43 Year-old Male's TRT Journey

[DJXS]

I'm a 43 year-old, diagnosed with hypogonadism nearly two years ago. My T level was tested several times, ranging from 60-250ng/dl, before the diagnosis was made. I was started out on 40.5mg gel, then increased to 81mg, but even at 81mg my T levels didn't exceed 250ng/dl. My endocrinologist refused to increase dose or switch to injections, so I changed to a different endocrinologist in May '21, who agreed that I should move to IM injections, and started me on 150mg/2weeks testosterone cypionate. Doctor had labs done two days before 4th injection, and level was 68ng/dl. But turns out doctor wanted labs done exactly one week after injection, so on day 7 following 4th injection had labs again and T was 319ng/dl. With this result, doctor increased dose to 200mg/2 weeks; doctor is reluctant to, but not completely against, increased frequency. Doctor wants me to get labs again exactly one week after 2nd injection at this new dose, aiming for 500+ng/dl midway between injections. I'm concerned that with 500-600ng/dl midway, my levels will be low again for 3-6 days before injections, resulting in rollercoaster levels between peaks and troughs. From the labs we have thus far, it seems that 175-200mg/week would keep me above 500ng/dl at trough and help maintain more stable levels; guessing between 1200ng/dl at peak and 500+ng/dl at trough, rather than 1200ng/dl at peak and about 250ng/dl at trough with injections every 2 weeks. If my PSA and Hematocrit remain normal with 175-200mg/week, I don't understand why doctor is against this, yet doctor says if the 200mg/2 weeks doesn't work, that we can try 100mg/week, but says that won't increase above that regardless of numbers. Doctor doesn't want to check FT or estradiol, but says we can maybe look at those later on. I'm guessing that my T levels are testing so low is related to my low SHBG (see below); that my body burns through the T rapidly. What are your thoughts on my doctor's approach, protocol, and resistance to prescribing anything in excess of endocrine society's "gold standard" TRT recommendations? Thanks in advance for your feedback!

*I'm 6'0, 235lb., and in otherwise good health according to blood, psa, metabolic, and lipid panels, other than somewhat elevated cholesterol levels (and HDL +/-50). SHBG is low though: was +/-14 before TRT, dropped to +/-10 on gel, and a very low 2-4 on injections.

 

[madman]

I'm a 43 year-old, diagnosed with hypogonadism nearly two years ago. My T level was tested several times, ranging from 60-250ng/dl, before the diagnosis was made. I was started out on 40.5mg gel, then increased to 81mg, but even at 81mg my T levels didn't exceed 250ng/dl. My endocrinologist refused to increase dose or switch to injections, so I changed to a different endocrinologist in May '21, who agreed that I should move to IM injections, and started me on 150mg/2weeks testosterone cypionate. Doctor had labs done two days before 4th injection, and level was 68ng/dl. But turns out doctor wanted labs done exactly one week after injection, so on day 7 following 4th injection had labs again and T was 319ng/dl. With this result, doctor increased dose to 200mg/2 weeks; doctor is reluctant to, but not completely against, increased frequency. Doctor wants me to get labs again exactly one week after 2nd injection at this new dose, aiming for 500+ng/dl midway between injections. I'm concerned that with 500-600ng/dl midway, my levels will be low again for 3-6 days before injections, resulting in rollercoaster levels between peaks and troughs. From the labs we have thus far, it seems that 175-200mg/week would keep me above 500ng/dl at trough and help maintain more stable levels; guessing between 1200ng/dl at peak and 500+ng/dl at trough, rather than 1200ng/dl at peak and about 250ng/dl at trough with injections every 2 weeks. If my PSA and Hematocrit remain normal with 175-200mg/week, I don't understand why doctor is against this, yet doctor says if the 200mg/2 weeks doesn't work, that we can try 100mg/week, but says that won't increase above that regardless of numbers. Doctor doesn't want to check FT or estradiol, but says we can maybe look at those later on. I'm guessing that my T levels are testing so low is related to my low SHBG (see below); that my body burns through the T rapidly. What are your thoughts on my doctor's approach, protocol, and resistance to prescribing anything in excess of endocrine society's "gold standard" TRT recommendations? Thanks in advance for your feedback!

*I'm 6'0, 235lb., and in otherwise good health according to blood, psa, metabolic, and lipid panels, other than somewhat elevated cholesterol levels (and HDL +/-50). SHBG is low though: was +/-14 before TRT, dropped to +/-10 on gel, and a very low 2-4 on injections.

Welcome to excel!


I'm a 43 year-old, diagnosed with hypogonadism nearly two years ago. My T level was tested several times, ranging from 60-250ng/dl, before the diagnosis was made. I was started out on 40.5mg gel, then increased to 81mg, but even at 81mg my T levels didn't exceed 250ng/dl. My endocrinologist refused to increase dose or switch to injections,

Unfortunately, this was looking disastrous from the get-go!

Although transdermal can be a good starting point when jumping on trt there are men who will continue to be poor responders due to absorption issues or in many cases not using a high enough dose of T seeing as most endos rely on using big pharma transdermal T and the strength/potency is much less than what can be achieved using compounded transdermal T gels/creams.

Keep in mind that absorption using standard transdermal T application whether gel/cream is anywhere from 9-14%.

A common starting dose for Androgel was 50mg T/day which would be roughly 5 mg T/day and in most cases, men would only hit a mid-normal T level at best.

