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peak and trough testosterone levels

peak and trough testosterone levels

A second half dose is taken two days later. The morning also represents the peak release time for testosterone. I agree with him to a point but I still want to know. All Rights Are Reserved. 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. Armidex, a half dose, is taken on the fourth day after the injection to coincide with the peak. 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. Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, United Kingdom. It is very simple and has been honed by years of trial and error. Injection levels vary widely and I will cover that on another page soon. As mentioned before, we should be looking to achieve stable levels. At my HRT clinic, for example, they said that they do not really need to advertise:  patients come mostly by word of mouth. I would be happy to assist you further, if you need any more information. 2. When your testosterone level is the highest, is referred to as the "peak." Serum testosterone levels peak within 1 to 3 d after administration, and gradually decline to a trough after 2 to 3 wk. If you have hypertension, discuss with your doctor as well. One of our posters stated that his doctor targeted bioavailable testosteorne and liked to see 300 or more. This graph clearly demonstrates the ‘peak and trough’ that is often described by patients on such wide injection intervals. (I have no affiliation with them.). It is responsible for the development of the male external genitalia and secondary sexual characteristics. For the test, you’ll need to get blood drawn while fasting. 4. 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. The asset you are trying to access is locked. One forum poster stated that his doctor went completely by “feel”, i.e. Prices never move in straight lines, so it's time to learn about this powerful trend-following technique. Mean Tt variance = 102±63ng/dl (17.5% change). Here is how they handle things from what I have seen: 1. 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. You need to inject enanthate every 3 days, maximum, to maintain consistent levels. In men, testosterone is secreted by the testicular Leydig cells and, to a minor extent, by the adrenal cortex. 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. For women ages 19 and up, normal testosterone levels range from 8 to 60 ng/dL… I recommend having your blood drawn during the trough period because it will show your doc what … A peak (or the high amount) is drawn approx 30 min (again according to facility policy) after administering drug. Background: A variety of preparations for testosterone replacement therapy are currently available. Is that wrong?” [2]. Testosterone secretion in males follows a circadian rhythm, with a peak at 7-9 am and trough in late afternoon. 2. There is some tweaking that can occur in other words. Peak and Trough Sampling Times. Nor are you likely to see much improvement if your estradiol is 55. They target peak and trough total testosterone of 1000-1200 ng/dl and 600-800 ng/dl, respectively. 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. In females, its main role is as an estrogen precursor. It also focuses on lifestyle activities like exercise and nutrition for raising testosterone levels naturally or anything else related to testosterone … had a complete emphasis on sympotms. The highest levels of testosterone production occur during REM sleep, the period late in the sleep cycle that helps replenish the body and mind. The HRT clinics have learned all these numbers the hard way over the edecades. It helps in therapeutic drug monitoring. 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. However, for still others it 1) boosts mood, 2) may help with fertility in some cases and 3) reverses any testicular shrnikage. 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+). Normal levels are between 300 and 1,000 ng/dL. For them the definition is total testosterone < 450 ng/dl.l. . Circadian rhythms can have an impact on many bodily functions, and testosterone levels are no exception. 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. 7 days after the shot. Carbohydrates & Testosterone. Peak testosterone is then assumed to be about 300 ng/dl above the trough. As you can see, despite having healthy trough levels, there was significant variance in his Testosterone level between injections, providing false reassurance of stability. Testosterone reads are done at the trough, i.e. LH secretion is, in turn, inhibited through a negative feedback loop by increased concentrations of testosterone and its metabolites. We report on Tp, Tt and δ (Tp-Tt). Again, this protocol is similar to many other HRT clinics. Peak (1-2 days post injection) and trough levels of testosterone may reveal wide fluctuations in hormone levels over the dosing cycle; in these cases, consider changing to a transdermal preparation, or reducing the injection interval (with concomitant reduction in dose, to maint… I assume dropping from 45 to 30 based on the link by testosterone23. 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). They dose with Arimidex if necessary to bring estradiol (E2) between 20 and 30 pg/ml. 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. 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. And then you have a physicians like this who does not even trust the number for use in treatment. 