Welcome to Nelson's domain!
Glad to have another fellow canuck on here.
Eventually I told my other doctor who prescribes my methadone about it. He immediately sent me for blood work and then started me on a very low dose of oral test. It was called “taro-testosterone”. 50MG a day. My levels didn’t move. Then I went to 2 a day and all the way to 4 a day. I did not respond at all to the pills.
Unfortunately, you were started on the generic (Taro-Testosterone) oral TU which replaced the former big pharma Andriol which was discontinued.
Keep in mind that many men have a hard time achieving healthy T levels/have a poor response when using the older oral TU (Andriol) formulations due to issues with absorption.
@Marcel https://www.
excelmale.com/forum/threads/the-dea-wants-to-limit-your-access-to-trt-telemedicine.27274/page-6 We have always been far worse off than the US when it comes to the treatment of men for testosterone deficiency. Although there has been some improvement in certain areas we...
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https://www.americanbazaaronline.com/2022/10/11/testosterone-drug-
kyzatrex-hits-market-451261/
Kyzatrex could be a potential blockbuster to treat testosterone deficiency, a severely undertreated disease. Testosterone has been historically perceived as a lifestyle issue for men who want to...
www.excelmale.com
My doctor didn't start me out on the recommended starting dosage of 237mg and therefore my levels were low for much of 2021. My progress accelerated once I got on 237mg twice daily. No there isn't anyone else I know of that is on Jatenzo. That sounds reasonable. How many months have you been...
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*(Andriol®) was highly influenced by dietary fat, thus leading to significant intra- and inter-patient variability in T response and questionable clinical utility.7,8 Reformulation of this product to reduce the effect of dietary fat did not address the low TU content of the capsules, thus resulting in the need to dose hypogonadal men with several capsules three or more times daily. Even then, reported serum T response would not result in average serum T levels in the normal range
My doctor didn't start me out on the recommended starting dosage of 237mg and therefore my levels were low for much of 2021. My progress accelerated once I got on 237mg twice daily. No there isn't anyone else I know of that is on Jatenzo. That sounds reasonable. How many months have you been...
www.excelmale.com
*An early oral TU formulation (ANDRIOL®) was approved for use in many countries but never in the United States. This formulation is heavily reliant on dietary fat intake as a means of increasing absorption and therefore leads to significant intra- and inter-patient variability in testosterone response [23, 24]. This results in the need to dose hypogonadal men with several capsules three or more times daily affecting compliance. Several studies have also demonstrated both gastrointestinal and liver adverse effects including severe cholestasis and jaundice [25, 26]. Consequently, these oral TU formulations have never been widely utilized to treat TD in the United States although they remain available in many countries
*Although there is a paucity of detailed serum T PK data with repeat dosing of Andriol in the literature, recent large studies showed that trough serum T levels after oral TU in oil were near to or lower than the baseline serum T levels in hypogonadal men (Emmelot-Vonk et al, 2008; Legros et al, 2009). And although serum T levels increased after administration of Andriol at the recommended dose of 80 mg twice a day (equivalent to T 50 mg twice a day; Nieschlag et al, 1975; Jungwirth et al, 2007), a significant percentage of hypogonadal men failed to achieve serum T levels in the eugonadal range (Skakkebaek et al, 1981; Gooren, 1994).
Been around the board for a LONG time. Use to be a member of SWALES board. Was around when SWALE posted on several other well know boards. Have been on TRT for quite a few years now (20yrs). I also have a doctor providing my script. Previously mine was self monitors but I will see how my...
www.excelmale.com
Conversely, while oral TU has not been associated with liver toxicity, an early oral TU formulation approved for use in many countries but never in the US (Andriol®) was highly influenced by dietary fat, thus leading to significant intra- and inter-patient variability in T response and questionable clinical utility.7,8 Reformulation of this product to reduce the effect of dietary fat did not address the low TU content of the capsules, thus resulting in the need to dose hypogonadal men with several capsules three or more times daily. Even then, reported serum T response would not result in average serum T levels in the normal range9 and therefore would not pass current-day regulatory scrutiny for efficacy. Consequently, these oral TU formulations have never been widely used to treat T deficiency although they remain available in many countries.
