By Mike Kocsis | 7 minutes read | Last updated: July 5, 2020 Categories: Medication Testosterone TRT
Medically Reviewed by Dr. George Touliatos
Testosterone microdosing involves the administration of small, controlled amounts of testosterone as opposed to larger, but fewer doses. It is a practice gaining attention amongst various health and wellness circles, This nuanced approach to hormone optimisation aims to balance hormonal levels and enhance well-being without the drastic changes associated with larger dosing. Testosterone microdosing addresses concerns related to energy, mood, and overall vitality while minimising the potential for unwanted side effects. As this practice becomes more widely discussed, understanding the benefits and drawbacks is crucial for those exploring alternative approaches to hormonal balance.
In this article, we explore microdosing and testosterone replacement therapy, drawing insights from reputable citations and our own experiences. By the conclusion, you will have gained a more comprehensive understanding of microdosing and its significance in hormonal optimisation.
How much testosterone does a male naturally make?
In the average male, the testes produce around 5-10mg of testosterone per day. Some evidence suggests that it is closer to 6mg. So one would think that the traditional 200-250mg (given every 2 weeks) divided by the number of days would give a man his daily dosage right? This would be roughly 17mg. This unfortunately is just a number on paper and a man will not receive this total dose in even distribution over this number of days when injecting every 2 weeks.
What are the issues with large dosing in TRT?
Receiving a substantial injection of testosterone every two weeks results in a fluctuation of hormone levels, initially rising to supra-physiological levels within the initial days. Subsequently, these levels start to decline, reaching sub-therapeutic levels around the fifth day and persisting until they return to baseline by the fourteenth day. This injection pattern often leads to challenges for patients, including a surge in energy, heightened sexuality, and sometimes anxiety, followed by a recurrence of low testosterone symptoms. Described as a cycle of high peaks followed by low troughs, this fluctuation contributes to a suboptimal experience for individuals and gave rise to the popular TRT term of feeling ‘unstable’.
Understanding the “Unstable” Feeling on TRT
More recently, the term “unstable” has become commonly associated with the sensation of not feeling optimal on Testosterone Replacement Therapy (TRT). The influence of social media has heightened this anxiety among patients starting TRT. Compounded by certain doctors and social media influencers advocating a singular treatment protocol as the “best” or “gold standard,” this narrative often originates from private medical practices aiming to create anxiety and then offer a solution for financial gain. It is crucial to recognise that doctors running private practices are, in essence, running a business. Unfortunately, this approach can lead patients to doubt their current protocols or physicians, prolonging the time it takes for individuals to find an effective TRT regimen. Interestingly, older gentlemen, less influenced by internet or social media trends, tend to start TRT faster and experience optimal results quicker.
Natural production of testosterone levels is NOT stable. We are used to fluctuation. The amount of testosterone in the morning can be as much as 20% higher than the levels in the evening so even nature doesn’t give you this elusive rock bottom stability that we hear so much of in social media and from doctors. In fact the BSSM British Society for Sexual Medicine has said as much that it directs doctors in their guidelines to be aware of this when diagnosing men with testosterone deficiency.
What do the human studies say?
A PK study (Nankin HR 1987) evaluated serum levels of testosterone periodically for 14 days after administration of TC 200 mg IM in 11 hypogonadal men (Reference). The mean Cmax was supratherapeutic (1,112±297 ng/dL) and occurred between days four and five post-injection. After day 5, testosterone levels declined and by day 14 the mean Cavg approached 400 ng/dL. These large fluctuations in serum testosterone over a 2-week period illustrate the less than ideal kinetics of TC IM injections.
When working with a doctor to determine a suitable TRT protocol, it’s essential to recognise that each individual responds differently. Factors such as sex hormone-binding globulin (SHBG) levels can guide a doctor, but optimal dosing varies from daily to weekly. Patients with similar dosing and blood levels may still experience distinct outcomes. Beware of clinics, doctors, coaches, or social media influencers claiming a one-size-fits-all treatment protocol; this is likely a sales technique rather than an accurate representation of the individualized nature of TRT.
HCG and TRT microdosing
HCG (Human Chorionic Gonadotropin) is a medication designed to mimic the action of LH (Luteinizing Hormone) and is often incorporated alongside Testosterone Replacement Therapy (TRT) to provide testicular stimulation, aiding in the preservation of fertility. Some men also report improvements in ejaculate volume and occasional enhancements in overall well-being. However, it’s crucial to understand that HCG is a human-derived medication extracted from pregnant women’s urine, acting similarly to LH in the testicles but not in other areas of the body. Users have reported adverse effects, both mentally and physically, even in small doses, including acne and potential autoimmune responses, presenting as skin complaints such as rash or folliculitis patterns.
