Sample Dosing and Lab Results

[highpull]

WEEKLY DOSE	FREQUENCY	TTEST	FTEST	E2 (IA)	E2 (LC/MS)	SHBG
200mg	q7d	734	193	38	52	21
140mg	q3.5d	1130	310	57		22
120mg	q3.5d	1228	259	46		24
200mg	q7d	900	334	71		7
200mg	q7d	1431	435	35	36	20
160mg	q3.5d	432	89	51		13
200mg	q7d	966	241	52		15
200mg	q7d	987	134	32		49
200mg	q7d	1152	223	31		32
200mg	q7d	1034	322	22		15
200mg	q7d	922	220	56	71	26
160mg	q7d	1184	263	47		28
160mg	q7d	1284	251	36		24
140mg	q7d	588	230	22		9
160mg	q7d	1072	184	56		32
160mg	q7d	956	197	39		44
160mg	q3.5d	1162	196	67		31
160mg	q7d	1196	261	49		25
160mg	q7d	654	161	71		17
200mg	q7d	1126	280	36		25
200mg	q3.5d	870	204	15 (AI)	10	17
140mg	q3.5d	939	234	76		33
160mg	q3.5d	1682	589	35	1 day post	16
140mg	q7d	988	163	20		15
200mg	q7d	637	146	58		14
160mg	q7d	921	276	33	36	26
160mg	q7d	1318	268	47		40
200mg	q3.5d	1649	523	44		10
200mg	q7d	1444	408	59	3 day post	22
160mg	q7d	971	211	73		37
200mg	q3.5d	736	192	50		38
80mg	q7d	321	58	<15		18
240mg	qod	763	246	37		12
160mg	q3.5d	2010	749	40	1 day post	19
160mg	q3.5d	767	169	49		18
160mg	q7d	842	167	34		44
200mg	q7d	568	128	46		14
200mg	q3.5d	1129	418	24	22	7
200mg	q7d	1620	440	63		18
200mg	q3.5d	1129	322	69		29
200mg	q7d	856	178	39		44
200mg	q7d	739	120	41		36
200mg	q3.5d	596	126	36		22
160mg	q7d	2054	590	41	1 day post	26
150mg	q7d	1893	470	45	2 day post	34
200mg	q7d	1083	221	71		24
180mg	q7d	943	246	48		30
200mg	q7d	1251	237	53		22
200mg	q7d	1011	267	31		31

I said I would do this a while back. Most of these were randomly pulled by staff and all names are redacted, so I cannot answer specific questions on any particular one. Some, yes, and you can probably figure out who they are, the outliers.

I think the take home is that numbers do not mean much and do not directly correlate with dosages or even each other. All of them are current and have been with us a while, so whatever symptoms brought them in have been resolved.

[justpanicnodisco]

@readalot

From the data I’ve seen on here, clearance rate seems to have a lot of variability across users — even when accounting for other potential correlates such as age, weight, SHBG, liver function, etc. I would guess the strength between these variables and clearance rate to be somewhat weak - moderate , and as such, I think it would be difficult to develop such a model using these known variables as a proxy for clearance rate (though, admittedly, I haven’t tested it).

If you use R at all, there are some neat pharmacokinetic packages that predict serum concentrations across time. I’ve played around with them a bit.

[swoops39]

@justpanicnodisco

there are some neat pharmacokinetic packages that predict serum concentrations across time

I’d be interested in that just out of curiosity, if you could point me in that direction

[oldkid]

If you could put the ranges would be nice assuming all these labs are the same units, thanks for posting anyway man

[highpull]

@anon18050987

The hidden variables here are metabolic clearance rate and patient size which will affect their distribution volume.

Right, I am aware of that, but I figured this would be ok without adding age, bodyweight, diet, CBC, LFTs, other medications and other information.

@anon18050987

Are these patients all doing the same injection type at the same site?

Some are cypionate, some enanthate. Most glute, maybe a few thigh. All 23g, 1 inch needles. Some are six days post injection, maybe some five. As noted, some less.

@anon18050987

The challenge is teasing apart the variables I mention above to create a reasonable model for how a patient’s level will respond to a given dose beforehand.

Right, if aiming for a number, good luck with that, which was really my point.

@anon18050987

i am slowly getting the message that its fruitless. As I usually find and someone told me long ago, complexity is in the eye of the beholder.

Yes, many overthink it. However, I do know that starting them at 150-200mg a week works well 90% of the time.

[highpull]

@oldkid

If you could put the ranges would be nice assuming all these labs are the same units

They are.

Total test (250-1100)
Free test (35-155)
E2 <39 and for LC/MS/MS <29
SHBG (10-50) and (22-77), for the old guys.

