My Dr is challenging testosterone micro dosing

[Voltz]

Long story short I decided to switch from weekly IM injection's to micro dosing. If you're interested why info is here.

Struggling with getting dialed in

Hi there, been reading the past week or so in search of a solution to my problems listed below. - Age, 43 - Weight 284 - Height 6'1 - 22 year lifter, former competitive powerlifter - Absolutely zero libido - Fatigue, no motivation, do not find enjoyment in activities I normally would. - Feel...

www.excelmale.com

My doctor is challenging my new protocol and he wants me to send him references / studies regarding the benefits etc of micro dosing so he can be more informed and issue me his opinion. I've put a lot of my time into reading and listening to advise from declarated members here. I do not however have any of the studies that I have read through my various internet searches saved to send him. If anyone has something substantial I can send him please post the link. In the meantime I'll continue to search for the studies/ articles I've found.

Thank you

 

[Anonymon]

I microdose and I’m much better that way. That said, I doubt there’s a single formal study on daily dosing considering how bad all the testosterone dosing standards are that doctors use. If there was anything, it’d probably be in Dr. Crisler’s work. In general I’ve found the open TRT community that has connected online and on social media is where the forefront of things are since it’s made of people actually doing this stuff and non-traditional doctors administering it with more open minds and seeing more bloodwork on it. I’d be terrified of going to a normal endo type for any TRT related protocol.

 

[Voltz]

I microdose and I’m much better that way. That said, I doubt there’s a single formal study on daily dosing considering how bad all the testosterone dosing standards are that doctors use. If there was anything, it’d probably be in Dr. Crisler’s work. In general I’ve found the open TRT community that has connected online and on social media is where the forefront of things are since it’s made of people actually doing this stuff and non-traditional doctors administering it with more open minds and seeing more bloodwork on it. I’d be terrified of going to a normal endo type for any TRT related protocol.

Those were my thoughts also. The community is where the majority of the information is stemming from. If there was a one size fits all approach regarding TRT/HRT that worked for everyone these forums might not exist. I know I've come across charts and graphs of the various dosing protocols and information explaining the various benefits to micro dosing vs weekly IM injections etc over the past week or so. I've spent so much time researching and have clicked so many links within various articles I'm afraid I won't be able to find the information I want to provide him with. Either way, he's either on board with me and willing to work or I'm moving on. It's like pulling teeth to get him to agree to requesting labs to check my prolactin levels just so I can check it off my list.

 

[CKO]

I haven't seen any studies on it, but this forum is mostly supportive of it. I personally feel better at 2 injections per week, than I did on more frequent.

 

[Anonymon]

Those were my thoughts also. The community is where the majority of the information is stemming from. If there was a one size fits all approach regarding TRT/HRT that worked for everyone these forums might not exist. I know I've come across charts and graphs of the various dosing protocols and information explaining the various benefits to micro dosing vs weekly IM injections etc over the past week or so. I've spent so much time researching and have clicked so many links within various articles I'm afraid I won't be able to find the information I want to provide him with. Either way, he's either on board with me and willing to work or I'm moving on. It's like pulling teeth to get him to agree to requesting labs to check my prolactin levels just so I can check it off my list.

Although it might not be covered by insurance if your current guy is, I’d recommend moving on either way if you could afford it. I can recommend my clinic in PM if you’d like as they’re really great, but honestly anyone that isn’t a standard cookie cutter endo would be better than the experience you’re having. Mine’s fully willing to do and try out anything if it at all makes sense. He himself’s on TRT so he gets it. My protocol works for me but I doubt I’d have been given the freedom to find it with an endo type. I’ve been lucky in that regard as my guy’s a full supporter of the Crisler style approach, and prioritizes symptoms over just the bloodwork.

I haven't seen any studies on it, but this forum is mostly supportive of it. I personally feel better at 2 injections per week, than I did on more frequent.

Seems that seem people do better with some dosing schedules based on their SHBG. Manipulating that and E2 and potentially DHT and Free T based on how we all respond to frequencies and esters and subq vs IM seems to be the main benefit of trying out different methods.

 

[Systemlord]

My doctor is challenging my new protocol and he wants me to send him references / studies regarding the benefits etc of micro dosing so he can be more informed and issue me his opinion.

You're not going to find studies showing anything regarding micro-dosing, typically the only doctors suggesting micro-dosing are those with greater medical freedom operating privately out of the sick care setting where insurance companies have no influence.

