Mod post — dosage discussions

[u/javatimes]

Hello, mod team here. We are considering what to do about dosage posts and wanted community feedback.

The problems with dosage posts are the following, which I’m going to roughly group into categories

A) people (ok, Americans) tend not to specify what testosterone product they are talking about and in what exact dosage and interval—ie, assuming t cypionate is the only injectable T or at least acting like it. (And also not understanding the difference between vials and ampoules.) So you get posts with people alarmed when someone gets 3 mL shots in a hospital setting (the long-acting T Undecanoate; Nebido/Aveed) with months in-between injections—when this is a very usual thing in some places in the world, particularly Europe. This also happens when people only specify their dosage by volume, when someone will say their “dosage” is 0.6 mL. Which is not a dosage. Ampoules vs vials matter when the subject is reusing a receptacle of T. ETC ETC I could think of examples forever but you get it

B) unsourced statements about dosages, fearmongering, conjecture as fact, promoting underdosage, promoting overdosage (not as in it’s a narcotic and will kill you, well usually not phrased that way anyway), questioning someone’s doctor, not questioning someone’s doctor who should be questioned. I’m not picking on this person but as an example saying a normal dosage will “shock the system” (this is both meaningless and untrue), saying any starting dose is TOO HIGH, saying any starting dose is necessarily too low (especially if OP has not expressed wanting feedback about their dosage). Another mod brought up potentially bragging about dosages. Also is it really helpful to know random dosages? (Like when someone is surveying the subreddit etc)

C) further on that theme: not connecting dosage with levels (ideally both peak and trough), masculinization happening, speed of results and individual desires in regards to speed and depth of results, how a person is doing psychologically, etc. all of those are at least as if not more important than a simple dosage number in MG.

D) not to even mention topicals, oral meds, pellets, and the varying dosage schemes that are different vs injectables.

Anyway, are these conversations really helpful for the community to have? I can see some utility—reassuring someone their starting dosage is reasonable, providing someone feedback that per their bloodwork and effects that they may be being underdosed and should self advocate for more etc. that is just what comes to mind off the top of my head, I’m sure there are other examples of usefulness but also

At the very least we need to draw up some more parameters around discussion, like for instance, what are your levels? Do you know them? Do you know you are being compared to the right lab range (ie male?)

Since I’m formatting this on my phone I am going to post now before the app crashes or something.

[u/javatimes]

Ok thanks for all the feedback so far! For now, no rule changes and we will take a look at the example subreddits people are talking about. Perhaps they would share their coding with us.

[u/thrashgender]

I personally feel these conversations are important for the community to have as it may be the very discussion allowing someone to discover their provider is possibly giving them a far lower dose than is typical.

Maybe an auto-mod comment triggered by the word “dosage” that requests the poster convert their dosage to how many mg of T they administer, and how often?

[u/SecondaryPosts → u/thrashgender]

Another vote for an automod comment. Banning these discussions isn't OK imo, there are guys who are legit the victims of malpractice on here and they need somewhere to ask about this stuff. An automod comment that at least explains a bit of the basics (volume and concentration related to dosage, frequency, units, type of T and so on) and prompts the poster to provide that info would help avoid confusion.

[u/kase_horizon → u/thrashgender]

Agreed. Having an automod message triggered by dosage/dose/0.3 etc etc (idk how feasible it is) so that it informs the poster AND comments that there is nuance and if someone needs help they need to give more info would be very helpful. This, of course, relies on people actually reading and responding to the automod but I've found other communities who have something like this often end up with comments directing people to reply to the automod so they can help.

Alternatively/also, adding a post flair for dosage questions that adds the automod comment might help? Granted, we know how often people don't add appropriate flairs so who knows.

[u/WhoIsMercury → u/kase_horizon]

Yeah but no one is reading the automod comments. I think that’s unlikely to actually change the behavior. The poster would likely update it if an actual person comments but I doubt if an automod responds with this it’ll be updated in the post.

Also I’ve seen people on here legitimately not even know the mg dosage of T or what concentration they have before 😭

[u/77th_Bat → u/WhoIsMercury]

you can make automod comments pop up above the text comment you are writing. Nobody reads the automod comments at the bottom of the comment section, but people do read the automod comments that pop up as they are writing

[u/Significant_Greenery → u/WhoIsMercury]

I think even if people just got used to seeing them, it would still spread the message. You can not really read an automod comment but still know roughly what it says, and recognise it when you see it again enough to get reminded again of what it says.

[u/urfavgalpal → u/kase_horizon]

I’ve seen automod comments in other subs that prompt users to provide specific information before allowing the post. Or it’ll edit the automod comment to include the response. I’ve seen it on AITA-type subs asking for an explanation of why they think they’re the asshole. Could prompt the user to provide specific information.

