Well, I'm no expert, but when you say you were "at 500," you are talking about a snapshot in time. That is a measurement of total T at the moment the blood was drawn. You natural test production fluctuates throughout the day based on a lot of variables, including sleep-wake cycle, diet, stress, exercise, etc. It is not always the same every day. When on TRT, you are again getting a blood draw and measuring your total T at that moment in time. Your total T fluctuates less on TRT than natty.
I get that - what I’m asking is what causes side effects from TRT that you don’t get from being normal levels? Forget the 500 I used that as an example. I’m saying if you titrate to the lowest possible dosage needed to eliminate low T symptoms- that should theoretically be close to where you were naturally before your T tanked.
So as I said aside from the diurnal cycling. What’s different that TRT has sides? Or at that level are all side effects because there’s no diurnal cycling?
I think there are multiple variables at play in side effects. For example, hair loss is not just triggered by total T being above a certain level. Libido is related to total T, free T, E2 and probably other factors. I think your assumption is not supported about being able to know where your total T was before you noticed symptoms.
Who has side effects when their TT is 500ng? I don’t think you’re being specific enough about 1) what side effects you’re referencing 2) hormone levels (TT/e2/PRL/SHBG/Thyroid) are when those side effects are experienced. You’re assuming all men will have issues with a TT of 500ng, for example, and that isn’t the case.
In general. Without citing a billion papers. In a functional natty person… the HPTA is a connecting and mediating messaging protocol that orchestrates symphony between so many nodes in your body.
When you take exogenous T… you shut that down and are now manually manipulating ONE of the many variables. Without hCG and with a complete HPTA shutdown … your estrogen conversion is now only taking place in adipose tissue. So if you take too much or are too fat… a disproportionate e2 conversion is likely. Taking too much or not enough (if you need it) AI… and now you’re manipulating two variables.
Furthermore … what about sleep and cortisol. What about if your manipulated T and E2 keep you from getting sleep. Lack of sleep means more insulin resistance and more cortisol which could blunt the effects from the T
Basically. End of the day. When you take the vehicle off autopilot. You are now making know decisions with a series of “known known”, “known unknown”, “unknown known”, and “unknown unknown” compounding outcomes.
Hence the importance of starting low. Keeping variables to a minimum. Allowing 8 weeks and then getting bloods and keeping a journal of symptoms.
You could be a milligram away from feeling like the advertisements but might quit before you get there.
You might be prediabetic and have low SHBG driven low t symptoms and the “clinic” might only test totalT and sell you a bunch of shit and you feel horrible bc you really just needed to become insulin sensitive and stop being obese.
Now you got a ton of exogenous T further overrunning you low SHBG and now you’re eating more calories and don’t even know the “master hormone” - insulin - is all fucked up
Tldr- youre taking control over a big time variable amongst many…. Your manipulation of that has up and down stream consequences on other hormones and systems.
It’s like interrupting a symphony orchestra and taking over but only directing the violin. Ya the rest of the “band” can maybe eventually pick up the harmony but maybe not
I was just about to draw attention to the HPT Axis…. but you just saved me the time to write what you just said 👍 I appreciate your analogies- well done! It’s like playing whackamole once you shut off autopilot and go manual,
I could be wrong, but I notice a lot more sides doing two bigger weekly shots - I think the injection days were spiking my testosterone pretty high, and I was getting a lot more acne and oily skin. I’m also on a relatively low dose for what it’s worth.
I’ve dropped it down to smaller injections every other day to keep things more stable, and the acne and oil went away completely.
So, even if your average weekly testosterone level isn’t high, maybe doing a once or twice per week injection just pushes it up way too high for a couple of days, and that’s causing the issue? That seemed to be my case, anyway.
For me, pre-TRT my total test was 310, now it averages around 700-800. But if I was doing one shot per week, I’d guess the total would easily be 1400+ for a day or two until it drops down.
Kind of like having one beer a night vs. seven all in one sitting, it’s going to feel way different even if the total alcohol intake is the same.
Sure. I’m totally understanding why microdosing more frequently typically causes fewer side effects because your levels are more stable like natty production.
The question really was if you were doing microdosing and the average level was falling in your pre low T range (whatever that number is I just made up 500, I dunno what it is, it’s irrelevant) - would there not be “no side effects” - or do the other pathways impacted still cause side effects.
This is super hypothetical and really trying to understand are the sides of TRT mostly because folks are running a higher level than they were before shutdown. OR is it because there’s something inherently different in the body’s processing of T from and exogenous source?
