TRT monotherapy. 5 week lab check due to nipple symptoms. Thoughts/Guidance please.

[MSnomad24]

Hey guys,
I've been on TRT monotherapy, no other drugs, for 5 weeks now. I went ahead and pulled some labwork at week 5 instead of waiting till week 12.
Why did i pull labs early?
Answer: I started to have bilateral axillary soreness about 2 weeks in. That subsided and was immediately followed by nipple symptoms at week 4. Symptoms: tenderness, sensitive, firm all the day and itchy. Those symptoms have decreased some to just mild sensitivity and nipple firmness most the day. No lumps or nodules noted to chest, thankfully. I've gained 11 pounds in this time frame going from 133 lbs to 143 lbs; my height is 5'7" and i've never gain weight this fast. I'm also have some very mild acne has started to appear as well.
So....with all those symptoms i just wanted to peak at my hormone levels.

Background:
37 y/o
I'm a TRT virgin, first experience ever taking testosterone. I take Test Cypionate 120mg/week. Dosing 40mg M/W/F. Shallow IM injections rotating deltoids and Ventri-Glute.
My diet, workouts and sleep were dialed in long before starting TRT. Rarely drink. No other drug use.
Workout: weightlifting 5 days per week.
I'm 5'7" and i would say an average build and don't carry alot of fat other than around the lower abdomen and obliques.

How do i feel on TRT today?
Workouts are really good, strength increased and more tenacity to go hard.
Mentation is good. Confidence increase and more outgoing.
Mood can be more labile but overall good.
Sleep has been a bit poor lately even though my wake/sleep cycle is kept consistent.

Baseline labwork pre-TRT. *CMP,CBC not included bc it's all normal.

5 week labwork. Collected on a Wednesday morning before my Wednesday AM injection. MWF injection schedule. Why wednesday...lab not open on Monday (new year's day).

Finally: My QUESTIONS??

I'm concerned about the elevated Estradiol and DHT levels. As a newbie to TRT i don't want to put myself at unnecessary risk for hair loss or gynecomastia.
1. With time will the estrogen and DHT levels self correct, if i don't make any changes or take any other drugs?
2. Should i just sit tight and wait to get bloodwork at 12 weeks and tolerate the nipple symptoms?
3. Will weight gain/water retention self correct along with hormone levels?
4. I know it takes time for the body to adjust and adapt to this new surge of exogenous testosterone but i didn't know if these levels require any short-term intervention or concern?

My goal is to avoid taking other dugs (AI/SERMs) to chase symptoms throughout TRT therapy, but i'd be willing to take a drug for a short course just brings things back in line and continue onward with TRT monotherapy.

I'm going to reach out to my TRT clinic provider, but i was hoping for some input from you guys, as well.

 

[Systemlord]

I'm concerned about the elevated Estradiol and DHT levels. As a newbie to TRT i don't want to put myself at unnecessary risk for hair loss or gynecomastia.

Serum levels of estrogen and DHT are practically meaningless, once your tissues are fully saturated with estrogen and DHT,, tissues can take in no more and you’re left with serum levels, leftovers, which is what you’re testing.

There’s 50 times more estrogen and DHT in target tissues.

Gyno is rare around here, don’t see too many cases in the 7 years I’ve been here. Gynecomastia is genetic and other hormones trigger gyno flare-ups. Testosterone, estrogen, DHT, prolactin and high IGF-1 all contribute to gyno development.

If you have never had gyno at a younger age, you likely never will.

The nipple tenderness is likely fluid retention from the testosterone, since it can increase other hormones that tell the kidneys to hold onto more sodium, and sodium carries water.

You will mostly notice this after dosing changes, and once the body adapts the steady state hormones, nipple tenderness should subside.

If you’re genetically predisposed to hair loss, you will lose your hair eventually, regardless, and TRT may accelerated it.

If that’s the case, embrace the razor.

I’m thinning on the back of the head, what do I care, at 51 I got women in their early to mid 20’s putting themselves in my spaces, staring at me in the mirror at the gym.

It’s not much different at work either.

If you’re confident, handsome, are a gentleman, women don’t give a sh** about your hair!

 

[MSnomad24]

Serum levels of estrogen and DHT are practically meaningless, once your tissues are fully saturated with estrogen and DHT,, tissues can take in no more and you’re left with serum levels, leftovers, which is what you’re testing.

