What is TRT and What is NOT TRT

And even more data from Bhasin’s work in the 2000s:
image

image

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.

image

Please expand on your hypothesis.

1 Like

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:

  • 70% of patients have mean TT level above 1200 ng/dl
  • 87% above 1000 ng/dl
  • 96% above 800 ng/dl

Summary for the 160 mg/week group:

  • 77% of patients have mean TT level above 1200 ng/dl
  • 85% above 1000 ng/dl
  • 92% above 800 ng/dl

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
4 Likes

Nice. I’ll have to put together another one, as most guys are doing twice weekly now, average dose 160mg per week.

2 Likes

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.

1 Like

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.

3 Likes

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. :grin:

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.

1 Like

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

3 Likes

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!

1 Like

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!:crazy_face:

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?