What did @harveylonsdale_ actually say?
The core argument here is straightforward: TRT doses typically run 80 to 150mg weekly, the goal is to sit at the top end of the reference range (not supraphysiological), and the best strategy is to start at 150mg then adjust downward based on bloods. He explicitly said "it's very hard to find a true milligram dose based off your natural blood work" before starting TRT.
He also made a practical case for starting higher: if you overshoot, a small reduction brings you back in range. If you start low and come back suboptimal, he argued it's "much harder to gauge the push up." That's the central clinical claim worth examining. To his credit, he was clear this is about health and longevity, not sitting at supraphysiological levels, which separates this from straight-up performance enhancement content.
Does the science back this up?
Partially. The 80 to 150mg weekly range is consistent with mainstream clinical practice, but the "start high and work down" philosophy is not standard medical guidance, and there are real reasons to be cautious about it.
The Endocrine Society's 2018 clinical practice guidelines recommend titrating testosterone doses to achieve mid-to-upper normal range serum levels, typically targeting 400 to 700 ng/dL in most men, with individual variation. Starting at the higher end of a dose range without knowing how a patient metabolizes testosterone introduces unnecessary risk of erythrocytosis, elevated hematocrit, and cardiovascular strain before you even have a baseline on that patient's response.
A 2020 review by Bhasin et al. in the New England Journal of Medicine noted that interindividual variability in testosterone pharmacokinetics is significant. Two men on identical doses can land in completely different serum ranges. Starting everyone at 150mg as a default does not account for this. The claim that adjusting downward is easier than adjusting upward lacks published support and reads more as a clinical preference than an evidence-based protocol.
What did they get wrong (or right)?
He got the dose range right. 80 to 150mg weekly aligns with what most clinics use and what clinical literature describes for hypogonadal men on testosterone cypionate or enanthate. The acknowledgment that "past 150 milligrams puts you beyond the reference range" for most men is also broadly accurate.
Where this gets shakier is the blanket starting-dose approach. Saying "we start all lads on 150mg" without factoring in age, baseline hematocrit, cardiovascular risk, or SHBG levels is a real gap. SHBG levels alone can dramatically affect free testosterone response to a given dose (Vermeulen et al., 1999, Journal of Clinical Endocrinology and Metabolism). A man with low SHBG will free up far more testosterone per milligram than someone with high SHBG.
He also said it's harder to adjust upward than downward if you undershoot. In practice, both adjustments take weeks to months to stabilize. There is no strong clinical rationale that makes downward titration meaningfully simpler.
What should you actually know?
TRT is not a one-size-fits-all protocol, and starting everyone at the same dose regardless of individual factors is not how the best-practice guidelines read. The goal of sitting in the upper end of the reference range is reasonable for many men, but what that requires in milligrams varies considerably between individuals.
If you are considering TRT, the conversation with a prescribing clinician should include full bloodwork: total testosterone, free testosterone, SHBG, LH, FSH, hematocrit, PSA, and a metabolic panel. These numbers matter for determining a starting dose that is appropriate for you, not just a population average. Bhasin et al. (2010, Journal of Clinical Endocrinology and Metabolism) emphasized individualized dose titration as the standard, with monitoring at 3 and 6 months after initiation.
The point about natural bloods being hard to use as a dosing predictor is fair. Endogenous testosterone levels fluctuate and do not map cleanly onto exogenous response. But that is an argument for careful titration with monitoring, not for defaulting to the higher end of a dose range without a patient-specific rationale.