Most men would need the higher end dose of 100 mg T/day which would be roughly 10 mg T/day to achieve a high-end or in some cases very high T level.

Seeing as you were hitting such piss poor T levels then injections would have been the more sensible option.


My endocrinologist refused to increase dose or switch to injections, so I changed to a different endocrinologist in May '21,

Now, who would do such a thing.....LOL.

Looks as though you jumped from one idiot to the next.


so I changed to a different endocrinologist in May '21, who agreed that I should move to IM injections, and started me on 150mg/2weeks testosterone cypionate. Doctor had labs done two days before 4th injection, and level was 68ng/dl. But turns out doctor wanted labs done exactly one week after injection, so on day 7 following 4th injection had labs again and T was 319ng/dl.

Should have run and never looked back when he told you that he wanted to prescribe T injections every 2 weeks let alone 150 mg.

He had you back to being hypogonadal well before the 2 days before the 4th injection as you were hitting an absurdly low-t 68 ng/dL.

Even on 150 mg T (every 2 weeks) 7 days post-injection, you were only hitting a TT 319 ng/dL most likely due to your low SHBG.

With a piss poor trough TT 319 ng/dL your FT would still be low even with low SHBG.

Most endos are still stuck with that neanderthal mindset with those prehistoric protocols of 200mg T every 2 weeks which would have your TT, FT, and estradiol levels absurdly high post-injection/during the first few days only to be followed by much lower levels to the point of being hypogonadal well before the 2 weeks mark.

A rollercoaster ride anyone!

Top it off that many tend to be dead-set on keeping your TT in a specific range regardless of symptoms.

Aim for mid-normal of the physiological range they say!

Many go on ranting and raving about where your TT sits without giving any thought to SHBG level let alone FT and top it off that brushing off the importance of testing e2 can be common.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

This is a complete mess.

You need to look into finding someone who understands the ins and outs of treating a man for low-t.


With this result, doctor increased dose to 200mg/2 weeks; doctor is reluctant to, but not completely against, increased frequency. Doctor wants me to get labs again exactly one week after 2nd injection at this new dose, aiming for 500+ng/dl midway between injections. I'm concerned that with 500-600ng/dl midway, my levels will be low again for 3-6 days before injections, resulting in rollercoaster levels between peaks and troughs

Again you should have run and never looked back when he told you that he wanted to prescribe T injections every 2 weeks let even when using 200 mg T.

I stated previously:

Most endos are still stuck with that neanderthal mindset with those prehistoric protocols of 200mg T every 2 weeks which would have your TT, FT, and estradiol levels absurdly high post-injection/during the first few days only to be followed by much lower levels to the point of being hypogonadal well before the 2 weeks mark.

A rollercoaster ride anyone!

Top it off that many tend to be dead-set on keeping your TT in a specific range regardless of symptoms.

Aim for mid-normal of the physiological range they say!

Many go on ranting and raving about where your TT sits without giving any thought to SHBG level let alone FT and top it off that brushing off the importance of testing e2 can be common.


From the labs we have thus far, it seems that 175-200mg/week would keep me above 500ng/dl at trough and help maintain more stable levels; guessing between 1200ng/dl at peak and 500+ng/dl at trough, rather than 1200ng/dl at peak and about 250ng/dl at trough with injections every 2 weeks. If my PSA and Hematocrit remain normal with 175-200mg/week, I don't understand why doctor is against this, yet doctor says if the 200mg/2 weeks doesn't work, that we can try 100mg/week, but says that won't increase above that regardless of numbers.

Regardless of where your trough TT/FT levels would truly sit when injecting 175-200mg T/week, it would still be a piss poor protocol seeing as you have low SHBG.

Most men on trt are injecting 100-200 mg T (high-end).

Most can easily achieve a healthy let alone very high or in some cases absurdly high trough FT on 100-150 mg T/week whether split twice weekly (every 3.5 days), M/W/F, EOD let alone daily even men with highish/high SHBG.

Sure some may need the higher end dose but it is far from common.

SHBG is critical to know as not only will it have a significant impact on TT/FT but can dictate what injection frequency may suit you best.

Men with highish/high SHBG may fair better when injecting less frequently as in once weekly or twice weekly (every 3.5 days)

Although it is not a given and comes down to the individual as many men with highish/high SHBG inject more frequently.

The downfall of injecting higher doses of T less frequently is there will be a big difference in peak--->trough and blood levels will not be as stable throughout the week which can have a negative impact on mood/energy/libido/erectile function due to the rollercoaster ride.

Injecting a lower dose more frequently will clip the peak--->trough let alone result in achieving more stable blood levels throughout the week.

Men with lowish/low SHBG tend to do better injecting a lower dose of T more frequently as in daily or EOD.

Keep in mind that men with lowish/low SHBG can get away with running a lower TT and still achieve a healthy let alone high FT.

Most tend to get caught up on TT and although important FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.


Doctor doesn't want to check FT or estradiol, but says we can maybe look at those later on. I'm guessing that my T levels are testing so low is related to my low SHBG (see below); that my body burns through the T rapidly. What are your thoughts on my doctor's approach, protocol, and resistance to prescribing anything in excess of endocrine society's "gold standard" TRT recommendations? Thanks in advance for your feedback!

He is out to lunch!

Definitely not coming back.

FT let estradiol are critical blood markers and should always be included when getting blood work done.

