T Nation

Doctor Saying Over 150mg Weekly is Far Too Much

Hi All,

I’ve been on TRT for about 3 months now and haven’t quite got back my libido since I started. I started on 100 mg weekly (weekly injections), I felt very very mild improvement after 5 weeks so we moved to 150 mg weekly (weekly injections), once again mild improvement so I decided to switch to twice weekly injections which I’ve been doing for the last two weeks and still haven’t got to where I need to be. My libido feels like 40% of what it was before hypogonadism.

The one day that I felt close to 70% of what I was was when I switched from weekly to twice weekly and had a 150mg injection on a Wednesday then a 75mg the following Monday. That Monday I did feel better for a few days then back to low libido.

I was speaking with my doctor about moving to a higher dosage and he says he’s worried because too much testosterone can cause liver damage. I know really high T can cause issues but was not under the impression that between 150-200 weekly is really dangerous. Does anyone else have any insight on this? Should I find a new doctor?

Here are labs
Pre TRT:
LH: 1.6 (1.7-8.6)
FSH: 2.1 (1.5-12.4)
Test: 220 (264-916)
Free T: 8.6 (8.7-25.1)
DHT: 23 (30-85)
E2: 8.2 (7.6-42.6)

After 5 weeks of 100mg weekly:
Test: 270 (264-916)
Free T: 9.3(8.7-25.1)
DHT: 27 (30-85)
Estrogens: 85 (40-115)

After 5 weeks of 150mg weekly:
Test: 709 (264-916)
Free T: 25.6.3(8.7-25.1)
DHT: 47 (30-85)
Estrogens: 150 (40-115)

I asked for Estradiol to be taken and they tested for Estrogens instead… I assume estradiol is fairly high due to estrogens level but still think my dosage is too low.

There’s nothing to support the statement that high levels of exogenous testosterone causes liver damage. The liver damage is only with the orally-administered forms of testosterone.

The testosterone levels, not the dosage are important as everyone metabolizes testosterone differently. I have seen some hypermetabolizer needing very high doses to achieve normal healthy testosterone levels.

Your latest protocol looks good on paper, but how you feel is more important than the numbers and there is nothing wrong with estrogen above the ranges for men on TRT.

Also something to consider, when you change your dosage, testosterone and estrogen levels become unstable and are going to be in flux for 4-6 weeks and you may notice inconsistent relief of low-T symptoms.

I always feel better right after increasing my dosage, then the body attempts to reach homeostasis which takes at least 6 weeks and sometimes longer for your body to adapt. You also drew labs too early, 6 weeks to a stable state, not 5 weeks.

So my advice is wait it out on this protocol for at least 6-8 weeks to see how you feel, but know that hormones don’t act quickly like drugs, time is needed for the body to utilize hormones and greatly affect outcomes.

TRT is a marathon, not a sprint.

Appreciate the insight, I agree I did not switch to twice weekly until the 6 week mark but we did take labs after 5. I do think based on my estrogen levels that playing out the twice weekly protocol makes sense before switching dosage.

I’m just concerned that after 6 weeks nothing has changed my doctor is unwilling to increase dosage because he’s uneducated on the effects of high T on the liver. I was under impression that liver damage was only due to Testosterone pills which I’m glad you confirmed. This doctor is good in some ways because he listens to me but I feel like I have to educate him on TRT which is really not a good sign. He wasn’t aware that you could inject sub Q, he also didn’t think ppl ever injected more than once weekly until I told him many do and that I wanted to switch to that…

I’ll wait this out for 4-6 more weeks (on second week now of twice weekly injection) and see if I feel any different. If I don’t feel better and he refuses to up my dosage of T I think I’m going to need to find someone else.

You may very well struggle to find a doctor in the sick care system willing to allow out of range testosterone levels as most doctors follow recommended guidelines.

Now private doctors have more medical freedom and can deviate from guidelines, telemedicine is another option or finding a private doctor that could possibly offer better care.

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Yea I’m debating that but will try to find someone in my network who’s open to it to avoid the high out of network costs. I’m just surprised to learn over 150mg per week is considered way too high.