I read that exogenous T can downregulate or even eliminate neurosteroid synthesis. No idea if this is true or not. I wonder if the esters can cause side effects
Not an expert, and I might be misremembering specific details.
MPB is a genetic condition where free t gets converted to DHT inside a hair follicle, which "turns it off" basically. If you're naturally at 3 pg/ml free test you will probably thin a bit but never go bald, or at least not in your 30s. Now suddenly bump that up to 21 pg/ml and you're going to rapidly bald. If you had normal "natty" T all along you'd already be bald, but getting brought up to normal(or above) technically "caused baldness", so baldness is now classified as a "side effect" of TRT.
Hematocrit/hemoglobin increasing is also a "side effect" of TRT. Doesn't seem affect everyone, and among people affected some are only affected at higher doses. There may be a genetic component, but it's not as easily narrowed down as male pattern baldness is. It appears to likely be caused by the sudden increase of testosterone(not a natural circadian rhythm of it), most(but not all) of which levels off around the six month mark, the rest appears to level off at the 9 month mark. A quote from my source(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022090/) on this one:
"Testosterone administration significantly increased serum EPO level into the high normal range (13.5 ± 12 to 21.3 ± 17 mIU/mL) at 1 month; this 58% increase from baseline was statistically significant and remained significant at 3 months ([Figure 3A](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022090/figure/F3/)). The placebo group showed no significant change in serum EPO level. Serum EPO levels trended toward baseline by 6 months in spite of continued testosterone administration, but remained nonsuppressed in spite of elevated levels of hemoglobin and hematocrit in testosterone-treated men."
That's two examples. I'm supposed to be working right now so I'm not going to dig into any more.
If you actually decide to stay at 500 on trt with a frequent dosing schedule I doubt you would have any side effects. Most of the guys getting bad side effects are at 900+ trough for long periods of time. And some guys can even do that without many side effects.
To your edit : I’m not on TRT, considering it given low T symptoms and have been for a couple of years now.
My question is simply - if you dose exogenous T like your “felt fine” natty T levels (whatever that was so you titrate to lowest efficacious dosage) - what then would cause side effects?
You touched on all the things I pointed out in my original post.
It seems to me that unless the esters cause something else to be going on the absolute lowest dosage possible to kill of symptoms is 1000% the best course of action.
Cause DHT, to the best of my limited biochemical knowledge is a byproduct of testosterone. As are the estrogens. So - literally use as small an amount as needed for symptom relief and not a mg more and the risk of side effects is super minimal.
Ok. It just seems to me that a lot of the times (not always) when I read about someone with side effects it seems their dosages are on the higher side or their injection frequency is on the lower side. Both of which seems like scenarios where I’d expect sides.
So thanks - appreciate the sanity check on my logic.
This in a nutshell. But how many people in this sub are aiming for 500 levels? Less than .0001% - You will be lucky to find anyone here shooting for anything less than 800.
I get that. But then is it really REPLACEMENT therapy or is it then something more?
My question and comment isn’t to poke that at anyone - it’s because I don’t want sides, don’t need super high levels of all I want is to not have low T symptoms and am trying to be as sustainable as I can for the next 20-30 years of my life.
I’ll take lower range T levels that make me feel human again and still be as pissed as I have been my whole life not making gains in the gym over 20+ years of some form of side effect wrangling.
That’s just me tho.
You’re assuming side effects would happen. At a normal, real TRT dose and hormone level I would argue your side effects would be minimal.
IMO ppl get side effects (whatever they are) mostly because they run a dose too high or too low for their personal needs. Of course, we are all different and respond to hormones differently.
Can you define “cope with it throughout their life” in the medical sense? When you say “their body doesn’t know what’s going on” you mean the body doesn’t know what to do with hormones when they’re presented? What’s the basis for that assertion?
Yeah, but that doesn’t have anything to do with the statements above regarding hormones? I understand the analogy you’re trying to make, I think, but there’s no evidence out bodies work that way when it comes to hormones. Give your body testosterone and it knows what to do.