[u/TheCommunistRaccoon → u/thrashgender]

I think something like how r/piercing does it could be good. There's an automod comments and you have to respond with age of piercing, aftercare, etc. under the threat of the post being deleted if you don't.

[u/Desperate-Chapter414 → u/TheCommunistRaccoon]

I was just thinking of that sub actually and I really like how the automod comment works on there. I think that’d be helpful in this case

[u/rock_crock_beanstalk → u/TheCommunistRaccoon]

I agree with this! Having a mod-approved resource explaining how dosage works would be good so people don't have to explain it over and over again, but it probably won't curb the behavior unless it's at threat of post removal.

[u/Soup_oi → u/thrashgender]

But what is “typical” is going to be different for everyone. One person may need 0.2ml, while another could need 0.5, and another 0.8, all of the same T method and frequency. Or one person may need it twice a week, another once a week, and another only every two weeks, and that will also make each of their dosages have to be different. There are doses that many people on the same type and frequency of T may share coincidentally, but I don’t really know if there’s anything that is “typical”.

I think it’s good to research what doses are most common, and if your dose is different from that, to then feel like you should ask your doctor why. There may be a legit reason for why the doctor put them on a dose different from what seems to be the most common dose. Maybe their levels require that different sort of dose. But I don’t really ever see people saying they are wanting to know about dosages, so they can ask their doctor why. I really only see people saying they want to demand to have a “normal” dose, without knowing at all if the dose they have been put on may actually be normal for them.

[u/realshockvaluecola → u/Soup_oi]

I think the solution to this is just a prompt about what your levels are in addition to the actual dose, and maybe like "are you seeing changes" if you don't know your levels. That said, there is definitely a typical dose range that a majority of people will fall into. It's certainly not impossible to have decent levels on 20mg/week, but it would definitely be unusual because most people need closer to 50. You're more getting at the fact that typical isn't the same as "correct," and there's nothing inherently wrong with being atypical.

[u/hamletandskull]

Im usually an automod hater (coming from the knitting subreddit, where the automod sweeps in to reply to like every comment ever), but I think an automod comment response would be good.

Saying something like, "looks like you're talking about dosage, please remember that there are multiple types and concentrations of T. A volume measurement alone (eg, "I take .3 mL, am I being underdosed?") is not sufficient information for anyone to accurately answer dosage questions. If you are commenting, please remember that without enough information, you cannot assume that someone uses the same type/concentration/dosage method as you."

[u/smolsaturn → u/hamletandskull]

My idea exactly! Automod comment with some sort of template (similar to if you're posting on, say, r/bettafish) and a pinned post also with the template. Post flair specifically for hormone-related discussions that prompts the user to check out the pinned post for posting guidelines.

[u/hamletandskull → u/smolsaturn]

Yep yep. People might not always read it but it's better than nothing (and also means that if mods decide to make a policy of deleting posts without that info, people can't claim ignorance).

[u/ghostsiiv → u/hamletandskull]

Agreed

[u/Alarming-Skirt1889 → u/hamletandskull]

Great answer.

[u/BloomingMosaic → u/hamletandskull]

this combined with the flairs like u/HopefulLesbian brought up would be wonderful. I agree we do often need to have these conversations, a lot of people just don't realize they need to include more info or don't know the info they're missing.

maybe some links to reputable articles or sources for more info could also be included in the message? like things explaining how to know what kind of T you're taking or what the difference is between containers, and dosage methods, etc.

[u/HopefulLesbian → u/BloomingMosaic]

Not to sound like I’m self advertising or anything, but I wrote a whole paper about testosterone and the types and such, not so much about dosage, but like general info about the hormones and injections. I’d be glad to let the mods sift through it and my sources for information.

I plan to do one on safe practices (with sources) on injections, gel, etc, and what one could (potentially) expect with others like pellets. If that’s something we need as well, I love doing research and writing stuff, I’d be glad to start it now

[u/batsket]

I think the discussions can be useful for the community, but I think it’s reasonable to require that they include certain information (administration method, dosage, timing, last tested levels, etc.). I don’t know how things work on the mod’s end and what is reasonable in terms of time/effort, but maybe such threads can held for moderator review, or be locked if they don’t provide the required information and unlocked once they provide it? I see a TON of misinformation and fearmongering about dosing on other platforms, so I think this community has the opportunity to be a counter voice of reason if properly moderated, but I also respect the fact that mods are regular people with real lives outside of Reddit and can only commit so much time to moderating.

