And even more data from Bhasin’s work in the 2000s:
The ordinate (y-axis) is mean (AUC/delta t) TT level which I calculated as ~1.6*TT(trough) from the papers.
Understanding serum mean TT level (mean calculated as AUC/delta t) allows one to very quickly conclude 200 mg/week TC dosage (or even 150 mg/week) brings an older guy way above reference range.
Feel free to take over to Facebook groups to help educate.
The problem is the reference range. Isn’t that range based on men who are NOT on TRT?
I used 300-1200 ng/dl just to be generous on the high side. Is that range not applicable to people on TRT/TRT+/TOT, etc?
Of course very few persons on Planet Earth run a mean endogenous TT level of 1200 ng/dl (without assistance). Mutant level for a healthy 18-21 YO.
Please expand on your hypothesis.
I don’t understand this either. I mean isn’t that the point of TRT to bring a non functioning HPTA or testicular failure to the levels of a healthy natural male?
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 drum roll:
Not bad.
Summary for the 200 mg/week group:
Summary for the 160 mg/week group:
So as you can see leveraging both (1) clinical trial literature data and (2) generous data provided by a TRT practitioner on T-Nation, doses > 150 mg/week Test Ester result in majority of patients having AUC mean TT level above 1200 ng/dl.
Appendix (First column is my calculation of mean TT from trough TT) based on dosing frequency:
| calc AUC mean TT (ng/dl) | WEEKLY DOSE | FREQUENCY | TT (ng/dL) | FTEST (pg/mL) | E2 (IA) | E2 (LC/MS) | SHBG (nmol/L) | fT (ng/dL) |
|---|---|---|---|---|---|---|---|---|
| 1174 | 200mg | q7d | 734 | 193 | 38 | 52 | 21 | 19.3 |
| 1367 | 140mg | q3.5d | 1130 | 310 | 57 | 22 | 31 | |
| 1486 | 120mg | q3.5d | 1228 | 259 | 46 | 24 | 25.9 | |
| 1440 | 200mg | q7d | 900 | 334 | 71 | 7 | 33.4 | |
| 2290 | 200mg | q7d | 1431 | 435 | 35 | 36 | 20 | 43.5 |
| 523 | 160mg | q3.5d | 432 | 89 | 51 | 13 | 8.9 | |
| 1546 | 200mg | q7d | 966 | 241 | 52 | 15 | 24.1 | |
| 1579 | 200mg | q7d | 987 | 134 | 32 | 49 | 13.4 | |
| 1843 | 200mg | q7d | 1152 | 223 | 31 | 32 | 22.3 | |
| 1654 | 200mg | q7d | 1034 | 322 | 22 | 15 | 32.2 | |
| 1475 | 200mg | q7d | 922 | 220 | 56 | 71 | 26 | 22 |
| 1894 | 160mg | q7d | 1184 | 263 | 47 | 28 | 26.3 | |
| 2054 | 160mg | q7d | 1284 | 251 | 36 | 24 | 25.1 | |
| 941 | 140mg | q7d | 588 | 230 | 22 | 9 | 23 | |
| 1715 | 160mg | q7d | 1072 | 184 | 56 | 32 | 18.4 | |
| 1530 | 160mg | q7d | 956 | 197 | 39 | 44 | 19.7 | |
| 1406 | 160mg | q3.5d | 1162 | 196 | 67 | 31 | 19.6 | |
| 1914 | 160mg | q7d | 1196 | 261 | 49 | 25 | 26.1 | |
| 1046 | 160mg | q7d | 654 | 161 | 71 | 17 | 16.1 | |
| 1802 | 200mg | q7d | 1126 | 280 | 36 | 25 | 28 | |
| 1053 | 200mg | q3.5d | 870 | 204 | 15 (AI) | 10 | 17 | 20.4 |
| 1136 | 140mg | q3.5d | 939 | 234 | 76 | 33 | 23.4 | |
| 160mg | q3.5d | 1682 | 589 | 35 | 1 day post | 16 | 58.9 | |
| 1581 | 140mg | q7d | 988 | 163 | 20 | 15 | 16.3 | |
