Why is 200 mg/wk the "upper limit" for TRT?

[Gianluca]

Vince, thank you very much for explaining this, I really appreciate it, this is definitely something new I need to consider, you know when my E2 LC/MS/MS goes over 40/50 I really start feeling "crazy" meaning more emotional, anxiety, bloated reddish face and I develop some type of sexual addiction, like it is always my mind in a crazy way......I wonder where actually. according to this theory, my FE would be....very interesting, I may want to try to up my AI and see how I feel

Per one of Dr Crisler's recent books the thought that with low SHBG as you know means there's more T that is unbound and is able to be used by the body, typically us guys see Free T that is way above lab ranges, over 3% of total. The thought goes that along with the Free T, there is Free Estrogen for the same reason...low SHBG. AS the theory goes the Free E results in the idea that low SHBG guys may need to be in the teens with LC/MS/MS testing because the amount of Free Estrogens. This is opposed to the standard thought of ~21-30 for E2. It's a very new idea this Free Estrogens and SHBG.

 

[Gianluca]

Vince

My FT since I started TRT has always been anything from 27 to 37, usually just about 30, so most of the time over what is defined "physiological" levels, have you try to stay with FT within normal ranges? if so how did you feel?

I always had a misconception about what would be the type of Testosterone level to look at based on the way I felt, the last follow up I had with Doctor, he told me that FT is basically the T that do the good things for us, before that I always thought TT would be the one to look at. Now considering low SHBG guys and the conversation with the doc, I focused my self on just reading FT, since TT for us is not an accurate level, like E2 LC/MS/MS probably is in our case,

so my FT has been way to high most of the time with my HDL now down to 32, H&H are on the high side too but that is a sleep apnea discussion, I do want to try to lower my T dose 0,05ml for each of the 3 weekly injections and actually use more AI to squeeze in more T, but aim for no more than 25 FT range this time and see how I feel

Do you guys think there is always the need for a LOW SHBG guy to stay above normal FT level to start experiencing benefit from TRT?

I feel like we should open a Forum section for LOW SHBG GUYS??

 

[Will Brink]

I would add when I see comments of "I feel best on" and they exceed TRT, I cringe. Ask any bber and he'll tell you he feels best off season on doses of T and AAs that are 10X TRT. I felt like super man back in the day on doses well above TRT. The Q is, what's it doing to their body? If we use feeling our best as the only metric, I assure you, bad things can happen.

So, I'd posit finding the dose o TRT that's within physiological range while other metrics suggest good health. I have had many a conversation with ex bbers who TRT is 300-400mg per week of T, "because that's the dose they feel their best" yet their body suggests otherwise and risk factors for CVD, elevated BP, etc are found.

So, TRT , done right, is about robust health and longevity in addition to psychological benefits, etc, but I can tell you 300mg "feels" better than 200mg, and 400mg "feels" better than 300mg, and off you go...

There's no free lunch in human biology, so keep that in mind.

- Will @ www.BrinkZone.com

 

[Sakuraba39]

Vince, thank you very much for explaining this, I really appreciate it, this is definitely something new I need to consider, you know when my E2 LC/MS/MS goes over 40/50 I really start feeling "crazy" meaning more emotional, anxiety, bloated reddish face

Bonetti Gianluca, I've had doctors prescribe some reckless T protocols over the years, but nothing ever made me feel those symptoms (bloated, anxiety, rashes, etc...) like taking too much HCG.

 

[Will Brink]

Bonetti Gianluca, I've had doctors prescribe some reckless T protocols over the years, but nothing ever made me feel those symptoms (bloated, anxiety, rashes, etc...) like taking too much HCG.

Now you know what it must feel like to be a woman.

 

[Sakuraba39]

Will, yeah, I had a hot flash or two. I've read so many horror stories on various web boards that I didn't need labs to tell me what was going on.

 

[Gianluca]

you know that I had actually noticed some peak and valley from HCG when I was doing 350IU 3 x week, I do now 200IU 5 x week and that took care of it, do you think it was a spike in E2 due to HCG?

Bonetti Gianluca, I've had doctors prescribe some reckless T protocols over the years, but nothing ever made me feel those symptoms (bloated, anxiety, rashes, etc...) like taking too much HCG.

 

[Sakuraba39]

do you think it was a spike in E2 due to HCG?

Absolutely

 

[CSI007]

When you guys are talking about sexual function are you talking about erection quality or libido or both? The reason I ask is my previous and current protocol I have crazy libido - been like that since the first/second week of starting TRT. I just can't enough sex. But I am still dealing with lack of penile sensitivity and ED issues. There was a smallish window of about 2 to 3 weeks that everything was on point and working damn near perfectly. Nothing changed in the protocol at that time but it vanished. 2 weeks into my slightly increased dosage (30MG EOD w400mg HCG E3.5) I am not seeing any changes yet.

I had very low E2 before starting TRT and now it's above normal around 34 or 35 before the increase in dosage. Wondering if I need to be in upper teens and low 20s with E2. How in the heck can you get these things dialed in and figured out? Waiting 6 weeks to to test seems like an eternity some times.