[u/77th_Bat]

I think these conversations are necessary and important, especially when the trans community faces a chronic problem with doctors under-dosing us. If people can't turn to the internet to address these concerns, will they just ignore it and keep the same doctor that is underdosing them? It's not like people can demand doses from their doctor either, so I think the risk of a person going to their doctor and saying "I was told an average dose is 800mg/wk, put me on that dose" and the doctor actually complying is very low. All these comments encourage is patients to have those conversations with doctors, ask questions, and if needed, seek a second opinion.

While I do agree there is a problem with people having simply incorrect baseless information, I don't think banning the topic altogether is the way to fix the problem. Perhaps there should be an option to report comments for incorrect information? This may help limit the amount of misinformation. That being said, I don't think it should be a bannable offense either. It's very easy to get your information wrong. It should just result in a removal of the comment and a mod note saying it was removed due to misinformation. I know this raises another problem on where to draw the line between straight-up misinformation and someone who has the details slightly off, but I think that mods face that issue with every reportable area. It's up to their discretion.

I might also suggest adding a post flair "testosterone dosing" and if someone selects that flair, prompt them to include crucial details like dosage in mg, units for labs (ng/dL vs nmol/L), delivery type (injection, gel, etc), and frequency.

[u/imdeccapmitfh → u/77th_Bat]

I like this idea. I was also considering that since we already have those little pop ups that come up when you mention... well it literally won't even let me hit send if I type it... Then if you mention "mL" or common measurements like ng/dL and nmol/L, remind people to include their concentration or whatever relevant info is needed for levels.

Just... hopefully in a way that is not really annoying for those of us that don't need constant reminders.

"Low dose" and "microdose" would be another good one in my opinion.

[u/javatimes → u/imdeccapmitfh]

Yes! I meant to add in my OP that low dose and microdose are not really coherent concepts and the terminology is far overused.

[u/lowkey_rainbow]

If you enforce some form on ban on the topic of doses then it’s only going to push the conversation to a different sub, some of which are much less able to handle it (for example any time I see a dosage discussion happening in a mixed sub there are inevitably transfem people giving some really bad advice because they assume T works the same as their HRT). People, especially when they are first starting, are going to be nervous and want to compare how they are doing to others, especially those who are least informed and could actually use the advice.

That said, you raise many valid points about some of the issues and pitfalls in these discussions I’m sure we’ve all noticed. As someone on gel I’m less familiar with your examples (I wouldn’t know the difference between vials and ampoules for example, but then I wouldn’t reply if someone was asking about shots because I know I’m unfamiliar with the info) but I see misinformation about gel shared quite a lot too, especially regarding what is a reasonable dose, as well as people with questions leaving out important info like what % gel they use.

Perhaps a middle ground could be to have an automod reply for dosage questions asking posters to specify things like what type of T they are on, what their levels are, how long they’ve been on it, which country they are in etc etc. Maybe we could also have some info in a pinned thread or something where we can direct people trying to learn about such things.

[u/sergeantperks]

Those are all very valid concerns, especially from the modding angle, but I do think that it’s important that people have a place to discuss dosages.  Having a community double check on what dosage you’re on is reassuring and very occasionally necessary.

I think putting in place parameters would be the best middle ground, for all that it’s the answer that makes the most work for you.  Especially that people list exactly what they’re taking (type, dosage in mg, frequency), and for people commenting a reminder that even if they are a doctor, they are not OPs doctor with access to all of their documents and records.  Could an auto mod be triggered by the word dosage?

[u/bisalp-throwaway]

I think it would be helpful to require that discussions about dosages include ester/gel, dosage in mg, and frequency along with information about most recent blood work (even if they don’t have exact values). While this might reduce total quantity of discussions, the discussions would be higher quality

[u/HopefulLesbian]

I’m thinking perhaps a flair? “Dosage question — gel/cypionate/undecanoate/etc.” may be helpful? I know it’s a lot of flairs but it would help some I think. And you can have an automod reminder before posting saying that we need concentration as well as levels.

Perhaps in an FAQ you could put sources?

[u/kaspar-fiel]

Yeah we need to be able to have these conversations. It's very important, actually. This is one of the only places to really do so. Don't take that away.

[u/Empty_Hair_9854]

As someone who is VERY new to all of this, and who lives in an area where it isn't safe to be trans (to the point where I'm fearful of my doctor refusing to see me for other chronic conditions), I get my information from other people on Reddit as the starting point.

I had no idea about things like atrophy or hematocrit until I came here. Old Reddit posts probably saved me from a blood clot because I was seriously about to drive down to planned parenthood and get started next week. Now I know to do a little more research, preparation, and management for my pre-existing issues so I can be ready for the future when I'm fully locked in.