 

[Voltz]

I microdose and I’m much better that way

Can you tell me what changed when you started micro dosing vs your previous protocol? Curious if you were experiencing the same symptoms Ive been dealing with for years

 

[Anonymon]

Can you tell me what changed when you started micro dosing vs your previous protocol? Curious if you were experiencing the same symptoms Ive been dealing with for years

I admittedly wasn’t on less frequent dosing for long, but when I went to daily, my unwanted water retention went down, my mood was better, I slept better, I was calmer, a little less anxious, libido was a little higher. Everything TRT helped me with just got a little better. My bloodwork was also better, showing higher free T despite the Total T being about the same. Everything was superior so I kept at it. My starting protocol was 2-3x a week, and my doc was fully behind more frequent is better, so I asked if I could do it daily and he said sure and then he later went to daily as well from his 4x a week approach.

 

[Cataceous]

Just point the doctor to studies of transdermal testosterone. It's the same concept: daily micro-dosing. The pharmacokinetic data for Androgel show fairly stable levels—though I sure didn't get that—which means that serum testosterone wouldn't be that much different from when injecting a longer ester daily. Of course I've argued that it's even more natural to introduce diurnal variation in levels by using a propionate blend daily.

Evaluation of the pharmacokinetic profiles of the new testosterone topical gel formulation, Testim, compared to AndroGel - PubMed

A two-period, randomized, complete crossover study was performed to evaluate the pharmacokinetic profiles of Testim (AA2500), a new 1% testosterone topical gel formulation, compared to AndroGel, an already available 1% testosterone topical gel. Twenty-nine hypogonadal subjects received a single...

pubmed.ncbi.nlm.nih.gov

Long-Term Pharmacokinetics of Transdermal Testosterone Gel in Hypogonadal Men1

Transdermal delivery of testosterone (T) represents an effective alternative to injectable androgens. Transdermal T patches normalize serum T levels and re

academic.oup.com

Pharmacokinetics and relative bioavailability of absorbed testosterone after administration of a 1.62% testosterone gel to different application sites in men with hypogonadism - PubMed

Although lower testosterone bioavailability was observed after abdominal application of 1.62% testosterone gel in comparison with application to the upper arms/shoulders, application to either site yielded eugonadal levels of serum testosterone.

pubmed.ncbi.nlm.nih.gov

 

[Voltz]

Just point the doctor to studies of transdermal testosterone.

I thought about that , basically same concept without the absorption issues of transdermal. It just blows my mind that these doctors are stuck in the stone age. To me it just goes to show how un motivated these doctors are to actually solve problems for their patients. I can see where a doctor such as mine who is employed by a large medical group my be apprehensive to introduce certain therapy's opposed to a doctor working from a clinic but WTF some of this stuff is very basic and the information is easily obtainable. Where's the motivation to solve a problem for a suffering patient. I feel like it's just a money grab. Honestly, I felt better and had a regular libido etc before TRT and I've stressed this to him multiple times. Very frustrating, either way Im looking to ditch him and pay out of pocket for a more progressive and motivated doctor. Sorry for the rant, this has really been getting to me.

 

[Vince]

Here's a good thread on daily injections.

Two and One-Half Years on Daily Injections: Stability Maintained

For two and one-half years I've been injecting 16mg of testosterone enanthate on a daily basis along with 250 iu of HCG twice weekly. It's been an enormous success for me, success confirmed by labs drawn in December when I (a Canadian) visited family in the States for Christmas. I have clearly...

www.excelmale.com

 

[madman]

Long story short I decided to switch from weekly IM injection's to micro dosing. If you're interested why info is here.

Struggling with getting dialed in

Hi there, been reading the past week or so in search of a solution to my problems listed below. - Age, 43 - Weight 284 - Height 6'1 - 22 year lifter, former competitive powerlifter - Absolutely zero libido - Fatigue, no motivation, do not find enjoyment in activities I normally would. - Feel...

www.excelmale.com

My doctor is challenging my new protocol and he wants me to send him references / studies regarding the benefits etc of micro dosing so he can be more informed and issue me his opinion. I've put a lot of my time into reading and listening to advise from declarated members here. I do not however have any of the studies that I have read through my various internet searches saved to send him. If anyone has something substantial I can send him please post the link. In the meantime I'll continue to search for the studies/ articles I've found.

Thank you!

Threads with the same study below.

If anything it shows that daily subcutaneous injections of T are effective.

At least the most accurate assays were used for TT (LC/MS-MS) and FT (Equilibrium Ultrafiltration).

Unfortunately, an AI let alone hCG was used from the get-go!

Derive what you will from the study!




