Dr. Crisler's current protocol recommendations?

[jth0524]

For those in the know, what is Dr. Crisler's most up to date protocol. I've gathered that he's recommending 100iu of HCG every morning. I think he also is recommending test injections in the fat pads above the glutes every 3.5 days with a .5" needle. Is this close to his current protocol for those who would know? Does he also still recommend pregnenolone and dhea and at what doses? Also, does this differ with Dr. Saya's thinking at all? Thanks

 

[Tommy Wall]

And were exactly is that fat pads located?

 

[Vince Carter]

For those in the know, what is Dr. Crisler's most up to date protocol. I've gathered that he's recommending 100iu of HCG every morning. I think he also is recommending test injections in the fat pads above the glutes every 3.5 days with a .5" needle. Is this close to his current protocol for those who would know? Does he also still recommend pregnenolone and dhea and at what doses? Also, does this differ with Dr. Saya's thinking at all? Thanks

I believe that's reasonably close on those accounts, I don't know the start point for Cyp dosing though, 120 E3.5D would be an sound guess. Preg/DHEA I think 25mg each.

 

[CoastWatcher]

I know, from what his patients post here at EM, that Dr. Crisler tailors prescribed protocols to meet individual needs. A "bare-bones" template as described may be a starting point, but he doesn't hesitate to make modifications on an ongoing basis. All dictated by patient response.

 

[James]

I'm against injecting into fat pads in the butt, as I had a very dangerous result from doing so, but will acknowledge Dr. Crisler as one of the leading, most respected TRT voices in the industry. I think in 10 years we will look at injection spots very different and subQ will no longer be recommended. Just my crystal ball prediction.

 

[Jackie Treehorn]

I'm against injecting into fat pads in the butt, as I had a very dangerous result from doing so, but will acknowledge Dr. Crisler as one of the leading, most respected TRT voices in the industry.

A dangerous result? Oh please, do tell. Were you injecting into the dorso glute, and/or ventral glute?

 

[Vince]

An update to the Crisler HCG protocol http://defymedical.com/resources/he...-the-crisler-hcg-protocol?cu=27406&iu=1&cr=37

 

[Vince]

What is the best dose of HCG? Dr Saya presents two case studies. https://www.excelmale.com/forum/sho...dose-of-HCG-Dr-Saya-presents-two-case-studies

 

[Dr Justin Saya MD]

For those in the know, what is Dr. Crisler's most up to date protocol. I've gathered that he's recommending 100iu of HCG every morning. I think he also is recommending test injections in the fat pads above the glutes every 3.5 days with a .5" needle. Is this close to his current protocol for those who would know? Does he also still recommend pregnenolone and dhea and at what doses? Also, does this differ with Dr. Saya's thinking at all? Thanks

Will copy here what I posted over on PeakTestosterone in response to same:

Each of us have patients on just about any combination of protocols imaginable...that is the "art" of the craft. In fact, the starting regimen is exactly that...a STARTING point, and success or failure of a regimen is often found in the modifications/adjustments that are made over time under the watchful eye of a knowledgeable and experienced practitioner.

The regimen details stated are indeed a common preference of Dr Crisler at this time, but I can attest that he, just as I, custom tailor each regimen to the INDIVIDUAL - and these recommendations can sometimes vary drastically depending on all of the details of the clinical case.

The only real differences between what I favor and what Dr Crisler favors, albeit of minor clinical significance, are the daily HCG injections and how strongly we favor SQ T cyp injections. I certainly have a good percentage of patients on daily HCG injections, but this is typically only if determined necessary or preferable for a patient (i.e. very low SHBG for example - although often these guys do okay on EOD HCG anyways). The majority of my patients are started on BIW-TIW HCG injections and most do well...if not, we adjust appropriately.

I am not as firm on doing T cyp injections SQ. From my observations, I have not seen a clear trend towards better or worse outcomes when going IM->SQ or SQ->IM. The MAIN difference is often noticed when going from LESS frequent injections (q1-2 weeks) to MORE frequent injections (BIW-TIW, etc) typically independent of the route of administration. After several weeks with at least BIW T cyp injections (either SQ or IM), much more stability should be achieved in serum levels than with once weekly or certainly every 2 week injections. I typically educate patients on the injection techniques and allow patient preference to dictate (I often give them freedom to "try" both and see which they prefer and can tolerate the best)...ultimately being on a regimen that you can REMAIN COMPLIANT to is an absolutely necessary ingredient for success.

