Studies to Support High Normal as Target for TRT

Hi,

I hear many people saying you will feel your best, or the most efficacious level for total T is the high normal range. Does anyone have any links to actual studies supporting the high normal range to back this up? The endocrinologist I have a prescription from is for 100ng/dl of cypionate per week which seems to be on the low end and he said it’s not healthy to give me the level of an 18 year old. I’m 55 and in good health except for a total T of just under 300 and have never been on Testosterone or anything else.

I’ve been lifting in and off my whole life and never seem to make much in size or strength gains. I haven’t started the on the TRT yet and sure would like to get the most out of it if we m going to start. Does anyone know of any studies that back up the higher level of total testosterone being safe and better at alleviating symptoms?

Many ppl may say this but it’s different for just about everyone. I’d find the TT/FT you feel best at and go with that

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In before @tareload throws a dozen graphs at you

This is dependent on the person. Many people undergoing TRT are going to feel better “Symptom relief”. There are also many undergoing TRT, like yourself, because your TT levels are below normal range… So the term “it’s not healthy” is a bit of a loaded claim here, and you will get answers on both sides of the aisle.

100mg/wk should make you “healthy” as far as your endo is concerned, but may not relieve some of your symptoms. There certainly are health concerns with staying at the absolute top range of TT all the time, but many people on 200mg/wk (relative top-end of TRT realm) who actually feel much better at this dose.

To answer the question of “is it healthy?” really depends on your definition of “healthy”. I recommend seeking symptom relief for low testosterone, and if that requires you to be on the upper end of the dosage spectrum - so be it… Just know that there are some health concerns that can arise from this. IF your symptoms are relieved with 100mg/wk, then you have achieved both health and relief.

P.S your endo probably won’t raise your dosage to the top end of the range, but TRT clinics like Defy Medical (and many others) are more willing to do so. Consider the top end of the range “Testosterone Optimization Therapy” rather than Testosterone Replacement Therapy. Either way, there are quite a few knowledgeable heads here.
@highpull @swoops39 (I already see him commenting) @blshaw @lordgains
Probably missing quite a few… clearly I haven’t maintained my rolodex well enough.

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Lol I still remember most folks rolodex back in the 80s.

@Andrewgen_Receptors You’re pretty spot on in your analysis of options.

@FredMertz there is no “feel your best” protocol and some honestly don’t feel better with higher testosterone. The best thing for you to do is find a doctor that you feel is knowledgeable and try their protocol. A smart doc will put you on solo Testosterone without an AI and see how your body does on that. A good starting dose is 100mg/Wk to possibly 150mg/Wk if you have higher SHBG.

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:rofl::rofl::rofl::rofl::rofl::rofl:

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Just when I started to lose hope on this forum, you went and posted this. Great post!:fist_left:

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If someone feels better at 250mg/wk, then have at it! just know there will be some adverse health effects. I agree with much of what Tareload says because he’s right in that most people don’t actually need as much as their taking, but they feel better on higher levels - so that is what they do. I have no problem with this in all honesty, so long as people don’t fool themselves into thinking they need to microdose 200mg/wk to feel right while their ‘trough’ is 1175ng/dl.

SURE, you might feel better, but are we really going to say this is a medical need? More likely a medical want.

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They dont exist.

I could post more than 10 studies in the last 10 years showing significant patient satisfaction and symptom relief for various cutoffs (TT/fT) in the physiologic range. But those subjects arent you. Find what works for you and makes you happy within your risk tolerance. That means you need to understand what you are getting into.

Please check your Rx. 100 mg/week of TC?

You have at least two options that i am aware of …

In network doctor / Endo who will put you in range (usually prescribe 50-100 mg/week of TC and dose titrate in range) if you demonstrate measurable need with hypo diagnosis.

“TRT”/“TOT” clinics which will typically prescribe 100 to 200 mg/week which puts most at high part of range or above for potential feelz/gainz/symptom relief. You dont always need to show levels below range. They are cash pay or use your HSA card :grinning:

Was actually just in correspondence with well known provider at Defy. He stated median dose at Defy was 140 mg/week with 100/180 covering vast range of patients. Needless to say I immediately understood what this means for a good fraction of their patients. I am still waiting for him to get back to me on levels he sees with these doses. But hell if you are paying cash i can see why you would want to be above range. If a little is good maybe more will be better. No one can tell you. That is why i deal in distributions.