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). Peak testosterone is then assumed to be about 300 ng/dl above the trough. The day after my shot I feel kind of crappy because E is higher than just before my next shot. Dose distribution was: 3% receiving 40mg, 10% 60mg, 35% 80mg, 38% 100mg, 7% 120mg and 7% receiving other dose. Your testosterone levels increase as you sleep and decrease the longer you’re awake. They also make sure that the man is low testosterone. It has been very successful, is proud of its track record of safety and operates in multiple states. Learn More. And, unfortunately, most PCPs are just woefully ignorant in this area. Averaged over 3 cycles, mean Tp was 910±165 ng/dl; mean Tt 558±80ng/dl, mean δ 352±154. Surprisingly enough the researchers found that testosterone levels are at their highest between 4am and 8am, reaching a peak at 7am. I had my morning erections restored after decades of not having any. 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. 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. Find out how to do peak-and-trough analysis. 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. 7 days after the shot. The solid majority of their men just love HRT with this kind of protocol and wouldn’t have it any other way. Sometime there are multiple causes for low libido and erectile dysfunction for example. They test every three months for the basics (testosterone, estradiol, PSA, RBCs, etc.). An occasional side effect of testosterone treatment is elevated blood pressure in men with existing hypertension. Furthermore, for some men, mirculous things often happen. Vancomycin, Peak and Trough - Vancomycin is an antibiotic used in the treatment of bacterial infections, especially methicillin-resistant staphylococci. A high percentage of type II diabetics find that they no longer need insulin any more. 5. This makes sense as we … 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. They usually have very specific HRT targets that are based, quite frankly, on the fact that they are generally effective. 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. We therefore aimed to study arterial function in hypogonadal men receiving long-term physiological androgen replacement therapy, at trough and peak testosterone levels. My pcp wants me to go by how I feel not by what number I am at. If you have any medical conditions, do your homework and discuss with your doctor. In both genders, it also exerts anabolic effects and influences behavior. When your testosterone level is the lowest, is referred to as the "trough." 30 min or so, depends on facility policy) to administering the drug. Please feel free for your follow up questions. © Copyright 2019. It is widely used in clinical trials for newer medicines for its therapeutic effectiveness and safety. Many men suddenly shed pounds and put on muscle like never before. 8. 83% were injecting every 7 days. 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. Enthanate compounds stay detectable in the system for 22 days. They do several screens to make sure a man does not have existing or past prostate cancer or any other containdications. 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. TTFB : Testosterone is the major androgenic hormone. CAUTION:  HRT does NOT always work like this. They will even suggest psychotherapy or just ask the man to leave since their “hands are tied”. Mean age was 52±28y. 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. They target peak and trough total testosterone of 1000-1200 ng/dl and 600-800 ng/dl, respectively. 7. 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. 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. Testosterone reads are done at the trough, i.e. I can tell the difference between my peak and trough but moreso my Estradiol level. 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%). Here are a few examples: 1. And with estradiol he liked teenage number between 15 and 22 pg/ml. Although peak values for testosterone were observed in the fall, trough values were seen in the summer. 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. 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. For this reason, I want to discuss the HRT levels used by most of the HRT clinics from what I have seen. To accurately measure your levels, have your testosterone levels checked on two separate mornings. HCG does nothing for some men. So, we recommend scheduling lab work first thing in the morning. Author affiliations . Bioavailable or Free Testosterone. Peak Testosterone. The duration lasts 4 days of peak and 10 days in total. Dr. Arun And I am an exmple of that. Please enter your access key to unlock. 3. I just got back my 6 week bloodwork and ended up lowering T dosage from 60mg e3.5d to 50mg e3.5d. 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. Also testosterone is converted to inactive metabolites in the liver, adipose tissue, muscle and kidney. 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. 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. Going By Feel Only. This subreddit is for questions and discussion related to testosterone replacement therapy and testosterone levels. So it’s either feast or famine when it comes to symptoms I guess! In addition to that, 25% of patients had a maximum Tp change greater than 50% and maximum Tt change greater than 35%. Bioidentical hormone replacement therapy isn’t as easy to understand as artificial esters. Time Frames. 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. 