Subcutaneous Testosterone Injections Are A Good Alternative to Intramuscular Ones

[the_shep]

Abstract

Context:
Testosterone (T) is commonly administered intramuscularly to treat hypogonadal males and female-to-male (FTM) transgender patients. However, these injections can involve significant discomfort and may require arrangements for administration by others.

Objective:
We assessed whether T could be administered effectively and safely subcutaneously as an alternative to intramuscular (IM) injections.

Two preliminary reports (10, 11) and a pharmacokinetic study (12) of SC T administration suggest that the SC route may be a safe, convenient, and effective alternative to currently available options. The preliminary reports assessed short-term therapy in hypogonadal men (10) and FTM transgender patients (11) and did not universally attain serum levels of T within the normal range. The pharmacokinetic study used fixed doses from a potentially expensive autoinjector (12). To further characterize SC T as a practical and acceptable alternative to IM administration, we evaluated the efficacy, safety, and acceptability of manual SC injections of T cypionate to patients undergoing FTM sex transition in our clinic.

Subcutaneous Injection of Testosterone Is an Effective and Preferred Alternative to Intramuscular Injection: Demonstration in Female-to-Male Transgender Patients

Apologies if this has been posted previously.

How to Inject Testosterone Intramuscularly, Shallow IM or Subcutaneously ?

Click here to watch videos on how to inject testosterone intramuscularly or subcutaneously More information on subcutaneous testosterone injections: https://www.discountedlabs.com/blog/intramuscular-vs-subcutaneous-testosterone-injections-are-they-both-effective Subcutaneous Testosterone...

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[Vince]

I prefer shallow IM with an Easy Touch 29g 1/2" syringe, for both T and HCG.

 

[FeelingLost]

I don't understand why the carrying agent has to be so thick. That is the real problem. The thick fluid requires a larger needle.
Many who try subcutaneous complain of the lumb that is left behind and again I believe this is do to the thick carrying agent not allowing the injection to dispurse quickly.

 

[Jinzang]

The carrying agent is oil instead of water to slow down absorption of the testosterone. Testosterone suspension, which is dissolved in water, is absorbed immediately. The ester bound to testosterone (cypionate, etheanate) binds to the oil and slows down release into the blood.

 

[FeelingLost]

The carrying agent is oil instead of water to slow down absorption of the testosterone. Testosterone suspension, which is dissolved in water, is absorbed immediately. The ester bound to testosterone (cypionate, etheanate) binds to the oil and slows down release into the blood.

Is it the oil base or the viscosity that slows the adsorbtion?
Oil does not have to be thick sewing machine oil is like water and then there is 90 weight for vehicle transmissions.
From what I read here most pin subcutaneous daily or EOD does the rate of adsorbtion still need to be the same as the old every other week back when our current cypionate, etheanate were designed.
I'm just saying the compounding industry is falling behind or heck not even looking into better ways to deliver cypionate whe one chooses more frequent injections.

 

[Jinzang]

It's the oil that slows down the absorption. The ester attached to the testosterone keeps it bound to the oil. You would want to use a vegetable oil, not a mineral oil, to dissolve the testosterone. A brief check shows that safflower oil and walnut oil are the lowest viscocity vegetable oils. I doubt the pharmacies care as much about the needle gauge as shelf life and cost, but it's a novel idea to use a thinner oil. Maybe someone who works for a pharmacy (Jasen?) could give their opinion.

 

[Nelson Vergel]

There are two pages of interesting posts here
Should You Be Injecting Testosterone Under the Skin?

Shaun and Jasen added some good points here

Should I swap needles when drawing and injecting Testosterone?

 

[Nelson Vergel]

New members with little knowledge of subcutaneous testosterone injections should read this thread:

Subcutaneous Administration of Testosterone

 

[madman]

Is it the oil base or the viscosity that slows the adsorbtion?
Oil does not have to be thick sewing machine oil is like water and then there is 90 weight for vehicle transmissions.
From what I read here most pin subcutaneous daily or EOD does the rate of adsorbtion still need to be the same as the old every other week back when our current cypionate, etheanate were designed.
I'm just saying the compounding industry is falling behind or heck not even looking into better ways to deliver cypionate whe one chooses more frequent injections.

