better with lower levels
• Lowest free T observed in a dialed in man was 16 ng/dl
• Highest free T in dialed in men: 43 ng/dl
• Personally he does best between 38 – 43 ng/dl
• Majority of his clients sit around 26 – 35 ng/dl
• Very few clients do well with free T below 20 ng/dl
• Decent handful of clients start to get negative sides above 32 – 35 ng/dl
• Equal number of clients don't receive much benefit until free T is above 35 ng/dl
• Most men over 60 do best with 17 – 26 ng/dl
• Men under 25 do best with 35 – 43 ng/dl

Does Doctor Lee state the optimal estrogen and DHT levels in the above said age groups?
Edit: Wrote to wrong person. Meant to write to @FunkOdyssey

 

[FunkOdyssey]

On the libido front, there is no shame in using somethign from the viagra family, and the beetroot/nitric oxide pills may help as well. DHEA helps me as does vitamin C. The indigestion is strange, but yes, try a lower dose and maybe try at night after your daily digestion should be done. Trying GHRP6 to speed intestinal motility is another possibility, but only if nothing else works. Also, over-training will absolutely hurt erections and libido so I would avoid all max-effort lifts and be mindful of any signs of over-training.

On the lifting front, some thoughtlets:

- If you have access to a trap bar, I would do your deadlifts with that as it should be much more spine-friendly, especially for your body type.
- I would not adopt the goals of others or compare yourself to others as that is a sure path to frustration. If you can add 20lbs per year to each of your major movements, you will be up 100lbs in 5 years which should equate to good strength. By progression I mean that you might add 5 lbs to one set every other week and that would equate to 5lbs every 10 weeks which is fine too if maintained over multiple years. You can also adapt you can also adapt you program to add sets which creates an undulating load pattern, such as working from 4 sets of three up to eights sets adding a set every two weeks, for example. Anything that creates gradual volume progression which will eventually lead to strength progression.
- I would also add an explosive movement or two such as cleans and/or box jumps. Maintaining the ability to sprint is also key as is basketball for agility work and fine motor skills.
- For all movements I would be hyper-attentive to form (e.g. dead stop at the bottom for bench presses and learning to "coil" during the descent.)
- Something I have repeatedly found is that your body will tell you when you are reaching a point where you need to maintain at a strength level instead of gain and add in other things instead. For example. my flat bench tends to follow my decline bench up, and pec deck/loaded stretches also seem to help, but the key is to not train thru cumulative joint trauma. The numbers will be what they will be. Become a student of training and let the numbers take care of themselves.
- Also, you don't have to go to failure to know when you are stronger. You will feel it. If you have to grind out a rep and your form is at risk, then you are risking increased recovery time.
- You didn't say what style of quats you are doing, but if they are back squats, I would devote the time to developing a form that allows you at maintain a fairly vertical back posture which usually means using a slightly wider stance that what initially seems natural. If you can front squat comfortably and/or have access to a safety squat bar, those are both preferable movements IMO.

Above all, develop a long-term mindset and let consistency, learning, safety and form be your goals, and let the weights take care of themselves. You will be lifting (hopefully) for the next 60 years at least so develop a long-term mentality.

So much good advice here, thank you.

I do have a trap bar. I was thinking it wasn't well suited for this program I'm doing with the squatting every session, because the trap bar deadlift is usually more quad-oriented. However, I found an article that suggests it is probably overall better than the barbell deadlift for most people. You can also lift in the traditional hip-dominant deadlift style just by limiting the forward knee movement and pushing your butt back. I think I will experiment with trap bar deadlifts instead.

Trap Bar Deadlifts are Underrated

Trap bar deadlifts allow for more flexibility in the movement, higher velocity and power output, and are safer and easier to learn for a lot of people.

www.strongerbyscience.com

I am doing back squats. When I have my feet shoulder width apart, it feels like I am leaning forward too much as I squat down and it feels hard on the lower back. I was already tending towards the wider stance that you are describing and I do find that more comfortable.

Yes to the long-term mentality, safety, and patience. Patience seems to be a recurring theme on this thread -- patience with TRT, patience with lifting. Easier said than done, but I will try.

 

[FunkOdyssey]

Does Doctor Lee state the optimal estrogen and DHT levels in the above said age groups?
Edit: Wrote to wrong person. Meant to write to @FunkOdyssey

Dave Lee is not a doctor, he's a "health coach". I don't think that should diminish his credibility though. I think any smart person with access to enough patient data could become very good at managing TRT protocols. Contrast with the poor performance of those who have received the most formal education on this topic: your typical endocrinologist.