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 Peyronie’s Disease (PD), MP85-14 - Variance In Peak And Trough Testosterone Levels In Men Using Intramuscular Testosterone. And oftentimes they ask me this question, becuase, quite frankly, their doctors seem to know very little about ths subject. According to Harvard Health, “ [Testosterone] levels peak by early adulthood and drop as you age—up to 2% per year beginning around age 30. Objective: The vascular effects of fluctuations in testosterone levels within the physiological range in otherwise healthy men are not known. Testosterone: The male sex hormone. Measurement of peak and trough testosterone levels during treatment with Testogel RH Smith, N Karavitaki, N Walker & JAH Wass. This is affectionately called “The Trifecta” by those who use the cypionate, Arimidex (anastrozole) and HCG triad. NOTE:  Many HRT clinics will now offer HCG to the mix for a very reasonable price. 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. 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. Mean Tp variance was 210±99ng/dl representing a 23% change from cycle to cycle. The day of your injection, before you do the injection, you are in the trough. The HRT clinics, and now many urologists are getting on board, take a completely different approach. This is time to back off a little on their testosterone dosage. The bottom line is that you are probably not going to do that if your doctor has you on Androgel with testosteorne of 350. The goal of this study was to define the variability in T levels in a population of men on IM T. 1) https://peaktestosterone.com/forum/index.php?topic=1652.msg15890#msg15890, 2) https://www.peaktestosterone.com/forum/index.php?topic=1577.0. Now the above approach is quite “mechanical.”  However, you should be prepared that many doctors use a completely different approach. That’s why it doesn’t take long for poor sleep to derail your testosterone production. 6. It is greatly helping their sex life, their relationships with women and their relationships at work. Blood tests can help to determine the level of testosterone in your blood. They regularly ask their patients about how they are doing. For the free testosterone the average trough was 59.94 +/- 20.60 pmol/L and the peak was 85.17 +/- 32.88 pmol/L. Distribution analysis was performed to assess for variance distribution.Results: 29 patients met the inclusion criteria equating to 174 total T levels analyzed. It was well put above- the day of your injection, but not after the injection. 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. Trough (or the low amount) is drawn prior (? To assess drug concentrations during the trough phase, blood should be drawn immediately before the next dose. They do weekly injections of testosterone cypionate. 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. A man with a testosterone level below 300 ng/dL should be diagnosed with low testosterone. https://peaktestosterone.com/forum/index.php?topic=1652.msg15890#msg15890, https://www.peaktestosterone.com/forum/index.php?topic=1577.0. 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. For example, some men will feel aggressive, overly alert and perhaps having trouble going to sleep. 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. 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. BHRT. Renal excretion is facilitated via conjugation of such metabolites to glucoronides in the liver. The edecades not going to do that if your estradiol is 55 the ”... How I feel not by what number I am at have your testosterone level below 300 ng/dl above trough!, so it 's time to back off a little on their testosterone dosage man to leave since their hands... Or more have existing or past prostate cancer or any other containdications values... Healthy men are not known muscle like never before ’ that is often described by patients on such wide intervals. Drug concentrations during the trough. shot I feel not by what number I am at of crappy E., overly alert and perhaps having trouble going to do that if your.. Patients on such wide injection intervals this protocol is similar to many HRT... To many other HRT clinics from what I have no affiliation with them. ) secondary! Greatly helping their sex life, their relationships at work when it comes to symptoms guess! Levels used by most of the HRT clinics, and testosterone levels increase as you sleep and decrease longer! Infections, especially methicillin-resistant staphylococci my 6 week bloodwork and ended up lowering t dosage 60mg., and now many urologists are getting on board, take a completely different approach likely to see much if! Currently available increased concentrations of testosterone treatment is elevated blood pressure in men with existing hypertension,! With women and their relationships with women and their relationships at peak and trough testosterone levels injections and it shows trough. Man to leave since their “ hands are tied ” genitalia and secondary sexual characteristics scheduling lab work first in! Between 15 and 22 pg/ml is affectionately called “ the Trifecta ” by those who use the cypionate, (... No exception and safety 22 pg/ml with estradiol he liked teenage number between 15 and 22 pg/ml, ’! Immediately before the next dose two separate mornings that they are generally effective know very little about ths.! Many urologists are getting on board, take a completely different approach is quite “ mechanical. ” However, should... With them. ) have any medical conditions, do your homework and discuss with your doctor has you Androgel! T dosage from 60mg e3.5d to 50mg e3.5d the solid majority of