Some doctors have a saying, "I don't treat numbers, I treat individuals." This is not said about just TRT or HRT hormones. I don't know if this is a legitimate stance, but I've seen docs go above guidelines in psychiatry too. Like the max dosage of Vyvance amphetamine is 70mg according to the guidelines but some docs can go as high as 420mg!
Now could a serious doc say, well this guy has been on 1-2 grams of test for 2 decades, therefore he should be given 500mg to feel normal? They do sometimes but most of the time it's just clinics out to make money. Like how do they justify Anavar at any dose, but especially at like 50mg? But they do and authorities aren't stepping in. You know that Hell's Angels former president, bodybuilder Mel Chancey? The clinic he works for even prescribes E/C/A stacks. Ephedrine was never approved for weight loss in the first place. Many clinics now offer ketamine sprays too lol.