How to raise FREE T when on TRT

[ReillyJ]

Hi,

My husband is 69 and has been on TRT for about 5 months. Standard dosage 400 mg and he shoots twice weekly (well... i give him the shot)

His E2 is fine, his thyroid numbers are good (also on replacement therapy) and he has been testing above 500 and below 800 in a trough. This is Total T, however his Free T tests low.

Example:
Total: 513 ng/dl
Free: 34.2 pg/ml

We recently switched to a Naturopath that manages TRT instead of his disinterested Endo which refused to even run a E2 (we ordered it ourselves) and frankly i was shocked he even ordered a Free T on this go around. Anyway, i was surprised that the Naturopath didn't think he warranted an increase in dosage although i understand his reasoning in that when you up it, you certainly can run into more "management" problems, in addition, his PSA has been rising.

He was checked by a Urologist for BPH before initiating TRT and is treated for that and no lumps or anything suspicious, was given the green light. Of course, i am making an appt for him to go in and have a re-check.

PSA is now 3.27, 4.00 is the upper limit. So if he gets a go ahead from the Urologist (LORD WILLING) what can we do to increase his Free T if indeed there is anything we can do? Naturopath said the BW is just a snapshot in that period of time which of course we know....

He is doing OK on it, starting to see results after 4-5 months on it, libido could be better but not bad, energy OK...he has numerous health issues so all cannot be blamed on inadequate therapy if indeed it is inadequate.... Just wondering if there's anything i can do in addition to help him.

Oh his supplements do include 50 mg DHEA which he has been on for a few years, Vitamin D, etc... Also any input on PSA?

Thanks
Susie

 

[Systemlord]

Your husband's numbers suggest his SHBG is very low, if this is the case he needs to be injecting smaller doses every other day or possibly every single day. Low SHBG men excrete a lot of their testosterone into their urine due to low SHBG, large doses will drive his SHBG down and hurt his ability to hold onto his testosterone.

Your husband will feel a lot better injecting smaller more frequent doses, one reason is low SHBG men have a lot of free hormones and free estrogen which can make a guy feel terrible. I also recommend calcium D glucarate and DIM for low SHBG men as this will help rid his body of excess estrogens and he will feel better.

 

[Systemlord]

What is your husband's estrogen levels and is it LM/MS/MS method? Lots of doctors order the wrong E2 labs.

 

[ReillyJ]

What is your husband's estrogen levels and is it LM/MS/MS method? Lots of doctors order the wrong E2 labs.

Hi, last test was the Estradiol sensitive as i ordered it from discountlabs.com and it was 24.7 pg/ml (highest lab range is 35)

He does take DIM but not D-Glucarate.... FWIW he has non alcoholic mild liver cirrhosis and takes liver support. He also has lost at least 15 lbs which he needed to, his cholesterol is actually a bit low IMO (under 200) so no problem with that, he does have sleep apnea, not diagnosed but i know he does, he does breathe right strips which help but he complains he will not use a CPAP machine

Also, if anyone can help me, how do i inject every other day? I already get kind of anxious trying to draw .25 ml twice weekly (a bit gets lost in the needle and a tiny bit at bottom of vial when i'm almost finished so i draw just under .25 ml if that makes sense, don't know what i would do if i parced that out every other day (sorry if i sound wimpy!) and i have a bunch of 1 ml syringes. Also i don't do SubQ but IM.

Oh, he's also on 60 mg Zinc. i WILL inject every other day if that is going to help him, he's a wonderful husband and i do all i can to make his life better, thus all these questions and am trying to educate myself!

EDIT: i am wondering if i should switch him to SubQ?

