We may be over dosing on ALL of our TRT components

[ecdysone]

As I mentioned in that recent HCG thread, I am beginning to think we may all be over dosing on every component involved with our TRT. For example:

I. Testosterone. Dr. Crisler, in an recent interview on SuperH*manRadio (thanks, GD) stated that he has begun to lower his recommended starting dose from 100 to 80mg/week, and that Dr. Mark Gordon is using 60mg/week with great success. In fact, he feels that higher doses may actually be very suppressive on the the entire HPTA system and eventually lead to sexual dysfunction.

II. HCG. The study I recently cited indicated that doses of around 440IU/week were more than adequate in re-establishing both inter-testicular and serum test levels. Actually, a number of users had good effect with doses of just 200IU/week.

III. AI. The often accepted rule of 1mg (anastrozole) per 100mg test has found by many guys on this forum to be excessively high. 0.5mg or even 0.25mg seems to work as well.

IV. Over managing E2. Crisler and others like to see E2 levels around 30. I’ve mentioned that epidemiological studies show that bone density is best maintained with levels in the mid to higher 30s. However, many guys shoot for levels in the 20s, which may be too low. Some guys do just fine even when E2 values are in the 40s, but of course, it does seem to vary from individual-to-individual.

V. SHBG. New evidence shows this hormone may act directly on the HPTA. In addition, low levels may be just as bad as high levels. Trying to lower SHBG by using meds is fruitless since the HPTA will simply adjust. Thyroid function has an effect on SBHG and should not be neglected when starting TRT.

[kelkel]

I. Dose as always should depend on constant monitoring of BW in conjunction with how a patient feels. All over time. Less is more.

II. No real argument there. Less is more as long as goals are obtained.

III. Total agreement. Personal experience here and I've posted many times against the "accepted rule" and that users should start with the lowest possible dose and titrate up IF needed.

IV. No argument. Crucial to obtain baseline E2 levels which is where many people/doctors fail in their protocol.

V. Not sure I agree totally. SHBG will rise with age and as T levels decline, or from many other factors. HRT is about life extension as well as an improved quality of life. That said, there are supplements that will lower shbg. Herbal OTC and prescribed. Caveat is do you want to continually be on them. Hell, I'd prefer not to be on TRT but the opposite is far worse. My SHBG is a bit high now (see recent thread) and I'm trying to determine the correct path to take for me. It is a dilemma!

Good post Ecd..

[ecdysone]

That said, there are supplements that will lower shbg. Herbal OTC and prescribed.

Dr. C claims that whenever he has attempted to lower SHBG by administering danazol (for example) what happens is free-test rises, as expected, but eventually the HPTA simply reacts by producing less test. It is also possible by using a med to bind to SHBG that its feedback effect on the HPTA is negated thereby causing the same HPTA adjustment.

Whether herbal OTC preps work is anyone's guess - and whether they have any long term toxicity, or whether they may adversely affect other organ systems involved in SHBG production (liver) is another issue.

I'll put my money on diet (for example high protein, low grains) and monitoring and/or controlling thyroid function as the best ways to manage SHBG.

[DaRoq]

Dr. C claims that whenever he has attempted to lower SHBG by administering danazol (for example) what happens is free-test rises, as expected, but eventually the HPTA simply reacts by producing less test. It is also possible by using a med to bind to SHBG that its feedback effect on the HPTA is negated thereby causing the same HPTA adjustment.

Whether herbal OTC preps work is anyone's guess - and whether they have any long term toxicity, or whether they may adversely affect other organ systems involved in SHBG production (liver) is another issue.

I'll put my money on diet (for example high protein, low grains) and monitoring and/or controlling thyroid function as the best ways to manage SHBG.

That rationalization about SHBG makes sense (of course), but am I incorrect in thinking that it's not a concern for those who aren't using hCG and not producing any natural test? I'd like to think lowering SHBG to "optimal" levels can only help.

