Testosterone Cypionate vs Testosterone Undecanoate

[BigTex]

I was put on test cypionate over a year ago by my doctor. I have years worth the records of the time I spend using testosterone undecanoate. I always did good on this and the last dosage was 750mg IM every 4 weeks (test -780). My blood work was always in the normal range. Since getting on the test cypionate everything went crazy. Test level too high, and Hemoglobin and HCT through the roof. I was doing 40mg every 5 days sub-q. I told my doctor I was going to stop the cypionate and go back to TU and he was not so excited but I did it anyway. I don't really need a doctor to get what ever I want and he knows it. So I was hoping after the past 3 months everything would be fine and I would not look like to my doctor a pompous ass. Below is the test I did 2 days ago before I see the doctor in June.

Not worried at all about the creatinine, EGFR or ALT. I am taking a supplement with 1g of creatine in it and lift weights 4-5 days a week ever intensely for around 1 hour a session. I am concerned about the Glucose because I eat 650-700g of carbohydrates/d with 5700+ calories. I am also concerned that my guess at a TU dose did not screw up HCT and hemoglobin. Based on this test I will know if 40mg of TU every 4 weeks is good or I can go slightly higher.

COMPREHENSIVE METABOLIC PANEL Analyte Value

GLUCOSE 87 Reference Range: 65-99 mg/dL Fasting reference interval
UREA NITROGEN (BUN) 20 Reference Range: 7-25 mg/dL
CREATININE 1.41 H Reference Range: 0.70-1.35 mg/dL
EGFR 55 L Reference Range: > OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO 14 Reference Range: 6-22 (calc)
SODIUM 141 Reference Range: 135-146 mmol/L
POTASSIUM 4.2 Reference Range: 3.5-5.3 mmol/L
CHLORIDE 98 Reference Range: 98-110 mmol/L
CARBON DIOXIDE 35 H Reference Range: 20-32 mmol/L
CALCIUM 9.9 Reference Range: 8.6-10.3 mg/dL
PROTEIN, TOTAL 6.8 Reference Range: 6.1-8.1 g/dL
ALBUMIN 4.0 Reference Range: 3.6-5.1 g/dL
GLOBULIN 2.8 Reference Range: 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 1.4 Reference Range: 1.0-2.5 (calc)
BILIRUBIN, TOTAL 0.6 Reference Range: 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 62 Reference Range: 35-144 U/L
AST 34 Reference Range: 10-35 U/L
ALT 52 H Reference Range: 9-46 U/L

CBC (H/H, RBC, INDICES, WBC, PLT) Analyte Value

WHITE BLOOD CELL COUNT 6.8 Reference Range: 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.45 Reference Range: 4.20-5.80 Million/uL
HEMOGLOBIN 17.3 H Reference Range: 13.2-17.1 g/dL
HEMATOCRIT 50.9 H Reference Range: 38.5-50.0 % MCV 93.4 Reference Range: 80.0-100.0 fL

TESTOSTERONE, TOTAL, MS 355 Reference Range: 250-1100 ng/dL

TESTOSTERONE, FREE 35.6 Reference Range: 35.0-155.0 pg/mL

History of blood work

Hemoglobin
high - 20.3
when I stopped TC - 18.3
now - 17.3

HCT
high - 58.5 (4-18-22)
when I stopped TC - 53.9 (1-17-23)
now - 50.9 (5-11-23)

Testosterone
high - 2103
when I stopped TC - 934
now - 355

Well I certainly didn't screw up anything and in fact, things slightly improved. I am thinking I want to go up from 40mg every 5 days to 50mg, every 5 days and see where that puts me on the above. I would like to see the testosterone up to maybe ~600 as well as the free up more. I feel a little off right now but it is steady, no ups and downs. The libido is not so good either.

 

[Nelson Vergel]

I am confused. Why no go back to your old TU dose ?

Use Cystatin C instead of creatinine.

