Wondering if my TRT prescription schedule makes sense at all

[mitcHELLspawn]

So I had low test for quite a few years that was first tested when I was about 29. I have been on methadone since age 19. Though I have been on opiates for a long time, I was always a “functional addict” as I was a an athlete and was drafted into the QMJHL back in 2005. I always stayed in shape. But over the years since hanging up the skates I have become more and more sedentary.

When finally my blood work came back with very low test, Unfortunately my family doctor at that time was consistently not willing to prescribe me anything for it. I also have low thyroid. The combination of the two left me constantly exhausted and it was completely awful for a few years especially as I was in the middle of completing a computer science degree. Somehow I made it through. It was seriously torture living with such low test I got fat and had no sexual function pretty much whatsoever. It’s amazing my wife didn’t leave me.

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.

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.

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.

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.

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.

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.

Thanks in advance

 

[Vince]

This may be a dumb question but is any chance of you getting off methadone? I have a friend who was a heroin addict for about 15 years and then on methadone. He finally got clean and went on a low curb diet. Started working out and now looks awesome. If you're able to get clean, I think your testosterone would recover. but then again this may be a stupid question.

 

[mitcHELLspawn]

This may be a dumb question but is any chance of you getting off methadone? I have a friend who was a heroin addict for about 15 years and then on methadone. He finally got clean and went on a low curb diet. Started working out and now looks awesome. If you're able to get clean, I think your testosterone would recover. but then again this may be a stupid question.

Not a stupid question at all. It is very much a nuisance and I hate it. On the other hand, it saved my life at one point and I have been on it now for nearly… holy crap 20 years. I travel internationally semi-often for work and have an extremely successful career, and I hate having to think about bringing multiple small 100ML bottles on the trips especially when travelling with colleagues as I always get stopped at the security scans and the bag with the bottles get flagged. Thankfully most security workers know what it is and have discretion which I am eternally grateful for, but a trip to Atlanta recently and TSA just literally grabbed it out of my bag and held it above their head and was like “who owns this”

Anyways haha I went on a little tangent there. The short answer is yes. It is definitely possible but it has been a part of my life for so many years it is a very scary proposition. But even if I do start the process, I know it will be a very long slow one.

I would love nothing more, though.

 

[Vince]

My buddy od at least seven times. Probably even more, once I had to hit him up with narcan twice for him to come back. He went to Serenity Inns and lived there for 6 months. He thought he just get clean and then go back to using but it finally kicked in and he changed his life forever.

Well I hope forever. He's been clean now for almost a year and a half.

 

[Systemlord]

Diagnosis and management of testosterone deficiency

Testosterone supplementation therapy (TST) use has dramatically increased over the past decade, due to the availability of newer agents, aggressive marketing, and an increasing incidence of testosterone deficiency (TD). Despite the increase in TST, a ...

www.ncbi.nlm.nih.gov

Slightly longer but still relatively short-acting agents testosterone enanthate and testosterone cypionate require injections every 1–2 weeks due to half-lives of 5–7 days, respectively. All of the short-acting agents are plagued by a “roller coaster” effect by achieving supraphysiologic levels within 2–4 days after injection followed by sub-therapeutic levels by 10–14 days. A rapid decline in serum levels around 10–14 days has been called “testosterone crash” and is associated with sudden recurrence of TD symptoms. To minimize these effects, more frequent dosing from once to twice weekly has been suggested as is preferred by these authors.

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.

These barbaric every two week injection protocols, are far from optimal, and it just doesn’t make sense to have healthy hormone levels 50% of the time.

These every two week injection protocols also see higher rates of erythrocytosis.

 

[mitcHELLspawn]

My buddy od at least seven times. Probably even more, once I had to hit him up with narcan twice for him to come back. He went to Serenity Inns and lived there for 6 months. He thought he just get clean and then go back to using but it finally kicked in and he changed his life forever.

Well I hope forever. He's been clean now for almost a year and a half.

To be clear. I have been clean for well over 15 years. I do not get high or feel any effects from the methadone aside from stopping the onset of withdrawals.

 

[mitcHELLspawn]

Diagnosis and management of testosterone deficiency

Testosterone supplementation therapy (TST) use has dramatically increased over the past decade, due to the availability of newer agents, aggressive marketing, and an increasing incidence of testosterone deficiency (TD). Despite the increase in TST, a ...

www.ncbi.nlm.nih.gov

These barbaric every two week injection protocols, are far from optimal, and it just doesn’t make sense to have healthy hormone levels 50% of the time.

These every two week injection protocols also see higher rates of erythrocytosis.

This is what I feared.

So, I probably should then begin splitting my dose to 125MG a week vs 250 every 2 weeks? Keeping in mind that I also do the topical 50MG daily. I’m not asking for exact medical advice I understand these are just recommendations and I will be following up anything discussed here with my doctor.