[kelkel]

[I'll put my money on diet (for example high protein, low grains) and monitoring and/or controlling thyroid function as the best ways to manage SHBG.[/QUOTE]

Agree with the above but what do you do, as in my case, where diet has been pretty much excellent since I was a teenager, thyroid function is fine and shbg is still higher than I would like it to be? That is my dilemma. So, do I take some meds like Danazol or maybe even Proviron at minimum dosage for a short period of time? Maybe during that period add in stinging nettle or avenacosides to help maintain a lower level after prescribed meds are through? Could always up the test which would compress the shbg as well as add some much needed E2 to my seemingly inherent low E2 level. Definitely a conundrum. Curious to hear if other members have dealt directly with this issue.

[DaRoq]

Thank You

I've suggested in one thread or another that "balance" is the key, but it hasn't always been taken well. I actually prefer a more holistic approach, but that's not to say I'm about Alternative Medicine. I simply don't like the idea of having to stack an AI and hCG on top of Test just to feel normal, so looking at the whole picture makes sense to me.

Hopefully these findings by the experts will help us realize that the body is an amazing piece of engineering - that it can adapt as necessary if we give it a chance to. Maybe then we'll be able to see the initial change in e2 simply as an adjustment, rather than the beginning of ever-increasing levels requiring immediate AI intervention. Or that we might be able to mitigate HPTA shut down, thereby lessening the risk of testicular atrophy and the need for hCG.

[ecdysone]

I actually prefer a more holistic approach, but that's not to say I'm about Alternative Medicine. I simply don't like the idea of having to stack an AI and hCG on top of Test just to feel normal, so looking at the whole picture makes sense to me.

Hopefully these findings by the experts will help us realize that the body is an amazing piece of engineering - that it can adapt as necessary if we give it a chance to. Maybe then we'll be able to see the initial change in e2 simply as an adjustment, rather than the beginning of ever-increasing levels requiring immediate AI intervention. Or that we might be able to mitigate HPTA shut down, thereby lessening the risk of testicular atrophy and the need for hCG.

Nicely worded post!

I had been thinking about titling this one "The Holistic Approach to TRT" so we think alike

[Brohim]

Ive read reports from Europe from guys on Nebedio which is a very long lasting Test. The average dose is 80mg of test per week with no AI needed or HCG. They say they feel great.

[choker28]

Ive read reports from Europe from guys on Nebedio which is a very long lasting Test. The average dose is 80mg of test per week with no AI needed or HCG. They say they feel great.

Nebido is a 4ml/1000mg shot, same again 6 weeks later then reassessed after that,well that's what my Doctor has me on

[FONZY007]

Well I just had blood work done, I'm doing 60mg of test twice a week and I was at 275ng/dl. So I upped my dose 80mg twice a week see how it goes.. But me personally I don't take HCG but was thinking about it as it will most likely increase my numbers

[JD250]

We can try and try to get our levels in the optimal range but we all know that "OPTIMAL" is a mythical place that only exists on paper for most of us, all these discussions about the proper dosage are great for reference but are merely numbers for reference. The only way to know what dose works for you personally is through bloodwork.........Take Kel for example, he has a number that isn't "perfect" but maybe it's perfect enough for him and his body, I dunno. It seems to me that we go from one extreme to another sometimes, first we believe we should be less than 200mgs a week test now we say 60 is enough.......I say if you've been around this board or TRT for any length of time you ought to be well aware of how and why to get blood work done which, in my opinion, is the final word on what your dasage needs to be whether it's 200 ew or 50 ew.

[JimmySidewalk]

Well putting aside the fact that trt dose will be different from person to person and should be adjusted acording to blood work, if you think about it, the doses actually makes sense. The most comon dose is about 100mg per week. Considering trt users mostly go for enanthate which has only 70mg of test per 100mg of product(the rest beeing ester weight) its actually the normal dose which our body would produce normally. The body produces about 11mg per day, coming out to 70-80mg per week, so 100mg of enanthate per week would actually give you normal levels. If you take 60mg of enanthate per week, you would actually be getting about half of what the body would produce naturally.
So how does such a low dose that make sense to you my friend ? You would actually be on TRT but still go through the pain of not having normal test doses in you. So you are TRT-ing without getting the benefits of TRT. Why TRT at all then ? Just stay at shittty natural levels.

