Sustanon 500mg Dosing: Clinical Guidance
A 500mg dose of Sustanon (testosterone ester mixture) is not a standard therapeutic dose and significantly exceeds guideline-recommended testosterone replacement therapy dosing, which should be 100-200mg every 2 weeks or 50-100mg weekly for injectable testosterone esters. 1
Standard Therapeutic Dosing for Injectable Testosterone
Guideline-recommended dosing for testosterone replacement therapy is:
- 100-200mg every 2 weeks or 50-100mg weekly administered intramuscularly for testosterone enanthate or cypionate 1
- Weekly dosing of 50-100mg provides more stable testosterone levels compared to biweekly administration 1
- These can be self-administered in the thighs or given by another person in the gluteal region 1
Sustanon-Specific Considerations
Sustanon is a mixture of four testosterone esters (30mg propionate, 60mg phenylpropionate, 60mg isocaproate, and 100mg decanoate), totaling 250mg per mL 2:
- Standard Sustanon dosing is 250mg (1mL) every 3-4 weeks for hypogonadism treatment 3
- A 500mg dose represents double the standard single-dose formulation and is not supported by clinical guidelines for testosterone replacement therapy 3, 2
Critical Safety Concerns with 500mg Dosing
Supraphysiological testosterone levels (>1000 ng/dL) significantly increase adverse event risk:
- Erythrocytosis occurs in 43.8% of patients receiving intramuscular injections versus 15.4% with transdermal preparations 1
- Doses of 500mg weekly in research settings have been associated with psychological adverse effects including agitated and irritable mania-like symptoms in a minority of subjects 4
- Cardiovascular risk may be elevated with injectable testosterone, possibly due to fluctuating testosterone levels 1, 5
Recommended Approach
If testosterone replacement therapy is indicated:
- Start with 100-200mg every 2 weeks or 50-100mg weekly of testosterone enanthate/cypionate 1
- Target mid-normal testosterone levels of 450-600 ng/dL 1, 5
- Measure testosterone levels 2-3 months after initiation, checking midway between injections 1, 5
- Monitor hematocrit/hemoglobin at each visit due to erythrocytosis risk 1
Common Pitfalls to Avoid
- Do not use 500mg dosing for testosterone replacement therapy, as this exceeds therapeutic ranges and increases adverse event risk 1, 4
- Do not initiate testosterone therapy within 3-6 months of cardiovascular events 5
- Do not prescribe testosterone to men currently trying to conceive, as it interrupts spermatogenesis 5
- Consider weekly dosing over biweekly to minimize testosterone level fluctuations and potentially reduce erythrocytosis risk 1
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