Taro-Testosterone
DOSAGE AND ADMINISTRATION
Recommended Dose and Dosage Adjustment
Usually, a daily dosage of 120-160 mg divided in two doses, taken once in the morning and once in the evening for 2-3 weeks is adequate. Subsequent dosage (40-120mg daily) should be based on the subsequent testosterone levels and/or clinical effects obtained during therapy.
Missed Dose
Should you forget a dose, take your dose at the next scheduled time. Do not take a double dose of this medicine.
Administration
To ensure adequate absorption Taro-Testosterone (testosterone undecanoate capsules) must be taken with a meal and swallowed without chewing.
ACTION AND CLINICAL PHARMACOLOGY
Mechanism of Action
Testosterone undecanoate, an orally active testosterone preparation, is a fatty acid ester of the natural androgen testosterone. Unlike other oral testosterone preparations, testosterone undecanoate is able to bypass the liver via the lymphatic system and is therefore orally bioavailable.
Therapy with testosterone undecanoate increases plasma levels of testosterone and its active metabolites, leading to a regular therapeutic effect. In eugonadal men, peak testosterone levels are reached approximately 4-5 hours after ingestion, returning to basal levels after about 10 hours. In volunteers and hypogonadal men, 77-93% of an orally administered dose of testosterone undecanoate was excreted in the urine and feces within 3 to 4 days.1
Testosterone undecanoate delivers physiologic amounts of testosterone, producing circulating testosterone levels that approximate normal levels (e.g. 10.4 – 34.6 nmol/L [300 - 1000 ng/dL]) seen in young healthy men.
Pharmacokinetics
Absorption: The active substance of testosterone undecanoate capsules is well absorbed from the gastrointestinal tract. Both testosterone undecanoate and the newly formed 5-alpha dihydrotestosterone undecanoate are partly absorbed via the lymphatic system, circumventing first passage through the liver. Following oral administration of testosterone undecanoate, an important part of the active substance testosterone undecanoate is co-absorbed with the lipophilic solvent from the intestine into the lymphatic system, thus partially circumventing the first-pass inactivation by the liver. Testosterone undecanoate must be taken with a normal meal or breakfast to ensure absorption. The bioavailability is about 7%.
Finally, my doctor who is such a great guy (but is a psychiatrist and it doesn’t seem like this is his specialty) took pity on me and said - were going to get this under control…. He then prescribed me 250MG of test enanthate every 2 weeks plus also 50MG of topical gel of “taro-testosterone” a day.
You are in a bind here.
Forgive me but this guy treating you is an idiot!
He clearly has no clue how to treat men for low-t let alone does not understand the PKss (pharmacokinetic) of the different exogenous T formulations.
The protocol he put you on is out in left field.
The standard cookie-cutter protocol pushed by the old school endos and many of the uninformed doctors of injecting 200mg esterified TC/TE once every 2 weeks is outdated and has many disadvantages due to the PKs.
You are in for what we call the roller coaster effect where peak T levels will be absurdly high post-injection (12-24 hrs)/ during the first 3 days only to be followed by much lower levels come the weeks end and even though many men will still be hitting descent/high-end T levels 7 days in by day 10 levels will be much lower and you would be back to hypogonadal before you hit the 14-day mark when it is time for your next injection.
This can easily lead to fluctuations/wide swings in energy levels, mood, and libido/erectile function.
Top it all off it will wreak havoc on blood markers such as hematocrit.
Numerous T formulations to choose from in Canada such as pellets, patches (discontinued) transdermal (gel/cream), intranasal, and esterified injectables (TC/TE).
One formulation is chosen.
Most men are started on big pharma transdermal gel or more commonly esterified injectables (TC/TE).
Unfortunately, although some men will achieve healthy/high-end T levels using transdermal application there are many men who respond poorly due to issues with absorption.
None of this to worry about when using injections as they are highly effective and one can easily achieve mid-high let alone very high/absurdly high T levels.
Most men prefer the injectables as they are considered KING!
Most men on TRT are injecting anywhere from 100-200 mg T/week and some even <100mg whether once weekly or splitting the weekly dose and injecting more frequently as in twice-weekly (every 3.5 days), M/W/F, EOD, or even daily.
Keep in mind the majority of men can easily hit a healthy let alone high trough FT level injecting 100-150 mg T/week especially when split into more frequent injections.