[ecdysone]

The body produces about 11mg per day, coming out to 70-80mg per week, so 100mg of enanthate per week would actually give you normal levels.

I've seen more sources quote around 7mg day (range 4-12+), but you would have to factor in that many guys take HCG along with their supplemental test and therefore, need to subtract off their natural production amount (which is apt to be only a few mg) from any that was given.

[pugster]

im probably wrong from a medical viewpoint , but i get the idea that there should not really be any need for an A.I when taking trt , my understanding is that testosterone get converted to estrogen via aromatise action , so if you have high estrogen then you are using too much testosterone and need to back off abit to suit your own bodys needs.
the trouble comes because everyone is different in what is needed and doctors usually use standardised protocols rather than individual ones and also the fact that most ppl these days dont simply want to be functional , but be the best they think they can be ( i.e if my neighbour uses 200mg a week and lifts xxx kg why shouldnt i ? ) , this is simply misinformation on the user part , some of us simply arent genetically built to do those things , ppl dont like to think they may be genetically inferior in some way (even tho they more than make up for it on some other level)

*on another note this week ive started to goto the gym and lift heavy again for the first time in about 12+ years , i swear someone broke into my place the other night and beat the shit outta me with a bat when i was asleep , ibuprofen on standby....

[JD250]

The bottom line is that these numbers are suggestions and totally useless once a person has been on TRT for a while and had multiple bloodworks done, If I'm dialed in relatively close and feel great at 150mg a week, why on earth would I reduce to 60 because some study showed that 25 guys took that amount for 6 months and their levels were acceptable? If my body is in balance it's in balance regardless of popular belief. However I think it would be extremely wise for newcomers to start at these levels and go from there, this stuff is always changing and new studies are coming out all the time but for the time being I believe we need to put some more emphasis on blood work and establishing a PERSONAL zone for your hormones that is healthy and keeps you feeling great.

The more I observe this stuff and peoples protocols and issues the more I realize that everyone is more different than we openly recognize, I think about my very worst situation health wise before I started TRT.......I felt like crap, was 60 pounds overweight, drank way too much, mostly to make myself feel better, life sucked and I was a drinker and WAYYY overweight.........my baseline e2 at that time was 31.....that's damn near PERFECT.....go figure. As soon as I started TRT it went up, I believe the 70s somewhere so I started an AI....blah blah blah My point is that we are all different, I lost over 50 pounds so quick and easily I'm still amazed, other people struggle hard even on TRT to lose the weight, my e2 was fine even though I was an old fat guy that drank too much(I wasnt a drunk I just drank more than I should've considering my health) Some people have very high e2 before they start TRT.............I love the guidelines but they are just that "guidelines" not the final word on how much we should dose. Blood work will decide that.

[ecdysone]

T If I'm dialed in relatively close and feel great at 150mg a week, why on earth would I reduce to 60 because some study showed that 25 guys took that amount for 6 months and their levels were acceptable?

I think what Crisler and Gordon (along with others) are targeting is not necessarily the range where you "feel great," today, but the one that will last you a lifetime without future complications. From a blood level viewpoint, they are targeting a range around 700ng/dL rather than the 1000+ range many guys "think" they feel best. Nothing wrong with an occasional blast, but as Kel said, sometimes "less is more" when it comes to long term therapy.

[JD250]

I think what Crisler and Gordon (along with others) are targeting is not necessarily the range where you "feel great," today, but the one that will last you a lifetime without future complications. From a blood level viewpoint, they are targeting a range around 700ng/dL rather than the 1000+ range many guys "think" they feel best. Nothing wrong with an occasional blast, but as Kel said, sometimes "less is more" when it comes to long term therapy.

Totally understandable and I agree but using math just doesn't cut it for a personal protocol, it takes blood work, the protocol that gets you settled in at 700ish may be VERY different from mine as has been demonstrated hundereds of times on this forum.

That said, I also agree that the high end may not be the BEST place for a middle aged man to be, this is for life and I think most of us want that life to be a long one.