There is more than simply the oil carrier/ester regarding the absorption of testosterone. Pharmacokinetics and Pharmacodynamics of Nandrolone Esters in Oil Vehicle: Effects of Ester, Injection Site and Injection Volume

 

[Nelson Vergel]

Subcutaneous Testosterone and the Effect of BMI on Serum T in Men with low T

In this video, Jesse N. Mills, MD, discusses the important findings from the study, “Subcutaneous Testosterone Enanthate and the Effect of Body Mass Index on Serum Testosterone in Men with Testosterone Deficiency,” presented recently at the 2021 Sexual Medicine Society of North America Fall...

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[Nelson Vergel]

TRT with Subcutaneous Testosterone Injections: A Safe, Practical and Reasonable Option

Abstract Context: Injections with intramuscular testosterone esters have been available for almost 8 decades and not only result in predictable serum testosterone levels but are also the most inexpensive modality. However, they are difficult to self-administer and associated with some...

www.excelmale.com

 

[Nelson Vergel]

TRT with Subcutaneous Testosterone Injections: A Safe, Practical and Reasonable Option

Abstract Context: Injections with intramuscular testosterone esters have been available for almost 8 decades and not only result in predictable serum testosterone levels but are also the most inexpensive modality. However, they are difficult to self-administer and associated with some...

www.excelmale.com

 

[Nelson Vergel]

Subcutaneous Testosterone Enanthate and the Effect of Body Mass Index on Serum Testosterone in Men with Testosterone Deficiency

M Miner, T Amy, R Gollen, X Zhou, H Yan, J Jaffe - The Journal of Sexual Medicine, 2022

https://www.jsm.jsexmed.org/article/S1743-6095(22)00045-5/fulltext

​

Introduction​

Obesity (body mass index [BMI] ≥30 kg/m^2) in men is associated with low testosterone (T) levels, and the prevalence of testosterone deficiency (TD) is greater in obese men. Information is limited regarding how BMI affects the pharmacokinetic (PK) profile or dosing of testosterone therapies (TTh) in men with TD. Serum total testosterone (TT) trough concentration (C-trough)-guided dosing achieved physiological serum TT levels (300-1100 ng/dL) in a Phase 3 trial of subcutaneous (SC) testosterone enanthate (TE) administered weekly.

Objective​

This post-hoc analysis evaluated the association between BMI and serum TT to assess PK parameters of weekly SC TE treatment in men with TD and varying BMIs.

Methods​

Concentration-controlled SC TE was evaluated in a single-arm Phase 3 trial. The primary endpoint was the percentage of patients who received ≥1 dose of SC TE (Safety Population) achieving an average serum TT concentration of 300-1100 ng/dL over the 7-day dosing interval, C-avg (0-168h), at Week 12. The PK Population (n=142) included all patients in the Safety Population with ≥1 blood sample drawn post-dose. Patients in the PK Population who completed the study through Week 12 (n=137) were categorized into tertiles based on baseline BMI: Tertile 1 (BMI ≤29 kg/m^2; n=45), Tertile 2 (BMI >29-32 kg/m^2; n=33), and Tertile 3 (BMI >32 kg/m^2; n=59). Assessed PK parameters included C-trough, AUC-(0-168h), C-avg (0-168h), and C-max. Weeks 6 and 12 C-trough and C-avg (0-168h) were assessed by BMI tertiles. C-trough and C-avg (0-168h) were calculated according to their Week 12 treatment doses, and an overall dose-normalized linear regression model at Week 12 was used.

Results​

At baseline, mean (SD) serum TT levels for patients in Tertiles 1-3 were 250.7 (101.3), 235.3 (91.2), and 226.4 (81.1) ng/dL, respectively. Prior to dosing adjustments at Week 6, Tertiles 2 and 3 mean (SD) C-trough (459.2 [157.0] and 453.2 [133.0] ng/dL) were lower than Tertile 1 (616.9 [181.6] ng/dL). At Week 6, 21.2% of the total variance in C-trough levels could be predicted from BMI (P<0.001). At Week 12, patients in Tertiles 2 and 3 had lower TT C-trough (494.8 [137.6] and 469.0 [146.2] ng/dL) compared to 517.7 (153.5) ng/dL in Tertile 1. Mean (SD) C-avg (0-168h) values were 585.2 (148.1), 554.2 (104.5), and 528.5 (118.0) ng/dL in Tertiles 1-3, respectively. Mean doses at Week 12 for Tertiles 1-3 were 65.0 (13.48), 78.0 (12.12), and 78.4 (12.68) mg, respectively. Thus, the patients in Tertiles 2 and 3 require higher final doses of SC TE compared to patients in Tertile 1. Using an overall dose-normalized linear regression model at Week 12, 9.36% (P<0.001) and 16.96% (P<0.001) of the total variance in C-trough and C-avg (0-168h), respectively, can be predicted from independent BMI and dose variables. Overall, 98.5% of Week 12 completers achieved C-avg (0-168h) of 300-1100 ng/dL.