There’s 50 times more estrogen and DHT in target tissues.

Gyno is rare around here, don’t see too many cases in the 7 years I’ve been here. Gynecomastia is genetic and other hormones trigger gyno flare-ups. Testosterone, estrogen, DHT, prolactin and high IGF-1 all contribute to gyno development.

If you have never had gyno at a younger age, you likely never will.

The nipple tenderness is likely fluid retention from the testosterone, since it can increase other hormones that tell the kidneys to hold onto more sodium, and sodium carries water.

You will mostly notice this after dosing changes, and once the body adapts the steady state hormones, nipple tenderness should subside.

If you’re genetically predisposed to hair loss, you will lose your hair eventually, regardless, and TRT may accelerated it.

If that’s the case, embrace the razor.

I’m thinning on the back of the head, what do I care, at 51 I got women in their early to mid 20’s putting themselves in my spaces, staring at me in the mirror at the gym.

It’s not much different at work either.

If you’re confident, handsome, are a gentleman, women don’t give a sh** about your hair!

Well said Systemlord! Thank you for the reply and information. So do think i should just let it ride? Leave dose as-is, avoid temporary AI/SERM and let symptoms resolve on their own.

 

[Systemlord]

Well said Systemlord! Thank you for the reply and information. So do think i should just let it ride? Leave dose as-is, avoid temporary AI/SERM and let symptoms resolve on their own.

Too much testosterone can make some men feel amped up and affect sleep quality. Most members on this forum, 68% feel best near the top end of the ranges or slightly higher.

As long as blood pressure is good (<135/80), and all your symptoms are resolved, and other biomarkers are healthy, running slightly higher levels is fine. Some men feel less optimized above 1000 ng/dL, more is not always better.

Six months after starting TRT, it was mandatory that I do a sleep study, because TRT can take a mild case of sleep apnea much worse.

You need to give each protocol at least 8-12 weeks to access how you feel.

 

[MSnomad24]

Too much testosterone can make some men feel amped up and affect sleep quality. Most members on this forum, 68% feel best near the top end of the ranges or slightly higher.

As long as blood pressure is good (<135/80), and all your symptoms are resolved, and other biomarkers are healthy, running slightly higher levels is fine. Some men feel less optimized above 1000 ng/dL, more is not always better.

You need to give each protocol at least 8-12 weeks to access how you feel.

Roger that. Thank you for your input!

 

[Systemlord]

My estrogen is 70-90, for 2 years on the same protocol, and no issues at all.

 

[madman]

Hey guys,
I've been on TRT monotherapy, no other drugs, for 5 weeks now. I went ahead and pulled some labwork at week 5 instead of waiting till week 12.
Why did i pull labs early?
Answer: I started to have bilateral axillary soreness about 2 weeks in. That subsided and was immediately followed by nipple symptoms at week 4. Symptoms: tenderness, sensitive, firm all the day and itchy. Those symptoms have decreased some to just mild sensitivity and nipple firmness most the day. No lumps or nodules noted to chest, thankfully. I've gained 11 pounds in this time frame going from 133 lbs to 143 lbs; my height is 5'7" and i've never gain weight this fast. I'm also have some very mild acne has started to appear as well.
So....with all those symptoms i just wanted to peak at my hormone levels.

Background:
37 y/o
I'm a TRT virgin, first experience ever taking testosterone. I take Test Cypionate 120mg/week. Dosing 40mg M/W/F. Shallow IM injections rotating deltoids and Ventri-Glute.
My diet, workouts and sleep were dialed in long before starting TRT. Rarely drink. No other drug use.
Workout: weightlifting 5 days per week.
I'm 5'7" and i would say an average build and don't carry alot of fat other than around the lower abdomen and obliques.

How do i feel on TRT today?
Workouts are really good, strength increased and more tenacity to go hard.
Mentation is good. Confidence increase and more outgoing.
Mood can be more labile but overall good.
Sleep has been a bit poor lately even though my wake/sleep cycle is kept consistent.

Baseline labwork pre-TRT. *CMP,CBC not included bc it's all normal.
View attachment 40616

5 week labwork. Collected on a Wednesday morning before my Wednesday AM injection. MWF injection schedule. Why wednesday...lab not open on Monday (new year's day).
View attachment 40617

Finally: My QUESTIONS??

