Total Testosterone

When high

If elevated (on cycle / TRT):

• Supraphysiological testosterone is expected on AAS/TRT — this is NOT a problem to fix
• Monitor: haematocrit/HCT (target <52%), blood pressure, lipid panel (HDL often drops), E2 symptoms
• If HCT is elevated: donate blood or reduce dose; consider naringin 500mg/day
• If lipids are impaired: prioritise cardio (150+ min/week), omega-3 (3-4g EPA/DHA), reduce oral AAS
• If blood pressure is elevated: assess sodium intake, consider telmisartan 20-40mg/day
• Ensure regular bloodwork every 8-12 weeks while on cycle
• If the number is higher than expected, check when you drew it: a peak-timed draw inflates total testosterone badly. See How to time your blood draw on TRT

Pharmacological HCT management (when donation/dose reduction insufficient):

• Switch IM to subcutaneous testosterone -- subQ delivery produces lower peak levels and reduces erythropoietic drive; meta-analyses show ~30% reduction in erythrocytosis incidence vs IM at the same weekly dose
• Increase injection frequency (EOD or E3D) -- micro-dosing flattens peaks and troughs, often lowers HCT without any change in total weekly dose
• Split dose across multiple sites/days -- reduces the supraphysiological peak that drives EPO release
• Drop or reduce Boldenone (EQ) -- EQ is the single highest-leverage compound choice for HCT; discontinuing often resolves elevation alone
• Therapeutic phlebotomy (250-500 mL every 8-12 weeks under haematologist supervision) when donation is refused in-jurisdiction; see Haematocrit marker for full protocol
• ACE inhibitor (e.g., lisinopril 5-10mg/day) -- reduces haemoglobin 5-10 g/L via EPO suppression; physician-supervised alternative when telmisartan is contraindicated

When low

Supplements (natural support):

• Vitamin D3 -- 5000 IU/day (with fat-containing meal)
• Zinc -- 30mg/day (picolinate or citrate, before bed on empty stomach)
• Magnesium -- 400mg/day

PCT Protocol (restart attempt):

• Enclomiphene -- 12.5-25mg/day for 4 weeks
• Nolvadex -- 20mg/day to stimulate LH/FSH recovery
• HCG -- 500 IU EOD for 2 weeks pre-PCT to restore testicular sensitivity

TRT (when recovery fails, or was never going to happen):

A restart is the first move, not the only one. If total T is still below range on two morning draws at least 4 weeks apart, with symptoms, after a genuine recovery window (3-6 months post-cycle, longer after 19-nors or long esters), replacement is the honest next step rather than a fourth PCT.

• Confirm the diagnosis first. Two morning (07:00-10:00) total T readings, plus LH and FSH to separate primary (high LH, testicular) from secondary (low or normal LH, pituitary or hypothalamic). Add prolactin, TSH and a morning cortisol. Rule out the reversible causes before committing: untreated sleep apnoea, opioids, glucocorticoids, severe energy deficit and a prolactinoma all suppress testosterone, and all respond to treating the cause instead.
• If you want children in the next few years, do not start TRT. Exogenous testosterone suppresses sperm production, sometimes durably. Fertility-preserving options that raise testosterone without shutting the axis down: enclomiphene 12.5-25mg/day, HCG 500-1500 IU 2-3x/week, or HCG plus FSH in primary testicular failure. See HCG, fertility and TRT.
• Typical starting protocols, prescribed and supervised: testosterone cypionate or enanthate 100-150mg/week, split into two injections to flatten the peak-to-trough swing, or a transdermal cream or gel where injections are unwanted. Target the mid-to-upper end of the reference range on a trough draw, not a supraphysiological number.
• Consider adding HCG 250-500 IU 2x/week alongside TRT to maintain testicular volume and some intratesticular testosterone.
• Monitoring: total T (trough, immediately before the next dose), E2, full blood count for haematocrit, lipids, PSA if over 40, and blood pressure. Baseline, then 6-12 weeks after starting or changing dose, then 6-12 monthly. Haematocrit above 54% means a dose reduction or therapeutic phlebotomy, not carrying on regardless.
• Understand what you are signing up for. TRT is generally lifelong: once the axis is suppressed by replacement, stopping returns you to the same reading or lower. That is a reasonable trade for confirmed hypogonadism and a poor one for a number you have not properly confirmed.

How the process actually runs, what to ask for, and what a first appointment looks like: Starting TRT in Australia.

Lifestyle:

• Optimise sleep (7-9h) and nutrition
• Treat sleep apnoea if present: it suppresses testosterone independently of anything else
• Avoid crash dieting; a sustained large energy deficit lowers testosterone on its own