I wont bore you with the graphs and such. Good luck.

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Take what you want. Amen! Feel your best.**

**fine print

Seriously, you gotta do you. Nice post @Andrewgen_Receptors. You got a good head on your shoulders.

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I get you’re trying to give me a compliment here, but my body dysmorphia is telling my this means I need to bring my shoulders up…

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How do you know this?

Again, how do you know this?

So, in your mind nobody could possibly need to have a trough total t level of 1175 as the amount to relieve low t symptoms?

More likely? As in the majority of men? More than 50% of men with low T don’t need 200mg per week to relieve symptoms? That’s a good possibility. But I certainly wouldn’t make a blanket statement that 200mg per week is unnecessary. There are some that need at least 200mg per week. Just like there are some men that take 50-75mg, and have symptom resolution.

I spoke something about this in another thread where I showed my blood work to be the best it’s ever been. Your diet and lifestyle will provide you the majority of health benefits while the TRT supplements it. Even with an AI and going to the highest T dose, 175mg a week, I ever have. It depends on what people do with it. If a 65 year old dude did that T protocol, ate hella protein that his old kidneys couldn’t handle anymore, lifted weights that would just put too much stress on his older body, and wanted to maintain 8% body fat while being 5”7 and weighing 240 pounds then yeah OK giving him his 18 year old T levels isn’t healthy. That’s so misleading though, and everyone assumes that’s the goal.

If you a normal healthy dude, living a healthy lifestyle, doing a “TOT” protocol I agree there ain’t no problem there.

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Unless proven otherwise everyone always needs to bring their shoulders up. And now days their heads up out of their phones.

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To spare OP from yet another argument in the TRT forum, I’m just going to refer back to my first comment

Most people take 800mg (max dose) Advil to relieve all headaches, no matter how bad the headache is. Why would you think this is different for other medications? (rhetorical question)

Again, I say that the definition of “health” is maleable in this context. Don’t twist it, don’t apply a narrative to it, just take it at face value. If you disagree, that is fine - I’m just not going to argue other points… I’m pretty middle of the road in my opinions here.

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I responded to this in the other thread, not gonna bother here again :smiley:

You are right on the OPs options. Good post.

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OP got his money’s worth.

When I first started TRT my mentality was “I’m not marrying myself to this drug for life to get mediocre normy TT levels”. If I’m gonna inject, why not make sure I’m at the top the allowable limits from my clinic. I realized that while I can do this (and sometimes still do) I don’t really feel my best there. Always some side effect or worry that comes with it. I am ok with that for short periods, but not consistently.

For the “no one can tell you” part, I completely agree. For some damn reason we all respond differently to the same medications and yet there are soooo many posts on here trying to crowdsource responses to doses or frequencies or whatever. The answer to 99% of these is “no one can tell you”. You gotta try it and see, and hopefully report back to us so we have more data to go off of

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@swoops39 What are your levels in where you distinguish TRT vs TOT? I think I am now headed down this path as well.

I guess I have a hang up with the term “optimized”. Wouldn’t that be different for everyone? If you need extra meds other than testosterone, are you really optimal?

Whatever you want to call it, if lipids, CBC, BP, heart, kidneys, etc all are healthy I say run your TT as high as you can. Most of us run into issues with HCT or BP or high e2/PRL when we do that tho.

Edit: for me, I’ve had my TT >1500ng with all the usual health parameters well within range (I also have Ezetimibe and an ARB on hand if needed). BP stays low up to 480mg test weekly. So I guess I could just keep it high, for a while, and keep an eye on my heart. That brings in some worry tho, and I’d rather not have that for long periods

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I suppose this is as good a thread as any for my question. Understanding that this is T-Nation Forum, I make the assumption that most all discussions have a strong weight training consideration to them. People want to optimize their physique and/or strength.

My question is about the central focus of the subforum, T Replacement. Is it about minimizing Low-T symptoms or improving weight lifting ability. I cannot tell from individual posts which is the case.

I actually have no idea how to interpret or respond to the posts. Sometimes it seems like they are focused on minimizing symptoms, and then other times they want improve their physique, as if testosterone is the final missing piece of the puzzle.

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