Hello and thankyou for approaching DoctorSpring with your query.
I have gone through your tests, and from the tests before treatment, it shows that you had primary hypogonadism.
What your doctor has said is right. Testosterone acts by a threshold level, which means that any level above a set minimum level of threshold works well, and no further amount of the increasing will help.
In addition excess of testosterone also has its side effects. In a patient using gel, the normal value is 400-700ng/dl . In your case you are withing normal range but you repeat your test in 3months to make sure the level is maintained.
Normaliztion of your testosterone levels will lead to an increase in libido, muscle gain, bone density and the confidence. Over a few months you will feel there is a further increase in the positive benefits that you are already experiencing.
Hence my advise to you is continue with the same dose and get your testosterone and LH levels repeated in another 3 months.
I hope this has helped. Feel free to follow up with any further query.
Thankyou
Patient replied :
Thank you for answering my question, but I really need to clarify some things.
First of all, my total testosterone levels were in the MINIMUM normal range at their PEAK (2 hours after I applied the gel). You are telling me that it literally makes no difference whether the total testosterone is 400 ng/dL or 900 ng/dL?? Don't most 25 year olds have closer to 700-900 ng/dL total testosterone?? So, wouldn't it make sense to have the total testosterone level be normal for my age?
Second, when you wrote that "Over a few months you will feel there is a further increase in the positive benefits that you are already experiencing", do you mean that over the next 3 months I will experience an increase in benefits, meaning MORE than I already have experienced? Like that I haven't experienced all the effects of TRT yet? I thought it took only up to six weeks to feel the full effects of it (according to most of the literature on it, and I have been on it for about 13 weeks now).
Third, what happens if I FEEL like I have retracted in its positive effects, like they became less (which I do, this is the whole reason I brought up the question), even if the total testosterone IS within normal range? Is it not possible for me to have an optimal level (within normal range) that actually would make a difference?
Thank you for taking the time to fully answer my questions. I very much appreciate it.
Hello,
Please allow me to explain. First of all it is difficult to predict the levles when you are using a gel. So it is possible that you are having a higher T levels at some point of time.
You are seeing the T levels are a numerical concept. There are many more factors interplaying making it much complex. Imagine there is an cinema hall with 100 seats. Even if you allow 200 or 300 people inside the hall still only 100 people can still sit. Similarly once all the testosterone receptors are activated , there is no point in pumping more T. And remember we are supplementing for hypogonadism (so the normal self regulatory mechanisms of the body won't act fully).
Moreover, if there is increased testosterone it can lead on to lot of side effects like prostate enlargement, erythrocytosis, sleep apnoea and most importantly decreased sperm production. If you have noticed the FSH and LH values after T supplementation you might have noticed that they have actually come down. This is because of the negative feedback effect of T on FSH and LH. The hormone LH is required for normal sperm production. So if the T levels go high it can reduce LH levels thereby impairing sperm production. I am sure that you would not want that to happen.
Bottomline is your levels are good enough and there is no reason for concern here.
Hope this helps
Feel free to ask followups
Thank you
Patient replied :
Okay, so I am starting to understand the concept now. I do have a few more questions though: If it is difficult to predict and manually control the levels of testosterone through the gel, which form of TRT would you recommend in order to more accurately predict the levels? How do I really know if ALL the testosterone receptors are activated? Is there any way to get an accurate indication of that? And lastly, if all the testosterone receptors are activated, then why do men who take steroids in order to highly increase their testosterone levels WAY ABOVE the maximum, have great increase in muscle size and development? I have no interest in taking steroids, I just want to know how this all works. Thank you.
Testosterone levels above normal is a good enough indication that the gel is working. There is no need for precise control (not possible either) . I generally prefer gels like AndroGel, Testim.
And exactly what ever you have mentioned in body builders is correct. You do not want to over do the testosterone dose and have side effects. You will be able to supersaturate the receptors, but then you will supress the LH levels causing negative side effects. The dose in needed can be adjusted by monitoring the blood values in long term.
Hope this helps
Thank you