Yes, there are some outliers who may need the higher-end dose of 200 mg T/week but this is far from common as such a dose would have the majority of men running around with high/absurdly high trough FT levels.
Keep in mind that running too high a trough FT level can be just as bad as running too low an FT level in many ways especially when it comes to libido/erectile function let alone mood/energy as T has a tonic effect on the CNS and can easily leave one feeling agitated/amped up.
The best piece of advice is to start on a T-only protocol.
Always start low and go slow as we want to see how your body reacts to testosterone.
There will always be time to add in hCG or increase the dose of T if need be.
Much easier going up than coming down.
Do not get caught up on the more T is a better mentality as it is almost a given that you will struggle one way or another in the long run.
Most men are started on 100mg T once weekly or better yet split into twice-weekly injections (50 mg every 3.5 days).
Blood work will be done 6 weeks in once blood levels have stabilized (steady-state) so we can see where said protocol (dose of T/injection frequency) has your trough (the lowest point of your injection cycle) TT, FT, estradiol and other important blood markers such as CBC (complete blood count) which includes RBCs, hemoglobin, and hematocrit.
Within a few weeks it was just like total night and day. This was about a year ago and I have made SO many positive changes in my life since and I am becoming so much more proactive. I’ve started back to the gym recently (1 month) and am starting to see some real gains already.
Glad to hear.
Having healthy T levels has numerous benefits (physical/mental).
Going from low T--->healthy T will have a huge impact on your overall quality of life.
The key is finding a healthy T level where you can derive all of the positive effects while at the same time minimizing/preventing sides.
Keep in mind that having healthy T levels is only one piece of the puzzle and in order to truly reap the full beneficial effects thyroid/adrenal health needs to be addressed along with diet, sleep, stress (physical/mental), and exercise.
The question I have is around my dosing and schedule. Sorry unfortunately I don’t have my test level information as my doctor hasn’t really told me the exact numbers , not that I’d understand them anyways… but anyways. So right now like I said I take 1 injection of 250MG enanthate every 2 weeks and then every morning I have a packet of 50MG taro-testosterone topical gel I use.
I’ve been reading about enanthate and I see that it’s half life is less than 2 weeks, so I’m wondering if I should be splitting my dose in half and taking it weekly rather than bi-weekly.
The standard outdated cookie-cutter protocol is 200 mg TC or TE per week, not 250 mg, and even then as I stated earlier it is a horrible protocol.
Not only did he upp your dose of T by 50 mg but also decided to throw in 50 mg T (transdermal application) which is overkill and would never be needed.
Even then a majority of those idiotic doctors with that old-school mentality would only prescribe one formulation whether the 200 mg T every 2 weeks protocol or strictly transdermal T gel (standard application).
As I stated earlier once weekly or splitting the dose and injecting twice weekly (every 3.5 days) is where it's at due to taking advantage of the PKs.
Even when injected once weekly there will still be a rollercoaster-type effect as T levels will be highest meaning peak (12-24 hrs) post-injection and remain high for the first 3 days on to be followed by lower levels come weeks end as there will be a big difference between peak--->trough and blood levels will not be as stable throughout the week.
Splitting the dose and injecting more frequently will clip the peak--->trough and result in more stable blood levels throughout the week.
Need to find what works best for you.
Going forward drop the transdermal T gel and stick with the injectable T.
Many start on once-weekly or twice-weekly injections
The common starting dose is 100mg T/week.
If you want to start a little higher 120 mg/week go nuts.
Again it is always best to start low and go slow.
You may very well end up achieving healthy let alone high trough FT levels on such a dose.
Again lots of time to increase the dose of T if need be.
Patience is key.
I know my Dr isn’t super knowledgeable on this as I overheard the conversation with the pharmacist the first time I filled it, he had way too much prescribed and the pharmacist had to tell him it was not normal.
Most definitely!
No brainer here.
I will 100% take what I can get though. I’m in Alta tic Canada and the Dr situation here is incredibly dire. I put myself on a list to see and endocrinologist but the wait list is like a year. So I’m just wondering if I should start splitting my dose in half or if there is anything else I should be considering.
Every time I hear the word endo it makes me cringe!
As long as you have a prescription for T stick around and we will set you right.
Hoping you can look into finding a decent urologist to treat you.
All the best with your journey.
Keep us posted.
Feel free to PM me anytime.