[ncsugrad2002]

Hey hey hey I see an 80mg’er up there. Someone has some explaining to do.

[highpull]

It’s the same explanation as with all the others. That’s what works for him and he is happy with the results. Every patient he has referred is on at least double what he is. It’s always tempting to take the protocol that works for you and shove it down everyone’s throat. It’s also a mistake.

[oldkid]

Thanks man

[ncsugrad2002]

@highpull

It’s the same explanation as with all the others. That’s what works for him and he is happy with the results.

Kidding. I was already sure that was the answer.

[highpull]

@ncsugrad2002

Kidding. I was already sure that was the answer.

I thought as much, just put it out there in case I was wrong, and for the benefit of others.

[highpull]

That’s impressive. I’ll have to take a closer look at the stats when I have time. I’ve love to get something published along these lines. if I had the time.

Yes, there is a TT, fT and SHBG correlation. But, no SHBG correlation with dose or injection frequency. At least that I see, anyway. Too many low SHBG guys do fine with once weekly dosing.

[highpull]

@anon18050987

TT is in units of ng/dL and fT in units of pg/mL. To convert fT to ng/dL, take the numbers in pg/mL and divide by 10. I believe these are Quest data looking at the ranges. @highpull could confirm.

That, is correct.

[oldkid]

Good to know man, thanks!

[dbossa]

@anon18050987 I apologize for giving you a hard time. This stuff isn’t important to me right now to be honest. My ‘real job’ is keeping me extremely busy and this stuff is frankly just a distraction right now.

Be well.

[highpull]

@anon18050987

I’d value your opinion on this as well.

I’m not sure what the question is?

[highpull]

@anon18050987

• Which one of these guys are on a cycle?
• How do you determine this?

I know this has been discussed repeatedly, replacement, restoration, optimization, mini-cycle, PED, cycle. If you want to call anyone taking 150-200mg a week on a cycle, that’s fine. That would be almost everyone outside of a general practice or endocrinologist (200mg every other week).

If you want to call anyone that drifts above the top end of the range supraphysiological, that’s fine too. That would also be almost everyone using injections, unless they are micro dosing every day.

Regarding which of them are on a cycle, none of them are. What’s a cycle, I don’t know, maybe 300-400mg on up a week or on a program in which dosing is varied over a short time. Cycle implies dosing manipulation over time with a down/off time. Of course, I come from a place when 200mg a week was for the lightweight guys. Although if they were using only 1cc of test, they were still on other injectables plus the obvious oral AAS. Middleweights used 400-600mg and heavyweights 400-1000mg, also with the previously mentioned. So, 150-200mg is nothing in the world of testosterone “cycling”.

Questions #3 and #4 seem directed towards Danny. I think I’ve mentioned a couple of cardiologists refer patients. I have a put patients with a history of afib on testosterone. I have one in afib right now, the cardiologist is fine with it. I think I’ve seen something in the literature showing an association between afib and low testosterone. I expect there will be more research on the benefits of testosterone for the heart, whether direct or indirect. I don’t think anyone would argue that losing visceral fat, improving lipids, reducing blood pressure, increasing insulin sensitivity, etc., is bad for the heart. But, more to your question, #3, I want the cardiologist’s approval on patients with existing cardiac conditions, then I’d treat them like everyone else.

Regarding #4, I suppose that would be on a case by case basis, generally, they are treated as anyone else would be. I’m going to give the overweight, belly fat, prediabetic or diabetic, dyslipidemia, hypertensive guy every chance to benefit from testosterone, like everyone else.

Hope this helps.

[highpull]

@anon18050987

And I’ll be happy to participate if you ever want to write that paper.

Busy practice, no time for that. Leave it to the academics and guys like you with a research background.

[Rednose]

@highpull

Leave it to the academics and guys like you with a research background.

I understand your a busy man, but the " academics" need boots on the ground guy’s like you. Way I see it the academics need to be gathering their Data from the TRT Doc’s and clinics.

Just say’n

[tareload]

@Rednose

. Way I see it the academics need to be gathering their Data from the TRT Doc’s and clinics.

Just say’n

What is TRT and What is NOT TRT

Another item I wanted to check. Here’s a real world provider set from @highpull that we discussed some time ago. I’ve put those data on the graph I shared above to see how they match up. Since almost all the data he shared are trough TT values (I culled the few non-trough values as per comments in his table.), here’s the key to convert trough values to mean values (AUC mean) assuming 5 day elimination half life: mean/trough ratio q7d 1.6 q3.5d 1.21 qod 1.09 qed 1.03 And dru…

We did it! Thanks for the motivation!