You definitely need to find a new doctor and would do much better-injecting daily or EOD using lower doses of T.

The best piece of advice would be to start low and go slow.

100-120 mg T/week split into more frequent injections would be a sensible move.


*I'm 6'0, 235lb., and in otherwise good health according to blood, psa, metabolic, and lipid panels, other than somewhat elevated cholesterol levels (and HDL +/-50). SHBG is low though: was +/-14 before TRT, dropped to +/-10 on gel, and a very low 2-4 on injections.

Your SHBG was low 14 nmol/L before TRT and driven into the ground 2-4 nmol/L on the piss poor injection protocol.

When using exogenous T many factors can come into play when it comes to what dose of T is needed to achieve a healthy FT level.

SHBG level, injection frequency, metabolism, the sensitivity of the AR, polymorphism of the AR, and CAG repeat length (long/short), bodyweight.

 

[madman]

Stick around and search the stickies for lots of good info.

 

[madman]

Seeing as you have low SHBG I would put money on it that you can achieve a healthy let alone very high FT injecting much less than 175-200 mg T/week when split into daily let alone EOD injections!

 

[Systemlord]

From the labs we have thus far, it seems that 175-200mg/week would keep me above 500ng/dl at trough and help maintain more stable levels; guessing between 1200ng/dl at peak and 500+ng/dl at trough, rather than 1200ng/dl at peak and about 250ng/dl at trough with injections every 2 weeks.

These protocols also are known to drive up hematocrit over time as well forcing the patient to stop treatment is some cases. Also this protocol is helping to crush your SHBG levels.

The smaller more frequent injections in most cases have a smaller impact on suppressing SHBG.

What are your thoughts on my doctor's approach, protocol, and resistance to prescribing anything in excess of endocrine society's "gold standard" TRT recommendations?

The standard of care for TRT is deplorable and most doctors will only follow standard of care even though it is inadequate.

You're wasting time with this doctor.

 

[Systemlord]

Doctor wants me to get labs again exactly one week after 2nd injection at this new dose

It would appear your doctor doesn't understand half-lives of medications, it takes 4-6 weeks to reach steady blood levels after dosing changes, so checking levels after 2 weeks is the wrong move because in the weeks ahead your levels will be higher.

 

[DJXS]

It would appear your doctor doesn't understand half-lives of medications, it takes 4-6 weeks to reach steady blood levels after dosing changes, so checking levels after 2 weeks is the wrong move because in the weeks ahead your levels will be higher.

Thanks Systemlord! I mistakenly wrote "one week after 2nd injection," when it is actually going to be one week after the 3rd. My first injection with the revised protocol of 200mg/2 weeks was 09/29, followed by 10/13, 10/27, and then labs on 11/03. Doctor has consistently wanted labs midway (not trough) between 3rd and 4th injections, for the reason you state.

 

[DJXS]

Seeing as you have low SHBG I would put money on it that you can achieve a healthy let alone very high FT injecting much less than 175-200 mg T/week when split into daily let alone EOD injections!

Thanks for the quick and great feedback, madman! Considering I'll be having to self-inject for the rest of my life, which will hopefully be many decades longer, I'd prefer to minimize frequency, balancing this with the parallel goal of keeping levels above 500ng/dl at trough and within 1200ng/dl at peak. With this, I'm hoping to avoid frequency of more often than every 5 days; perhaps 120mg/5 days.
I'm currently using 23g x 1.5" needles. I inject quite slowly, on purpose, but I've still been left with charlie horses for about 3 days post-injection. I'm thinking to try 27g x 1.25" needles, hoping this will help avoid post-injection pain; I know, I'm a sissy. My doctor insisted on 22g x 1.5" needles, yet the oil is easy to inject with 23g. But do you think the cyp. oil will push through a 27g just fine (with 3cc barrel)? Do you think 27g would be the smallest reasonable needle, or might I even be able to get away with a 29g? I'm using BD precisionglide.

 

[Deleted member 42882]

I bought 1.5's (23g) because I liked the thought of going deep. The first injection felt great going in. But I woke up sore the next day, and the pain lasted a week. I have not, and will not, ever do it again. And I've never heard of a doctor insisting on it...but I am pretty new to the game.

 

[madman]

Thanks for the quick and great feedback, madman! Considering I'll be having to self-inject for the rest of my life, which will hopefully be many decades longer, I'd prefer to minimize frequency, balancing this with the parallel goal of keeping levels above 500ng/dl at trough and within 1200ng/dl at peak. With this, I'm hoping to avoid frequency of more often than every 5 days; perhaps 120mg/5 days.
I'm currently using 23g x 1.5" needles. I inject quite slowly, on purpose, but I've still been left with charlie horses for about 3 days post-injection. I'm thinking to try 27g x 1.25" needles, hoping this will help avoid post-injection pain; I know, I'm a sissy. My doctor insisted on 22g x 1.5" needles, yet the oil is easy to inject with 23g. But do you think the cyp. oil will push through a 27g just fine (with 3cc barrel)? Do you think 27g would be the smallest reasonable needle, or might I even be able to get away with a 29g? I'm using BD precisionglide.

Thanks for the quick and great feedback, madman! Considering I'll be having to self-inject for the rest of my life, which will hopefully be many decades longer, I'd prefer to minimize frequency, balancing this with the parallel goal of keeping levels above 500ng/dl at trough and within 1200ng/dl at peak. With this, I'm hoping to avoid frequency of more often than every 5 days; perhaps 120mg/5 days.