| 1019 | 200mg | q7d | 637 | 146 | 58 | 14 | 14.6 | |
| 1474 | 160mg | q7d | 921 | 276 | 33 | 36 | 26 | 27.6 |
| 2109 | 160mg | q7d | 1318 | 268 | 47 | 40 | 26.8 | |
| 1995 | 200mg | q3.5d | 1649 | 523 | 44 | 10 | 52.3 | |
| 200mg | q7d | 1444 | 408 | 59 | 3 day post | 22 | 40.8 | |
| 1554 | 160mg | q7d | 971 | 211 | 73 | 37 | 21.1 | |
| 891 | 200mg | q3.5d | 736 | 192 | 50 | 38 | 19.2 | |
| 514 | 80mg | q7d | 321 | 58 | <15 | 18 | 5.8 | |
| 832 | 240mg | qod | 763 | 246 | 37 | 12 | 24.6 | |
| 160mg | q3.5d | 2010 | 749 | 40 | 1 day post | 19 | 74.9 | |
| 928 | 160mg | q3.5d | 767 | 169 | 49 | 18 | 16.9 | |
| 1347 | 160mg | q7d | 842 | 167 | 34 | 44 | 16.7 | |
| 909 | 200mg | q7d | 568 | 128 | 46 | 14 | 12.8 | |
| 1366 | 200mg | q3.5d | 1129 | 418 | 24 | 22 | 7 | 41.8 |
| 2592 | 200mg | q7d | 1620 | 440 | 63 | 18 | 44 | |
| 1366 | 200mg | q3.5d | 1129 | 322 | 69 | 29 | 32.2 | |
| 1370 | 200mg | q7d | 856 | 178 | 39 | 44 | 17.8 | |
| 1182 | 200mg | q7d | 739 | 120 | 41 | 36 | 12 | |
| 721 | 200mg | q3.5d | 596 | 126 | 36 | 22 | 12.6 | |
| 160mg | q7d | 2054 | 590 | 41 | 1 day post | 26 | 59 | |
| 150mg | q7d | 1893 | 470 | 45 | 2 day post | 34 | 47 | |
| 1733 | 200mg | q7d | 1083 | 221 | 71 | 24 | 22.1 | |
| 1509 | 180mg | q7d | 943 | 246 | 48 | 30 | 24.6 | |
| 2002 | 200mg | q7d | 1251 | 237 | 53 | 22 | 23.7 | |
| 1618 | 200mg | q7d | 1011 | 267 | 31 | 31 | 26.7 |
Nice. I’ll have to put together another one, as most guys are doing twice weekly now, average dose 160mg per week.
Thanks for sharing and look forward to it. Let me know if I misconstrued the data (trough vs other). It was pretty clear from the comments but double check me.
Hey if I remember correctly you do 200mg once a week, are your trough levels if you don’t mind me asking.
It’s not a hypothesis. The reference ranges are for men who are not on trt. In other words, men whose t levels don’t have peaks and troughs like men on twice a week, or less frequent injections of T. My trough with twice a week injections is usually around the 800-1000 range. Again, that’s my trough. I’m pretty sure that 30 years ago when I didn’t have hypogonadism, my t levels on a daily basis, weren’t around 1000. And I don’t feel better now, than I did 30 years ago. So, my point is that I don’t think it’s comparing apples to apples, if we are trying to keep men on trt, in the “high normal” range of men NOT on trt.
I was around 880-920 total and 200-220 free taking 200mg once weekly.
Currently, taking 80mg twice weekly with levels about the same.
Interesting, why did you decide to go to twice a week injections?
Just messing around, wanted to see if the internet experts were on to anything. No change, at least for me, I’ve seen no difference.
You stated the problem is the reference range. What problem? I didnt know there was a problem. The graphs speak for themselves. Hence you are making an assumption for the sake of argument.