I feel like maybe I should have tested when I felt my best because now I will never know where that "ideal" range was.

 

[Vince Carter]

Perfect question that I don't think get's the right attention, interest and the ability to act on and carry out the physical act seem to me to be different things. For instance I would say about like you, plenty of interest yet sensitivity/ED issues.

For changes like that if you're set and stable and just making small changes trying to dial up E2 I don't see the problem in pulling blood every two weeks. And I mean small minor changes where you're already in the right ballpark. A large change I would think you'd need 4-6 to stabilize.

 

[CSI007]

What seems to be a terrible fact for me is using Cialis seems to help enough in the erection department but it makes climaxing very difficult. It seems to decrease sensitivity even more for me. :/

For me when everything started to go to hell it was this that led the way. I noticed that sensitivity really began to fade and get worse and worse...Then the ED followed. This was about a year and half before I started searching for a reason.

It feels like there is a piece of the puzzle that I (we) are missing.

 

[Millere]

Good point csi, it does seem like it reduces sensitivity

 

[msmartsmart]

Started TRT in September/October on 200 mg/wk, once a week. Came here and read a bunch of stuff and talked to my doctor about going to twice a week at 100 mg. Doctor wasn't convinced that I was having highs and lows due to frequency, but rather thought that I wasn't getting enough. Bumped me up to 220 mg/wk once a week. Following visit, I again said that I wanted to go to twice a week. He finally agreed and also bumped me to 240 mg/wk. I did 120 mg twice a week for a month. Bloods came back at 857 ng/dl and doc said that he wanted to bump me again. I am now at 140 mg twice a week with .5 mg of AI twice a week at time of injection. I feel better than ever, but am waiting to see what my blood looks like. Doc says he wants me at 1,100-1,200 ng/dl.

Thoughts?

 

[CSI007]

Started TRT in September/October on 200 mg/wk, once a week. Came here and read a bunch of stuff and talked to my doctor about going to twice a week at 100 mg. Doctor wasn't convinced that I was having highs and lows due to frequency, but rather thought that I wasn't getting enough. Bumped me up to 220 mg/wk once a week. Following visit, I again said that I wanted to go to twice a week. He finally agreed and also bumped me to 240 mg/wk. I did 120 mg twice a week for a month. Bloods came back at 857 ng/dl and doc said that he wanted to bump me again. I am now at 140 mg twice a week with .5 mg of AI twice a week at time of injection. I feel better than ever, but am waiting to see what my blood looks like. Doc says he wants me at 1,100-1,200 ng/dl.

Thoughts?

I would probably be looking for a new Doctor. This Doc seems to want to treat you based on numbers and not how you feel. 1100-1200 is over the "new" range for normal. Even before the change shooting for the upper levels of normal is probably not ideal. You will likely be dealing with prostate issues (PSA) and certainly have very high hematocrit which will require you to donate blood more frequently then most would want to leading to iron issues etc.

You feel good now but it wont last long and when you finally "come down" of your inital T jolt you will not be a happy camper.

 

[madman]

Started TRT in September/October on 200 mg/wk, once a week. Came here and read a bunch of stuff and talked to my doctor about going to twice a week at 100 mg. Doctor wasn't convinced that I was having highs and lows due to frequency, but rather thought that I wasn't getting enough. Bumped me up to 220 mg/wk once a week. Following visit, I again said that I wanted to go to twice a week. He finally agreed and also bumped me to 240 mg/wk. I did 120 mg twice a week for a month. Bloods came back at 857 ng/dl and doc said that he wanted to bump me again. I am now at 140 mg twice a week with .5 mg of AI twice a week at time of injection. I feel better than ever, but am waiting to see what my blood looks like. Doc says he wants me at 1,100-1,200 ng/dl.

Hard to believe you only hit a TT 857 ng/dl on 240 mg test/week (120mg every 3.5 days). 200 mg/week would put many over the upper end of the physiological range.

What is your shbg sitting at?

As CSI007 stated the numbers are not what really matters it comes down to your relief/ improvements in low t symptoms and how you feel overall and of course blood work with healthy ranges (TT/FT/estradiol/dht/psa/cbc (hematocrit/hemoglobin) and other overall blood markers.

Sure some may need to have their testosterone levels in the upper end or slightly above the top end of the physiological range (with other hormones in check) to feel their best but remember more is not always better as there are many who feel their best having levels in the 600-700 ng/dl range.

Numbers are important as they are used to gauge results but how you feel is what truly matters!

 

[CSI007]

Started TRT in September/October on 200 mg/wk, once a week. Came here and read a bunch of stuff and talked to my doctor about going to twice a week at 100 mg. Doctor wasn't convinced that I was having highs and lows due to frequency, but rather thought that I wasn't getting enough. Bumped me up to 220 mg/wk once a week. Following visit, I again said that I wanted to go to twice a week. He finally agreed and also bumped me to 240 mg/wk. I did 120 mg twice a week for a month. Bloods came back at 857 ng/dl and doc said that he wanted to bump me again. I am now at 140 mg twice a week with .5 mg of AI twice a week at time of injection. I feel better than ever, but am waiting to see what my blood looks like. Doc says he wants me at 1,100-1,200 ng/dl.