Need to get out of the mindset of getting caught up on TT.

FT is what truly matters as it is the unbound active fraction of T responsible for the positive effects.

Some may feel great overall with high-end trough TT/FT levels whereas others may feel better running lower levels.

FT 5-10 ng/dL would be considered low.

FT 16-31 ng/dL (high-end) is healthy.

Most men will do well with FT 20-30 ng/dL, some may feel better running higher levels.

Comes down to the individual.

As I stated previously most men can easily achieve a high-end let alone in many cases absurdly high FT on 100-150 mg T/week whether split twice-weekly (every 3.5 days), M/W/F, EOD let alone daily, and yes even men with highish/high SHBG!

Some may need what would be considered the high-end dose but it is far from common.

Always better to start slow and go slow as we want to see how your body reacts to testosterone.

Much easier to go up if need be than come down.

Still too high a starting dose seeing as 120 mg T every 5 days would be 168 mg T/week.

Splitting up the overall weekly dose 100-120 mg T twice-weekly (50-60 mg every 3.5 days) would be a more sensible move as you will be clipping the peak--->trough let alone have more stable blood levels.

Even then with an absurdly low SHBG injecting lower doses of T as in daily or EOD would most likely be optimal.

Using an LDS fixed U-100 insulin syringe will take care of any concerns you may have when it comes to minimizing pain/scar tissue that can be common when poking yourself with those 22-23G harpoons.

Whether injecting strictly sub-q or shallow IM using and LDS fixed insulin syringes will make a huge difference.


I'm currently using 23g x 1.5" needles. I inject quite slowly, on purpose, but I've still been left with charlie horses for about 3 days post-injection. I'm thinking to try 27g x 1.25" needles, hoping this will help avoid post-injection pain; I know, I'm a sissy. My doctor insisted on 22g x 1.5" needles, yet the oil is easy to inject with 23g.

Forget using the 22-23G harpoons.

If you plan on injecting strictly IM then you would be far better of using a 27G X 1"/1.25" tuberculin syringe.

Even then you can also inject shallow IM using a 27-29G X 1/2" needle length depending on where you are injecting/amount of adipose.

If you decide to inject strictly sub-q then you can easily use a 27-31G x (6MM/8MM/12.7MM needle length).

The main benefits of using LDS (low dead space) fixed insulin syringes are a minimal waste of medication (esterified T), virtually painless, minimize scar tissue/trauma, easier to read for accurate dosing especially when injecting lower volumes of oil more frequently.

Principles of Testosterone and hCG Injection Technique

Selecting the Devices There are many different syringes and needles, suiting many different procedures. It is important to choose the needles and syringes carefully according to the type of injection to be administered. For example, the length and gauge of the needle and type of syringe must...

www.excelmale.com

My doctor insisted on 22g x 1.5" needles, yet the oil is easy to inject with 23g.

Those prehistoric protocols are bad enough no need to use those harpoons even if you are only injecting once every 2 weeks.....LOL!

Let me guess.....he wanted you to take it in the butt!


But do you think the cyp. oil will push through a 27g just fine (with 3cc barrel)? Do you think 27g would be the smallest reasonable needle, or might I even be able to get away with a 29g? I'm using BD precisionglide.

Although big pharma cypionate uses cottonseed oil as the carrier which tends to be more viscous keep in mind that one of the excipients in the oily solution is BOH which acts as an oil viscosity reducer.

Regardless of the viscosity of the oil carrier used as some oils are more viscous than others one of the benefits of the added BOH which is a commonly used excipient in the oily solution is it acts as an oil viscosity reducer which should improve the ease of injecting.

You could always warm up the vial before drawing.

There should be no issues pushing cyp in cottonseed oil through a 27 G and if you plan on using the 27G go with a 1cc.

29G should be no issue other than it may be a little slower when drawing from the vial/injecting.

Keep in mind that 29G would be 1/2" needle length so you better plan on injecting shallow IM.


Benzyl alcohol (BOH) is a commonly used excipient in oil depots in concentrations ranging from 1.5-10% v/v and is used as a

- solubility enhancer
- oil viscosity reducer
- local anesthetic

 

[Systemlord]

Considering I'll be having to self-inject for the rest of my life, which will hopefully be many decades longer, I'd prefer to minimize frequency

Maybe you need to rethink your strategy, I take Jatenzo orally twice daily.

 

[DJXS]

Thanks for the quick and great feedback, madman! Considering I'll be having to self-inject for the rest of my life, which will hopefully be many decades longer, I'd prefer to minimize frequency, balancing this with the parallel goal of keeping levels above 500ng/dl at trough and within 1200ng/dl at peak. With this, I'm hoping to avoid frequency of more often than every 5 days; perhaps 120mg/5 days.

Need to get out of the mindset of getting caught up on TT.

FT is what truly matters as it is the unbound active fraction of T responsible for the positive effects.

Some may feel great overall with high-end trough TT/FT levels whereas others may feel better running lower levels.

FT 5-10 ng/dL would be considered low.

FT 16-31 ng/dL (high-end) is healthy.

Most men will do well with FT 20-30 ng/dL, some may feel better running higher levels.

Comes down to the individual.

As I stated previously most men can easily achieve a high-end let alone in many cases absurdly high FT on 100-150 mg T/week whether split twice-weekly (every 3.5 days), M/W/F, EOD let alone daily, and yes even men with highish/high SHBG!

