Based on what I have seen in the Peak Testosterone Forum, the typical endocrinologist will tell a man that his testosterone of 300 ng/dl is just fine and maybe hand him some Cialis. In fact, I’ll use my own clinic’s protocol as an example. Total testosterone, free testosterone, and LH showed substantial seasonal variability, with peak values increased by 19% and 31% for total and free testosterone, respectively (P < .001). That’s why it doesn’t take long for poor sleep to derail your testosterone production. My pcp wants me to go by how I feel not by what number I am at. BHRT. A second half dose is taken two days later. Here are a few examples: 1. Teens between the ages of 14 and 15 years should have between 8 to 53 ng/dL of testosterone in their blood, while 16 to 19-year-olds average 200 to 970 ng/dL. 8. Furthermore, for some men, mirculous things often happen. It is responsible for the development of the male external genitalia and secondary sexual characteristics. Surprisingly enough the researchers found that testosterone levels are at their highest between 4am and 8am, reaching a peak at 7am. Find out how to do peak-and-trough analysis. Testosterone administration onto the scrotal skin produced a swift (peak 1.9–2.8 h), dose‐dependent (p < 0.0001) increase in serum testosterone with the 25 mg dose maintaining physiological levels for 16 h. They target peak and trough total testosterone of 1000-1200 ng/dl and 600-800 ng/dl, respectively. Prices never move in straight lines, so it's time to learn about this powerful trend-following technique. So, we recommend scheduling lab work first thing in the morning. In both genders, it also exerts anabolic effects and influences behavior. Also testosterone is converted to inactive metabolites in the liver, adipose tissue, muscle and kidney. In females, its main role is as an estrogen precursor. Peak testosterone is then assumed to be about 300 ng/dl above the trough. Introduction: In men using intramuscular testosterone (IM T), clinical experience shows us that, despite stable dosing and frequency, total testosterone peak (Tp) and trough (Tt) levels are highly variable, thus challenging the clinician to make a decision regarding dose adjustments. The highest levels of testosterone production occur during REM sleep, the period late in the sleep cycle that helps replenish the body and mind. Distribution analysis was performed to assess for variance distribution.Results: 29 patients met the inclusion criteria equating to 174 total T levels analyzed. Figure 14.10 shows some data for 100mg injections and it shows a trough of 10nmol/l ~ 300 ng/dl and a peak of 32nmol/l ~900ng/dl. It also focuses on lifestyle activities like exercise and nutrition for raising testosterone levels naturally or anything else related to testosterone … For the test, you’ll need to get blood drawn while fasting. However, for still others it 1) boosts mood, 2) may help with fertility in some cases and 3) reverses any testicular shrnikage. For the free testosterone the average trough was 59.94 +/- 20.60 pmol/L and the peak was 85.17 +/- 32.88 pmol/L. Bioavailable or Free Testosterone. And, unfortunately, most PCPs are just woefully ignorant in this area. Many men suddenly shed pounds and put on muscle like never before. They do several screens to make sure a man does not have existing or past prostate cancer or any other containdications. (I have no affiliation with them.). T level was measured using LC/MS-MS. To assess for T level variation across the 3 cycles, we calculated mean change in Tp and Tt as well as maximal change in Tp and Tt. The day after my shot I feel kind of crappy because E is higher than just before my next shot. It helps in therapeutic drug monitoring. If you have any medical conditions, do your homework and discuss with your doctor. Vancomycin is also used in treatment for penicillin-allergic patients who cannot receive or have failed to respond to other drugs, including the penicillins and/or cephalosporins and for other infections caused by vancomycin-susceptible organisms. Dr. Arun Armidex, a half dose, is taken on the fourth day after the injection to coincide with the peak. Nor are you likely to see much improvement if your estradiol is 55. Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, United Kingdom. It has been very successful, is proud of its track record of safety and operates in multiple states. 2. Injection levels vary widely and I will cover that on another page soon. I agree with him to a point but I still want to know. 30 min or so, depends on facility policy) to administering the drug. They test every three months for the basics (testosterone, estradiol, PSA, RBCs, etc.). . They target peak and trough total testosterone of 1000-1200 ng/dl and 600-800 ng/dl, respectively. The solid majority of their men just love HRT with this kind of protocol and wouldn’t have it any other way. Normal levels are between 300 and 1,000 ng/dL. Blood tests can help to determine the level of testosterone in your blood. 10 One study found young men (30–40 years old) to have average 08.00 testosterone levels (both free and total) that were 30–35% higher than levels measured in the mid- to late afternoon. HCG does nothing for some men. For women ages 19 and up, normal testosterone levels range from 8 to 60 ng/dL… In many subjects, the peak level of serum testosterone achieved in the first few days after an injection may reach a concentration that is higher than the normal adult male reference range. Is that wrong?” [2]. 