Keywords: BodyBuilding Testosterone Dosage, TRT, Low-T, Free Testosterone, Testosterone levels. Anabolic Steroids, Physique Athlete, LabCorp, Quest
According the American Urologic Association (AUA) Guidelines, a testosterone value of less than 300ng/dL is recommended as a reasonable cutoff to support the diagnosis and confirmation of low testosterone (Low-T). The AUA guidelines are the most often utilized guidelines for diagnosing and managing Low-T. Other medical guidelines report a recommendation of 250ng/dL or 350nd/dL as a serum testosterone value for the laboratory diagnosis of Low-T. The 300ng/dL value for the diagnosis of Low-T was established by the FDA and used by many insurance companies in order to establish a diagnosis of Low-T and cover testosterone medication. However, some men experience signs and symptoms of Low-T despite their serum testosterone level being within the normal reference range. The normal reference range of testosterone can be between 300ng/dL – 800ng/dL depending on which laboratory and assay utilized. For example the two most popular and largest laboratory testing sites are LabCorp and Quest. The LabCorp testosterone assay has a normal testosterone reference range of 264-916 ng/dL. In comparison the Quest Lab testosterone assay has a normal testosterone reference range of 250-1100ng/dL. While both laboratories are roughly within a similar range, there exists variability.
Given the wide range of normal testosterone level values, men can still exhibit signs and symptoms of Low-T despite their testosterone being in the reference rage. If all other causes for symptoms of Low-T have been excluded and a man’s serum testosterone level is within the low normal reference range, a clinical argument can be made for a trial period of testosterone. If symptoms are improved with testosterone replacement therapy, a patient can continue on testosterone replacement therapy (TRT). Cut off values should not be utilized as a hard-fast rule, but rather interpreted in coordination with the patient’s signs and symptoms.
Do I have need to have a testosterone value below 300ng/dL in order to get Testosterone replacement therapy (TRT)?
No. Not all men respond to testosterone the same. For example, a man who has testosterone level of 500ng/dL may not exhibit signs and symptoms of Low-T, while another man with the same testosterone value of 500ng/dL may have significant signs and symptoms of Low-T. A clinical judgement can be made that a man can still be on testosterone replacement therapy even if their serum testosterone value falls within the normal reference range.
How should I use free testosterone during my testosterone therapy management?
The AUA guidelines do not provide a recommendation on the utilization of free testosterone in the work up and management of Low-T. Several clinicians and studies have argued and demonstrated, respectively, that free testosterone is a more clinically relevant maker of low testosterone symptoms in a man.
While total testosterone is excellent indicator and marker of a man’s androgen status, total testosterone is invariably affected by other parameters such as sex hormone binding globulin concentrations. If man has a total testosterone level that is within the normal reference range, but free testosterone is low ( < 100pg/mL or <1.5ng/dL) , testosterone therapy can still and should be warranted.
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What is a common body building regimen and dosage of testosterone replacement therapy?
It is estimated approximately 1-3 million men in the United States use testosterone recreationally. In and among bodybuilding athletes the majority of high doses of testosterone and steroid use is guided on anecdotal evidence, word of mouth rather than clinical trials and guidelines. As thus, most regiments among elite athletes is difficult to uncover, yet several investigations and sources have concluded some of the following information.
Testosterone is often combined with other anabolic agents and used in cyclic fashion often between 4-12 weeks in duration. After this time most athletes report a plateau effect and increasing unwanted side effects. As thus, intervals of steroid rest, often termed cycling, exists before resuming the anabolic steroid regimen.
More experienced bodybuilding athletes often have rest cycles of steroid use between 4-6 weeks before resuming the cycle. More regular and recreational users of have several months of steroid free intervals before resuming anabolic steroids. Resting provides medication to clear from the body, reducing overt side effects and reduce the plateau effect.
Testosterone regimens for bodybuilders can range from 500mg to 1000mg IM weekly. Other athletes, use may use a weight-based regiment of 1mg/kg.
Combining testosterone with other anabolic steroid agents has been practiced by 88% of men desiring a bodybuilding physique.
Stacking is a term often used to describe the addition of multiple medications together to enhance their synergistic properties.
Other non-steroidal agents that bodybuilding and other physique athletes may use include Ephedrine, L-Thyroxine, Growth Hormone, Furosemide, Tamoxifen, Anastrozole.
What is the goal testosterone level a clinician should try to achieve when administering testosterone replacement therapy to a male patient?
According to the AUA guidelines the treatment goal of testosterone replacement therapy is to achieve a serum testosterone level of 450-650ng/dL. If the goal of of therapy is to alleviate symptoms of Low-T, some men may require a higher goal to be reached such as 750-1000ng/dL to achieve the benefits of testosterone replacement therapy. Goals of therapy should be individualized and tailored to the patient’s symptoms rather than to an exact number. While serum testosterone levels greater than 1000ng/dL can raise the risk to benefit ratio, therapy should be guided by symptom relief, reduce unwarranted side effects and safe and monitoring of acceptable laboratory values of Hemoglobin, Hematocrit, Liver Function Tests , and Prostate Specific Antigen among others.