 

[BigTex]

@Nelson Vergel , I am not really wanting to go the IM route any more, too much scar tissue. I am fine with sub-q so I am trying to figure out what dose I need to go doing it. 750 every 4 weeks would come out to 25mg/d or 125mg/every 5 days. Right now I am guessing that it was the TC that cause all of the side effects. Might be age even? So I don't want to screw things up going up too high on the dose, especially with this long ester stuff. I could really be a mess to straighten out any issues. I think I want to go 50mg from now until I test again in the middle of June and see how it goes. The big problem is I am not sure how many doctors have a lot of experience in doing TU sub-q so this is all very much a lot of educated guess work.

I am going to do the Cystine C next time, thanks for reminding me.

 

[TRicker]

@BigTex From a simplistic and amateur view....

Your old protocol was 750mg of TU/month
Your recent protocol with Cypionate comes out to be 240mg/month (40mg every 5 days)

You are taking less than 1/3rd the amount of testosterone per month, so I think you could definitely raise it, and your test numbers obviously shows that. Even if you cut your old TU dose in half, it would be 375mg of TU/month (or 62.5mg every 5 days).

By the way, I thing your glucose is great. Awesome number for 700g of carbs/day...you're a beast!

 

[BigTex]

I agree with you and judging from my free and total test levels I definitely need to increase the dose. Again, the issue I have is I am not 100% sure to this point if it was the TC that caused my HCT to be so out of whack or if it is just age. So I don't want to get carried away with going up too fast and create a mess. I got tired of doing blood dumps twice a month and worrying about getting another DVT. Since the half life of TU is about 20 days depending on the oil, it is much harder to clean up mistake in dosing.

The thing about TC is it peaks quickly in the blood stream and even with the residual left at the next injection the blood reaches peak saturation quickly and never goes any higher. For instance with the TC, the lowest amount in the blood (ester only) is 48mg and the high stays at 71mg as long as I continue dosing 40mg ever 5 days. With the TU the trough gradually increases to 147mg over time and the peak slowly increases to 167mg after about 6 months. This is why I don't want to go up too quickly. This every 5 days sub-q is much different that doing 750mg at one time every 4 weeks where the peak (400mg ester only) and tough (137mg) will be much greater, quicker. By the 2nd injection the peak shoots up to 970mg. So despite me wanting to do more, I am hesitant. This is completely new territory for me. But I recognize that I may have to do this if there are no issues with unhealthy side effects.

Appreciate the glucose comments. I also have diabetes in my family Most all of the people in my side of the family have type II diabetes. I am the oldest. The one thing I do that none of my family has ever done is lift weights. Type II muscles and high intensity exercise are very glucose dependent.

 

[testiculus]

I agree with you and judging from my free and total test levels I definitely need to increase the dose. Again, the issue I have is I am not 100% sure to this point if it was the TC that caused my HCT to be so out of whack or if it is just age. So I don't want to get carried away with going up too fast and create a mess. I got tired of doing blood dumps twice a month and worrying about getting another DVT. Since the half life of TU is about 20 days depending on the oil, it is much harder to clean up mistake in dosing.

The thing about TC is it peaks quickly in the blood stream and even with the residual left at the next injection the blood reaches peak saturation quickly and never goes any higher. For instance with the TC, the lowest amount in the blood (ester only) is 48mg and the high stays at 71mg as long as I continue dosing 40mg ever 5 days. With the TU the trough gradually increases to 147mg over time and the peak slowly increases to 167mg after about 6 months. This is why I don't want to go up too quickly. This every 5 days sub-q is much different that doing 750mg at one time every 4 weeks where the peak (400mg ester only) and tough (137mg) will be much greater, quicker. By the 2nd injection the peak shoots up to 970mg. So despite me wanting to do more, I am hesitant. This is completely new territory for me. But I recognize that I may have to do this if there are no issues with unhealthy side effects.

Appreciate the glucose comments. I also have diabetes in my family Most all of the people in my side of the family have type II diabetes. I am the oldest. The one thing I do that none of my family has ever done is lift weights. Type II muscles and high intensity exercise are very glucose dependent.

