Who uses TRT? What is their TRT dosage?
Written by Leann Poston, M.D.
Who is using TRT therapy, and what dosage are they using? Approximately one percent of the U.S. population, regardless of age, gender, or intention, use anabolic-androgenic steroids (AAS) (Pope et al., 2014). We know the negative impact on health from misusing these drugs. Even more concerning is the use of designer anabolic-androgenic steroids to evade legal detection as these drugs’ side effects are typically unknown (Joseph & Parr, 2015). In this article, we explore the non-medical use of TRT. Medical use of AAS or testosterone is to restore testosterone to normal levels. Non-medical use is typically to increase testosterone levels above the normal range. It may surprise you to learn that the typical non-medical user is not a college athlete or a professional athlete.
Read Also: Is it Legal to Buy Testosterone Online?
Making a diagnosis of low-T
Testosterone replacement therapy is legal in the U.S. when prescribed by a licensed physician after making a medical diagnosis that is aligned with a need to replace testosterone hormone. This process begins with obtaining a blood panel or set of lab values that are used to determine whether testosterone levels are low and to provide some context on why they are low. A history and physical exam follow the lab evaluation. Symptoms consistent with low testosterone levels and lab values that support the diagnosis of low testosterone levels as a cause of these symptoms should back a diagnosis of low testosterone and the need to replace it.
Physiologic TRT dosage for therapy
Ideally, TRT therapy and the physician’s TRT dosage should closely match what is physiological or naturally secreted in the body. This can be challenging because testosterone levels follow a diurnal pattern, fluctuate throughout the day, and are affected by other factors such as insufficient or poor sleep.
Non-medical users of AAS, such as testosterone, may also design TRT dosage schedules to reduce the side-effects of TRT therapy on the hypothalamic-pituitary-testicular axis. In this article, we will examine some methods that are used. We advocate for none of these methods. Your physician should choose the TRT therapy dosage that is best for you. Invigor Medical has board-certified physicians licensed in your state to provide individual medical diagnosis and treatment if TRT is appropriate for you.
Testosterone Preparation Options
There are many options for testosterone replacement therapy. Liver damage from oral preparations is a major known risk factor. Oral preparations are not sold in the U.S. Testosterone injections bypass the liver and its “first-pass metabolism” and are considered a much safer alternative.
- Gels: Testosterone gels are absorbed through the skin. The biggest risk factor is inadvertently transferring testosterone to women or children.
- Patch: Testosterone patches are applied to the skin. They may cause burn-like blisters, redness, pain, or itching at the application site.
- Buccal: A testosterone patch is applied to the upper gum. The patch can cause local irritation and an unpleasant or bitter taste in the mouth, which can also impair the ability to taste foods.
- Nasal: Nasal testosterone is a gel that is squirted up into the nose. Nasal preparations can cause headaches, cough, sinus pain, and change the sense of smell.
- Implantable Pellets: Pellets are surgically implanted under the skin every three to six months. There is the risk of a skin infection or the pellets working their way out from the skin.
- Injections: Testosterone injections have been used for decades. Side effects can cause pain, redness, and bleeding at the injection site.
TRT dosage methods
Cycling is a TRT dosing method that is believed to decrease side effects. This method uses alternating active periods of AAS use for 4 to 18 weeks, followed by rest periods of 1 to 12 months. The hypothalamus is a part of the brain that stimulates LH and FSH release from the pituitary gland. LH and FSH stimulate the production of testosterone and sperm in the testes. The control of this endocrine axis is by negative feedback. When testosterone levels increase, they inhibit the hypothalamic-pituitary-testicular axis.
Testosterone injections can inhibit the production of testosterone by the testes and cause AAS induced hypogonadism. Cycling aims to promote a return to normal physiological levels of testosterone production during the rest periods and reverse AAS-induced hypogonadism (Peters et al., 1997).
Stacking is a pyramid dosing strategy in which the user gradually works up to the highest AAS dose and then back down to the low starting dose before the cycle’s conclusion (Peters et al., 1997). AAS abusers pyramid their doses in cycles of 6 to 12 weeks. This method is believed to decrease rebound or withdrawal effects, but this has not been scientifically established to be true (NIDA, 2000).
Stacking is using multiple testosterone preparations at the same time. Users may take as many as six different AAS with the goal of maximizing androgen receptor binding and activating multiple steroidal receptor sites (Peters et al., 1997). Scientific evidence does not back up the theory that this works (Clement, 2012).
Who is using AAS?
