It doesn’t specify the dosage given… anecdotal reports indicate many taking the “PCT” dosage of 50mg for secondary hypogonadism (say starting TT of 300/dl
For me 200mg = about 1300ng/dl at a push (say I backfill the syringe with no air… perhaps getting closer to 225mg)
THIS guy reached 1200ng/dl on Clomid alone
That being said, thank you for the study, I haven’t seen this one before. The ratio of those becoming eugonadal and those reporting symptomatic relief is somewhat out of proportion though
Just keep in mind that the direct RIA assay doesnt really measure freeT. But its a reasonable approximation as long as SHBG is at or close to the population average.Otherwise calc freeT is a better measure of freeT.
There is a lot of mixed opinions on the subject, so keep in mind that this is my opinion, which happens to be shared with a very high profile TRT doc that got me started on this over 8 years ago.
Take a look at the graph I previously posted. The dotted line is a regression like that predicts the response I will get in Free T at various doses. Note that it has an 89% correlation coefficient (that’s a very strong predictive value). Also keep in mind a couple of other factors:
I have high SHBG, so it takes more T for me to saturate the protein so that enough spills over to Free T. You have a normal level of SHBG, so you might have a higher response that will effect the slope of your response curve (meaning you will have a higher Free T at the same T dose as I get).
THIS IS IMPORTANT. I do (and promote) more frequent dosing intervals of smaller amounts of T. This is so the peek levels (which occur about 24 hours after the injection) stay closer to the normal range than if you were to do less frequent weekly dosing of the same (weekly) amount. Since conversion of T to E2 and DHT is driven by mass action, that is, the more T that is in your system the faster the conversion to these other hormones will be. Controlling E2 and DHT conversion with enzyme blockers is very controversial (as evidence by all the bickering in this forum). My approach is to try to minimize this conversion by avoiding those huge spikes in T with weekly or (God forbid) 2 week dosing. I recommend at a minimum twice per week dosing but I much prefer every 3 day (E3D) dosing.
Take a look at the calculated T release graphs at the end of this post. These graphs show the calculated amount of T being released by T-cyp into your body based on the published half-life of the compound. Keep in mind that the average male produces about 7 mg of T per day. At 40mg E3D (0.2mL of a 200mg/mL soultion), the average amount released per day once a stable level is achieved is 9.3mg with a range of 7.9 to 11.2mg (at peak). Compare this to 200mg once per week (frequently recommended by certain influential people in this forum) where the daily release of T is about 21mg (3 times the average physiological amount) and the nadir is around 13mg. Yeah, you’re going to feel good mostly because you are recovering from exercise better, but call it what it is “Testosterone Augmentation Therapy”, not TRT. No judgement on my part, but you should not jump straight to those levels without understanding how T affects your primary symptoms (and relief).
BOTTOM LINE RECOMMENDATION: Sorry for the long answer to a short question, but there’s a lot of background information behind my recommendation that you need to understand.
Start at 40mg of T-cyp E3D (0.2mL of 200mg/mL solution). This will result in an overall weekly dose of 93mg. Maintain this dose for 6 weeks and then assess how you feel and run a new set of labs (TT, FT, E2, and DHT at a minimum). Note: For me, this is where most of my cognitive symptoms were alleviated.
If you feel you need more symptom relief (or desire better performance in the gym), increase the dose to 50mg E3D (0.25mL). This will result in an overall weekly dose of 117mg). Then run the same labs to see where you are, particularly with Free T. Note: For me, I noted more relief from ED symptoms and only a slight further improvement in cognitive symptoms).
If you feel you need more symptom relief (or gym performance), bump the dose up to 60mg E3D (0.3mL). This is the last point in the curve I posed above that I’m working on now. You might want to also consider layering in a small dose of HCG (~200 IU on the same E3D schedule). That’s up to you. For me, I have not noted any further symptom relief, but I do feel better because of improved recovery from an intense workout schedule at the gym. I’ve also noticed the weights seem lighter and I’ve been able to progress faster on the weight. NOT TO MINCE WORDS, this is not TRT this is performance enhancement (in my humble opinion). Going any higher, I’d only delude myself if I called it TRT (I’m sure that will ruffle a few feathers in this forum).
Excellent advice. I’d add frequency of injections is also important. I usually go for 6 weeks before evaluating a dose, but 8 weeks is also good. The problem is getting guys to hold off this long before mucking with the protocol. They are usually feeling bad and are looking for the silver bullet to cure them. For me, 100mg (actually 93 E3D) was a silver bullet. I felt like superman the first week, but then again I started with a really pathetic 7.1 pg/mL Free T.