I'm concerned about the elevated Estradiol and DHT levels. As a newbie to TRT i don't want to put myself at unnecessary risk for hair loss or gynecomastia.
1. With time will the estrogen and DHT levels self correct, if i don't make any changes or take any other drugs?
2. Should i just sit tight and wait to get bloodwork at 12 weeks and tolerate the nipple symptoms?
3. Will weight gain/water retention self correct along with hormone levels?
4. I know it takes time for the body to adjust and adapt to this new surge of exogenous testosterone but i didn't know if these levels require any short-term intervention or concern?

My goal is to avoid taking other dugs (AI/SERMs) to chase symptoms throughout TRT therapy, but i'd be willing to take a drug for a short course just brings things back in line and continue onward with TRT monotherapy.

I'm going to reach out to my TRT clinic provider, but i was hoping for some input from you guys, as well.

A decent starting dose of 120 mg T/week but not sure why you felt the need to jump in on a 3X weekly protocol.

As you would know your true trough (lowest point) on such protocol would be Monday morning just before your next injection.

You made it clear why you had blood work done on Wednesday morning which is 48 hours post-injection and as you can see you are hitting a very high TT and more importantly your FT is very high.

This was tested using what would be considered the most accurate assay (Equilibrium Dialysis).

Keep in mind that although this is not true trough even if you tested at true trough your TT/FT would still be on the high end.

You are missing critical blood markers RBCs, hemoglobin, and hematocrit which will increase when using exogenous T.

Driving up FT will drive up such blood markers within the first month after starting and will take anywhere from 6-9 months and in some cases a year to reach peak levels.

Where such blood markers sit 5 weeks in is not where they are going to end up 6-9 months from now.

Not sure where everything sat pre-trt as you never posted but there is a good chance they will be driven much higher especially when using injectable T let alone running a high FT like you are.

Something that you need to keep an eye on over the following months.

Increasing FT will drive up estradiol/DHT.

Increased nipple sensitivity can happen in some.

Much more to gynecomastia than just elevated estradiol.

If you are experiencing swelling/pain or tenderness it can be early signs of gynecomastia developing but in many cases, it will only happen to the genetically prone and is rare when using therapeutic doses of T.

As long as you do not feel a lump/rubbery mass when squeezing then I would not jump to any conclusions as of yet as your hormones are in flux during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE).

When it comes to acne let alone hair loss genetics plays a strong role and one can still have issues without having high DHT as the sensitivity of the AR (hair/skin) will play a big role.

In most cases running too high a FT will contribute to such.

Although many tend to blame estradiol when it comes to bloat/water retention keep in mind that androgens increase sodium/water.

Androgens increase the retention of electrolytes.

The use of exogenous androgens will result in the retention of sodium, chloride, water, potassium, calcium, and inorganic phosphates.

Bloating/edema can be common in some and to what degree depends on many factors.

Inhibition of corticosteroid 11β-hydroxysteroid dehydrogenase enzymes plays a role.

Most of the initial increases in weight gain on trt are water-related whether extra-cellular/intra-cellular.

Many men on trt can gain 5-15 lbs of water weight within the first month.

The majority of gains when first starting trt are due to extra-cellular water (between the muscle and skin) which shows up as bloat/puffiness and intra-cellular water (inside the muscle cell) which will make the muscle look fuller and harder due to increased glycogen stores.

Even then once the body adjusts or measures have been taken to minimize the bloat/puffiness you are always going to hold more water when using androgens as the muscle cells will retain more water (intra-cellular).

When coming off androgens, especially high doses you are always going to be pissing out the water weight (extra/intracellular).

Part of the reason why men who abuse androgens mainly the so-called wet compounds deflate when they come off is because they are holding a shit load of excess water weight which is always going to be pissed away.

If you are feeling great overall minus any significant sides then I would stick with your protocol for the time being.

Again when first starting TRT or tweaking a protocol (dose T/injection frequency) hormones will be in flux during the following weeks until blood levels have stabilized (4-6 weeks) and it is common to experience ups/downs during the transition as the body is trying to adjust.