You probably know all this, but here's my speculation as to what's happening. From Bhasin, the incidence of side effects from supraphysiologic doses of testosterone is higher in older men, than in young men.

Older men are as responsive as young men to the anabolic effects of graded doses of testosterone on the skeletal muscle​

Men who genetically are high responders to testosterone (AR sensitivity) are more likely suffer from adverse hematocrit effects from TRT. Given your competitive powerlifting history, you likely fall into this category.

Androgen receptor gene CAG repeat length and body mass index modulate the safety of long-term intramuscular testosterone undecanoate therapy in hypogonadal men​

Many factors affect the pharmacokinetics of various testosterone preparations. When going from test undecanoate to test cypionate it's not just the shorter ester that reduces the half life. The carrier oil affects the half life as does the size of the oil depot. I don't know what preparation you were using of TU but the commercial preparations use castor oil, which due to its high viscosity extends the half life by slowing dissolution into surrounding tissue. The infrequent dosing results in a large oil depot which also slows dissolution (less surface area to volume ratio of the depot). It is possible that your particular physiology results in very slow dissolution of the oil depot with monthly TU injections, but relatively rapid de-estrification, such that when switching to TC every 5 days, results in much faster dissolution (due to smaller oil depot and different carrier oil) along with even faster de-estrification, giving you a large supraphysiologic peak post injection that you don't experience with monthly TU. The supraphysiologic peak then drives the increase in hematocrit.

Have you tried daily dosing to achieve stable levels? For some that reduces hematocrit. Daily doesn't work for me, as it didn't reduce my hematocrit at all and creates other issues. Everyone is different. Some respond well to very stable T levels, others need variation. Good luck figuring things out.

 

[BigTex]

Excellent information @testiculus. Yeah, I tried daily dosing and it didn't work. The best I could do was every 5 days. Unfortunately that didn't help either. Switching esters did.

Yet another complication, I was doing at one time TU in GSO, then switched to castor oil. The castor oil preparation had a longer half-life than TU in tea seed oil (33.9+/-4.9 vs 20.9+/-6.0 days (mean pm S.E.M.)). So to complicate this now I have switched from castor oil to miglyol which has a very low viscosity and a smaller bolus. So I have no idea what the half life is but assume it is lower than tea oil. I did however do testing on the 5 day after the injection going every 5 days. So at least I know where I am at the lowest. As I said, I expect over time the value will increase.

Anyway, thanks for the ideas!

 

[BigTex]

Ok, I finally got things straightened out....pretty much 55mg of test undecanoate every 5 day sub-q. In a months time from the last test the levels have started to peak.


TESTOSTERONE, TOTAL, MALES (ADULT), IA Analyte Value TESTOSTERONE, TOTAL, MALES (ADULT), IA 802 Reference Range: 250-827 ng/dL

ESTRADIOL 66 H Reference Range: < OR = 39 pg/mL R

No change in HCT so I ca start back on the anastrozole 1 times a week.

 

[BigTex]

So I am convinced now that the cypionate ester did not agree with my body and forced everything out of whack. 3 months after the last blood work my testosterone has stabilized, 783mg. My E2 has dropped from 66 to 24 with 0.5mg of anastrozole/wk. So I am going to drop that all together. RBC are normal and HCT is stabilized at 50.4

TESTOSTERONE, TOTAL, MALES (ADULT), IA 783
ESTRADIOL 24 Reference Range: < OR = 39 pg/mL
RED BLOOD CELL COUNT 5.66 Reference Range: 4.20-5.80 Million/uL
HEMOGLOBIN 16.8 Reference Range: 13.2-17.1 g/dL
HEMATOCRIT 50.4 H Reference Range: 38.5-50.0 %

I was going 40mg of test cyp every 5 days and now I am going 55mg of TU every 5 days. No HCG either since last testing. Looks like it is going to be TU from here on out.