For hypogonadal patients on TRT, steady state testosterone levels are preferable to avoid side effects from peaks and troughs.

“If they're a hypogonadal patient whose benefits outweigh risks of TRT, then you want to have a nice even steady state. It's not going to be exactly the same as producing pulsatile testosterone release endogenously from your own body. When you have a steady state, you don't have a peak or a trough. And when you have a peak, that's when the antigen receptor gene is overactive, that's when you get more erythropoietin or EPO release, and that leads to a lot of the side effects of thick blood, so higher hemoglobins, and hematocrits. And then when you have a crash, you don't feel good. So it's definitely not optimal.”