Some may need what would be considered the high-end dose but it is far from common.

Always better to start slow and go slow as we want to see how your body reacts to testosterone.

Much easier to go up if need be than come down.

Still too high a starting dose seeing as 120 mg T every 5 days would be 168 mg T/week.

Splitting up the overall weekly dose 100-120 mg T twice-weekly (50-60 mg every 3.5 days) would be a more sensible move as you will be clipping the peak--->trough let alone have more stable blood levels.

Even then we have no idea where your SHBG sits and there is a good chance that it may be lowish/low and if such is the case injecting lower doses of T as in daily or EOD may be needed.

Without knowing SHBG your best bet would be to try splitting your weekly dose into twice-weekly injections (every 3.5 days).

Using an LDS fixed U-100 insulin syringe will take care of any concerns you may have when it comes to minimizing pain/scar tissue that can be common when poking yourself with those 22-23G harpoons.

Whether injecting strictly sub-q or shallow IM using and LDS fixed insulin syringes will make a huge difference.


I'm currently using 23g x 1.5" needles. I inject quite slowly, on purpose, but I've still been left with charlie horses for about 3 days post-injection. I'm thinking to try 27g x 1.25" needles, hoping this will help avoid post-injection pain; I know, I'm a sissy. My doctor insisted on 22g x 1.5" needles, yet the oil is easy to inject with 23g.

Forget using the 22-23G harpoons.

If you plan on injecting strictly IM then you would be far better of using a 27G X 1"/1.25" tuberculin syringe.

Even then you can also inject shallow IM using a 27-29G X 1/2" needle length depending on where you are injecting/amount of adipose.

If you decide to inject strictly sub-q then you can easily use a 27-31G x (6MM/8MM/12.7MM needle length).

The main benefits of using LDS (low dead space) fixed insulin syringes are a minimal waste of medication (esterified T), virtually painless, minimize scar tissue/trauma, easier to read for accurate dosing especially when injecting lower volumes of oil more frequently.

Principles of Testosterone and hCG Injection Technique

Selecting the Devices There are many different syringes and needles, suiting many different procedures. It is important to choose the needles and syringes carefully according to the type of injection to be administered. For example, the length and gauge of the needle and type of syringe must...

www.excelmale.com

My doctor insisted on 22g x 1.5" needles, yet the oil is easy to inject with 23g.

Those prehistoric protocols are bad enough no need to use those harpoons even if you are only injecting once every 2 weeks.....LOL!

Let me guess.....he wanted you to take it in the butt!


But do you think the cyp. oil will push through a 27g just fine (with 3cc barrel)? Do you think 27g would be the smallest reasonable needle, or might I even be able to get away with a 29g? I'm using BD precisionglide.

Although big pharma cypionate uses cottonseed oil as the carrier which tends to be more viscous keep in mind that one of the excipients in the oily solution is BOH which acts as an oil viscosity reducer.

Regardless of the viscosity of the oil carrier used as some oils are more viscous than others one of the benefits of the added BOH which is a commonly used excipient in the oily solution is it acts as an oil viscosity reducer which should improve the ease of injecting.

You could always warm up the vial before drawing.

There should be no issues pushing cyp in cottonseed oil through a 27 G and if you plan on using the 27G go with a 1cc.

29G should be no issue other than it may be a little slower when drawing from the vial/injecting.

Keep in mind that 29G would be 1/2" needle length so you better plan on injecting shallow IM.


Benzyl alcohol (BOH) is a commonly used excipient in oil depots in concentrations ranging from 1.5-10% v/v and is used as a

- solubility enhancer
- oil viscosity reducer
- local anesthetic

This is all very good, helpful info! I understand your point on FT being the more important marker, and I'm hopeful to get to a protocol that puts me in a good spot, perhaps 25-35ng.
Regarding "Still too high a starting dose seeing as 120 mg T every 5 days would be 168 mg T/week," my rationale was based on 150mg putting me at 319ng on day 7 post-injection. But, as you and Systemlord have pointed out, by increasing injection frequency my blood serum levels will hopefully balance out, leading to 500+ng at trough with 100-120mg/wk...and likely even more achievable with 70-85mg/5days, let alone 50-60mg/3.5days. I'd like to start with trying 70mg/5days, if I can find a doctor within my insurance network that will support me with this, keeping the possibility open to the 50-60mg/3.5days that you've recommended; I don't disagree with you that 3.5days would be better for outcome, but I do want to balance outcome with frequency.
Increasing the frequency will also likely allow my SHBG to increase some, but that will most probably still mean a SHBG of <10, like it was on gel, before current protocol crushed it to 2 at last labs.
I also plan to switch to 27g x 1.25" needles, so that I'm still able to bury the oil quite deeply IM; I'll get some 1cc barrels, per your advice. My doctor has me injecting into quads, not butt. I load with 18g, and then switch to injection needle. You have piqued my interest in using 29g x 0.5", though. I wonder if the benefits of 29 v 27 would outweigh disadvantage of 0.5 v 1.25"...It seems my body flushes through the T quite quickly, with my super low SHBG, and I've read IM release is slower than subq. Also, my body fat is somewhat high, so I'm not sure if a 0.5" would still even make it to shallow IM.
First things first, though. I need to find a competent, progressive doctor to guide me on my TRT path, who is covered by my insurance (finances are very tight - hypogonadism has been really hard on me...I haven't been able to work...no energy, no drive, super high anxiety, and depressed mood).
Thanks again for your advice and support!