I’m just looking to see if there is any sort of consensus on the opinion you just raised. I feel as though there is but more people weighing in is certainly welcomed.

Other things to note I’m 37, aside from the test and the thyroid I am in good health. I am working out 4 days a week and am losing a few pounds a week which is really kind of blowing my mind. I’m 5’9 and 234 but I have always been very stocky. I know that weight sounds very overweight for my height but i do have a lot of muscle mass on my body from my late teens and early 20s I was very much into bodybuilding/weight lifting. It has been 10 years since I last picked up a weight, but it’s kind of crazy how quickly my body is reacting to working out. I wonder how much is muscle memory and how much is the TRT

 

[RotnGun]

A lot of people seem to do their best at everyday injections on this for forum. I also think that your doctor prescribed you to much test. I would say that 70mg per week of test enanthate and 50mg of taro testosterone gel a day would be more than enough to bring your total test and free test up to normal levels. Infact, I would even go without the taro testosterone gel

 

[Systemlord]

So, I probably should then begin splitting my dose to 125MG a week vs 250 every 2 weeks?

That’s a reasonable dosage.

Keeping in mind that I also do the topical 50MG daily.

This is over complicating your protocol, if you need more testosterone, increase the amount of injectable testosterone.

Keep it simple.

 

[Vince]

To be clear. I have been clean for well over 15 years. I do not get high or feel any effects from the methadone aside from stopping the onset of withdrawals.

Scientists found that the men receiving methadone had about one quarter of the testosterone level of men not using opioids. No changes were noted among the women.


Low testosterone in men has side effects including mood swings, fatigue, and erectile dysfunction. At Hamilton’s John Street Clinic, officials said that about 20% of men receiving methadone treatment need some sort of hormone replacement therapy. And since opioids already deplete testosterone due to the way they work on the hypothalamus, many men already have depleted levels of testosterone before starting treatment.

Does Methadone Treatment Suppress Testosterone in Opioid Addicts? - DrugAbuse.com

A new study out of McMaster University in Canada has found that common treatments for opioid addiction reduce the level of testosterone in men, but not in women. The research project, published in the journal Scientific Reports, collected data from 231 opioid addicts receiving methadone...

drugabuse.com

 

[madman]

So I had low test for quite a few years that was first tested when I was about 29. I have been on methadone since age 19. Though I have been on opiates for a long time, I was always a “functional addict” as I was a an athlete and was drafted into the QMJHL back in 2005. I always stayed in shape. But over the years since hanging up the skates I have become more and more sedentary.

When finally my blood work came back with very low test, Unfortunately my family doctor at that time was consistently not willing to prescribe me anything for it. I also have low thyroid. The combination of the two left me constantly exhausted and it was completely awful for a few years especially as I was in the middle of completing a computer science degree. Somehow I made it through. It was seriously torture living with such low test I got fat and had no sexual function pretty much whatsoever. It’s amazing my wife didn’t leave me.

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.

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.

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.

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.

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.

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.

Thanks in advance

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.

Testosterone Therapy in Canada

@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...

www.excelmale.com

A pill that could outsell Viagra: New testosterone Rx drug

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 Experience On Jatenzo (Oral TRT) Log

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

*(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 Experience On Jatenzo (Oral TRT) Log

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).

New member - 66 yo

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.

 

[mitcHELLspawn]

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.

Testosterone Therapy in Canada

@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...

www.excelmale.com

A pill that could outsell Viagra: New testosterone Rx drug

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 Experience On Jatenzo (Oral TRT) Log

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

*(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 Experience On Jatenzo (Oral TRT) Log

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).

New member - 66 yo

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.

Wow. Thank you so much for taking the time to type out such a thoughtful and informative response. It is very eye opening and makes total sense. I am very happy to have a doctor that took pity on me and prescribed something for it as my family doctor simply didn’t care, but at the same time I’ve always kind of known he definitely doesn’t really know what he’s doing.

Like you said though as long as I have the prescription I can make the necessary changes.

So I actually proactively started splitting my dose on Monday - I injected 125MG rather than my prescribed 250MG, and I will be continuing with the 125MG injections weekly.

Understanding that even weekly I will have some hormone fluctuation, I honestly think it would be very hard for me to move to twice a week as the process of injecting is a very rough experience every time without fail.

I do injections into the glute with 1.5” 23 gauge needles and man it hurts sometimes. My wife actually does it for me thankfully cuz I don’t think I could do it myself haha. I did try a few 1” in the shoulder which wasn’t bad, but I wonder if I’m starting to build up any kind of scar tissue or something because sometimes it’s like the needle gets stuck half way and then she has to push past it and it finally goes in. It’s not very pleasant to say the least haha.

So with that being said, I will man up and keep going with weekly at least.

Finally, in regards to the topical 50MG - it seems to be a running theme from everyone who comments to say to stop using it. I have a few questions about that.