Now there are always special cases that seem to do better on IM or that seem to do better on SQ, just as there are some that seem to do better on T cyp and some that seem to do better on T enanthate...there are even some cases that seem to defy logic...this is where the art and individualized care come to the surface.

 

[Vince Carter]

I'm against injecting into fat pads in the butt, as I had a very dangerous result from doing so, but will acknowledge Dr. Crisler as one of the leading, most respected TRT voices in the industry. I think in 10 years we will look at injection spots very different and subQ will no longer be recommended. Just my crystal ball prediction.

everyone get's their own sites I think that they're comfortable with, I for one don't like Cyp in the belly fat, too much localized reactions...itchy, red nubs for days, but this was on a rather haphazard protocol that had me shooting to much liquid, close to .75ml there.

 

[James]

A dangerous result? Oh please, do tell.

You got it Jackie. Yeah, I think it qualifies as a 'dangerous result.' I'm 44, but in my early/mid 20's I was injecting cypionate fairly regularly in the fat pad of my right butt cheek. I was young and dumb at the time and when someone told me to inject in my ass, I had no idea they meant intramuscular injections...I simply injected in the fat in that right butt cheek. Over the years I noticed some slight discomfort in the injection spot, but nothing to be concerned with and certainly nothing to cause worry or prevent me from doing anything. I eventually discontinued the cypionate (due to not having a job and no money to afford it), and over the next 10 - 15 years, the discomfort continued to get worse, resulting in what I can best describe as an aggressive looking 'sore.' Many doctors dismissed it as 'probably nothing' and since we're conditioned as a society (especially back a couple decades ago) to trust what the good doc says, I just lived with it (which of course is my mistake for not taking responsibility for my own health). Finally I met with a physician's assistant, who while treating me for a different matter, I offered to show this nice looking young woman my ass to get her opinion on what it could be. In as professional way as possible, she told me I'm a idiot if I don't get it biopsied. I had them scrape a piece off and it came back as what the oncologist would refer to as a very aggressive cancer called angiosarcoma. They sent my sample to 2 labs with the same diagnosis. I had multiple surgeries to remove the cancer. The cancer was resistant to chemotherapy and I then under went 6 weeks of daily, Monday - Friday radiation on my right butt cheek. It's been almost 4 years now and after a few PET, CT scans, and an MRI every 90 days, the cancer has not returned and did not spread. The naysayers will dismiss this by saying things like, 'well you have no proof it was caused by the cypionate,' and they're right, I don't have any proof. What I do know is that a decade after several years of consistently injecting cypionate into the fat of my right butt cheek, I developed what could have been the death of me. In my opinion, it's just not good to inject oil based products into fat. You'll be fine tomorrow and possibly 5 years down the road, but eventually it has the potential to be very dangerous in my opinion. There's no doubt in my mind this was caused by my protocol of injecting cypionate into my fat.

 

[new_man]

Thank you James for sharing this experience from your last post! Sorry to hear that about the cancer.
I'm looking forward to hear what a specialised doctor has to say about this.

I think in 10 years we will look at injection spots very different and subQ will no longer be recommended. Just my crystal ball prediction.

I could imagine that somebody else on this planet has experienced this with IM too. I believe that there are so many factors that influence the outcome (genetics, techniques, medicin, lifestyle, and and and and). Since you made this experience you don't like SQ a lot. If I would experience the same like you did, then I wouldn't like SQ too. But If I would have made this experience with IM, then I would maybe dislike IM because of the bad experience. I think it is not possible to make a general statement because of the experience from one person. I believe that we would need to monitor 1 million men doing TRT for more than 10 years and then see if IM or SQ has the most cancer (where someone inject the Testosterone).

I'm saying this again. I'm really thankful that you shared this experience with us James. Lesson learnt for me: I'm gonna change injection side for SQ quite a lot since using the same spot over and over can be a huge pressure for the body. With changing injection location I'm gonna give the body on certain points some rest. I hope this makes sense! Excuse me for my english.