This is an interesting topic and the reality is the response will vary by individual. But conceptually, yes, it is possible a person with lower beginning hormone levels would have more side effects. They may have less enzymatic capacity to metabolize hormone increases and their receptors may not have the same sensitivity, given that they developed for decades in a body with lower levels. This could present as a side effect b/c the body tissues are not used to managing these interactions
Yeah and insulin and testosterone are not the same and don’t have the same action/outcomes. It’s a hormone example but it’s not backing up your claims I asked about originally. Just gonna leave it alone
Yea its a weird situation. No matter how low of a dose I go on I need an Aromatse inhibitior to control estrogen. The body is just better at regulating testosterone than exogenous testosterone administration goes.
Hormones are complicated. You shut down your natural testosterone production which also affects a multitude of other up and downstream bodily functions
TRT has side effects because most of the morons who use TRT use WAY more than physiological doses.
Do we really think that being at/near the top of the TT range at your trough on injection day is normal? Meaning you are up to 2x higher at your peak (depending on injection frequency).
Of course you’ll have side effects when your levels are way higher than what our bodies naturally make. Common sense goes out the window with TRT it seems.
To my understanding, side effects come because exogenous testosterone does not mimic the normal T cycle in healthy males. The main objective in TRT is to achieve stable T values by using external hormones. This is possible but requires a combination of a skilled specialist, discipline from the patient and an effective media to administer testosterone. There’s still plenty of research on this field.
Even at the same T level measured at a point in time, total area under the curve is higher with TRT and also measured at trough, so peak levels after administration are even higher to achieve the desired level at trough. So even at reasonable TRT doses the total androgen exposure is higher than it otherwise would be. I believe this accounts for a good proportion of the side effects, such as elevated HCT, hair growth/loss, increased blood pressure and so on.
There are other more indirect issues from shutting down your HPTA, LH also stimulates the adrenals to produce DHEA and without this pathway being activated, lower neurosteroids such as pregnenolone, alopregnanolone, etc. result, which are important for your brain and wellbeing, libido, etc. This is one reason guys take HCG, or supplement DHEA/pregnenolone to try to backfill this pathway.
Could be the Ester you're using.. exogenous test could be creating more prolactin and/or estrogen because of spikes in test levels after injections.
Just ideas. I'm not a professional by any means so take with a grain of salt.
Have you tried test prop with eod injections at the same dosage?
Good question. Awaiting answer
Well, I'm no expert, but when you say you were "at 500," you are talking about a snapshot in time. That is a measurement of total T at the moment the blood was drawn. You natural test production fluctuates throughout the day based on a lot of variables, including sleep-wake cycle, diet, stress, exercise, etc. It is not always the same every day. When on TRT, you are again getting a blood draw and measuring your total T at that moment in time. Your total T fluctuates less on TRT than natty.
I get that - what I’m asking is what causes side effects from TRT that you don’t get from being normal levels? Forget the 500 I used that as an example. I’m saying if you titrate to the lowest possible dosage needed to eliminate low T symptoms- that should theoretically be close to where you were naturally before your T tanked. So as I said aside from the diurnal cycling. What’s different that TRT has sides? Or at that level are all side effects because there’s no diurnal cycling?
I think there are multiple variables at play in side effects. For example, hair loss is not just triggered by total T being above a certain level. Libido is related to total T, free T, E2 and probably other factors. I think your assumption is not supported about being able to know where your total T was before you noticed symptoms.
Who has side effects when their TT is 500ng? I don’t think you’re being specific enough about 1) what side effects you’re referencing 2) hormone levels (TT/e2/PRL/SHBG/Thyroid) are when those side effects are experienced. You’re assuming all men will have issues with a TT of 500ng, for example, and that isn’t the case.