Is it simply because you think the 125MG weekly is enough, or is there additional reasons such as mixing 2 types of test?

I’m wondering - if my levels are still going to fluctuate with the weekly injections, wouldn’t the daily topical application then at least aid a bit in making sure the levels remain someone stable?

Again thanks so much for taking the time to respond. Everyone really. I didn’t expect to get such a great range of responses and I am so appreciative!

 

[Systemlord]

I do injections into the glute with 1.5” 23 gauge needles and man it hurts sometimes.

This is completely unnecessary, there's no reason to inject with such a large needle. A 30 gauge insulin syringe is painless when injecting in the deltoids.

 

[mitcHELLspawn]

This is completely unnecessary, there's no reason to inject with such a large needle. A 30 gauge insulin syringe is painless when injecting in the deltoids.

Wait.. what? aren’t those syringes more for subcutaneous injections? I was under the impression from what I’ve read and what my pharmacist has told me that this needs to be injected deep into the muscle (1 inch for shoulder and 1.5 for for butt)

The liquid is quite thick as it’s oil based, are you sure 30 gauge would suffice?

Mostly everything I’ve read in responses thus far has all been things I’ve at least read myself elsewhere or heard from my medical professionals (Dr, pharmacist etc ) that one is new to me… but if true could be a big game changer I think.

If that is the case, would it also work for the thigh as well?

 

[Blackhawk]

Wait.. what? aren’t those syringes more for subcutaneous injections? I was under the impression from what I’ve read and what my pharmacist has told me that this needs to be injected deep into the muscle (1 inch for shoulder and 1.5 for for butt)

The liquid is quite thick as it’s oil based, are you sure 30 gauge would suffice?

Mostly everything I’ve read in responses thus far has all been things I’ve at least read myself elsewhere or heard from my medical professionals (Dr, pharmacist etc ) that one is new to me… but if true could be a big game changer I think.

If that is the case, would it also work for the thigh as well?

Welcome to the 21st century.

 

[FunkOdyssey]

Wait.. what? aren’t those syringes more for subcutaneous injections? I was under the impression from what I’ve read and what my pharmacist has told me that this needs to be injected deep into the muscle (1 inch for shoulder and 1.5 for for butt)

The liquid is quite thick as it’s oil based, are you sure 30 gauge would suffice?

Mostly everything I’ve read in responses thus far has all been things I’ve at least read myself elsewhere or heard from my medical professionals (Dr, pharmacist etc ) that one is new to me… but if true could be a big game changer I think.

If that is the case, would it also work for the thigh as well?

Almost no one that is well informed uses a needle longer than 1/2" or uses a gauge larger than 27g for testosterone injections anymore. Your doctor and pharmacist have old information and are not TRT gurus. You want 27-30g 1/2" needle insulin syringes for shallow IM in the delt, ventroglute, or quad, or you can even get away with something smaller like 30-31g 5/16" for subcutaneous injection.

 

[mitcHELLspawn]

Welcome to the 21st century.

Super helpful. Keep up the great work

 

[mitcHELLspawn]

Almost no one that is well informed uses a needle longer than 1/2" or uses a gauge larger than 27g for testosterone injections anymore. Your doctor and pharmacist have old information and are not TRT gurus. You want 27-30g 1/2" needle insulin syringes for shallow IM in the delt, ventroglute, or quad, or you can even get away with something smaller like 30-31g 5/16" for subcutaneous injection.

Wow that really changes things. The injection has been such a horrible part of all of this. This really could make it so much better.

I’m going to start reading up on this but this might really chang everything for me. I might actually be able to do twice a week without any issues. So the same test that is for intramuscular can also be done subcutaneously without any issue? Am I able to do it on my lower stomach there as well? Thanks in advance

 

[mitcHELLspawn]

Can someone drop me a link for a good resource on information about switching from IM to subcutaneous and best practices and procedures etc that I can read up on? Most of the stuff I’ve found still is saying the things I’ve learned about IM and 1-1.5 and 23 gauge etc.

Thanks in advance !

 

[FunkOdyssey]

So the same test that is for intramuscular can also be done subcutaneously without any issue? Am I able to do it on my lower stomach there as well? Thanks in advance

Yes, even when the medication says "for intramuscular injection only". You can do subcutaneous injections all over, but most commonly people do them somewhere around the stomach (except within a couple inches of belly button) or love handles.

Compared to IM injections, SC injections have some differences, like less impact on hematocrit, slower absorption and longer half-life. The volume you can comfortably inject SC is a bit more limited. Too large volume will cause an inflamed nodule -- depending on the individual, that might be around. 4 ml or greater. Rarely some people will see poor absorption with SC or otherwise feel it doesn't work as well as IM.

Most people are fine with SC though. It seems to work well for me and a lot of other guys here.