 

[Vince Carter]

You got it Jackie. Yeah, I think it qualifies as a 'dangerous result.' I'm 44, but in my early/mid 20's I was injecting cypionate fairly regularly in the fat pad of my right butt cheek. I was young and dumb at the time and when someone told me to inject in my ass, I had no idea they meant intramuscular injections...I simply injected in the fat in that right butt cheek. Over the years I noticed some slight discomfort in the injection spot, but nothing to be concerned with and certainly nothing to cause worry or prevent me from doing anything. I eventually discontinued the cypionate (due to not having a job and no money to afford it), and over the next 10 - 15 years, the discomfort continued to get worse, resulting in what I can best describe as an aggressive looking 'sore.' Many doctors dismissed it as 'probably nothing' and since we're conditioned as a society (especially back a couple decades ago) to trust what the good doc says, I just lived with it (which of course is my mistake for not taking responsibility for my own health). Finally I met with a physician's assistant, who while treating me for a different matter, I offered to show this nice looking young woman my ass to get her opinion on what it could be. In as professional way as possible, she told me I'm a idiot if I don't get it biopsied. I had them scrape a piece off and it came back as what the oncologist would refer to as a very aggressive cancer called angiosarcoma. They sent my sample to 2 labs with the same diagnosis. I had multiple surgeries to remove the cancer. The cancer was resistant to chemotherapy and I then under went 6 weeks of daily, Monday - Friday radiation on my right butt cheek. It's been almost 4 years now and after a few PET, CT scans, and an MRI every 90 days, the cancer has not returned and did not spread. The naysayers will dismiss this by saying things like, 'well you have no proof it was caused by the cypionate,' and they're right, I don't have any proof. What I do know is that a decade after several years of consistently injecting cypionate into the fat of my right butt cheek, I developed what could have been the death of me. In my opinion, it's just not good to inject oil based products into fat. You'll be fine tomorrow and possibly 5 years down the road, but eventually it has the potential to be very dangerous in my opinion. There's no doubt in my mind this was caused by my protocol of injecting cypionate into my fat.

Unfortunate coincidence but many things could be in play...poor sterilization, poor injection technique, but you're the 1 in a Trillion that thinks he got cancer from injecting Cyp in to body fat.

 

[trt4me]

I don't think it matters much where you inject on the realm of accepted areas just as long as you are getting good absorbtion indicated by labs.
I currently use quads with a 1/2 inch insulin syringe.
As far as protocols, they are not set in stone but the thing that seems to be tailored most to the person is the ai and Hcg.
Of course this mean that issue like thyroid and such wouldn't be looked at.

 

[James]

Unfortunate coincidence but many things could be in play...poor sterilization, poor injection technique, but you're the 1 in a Trillion that thinks he got cancer from injecting Cyp in to body fat.

I rarely share this story, but when I do, yours is the simple response I tend to get. No, there were no issues with sterilization. Alcohol swabs were always used (both to the skin and vial). A new needle was always in play. To suggest maybe I forgot to use an alcohol wipe and that caused cancer is far to simple? I consistently injected cypionate into a particular spot in the fat of my right butt cheek and eventually developed cancer in precisely that same spot. Can't get any more clear than that. But I get it, that's how medicine (and society in general) moves forward. We test new things and challenge the way things were done in the past...that's the way it's always been and should be. The world is full of ideas/techniques that seemed harmless in the moment, that looking back, were really bad for us. In this sense, I suspect the people most knowledgeable in this subject, 'kinda' know that it's 'maybe' not a good idea to consistently be shooting oil into fat....but we/they don't know for sure, so let's try it and seen what happens!!!Totally normal response and course of action (it's how we learn). We think it may not be a good idea, but we don't know for sure until enough guys try it! Hell, some of the docs that promote it today are on record just a few years ago saying it's not a good idea. They all acknowledge we're just 'scratching the surface of this new and exciting field of medicine,' and occasionally you'll get a honest/humble doc who admits we will likely be looking at HRT very differently in the future. I'm not sure there's a single part of HRT that doesn't generate great debate by both doctors and those individuals (like Nelson), who aren't docs but are tremendously knowledgeable in this area. The greatest voices in this field have tremendous disagreement on many things. Botton line, the wide-spread use of SQ injections for TRT is so new, give it 20 years as a popular injection technique and I really think people will look at it differently.

 

[Dr Justin Saya MD]

James - thank you for sharing that intimate/personal story and praise God that things have turned out favorably for you!