[ecdysone]

Totally understandable and I agree but using math just doesn't cut it for a personal protocol, it takes blood work, the protocol that gets you settled in at 700ish may be VERY different from mine as has been demonstrated hundereds of times on this forum.

That said, I also agree that the high end may not be the BEST place for a middle aged man to be, this is for life and I think most of us want that life to be a long one.

Can't say I disagree with absolutely anything you've said here and elsewhere. Truth be told, I've let my levels drift into the low thousand, but will be definitely pulling back soon.

I suppose in the back of my brain, I always remember that admonishment: The doctor who treats himself has a fool for a patient

[PetrX]

At the 2 hospitals I work at, I asked the endos to see what the range they use on the trt patients and they all average from 50-100 a week but all of them agreed that they won't prescribe more than 100 mg unless its absolutly needed and other doses didn't yield results. If I ever switch to injections, I will probably start on 60-75 mg a week to start and take it from there

[FONZY007]

At the 2 hospitals I work at, I asked the endos to see what the range they use on the trt patients and they all average from 50-100 a week but all of them agreed that they won't prescribe more than 100 mg unless its absolutly needed and other doses didn't yield results. If I ever switch to injections, I will probably start on 60-75 mg a week to start and take it from there

Im was at 60mg twice a week, so after third day of injection I got bw done and I was sitting at a low 275ng/dl

[PetrX]

Im was at 60mg twice a week, so after third day of injection I got bw done and I was sitting at a low 275ng/dl

Sorry to hear that. Once my experiment with the patches is over, I will be trying 70-80 mg a week of test E for a month and see what my numbers are. If im not at the 650-850 range than I will kick it up to 125-150 a week and compare numbers. Ill post up the numbers after each experiment (patches then Injections)

[HRTstudent]

Does anyone have a link to this interview with Crisler?

[Vettester]

I'm curious on why the doctor (presume Dr. Gordon) feels that higher doses on a patient will lead to sexual dysfunction? Actually, I'm on board with a lot of the thought concept of starting smaller, and I've always felt that 30 is a better place for my E2 than 20. I'm sure everyone has their preference range on this, but I've always had a greater libido in the low 30's.

Also, I'm not sure how or when the whole 1mg of AI for 100mg/cyp started up here ... It wasn't the normal advise given here at one point, then all the sudden guys started throwing that at new members. I've never supported that, and again, I totally agree that less is better, especially when it comes to managing E2.

Going back to the sexual dysfunction ... I'm just curious at what dosage does he, or they, feel is detrimental to one's sexual functionality, and what the rationalization is behind it? Normal logic would just presume that more testosterone will convert to higher estradiol levels, which can obviously have an impact on a man's libido. I don't quite understand where the scale of suppression on the HPTA is going to be amplified with let's say 150mg/wk as opposed to 80mg/wk; factoring the same administration protocol of HCG that they are suggesting?

In my case, I'm pretty much at full suppression, at least if we are talking in terms of GnRH secretion of LH and FSH. Both values are < .03. My protocol is 120mg/wk (60mgx2) with HCG. Again, I'm fully on board with what they're saying, I actually aim for that 700-750mg serum level. However, what additional suppression is going to be caused with more exogenous testosterone that doesn't already exist?

[ecdysone]

Going back to the sexual dysfunction ... I'm just curious at what dosage does he, or they, feel is detrimental to one's sexual functionality, and what the rationalization is behind it? Normal logic would just presume that more testosterone will convert to higher estradiol levels, which can obviously have an impact on a man's libido. I don't quite understand where the scale of suppression on the HPTA is going to be amplified with let's say 150mg/wk as opposed to 80mg/wk; factoring the same administration protocol of HCG that they are suggesting?

This one more of a puzzler, but I'm thinking it's simply estradiol related - maybe with the thought that not all guys take AI's. Then there's the more complex effect of E2 on thyroid function and SBHG binding, so not sure if it relates in anything more than a linear fashion.

