Dr. Mark Gordon is one of the heavyweights in TRT; he's a good friend of Dr. Crisler, and also the guy who invented the phrase "interventional endocrinology" to replace "antiaging medicine". Turns out both of these guys are moving against the standard 100 mg per week injections. Gordon said he averages about 60-80 mg per week, usually in divided doses, for his patients to reach good levels, and he doesn't use an AI for this reason (although he does use up to 160 mg per day of Zinc balanced with copper as an alternative to arimidex when needed), also because of health concerns with arimidex. The following is a quote from Gordon (taken from another forum because the original link to this quote is broken):
First off why would anyone need an estrogen blocker? Not rhetorical but, I can't hear your answer. So here is my take on this whole issue of testosterone replacement . If you replace or supplement the body with the amount of testosterone that it makes you don't run into needing estrogen blockers EBs. A number of studies from as far back as 1963 (in my collection) show that healthy solid males between the age of 25-35 produce from 4.1-10mg of T a day. That is about 60mg a week (median). So why would you need more?
I believe that the medical world has relied on the bodybuilding world for directions in how to abuse our bodies with super physiological doses of T. In 15 years with over 10,000 patient cycles (3 months) I've never used EBs to recover from E2 overload in a male. Also, Zinc blocks conversion of T to E2 by competitive inhibition of magnesium at the estradiol synthetase enzyme that we call Aromatase. So if you perform comprehensive assessments of your patients before starting hormones then add the Zn.
More than 80% of my population use 60-40mg [typo? 80 mg?] of T a week. I have some very physically active males...who use 40mg twice a week. A rare 100mg a week. I am in shock at the number of traditional physicians that start a patient on 200-300mg a week and automatically use an EB. I am even more perplexed over those of us who trained in interventional endocrinology and use excessive amounts. If we are to promote ourselves as safe alternatives to traditional medicine should we not provide that to our patients? All the best. M L Gordon. Watch for my new Medical Tidbits coming exclusively to the Anti-Aging Space.
All this is both interesting and perplexing. I don't know if Dr. Gordon does subcutaneous injections, but since I've started them I've noticed my levels get too high (with T and E2) on two different occasions, even though I was only injecting around 77 mg per week. So it's looking like, at least since going subq, Dr. Gordon's advice is likely spot on for me -- I've been injecting too much all along, causing my estrogen to get too high, and should be aiming for 60 mg a week (which is what I'm trying now, third time's a charm). It's also perplexing in that there are plenty of guys whose bloodwork shows that 100 mg or less per week clearly isn't enough. Dr. Gordon (and Crisler) also believe in supplementing pregnenolone and other hormones preceding testosterone.
On a related note, it's interesting how all the studies on subcutaneous injections use 50-60 mg per week, such as the following:http://online.liebertpub.com/doi/abs/10.1089/lgbt.2014.0018?journalCode=lgbt
(average 46.4 mg per week for average T level of 521 ng/dl)https://endo.confex.com/endo/2013endo/webprogram/Paper9064.html
(50-60 mg per week for average T level of 608 ng/dl)
Maybe we're all injecting too much?