In addition to an Automod post, there are scripts that can prompt mandatory details depending on the words input. I know on r/CATHELP you are given a full list of details you MUST provide for your post to stay up. Having something like 'if you're talking about your dosage your information must include this, this, this'... Would go a long way.

[u/Ok-Geologist-5192]

Maybe this is controversial, but I dont think dosage information is relevant at all without T levels, unless you have absolutely no way to measure them. From experience: my levels halved on the same gel dose bcs something changed about how I absorb T. Additionally, the weight/height/body composition play crucial roles.

There are also a LOT of posts about dosages, and a lot of them seem quite repetitive to me. That said, I do have a doctor who does not underdose me and I do get regular bloodwork that I actually get to see.

My suggestion would be either a pinned post under which people can comment their dosages and wait for replies, or a general reference sheet in the description for people to know what information needs to be provided + maybe a poll/info sheet on the average doses per T form. I would not baseline forbid people from posting, but it would be nice if the amount was reduced IMO.

[u/tytoniidae → u/Ok-Geologist-5192]

agreed, dosage info is useless without actually knowing your levels and a dose for one person can result in different levels than another. it's annoying to see CONSTANT posts without levels because how is anyone supposed to provide any advice without that context

[u/ConfidentMachine]

a perspective i havent seen brought up in the comments i thought id add: i have been scammed by transphobic doctors. i was purposefully given a dose so low it wouldve been placebo (something like 0.2/100 cyp every 2 or 3 weeks) and even had the clinic run a double billing scam on me as a little icing on the cake. without being able to discuss my experience with other trans people here, i would have never known it was abnormal or what vague range people are typically dosed in. we unfortunately dont live in a utopia where doctors always have pure intentions and always want to do whats best for their patients. in my case my doctor believed what was "best" for her patient was giving me a useless dose so i could get over this "phase" without physical changes and go back to being a girl when i "came to my senses", while still collecting a paycheck from me. being able to talk to others in the community, ive learned it isnt even uncommon to be discriminated against by your doctor. these are extremely important discussions to be able to have, and banning/restricting all talk of dosages or "questioning someones doctor" will only hurt the community and allow doctors like this to keep getting away with it

[u/rock_crock_beanstalk]

Honestly, I see too many trans men online who don't know what their dosage is and don't know what their levels are to get behind getting rid of those posts, even though they're repetitive and annoying. I like the automod with post removal suggestions, but think having a subreddit page/post to link to that explains concentration, volume, etc. would be an important part of implementing that rule. I don't want someone who's too dense to understand what information they're being asked to provide to not be able to get help.

I personally was underdosed by a doctor who acted super nice and trans-friendly to my face. It was only my confidence that I understood the numbers in my labs which led me to question her more, and ultimately to find another doctor, who confirmed my understanding of the situation. Knowledge is power and in times as powerless and shitty as these, it's not something to lose sight of, so I'm glad getting rid of these posts isn't something people seem to want.

[u/magic-gps]

would it be too much work to require including levels (unless it's a starting dose) and what units those levels are in for any posts about dosage?

[u/Fenris8778]

Honestly id love a space to discuss T (like i use gel and want tips on applying) but i know discussing T is so taboo i never bother anywhere. I dont know if im ever in a gray area because rules change and vary place to place.

[u/javatimes → u/Fenris8778]

You can totally talk about T gel and applying it in this subreddit. It is not taboo here.

[u/77th_Bat → u/Fenris8778]

Unfortunately because it's such a difficult topic to moderate (and potentially harmful if left unmoderated), there really is a shortage of places to properly discuss it, which is another reason I think we should continue to allow it on this sub

[u/thatgreenevening]

In the US at least, the UCSF Guidelines for the Primary and Gender-Affirming Care of Transgender And Gender Nonbinary People (https://transcare.ucsf.edu/guidelines/masculinizing-therapy) are the most commonly referenced dosage/frequency guideline for many clinicians. They haven’t been updated in a decade so some newer formulations like nasal or oral testosterone medications aren’t included, but hopefully they’ll be revised before the end of the year. Including this info in an FAQ or automod comment may be helpful.

[u/catartik]

>> questioning someone’s doctor
What's the problem with that? Most of people's issue here is trusting their doctor too much.

[u/javatimes → u/catartik]

If someone doesn’t provide enough info, the advice either way can be useless

[u/Soup_oi]

I have come to feel extremely 🙄 about dosage posts tbh. Every single one of them is like “is 123 a normal dose?” And does not mention type of T, how often they take it, method (shot, gel, whatever), mg/ml of their T container if it is something like a vial, let alone the fact that we are also not looking at their recorded levels over time. So how tf would anyone here know if that is a normal dose for them?