The possible connection (on a population-wide basis) I would suspect would certainly be a tenuous and rare one, if any...but certainly wouldn't discount it as the possible causative factor in YOUR specific case.

A possible take home message/implication is the importance of continually rotating injection sites, which is a good practice in general. "Spread the wealth" so to speak, so that the same tissue is not continually/excessively exposed to a possible irritant. As our understanding of cancer(s) evolves, we are drawing stronger connections between inflammation and cancer...tissue irritation (longterm, repetitive in SAME location)> inflammation -> ? Cancer...

Rotate sites fellas.

 

[Nelson Vergel]

I disagree with daily 100 IU HCG with TRT protocol.

I believe that 100 IU of HCG daily along with TRT does NOT do much at least when it comes to intratesticular T which has been correlated to fertility. This study gave men on TRT three doses of HCG and only when the dose of HCG reached 250-500 IU was when ITT got back to baseline before TRT.

Extrapolating data on daily production of LH in healthy men who are not on TRT to apply it to men on TRT is not really the best way to set a protocol for men with suppressed LH and suppressed ITT.

Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression.

Randomized controlled trial. Coviello AD, et al. J Clin Endocrinol Metab. 2005

Abstract

In previous studies of testicular biopsy tissue from healthy men, intratesticular testosterone (ITT) has been shown to be much higher than serum testosterone (T), suggesting that high ITT is needed relative to serum T for normal spermatogenesis in men. However, the quantitative relationship between ITT and spermatogenesis is not known. To begin to address this issue experimentally, we determined the dose-response relationship between human chorionic gonadotropin (hCG) and ITT to ascertain the minimum dose needed to maintain ITT in the normal range. Twenty-nine men with normal reproductive physiology were randomized to receive 200 mg T enanthate weekly in combination with either saline placebo or 125, 250, or 500 IU hCG every other day for 3 wk. ITT was assessed in testicular fluid obtained by percutaneous fine needle aspiration at baseline and at the end of treatment. Baseline serum T (14.1 nmol/liter) was 1.2% of ITT (1174 nmol/liter). LH and FSH were profoundly suppressed to 5% and 3% of baseline, respectively, and ITT was suppressed by 94% (1234 to 72 nmol/liter) in the T enanthate/placebo group. ITT increased linearly with increasing hCG dose (P < 0.001). Posttreatment ITT was 25% less than baseline in the 125 IU hCG group, 7% less than baseline in the 250 IU hCG group, and 26% greater than baseline in the 500 IU hCG group. These results demonstrate that relatively low dose hCG maintains ITT within the normal range in healthy men with gonadotropin suppression. Extensions of this study will allow determination of the ITT concentration threshold required to maintain spermatogenesis in man.

 

[Dr Justin Saya MD]

Nelson - my HCG dosage case study results are generally in agreement with you, especially when correlating serum hCG levels to serum Luteinizing hormone levels. In fact, mention was made of likely needed higher doses ESPECIALLY when fertility is a primary concern. When fertility is NOT a concern...well then the door is open to much debate on what the "ideal" hCG dosage may be.

 

[Jackie Treehorn]

You got it Jackie. Yeah, I think it qualifies as a 'dangerous result.' I'm 44, but in my early/mid 20's I was injecting cypionate fairly regularly in the fat pad of my right butt cheek.

James,

I appreciate you sharing this with the excel community. Could you be more specific as to exactly where you were injecting the test, and with what kind of needle (length and gauge)?

Just to be clear, you said you were injecting into the fat pad of your right glute. So, we're talking dorso glute here...the upper, outer quadrant of the right glute, correct?

Bottom line, I'm glad that you questioned your doctor's claim that "everything is ok," and took matters into your own hands. You literally saved your own life. Bravo sir!

 

[maxadvance]

His cancerous tumor developed where he injected, pretty damn safe to say the injections contributed to the condition. Since you were doing it in your 20's , would it be safe to say you were doing it 'recreationally'? Perhaps with UG Test? If that's the case, and I don't know that it is, it's just as if not more likely that the stuff they brewed it with was the cause of the cancer. UG brewers with thousands on the line in a specific batch will mix in who knows what poisons and how much of it to stabilize the batch so it is useable and injectable. Especially back then. And your right, the fact that it was injected into fat made it likely to drain and metabolize at a much slower rate.