Even once blood levels have stabilized (4-6 weeks) it will still take time (a few months) for the body to adapt to its new set-point and this is the critical period when one needs to truly gauge how they feel overall regarding relief/improvement of low-t symptoms and overall well-being.

Every protocol needs to be given a fighting chance (12 weeks) to claim whether it was truly a success or failure.

Otherwise, you will be left chasing your tail endlessly until the cows come home.

 

[MSnomad24]

My estrogen is 70-90, for 2 years on the same protocol, and no issues at all.

Do you mind sharing you're TRT protocol. Height/weight. Test serum level ?

 

[madman]

Serum levels of estrogen and DHT are practically meaningless, once your tissues are fully saturated with estrogen and DHT,, tissues can take in no more and you’re left with serum levels, leftovers, which is what you’re testing.

There’s 50 times more estrogen and DHT in target tissues.

Gyno is rare around here, don’t see too many cases in the 7 years I’ve been here. Gynecomastia is genetic and other hormones trigger gyno flare-ups. Testosterone, estrogen, DHT, prolactin and high IGF-1 all contribute to gyno development.

If you have never had gyno at a younger age, you likely never will.

The nipple tenderness is likely fluid retention from the testosterone, since it can increase other hormones that tell the kidneys to hold onto more sodium, and sodium carries water.

You will mostly notice this after dosing changes, and once the body adapts the steady state hormones, nipple tenderness should subside.

If you’re genetically predisposed to hair loss, you will lose your hair eventually, regardless, and TRT may accelerated it.

If that’s the case, embrace the razor.

I’m thinning on the back of the head, what do I care, at 51 I got women in their early to mid 20’s putting themselves in my spaces, staring at me in the mirror at the gym.

It’s not much different at work either.

If you’re confident, handsome, are a gentleman, women don’t give a sh** about your hair!

Gynecomastia Evaluation and Treatment: EAA clinical practice guidelines

ABSTRACT Background Gynecomastia (GM) is a benign proliferation of the glandular tissue of the breast in men. It is a frequent condition with a reported prevalence of 32–65%, depending on the age and the criteria used for definition. GM of infancy and puberty are common, benign conditions...

www.excelmale.com

GM can be unilateral or bilateral, most commonly the latter (Nuttall, 1979; Mieritz et al., 2017). GM has to be distinguished from pseudogynecomastia (i.e., lipomastia), which is characterized by excess fat deposition without glandular proliferation.





Figure 5 Technique and findings in breast palpation. Reprinted by permission from Massachusetts Medical Society, The New England Journal of Medicine, Gynecomastia, Braunstein (2007).

post #6 (go nuts)

Approach to Gynecomastia in Primary Care Clinics

An Approach to Gynecomastia in Primary Care Clinics (2022) Kavya Bharathidasan, MD, Jordan Curl, BS, Vedesh Kumar Babu, MD, Shaili Felton, MD, and Kenneth Nugent, MD Abstract Gynecomastia is a more common finding in primary care clinics than is recognized. Because this finding can be easily...

www.excelmale.com

 

[Systemlord]

Do you mind sharing you're TRT protocol. Height/weight. Test serum level ?

Jatenzo, a new oral testosterone capsule @237 mg twice daily, the recommended starting dosage, peaks levels @988 ng/dL within 2 hours, midpoint levels 552 ng/dL @5 hours and trough 289 ng/dL @12 hours.

This is why Jatenzo is dosed twice daily. The average levels are 489 ng/dL.

I’m 6 foot, 202 lbs, 32 inch waist, tall skinny athletic build.

I still need to lose some more weight, 160-170 being my optimal weight with a muscular a build.

I have lost 8 inches off my waist since I was at my heaviest.

I go to the gym 7 days a week, 1.5 hours per day. Work at Amazon and never run out of energy. This endless energy runs in the family.

 

[madman]

Too much testosterone can make some men feel amped up and affect sleep quality. Most members on this forum, 68% feel best near the top end of the ranges or slightly higher.

As long as blood pressure is good (<135/80), and all your symptoms are resolved, and other biomarkers are healthy, running slightly higher levels is fine. Some men feel less optimized above 1000 ng/dL, more is not always better.

Six months after starting TRT, it was mandatory that I do a sleep study, because TRT can take a mild case of sleep apnea much worse.