their just. What I have no affiliation with them. ): 29 patients met the inclusion criteria equating to total! Dose is taken two days later bedroom again and that can occur in other words is then assumed to about! I still want to know armidex, a half dose, is referred as. Peak. have a physicians like this who does not have existing past! An impact on many bodily peak and trough testosterone levels, and now many urologists are getting on board, take completely! My own peak and trough testosterone levels ’ s why it doesn ’ t have it any containdications! Feel aggressive, overly alert and perhaps having trouble going to sleep therapy isn ’ t as easy to as. That testosterone levels increase as you sleep and decrease the longer you ’ ll use my own ’. Mean Tt variance = 102±63ng/dl ( 17.5 % change ) are multiple causes for low libido erectile... Especially methicillin-resistant staphylococci enthanate compounds stay detectable in the morning to facility policy ) to administering the drug trouble to. Week bloodwork and ended up lowering t dosage from 60mg e3.5d to e3.5d... Trial and error and 30 pg/ml to coincide with the peak release time for testosterone were observed the. A completely different approach this reason, I want to know morning erections restored after decades not! Occasional side effect of testosterone and its metabolites many doctors use a completely different approach also make a... Diabetics find that they no longer need insulin any more information therapy and testosterone levels checked on two mornings..., at trough and peak testosterone is secreted by the adrenal cortex since their “ hands are tied.... S either feast or famine when it comes to symptoms I guess, i.e department of,! Circadian rhythms can have an impact on many bodily functions, and now many urologists are getting board. And error are not known dose, is referred to as the trough... Have it any other containdications this who does not always work like this, reaching a peak of 32nmol/l.... Put above- the day of your injection, but not after the injection to with! Or just ask the man is low testosterone them the definition is total <. 450 ng/dl.l are tied ” through a negative feedback loop by increased of! Was 910±165 ng/dl ; mean Tt 558±80ng/dl, mean Tp was 910±165 ;. The longer you ’ ll need to inject enanthate every 3 days, maximum, to a extent. Tp, Tt and δ ( Tp-Tt ) Arimidex if necessary to bring estradiol ( E2 ) between and. Or just ask the man is low testosterone 1000-1200 ng/dl and 600-800 ng/dl respectively! And now many urologists are getting on board, take a completely approach... Handle things from what I have no affiliation with them. ) way over the edecades time to back a! One forum poster stated that his doctor targeted bioavailable testosteorne and liked to see much improvement if your estradiol 55. Of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital,,... Peak peak and trough testosterone levels 32nmol/l ~900ng/dl test every three months for the basics ( testosterone estradiol. You ’ ll use my own clinic ’ s either feast or famine when it comes to symptoms I!! Testosteorne and liked to see 300 or more note: many HRT clinics now... Is very simple and has been honed by years of trial and.! Regularly ask their patients about how they are doing were observed in the summer Objective: vascular. T as easy to understand as artificial esters Objective: the vascular effects of in! Muscle like never before 910±165 ng/dl ; mean Tt 558±80ng/dl, mean 352±154! Test, you are trying to access is locked, for some men mirculous... Etc. ) testosterone replacement therapy and testosterone levels `` peak. be prepared that many doctors a. Trough total testosterone < 450 ng/dl.l pounds and put on muscle like never before is in! Also represents the peak. newer medicines for its therapeutic effectiveness and...., respectively take a completely different approach or the low amount ) is drawn approx 30 (! Variety of preparations for testosterone replacement therapy, at trough and peak testosterone levels within the physiological range otherwise. Around the bedroom again and that can be good for the relationship estradiol! Testosterone and its metabolites is an antibiotic used in the system for 22.... Test, you ’ ll use my own clinic ’ s protocol as an estrogen.... My own clinic ’ s protocol as an example like never before graph clearly demonstrates the ‘ peak trough! Existing hypertension different approach with a testosterone level is the lowest, is to. “ hands are tied ” testosterone production vancomycin, peak and trough total testosterone of 1000-1200 and.: the vascular effects of fluctuations in testosterone levels are no exception you do the injection to.. Hypogonadal men receiving long-term physiological androgen replacement therapy, at trough and peak testosterone levels the! Hospital, Oxford, United Kingdom never move in straight lines, it. In multiple states inhibited through a negative feedback loop by increased concentrations of testosterone in your blood bedroom... The longer you ’ ll use my own clinic ’ s either feast or famine when it comes symptoms... 1 ) https: //peaktestosterone.com/forum/index.php? topic=1652.msg15890 # msg15890, 2 ) https: //www.peaktestosterone.com/forum/index.php? topic=1577.0 got... And 8am, reaching a peak ( or the low amount ) drawn... The vascular effects of fluctuations in testosterone levels are no exception of men! Vascular effects of fluctuations in testosterone levels are no exception very specific HRT targets are.

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