Susie

 

[FeelingLost]

Hi, last test was the Estradiol sensitive as i ordered it from discountlabs.com and it was 24.7 pg/ml (highest lab range is 35)

He does take DIM but not D-Glucarate.... FWIW he has non alcoholic mild liver cirrhosis and takes liver support. He also has lost at least 15 lbs which he needed to, his cholesterol is actually a bit low IMO (under 200) so no problem with that, he does have sleep apnea, not diagnosed but i know he does, he does breathe right strips which help but he complains he will not use a CPAP machine

Also, if anyone can help me, how do i inject every other day? I already get kind of anxious trying to draw .25 ml twice weekly (a bit gets lost in the needle and a tiny bit at bottom of vial when i'm almost finished so i draw just under .25 ml if that makes sense, don't know what i would do if i parced that out every other day (sorry if i sound wimpy!) and i have a bunch of 1 ml syringes. Also i don't do SubQ but IM.

Oh, he's also on 60 mg Zinc. i WILL inject every other day if that is going to help him, he's a wonderful husband and i do all i can to make his life better, thus all these questions and am trying to educate myself!

EDIT: i am wondering if i should switch him to SubQ?

Susie

Hi Susie,
.16 on your syringe Monday/Wednesday/ Friday(32x3=96mg/wk) might be worth considering. I am 64 and this is what I am doing currently.
I also take HCG and put it in the same syringe. Put it in first and then it is last to come out so no T cyp is wasted in the needle.

IM vs SubQ I only do sub Q and find it painless using an easy touch 27ga 1/2" needle. I pinch a small wad of skin (see pict below) to lift it off my muscle poke it in and its done.



Hope that Helps.

 

[Systemlord]

It's unfortunate he will not use CPAP machine for sleep apnea, because overtime his brain will get less oxygen from the sleep apnea and it will affect him in many ways. Fatigue, low energy and generally not feeling well and it will also affect his immune system and overall quality of life.

A lot of members here including myself use 27-29 gauge insulin syringes non-dead space design, therefore no medicine is wasted. It's also painless and overtime will cause less scar tissue from all those poke holes. You can inject in the shoulders if he's got some muscle up there. Sub-Q is also a great idea, we have videos on YouTube showing how to do it.

Note when injecting smaller more frequent doses you need to lower the total weekly dose because due to the fact that his levels don't drop as much means you need less testosterone to maintain stable levels. An example I'm fine injecting 50mg twice a week, if I start injecting 25mg every other day my total testosterone score will soar from the 600-700's into the 900-1000 range.

You want to recheck all his levels four to six weeks after a dosage change, it takes this long for blood levels to stabilize so he should be feeling better by week 6, some guys take a little longer to get dialed in to a new protocol especially low SHBG men.

Can you please post the labs ranges so we can see where his levels land him?

 

[ReillyJ]

It's unfortunate he will not use CPAP machine for sleep apnea, because overtime his brain will get less oxygen from the sleep apnea and it will affect him in many ways. Fatigue, low energy and generally not feeling well and it will also affect his immune system.

I will try hard to get him tested, just need to find out what insurance will cover.

A lot of members here including myself use 27-29 gauge insulin syringes that do not have a dead space, therefore no medicine is wasted. It's also painless and overtime will cause less scar tissue from all those poke holes. You can inject in the shoulders if he's got some muscle up there. Sub-Q is also a great idea, we have videos on YouTube showing how to do it.

OK, i'll ask my pharmacy to order specifically 27 g insulin syringes...still unsure about SubQ but maybe we should go for it..

Note when injecting smaller more frequent doses you need to lower the total weekly dose because due to the fact that his levels don't drop as much means you need less testosterone to maintain stable levels. An example I'm fine injecting 50mg twice a week, if I start injecting 25mg every other day my total testosterone score will soar from the 600-700's into the 900-1000 range.

\

He's only rx'd 400 mg a month so dosage won't change, just the amount i will be injecting 3x weekly instead of twice.

You want to recheck all his levels four to six weeks after a dosage change, it takes this long for blood levels to stabilize so he should be feeling better by week 6, some guys take a little longer to get dialed in to a new protocol especially low SHBG men.

Thank you, i'm excited to see how he will do on this.