I’d be interested in understanding this better. Is there a good read on the subject you can point me too?
Here’s the description of the LabCorp Free and Total T from the web site where I order them: Free T: direct analog/radioimmunoassay (RIA); Total T: electrochemiluminescence immunoassay (ECLIA).
This makes it sound like the Free T is an actual measure of the hormone. I do understand their explanation that the ECLIA assay tops out at 1500ng/mL and that if you need more precise Total T measures you should use the more expensive LC/MS/MS method. I just don’t see the point in spending the money accurately measuring Total T since I don’t use the number for any decision making.
@jas0917 wow… I was also an accutane user, but I took it for 3 courses (18 months) over 7 years and we share similar symptoms. I’m still trying to figure it out, will have new labs soon before I decide on my treatment. Take a peep over at my thread to see what I’m running tests for. Have you checked prolactin/dht/vitamin d/etc? Curious to see what direction/solution you go with.
Personally I dont believe accutane is the cause of my issues. I was already beginning to have issues prior to accutane. The whole reason I got my thyroid checked was because of acne and low t symptoms. Yes it’s possible but I just feel it’s highly unlikely. Maybe accutane made my symptoms worse who knows. I hope that isnt the case because if it is I’m probably just screwed for life.
I havent done any specific tests for prolactin/dht/vit d in a long time. I probably should though. My vit d was low a couple years ago. I started supplementing it and never felt a big difference
Gotcha, I hope you’re able to figure it out. Right now I’m thinking that I have thyroid issues (hypothyroidism) that is causing my low t symptoms as well. Recently did a blood test with a complete thyroid panel (FT4, FT3, RT3,etc) plus 24 hr saliva cortisol test. Should have results in 2 days. Hope to fix these issues without starting/causing other ones.
Same to you, i’ll be watching your post to see if you figure anything out. I’ve upped my thyroid dose but I probably won’t feel the effects of it for a couple months. Still on the fence whether to start TRT. Although @johann77 has a good idea in my opinion to drop my clomid dose and up my thyroid dose then reevaluate in a couple months… I’m just so sick of feeling this way. It’s been years and I think I’m ready to just abandon ship when it comes to clomid and go for TRT. Yeah it sucks having to pin for the rest of my life but I think that’s just something i’ll eventually get used to and not care about.
I’ve roughed it out for years now… what’s a couple more months. Maybe I’ll be able to keep producing test myself and my thyroid is the problem… who knows. I just really hate the feeling that TRT might be the way to go and I might put it off yet again… when if I start now I may feel better in a couple months.
Would be nice if finding the root to our problems was more cut and dry.
Whats an additional month of waiting in comparison to the years that you have already suffered. Just give it a try, mark your calender at the 1st of April and if things arent moving into the right direction than you know you tried and move on with TRT.
But if you decide to pin try to go the official route supervised by a qualified physician.
And sorry for being persistent.
Just out of curiosity; whats your weight? Recommended LT4 dose is 1.5 to 1.8 mcg LT4 per kg bodyweight. Its depending on age and remaining thyroid function (TSH level before initiation of therapy).
If you have 80 kg this would translate into 120 to 144 mcg LT daily.
When I go to my dr appt in a few weeks what blood tests should I ask for? I’m not going to ask for testosterone levels since I just got those other ones 2 weeks ago. Same with thyroid. What would be a good idea to try to look at to maybe get some more background info?
check out my thread, I just received & uploaded my labs. It should give you some ideas and hopefully serve as a reference. Hope to get some good feedback from this community to fix my issues soon.
You do have a potential root cause for your symptoms, focus on this one instead of looking further. Your physician prescribed LT4 to treat thyroid disease. We dont know the exact diagnosis or the initial pre treatment TSH levels, but what we know is that it has been elevated and that he prescribed LT4.
All of your symptoms are pointing towards an undertreatment.
Firstly, your TSH is not down to the level at which your would expect to be euthyroid, there is many publications about this. So the answer to this one is to increase the dose as you are doing (at your bodyweight the 110 mcg could be a good dose). Anyhow this has to be further discussed and clarified with your treating physician.
Secondly, up to 15% of thyroid patients treated with LT4 only still report remaining symptoms. If you dont experience symptom improvement with the increased dose then you should talk to your physician about switching to a combination therapy consisting of T4 and T3.
Lowish T might be an additional factor, but if you dont treat your thyroid appropriately then T wont help.
Wouldnt it still be a good idea to look for other deficiencies that my thyroid wont help anyways? Say If I have extremely low vitamin d itd prob be a good idea to start supplementing it even if I’m working on my thyroid too?