He belongs to the "estrogen is not worth managing or perhaps even measuring" camp, so there is no discussion of optimal E2 levels. DHT is only mentioned in the context of scrotal cream, where the DHT boost is credited for superior results in some men, and warnings against the use of 5-AR inhibitors.

His views on initiating treatment, the timing of reviews and protocol adjustments, and expectations for the onset of benefits are entirely consistent with what you'll see on this forum. For example, some excerpts from his TRT 101 book:

"I recommend initiating treatment with Testosterone Cypionate or Enanthate at a dose of 100mg - 200mg per week, split into a minimum of two injections, as a shallow, intramuscular injection."

First Review
"It takes at least 6-8 weeks for levels to fully build up in your system. Your first review is to make sure that you have not hyper (over) or hypo (under) responded to your treatment. Each practitioner has different targets they roughly aim for on blood work, based on what they see as producing the best results for their patients."

"Blood work is a guide to make sure you are in the ballpark and symptoms are key in making sure your TRT is optimal. Keep in mind that early into treatment, while levels may have saturated, you do not feel the full effects of TRT at this point, not even close.

This is why it is important to understand that at your first follow up, it is only expected that you will feel like you have taken a step in the right direction. If you’re 10-20% better than when you started, that’s a good sign. Remember, the main benefits of TRT take time, and the goal of this appointment should be to make sure you're close to the bullseye and then to give it time and let it settle. I advise my clients to wait at least 12-16 weeks after this appointment for their next follow up."

Second Review (4-6 months into treatment)
"In my experience, assuming there are no other health factors at play, this is where most TRT patients start “feeling” the majority of the benefits of TRT, particularly those who have been looking after themselves well. In my experience, TRT continues to snowball in benefits over a period of years (I am still noticing growing benefits after 6 years) as the majority of the benefits begin to “kick” in around the 6 month mark.
At this point, it is also reasonable to assess your dose, to decide whether it is worth trying a higher or lower dose."

 

[tropicaldaze1950]

Dave Lee is not a doctor, he's a "health coach". I don't think that should diminish his credibility though. I think any smart person with access to enough patient data could become very good at managing TRT protocols. Contrast with the poor performance of those who have received the most formal education on this topic: your typical endocrinologist.

He belongs to the "estrogen is not worth managing or perhaps even measuring" camp, so there is no discussion of optimal E2 levels. DHT is only mentioned in the context of scrotal cream, where the DHT boost is credited for superior results in some men, and warnings against the use of 5-AR inhibitors.

His views on initiating treatment, the timing of reviews and protocol adjustments, and expectations for the onset of benefits are entirely consistent with what you'll see on this forum. For example, some excerpts from his TRT 101 book:

"I recommend initiating treatment with Testosterone Cypionate or Enanthate at a dose of 100mg - 200mg per week, split into a minimum of two injections, as a shallow, intramuscular injection."

First Review
"It takes at least 6-8 weeks for levels to fully build up in your system. Your first review is to make sure that you have not hyper (over) or hypo (under) responded to your treatment. Each practitioner has different targets they roughly aim for on blood work, based on what they see as producing the best results for their patients."

"Blood work is a guide to make sure you are in the ballpark and symptoms are key in making sure your TRT is optimal. Keep in mind that early into treatment, while levels may have saturated, you do not feel the full effects of TRT at this point, not even close.

This is why it is important to understand that at your first follow up, it is only expected that you will feel like you have taken a step in the right direction. If you’re 10-20% better than when you started, that’s a good sign. Remember, the main benefits of TRT take time, and the goal of this appointment should be to make sure you're close to the bullseye and then to give it time and let it settle. I advise my clients to wait at least 12-16 weeks after this appointment for their next follow up."

Second Review (4-6 months into treatment)
"In my experience, assuming there are no other health factors at play, this is where most TRT patients start “feeling” the majority of the benefits of TRT, particularly those who have been looking after themselves well. In my experience, TRT continues to snowball in benefits over a period of years (I am still noticing growing benefits after 6 years) as the majority of the benefits begin to “kick” in around the 6 month mark.
At this point, it is also reasonable to assess your dose, to decide whether it is worth trying a higher or lower dose."

So David Lee is similar to Danny Bossa; not a medical person, but someone who has acquired knowledge and uses it to advise. It has its value. Highpull is a doctor, as well as someone who's on testosterone replacement, like the aforementioned persons. His knowledge is based on diagnosing and managing patients. He has no bias as far as protocols. He gives his patients autonomy; whatever works and leads to symptom resolution and a more satisfactory life, he's cool with. Yes, he states that in his years of practice he's found most men do better with dosing between 140 & 200 mg, in one weekly injection. No, he's not the final word. Other doctors might recommend splitting the dose into 2 or three injections, including lower dosing. Some prefer subq. Dr. Rouzier seems to be all in on high dose topical applied to the scrotum.