Conclusions​

Week 12 TT C-trough, C-avg (0-168h), and C-max were inversely related to BMI, suggesting an important role for BMI and final dose selection in SC TE exposure. Patients with higher BMI tertiles may require higher testosterone dosing to replete physiologic levels.

Disclosure​

Yes, this is sponsored by industry/sponsor: Antares Pharma, Inc.

Clarification​

Industry initiated, executed and funded study
Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma, Inc.

 

[Nelson Vergel]

SUB-Q TESTOSTERONE INJECTIONS IN HYPOGONADAL MEN

SUBCUTANEOUS TESTOSTERONE INJECTIONS IN HYPOGONADAL MEN (2022) Rodney L Dennis MD Testosterone Therapy may be administered in various ways. But, one delivery route not often considered is a subcutaneous injection. Some reasons for this may include a lack of familiarity with the technique, a...

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[Deleted member 43589]

Is it the oil base or the viscosity that slows the adsorbtion?
Oil does not have to be thick sewing machine oil is like water and then there is 90 weight for vehicle transmissions.
From what I read here most pin subcutaneous daily or EOD does the rate of adsorbtion still need to be the same as the old every other week back when our current cypionate, etheanate were designed.
I'm just saying the compounding industry is falling behind or heck not even looking into better ways to deliver cypionate whe one chooses more frequent injections.

It is the viscosity of the oil used combined with the ester of the drug. I have a study somewhere showing the difference between grapeseed oil, cotton seed oil and castor oil used with testosterone undeconate and the differences are very substantial. Of course castor oil has the most viscosity of the three.

I do sub-q every 10 days using testosterone cypionate made with cotton seed oil

 

[Nelson Vergel]

Subcutaneous TRT injections reduce the number of men with high hematocrit

Erythrocytosis in Subcutaneous Testosterone Replacement Therapy Author links open overlay panel (2022) TWilliamson, JTrussler, AMcCullough Introduction Intramuscular (IM) testosterone replacement therapy (TRT) is commonly administered to treat symptomatic male hypogonadism and can result in...

www.excelmale.com

SUB-Q TESTOSTERONE INJECTIONS IN HYPOGONADAL MEN

SUBCUTANEOUS TESTOSTERONE INJECTIONS IN HYPOGONADAL MEN (2022) Rodney L Dennis MD Testosterone Therapy may be administered in various ways. But, one delivery route not often considered is a subcutaneous injection. Some reasons for this may include a lack of familiarity with the technique, a...

www.excelmale.com

 

[Nelson Vergel]

Subcutaneous Testosterone Injections Are Effective for TRT

Table of Contents Over 10-15 years ago there were several progressive doctors in the cash HRT/TRT (hormone replacement therapy/testosterone replacement therapy) space who at some point realized subcutaneous administration of testosterone cypionate or enanthate not only absorbed as...

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Pharmacokinetics and Acceptability of Subcutaneous Injection of Testosterone Undecanoate

Context Can injectable testosterone undecanoate (TU) be administered effectively and acceptably by the subcutaneous route? Objective To investigate the acceptability and pharmacokinetics (PK) of sc injection of TU. Design Randomized sequence, cross-over clinical study of sc vs im TU...

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[Nelson Vergel]

Dr. John Crisler on Subcutaneous Testosterone Injections

In this video we hear from Dr. John Crisler about Subcutaneous Testosterone Injections in The Cutting Edge Series of videos. https://vimeo.com/131544919

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[Nelson Vergel]

Sore, hot and raised stomach from SubQ injection..did I mess up? Should I keep using the site?

Hey all, New to TRT and had my first pin on Wednesday night. 40iu test C in the abdomen. Everything was fine. Today (3.5d later), I inject on the other side of my abdomen. I was feeling my stomach to see where my initial injection was though, which I found because it was harder than all the...

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[Nelson Vergel]

Shallow Testosterone IM versus SubQ Injections - Lab Results

Background: I have been on TRT for about 15 years. I've never really struggled with TRT but I was always tweaking my protocol like many do. The past several years I have been really dialed in well and have not messed with my protocol at all. That protocol has been injecting 24mg shallow IM...

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