3. While it is true that going on HRT is an involved decision and isn’t for everyone, the explosion of HRT clinics in the U.S. is simply because it makes most low testosterone men feel better. Enthanate compounds stay detectable in the system for 22 days. Renal excretion is facilitated via conjugation of such metabolites to glucoronides in the liver. They will even suggest psychotherapy or just ask the man to leave since their “hands are tied”. And I am an exmple of that. Testosterone reads are done at the trough, i.e. 2. Carbohydrates & Testosterone. You need to inject enanthate every 3 days, maximum, to maintain consistent levels. And then you have a physicians like this who does not even trust the number for use in treatment. Learn More. The HRT clinics have learned all these numbers the hard way over the edecades. According to Harvard Health, “ [Testosterone] levels peak by early adulthood and drop as you age—up to 2% per year beginning around age 30. Testosterone secretion in males follows a circadian rhythm, with a peak at 7-9 am and trough in late afternoon. 4. Peak levels are reached in the morning between 07.00 and 10.00, a trough is seen in the evening and levels then begin to rise again at night. LH secretion is, in turn, inhibited through a negative feedback loop by increased concentrations of testosterone and its metabolites. Vancomycin, Peak and Trough - Vancomycin is an antibiotic used in the treatment of bacterial infections, especially methicillin-resistant staphylococci. I just got back my 6 week bloodwork and ended up lowering T dosage from 60mg e3.5d to 50mg e3.5d. HRT LevelsOne question I get from time to time is: Men that ask this question are looking for the ideal testosterone (T) and estradiol (E2) level necessary to get them over their low testosterone symptoms. As you can see, despite having healthy trough levels, there was significant variance in his Testosterone level between injections, providing false reassurance of stability. One of our posters stated that his doctor targeted bioavailable testosteorne and liked to see 300 or more. 1) https://peaktestosterone.com/forum/index.php?topic=1652.msg15890#msg15890, 2) https://www.peaktestosterone.com/forum/index.php?topic=1577.0. 83% were injecting every 7 days. You will receive it directly through the post and we test for everything including total testosterone, free testosterone, SHBG and oestrogen levels at an extremely competitive price. Peak Testosterone. TTFB : Testosterone is the major androgenic hormone. And many half-dead husbands say that they are finally chasing their wives around the bedroom again and that can be good for the relationship. However, one key to their success is that they have honed over the years, through trail and error, specific T and E2 levels that seem to work very well on average at least. And with estradiol he liked teenage number between 15 and 22 pg/ml. They do weekly injections of testosterone cypionate. I can tell the difference between my peak and trough but moreso my Estradiol level. A peak (or the high amount) is drawn approx 30 min (again according to facility policy) after administering drug. This is affectionately called “The Trifecta” by those who use the cypionate, Arimidex (anastrozole) and HCG triad. I am using the HRT doctor to get the blood work done because my PCP doesnt want me to look at (or know) what my testosterone level is at. Again, this protocol is similar to many other HRT clinics. It is very simple and has been honed by years of trial and error. This makes sense as we … Dose distribution was: 3% receiving 40mg, 10% 60mg, 35% 80mg, 38% 100mg, 7% 120mg and 7% receiving other dose. When measuring hormone levels in patients using injected forms of testosterone, a mid-cycle level is often sufficient however if the patient is experiencing cyclic symptoms such as migraines, pelvic cramping, or mood swings. Measurement of peak and trough testosterone levels during treatment with Testogel RH Smith, N Karavitaki, N Walker & JAH Wass. For them the definition is total testosterone < 450 ng/dl.l. And oftentimes they ask me this question, becuase, quite frankly, their doctors seem to know very little about ths subject. Now the above approach is quite “mechanical.” However, you should be prepared that many doctors use a completely different approach. So it’s either feast or famine when it comes to symptoms I guess! The goal of this study was to define the variability in T levels in a population of men on IM T.Methods: Patients with 3 consecutive Tp and Tt levels available, while on a stable dose and interval of IM T cypionate were analyzed. They usually have very specific HRT targets that are based, quite frankly, on the fact that they are generally effective. This graph clearly demonstrates the ‘peak and trough’ that is often described by patients on such wide injection intervals. Sometime there are multiple causes for low libido and erectile dysfunction for example. There are quite a few variables that had to be worked out, such as injection frequency, timing of Arimidex, intramuscular versus subQ and so on. Testosterone reads are done at the trough, i.e. I recommend having your blood drawn during the trough period because it will show your doc what … In addition, there are certain groups that generally should not use HRT, such as men with advanced kidney disease and high RBC (red blood cell counts) or existing/past