Your comments evoke a new term we could use…Testosterone Compensation Therapy more commonly called a permacruise. Dr. Nichols has another cool name for it. Or at least he did. Guys taking their peak TT 2000+ ng/dl and trough 1000+ ng/dl in order to alleviate symptoms. If it works for you more power to you. Unfortunately it may not work long term for many as there is that pesky other side of the coin which is the increased risk for side effects with such a dosing regimen especially in the medium to long term. Hence, such a strategy will do harm. Kind of an issue if you have to follow the pillars of medical ethics. Fortunately guys have the cash pay providers who arent big on all those pillars. 
Nevertheless you have switched the goal posts so to speak. My intent was to show why a starting dose regimen of 200 mg/week is awful as a general rule or standard TRT protocol as some have put forth. And I have shown why.
Thanks for the TCT term.
I just explained what I believe the problem with the reference range is. Like I said, the reference range is for men not on exogenous testosterone. Trying to fit men on exogenous T, into a range that doesn’t apply to men who are hypogonadal, isn’t really good science, is it? Trying to fit hypogonadal men into a range meant for men who are not hypogonadal, leads to people who don’t know any better to cry, “SUPRAPHYSIOLOGICAL”, and “THAT’S A CYCLE NOT TRT”, when men on trt have total t higher than the top of the range that doesn’t even apply to them.
Isn’t the goal of TRT supposed to be symptom resolution? If some men need higher TT levels to get that symptom resolution, who the hell are any of us to deny them that opportunity?
It’s not rocket surgery. Those of us who are stuck on lifelong TRT should be able to get the most benefits from it.
Could you point to the proper range for the hypogonadal men? Serious question.
How about the rest of the physiology (in addition to short term symptom resolution) for the hypogonadal men? I am thinking medium and long term. Someone who wants to be around for another 20 or 30 years. Does the normal human male reference range not apply with respect to all this machinery as well?
Does it apply to hematocrit for these guys? Insomnia? CNS effects? BP? RAAS overexpression? Heart fibrosis? LVH?
But seriously if its working for you I am happy for you. I dont want to take away your symptom resolution.
Thanks for your thoughts and comments.
Well that’s actually the point of TRT so you’re not making a lot of sense. The point is to take a hypogonadal man and bring him back to normal healthy levels. Is it not?
Sure of course but not if it requires “drug abuse” to do so. That’s really what it comes down to. I actually like @tareload TCT term. TRT is not a cure all for lethargy, depression, or libido issues. Take enough or abuse it and I’m sure you could mask / compensate for a lot of things.
@cliteastwood What do you call someone who is prescribed a reasonable dose of Oxy for pain but then goes to a pill mill to get more because the still don’t “feel good”? Just curious
TRT: Drug abuse, “TRT”, pSFRT, permacruise, TOT, TCT, MCC.
AAS: safe, safer, harm minimization, safe and effective.
Too bad George Carlin isnt around to do a skit on AAS, TRT.
I wish everyone their symptom resolution. Just dont fool yourself if you have lots of time left.
@blshaw thanks. I do kinda like that TCT term. Helps the patient understand we probably dont know what the hell is wrong with you but a little more T should smooth it over. Maybe TMT could work as well…Testosterone Masking Therapy.
Good discussion guys.
@wanna_be we got you some more abbreviations!
Healthy levels? What exactly is a healthy level? One guy has symptom resolution on 75mg per week, with a total T of 400. Another only has symptom resolution with 250mg per week, with a total t of 1200. See the problem?
The point of trt SHOULD be to alleviate low t symptoms, not to shoot for some range.
Who defines drug abuse with a necessary hormone?
You’re comparing oxy to a bioidentical hormone that we are no longer able to make?
I’m not aware of any range of it exists. But I’m sure you already know that.
I’m also talking long term. How about the long term effects of low t? And again, your low t level is not necessarily my low t level.
I honestly couldn’t tell you. I’m talking specifically about the T range.
Great! That’s all I’m suggesting. See, you can be reasonable!
Yes. Would you mind answering the question? We clearly don’t “make” the amount of T you’re suggesting either. Whether bioidentical or not it’s a a drug that alters your natural state much like any other drug.
Would it change your mind if I changed Oxy to overuse of a synthetic dopamine agonist since we make dopamine naturally?