If there’s anyone on here in the Phoenix area who knows of a good doc with an understanding of TRT I’m all ears

Honestly this looks pretty damn good. Free T is off the charts and I assume you are testing on a trough day. You also appear to be a lower SHBG guy which some benefit from more frequent injections. As @systemlord said give it some more time on the 150mg dose. I think you’ll see yourself doing well.

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Appreciate it, yea you’re right it was taken on a trough day which is why he’s concerned about upping the dose. I understand the concern but his concern is that it will hurt my liver and I don’t think that I’d run into issues there unless I was taking T pills.

I just want to go off feel rather than numbers and as of now I feel essentially the same maybe a very mild improvement since day 1 of starting. I’m going to give the twice weekly protocol 6 weeks before taking a look again but if I don’t feel any better I’ll need to find someone who’s more open to the 150-200mg weekly range.

You numbers preTRT and 5 weeks on 150 is night and day difference on the paper, specially free T, how would u rate from 0 to 10 your well being, libido, stamina, etc, pre TRT and after these 5 weeks on 150mg which show a dramatic improvement in numbers?
Cheers

It is night and day from a numbers perspective but the libido increase has been marginal at best. I think switching to twice weekly will be helpful because it was usually 4 days after injection I’d feel slightly better and have less ED when I was doing once a week. I switched to two injections a week 2 weeks ago.

My mood is better on the twice weekly protocol I’ve noticed, I feel better working out, hoping libido comes next… I still think I’ll need a larger dosage than 150mg per week to feel 100% or more.

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Also in the Phoenix/N Arizona area. Contact Defy Medical. Dr. Saya or Dr. Calkins. They might be able to take you on as a patient under the category of “continuing care” or something like that. They told me that otherwise, they’d have to see you personally on the initial visit. Send them all your records and labs. The staff is incredibly efficient and responsive. However, my insurance covers things using my regular doc, but not for Defy which I pay direct. So, you’d have to ask Defy about all that.
In my experience, Defy started and initial protocol based on what I already was on, then follow up with full labs and needed adjustments and tweaking 3 months later. If things are in the ballpark, then follow up 6 months later, etc.
Defy’s TRT protocols are the top in the field IMHO compared to the “average sick doc MD” and a handful of Endos and Naturopaths I’ve worked with. Give Defy a call at least, it might be interesting to get their initial input.

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Much appreciated. I will definitely do that thanks

You can easily track liver function when you do labs. It’s in the metabolic panel.

My liver function stayed perfect or even better since starting trt. I inject about 120 a week and have done 140 liver still perfect.

Stick with the current dose and switch to dailies. Wait for about a good 6 months for things to align better, and then in a year you will see that your first three months were bootcamp. Daily dosing should yield you better results with prolly no need to increase. Although, Ill be honest, I feel best when I run 220mg/week. Labs look great with the exception of total test running at 1500-1600. Levels up there really freaks out doctors that dont practice on themselves.

Yea I don’t think he really knows what he’s doing honestly. The good thing about him is he listens and takes my advice on some things but he really doesn’t want to up my dosage and if I need to do that I’ll have to find someone else

I hear ya I’m going to stick with this for a bit. I’m sure dailies will help me but having to inject every day really seems like a lot. I’m going to see it twice a week will work and if not maybe 3 times a week. If I have to I’ll get to dailies

Youre welcome, aloha, kimo

Your doc is treating numbers instead of symptoms. Change docs. He’s also measuring total estrogens which is a useless test. No, you cannot determine estradiol levels from that. Not that serum estradiol measurements mean anything as it is a paracrine hormone in men.

Cannot*

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Yea I asked for estradiol which he tested for the first time and the last two they’ve messed up and tested for estrogens… I was not happy with him. He definitely doesn’t know what he’s doing, the only positive is his willingness to listen to my input and not be stubborn.

This dosage issue could be why I switch assuming my symptoms don’t improve after 4-5 weeks or so

So I had the t-score of 137 and started my trt at 200 weekly injections. 8 weeks in I noticed moodiness libido drop and a few other symptoms of high estrogen.

I’m now on anastrozole (1 mg every other day), tamoxifen (10 mg every other day), and clomiphene citrate (25mg ever other day).

Ever since all that everything has returned to how I was when I was 20.