What is your routine and what MG do you shoot for weekly? I don’t want to be the guy that gets caught up thinking more is better. Yes I did initially but I’m all ready feeling better after a week at 60mg 2 x a week. I know it’s going to take time to get the right levels but it’s crucial that I just get everything within the safe zone for this Dr whether it is to appease him or whatever. He said because my rbc and hemoglobin is high in at risk of a heart attack and a stroke and if I am going to continue to take the current dosage I am putting myself at risk he will stop my prescription. This guy thinks 200mg every 2 weeks is a proper approach. I had to fight with him to do the 2x a week at 60mg. I just don’t want this to put me over my marks when I see him next. After that I can experiment with other dosages if I’m too low or not feeling my best. My libido was really good at 100mg 2x a week. I’m hoping it improves now with the lower dosage.
Hey thanks for the reply. My pre t level was 190 after fasting for 24 hours. So anything above that is better for me. What is your current dosage and routine? What numbers do you stay at? Total and free t? My Dr said that I am at risk of a heart attack and stroke because my rbc and hemoglobin are high. He’s an asshole and I’m a liability to him so I gotta appeal to him for now then find another Dr. If I can feel great at 500 or 600 I don’t care I just want to feel great and be able to keep my woman satisfied. Keeping on the high end of the spectrum would be awesome and to gain a little muscle would be good too. So yeah if I can shoot for 800 and maintain good numbers then I’m all for it. I just gotta stay in the safe zone this month and I have 3 weeks to get the hemoglobin and rbc down. This is why he recommended that I donate blood.
If 600 is the level you feel great on then that’s awesome. Everyone is different.
If you’re in the US and need a doc email me (email in bio). It shouldn’t be too hard to find a decent doc though. Mine does telemedicine so it’s basically over the phone 220mg/week shipped in the mail that I do what I want with $150/month.
I just realized the way you posted your blood work numbers that I was reading the low range as your actual level. I see now.
These labs are from April doing 185mg/week daily sub-q but probably not much different than 200mg IM.
Zero evidence that TRT causes blood clots or heart attacks.
Well at this point it’s about getting him to continue my prescription. He’s being an asshole because I contradict everything he says because he thinks 200mg every 2 weeks is the proper solution. I felt like shit doing it like that. Now he’s trying to get rid of me so it’s about complying withing the safe zones of his idiot gauge.
Why not find a different doc?
This is the 3rd urologist within my area I’ve seen, and the last guy that I have anywhere close that is on my provider list for my insurance. This guy was the only one who would even work withe a little. Other options are way to far from my area to drive. Appreciate your help.
Thank you for sharing this I will keep your Dr in mind. My total testosterone needs to be within 249-836 and free testosterone 4.46 to 17.1 to comply with his protocol.
@jaybourbon
Well, TRT is all about bringing T to a ‘healthy’ level. TRT and steroid abuse are two sides of the same coin, but still very different. If your T levels are brought into a supraphysiological space (which 1300 ist) then you are at a comparable level with people who abuse steroids for other reasons.
When you were Living with 200 ng/dl the last 20 years and all of a sudden you increase your T levels to 1300 of Course your Body will go crazy. Going down to 2x60 is the right move, maybe even lower. With subq the standard starting dose of e.g. XYOSTED is 75mg Weekly, which you can split up into 2 doses.
If you adjust your dose then there is a high probability that you dont need any AI. They only cause side effects such as osteoporosis anyway if overdone.
A golden rule in pharmacology is, that you find the lowest effective dose. Too little T is associated with an increased risk cardiovascular events, too high es equalliy risky.
Its from this meta study, one of the most interesting articles that you can read:
And there is a direct linear relationship between T and erythropoiesis. Some men are more prone for developing polycythemia (high HCT), but if you are one of the them, a dose reduction is even more important
Because his HCT is almost 55… He listed the range first and the value second…
Yes…you should probably donate blood and dropping your dose was a good move…
Thank you so much for taking the time to put all this together. It’s much appreciated. OK I have to first ask about this chart “figure 4”. Let me make sure I have this straight. This chart shows weekly dosages over 45mg are potential risks for stroke and CVD as per the findings in these write ups?
Thank you. I scheduled a donation at a red cross blood drive near me in 8 days. My question is. Will 60mg 2x a week bring me into the range I need to be in? Should I skip a shot before I see my Dr? I have a feeling if I’m over he’s gonna cut my script. I do also want to be in a healthy range but the fear of crashing or feeling like I did is a battle for me lowering my dosage any further.
You would probably be in a good spot at that dose. Stick with it for 6-8 weeks and see where things land. If you’re just a tad low after that, no biggie…just bump it to 75mg twice a week.
Going that low is a very good decision to get HCT back under control. Let that serve as a good marker that you’re starting to push things too far.
You’re not going to crash to where you were before TRT unless you just go ridiculously low or stop altogether.
No thats a misunderstandig. It had nothing to do with the amount of T that you inject. The graph show the relationship between the blood DHT Levels (dihydrotestosterone a product of T metabolism) and the risk of stroke and cardiovascular events.
It show that the relationship is U shaped, meaning too low is bad and too high is also bad.