Daily subcutaneous testosterone for management of testosterone deficiency (2018)


1. ABSTRACT

Testosterone deficiency (TD) is a public health concern, a predictor of metabolic syndrome, and is associated with an increased all-cause and cardiovascular mortality. Testosterone deficiency in men is treated by a variety of methods including injectable testosterone compounds, patches, gels, pellets, and oral preparations. The use of testosterone alone has been linked to various adverse effects including, infertility, testicular atrophy, erythropoiesis, and gynecomastia. To determine the effectiveness of therapy using the Daily Subcutaneous Testosterone (DST) method in combination with human chorionic gonadotropin (hCG) and an aromatase inhibitor (anastrozole), a retrospective analysis was conducted of men diagnosed and treated for TD. Changes in testosterone, estradiol, sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA-S), prostate-specific antigen (PSA), pregnenolone, and hemoglobin was determined. There was a significant increase in total testosterone, free serum testosterone, and direct free testosterone in the testosterone-treated patients. There was a significant increase in total and free testosterone levels with the DST method combined with hCG and anastrozole, suggesting that DST therapy is a viable option to restore testosterone levels in men.




2.2. Diagnosing and treatment approaches to testosterone deficiency

In general, IM testosterone injections are administered by medical personnel in a clinic setting on a weekly or biweekly interval. The advantages of injectable testosterone are the achievement of reliable serum peak levels and low cost. Infrequent injections, however, result in large variability of peak-trough blood testosterone levels and are also associated with fluctuations in mood and libido (20). Similarly, large fluctuations in other hormones such as serum estradiol and DHT are found with infrequent, large IM injections (21). A third of patients experience pain and bleeding with deep intramuscular injection (20).




2.3. Complications associated with common treatment approaches

We postulate that shorter testosterone injection intervals using lower doses can further lessen the cyclical peaks and lows leading to more stable blood testosterone levels, a pattern resembling normal physiologic hormone activity. The application of daily subcutaneous testosterone (DST) injections is rarely used by most clinics. DST therapy combines the benefits of achieving stable blood concentrations seen with topical or pellet routes of administration, but avoids many of the adverse effects such as the serious risk of transference or invasiveness, respectively. Further, subcutaneous injections are easier to self-administer than intramuscular injections and associated with significantly less discomfort. The cost of in-center administration is also mitigated by this method, which may lead to overall savings in healthcare expenditure.

A treatment for TD that takes advantage of the pharmacokinetic benefits of daily testosterone administration with limited adverse effects would have a significantly positive impact on the therapeutic options for low testosterone. Also, co-administration with hCG and aromatase inhibitors may add to the clinical benefits of testosterone therapy and further prevent undesirable clinical outcomes associated with testosterone-only therapy. To determine the effectiveness of combining the DST method, hCG, and aromatase inhibitor, we conducted a retrospective analysis of men diagnosed or treated for low testosterone at our Seaside Medical Practice from 2009-2016. We determined the changes in various hormones and factors including serum total testosterone, free testosterone, % free testosterone, estradiol, SHBG, LH, FSH, DHT, DHEA-S, PSA, pregnenolone, and hemoglobin.




3. METHODS

A retrospective analysis of men diagnosed with and treated for TD was conducted. Review was performed on 356 male patients identified on the medical practice electronic medical database. Fifty-four of these met the following criteria of inclusion in the study: any age (resulting from an age range of those included in the study is 26-82 years), any race, have at least 2 laboratory points of total testosterone level, and prescribed daily subcutaneous testosterone injection per DST Method (Daily Subcutaneous Testosterone Method). The study was approved by the Seaside Medical Practice Institutional Review Board. Informed consent was not required.

The testosterone was administered as testosterone cypionate (7-18 mg) in more than 95% of the patients included in the study; the remaining received a combination of testosterone cypionate and testosterone enanthate. The testosterone was administered via subcutaneous injection using a 30 gauge, 1/2-inch hypodermic needle into the outer thigh, biceps, or gluteal muscles. The daily injection dose levels mirror the gonads’ release of testosterone in small pulses throughout the day equaling about 4-9 mg per day (41-44). The patients also self-administered hCG (220 units two days per week, Mondays and Fridays) via subcutaneous injection with a 30 gauge, 5/16-inch hypodermic needle into the mid-abdominal wall. Anastrozole was administered as a once-daily oral 0.25-0.5. mg tablet. This approach involved administering smaller subcutaneous daily injections versus large intramuscular weekly or biweekly injections.