Do you have a comment on his E2 levels? We shouldn't investigate an AI at this point, right? i kind of cringe at asking his new doctor.

Susie

 

[ReillyJ]

Hi Susie,
.16 on your syringe Monday/Wednesday/ Friday(32x3=96mg/wk) might be worth considering. I am 64 and this is what I am doing currently.
I also take HCG and put it in the same syringe. Put it in first and then it is last to come out so no T cyp is wasted in the needle.

IM vs SubQ I only do sub Q and find it painless using an easy touch 27ga 1/2" needle. I pinch a small wad of skin (see pict below) to lift it off my muscle poke it in and its done.



Hope that Helps.

Well you are doing something right, you look great! i don't know what to do about HGC or if he should be taking it? Is this something i should bring up to his doctor? Is it absolutely necessary?

The 27g needle, it's an insulin needle? Does it come w/syringes or do i order those separately (forgive the ignorance...) i have a lot of 1 ml syringes but i kind of don't want to use those if measuring is going to be a PITA, also it sounds like from what SystemLord says, the insulin needles don't have the "dead space" that i have w/the needles i am using for IM injection?

Again, TY for your help, it is so appreciated. Oh, do you use an AI? And your dosage is 400 mg monthly?

Susie

 

[Systemlord]

I will try hard to get him tested, just need to find out what insurance will cover.

Insurance will usually cover the in-home testing, it's non-intrusive and only one night worth.

OK, i'll ask my pharmacy to order specifically 27 g insulin syringes...still unsure about SubQ but maybe we should go for it..

The love handles is a popular place to inject SQ.

He's only rx'd 400 mg a month so dosage won't change, just the amount i will be injecting 3x weekly instead of twice.

It sounds like 100 weekly, the typical starting dosages. This will get most men to midrange to high normal ranges. 3x a week is good enough, you will find what works and what doesn't work over time.

Thank you, i'm excited to see how he will do on this.

Do you have a comment on his E2 levels? We shouldn't investigate an AI at this point, right? i kind of cringe at asking his new doctor.

His E2 levels look good, if his E2 is between 20-35 pg/mL he's fine without an AI as long as he has no symptoms, we prefer to not use AI's if we can help it and if the need arises use the minimal dose possible. You can always lower the dosage of testosterone to lower E2 before resorting to an AI.

 

[ReillyJ]

Oops, i stand corrected...i think he's rx'd 200 mg a month, because i've been injecting him with .025 ml's twice weekly and his rx lasts one month, the instructions say inject .05 ml once weekly and i've been dividing that into 2 doses so you can see why i'm fretting about breaking that down into 3 doses (which is FINE but i'm terrible at math) so if i have to break it down to 3 weekly doses, what syringe (no dead space) and what ml syringe, if there is one smaller than 1 ml? and should i do SubQ? What do you do, Systemlord?

i think that is the average starting dose (200 mg) and doc doesn't want to raise it yet, i think mostly because of the rising PSA which we need to get checked but like i said when we initiated TRT, Urologist said he was good to go (he has BPH and is on daily Cialis) i kind of wish he would have raised the dosage slightly but he will not at this point.

Susie

 

[Vince Carter]

When talking about his dosing you're saying things as a volume which isn't a dose, you need to express it as "X" mg/milligrams. So youve been inj .25mL that would be 50mg twice per week from a standard 200mg/mL vial (assuming). SO split 100mg by three and it's 33mg E3D. Use the 29g 1/2" 1mL U100 insulin syringe, For 33mg you would draw it back to 16 or 17 on that syringe.

For his prostate, its generally advisable to avoid sex/orgasm 24-48hrs prior to a PSA blood test as the test can possibly be influenced by orgasm, if he hasn't been refraining prior to his tests.