We're not lost at sea; each of us has to find a protocol & dosing that works. It does take time. On that, David Lee and Danny Bossa concur with clinicians. And its been said by others, as well as me; the right protocol is the one that works for you!

 

[Mastodont]

What was it that got you settled on EOD this time around?

 

[FunkOdyssey]

What was it that got you settled on EOD this time around?

For my first shot at TRT via Ryan Root, he recommended 150 mg weekly for me with EOD injections. I ignored him, did something totally different, crashed and burned.

This time around with Defy, Ben prescribed 140 mg weekly with EOD injections. I decided to just do the thing I was being told to do this time, assuming these guys know a thing or two after dealing with thousands of men on TRT.

My understanding of the impact of frequency is that higher frequency is almost always better for overall side effect reduction, with the possible downside of less libido than you'd have with less frequent injections. The ratio of people saying they feel generally better with more frequent injections to people who complain about less libido on higher frequency is something like 20:1 or higher though. I imagine the practitioners I'm dealing with tend towards higher frequency in light of these realities.

We know there are diminishing returns associated with each increment of higher frequency. It seems like most people do not feel any different on EOD vs ED injections. This would be doubly true with subcutaneous injections and their slower pattern of release. So, it seems like EOD can often be a sweet spot that captures 97% of the max benefit of increased frequency while cutting your total number of injections in half.

 

[Guided_by_Voices]

So much good advice here, thank you.

I do have a trap bar. I was thinking it wasn't well suited for this program I'm doing with the squatting every session, because the trap bar deadlift is usually more quad-oriented. However, I found an article that suggests it is probably overall better than the barbell deadlift for most people. You can also lift in the traditional hip-dominant deadlift style just by limiting the forward knee movement and pushing your butt back. I think I will experiment with trap bar deadlifts instead.

Trap Bar Deadlifts are Underrated

Trap bar deadlifts allow for more flexibility in the movement, higher velocity and power output, and are safer and easier to learn for a lot of people.

www.strongerbyscience.com

I am doing back squats. When I have my feet shoulder width apart, it feels like I am leaning forward too much as I squat down and it feels hard on the lower back. I was already tending towards the wider stance that you are describing and I do find that more comfortable.

Yes to the long-term mentality, safety, and patience. Patience seems to be a recurring theme on this thread -- patience with TRT, patience with lifting. Easier said than done, but I will try.

I wrote the prior post in a hurry, so here is a bit more context. My number one priority, and what I recommend for everyone past college age and not competing, is to protect your joints. By spine-friendly I mean keeping the spine in a fairly neutral position such that the compressive force is roughly equally distributed around the disks rather than on one part of the disks as will likely be the case if the back bends too far forward or back. By putting your hands next to your knees the trap bar tends to keep the spine more neutral, however with your height, you may need to lift from blocks as well as using the high handles. You just have to be very mindful of your back position. This is harder to accomplish with back squats, especially for people with long femurs and hence why if I had it to do over again I would have de-emphasized back squats in favor of front squats or the safety squat bar. If you insist on back squats I would avoid any forms that create significant forward lean (I did that for many years and now have the MRIs of disc compression to prove it, not something you want). Two things to try are 1) set your form based on where you feel comfortable at the rock-bottom of the lift, which will usually mean a narrower stance with more leg flare similar to what an olympic lifer would use and or 2) use a slightly wider stance and only go to parallel but with your descending cue being to force your knees out as wide as you can such that your back stays fairly vertical. You will likely be unable to do this without weight on the bar to force you down into that position. I used approach number one for several years but eventually found that it was also hard on my back, so now when I do back squats I use approach number 2, but mostly do other movements for my hips and legs.

As far as patience and progression go, one of the issues I have with the strong-lifts program you described is that once you take reality (travel, injuries, burnout, experimentation, colds, the holidays, etc.) into account, it will take at least a year just to validate your progression approach, so again, steady progression over years without major setbacks is key. Almost all mainstream strength programs imply short bursts of improvement which are clearly unsustainable even if they "work" for a short period. Otherwise there would be 500lb benchers in every gym. Also note that you may need to prioritize a squat movement or a deadlift movement, especially if you are using a 7 day "week" vs a 9 or 10 day week, and once you reach a reasonable goal or genetic maximum (another topic) then maintain one and switch to building the other. Otherwise spine or leg overwork could be a limiting factor. Trying to simultaneously progress on everything can make progress less likely than building a few things and then shifting emphasis to other things. Ok, good luck with it.