Pulmonary Oil Micro Embolism Research - Intro

[DiegoMarinDO]

Hello everyone,

My name is Diego Marin D.O. and I am a Pulmonologist and Intensivist.

I am working on a research project with a medical resident based around a patient that I saw that I diagnosed with POME. We found that this appears grossly under-reported in the medical literature and we are writing a case report with review of the literature. As part of this, I thought it would be a great addition to gauge a "real world" incidence of coughing, coughing fits, shortness of breath, or other respiratory symptoms associated with testosterone injections or other anabolics. What better population to ask than those in an active testosteorne supplementation community.

I hope you will all participate and help in our understanding of this entity. Since it seems I cannot post links in my first post, I figured I would start here.

Stay tuned for when I can post links for more information.

Thank you,
Diego Marin D.O.

 

[Cataceous]

Welcome, and thank you for your effort to increase our knowledge. In my ten years of frequenting the forums I have seen only a few reports of such symptoms. Perhaps this is due in part to the greater emphasis on taking divided doses. It's becoming less common to see men injecting 200 mg of testosterone cypionate once every two weeks—the "grandfather" protocol. Now we see this divided into smaller doses delivered more often, with some even choosing to inject small amounts daily. Is it reasonable to assume that the odds of POME decrease with the amount of oil delivered per injection?

 

[Seagal]

Testosterone undecanoate with the nebido protocol injecting 4ml deep IM at once has the POME risk warning.
Versus small volumes (0.3ml) and shallow IM injection... With SC injection there is even less risk.
That are parameters I would keep track off if wanted to study the risk of POME with TRT injections.

 

[DiegoMarinDO]

Welcome, and thank you for your effort to increase our knowledge. In my ten years of frequenting the forums I have seen only a few reports of such symptoms. Perhaps this is due in part to the greater emphasis on taking divided doses. It's becoming less common to see men injecting 200 mg of testosterone cypionate once every two weeks—the "grandfather" protocol. Now we see this divided into smaller doses delivered more often, with some even choosing to inject small amounts daily. Is it reasonable to assume that the odds of POME decrease with the amount of oil delivered per injection?

If we assume the pathophysiology is indeed oil getting into a small vein and embolizing to the pulmonary vasculature where it triggers a cough, then it makes sense that yes larger volumes would be higher risk. Part of the survey I've made does ask for dosing in mg per week per testosterone/anabolic so hoping to see a dose ie volume response.

 

[DiegoMarinDO]

Testosterone undecanoate with the nebido protocol injecting 4ml deep IM at once has the POME risk warning.
Versus small volumes (0.3ml) and shallow IM injection... With SC injection there is even less risk.
That are parameters I would keep track off if wanted to study the risk of POME with TRT injections.

Interestingly my patient we're doing the report on injects testosterone cypionate 0.6ml twice weekly into his lower abdomen (subcutaneous using 27g 0.5" needle) and had had multiple episodes over the last 2.5 years. But yeah the survey will ask injection location and dosages for all testosterone/anabolics in case we do see a increased incidence with things like dose but also injection site, depth, etc

 

[Nelson Vergel]

This issue has disappeared since we started to inject lower doses with insulin syringes.

 

[DiegoMarinDO]

This issue has disappeared since we started to inject lower doses with insulin syringes.

I've been reading thru the forum and do see a thankfully low amount of posts about it, which is encouraging. But you bring up a good point about asking what gauge people use and seeing if it is associated with a higher incidence (assumption would be maybe). My patient routinely uses 27g 0.5" needles

 

[Nelson Vergel]

I've been reading thru the forum and do see a thankfully low amount of posts about it, which is encouraging. But you bring up a good point about asking what gauge people use and seeing if it is associated with a higher incidence (assumption would be maybe). My patient routinely uses 27g 0.5" needles

That’s what most of us use. We no longer do deep IM. Mostly subcutaneously or shallow IM. Injection volumes less than 0.5 cc

 

[Vince]

You aspirate a syringe with a long needle, especially for intramuscular (IM) injections, to check if you've hit a blood vessel; pulling back the plunger and seeing blood means you're intravascular.

I do believe most of us know that already.

W

Post in thread 'How should I start on shots?'

Aug 25, 2018

You can aspirate with the syringe if you wish, is pretty easy to aspirate on the thigh. Most men on trt don't aspirate.

Is aspirate when you pull back on the plunger?

• Whatzup

 

[madman]

Hello everyone,

My name is Diego Marin D.O. and I am a Pulmonologist and Intensivist.

I am working on a research project with a medical resident based around a patient that I saw that I diagnosed with POME. We found that this appears grossly under-reported in the medical literature and we are writing a case report with review of the literature. As part of this, I thought it would be a great addition to gauge a "real world" incidence of coughing, coughing fits, shortness of breath, or other respiratory symptoms associated with testosterone injections or other anabolics. What better population to ask than those in an active testosteorne supplementation community.

I hope you will all participate and help in our understanding of this entity. Since it seems I cannot post links in my first post, I figured I would start here.

Stay tuned for when I can post links for more information.

Thank you,
Diego Marin D.O.

Welcome to Nelsons house!

Most of the formal data on POME concern intramuscular TU in castor oil (Nebido, Aveed).

Nebido/Aveed are considered the preparations with the highest practical POME risk, mainly due to the large injection volume 3-4 mL and vehiculum (castor oil).

Even then it is rare.

Injection technique is critical.

Any oil‑based IM ester (TE/TC/TP/mixed esters) can theoretically cause POME if oil is accidentally injected into the venous circulation.

Review of T-therapy with sub-q or IM using smaller-volumes of the oily solution weekly TC/TE (0.5–1 mL) acknowledge the theoretical risk of POME with any oil‑based ester if oil enters the bloodstream but stress that events have mainly been reported with higher‑volume T/U injections.

Chances are extremely slim injecting lower volumes of the oily solution.

Most men on T-therapy are injecting 100-200 mg T/week whether once weekly or split into more frequent injections as in twice-weekly, M/W/F, EOD or daily.

Some men are injecting <100 mg T/week.

Most are injecting shallow IM vs sub-q and even then the go to syringe used is an LDS insulin syringe (fixed needle) 27-31G various needle lengths.

The most common esters used whether injecting strictly sub-q or IM would be (TC/TE) 200 mg/mL strength so even if you are injecting the high-end therapeutic dose once weekly the maximum volume of the oily solution would be 1 mL.

Never heard any of the experts in the field who specialize in testosterone therapy raise any concerns about POME when using standard therapeutic doses of TC/TE/TP/mixed esters.

Post in thread 'Pome?'

Apr 6, 2024

Hi lads,

Taking Nebido every 8 weeks the past 6 years an no problems.

But just now, took my 4ml in buttock, immediately felt laboured breath and acute continuous coughing, it is just about stopping now after 10 minutes.

Coming back to normal now, but should I be worried

Thanks for advice

Rare occurrence but would be scary having it happen for the first time.

If your symptoms resolve fairly quick then this is a good sign.

Glad you are feeling better.

Take home point here:

*POME presenting as cough/syncope symptoms during...

• madman

• 

Disadvantages

- risk of POME

Post in thread 'New and emergent preparations for male hypogonadism treatment'

Nov 18, 2023

Table 1. Characteristics of available T preparations. Only brand names have been quoted. POME=pulmonary oil microembolism. * available only in the Australian market; **Available only in the US market.

• madman