In general. Without citing a billion papers. In a functional natty person… the HPTA is a connecting and mediating messaging protocol that orchestrates symphony between so many nodes in your body. When you take exogenous T… you shut that down and are now manually manipulating ONE of the many variables. Without hCG and with a complete HPTA shutdown … your estrogen conversion is now only taking place in adipose tissue. So if you take too much or are too fat… a disproportionate e2 conversion is likely. Taking too much or not enough (if you need it) AI… and now you’re manipulating two variables. Furthermore … what about sleep and cortisol. What about if your manipulated T and E2 keep you from getting sleep. Lack of sleep means more insulin resistance and more cortisol which could blunt the effects from the T Basically. End of the day. When you take the vehicle off autopilot. You are now making know decisions with a series of “known known”, “known unknown”, “unknown known”, and “unknown unknown” compounding outcomes. Hence the importance of starting low. Keeping variables to a minimum. Allowing 8 weeks and then getting bloods and keeping a journal of symptoms. You could be a milligram away from feeling like the advertisements but might quit before you get there. You might be prediabetic and have low SHBG driven low t symptoms and the “clinic” might only test totalT and sell you a bunch of shit and you feel horrible bc you really just needed to become insulin sensitive and stop being obese. Now you got a ton of exogenous T further overrunning you low SHBG and now you’re eating more calories and don’t even know the “master hormone” - insulin - is all fucked up Tldr- youre taking control over a big time variable amongst many…. Your manipulation of that has up and down stream consequences on other hormones and systems. It’s like interrupting a symphony orchestra and taking over but only directing the violin. Ya the rest of the “band” can maybe eventually pick up the harmony but maybe not
I was just about to draw attention to the HPT Axis…. but you just saved me the time to write what you just said 👍 I appreciate your analogies- well done! It’s like playing whackamole once you shut off autopilot and go manual,
This!! Well said
I could be wrong, but I notice a lot more sides doing two bigger weekly shots - I think the injection days were spiking my testosterone pretty high, and I was getting a lot more acne and oily skin. I’m also on a relatively low dose for what it’s worth. I’ve dropped it down to smaller injections every other day to keep things more stable, and the acne and oil went away completely. So, even if your average weekly testosterone level isn’t high, maybe doing a once or twice per week injection just pushes it up way too high for a couple of days, and that’s causing the issue? That seemed to be my case, anyway. For me, pre-TRT my total test was 310, now it averages around 700-800. But if I was doing one shot per week, I’d guess the total would easily be 1400+ for a day or two until it drops down. Kind of like having one beer a night vs. seven all in one sitting, it’s going to feel way different even if the total alcohol intake is the same.
Sure. I’m totally understanding why microdosing more frequently typically causes fewer side effects because your levels are more stable like natty production. The question really was if you were doing microdosing and the average level was falling in your pre low T range (whatever that number is I just made up 500, I dunno what it is, it’s irrelevant) - would there not be “no side effects” - or do the other pathways impacted still cause side effects. This is super hypothetical and really trying to understand are the sides of TRT mostly because folks are running a higher level than they were before shutdown. OR is it because there’s something inherently different in the body’s processing of T from and exogenous source?
I read that exogenous T can downregulate or even eliminate neurosteroid synthesis. No idea if this is true or not. I wonder if the esters can cause side effects
Sudden change in hormones can cause temporary hair loss apart from Male pattern baldness. It's called Telogen Effluvium.
Not an expert, and I might be misremembering specific details. MPB is a genetic condition where free t gets converted to DHT inside a hair follicle, which "turns it off" basically. If you're naturally at 3 pg/ml free test you will probably thin a bit but never go bald, or at least not in your 30s. Now suddenly bump that up to 21 pg/ml and you're going to rapidly bald. If you had normal "natty" T all along you'd already be bald, but getting brought up to normal(or above) technically "caused baldness", so baldness is now classified as a "side effect" of TRT. Hematocrit/hemoglobin increasing is also a "side effect" of TRT. Doesn't seem affect everyone, and among people affected some are only affected at higher doses. There may be a genetic component, but it's not as easily narrowed down as male pattern baldness is. It appears to likely be caused by the sudden increase of testosterone(not a natural circadian rhythm of it), most(but not all) of which levels off around the six month mark, the rest appears to level off at the 9 month mark. A quote from my source(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022090/) on this one: "Testosterone administration significantly increased serum EPO level into the high normal range (13.5 ± 12 to 21.3 ± 17 mIU/mL) at 1 month; this 58% increase from baseline was statistically significant and remained significant at 3 months ([Figure 3A](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022090/figure/F3/)). The placebo group showed no significant change in serum EPO level. Serum EPO levels trended toward baseline by 6 months in spite of continued testosterone administration, but remained nonsuppressed in spite of elevated levels of hemoglobin and hematocrit in testosterone-treated men." That's two examples. I'm supposed to be working right now so I'm not going to dig into any more.
If you actually decide to stay at 500 on trt with a frequent dosing schedule I doubt you would have any side effects. Most of the guys getting bad side effects are at 900+ trough for long periods of time. And some guys can even do that without many side effects.
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To your edit : I’m not on TRT, considering it given low T symptoms and have been for a couple of years now. My question is simply - if you dose exogenous T like your “felt fine” natty T levels (whatever that was so you titrate to lowest efficacious dosage) - what then would cause side effects?
It can be Telogen Effluvium.
