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By Mike Kocsis | 7 minutes read |
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    what is microdosing and testosterone replacement therapy

    Microdosing refers to dosing testosterone in lower doses but usually every day or every other day. It has been discussed a lot before and has been discussed again a lot recently by doctors in the social media space particularly. In this article we will examine microdosing and testosterone replacement therapy using citations and references and our own experience and by the end of it you should have a better understanding of how microdosing works and why it’s important.

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    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 when dosing is large and infrequent in TRT?

    Being injected with a large bolus of testosterone every 2 weeks it leads to levels rising and then falling from sometimes supra physiological levels within the first few days and then levels begin to drop to sub-therapeutic levels from 5 days to then reaching these levels by day 14. If injected in this way patients often experience issues from massively elevated energy, sexuality, sometime anxiety, followed by a return of symptoms of low testosterone.  It is a large peak followed by a low trough that causes men to feel suboptimal and where the term “unstable” originated from.

    More recently the term “unstable” is more commonly used when describing not feeling optimal on TRT. Social media influence has made this quite a common anxiety in patients starting TRT. This is also worsened by some doctors and aocial media gurus that often choose one type of treatment protocol and profess that this one way of injection frequency is “The best” or “Gold Standard”. This has developed from the area of private medicine where TRT doctors use this approach to create anxiety in patients about their current protocol whilst offering a solution to the anxiety that the doctor initially created. This is a manipulative sales technique that has been around for a long time. which drives anxious patients to them so that they can make more money in private practice.  People often forget that doctors with their own private practices are running a business to make money for themselves. Unfortunately it is often at the cost of making patients doubt their protocol or current doctor which actually then lengthens the time it can take for someone to get dialled in. We now commonly see that the guys that get dialled in fastest and feel the best quickly are often some of the older gentlemen that do not really use the internet or social media.

    A PK study 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.

    Reference: 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]

    It is key to note that when a doctor is working with a patient to find a protocol that works that each person has to find what works for them. This generally will fall somewhere between daily to weekly dosing. SHBG levels can be a guide for a doctor but even then it does not always mean that a person with lower levels of SHBG will feel better with frequent dosing and someone with high SHBG levels, more infrequent.  A number of patients can have similar dosing, similar blood levels and feel completely different. Men who have tried daily injections or creams and had great numbers may not feel as good as when they do a weekly or twice weekly injection, and vice versa.  Nothing can be ruled out as an option therefore it is sensible to be wary of a clinic/doctor/coach/social media guru saying that there is only one type of treatment protocol that works, this is likely a sales technique as mentioned before.

    HCG and TRT microdosing

    HCG is a medication that mimics action of LH (but is not LH), and is used by men alongside TRT to provide stimulation to the testicles to help maintain fertility, and some men report better ejaculate volume and sometimes feeling slightly better.  However, it is human derived medication extracted from pregnant women’s urine, it is not LH it acts like it on the testicle but does not in other areas of body, it does cause men not to feel good (they report feeling unwell mentally and physically even is small doses), it can cause acne and an autoimmune type response in some presenting in skin complaints (acne/rash/folliculitis pattern) or general malaise. This would make sense being a human derived medication. If it is needed to maintain fertility and a man feels ok with it then this is great, however it cannot be suggested by doctors or otherwise that this has to be given to every man on TRT for treatment to work, in fact this is not evidence based and is poor practice. TRT has been around as a successful treatment for decades and in 2015 an algorithm was made to help give doctor an idea of how to use HCG with TRT to maintain fertility, not to make TRT outcomes better (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] ). TRT has been life changing for patients for a long time and HCG offers a solution for fertility if a patient is worried about it. It cannot be said that TRT treatment is better with HCG at any dose for all men as it is not evidence based and results in practice definitely show mixed results of feeling slightly better to feeling a lot worse and increase in side effects when HCG is used alongside TRT.

    What does ‘feeling unstable’ mean?

    Natural production of testosterone levels are NOT stable. We are used to fluctuation. The amount of the 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 doctor. 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.

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    Do you have to change your dosing/frequency of testosterone?

    Recently, as mentioned above, doctors promoting microdosing daily as the only way of treating patients (so that they can create anxiety in patients about their current protocol with the aim of attracting patients for financial gain) often use the description of “daily injections or microdosing preventing peak and troughs of testosterone that cause are the cause of why patients feel unstable”.  Obviously this would create anxiety in a patient if they have noted that they had an episode of more anxiety, flatter mood, lower sex drive etc. and would naturally and understandably cause patients to create a correlation in their brain that the peaks and troughs that they “must be experiencing from their protocol which is not currently daily injections” is the reason why sometimes they feel good and sometimes they feel not so good. The fact is some men only feel better when their dosing and associated peaks and troughs are of a pattern of 5-7 days frequency and not daily or every other day.  Men who have worked with the doctor to try microdosing after having been on weekly or bi weekly have often found that they actually don’t feel any different or worse and now have to inject more often and that some of the symptoms they were feeling before could be improved by changing dose or were actually just the normal ebbs and flow of daily life, normal emotions overtraining, undereating, maybe consuming a few too many alcoholic drink, poor sleep patterns etc. It is sometimes found that there are some patients no matter the testosterone treatment dosing protocol they may still have some unwanted symptoms and this can be a sign of other medical issues including other hormone imbalances outside of TRT that need to be considered.

    So reverting back to the original question What does “feeling unstable” mean? Does it mean that you have to change your 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 but be aware that we are all different and as every other day every 3,4,5,6,7 days dosing does not work for some people, microdosing may not work for you.

    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 below to speak to one of our highly experienced consultants who can check your blood levels and correct your hormone imbalance, we are here for you every step of the way.

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    View our discussion on TRT and Microdosing


    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.

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    Last update: April 6th, 2021

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