4. RESULTS AND DISCUSSION

Table 1 shows the means and standard error of the means (SEMs) for the measured blood values between the pre-and post-testosterone (T) treatment groups (lab dates 1 and 2). Total T increased from 385.17± 21.75 ng/dL to 846.78 ± 45.35 ng/dL (p<0.01), free serum T from 40.12 ± 7.20 pg/mL to 118.88 ± 19.18 pg/mL (p<0.01), and direct free T increased from 30.60 ± 7.90 pg/mL to 106.34 ± 35.37 pg/mL (p<0.05). There was also a significant increase of DHEA-S after treatment from 217.15 ± 20.14 µg/dL to 333.46 ± 23.85 µg/dL (p<0.01). LH and FSH both decreased (5.43 ± 0.70 IU/L to 1.16 ± 0.63 IU/L (p<0.01) and 4.74 ± 0.59 mIU/L to 1.60 ± 0.74 mIU/L (p<0.05), respectively). No significant differences in the % free T and the levels of estradiol, SHBG, DHT, PSA, pregnenolone, or hemoglobin were observed.

Figure 1A shows the differences in total testosterone measurements between the two laboratory testing dates by age group, and figure 1B shows the differences in serum-free testosterone measurements. In the 20 to 39-year age group, total testosterone increased from 349.50 ± 38.39 ng/dL to 827.00 ± 81.92 ng/dL (p<0.01) and free serum testosterone increased from 23.32 ± 10.05 to 73.04 ± 25.57 pg/mL (p<0.05). In the 40 to 59-year age group, total testosterone increased from 416.11 ± 52.04 ng/dL to 1072.00 ± 120.33 ng/dL (p<0.01) and free serum testosterone increased from 49.72 ± 14.15 to 195.26 ± 61.81 pg/mL (p<0.05). Finally, in the 60 and over year age group, total testosterone increased from 436.80 ± 49.31 ng/ dL to 901.13 ± 60.47 ng/dL (p<0.01) and free serum testosterone increased from 60.84 ± 23.89 to 147.22 ± 26.40 pg/mL (p<0.05). Therefore, the treatment caused increases in testosterone regardless of age group.

The results show that treatment with testosterone, hCG, and anastrozole increased testosterone levels in men with low or low normal testosterone. Although the pre-treatment mean serum testosterone of our study is 385 ng/L, free serum testosterone is below normal limits (346 ng/ dL) as defined by Wang et al (13). As previously mentioned, it is not recommended to rely solely on clinical laboratory values for the diagnosis of low testosterone. The men of our study all had clinical signs and symptoms of low testosterone and free testosterone levels below normal leading to a diagnosis of TD. The DST method did not lead to supra-physiologic or highly variable testosterone levels as frequently as that reported in the literature for the IM administration method (where peak testosterone concentration is high at the beginning of the injection period and very low toward the end).

This treatment method involved the administration of the aromatase inhibitor anastrozole throughout testosterone treatment, which accounted for stable estradiol levels pre and post-testosterone therapy (40). Changes in estradiol levels are associated with increased adiposity, mood swings, decreased libido, and gynecomastia in men treated with testosterone replacement. There were no posttreatment reports by the patients of the study of adverse changes in libido. Rare reports of gynecomastia were noted. In a study by Pastuszak et al., some of the study participants on testosterone-therapy had higher estradiol levels, which was successfully treated with an aromatase inhibitor (45). The findings reported by Pastuszak et al. were consistent despite variable laboratory testing intervals.

The DST therapy method used was not associated with an increase in hemoglobin. Higher changes in hemoglobin and hematocrit occur more frequently with IM vs. topical or pellet administration, a trend not observed in our sample (7). Testosterone replacement inhibits hepcidin activity, thereby leading to increased iron absorption and increased erythropoiesis. It is plausible that smaller daily testosterone injections, resembling physiologic secretion, do not affect hepcidin activity to the same degree that is seen with supra-physiologic testosterone level from weekly IM injections.

Although there were statistically significant increases in testosterone levels using the DST therapy method with anastrozole and hCG cotreatment, there were some limitations of the study. There was variability between individuals in the time interval between the 2 laboratory testing dates. Also, a few of the patients received two forms of testosterone for therapy. Additional factors that could influence the observed changes in blood testosterone levels were supplements and other treatments taken by the patients before, during, and/or after the initiation of testosterone therapy. Some patients that received the DST treatment also took pregnenolone, HGH, DHEA, or vitamin D. These treatments may have affected the magnitude of observed testosterone levels after the testosterone therapy. Finally, the ages of the individuals varied greatly. However, an analysis based on age group showed consistent increases in testosterone levels. However, the magnitude of responses to testosterone treatment may have differed according to the age and health status of the individuals treated.




5. DISCUSSION

Despite the noted limitations, the consistent and statistically significant increases in the three testosterone values suggest that the DST therapy method used for the patients included in the study has positive effects on testosterone level status. Co-treatment with an aromatase inhibitor and hCG appears to have prevented some of the adverse effects commonly observed with testosterone-only treatment. These findings can serve as a basis for further studies (including prospective controlled trials) to determine the range of benefits and better define the expected outcomes with the DST therapy method using aromatase inhibitor and hCG co-treatment.