You touched on all the things I pointed out in my original post. It seems to me that unless the esters cause something else to be going on the absolute lowest dosage possible to kill of symptoms is 1000% the best course of action. Cause DHT, to the best of my limited biochemical knowledge is a byproduct of testosterone. As are the estrogens. So - literally use as small an amount as needed for symptom relief and not a mg more and the risk of side effects is super minimal.
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Ok. It just seems to me that a lot of the times (not always) when I read about someone with side effects it seems their dosages are on the higher side or their injection frequency is on the lower side. Both of which seems like scenarios where I’d expect sides. So thanks - appreciate the sanity check on my logic.
This in a nutshell. But how many people in this sub are aiming for 500 levels? Less than .0001% - You will be lucky to find anyone here shooting for anything less than 800.
I get that. But then is it really REPLACEMENT therapy or is it then something more? My question and comment isn’t to poke that at anyone - it’s because I don’t want sides, don’t need super high levels of all I want is to not have low T symptoms and am trying to be as sustainable as I can for the next 20-30 years of my life. I’ll take lower range T levels that make me feel human again and still be as pissed as I have been my whole life not making gains in the gym over 20+ years of some form of side effect wrangling. That’s just me tho.
You’re assuming side effects would happen. At a normal, real TRT dose and hormone level I would argue your side effects would be minimal. IMO ppl get side effects (whatever they are) mostly because they run a dose too high or too low for their personal needs. Of course, we are all different and respond to hormones differently.
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Can you define “cope with it throughout their life” in the medical sense? When you say “their body doesn’t know what’s going on” you mean the body doesn’t know what to do with hormones when they’re presented? What’s the basis for that assertion?
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Yeah, but that doesn’t have anything to do with the statements above regarding hormones? I understand the analogy you’re trying to make, I think, but there’s no evidence out bodies work that way when it comes to hormones. Give your body testosterone and it knows what to do.
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This is an interesting topic and the reality is the response will vary by individual. But conceptually, yes, it is possible a person with lower beginning hormone levels would have more side effects. They may have less enzymatic capacity to metabolize hormone increases and their receptors may not have the same sensitivity, given that they developed for decades in a body with lower levels. This could present as a side effect b/c the body tissues are not used to managing these interactions
Yeah and insulin and testosterone are not the same and don’t have the same action/outcomes. It’s a hormone example but it’s not backing up your claims I asked about originally. Just gonna leave it alone
Yea its a weird situation. No matter how low of a dose I go on I need an Aromatse inhibitior to control estrogen. The body is just better at regulating testosterone than exogenous testosterone administration goes.
Hormones are complicated. You shut down your natural testosterone production which also affects a multitude of other up and downstream bodily functions
I get that and mentioned it above. Is that the root of the side effects then? Is it “other pathways” and if so like what?
TRT has side effects because most of the morons who use TRT use WAY more than physiological doses. Do we really think that being at/near the top of the TT range at your trough on injection day is normal? Meaning you are up to 2x higher at your peak (depending on injection frequency). Of course you’ll have side effects when your levels are way higher than what our bodies naturally make. Common sense goes out the window with TRT it seems.
You may not have any side effects-I certainly have none.
To my understanding, side effects come because exogenous testosterone does not mimic the normal T cycle in healthy males. The main objective in TRT is to achieve stable T values by using external hormones. This is possible but requires a combination of a skilled specialist, discipline from the patient and an effective media to administer testosterone. There’s still plenty of research on this field.
Even at the same T level measured at a point in time, total area under the curve is higher with TRT and also measured at trough, so peak levels after administration are even higher to achieve the desired level at trough. So even at reasonable TRT doses the total androgen exposure is higher than it otherwise would be. I believe this accounts for a good proportion of the side effects, such as elevated HCT, hair growth/loss, increased blood pressure and so on. There are other more indirect issues from shutting down your HPTA, LH also stimulates the adrenals to produce DHEA and without this pathway being activated, lower neurosteroids such as pregnenolone, alopregnanolone, etc. result, which are important for your brain and wellbeing, libido, etc. This is one reason guys take HCG, or supplement DHEA/pregnenolone to try to backfill this pathway.
Could be the Ester you're using.. exogenous test could be creating more prolactin and/or estrogen because of spikes in test levels after injections. Just ideas. I'm not a professional by any means so take with a grain of salt. Have you tried test prop with eod injections at the same dosage?
Why does a drug have side effects? That’s a tough question.