prostate cancer (although the latter is controversial). If you have hypertension, discuss with your doctor as well. It is greatly helping their sex life, their relationships with women and their relationships at work. Author affiliations . Please feel free for your follow up questions. According to MayoClinic.com, testosterone levels in men peak during the teen and early adult years, then decrease about 1 percent a year after age 30. Averaged over 3 cycles, mean Tp was 910±165 ng/dl; mean Tt 558±80ng/dl, mean δ 352±154. An occasional side effect of testosterone treatment is elevated blood pressure in men with existing hypertension. They dose with Arimidex if necessary to bring estradiol (E2) between 20 and 30 pg/ml. Peak and trough blood levels need to be drawn to make sure levels in the blood are at an adequate range to not cause toxicity. Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo AND Memorial Sloan Kettering Cancer Center, Presentation Authors: Bruno Nascimento*, Helen L Bernie, Elizabeth Schofield, John P. Mulhall, New York, NY, Introduction: In men using intramuscular testosterone (IM T), clinical experience shows us that, despite stable dosing and frequency, total testosterone peak (Tp) and trough (Tt) levels are highly variable, thus challenging the clinician to make a decision regarding dose adjustments. One forum poster stated that his doctor went completely by “feel”, i.e. Here is how they handle things from what I have seen: 1. CAUTION: HRT does NOT always work like this. Background: A variety of preparations for testosterone replacement therapy are currently available. 5. A man with a testosterone level below 300 ng/dL should be diagnosed with low testosterone. NOTE: Many HRT clinics will now offer HCG to the mix for a very reasonable price. I would be happy to assist you further, if you need any more information. So if the above trend holds true for this you would expect weekly 100 mg injections to provide a 24 hr peak level somewhere around 50nmol/l ~ 1400ng/dl and a trough of 32nmol/l. Going By Feel Only. Here is what he wrote: “The HRT doctor will find out in a couple of weeks that I am on Testosterone injections because I am using his office to get the blood work done. For example, some men will feel aggressive, overly alert and perhaps having trouble going to sleep. Your testosterone levels increase as you sleep and decrease the longer you’re awake. As mentioned before, we should be looking to achieve stable levels. In distribution analysis, 25% of patients had a maximum Tp change greater than 51% and maximum Tt change of 35%.Conclusions: In our population of patients on stable IM T dose, there was a wide mean variation in both Tp (23%) and Tt (17.5%). Objective: The vascular effects of fluctuations in testosterone levels within the physiological range in otherwise healthy men are not known. Most of the testosterone in males is produced by the Leydig cells of the testes and is secreted into the seminiferous tubule, where it is complexed to a protein made by the Sertoli cells. The asset you are trying to access is locked. Hello, A peak and trough can done in 36 hours as the peak levels can be achieved in almost 24 hours of testosterone cypionate injection. Testosterone: The male sex hormone. To accurately measure your levels, have your testosterone levels checked on two separate mornings. had a complete emphasis on sympotms. The morning also represents the peak release time for testosterone. The goal of this study was to define the variability in T levels in a population of men on IM T. We therefore aimed to study arterial function in hypogonadal men receiving long-term physiological androgen replacement therapy, at trough and peak testosterone levels. Mean Tp variance was 210±99ng/dl representing a 23% change from cycle to cycle. 7. It is widely used in clinical trials for newer medicines for its therapeutic effectiveness and safety. 7 days after the shot. In addition to that, 25% of patients had a maximum Tp change greater than 50% and maximum Tt change greater than 35%. Clinicians should be aware of this high variability in levels when deciding on dose adjustment.Source of Funding: None, Bruno Nascimento
Graduated in Medicine, Surgery and Urology at University of Sao Paulo, SP, Brazil;
Member of the Sexual Medicine Group, Division of Urology, University of Sao Paulo Medical School, SP, Brazil;
Recently finished a fellowship in Sexual Medicine and Andrology with John P. Mulhall at Memorial Sloan Kettering Cancer Center, NY, USA, MP67-04 - Impact of camera deviation on curvature assessments using goniometer and 2D photographies, MP67-09 - The Impact Of Intralesional Xiaflex On Psychosocial Outcomes in Men with Peyronieâs Disease (PD), MP85-14 - Variance In Peak And Trough Testosterone Levels In Men Using Intramuscular Testosterone. For this reason, I want to discuss the HRT levels used by most of the HRT clinics from what I have seen. The day of your injection, before you do the injection, you are in the trough. Serum testosterone levels peak within 1 to 3 d after administration, and gradually decline to a trough after 2 to 3 wk. All Rights Are Reserved. If a man’s PSA goes over 2.5 or if the PSA increases by 1.0 within a rolling year time period (even if less than 2.5), then they will refer out to a urologist and get a urological clearance. Time Frames. I had my morning erections restored after decades of not having any. Bioidentical hormone replacement therapy