[BillyBob210]

The most imortant thing I have learned after 2.5 years on TRT is this:

You are not the other guys on this, or any other forum......you are you. Find what protocol works and run with it. True TRT patients just want to be normal or just a little better. If you are looking for an excuse to run a cycle, just run a FN cycle for God's sake. I have my levels at normal or above.....this works for me, as it should any normal man who just wants what he has been deprived. Anything more, is selfish and your problem. Get your BW numbers in line and bust you ass like a normal guy (that's what you have accomplished). Shut up and lift some FN weights. My 2 cents.

[jamotech]

The most imortant thing I have learned after 2.5 years on TRT is this:

You are not the other guys on this, or any other forum......you are you. Find what protocol works and run with it. True TRT patients just want to be normal or just a little better. If you are looking for an excuse to run a cycle, just run a FN cycle for God's sake. I have my levels at normal or above.....this works for me, as it should any normal man who just wants what he has been deprived. Anything more, is selfish and your problem. Get your BW numbers in line and bust you ass like a normal guy (that's what you have accomplished). Shut up and lift some FN weights. My 2 cents.

Agreed!

[BillyBob210]

Just to add to my post. REAL men are a dying breed. Look aroud you at the little sissies who think tight abs are the measure of manliness. Can you protect your family being a skinny little bitch with tight abs? I think not. Are we men or are we mice? Most here are older gents who have had to prove their worth........can you? If someone is attacking your family, can you stop them or are you too busy with your P9X workout? Sorry guys, just had to say it.

[Vettester]

If someone is attacking your family, can you stop them or are you too busy with your P9X workout? Sorry guys, just had to say it.

I'm old school with this part too ... It's just a matter of what option I choose that day ... 9mm, .45 ACP, .40, .380, 762x.39, are just a few of my friends.

[PPC]

Just to add to my post. REAL men are a dying breed. Look aroud you at the little sissies who think tight abs are the measure of manliness. Can you protect your family being a skinny little bitch with tight abs? I think not. Are we men or are we mice? Most here are older gents who have had to prove their worth........can you? If someone is attacking your family, can you stop them or are you too busy with your P9X workout? Sorry guys, just had to say it.

Man this is funny. Lots of truth there though. Love it when my husband cleans his guns, much sexier than tight little abs.

[AnabolicBoy1981]

Just to add to my post. REAL men are a dying breed. Look aroud you at the little sissies who think tight abs are the measure of manliness. Can you protect your family being a skinny little bitch with tight abs? I think not. Are we men or are we mice? Most here are older gents who have had to prove their worth........can you? If someone is attacking your family, can you stop them or are you too busy with your P9X workout? Sorry guys, just had to say it.

I just hear a guy whose angry cuz he's fat. Actually i prefer being jacked AND having abs, thank you very much. Few guys here want to be "skinny". I don't think being less ripped = more manly. I'm pretty sure Spartans were pretty manly and they celebrated the athleticism and beauty of the body, and they could kick ass. And yes...im sure the REAL Spartans were not as ripped as the guys in "300", but we don't know that they weren't either. Greco roman statues depicted men with 8 packs...so i doubt abs were look upon by feudal peoples as "sissy".
And nobody hear does P90X. We go to real gyms, take steroids, and eat boring diets instead of being WEAK and caving in to our food indulgences like SISSIES. It's not ripped peoples fault for being able to deal with the mental and physical stress of doing cardio. If you think cardio is for "sissies", maybe you should try it first. I'd like to see how much of a sissy you'd think i am after doing my high intensity interval cardio. Not exactly a girly aerobics class my friend. Neither is the monotony of my lower intensity 45-60 minute cardio sessions.
Just my 2 CENTS...
Sorry, just had to say it..

[JD250]

I like your thought process Vette, I don't have any of those answers except one, I do know where the 1mgAI per 100mg Test idea came from.....clinics, it seems like about a year ago a lot of members where prescribed 200ish from clinics and they suggested 1mg a day for the 4th and 5th day after injection or some such......and I think it just went from there. But keep in mind when I started TRT at 275lbs my e2 was fine but when I threw 200mgs of exogenous test into the mix that 1mg per 100 mg protocol actually worked quite well to bring my e2 back down.........now that I'm in MUCH better shape and weigh in at 225lbs I can use half of that amount or even less if I do smaller doses. I dunno, maybe I'm wrong but it seems like thats how it started.