You need to give each protocol at least 8-12 weeks to access how you feel.

Still lack the understanding of how this works years in!

More like 12 or slightly longer!

Did you even take notice that two of the heavyweights in the field played a big part in those guidelines?


*As such, patients should be counseled that symptom response will not be immediate. Expectations for treatment response should be established with each patient. Patients can anticipate improvements in many of the common symptoms of TD (libido, energy levels, sexual function) after 3 months of treatment or longer. Metabolic and structural (body composition, muscle mass, bone density) changes may take upwards of 6 months.

*Following the initiation of testosterone therapy, serum concentrations of testosterone are known to correct earlier than the symptomatic, structural, and metabolic signs associated with TD.

Canadian Urology Guideline on Testosterone Replacement

Canadian Urological Association clinical practice guideline on testosterone deficiency in men: Evidence-based Q&A (2021) Ethan D. Grober, MD; Yonah Krakowsky, MD; Mohit Khera, MD; Daniel T. Holmes, MD; Jay C. Lee, MD; John E. Grantmyre, MD; Premal Patel, MD; Richard A. Bebb, MD; Ryan...

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26. What is a reasonable timeline to begin to observe improvements in the signs and symptoms of testosterone deficiency?

*Following the initiation of testosterone therapy, serum concentrations of testosterone are known to correct earlier than the symptomatic, structural, and metabolic signs associated with TD.76,77 As such, patients should be counseled that symptom response will not be immediate. Expectations for treatment response should be established with each patient. Patients can anticipate improvements in many of the common symptoms of TD (libido, energy levels, sexual function) after 3 months of treatment or longer. Metabolic and structural (body composition, muscle mass, bone density) changes may take upwards of 6 months. 77 In addition, patients should be counseled that diet and exercise in combination with testosterone therapy are recommended for body composition changes.

*Appreciating this pattern of response to testosterone therapy is fundamental when determining the impact of treatment and the appropriate timing of follow-up evaluations while on therapy. For example, if patients undergo a symptom review and measurement of testosterone levels too early (< 3 months), it may lead both physicians and patients to conclude that the treatment has not been impactful (i.e. normal levels of testosterone without symptomatic/structural/metabolic benefit). However, if the same assessment was scheduled 3-6 months after the initiation of therapy, the clinical response tends to be more reflective of normalized levels of serum testosterone.

 

[MSnomad24]

A decent starting dose of 120 mg T/week but not sure why you felt the need to jump in on a 3X weekly protocol.

As you would know your true trough (lowest point) on such protocol would be Monday morning just before your next injection.

You made it clear why you had blood work done on Wednesday morning which is 48 hours post-injection and as you can see you are hitting a very high TT and more importantly your FT is very high.

This was tested using what would be considered the most accurate assay (Equilibrium Dialysis).

Keep in mind that although this is not true trough even if you tested at true trough your TT/FT would still be on the high end.

You are missing critical blood markers RBCs, hemoglobin, and hematocrit which will increase when using exogenous T.

Driving up FT will drive up such blood markers within the first month after starting and will take anywhere from 6-9 months and in some cases a year to reach peak levels.

Where such blood markers sit 5 weeks in is not where they are going to end up 6-9 months from now.

Not sure where everything sat pre-trt as you never posted but there is a good chance they will be driven much higher especially when using injectable T let alone running a high FT like you are.

Something that you need to keep an eye on over the following months.

Increasing FT will drive up estradiol/DHT.

Increased nipple sensitivity can happen in some.

Much more to gynecomastia than just elevated estradiol.

If you are experiencing swelling/pain or tenderness it can be early signs of gynecomastia developing but in many cases, it will only happen to the genetically prone and is rare when using therapeutic doses of T.

As long as you do not feel a lump/rubbery mass when squeezing then I would not jump to any conclusions as of yet as your hormones are in flux during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE).

When it comes to acne let alone hair loss genetics plays a strong role and one can still have issues without having high DHT as the sensitivity of the AR (hair/skin) will play a big role.

In most cases running too high a FT will contribute to such.

Although many tend to blame estradiol when it comes to bloat/water retention keep in mind that androgens increase sodium/water.

Androgens increase the retention of electrolytes.

The use of exogenous androgens will result in the retention of sodium, chloride, water, potassium, calcium, and inorganic phosphates.