The DHT level is determined by your genetics and when on TRT by the dose of T that you inject, swollow, or apply (creme) and by the route of application. The enzyme that converts T Info DHT sits (also) in your skin. If you use T cremes (eg Androgel) your DHT levels are typically much higher compared to injections at the same blood T level.
The key massage is the higher is not necessarily the better.
I love it when a reply begins with “well”. I appreciate the explanation as to what TRT is about. Thank you for that.
I’m not sure I would put someone who takes 200mg testosterone a week and hits 1300 total at some point in the week on the same side of the coin with one who injects 600-800mg, or more, a week (plus 50mg per day Dianabol, 25mg per day Winstrol, 200mg per week nandrolone, and 100mg per week Winstrol V) and hits who knows what level.
I guess I am not aware of many guys who went from low test levels to 1300 all of a sudden and reacted poorly. Not saying it does not happen.
Those are interesting studies, I’ve actually read a couple of them. Regarding the second one, it’s irrelevant to our discussion as TRT is not androgenic anabolic steroid abuse. I did review the abstracts on the others and will need to print them up and read the entre study when I get a chance. Good stuff, but I saw a bit of “may”, “suggest”, “associated with” in those. Did not see “cause”.
I’m still looking for one that shows TRT causing heart attacks, blood clots, strokes, etc. Even the American Urological Association, three years ago at their national convention, came out with a position paper stating TRT did not cause any of that. It’s in their minutes. They did a meta-analysis of over 400 studies.
I think Neal Rouzier makes a lot of sense.
I plan on restarting TRT at 7mg daily, 49mg weekly which after only 3 weeks got my TT 417 and FT 15 pg/mL (ranges 6.8-21.5).
Routine is inject in shoulders and quads rotating injection sites to minimize muscle tissue damage and build more muscle so I have more real estate to inject.
I use 1ml 29 gauge insulin syringes, the .5ml syringes don’t allow for mg per mg dosing.
The position on those 200mg every two week protocol is they are great if you’re a man looking to become a women making you estrogen dominate.
I have a 2005 clinical study which shows exactly that, "14 days after administration of injection “evels are at pre-art levels (hypogonadism) degrading the patients quality of life”.
Any doctor prescribing these protocols has their head buried in the sand like an ostrich and have made the choice to be ignorant.
The reason why you read these terms (associated with, may cause…) is the scientific language. In science one is extremely cautios to say that something has been demonstrated with 100% certainty. Only when molecular studies showing cause and relationship including all sorts of controls are done, then something is ‘demonstrated’.
Especially in human medicine one can typically only establish relationship (with lower or higher levels of confidence), eg you can not modify a gene in humans to demonstrate the impact of the gene on metabolism. You can also not study the effects of long term high dose T re9lacement because no ethic committee would endorse such a study based on the established data.
Most people in this forum are providing their personal opinion based on personal experience. I am trying to make use of my education and experience to provide the scientific perspective, posting the links to scientific articles. One can absolutely feel free to ignore this. But if one is making recommendations to other people against the current medical knowledge without showing evidence (and i am not saying that you do this please dont misunderstand) then i think thats problematic.
The problem with supraphysiological T doses is that there is no clinical long term data available that demonstrates efficacy and most importantly safety of such a protocol whereas there is plenty of data that such doses taken mid to long term are associated with an increased risk for side effects, some of them serious such as abnormal heart morphology or cardio vascular risks. This is why eg FDA only approved 3 doses of XYOSTED 50, 75 and 100 for the treatment of hypogonadism including a big black warning on the box.
And apologizes for the ‘well’ as a none native in the english language i might not be able to tell which reaction this is causing.
What were the supra physiological doses that were determined as the cause of these problems
Please read the following article. I am happy to further discuss then. I dont know if you will have access to the full article, but unfortunately i cant upload the .pdf file (if somebody knows a way to do so please let me know). Below you will find at least a screenshot of the articles key points.
The article describes the current unterstanding of the risks associated with TRT. Its published in Nature Reviews Cardiology, one of the highest journal in this area.
https://www.nature.com/articles/s41569-019-0211-4
The statement that there is zero facts is simply wrong. Its rather that there is conflicting data out there showing that we havent fully understood the relationship between T and CVD. And please keep in mind that we are only talking about physiological levels here. I personally am fully convinced that as long as one stays in the physiological range there is actually a decreased risk for CVD on TRT.
Regarding the above referenced studies showing a correlation between cardiac abnormalities and T, the non-physiolgical dosage was around 400 - 700 mg per week. Agreed a much higher dose then the average TRT user takes. But the question ist, where does the risky range start?
Regulators approve a product on the basis of the benefit to risk ratio. There is no doubt that if one is hypogonadal the benefits by far outweights the risks as long T is kept within the physiological range (but even in this range there is a scientific dispute - see the article). But there is also plenty of evidence, that way above the physiological range (400 to 700 mg/week produce average T levels of 3000 to 7000 ng/dl) T can have serious side effects to many organ systems. If you are somewhere between you are in a grey zone.
Its interesting because we are constantly discussing the evidence for the presence of side effects, but until now there is no evidence for the absence of (serious) side effects at levels above 1000 ng/dl. Unfortunately there is no study available that would demonstrate long term safety and efficacy of T replacement giving rise to levels of eg 2000 ng/dl.