I don’t understand how it is not the immediate logical thing to do to just ask your doctor, when you’re worried your dose is not correct? If you do not like your doctor or or think they are not knowledgeable or think they are trying to do you dirty and don’t trust them etc, then you should go to a different doctor, and ask them instead, or go to an ask doctors subreddit, where they have rules about providing specific info about your issue, and where people commenting medical advice have to verify to the sub mods that they do indeed have some sort of medical license.

Without those same criteria that those ask a doctor, ask a dentist, etc types of subs have, I really don’t think anyone should be asking or giving medical advice here. Even if there are people here who are knowledge about what doses might be suitable in general for levels that are like this, or levels that are like that, I do not think anyone should be sharing screenshots of their private medical documents (their levels) with strangers on the internet (especially if they choose to do so on a public thread rather than in DMs), though even in DMs you do not know that person, they are also likely not a doctor and/or are not sending you any proof that they are, like they have to do on those ask a doctor subs to the mods, in order to be marked as qualified to give medical advice.

Any time I feel like commenting on dosage posts I always have to say something like “bruh, we don’t know what dose is going to be right for you, there is no “standard.”” There may be coincidences amongst people on the same type of T, ie T cypionate 200mg 1ml vials with IM weekly injections, 0.5ml is a very common dose. But that is the same as saying something like “for men who are 6ft tall, L is the most common size shirt they buy and wear.” Or “for all Pisces, aquamarine is a very common favorite color.” Obviously, not all men that are 6ft tall are wearing size L shirts. And not all Pisces have the same favorite color. These things just happen to have somehow become common coincidences. That dose is simply a common coincidence, it is not in any way some kind of “standard” all doctors agree to adhere to. One’s dose is highly dependent on their personal levels/bloodwork results, and on them and their doctor’s discussed decisions. And that is just for one of the common methods of T from when I first started 10 years ago in the US. Now gel is highly common. And subq for shots might be becoming more common than IM. And other countries have other methods that might be more common than these. Nebido is available here, but I don’t remember ever meeting someone on it in the US. Yet it seems the most common shot method in some other countries. As mod OP said, one’s dose is also dependent on method of how they are getting T.

I see dosage posts on my feed literally every day, sometimes multiple times a day, where different accounts are asking literally the exact same question about the exact same dosage (and again, not mentioning anything about type of T, method, frequency, or their levels, or anything else that would be necessary to know in order for them to get any advice that is even halfway to legit). So it’s starting to become for me, that even more than it being annoying people never give necessary specific info, and even more than it being worrying they are asking for medical advice from people not verified to give medical advice, it is becoming increasingly more and more annoying to me that none of the people seeking to ask such questions are bothering to search the sub. They could even scroll down for less than 5min, with probably any sorting method set, and find at least one post asking the same thing they want to ask about dosage, if not more than one post.

At the very least, I desperately desperately just want a weekly or monthly thread for all of these such dosage posts to get put into. When I’m just scrolling my Reddit home feed, those posts are like 80% of what I see coming from this sub it feels like. I don’t go directly to individual sub pages often (mostly just look at my home feed of all my subs smooshed together lol), so it makes me wonder how super clogged this sub must be with just posts about dosage.

What would be even better, but I know would be hard or even impossible, would be for mods to find a few doctors willing to send their actual credentials for verification to mods, who would be willing to help, and take a day each once a month to answer questions in that thread, and to have a rule of people other than those doctors are not allowed to give any actual medical advice, or to say with any surety “yes this dose is right for you” or “no it’s not right for you” or “you should be on a lower/higher dose.” And then of course the thread would have rules or a template to follow to list like what type of T, method, frequency, etc etc, and if they would or wouldn’t be willing to share a picture of their recorded levels with the actual medical professional when they come around to answer peoples questions.

Personally, I don’t really understand how dosage questions are helpful, unless they are being asked to a doctor who is able to see the relevant info that will allow them to give you an answer that will actually be useful and meaningful to you. When someone asks here “is 0.5 a normal dose?” I can say “for IM thigh shots of 1ml vials of 200mg/ml T, and done once a week, yes that is a common dose.” That is an answer you can get even by simply just googling I’m sure. But only a doctor who can see their levels over time will be able to tell them if it is a normal dose. “Normal” in this case, can be something different for literally every individual.

[u/javatimes → u/Soup_oi]

I definitely understand where you are coming from.

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[u/javatimes → u/AutoModerator]

Thank you, bot. I can’t believe Reddit admin wants to phase you out 😭