Bloating/edema can be common in some and to what degree depends on many factors.

Inhibition of corticosteroid 11β-hydroxysteroid dehydrogenase enzymes plays a role.

Most of the initial increases in weight gain on trt are water-related whether extra-cellular/intra-cellular.

Many men on trt can gain 5-15 lbs of water weight within the first month.

The majority of gains when first starting trt are due to extra-cellular water (between the muscle and skin) which shows up as bloat/puffiness and intra-cellular water (inside the muscle cell) which will make the muscle look fuller and harder due to increased glycogen stores.

Even then once the body adjusts or measures have been taken to minimize the bloat/puffiness you are always going to hold more water when using androgens as the muscle cells will retain more water (intra-cellular).

When coming off androgens, especially high doses you are always going to be pissing out the water weight (extra/intracellular).

Part of the reason why men who abuse androgens mainly the so-called wet compounds deflate when they come off is because they are holding a shit load of excess water weight which is always going to be pissed away.

If you are feeling great overall minus any significant sides then I would stick with your protocol for the time being.

Again when first starting TRT or tweaking a protocol (dose T/injection frequency) hormones will be in flux during the following weeks until blood levels have stabilized (4-6 weeks) and it is common to experience ups/downs during the transition as the body is trying to adjust.

Even once blood levels have stabilized (4-6 weeks) it will still take time (a few months) for the body to adapt to its new set-point and this is the critical period when one needs to truly gauge how they feel overall regarding relief/improvement of low-t symptoms and overall well-being.

Every protocol needs to be given a fighting chance (12 weeks) to claim whether it was truly a success or failure.

Otherwise, you will be left chasing your tail endlessly until the cows come home.

Thank you for the reply and information.
-I chose MWF dosing based on trend. Alot of folks have shared that moving to everyday or every other day dosing helped with their symptoms management so i though i would start with more frequent dosing to avoid the possibility of unwanted symptoms. Preventative/proactive choice i suppose.
-My prescriber actually wanted me to start on 160mg TC dosed twice per week M/Thurs. Based on my research and smaller physical size i elected to start at 120mg and adjust upwards if needed.
-CBC,CMP were all text book normal prior to TRT start. I will collect more thorough labwork at week 12. I was mainly curious about my nipple symptoms so i only checked the hormones to see if there was a culprit or major abnormality that needed to be addressed.

Again, thank you for your input. The information you provided is helpful and re-assuring.

 

[MSnomad24]

Jatenzo, a new oral testosterone capsule @237 mg twice daily, the recommended starting dosage, peaks levels @988 ng/dL within 2 hours, midpoint levels 552 ng/dL @5 hours and trough 289 ng/dL @12 hours.

This is why Jatenzo is dosed twice daily.

I’m 6 foot, 202 lbs, 32 inch waist, tall skinny athletic build.

I still need to lose some more weight, 160-170 being my optimal weight with a muscular a build.

I have lost 8 inches off my waist since I was at my heaviest.

I go to the gym 7 days a week, 1.5 hours per day. Work at Amazon and never run out of energy. This endless energy runs in the family.

Thank you for sharing. I haven't heard of Jatenzo. I'll have to look into that! Wish i had the endless energy. My father is like that, goes hard all day everyday on minimal sleep, it's impressive.
Sounds like you're on track and dialed in.

 

[Systemlord]

I haven't heard of Jatenzo.

My Experience On Jatenzo (Oral TRT) Log

I wanted to start a thread detailing my personal experience with Jatenzo (oral TRT) which is remarkable in how quickly it has shown results when compared with injections. The first week on Jatenzo was very pleasant unlike my experience after dosing changes on injections, all with minimal swings...

www.excelmale.com

 

[madman]

Thank you for the reply and information.
-I chose MWF dosing based on trend. Alot of folks have shared that moving to everyday or every other day dosing helped with their symptoms management so i though i would start with more frequent dosing to avoid the possibility of unwanted symptoms. Preventative/proactive choice i suppose.
-My prescriber actually wanted me to start on 160mg TC dosed twice per week M/Thurs. Based on my research and smaller physical size i elected to start at 120mg and adjust upwards if needed.
-CBC,CMP were all text book normal prior to TRT start. I will collect more thorough labwork at week 12. I was mainly curious about my nipple symptoms so i only checked the hormones to see if there was a culprit or major abnormality that needed to be addressed.