In a study, researchers surveyed 2,663 males and females from 81 countries and found that the average AAS user was 31.1 years of age with a median age of 29. Approximately 88 percent of users were Caucasian, with 4.3 percent Hispanic/Latino and 2.3 percent multi or biracial. Approximately 51 percent were never married, 38 percent were currently married, and 9 percent were divorced. More than half of respondents, 64 percent, did not have children. Approximately 2/3rds of respondents held post-secondary degrees. Most were employed as professionals and had a median income that averaged about $20,000 more than the general population.
What TRT agents and dosages are non-medical users using?
Cohen et al. (2007) found that single ester testosterones, methandrostenolone, and nandrolone decanoate were the most commonly used agents, and single and multi-ester testosterone and trenbolone were rated most effective. Average total AAS dosages ranged from less than 200 mg to over 5000 mg/week with an average of 500-1000 mg/week. Approximately 32 percent of users used 600-999 mg/week, and 52 percent of users used 200-500 mg/week. Most users said their motivation for use was increased muscle mass, increased strength, and enhanced physical appearance. Other motivations included increased confidence, decreased fat, improved mood, and increased attractiveness. Sports participation motivated only around 5-6 percent.
Respondents to the survey said that they typically cycled their doses. There was a range in cycling length, but the median was 11 weeks. Most obtained their AAS and planned the cycle before it started. Two-thirds of users stated that they always stuck with their cycle plans, and 1/3rd said they frequently did (Cohen et al., 2007).
Most users in the study (95%) injected AAS. They denied reusing or sharing needles. Researchers reported infections resulting from injections in 7 percent of users. Approximately two-thirds of users were willing to seek medical supervision, and 61 percent obtained blood work at least once per year. Those who did not seek medical supervision either mistrusted physicians or felt they were ill-informed on AAS use.
Summary of TRT dosage and therapy
Most people think AAS use for TRT would be most common in users under or around age 20 and professional athletes, but several research surveys have found that this is not the case. Why is there such a misperception of who is using TRT and the dosage they are using? Approximately 3 million Americans may have used AAS, with one million having experienced AAS dependence. Why is there so little research on AAS usage? One theory is that since AAS users’ average age is in their 30s, many people do not tell others they are using. In one study, 56% of AAS users disclosed they told none of their health care providers they used AAS, and physicians rarely asked about AAS use when taking a medical history (Pope et al., 2004). Unlike other drug use, AAS users rarely present with medical emergencies. Since the period of use is still relatively short when compared to a lifetime, long-term complications may not have presented yet (Pope et al., 2014).
One point seems clear from these researchers; AAS use is widespread. Many men state they are willing to consult with a physician for help with managing their TRT, but they do not feel that research and medical education has caught up with the need for a better understanding of the use and misuse of TRT and other AAS. Invigor Medical follows the best practices for TRT dosage and therapy. They partner with a licensed, U.S. based pharmacy to fill prescriptions for those men for whom TRT is indicated.
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.
- Pope H. G., Kanayama G., Athey A., Ryan E., Hudson J. I., Baggish A. (2014). The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: Current best estimates. American Journal on Addictions, 23, 371-377. doi:10.1111/j.1521-0391.2013.12118.x
- Joseph J. F., Parr M. K. (2015). Synthetic androgens as designer supplements. Current Neuropharmacology, 13(1), 89-100. doi:10.2174/1570159×13666141210224756
- Peters R, Copeland J, Dillon P, Beel A. Patterns and Correlates of Anabolic-Androgenic Steroid Use (Technical Report No. 48) Sydney, AU: National Drug and Alcohol Research Centre; 1997.
- National Institute on Drug Abuse. NIDA Research Report Series: Anabolic Steroid Abuse (NIH Publication No. 00-3721) Washington, DC: U.S. Department of Health and Human Services; 2000.
- Clement, C. L., Marlowe, D. B., Patapis, N. S., Festinger, D. S., & Forman, R. F. (2012). Nonprescription steroids on the Internet. Substance use & misuse, 47(3), 329–341. https://doi.org/10.3109/10826084.2011.630225
- Cohen, J., Collins, R., Darkes, J., & Gwartney, D. (2007). A league of their own: demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the United States. Journal of the International Society of Sports Nutrition, 4, 12. https://doi.org/10.1186/1550-2783-4-12
- Pope HG, Kanayama G, Ionescu-Pioggia M, Hudson JI. Anabolic steroid users’ attitudes towards physicians. Addiction. 2004;99(9):1189–1194.
- Pope, H. G., Jr, Kanayama, G., Athey, A., Ryan, E., Hudson, J. I., & Baggish, A. (2014). The lifetime prevalence of anabolic-androgenic steroid use and dependence in Americans: current best estimates. The American journal on addictions, 23(4), 371–377. https://doi.org/10.1111/j.1521-0391.2013.12118.x