 

[blackebob]

I use these

https://westendmedicalsupplies.com/...-syringe-27g-x-1-2cc-1-2-needle-length-bx-100

But my doctor and pharmacist keep telling me that I need to go to an inch and a quarter needle to get IM. I don't know which is correct, but a 1/2 " is painless. The .5 cc lets you get accurate with small dosage.
Some reason is cheaper for me to pay cash than it is to go through Insurance in the pharmacy.

 

[CoastWatcher]

In reference to his PSA, where was it five months ago when TRT was initiated? Doctors look at the absolute value, and the velocity - how quickly did it rise in a given amount of time?

 

[ReillyJ]

When talking about his dosing you're saying things as a volume which isn't a dose, you need to express it as "X" mg/milligrams. So youve been inj .25mL that would be 50mg twice per week from a standard 200mg/mL vial (assuming). SO split 100mg by three and it's 33mg E3D. Use the 29g 1/2" 1mL U100 insulin syringe, For 33mg you would draw it back to 16 or 17 on that syringe.

For his prostate, its generally advisable to avoid sex/orgasm 24-48hrs prior to a PSA blood test as the test can possibly be influenced by orgasm, if he hasn't been refraining prior to his tests.

Hi, NO he's getting 0.50 mg/ml's WEEKLY (i divide that into two doses) because he's rx'd 200 mg/ml's MONTHLY so i am going to have to divide that 0.50 dose now into 3 doses instead of 2 and i have to figure out what needles and syringes i should buy as the needles i'm using now have dead space and i cannot afford to lose anymore with dosage now to 3 doses instead of 2..... and i have to figure out if we should go to SubQ instead of IM.
I'm OK with that but if it doesn't really matter, then i'd rather just stick to IM but i would like to use a smaller syringe than i'm using now (1 ml) and a needle that doesn't have dead space (sorry, this is all new to me)

His PSA numbers:

08/23/17 was 0.74 before TRT and he was dx'd with BPH
03/14/18 was 3.27 he started TRT in mid October.

He's scheduled for an exam soon. I cannot remember if he had sexual activity before the test, i know there are influences but it's clearly rising.

Susie

 

[ReillyJ]

I use these

https://westendmedicalsupplies.com/...-syringe-27g-x-1-2cc-1-2-needle-length-bx-100

But my doctor and pharmacist keep telling me that I need to go to an inch and a quarter needle to get IM. I don't know which is correct, but a 1/2 " is painless. The .5 cc lets you get accurate with small dosage.
Some reason is cheaper for me to pay cash than it is to go through Insurance in the pharmacy.

Thank you... so you use this IM and not SubQ? With these needles, can i choose either delivery?

And yes i've heard that you need at least 1/2 an inch, have you gotten any feedback about using this length IM?

Thanks

Susie

 

[Systemlord]

Hi, NO he's getting 0.50 mg/ml's WEEKLY (i divide that into two doses) because he's rx'd 200 mg/ml's MONTHLY so i am going to have to divide that 0.50 dose now into 3 doses instead of 2 and i have to figure out what needles and syringes i should buy as the needles i'm using now have dead space and i cannot afford to lose anymore with dosage now to 3 doses instead of 2..... and i have to figure out if we should go to SubQ instead of IM.
I'm OK with that but if it doesn't really matter, then i'd rather just stick to IM but i would like to use a smaller syringe than i'm using now (1 ml) and a needle that doesn't have dead space (sorry, this is all new to me)

His PSA numbers:

08/23/17 was 0.74 before TRT and he was dx'd with BPH
03/14/18 was 3.27 he started TRT in mid October.

He's scheduled for an exam soon. I cannot remember if he had sexual activity before the test, i know there are influences but it's clearly rising.

Susie

I've never heard of anyone on such a low dose before and would explain his lower levels, the typically weekly dosage is 100mg per week, 50mg weekly really isn't standard practice. You really need a competent doctor overseeing your husband care, this doctor is just getting TRT wrong. Most guys split it up either twice weekly (50x2) more depending on SHBG levels. He really needs to reach 600-800 ranges to feel good since these levels are associated with youthful levels.

