T Nation

TRT - A Provider's Input

All,
i’ve been around t-nation since it’s birth. I sold the old spray on topical pro hormones and still have an original testosterone T-shirt in the plastic.
I don’t post much and mostly just read articles but I thought I’d chime in here from my perspective.
I’m a medical professional who ran a testosterone replacement clinic for over three years. I’ve read a lot of information on here about dosing that I’d like to clear up.
There is no cut and dry, 100 mg a week, 100 mg split twice a week, 50mg eod, that makes T replacement for everyone.
Ive had gentleman on as high as 400 mg a week.
The key to all of this is your free testosterone. You can have a testosterone level of 1200 but if so much of it is bound up and useless, that number means nothing.
SHBG, A liver protein that stands for sex hormone binding globulin, is important in this equation. Some people have naturally high levels of shbg, some peoples are elevated due to starvation or stress, some people have very little.
I’ve read “anything more than X dose is a cycle”
Not true at all.
So if you’re having it done for you or doing it yourself, Pay a few bucks, go to a lab and have an SHBG drawn, and then do the equation yourself. Shoot for a free T between 15 and 25.
Takes guesswork out of it.

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Hi, and thanks for the info!
Do you mean these target numbers for TRT? So, up to 25 is OK for TRT?

Correct. A free t of 25 is a solid number on trt. Once again, the dose to get there is individual.
And it can fluctuate with activity, stress and food intake levels

I also assume you mean trough level.

I’m happy to see sg like your numbers, as I feel we seem to be obsessed with total T, while there’s a huge variation among men in freeT. I, for one, have low SHBG. Now, what do I do? Do I still shoot for 800-1000 total? I guess it makes more sense to set a desirable range for free T. So, cheers. :slight_smile:

Yes trough.
I had an endocrine issue briefly. Total T shot up over 1000 for no reason. Checked for tumors, etc. but was also going through a divorce, so wasn’t eating, obviously stressed. Free T was 2.9… so I was a 6’4” prepubescent girl from the waist down.
Total is important but not the most important

Alright doc I have a question…

This is hypothetical and completely for my own understanding…

Patient : John Doe
Age: 52
Height: 5’ 10”
Weight: 237 lbs
Lean Body Mass: 154 lbs

Scenario:
Patient has a Total T of 197 (range 207-879), Free T of 0.75 (range 1.1 - 17.2). Patient has symptoms of High E2 and low testosterone (puffy itchy nipples and depression, ED and zero libido). Patient has tried TRT in the past and has exhibited extreme over responsiveness to Aromarase Inhibiting drugs.

What’s your thoughts? Is your strategy to still shoot for a free T of 17-25?

You read that here? After hanging out here for the last couple years you rarely hear anyone talk with such ignorance. I feel we are WAY more progressive than that.

Granted every once in a while someone will pop through and spout such nonsense but generally they are paid no mind.

Shoot! I feel great but I thought my FT would fall into anyone’s mid-range to high range zone. I’m high range-ish at trough, according to hospital’s urologist guide:

Testosterone Free Calculated 565 pmol/L (110-660)

That converts to 16 ng/dl. Just one point higher than his base! (15 and 25)

120mg a week SubQ. I’m low SHBG of 14 with a TT of 18.3 nmol/L (6.1-27.1) which converts to an unspectacular 524 ng/dl and I don’t care about TT either, it’s all about the FT! :)))))

I have somewhat lower SHBG (22) and need Free T 20 pg/mL or higher to feel good, a Free T of 15 pg/mL is no better than 7.7 pg/mL for me. A Total T of 500, Free T is 21 pg/mL and Free T jumps to 29 pg/mL at a Total T of 677 ng/dL.

Another thing people need to realize is dosing isn’t linear, there’s a point where levels start to increase dramatically.

Shoot! Am I using the wrong calculator? It converts FT pmol/L to ng/dl and you are displaying pg/mL?

My free T is 193.4pg/ml on a scale of 35-155.

Too high? I get this on 30mg eod test.

I’ve read that verbatim on this site. Articles if you look.

Oh, ive read it. Its just not the current environment. We’ve grown :smiley:

Honestly? Not to sound like a dick? Lose some fat so not so much “area” for aromatization to happen.
These free t calculations are just that “calculations”
EVERY lab is gonna differ on normal levels, ranges, etc.

Honestly? That’s exactly what I was thinking too lol! I am NOT a doc or a professional for that matter. I’ve been trying my hardest to study all scenarios to further my own understanding and apply to myself over the course of my own TRT journey. When I started, I was not far off from the hypothetical above and based on what I researched, my pcp was pointing me in a very dangerous direction.

I just wanted to get a professional opinion to see if my understanding and line of thinking was on the right track or if I was way off. Thanks for taking the time.

If you lose the fat, TRT takes a great new turn man. Sometimes no AI. Better results, etc

Hard to get a good lab off that frequency of dosing. But if you have no sides, PSA is good and you feel ok, I wouldn’t argue it

Can someone clarify what the suggested measurement is beyond just “25”? 25 what? With all the different lab ranges, it would be nice to be extremely clear when these topics come up. Also, it’s probably worth reminding folks that how you feel is more important than a lab number…don’t want to get caught up chasing 22 E2, and 25 FT etc.

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OP’s 25 is FREE TEST in ng/dl. I had to convert from pmol/L which I showed. :)))

And a hell YES! Wish there was a standard measurement value the world uses, gets hellah confusing.

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25 is a calculated free t level
And as I stated, how you feel is part of the equation.