 

[DJXS]

Maybe you need to rethink your strategy, I take Jatenzo orally twice daily.

Wow, I'll look into this and discuss with my doctor! How long have you been taking it? What dose and what's your TT and FT on it? How about sides?
I really am not averse to needles/injections, though, so long as I can land on a protocol that gets me dialed in, hopefully not exceeding frequency of every 5 days, with 27g or 29g needles.

 

[madman]

This is all very good, helpful info! I understand your point on FT being the more important marker, and I'm hopeful to get to a protocol that puts me in a good spot, perhaps 25-35ng.
Regarding "Still too high a starting dose seeing as 120 mg T every 5 days would be 168 mg T/week," my rationale was based on 150mg putting me at 319ng on day 7 post-injection. But, as you and Systemlord have pointed out, by increasing injection frequency my blood serum levels will hopefully balance out, leading to 500+ng at trough with 100-120mg/wk...and likely even more achievable with 70-85mg/5days, let alone 50-60mg/3.5days. I'd like to start with trying 70mg/5days, if I can find a doctor within my insurance network that will support me with this, keeping the possibility open to the 50-60mg/3.5days that you've recommended; I don't disagree with you that 3.5days would be better for outcome, but I do want to balance outcome with frequency.
Increasing the frequency will also likely allow my SHBG to increase some, but that will most probably still mean a SHBG of <10, like it was on gel, before current protocol crushed it to 2 at last labs.
I also plan to switch to 27g x 1.25" needles, so that I'm still able to bury the oil quite deeply IM; I'll get some 1cc barrels, per your advice. My doctor has me injecting into quads, not butt. I load with 18g, and then switch to injection needle. You have piqued my interest in using 29g x 0.5", though. I wonder if the benefits of 29 v 27 would outweigh disadvantage of 0.5 v 1.25"...It seems my body flushes through the T quite quickly, with my super low SHBG, and I've read IM release is slower than subq. Also, my body fat is somewhat high, so I'm not sure if a 0.5" would still even make it to shallow IM.
First things first, though. I need to find a competent, progressive doctor to guide me on my TRT path, who is covered by my insurance (finances are very tight - hypogonadism has been really hard on me...I haven't been able to work...no energy, no drive, super high anxiety, and depressed mood).
Thanks again for your advice and support!

This is all very good, helpful info! I understand your point on FT being the more important marker, and I'm hopeful to get to a protocol that puts me in a good spot, perhaps 25-35ng.
Regarding "Still too high a starting dose seeing as 120 mg T every 5 days would be 168 mg T/week," my rationale was based on 150mg putting me at 319ng on day 7 post-injection. But, as you and Systemlord have pointed out, by increasing injection frequency my blood serum levels will hopefully balance out, leading to 500+ng at trough with 100-120mg/wk...and likely even more achievable with 70-85mg/5days, let alone 50-60mg/3.5days. I'd like to start with trying 70mg/5days, if I can find a doctor within my insurance network that will support me with this, keeping the possibility open to the 50-60mg/3.5days that you've recommended; I don't disagree with you that 3.5days would be better for outcome, but I do want to balance outcome with frequency.
Increasing the frequency will also likely allow my SHBG to increase some, but that will most probably still mean a SHBG of <10, like it was on gel, before current protocol crushed it to 2 at last labs.

I only recommended splitting your overall weekly dose 100-120mg T (50-60 mg every 3.5 days) seeing as you seem to be dead set on avoiding more frequent injections.

Even then seeing as your SHBG is absurdly low then injecting daily or EOD would most likely be more effective.

If you are dead set on less frequent injections (every 5-7 days) then give it a go.

Most that end up struggling with such protocols, especially in cases of lowish/low SHBG end up switching over to more frequent injections whether daily or EOD using lower doses of T.

I stated previously men with lowish/low SHBG can get away with running a lower TT and still achieve a healthy let alone high FT level.

With an SHBG 10 nmol/L, you can easily hit a high FT with a TT 800 ng/dL.


I also plan to switch to 27g x 1.25" needles, so that I'm still able to bury the oil quite deeply IM; I'll get some 1cc barrels, per your advice. My doctor has me injecting into quads, not butt. I load with 18g, and then switch to injection needle. You have piqued my interest in using 29g x 0.5", though. I wonder if the benefits of 29 v 27 would outweigh disadvantage of 0.5 v 1.25"...It seems my body flushes through the T quite quickly, with my super low SHBG, and I've read IM release is slower than subq. Also, my body fat is somewhat high, so I'm not sure if a 0.5" would still even make it to shallow IM.

There should be no difference in the absorption let alone effectiveness whether injecting deep vs shallow IM.

Whether one chooses to inject strictly IM (deep/shallow) or subcutaneously the needle length used comes down to where you plan on injecting/how much adipose.

If anything the main difference between sub-q vs IM would be that absorption may be slower when injecting subcutaneously but this point would be moot depending on half-life/injection frequency.

When injecting strictly IM or sub-q keep in mind the esterified T used whether (short, medium, or long) that the main role of the ester is to control the release rate of the prodrug (esterified T) from the oily depot.

When injecting esterified T (propionate, enanthate, cypionate, decanoate, undecanoate, or mixed esters) it is not active until it is cleaved which mainly happens when it enters the bloodstream as it is rapidly hydrolyzed by esterase enzymes and all that you are left with is pure T.


