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Testosterone Replacement Therapy Dosing and Dosage Considerations

Are you wondering how much testosterone you should take and what your weekly dosage should be? In this article we will discuss some ideas on testosterone replacement therapy dosing and dosage, like how much and how often.   

If this is something you're interested in keep reading. 

We get a lot of questions about dosing and frequency like,  "Am I on the right dose?" and  "Should I be taking it more often." These are good questions to ask because how much and how often you take your testosterone replacement therapy can dramatically change the effectiveness of the treatment.  The key is customization of your dosing. 

The exact dosage of testosterone will vary from one individual to the next.  So what tells us exactly how much testosterone you need?  The total amount of testosterone that's in your blood is a good approximation but a more specific way is to look at the free testosterone, also know as the bioavailable testosterone.  This is the distinction between free and total testosterone.  The free testosterone is unbound.  It has nothing bound to it like sex hormone binding globulin (SHBG) or any under other proteins,  These proteins limit the testosterone from binding to the testosterone receptor. 

So one person that has 1500 ng/dl of total testosterone may get similar results as someone with 700 ng/dl total testosterone.  The reason is both have the same or similar amount of free testosterone.  What should the free testosterone level be? You should target about 100 - 200 ng/dl for free testosterone. 

 

Testosterone Replacement Therapy Dosage Considerations

injection testosterone replacement therapy

If you are low in your free testosterone, your testosterone dose will reflect your free testosterone level.  Equally important is watching your level of estrogen.  Estrogen raises your sex hormone binding globulin.  So you have to control your estrogen and you have to be looking at the free testosterone to know how much testosterone you should be taking. 

On average the actual dose given per week is somewhere between 1 cc and 0.4 cc's of testosterone 200mg/ml. There is a pretty big range of actual testosterone given between those parameters.  At 0.4 cc you are getting 80mg and at 1 cc you are getting 200 mg.  The 0.4 is a lower dose and 1 cc is a higher dose.  I do have you know a few people that need 1 CC but it is few and far between.  Just to give you an idea, maybe 10-15% of my patients on testosterone replacement therapy need this much.  Most people are on the 0.5- 0.7ml range.  Your dose can vary at any given time too based on how much you are exercising, how much stress is in your life, new medications, etc. 

 

Non-Laboratory Testosterone Replacement Therapy Considerations

The other considerations have more to do with how you feel on your testosterone replacement therapy.  The biggest point to emphasize is that we don't want to focus too much on the lab values.  We don't treat the lab , we treat the human.  So instead of a heavy focus on the labs we want to treat how you feel. 

There is a limit on how much we emphasize both labs and symptoms, however.  We wouldn't not, for instance, just say take as much as you wanted until you feel good.  Typically we shoot for the minimum effective dose for optimal symptom resolution.  We are looking for you to be on the upper end of the free testosterone. With this you should experience improvement in things like sex drive, libido, and energy.  It is not advisable to take your testosterone above the upper end of the reference range for your free testosterone.  This is around 200 to 240 ng/dl.  Some people actually feel worse on that upper end.  So you have to pay attention to things like your stress level, your sleep, and things like that.  If these things are getting disrupted or you feel worse on higher levels that may be something to pay attention to.  For more on this topic check out,

Testosterone Anger and Anxiety

 

So it is not always good to just go to the upper end because you think more is better.  Sometimes it is, but not for everyone.  Keep this in mind when you and your doctor are checking your testosterone levels. 

 

Testosterone Replacement Therapy Dosing 

I also wanted to talk about dosing and how frequently you take your injection of testosterone.  Typically,  testosterone injections work in a seven day cycle. After the injection your testosterone will start to go up about 24-48 hours after your injection.  Then it will start to come down around 6-7 days. This is the typical with most people.  Sometimes people get a spike right after the shot and then it comes down quickly.  This occurs in people that are metabolizing it quicker.  For these people, we will usually switch to twice a week dosing or every 3.5 days.  They will do a smaller dose every 3.5 days.  You will only know if this is occurring if you are checking your levels frequently enough and checking in the middle of the week. 

As mentioned many times I find that people are checking their testosterone levels right before they get their injection.  When you do this, you are missing everything that happens in between, including high estrogen.  The estrogen will trail the testosterone by about a day or two.  So if you are at your peak of testosterone on day two, three, or four, then your estrogen is going to be peaking shortly after.  So you want to be checking your estrogen levels in the middle of your injection-week.  When you are taking it twice a week, this doesn't seem to matter as much.  Either way, you want to avoid checking your levels at the time when you are suppose to do an injection.  This is considered the trough levels.  

 

Hopefully this gives you a better understanding of how much and how often to administer your testosterone replacement therapy.  It should also give you a good idea of  when you should be checking your levels.  Before making changes to your testosterone replacement therapy you should always check with the prescribing doctor.  If you want to maximize the benefits of your testosterone replacement therapy, click on the link below to started with one of our doctors. 

 

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