Considerations for HCG Use: Fertility and Beyond
While HCG may be beneficial for maintaining fertility, its universal application alongside TRT is not evidence-based and can lead to varied outcomes. Doctors should not suggest or imply that HCG is a necessary component for every man undergoing TRT for treatment success. The use of HCG alongside TRT has been outlined in a 2015 guide to doctors on preserving fertility (Ramasamy R, 2015). TRT, a well-established and successful treatment for decades, has been transformative for many patients without the inclusion of HCG. While HCG can be a valuable solution for fertility concerns, its incorporation into TRT should be individualized, acknowledging that results vary from feeling slightly better to experiencing increased side effects.
Do you have to change your dosing/frequency of testosterone?
As previously mentioned, some doctors advocate for daily microdosing as the exclusive approach to treating patients, possibly to instill anxiety in individuals about their current protocols and attract them for financial gain. They often assert that “daily injections or microdosing prevent the peaks and troughs of testosterone that cause patients to feel unstable.” This narrative may induce anxiety in patients who have observed episodes of heightened anxiety, a flatter mood, lower sex drive, etc. The natural response is for patients to correlate these fluctuations with the dosing patterns of their current regimen, especially if it does not involve daily injections.
An individualised approach to dosing
The reality is that some men find optimal well-being when their dosing follows a pattern of 5-7 days frequency, as opposed to daily or every other day. Some of those who have transitioned to microdosing after previously being on weekly or bi-weekly regimens have reported not feeling any different or experiencing worsened symptoms. In some cases, adjusting the dose or realizing that certain symptoms are part of the normal ebb and flow of daily life, emotions, overtraining, undereating, alcohol consumption, poor sleep patterns, etc., has proven beneficial. Alternatively, other find that microdosing helps them feel more stable.
It is important to note that despite adherence to various testosterone treatment dosing protocols, some patients may continue to experience unwanted symptoms. This could signal underlying medical issues, including hormone imbalances outside the scope of Testosterone Replacement Therapy (TRT), which require careful consideration.
So reverting to the original question – What does “feeling unstable” mean? Does it mean that you have to change the dosing/frequency of your testosterone? The answer is it is worth a try. Work with your doctor to try a different frequency or microdosing and see how you feel. Just be aware that we are all different. Where larger dosing works for some people, microdosing may not.
How can Balance My Hormones help?
We have extensive experience with hormone replacement therapy (HRT), especially testosterone replacement therapy (TRT) and work to ensure all our patients receive the best possible dosages and treatments available that work best with their body. If you are struggling with your testosterone levels or existing TRT treatment plan then contact us above to speak to one of our highly experienced consultants. We can check your blood levels and correct your hormone imbalance, we are here for you every step of the way.
View our discussion on TRT and Microdosing
References/Bibliography/Scientific studies/Further reading
Nankin HR. Hormone kinetics after intramuscular testosterone cypionate. Fertil Steril 1987;47:1004-9. 10.1016/S0015-0282(16)59237-1 [PubMed Reference] [Cross Reference]
Ramasamy R, Armstrong JM, Lipshultz LI. Preserving fertility in the hypogonadal patient: an update. Asian J Androl2015;17:197-200. 10.4103/1008-682X.142772 [PMC free article] [PubMed] [CrossRef]
Evidence Based Research
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References, sources and studies used alongside our own in-house research have been cited below, most of which contain external clickable links to reviewed scientific paper that contain date stamped evidence.
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About the Author: Mike Kocsis
Mike Kocsis has an MBA with a focus on healthcare administration and is an entrepreneur and medical case manager for Balance My Hormones Ltd which offers medical services in the UK and Europe. Mike has over 20 years of experience in the healthcare sector, much of that working with people who have hormone imbalances. Mike has appeared on podcasts and radio and is an expert speaker on the subject of hormone imbalance. He specialises in Testosterone Replacement Therapy (TRT) and Hormone Replacement Therapy (HRT) and has helped thousands of people suffering from hormone imbalances recover and regain control of their lives. You can follow him on LinkedIn and on the Balance My Hormones YouTube Channel.
Last update: July 5th, 2020