CONCLUSIONS

It is interesting to realize that drug absorption from an oil depot cannot entirely be described by a simple two-phase mass transfer model where concentration gradients, diffusion, and partition coefficients would enable the calculation of the expected absorption. It is demonstrated in this dissertation that there is a role of the excipient BOH in yielding an initially high absorption. The oil depot forms a continuous phase after injection but will be dispersed and encapsulated at the injection site after some days. This in turn largely influences the way the prodrug becomes available; after release from the oil depot, it is present in the interstitial fluid which is drained through the lymph into the systemic circulation. Subsequently, the prodrug permeates through the wall of blood cells and is hydrolyzed. Both the lymph transport and the cell wall permeation take time which is expressed in a lag time. This lag time is different for each injection site: a subcutaneously administered prodrug will enter the systemic circulation via a short path and at a low drainage flow. This results in a short lag time and a slow absorption rate constant of the prodrug. Deeper administered prodrugs (i.e. intramuscular injections) are suggested to be absorbed via a longer path, but at a higher flow, which results in a longer lag time but a higher absorption rate constant of the prodrug.

Figure 7.2: Schematic overview of the new insights into drug absorption from oil depots. After release from the oil depot (yellow circle at the injection site), the prodrug is transferred towards the central compartment via the lymphatic system. Here, it will be hydrolyzed to the active substance (see circle). ka = absorption rate constant; ke = elimination rate constant.


First things first, though. I need to find a competent, progressive doctor to guide me on my TRT path, who is covered by my insurance (finances are very tight - hypogonadism has been really hard on me...I haven't been able to work...no energy, no drive, super high anxiety, and depressed mood).
Thanks again for your advice and support!

Most end up paying out of pocket when it comes to being treated by a doctor in the know.

You stepped into a mess from the get-go wasting all this time only to end up no better off.


I was started out on 40.5mg gel, then increased to 81mg, but even at 81mg my T levels didn't exceed 250ng/dl. My endocrinologist refused to increase dose or switch to injections, so I changed to a different endocrinologist in May '21, who agreed that I should move to IM injections, and started me on 150mg/2weeks testosterone cypionate.

The idiot started you off on 150 mg T every 2 weeks.....go figure!

Let's light you up on T for the first few days then take you on a f**king rollercoaster ride and we will be sure to have you back to being hypogonadal well before the 2-week mark!

F**king shameful.

Sorry, you had to experience this.

There is light at the end of the tunnel.

Keep your head up things will work out for the best.

 

[Systemlord]

How long have you been taking it?

About three months and my A1C has dropped 4% in that time.

I also have low SHBG, normally 12 pre-TRT and remains at 12 on Jatenzo. When on injections it increased to 24, double its original value.

How about sides?

No sides. My hematocrit and hemoglobin run a bit elevated though, at 469 ng/dL hematocrit is 55.9% and hemoglobin 18.7.

Since I started (158mg) my levels dropped and even the 198mg dosage wasn't enough (397 ng/dL), and just started on 237mg, the recommended starting dosage for Jatenzo and I'm beginning to see why.

 

[DJXS]

As I previously mentioned, 7 weeks after switching from androgel to test-c injections of 150mg/2weeks, my labs at 7 days post-injection (dr insists on midway rather than trough levels) came in at TT 319ng/dl with SHBG of 2; due to my misunderstanding doc wanted midway labs, I had just previously gotten labs at trough (day 14), with TT at 63ng/dl. With these numbers, doc increased dosing to 200mg/2weeks, and I just got midway lab results at week 7 on this protocol: TT came in at 602ng/dl. With this protocol, I'm guessing that my trough TT will be around 250ng/dl (and peak around 900ng/dl). Does these estimations seem likely to you? I understand we want to see FT and estradiol levels, but I can't afford labs with insurance, so I'm at the mercy of my doc, who says we may look at those later. And while I'd prefer more frequent injections of every 7 or even 5 days, I want to be honest and transparent and try to make things work with this doc. I'm thinking to request doc if it would be possible to move to injections of every 10 days (continuing with 200mg). While not ideal, how does this sound? My thinking is that if I can first get my doc to approve this, that some time later I could get doc to approve 140mg/wk...and maybe even eventually move to 100mg/5days, which is the protocol I'm really hopeful. I'm also hoping to add in HCG+fsh; I want to preserve fertility, and also hoping this addition will increase libido and improve firmness of erections. Do you think this addition will help in these areas? Any recommendations on how to approach doc with this request, for best odds of getting it approved? Thanks!

 

[Systemlord]

dr insists on midway rather than trough levels

I had just previously gotten labs at trough (day 14), with TT at 63ng/dl. With these numbers, doc increased dosing to 200mg/2weeks

There protocols are horribly outdated and have actually been updated. The Endocrine Society is also suggesting 75-100mg weekly, but it seems your doctor is completely unaware.

Sadly even at these dosages on a weekly regimen, some will be unable to get the most out of TRT and may still have symptoms of low-T.

We suggest initiating testosterone therapy with any of the following regimens, chosen on the basis of the patient’s preference, consideration of pharmacokinetics, treatment burden, and cost. (2|⊕⊕○○)

• 75–100 mg of testosterone enanthate or cypionate administered im weekly, or 150–200 mg administered every 2 wk.

Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline

The 2010 update of the Endocrine Society guideline for the evaluation and treatment of androgen deficiency syndromes in adult men, published previously in

academic.oup.com

So if your preference is a weekly regimen, simply request it. In reality you can inject however often you like, but you may need to buy your own syringes online.

I'm also hoping to add in HCG+fsh

The reality is your doctor is very ignorant and doesn't specialize in this area of medicine, and most doctors will not allow TRT being combined with HCG and will allow one or the other.

Your doctor may allow clomid with the TRT, but this is NOT recommended.

There is an exception though, if someone is having testicular pain on TRT, HCG can be used.

 

[DJXS]

There protocols are horribly outdated and have actually been updated. The Endocrine Society is also suggesting 75-100mg weekly, but it seems your doctor is completely unaware.

Sadly even at these dosages on a weekly regimen, some will be unable to get the most out of TRT and may still have symptoms of low-T.

Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline

The 2010 update of the Endocrine Society guideline for the evaluation and treatment of androgen deficiency syndromes in adult men, published previously in

academic.oup.com

So if your preference is a weekly regimen, simply request it. In reality you can inject however often you like, but you may need to buy your own syringes online.


The reality is your doctor is very ignorant and doesn't specialize in this area of medicine, and most doctors will not allow TRT being combined with HCG and will allow one or the other.

Your doctor may allow clomid with the TRT, but this is NOT recommended.

There is an exception though, if someone is having testicular pain on TRT, HCG can be used.

Thanks, Systemlord! Yeah, I've already stocked up on syringes and needles: 1ml syringes, 18g needles for drawing, and 27g x 1.25" for injections. But I'm thinking about getting 30g x 1/2 inch needles for shallow im/subq. I'm going to ask my doc to move to 100mg/wk, but starting next week I'm going to move to this on my own. I'd like to work with my doc in full transparency, as a team, but sadly the doc seems more dictatorial than a team player. My concern, as you've mentioned about getting the most out of trt, is that labs so far would have me believe I should be dosing 120 to 160/wk, to really benefit...along with hcg, maybe 500mg/wk.

It's so strange though, because my doc is an endocrinologist at a major, world renowned hospital, and I was directed to this doctor as being the resident specialist for hypogonadism treatment. Due to financial situation, going to an hrt clinic isn't an option. I wish I could find a knowledgeable doctor for my hrt that's covered by insurance....

 

[Systemlord]

It's so strange though, because my doc is an endocrinologist at a major, world renowned hospital, and I was directed to this doctor as being the resident specialist for hypogonadism treatment.

Some doctors are willing to experiment and some are by the book idiots who never deviate from standard of care even if they know it is wrong and inefficient.

I find that personality can get in the way of allowing a doctor to excel in their field of medicine. An arrogant doctor that thinks he knows everything can learn nothing new, an open-minded compassionate doctor can listen to his/her patients, learn and adapt.

 

[madman]

Thanks, Systemlord! Yeah, I've already stocked up on syringes and needles: 1ml syringes, 18g needles for drawing, and 27g x 1.25" for injections. But I'm thinking about getting 30g x 1/2 inch needles for shallow im/subq. I'm going to ask my doc to move to 100mg/wk, but starting next week I'm going to move to this on my own. I'd like to work with my doc in full transparency, as a team, but sadly the doc seems more dictatorial than a team player. My concern, as you've mentioned about getting the most out of trt, is that labs so far would have me believe I should be dosing 120 to 160/wk, to really benefit...along with hcg, maybe 500mg/wk.

It's so strange though, because my doc is an endocrinologist at a major, world renowned hospital, and I was directed to this doctor as being the resident specialist for hypogonadism treatment. Due to financial situation, going to an hrt clinic isn't an option. I wish I could find a knowledgeable doctor for my hrt that's covered by insurance....

Yeah, I've already stocked up on syringes and needles: 1ml syringes, 18g needles for drawing, and 27g x 1.25" for injections. But I'm thinking about getting 30g x 1/2 inch needles for shallow im/subq.

Forget drawing with the 18G.

You can easily draw/inject with the 27G.

Even then depending on how much adipose is at the injection site you can inject shallow IM using a fixed LDS insulin syringe 27G x 1/2" (12.7MM).


I'm going to ask my doc to move to 100mg/wk, but starting next week I'm going to move to this on my own. I'd like to work with my doc in full transparency, as a team, but sadly the doc seems more dictatorial than a team player. My concern, as you've mentioned about getting the most out of trt, is that labs so far would have me believe I should be dosing 120 to 160/wk, to really benefit...along with hcg, maybe 500mg/wk.

The best piece of advice would be to start low and go slow.

T only protocol at first as we want to see how your body reacts to testosterone.

The use of hCG can be added later if need be.

100-120 mg T/week split into more frequent injections would be a sensible move.

Much easier to go up than come down!

You need to forget about getting caught up on TT numbers achieved on your doctor-prescribed piss-poor injecting T every 2 weeks protocol.

Men with lowish/low SHBG can get away with running a lower TT <1000 ng/dL and still achieve a high FT level.

Even then seeing as you have absurdly low SHBG you would most likely do much better injecting lower doses more frequently.

If you are dead set on avoiding more frequent injections than if anything injecting twice weekly (every 3.5 days) would be more sensible than once weekly.


I'd like to work with my doc in full transparency, as a team, but sadly the doc seems more dictatorial than a team player.

Time to throw on your Airmax and JET!