#symptom_relief
Everybody seems to be doing it, so why can’t I get some?
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Obviously, we all have opinions. Still, if I am looking at a guy, and I feel with a reasonable degree of certainty they will need 150mg, I am not going to give them 100mg, let them waste two months with no benefit, waste the money, just to prove what I already knew.
Maybe this is not clear. I did not say 95% of them go up. Let me try this:
I have 50 guys taking 150/wk. Of them, 20 need a dose correction. Of those 20, 19 are increasing the dose and 1 will decrease it.
Lunch is over, back to work…
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I respect you man. This is an evolving field.
I just disagree with you on this point.
Happy Friday!
19 out of 20 is 95 percent. 
Bull shit! No you don’t. Why would you respect anyone out of touch? But, that is not the point. What makes me “out of touch”? You disagree. So, therefore, I’m out of touch? Please, explain how I am wrong. What makes me out of touch?
This is the problem with clinical practice vs academia. Or, in this case at least, internet academia. As a practitioner, I react and adapt based on a large part of what I see and experience. You disagree with it, why? Because of what you read, anecdotally, on the internet. You’ve never treated a patient. What I see in a real world clinical practice is different from what you have seen from a bunch of outliers on the internet. That makes me out of touch?
Actually, this applies to more than health care. Today, the world is driven by big data. No one can make a decision without examining the “data”. No critical thinking anymore. Kind of sad.
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I disagree that you think it is a waste of time to start trt patients at 100 mg.
I stand by that. You know different practices use different protocols.
You have your opinion on this and I have mine.
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Another good summary from someone I respect (not because I know who they are or what they do but because of their reasoning and scientific abilities):
Post in thread ‘Natural T vs. Test Cyp.’ Natural T vs. Test Cyp. | Excel Male TRT Forum
This has been discussed in detail, but here’s a quick recap from my perspective: First, testosterone cypionate is only 70% testosterone, so you need 70 mg of it to get the 49 mg of T per week. The testosterone in cypionate is bioidentical, meaning once it’s loose your body can’t tell it apart from natural T. Next, let’s be generous and say that the full range of natural production is 3-9 mg per day. This corresponds to 30-90 mg T cypionate per week. Also, because testosterone cypionate does not provide normal diurnal variation in serum testosterone you have to increase the dose by ~20% to achieve the same peak levels. With this calculation you get a maximum dose of about 110 mg TC per week. This is in line with the Xyosted product, which is injectable testosterone enanthate. The only doses available are 50, 75 and 100 mg per week. Enanthate has only slightly more testosterone than cypionate. A final factor is the injection frequency. If you’re injecting frequently—daily or EOD—then serum levels usually don’t fluctuate too much. But if you’re injecting once weekly then you can have large swings in serum testosterone, with peaks as much as 2.5-3 times larger than troughs. To put the troughs at minimum acceptable levels may require increasing the dose to over ~100 mg/week. However, this usually results in supraphysiological peaks.
This part is speculative: There are guys who insist they need supraphysiological dosing to feel good. If this is the case then perhaps the excessive dosing is compensating for the disruptions caused by TRT. For example, in some cases high doses may compensate for excessive estradiol, as eventually the aromatase enzyme starts to saturate and you can reduce your E2/T ratio. Of course there’s the very real possibility of creating other imbalances, and the long-term safety is uncertain.
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You’re insulting me when you say I am out of touch. Should I care? Nope. Should I have acknowledged you and replied? Probably not. You caught me at a bad time and it pissed me off. I was finishing a busy week after seeing a lot of patients on follow-up, and the same thing on a Friday morning. The impact this has on lives can be taken for granted when you do what I do and see it all the time. So, after listening to some very grateful patients saying very humbling things to me, I find out I am out of touch. Bad timing.
Why? Because it’s your opinion. Why? Because your read a couple of internet forums. Sorry, you don’t get a pass on that. I take care of real people. I know what I see. You call me wrong, essentially saying I am mistreating patients, and back it up with nothing.
By the way, that’s insulting too.
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What’s your take on daily cialis? Are many of your patients on it?
Just a few. I know a couple of guys who use it frequently in their practices. They believe it is one of the best things you can take for cardiovascular health. I’m not there yet, but at some point, maybe. There is some thought that it loses its effect with long term use, but I don’t think that has been proven yet.
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Do you ever use Buspar in your practice?
No, we try to avoid PCP and psychiatric territory. Leave it to them.
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Can you post your baseline bloodwork prior to restarting TRT with the cream?
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I am hesitant saying to interfere with riding out your treatment and giving it time but see you are really struggling:
Cut the pm dose and see if you are sensitive to raised T level before bed.
Some can be quite sensitive to elevating TT levels in the evening.
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Given your TT / fT your result makes sense / just indicates your E2 was below the measurement range for the assay.
The more sensitive lower detection limit E2 assay (lcms or sensitive) is termed pediatric at some labs.
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Your overall dosing is modest on paper but perhaps you could speak with your provider about continuing on with just AM dose.
Yes, if you inject everyday with test ester you would dampen the peak/trough but you would have to be careful with your mean levels since you appear quite sensitive to elevated TT/fT in the evening.
If you inject test ester once a week you are going to have a few days (including evenings) where your levels are higher and days/evenings where they are lower. My suspicion is judicious use of a fast acting option with just AM dose may strike the right balance for you. Also speak with your doc about just morning application with nasal gel (very short half life).
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