Again, thank you for your input. The information you provided is helpful and re-assuring.

-I chose MWF dosing based on trend. Alot of folks have shared that moving to everyday or every other day dosing helped with their symptoms management so i though i would start with more frequent dosing to avoid the possibility of unwanted symptoms. Preventative/proactive choice i suppose.

Yes but keep in mind that it is not just about clipping the peak--->trough as where you run your FT levels steady state can have a big impact on sides.

Too many men end up struggling in the long run because they are caught up on running high/absurdly high trough FT levels.

Big difference in one running a high trough FT injecting once weekly vs daily.

Even then many end up jumping on dailies in the hopes of managing elevated hematocrit or estradiol which is not a given as they can still end up struggling due to running too high an FT.



-My prescriber actually wanted me to start on 160mg TC dosed twice per week M/Thurs. Based on my research and smaller physical size i elected to start at 120mg and adjust upwards if needed.

Smart move.

The common starting dose is 100mg T/week or better yet 50 mg T split twice weekly (every 3.5 days).

160 mg T/week is too high a starting dose.

Start low and go slow we say.

Much easier going up if need be than coming down, trust me on this one.

Most men on TRT are injecting 100-200mg T/week whether once weekly or split twice weekly (every 3.5 days), M/W/F, EOD, or daily.

The majority of men can easily hit a high/very high trough FT level injecting 100-150 mg T/week especially when split into more frequent injections.

Of course, some outliers may need the higher-end dose but it is far from common.



-CBC,CMP were all text book normal prior to TRT start. I will collect more thorough labwork at week 12. I was mainly curious about my nipple symptoms so i only checked the hormones to see if there was a culprit or major abnormality that needed to be addressed.

Yes, but many can still end up with high levels if you jack up your trough FT too high.

Need to get labs 12 weeks in and even then as I stated earlier it will take 6-9 months or in some cases a year to reach peak levels.

 

[madman]

Thank you for sharing. I haven't heard of Jatenzo. I'll have to look into that! Wish i had the endless energy. My father is like that, goes hard all day everyday on minimal sleep, it's impressive.
Sounds like you're on track and dialed in.

Oral Testosterone: The New Frontier of TRT

https://www.prostatehealthpodcast.com/84-oral-testosterone-the-new-frontier-of-testosterone-replacement-therapy-with-wayne-kuang-md/#testosterone We are excited to partner with Marius Pharmaceuticals for today’s podcast and have Dr. Wayne Kuang joining us as our featured guest! Until...

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post #10

Oral TRT Products: Jatenzo, Tlando, Kyzatrex, & DiTest

Testosterone Replacement Therapy: A Narrative Review with a Focus on New Oral Formulations (2022) Salman Z Bhat and Adrian S Dobs Male hypogonadism affects 10–30% of the male population and is often under-recognized and under-treated. Different replacement formulations exist, each with...

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[MSnomad24]

-I chose MWF dosing based on trend. Alot of folks have shared that moving to everyday or every other day dosing helped with their symptoms management so i though i would start with more frequent dosing to avoid the possibility of unwanted symptoms. Preventative/proactive choice i suppose.

Yes but keep in mind that it is not just about clipping the peak--->trough as where you run your FT levels steady state can have a big impact on sides.

Too many men end up struggling in the long run because they are caught up on running high/absurdly high trough FT levels.

Big difference in one running a high trough FT injecting once weekly vs daily.

Even then many end up jumping on dailies in the hopes of managing elevated hematocrit or estradiol which is not a given as they can still end up struggling due to running too high an FT.



-My prescriber actually wanted me to start on 160mg TC dosed twice per week M/Thurs. Based on my research and smaller physical size i elected to start at 120mg and adjust upwards if needed.

Smart move.

The common starting dose is 100mg T/week or better yet 50 mg T split twice weekly (every 3.5 days).

160 mg T/week is too high a starting dose.

Start low and go slow we say.

Much easier going up if need be than coming down, trust me on this one.

Most men on TRT are injecting 100-200mg T/week whether once weekly or split twice weekly (every 3.5 days), M/W/F, EOD, or daily.