Daily subcutaneous testosterone for management of testosterone deficiency

54 men age range (26-82) prescribed daily subcutaneous testosterone injection per DST Method testosterone was administered as testosterone cypionate (7-18mg) in >95% of the patients included in the study remaining patients recieved combination of testosterone cypionate/enanthate testosterone...

www.excelmale.com

post#6

Subcutaneous Testosterone Injection Studies

Subcutaneous Testosterone: An Effective Delivery Mechanism for Masculinizing Young Transgender Men (2014)

www.excelmale.com

post#30

Subcutaneous Injection

When was testing done relative to injections? As long as you didn't have injection site leakage you should absorb the whole dose. SubQ has been shown to absorb a little more slowly than IM, but in the end you're getting all the testosterone. I injected sub q last Monday night, and tested Tuesday...

www.excelmale.com

 

[madman]

Table 1. Laboratory values for studied hormones/factors

 

[madman]

Figure 1. A. Plotted are the mean ± SEM for total testosterone (T) for three different age groups (20-39, 40-59, and 60+). Total T (ng/dL) was measured by liquid chromatography with mass spectroscopy. B. Plotted are the mean ± SEM for serum-free testosterone for the same three different age groups. Free serum T (pg/mL) was measured using the equilibrium ultrafiltration assay. Dark gray bars refer to lab date 1, and light gray bars refer to lab date 2.

 

[Voltz]

Threads with the same study below.

Excellent, this will suffice. Thank you

 

[madman]

interesting write up on micro dosing Test and HCG from England

Microdosing TRT – The Future of Testosterone Replacement Therapy Introduction The premise behind microdosing Testosterone Replacement Therapy (TRT) is quite simple; it is using the minimum effective dose, in the most effective manner, in order to achieve the desired outcome which, in this...

www.excelmale.com

Microdosing TRT – The Future of Testosterone Replacement Therapy - The Men’s Health Clinic

Microdosing is the most effective way to mimic natural Testosterone levels and minimise side effects. We explain why in this article.

themenshealthclinic.co.uk

 

[madman]

Here's a good thread on daily injections.

Two and One-Half Years on Daily Injections: Stability Maintained

For two and one-half years I've been injecting 16mg of testosterone enanthate on a daily basis along with 250 iu of HCG twice weekly. It's been an enormous success for me, success confirmed by labs drawn in December when I (a Canadian) visited family in the States for Christmas. I have clearly...

www.excelmale.com

Miss having him one here as Excel will never be the same.

Deeply respected and sorely missed.

Hope he is doing well.

 

[Voltz]

Microdosing TRT – The Future of Testosterone Replacement Therapy - The Men’s Health Clinic

Microdosing is the most effective way to mimic natural Testosterone levels and minimise side effects. We explain why in this article.

themenshealthclinic.co.uk

This is the article I've been searching for !!!

 

[S1W]

Long story short I decided to switch from weekly IM injection's to micro dosing. If you're interested why info is here.

Struggling with getting dialed in

Hi there, been reading the past week or so in search of a solution to my problems listed below. - Age, 43 - Weight 284 - Height 6'1 - 22 year lifter, former competitive powerlifter - Absolutely zero libido - Fatigue, no motivation, do not find enjoyment in activities I normally would. - Feel...

www.excelmale.com

My doctor is challenging my new protocol and he wants me to send him references / studies regarding the benefits etc of micro dosing so he can be more informed and issue me his opinion. I've put a lot of my time into reading and listening to advise from declarated members here. I do not however have any of the studies that I have read through my various internet searches saved to send him. If anyone has something substantial I can send him please post the link. In the meantime I'll continue to search for the studies/ articles I've found.

Thank you

Daily subcutaneous testosterone for management of testosterone deficiency

 

[Guided_by_Voices]

I think micro-dosing is very under-rated for all things hormonal/anabolic, but here are several other things to consider. A lot of your early-stage outcomes will depend on your starting point...IOW whether you are coming down from something else or starting from "natural" levels, even if those levels are low. For example, when I used Clomid only, reducing the dose did not improve my outcome, but stopping completely for a while and then restarting at a lower dose did. Also, the number of variables involved (dose, timing, delivery method, patient terrain, etc.) would make even a well-intentioned study very difficult to design in a way that actionable outcomes were produced. Perhaps it has been done, but the study design would have to be examined very carefully and it would not eliminate the need for a degree of experimentation for any specific individual.