Is 200 mg of testosterone per week too high for a testosterone level of 849 ng/dL?

Testosterone Dosage Adjustment for T Level of 849 ng/dL

A testosterone dosage of 200 mg per week is too high for a testosterone level of 849 ng/dL, as this exceeds the recommended target range of 450-600 ng/dL established in clinical guidelines. 1

Appropriate Testosterone Targets and Dosing

The American Urological Association (AUA) guidelines clearly state that testosterone therapy should aim to achieve levels in the middle tertile of the normal physiologic range, specifically 450-600 ng/dL 1. With a current level of 849 ng/dL, your testosterone is significantly above this recommended target range.

Dosing Considerations:

• The AUA recommends using "minimal dosing necessary" to reach the target range 1
• Your current level (849 ng/dL) exceeds the upper limit of the recommended range by approximately 40%
• Supraphysiologic testosterone levels increase risk of adverse effects

Potential Risks of Excessive Testosterone

Maintaining testosterone levels above the recommended range can lead to several adverse effects:

1. Erythrocytosis (elevated red blood cell count)

   • Particularly common with injectable testosterone 1
   • Can increase blood viscosity and potentially aggravate vascular disease
   • Up to 43.8% of patients on intramuscular testosterone injections experience elevated hematocrit 1

2. Cardiovascular considerations

   • While recent evidence suggests testosterone replacement therapy is noninferior to placebo for major adverse cardiac events 2, this applies to appropriate dosing
   • Higher doses may increase risk of atrial fibrillation and pulmonary embolism 2

3. Fertility impairment

   • Exogenous testosterone suppresses spermatogenesis 1
   • Higher doses are more likely to result in azoospermia 1

4. Other potential risks

   • Fluid retention
   • Sleep apnea exacerbation
   • Testicular atrophy 1

Recommended Approach

1. Reduce testosterone dosage:

   • Consider reducing to 100-150 mg per week or extending the interval between injections
   • A study examining different dosage regimens found that 100 mg weekly or 200 mg every 2 weeks maintained testosterone levels within the normal range 3

2. Monitor testosterone levels:

   • Recheck total testosterone 4-6 weeks after dosage adjustment
   • Aim for levels between 450-600 ng/dL 1

3. Monitor for complications:

   • Check hematocrit regularly, as this is a common side effect of testosterone therapy, especially with injections 1
   • Monitor for symptoms of polycythemia (headache, flushing, dizziness)

Important Caveats

• Testosterone levels fluctuate with injectable formulations, with peaks shortly after injection and troughs before the next dose
• Timing of blood draws relative to injections can significantly affect measured levels
• If symptoms are well-controlled but levels remain high, consider:
  1. Drawing blood at trough (just before next injection)
  2. Reducing dose while monitoring symptom control

Remember that the goal of testosterone therapy is symptom improvement while maintaining physiologic levels, not maximizing testosterone levels. The AUA guidelines specifically recommend stopping therapy if target testosterone levels are reached without symptom improvement 1.