Suggest Defy Medical, travel not necessary. You will not have to argue or fight with these doctors, they know what their doing. TRT isn't just about an RX script for testosterone and injecting testosterone, his hormone levels need to be balanced according to his blood biomarkers and not many doctors know how to do it.

 

[blackebob]

Thank you... so you use this IM and not SubQ? With these needles, can i choose either delivery?

And yes i've heard that you need at least 1/2 an inch, have you gotten any feedback about using this length IM?

Thanks

Susie

I really have no idea if it's IM or not. There's a different response from everyone on here when you ask somebody what's best subcutaneous and intramuscular, and how deep it has to be. I do IM straight into the deltoids,everyday. Unless you ask my doc, she says I need an inch and a quarter.

 

[ReillyJ]

I've never heard of anyone on such a low dose before and would explain his lower levels, the typically weekly dosage is 100mg per week, 50mg weekly really isn't standard practice. You really need a competent doctor overseeing your husband care, this doctor is just getting TRT wrong. Most guys split it up either twice weekly (50x2) more depending on SHBG levels. He really needs to reach 600-800 ranges to feel good since these levels are associated with youthful levels.

Suggest Defy Medical, travel not necessary. You will not have to argue or fight with these doctors, they know what their doing. TRT isn't just about an RX script for testosterone and injecting testosterone, his hormone levels need to be balanced according to his blood biomarkers and not many doctors know how to do it.

Yeah, the instructions say inject 0.5 ml weekly so yeah... for some reason i thought that was the standard starting dose. I just emailed his Naturopath with not much hope that he'll comply but i gave compelling reasons. I think he may be concerned about the PSA which we will have rechecked. If he doesn't comply and also after a Urologist exam, i guess we'll have to pony up the $$ for alternative doctors, i don't relish the $200 a month and i don't think my husband will go for that especially since we're low income... this is just getting ridiculous. I know Naturopath it sounds like, was concerned about more micro-management if dosage was raised...well... i am thinking so what at this point.

But the PSA does concern me a bit although the Urologist said there was no evidence at all of lumps when he was initially examined before TRT but that doesn't mean anything now at this point.

Susie

 

[FeelingLost]

Hi Susie, I use the same syringes as blackebob and I love them. They fill fast and are painless. The come complete and are 1 time use. 12 bucks for a 100 syringes.
If you are sure you are only giving your husband 50 mg /week that is a very low does. That would explain why he is not feeling very good.
Many can use 100mg/wk and not need and AI or have to donate blood do to high HCT (hematocrit) only testing will tell. IMO 100mg/wk is a very safe dose
I hope you can convince your doctor to up his dose.

On HCG usage. It is not mandatory at all. Some who take it report feeling better.

 

[ReillyJ]

Thank you FeelingLost,

If his doc ups the dosage then we probably won't have to buy new syringes/needles (we have a ton of them) because it'll be easier to measure the higher dosage... i may still do it 3x a week instead of twice weekly.

Do you all use Defy or how do you find a doc that will RX the correct amount? I mean...this is the second doctor and a Naturopath to boot (who has been rx'ing TRT for years..) and H is testing in the 500's which is low, in my humble opinion. I emailed him and said if the dosage stays the same then husband will be status quo and nothing will improve.

There's another Naturopath in my town that does TRT but then again to fork out more $$ and what if this person agrees with the dosage? Another $200 gone. Sorry for the laments....

EDIT: OK Naturopath emailed and said HE IS on the 400 mg monthly dosage, that 0.5 ml weekly equals out to be 100 mls... i am so embarrassed at this point.

SO if he's on this standard dosage and testing out low Free T and Total T at around 500's then i am guessing he is low SHGB like you all said and i'll have to figure out a needle/syringe that doesn't have dead space and what measurement to switch to 3 x a week. Right now i draw up w/one needle (20 g i think) and inject with a 25 g and right there some T is being lost ....