The majority of men can easily hit a high/very high trough FT level injecting 100-150 mg T/week especially when split into more frequent injections.

Of course, some outliers may need the higher-end dose but it is far from common.



-CBC,CMP were all text book normal prior to TRT start. I will collect more thorough labwork at week 12. I was mainly curious about my nipple symptoms so i only checked the hormones to see if there was a culprit or major abnormality that needed to be addressed.

Yes, but many can still end up with high levels if you jack up your trough FT too high.

Need to get labs 12 weeks in and even then as I stated earlier it will take 6-9 months or in some cases a year to reach peak levels.

Thank you!
Do you think switching to a twice per week dosing might be advisable? Or will that muddy the water?

A study i read showed that TC injected IM reached peaks serum levels between day 3 and day 5 post administration. I honestly did consider proceeding with twice per week dosing (mon/thurs) because of the pharmacokinetics illustrated in that study. It just made sense. But to your point about limiting peak serum levels by lower dose with more frequent administration and the current trend of trt gurus advocating more frequent dosing, i was influenced to go with MWF dosing.

Study i'm referencing from 1987.
It's old but i haven't found anything else like it.
Title: Hormone kinetics after intramuscular testosterone cypionate
By: H R Nankin

Hormone kinetics after intramuscular testosterone cypionate

There have not been reports analyzing in detail the reproductive hormone changes in hypogonadal men after usual therapeutic injections of testosterone…

www.sciencedirect.com

 

[Systemlord]

Do you think switching to a twice per week dosing might be advisable? Or will that muddy the water?

Every time you change your dosage, 4-6 weeks to reach steady states and 12 weeks to assess the new protocol.

The thing I love about Jatenzo, 7 days to steady state! I could go through three dosing changes and reach a steady state three separate times when you’re halfway into a new protocol and weeks away from a steady state.

No ups and downs beyond 7 days.

Kyzatrex is another competing brand-name oral testosterone, which is cash only.

Then there’s Orlando brand-name oral T.

 

[madman]

Thank you!
Do you think switching to a twice per week dosing might be advisable? Or will that muddy the water?

A study i read showed that TC injected IM reached peaks serum levels between day 3 and day 5 post administration. I honestly did consider proceeding with twice per week dosing (mon/thurs) because of the pharmacokinetics illustrated in that study. It just made sense. But to your point about limiting peak serum levels by lower dose with more frequent administration and the current trend of trt gurus advocating more frequent dosing, i was influenced to go with MWF dosing.

Study i'm referencing from 1987.
It's old but i haven't found anything else like it.
Title: Hormone kinetics after intramuscular testosterone cypionate
By: H R Nankin

Hormone kinetics after intramuscular testosterone cypionate

There have not been reports analyzing in detail the reproductive hormone changes in hypogonadal men after usual therapeutic injections of testosterone…

www.sciencedirect.com

No, you are already 5 weeks in just stick with your current protocol.

Give it a few more months before deciding on whether you need to make any adjustments.

You need to give it time for the body to adapt to its new set-point so you can gauge how you truly feel overall let alone claim whether it was a success or failure.

Anytime you tweak a protocol (dose T/injection frequency) you will need to start over as it will take another 4-6 weeks TC/TE for blood levels to stabilize.

I have posted numerous PK studies on the forum including the Nankin study you mention.

Regarding half-lives keep in mind that a majority of studies on the PK/PD of the various T-esters were done using IM (once weekly/fortnightly) injections in a small number of subjects and most of the literature is from decades ago.

Many other factors affect the rate at which testosterone is released from the oily depot at the injection site.

Sub-q vs IM, the volume of injection, injection depth, site of injection, lymphatic flow, and the concentration of BOH (benzyl alcohol) are other possible factors that can affect the absorption rates of the esterified hormone.

Keep in when using esterified testosterone whether (TC/TE/TP) that post-injection there will be an initial burst release of T and levels will start rising within the first 2 hrs.

T levels will spike up fairly quickly even when using the medium-chain esters.

Enanthate has been shown to reach Tmax 10 hrs.

When it comes to the PKs TC/TE are interchangeable.

Peak will be 8-24 hours post-injection.

Your blood work was done 48 hours post-injection so your true peak TT/FT will be higher.

 

[MSnomad24]

Excellent information! Thank you sir! Glad i found this site