Hard to believe you only hit a TT 857 ng/dl on 240 mg test/week (120mg every 3.5 days). 200 mg/week would put many over the upper end of the physiological range.

What is your shbg sitting at?

As CSI007 stated the numbers are not what really matters it comes down to your improvements in low t symptoms and how you feel overall and of course blood work with healthy ranges (TT/FT/estradiol/dht/psa/cbc (hematocrit/hemoglobin).

Sure some may need to have their testosterone levels in the upper end or slightly above the top end of the physiological range (with other hormones in check) to feel their best but remember more is not always better as there are many who feel their best having levels in the 600-700 ng/dl range.

Numbers are important as they are used to gauge results but how you feel is what truly matters!

I thought the same thing. I wonder if his doc was checking a week or two after beginning the protocol. It's not specified. He probably had not reached his maximum level before testing was done? Very narrow time frame from beginning to today and many changes all UP. Also, when are you testing?

 

[Vestpocket]

Will,

The difference is that you're dealing with men with impaired livers in this thread. Both Vince Carter and Bonetti Gianluca have naturally low SHBG. They're going to have supraphysiological free testosterone levels no matter what. They are going to have supraphysiological estradiol and free estradiol levers no matter what (without AI intervention.) With low SHBG, there is no such thing as "balance" or "health". There is only " majorly ****ed." As Dr. Crisler says, SHBG "deals the cards."

One thing that low SHBG men seem to notice, as demonstrated right in this nice petri dish of a thread -- is that they need supraphysiological levels of testosterone to feel normal. There are many possible reasons for this upon which modern studies are shedding light, including extracellular hormone signalling and the role of cellular free SHBG uptake. Most traditional broscience and messageboard expertise is blind to the concept. I've even heard people in this very forum claim they wished they had low SHBG. (wow.)

I've heard many men say they feel "fine" with low SHBG and almost universally, we later discover that they are taking at least 200 mg/wk, if not more.

Quantity of testosterone injected is meaningless if the net effect of the testosterone on androgen receptors is the same, and in these low SHBG men, it would seem that they are not doing anything at all unhealthy.

With low SHBG (<16 nmol/L), most men don't "feel" any effect of testosterone whatsoever. They will always be at natural extremes. There is no balance possible, because the free fraction of hormones will always be exaggerated and the metabolic clearance rate of testosterone will always be exaggerated.

 

[Vince Carter]

Will,

The difference is that you're dealing with men with impaired livers in this thread. Both Vince Carter and Bonetti Gianluca have naturally low SHBG. They're going to have supraphysiological free testosterone levels no matter what. They are going to have supraphysiological estradiol and free estradiol levers no matter what (without AI intervention.) With low SHBG, there is no such thing as "balance" or "health". There is only " majorly ****ed." As Dr. Crisler says, SHBG "deals the cards."

One thing that low SHBG men seem to notice, as demonstrated right in this nice petri dish of a thread -- is that they need supraphysiological levels of testosterone to feel normal. There are many possible reasons for this upon which modern studies are shedding light, including extracellular hormone signalling and the role of cellular free SHBG uptake. Most traditional broscience and messageboard expertise is blind to the concept. I've even heard people in this very forum claim they wished they had low SHBG. (wow.)

I've heard many men say they feel "fine" with low SHBG and almost universally, we later discover that they are taking at least 200 mg/wk, if not more.

Quantity of testosterone injected is meaningless if the net effect of the testosterone on androgen receptors is the same, and in these low SHBG men, it would seem that they are not doing anything at all unhealthy.

With low SHBG (<16 nmol/L), most men don't "feel" any effect of testosterone whatsoever. They will always be at natural extremes. There is no balance possible.

on .25mg EOD Im pulling LC/MS/MS @ 42, and Free Estrogen is twice the lab range @ .91 (0 < or = 0.45)

 

[Vestpocket]

on .25mg EOD Im pulling LC/MS/MS @ 42, and Free Estrogen is twice the lab range @ .91 (0 < or = 0.45)

Yeah, that's what I'm talking about. Not only that, but if you test your DHT, you'll find that even with midrange DHT, your free DHT is out of range.

With low SHBG, every free hormone will be out of range at normal bound values.

I've been doing a little research, and there actually might be a way for us to increase SHBG to normal physiologically appropriate levels, but it's a bit unconventional. Multiple studies show that oral ethinyloestradiol in males does not increase plasma E2, increases total testosterone and can boost SHBG significantly in small doses. Oral EE2's travel through first pass hepatic metabolism seems to totally break it down, but activates ERa in hepatocytes along the way. This could potentially be the actual cure.

 

[Vince Carter]

My next set of labs I'll add Free DHT as I've never run that one. "regular" test for DHT I was always running a little under 50% of the lab range I think ~40 on a 16-79 scale.