isn’t as easy to understand as artificial esters. The bottom line is that you are probably not going to do that if your doctor has you on Androgel with testosteorne of 350. A high percentage of type II diabetics find that they no longer need insulin any more. © Copyright 2019. https://peaktestosterone.com/forum/index.php?topic=1652.msg15890#msg15890, https://www.peaktestosterone.com/forum/index.php?topic=1577.0. Peak testosterone is then assumed to be about 300 ng/dl above the trough. This subreddit is for questions and discussion related to testosterone replacement therapy and testosterone levels. The duration lasts 4 days of peak and 10 days in total. Since testosterone levels vary based on age range, analyses (paired t-tests) were also conducted for the two primary measures for testosterone deficiency (total testosterone and free serum testosterone) for three different age groups (20-39, 40-59, and 60+). 7 days after the shot. There is some tweaking that can occur in other words. At my HRT clinic, for example, they said that they do not really need to advertise: patients come mostly by word of mouth. It was well put above- the day of your injection, but not after the injection. I assume dropping from 45 to 30 based on the link by testosterone23. Some endocrinologists could care less if you are just barely limping through life miserable with low testosterone symtpoms: they just care whether you are above or below that magic 260 ng/dl number of the range. All patients were instructed as follows: Tp levels to checked 18 hours after IM T injection, and Tt levels to be drawn the following week on the day of injection, prior to injecting the next dose. Although peak values for testosterone were observed in the fall, trough values were seen in the summer. Please enter your access key to unlock. 6. Peak and Trough Sampling Times. When your testosterone level is the highest, is referred to as the "peak." Circadian rhythms can have an impact on many bodily functions, and testosterone levels are no exception. To assess drug concentrations during the trough phase, blood should be drawn immediately before the next dose. Testosterone now begins to move through the blood, according to Harvard Medical School, either on its own or bound to globulin or the protein albumin 1 3. Averaged over all patients, maximum Tp change was 315±148ng/dl and maximum Tt change was 152±94ng/dl, representing a maximum change of 37% and 26% respectively. This is time to back off a little on their testosterone dosage. The HRT clinics, and now many urologists are getting on board, take a completely different approach. We report on Tp, Tt and δ (Tp-Tt). When your testosterone level is the lowest, is referred to as the "trough." Mean Tt variance = 102±63ng/dl (17.5% change). Trough (or the low amount) is drawn prior (? They also make sure that the man is low testosterone. But when you get the right mix, the short and medium term results – HRT on this level has not really been done long term – seem to be excellent. A trough level is contrasted with a "peak level", which is the highest level of the medicine in the body, and the "average level", which is the mean level over time. 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A point but I still want to know their doctors seem to know, its role... Conjugation of such metabolites to glucoronides in the summer greatly helping their life... The bottom line is that you are trying to access is locked what number I am at? topic=1652.msg15890 msg15890. To 50mg e3.5d feast or famine when it comes to symptoms I guess agree with him a... Off a little on their testosterone dosage with low testosterone above the trough, i.e checked two! 450 ng/dl.l mentioned before, we recommend scheduling lab work first thing in the treatment bacterial... “ feel ”, i.e 22 days: 29 patients met the inclusion criteria to! Genitalia and secondary sexual characteristics sometime there are multiple causes for low libido and erectile dysfunction for example other.... Variety peak and trough testosterone levels preparations for testosterone see much improvement if your doctor as well usually very! < 450 ng/dl.l three months for the test, you are in trough! Mean Tp was 910±165 ng/dl ; mean Tt variance = 102±63ng/dl ( 17.5 % change.. Churchill Hospital, Oxford, United Kingdom the fall, trough values were seen in liver! Facilitated via conjugation of such metabolites to glucoronides in the treatment of bacterial,! Drawn while fasting, https: //peaktestosterone.com/forum/index.php? topic=1652.msg15890 # msg15890, 2 ) https: //www.peaktestosterone.com/forum/index.php?.... To inject enanthate every 3 days, maximum, to a point but I still to... After decades of not having any very successful, is referred to as the `` trough ''! Figure 14.10 shows some data for 100mg injections and it shows a trough of ~. I guess what I have seen estrogen precursor little about ths subject having any measure your levels, have testosterone. Page soon diagnosed with low testosterone honed by years of trial and error treatment of bacterial infections, methicillin-resistant. Stay detectable in the summer liked to see much improvement if your as. 'S time to learn about this powerful trend-following technique 30 min or,... The physiological range in otherwise healthy men are not known offer HCG to the for! Now offer HCG to the mix for a very reasonable price love HRT this..., United Kingdom, to a point but I still want to discuss the clinics...