Ecdysone......I have thought about that admonishment MANY times in the last year when I placed my order at the clinic, maybe the only thing more foolish would be someone who lets themselves be treated by a clinic. Thats why I come here and try to keep up with whats going on with TRT cause my only two current choices for TRT care are foolish and foolisher. Sometimes the truth is scary.

[zaggahamma]

the 1mg arimidex per 100mg of test got thrown around here by a few members and it became a STARTING point only that i can recall...it was always advised that it was starting only that bloodwork was needed quite soon after starting....
ONCE AGAIN, trt is INDIVIDUAL...that theorized dose may work well FOR SOME and not for others...i think its been agreed on by all and for some time that the best way to start /manage a trt protocol is start with low doses and as few ancillaries as possible and go from there and bloodwork often as possible as well especially in the beginning especially before adding anything

[HRTstudent]

I favor the idea that you don't add anything until it's needed/desired.

Why add an AI if you never need it? Many don't.

Why add HCG if you don't need the potential short term fertility and you have minimal atrophy? Only reason I would think is if you want added sense of well-being. But again, you wouldn't want to do this until you got your T dose right first.

That's just my take...

[pugster]

I favor the idea that you don't add anything until it's needed/desired.

Why add an AI if you never need it? Many don't.

Why add HCG if you don't need the potential short term fertility and you have minimal atrophy? Only reason I would think is if you want added sense of well-being. But again, you wouldn't want to do this until you got your T dose right first.

That's just my take...

ive only been here a short time ,but have done a hell of a lot of reading over the last year , ive come to the conclusion that the above is the way im gonna be going (add something only if its needed ) , ive no doubt i'd probably feel alot better with a 1k range but it doesnt mean it doing me any good long term , as with most meds the more you increase dosages the more sides you get , the more side you get the more meds you have to add to counter them.
to use another euphemism i'd probably feel better on cocaine rather than coffee , dont mean im doing myself any favours in the long run tho

[zaggahamma]

Billy Bob for prez

[BillyBob210]

We can't let Old School die my Brother, or we become one of "them".

[JD250]

^^^^I love you guys, this is one of a few settings where I can discuss something as personal as my health issues and in the same breath go old school about how I would protect my family, .45ACP during the day, 12 ga. at home. Honestly it wouldn't matter, if someone was harming my family I could and would use anything and everything I could get my hands on as a weapon and if need be I'll use my bare hands. We'll sort out the details later.

I'm with JP, Billy Bob 2012!!!

[mlandog]

Billybob and JD 250 you guys had me rolling. Im old school all the way. Personally a 45 guy, but anything will do if somone is messing with the Fam.
was reading a workout in one of those mens health mags talking about old school tricept work out and I was like "hey thats the same workout i do"

[AnabolicBoy1981]

and as far as 1mg of arimidex per 100mg of test, i dont know where that dumb idea came from, I never agreed with that. A-dex at that dose is for when your on a cycle and has no place in hrt IMO, unless the patient is starting out very obese and producing a ton of aromatase from his extra adiposity. Maybe .25, eod for therapy.
Heck, some doctors actually use JUST adex as a form of TRT since it raises test levels. But if your shooting 100mgs a week anyway you certainly dont need that level of adex to have a good T/E ratio or T level.

[JD250]

and as far as 1mg of arimidex per 100mg of test, i dont know where that dumb idea came from, I never agreed with that. A-dex at that dose is for when your on a cycle and has no place in hrt IMO, unless the patient is starting out very obese and producing a ton of aromatase from his extra adiposity. Maybe .25, eod for therapy.
Heck, some doctors actually use JUST adex as a form of TRT since it raises test levels. But if your shooting 100mgs a week anyway you certainly dont need that level of adex to have a good T/E ratio or T level.

Not entirely true.......1mg per 100mgs can and does often work when just starting TRT.......BW is the only way to know for sure although typically it doesn't require that dose long term depending on the person. I'm just saying....we need to approach this from a logical standpoint and not make broad sweeping statements. I would start at a much lower dose and go from there but we can't say what will and will not work with such certainty.