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Wondering if my TRT prescription schedule makes sense at all
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<blockquote data-quote="madman" data-source="post: 269581" data-attributes="member: 13851"><p><strong><em>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.</em></strong></p><p></p><p>Strictly sub-q or shallow IM using an LDS 27-31G (various needle lengths) insulin syringe with a fixed needle to draw/inject is where it's at.</p><p></p><p>You are causing yourself much more grief than need be.</p><p></p><p>Not only will you minimize any pain/scar tissue, especially when poking yourself frequently but you can also draw/inject using the same syringe (fixed needle) let alone minimize the loss of any wasted medication from using an LDS (low dead space) fixed insulin syringe.</p><p></p><p></p><p><strong><em>“Fixed insulin type syringes have <u>no void space at the point where the needle joins the syringe</u>, and so are known as Low Dead Space Syringes, which is sometimes abbreviated in the literature to LDSS. They are made like this so that the <u>full accurate dose is delivered, and there is no waste</u>”</em></strong></p><p></p><p></p><p></p><p></p><p>[URL unfurl="true"]https://www.excelmale.com/forum/threads/principles-of-testosterone-and-hcg-injection-technique.20198/[/URL]</p><p></p><p><strong><em>post#4</em></strong></p><p>[URL unfurl="true"]https://www.excelmale.com/forum/threads/no-drawing-needles-is-this-normal-and-best-practice-for-subq-testosterone.28725/[/URL]</p><p></p><p></p><p></p><p></p><p></p><p><em><strong>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.</strong></em></p><p><em><strong></strong></em></p><p><em><strong>Is it simply because you think the 125MG weekly is enough, or is there additional reasons such as mixing 2 types of test?</strong></em></p><p></p><p><strong><em>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?</em></strong></p><p></p><p>Choose one formulation.</p><p></p><p>IM or transdermal.</p><p></p><p>The majority prefer intramuscular injections.</p><p></p><p>Again the starting dose for IM is 100 mg T/week.</p><p></p><p>Always best to start low and go slow.</p><p></p><p>To be honest you would be far better off starting on 100 mg/week split into twice-weekly injections (50 mg every 3.5 days).</p><p></p><p>If you want to jump in on 125 mg T once weekly do what you feel is best for you.</p><p></p><p>If your goal is to minimize fluctuations then you would need to inject more frequently which will clip the peak--->trough and result in more stable blood levels throughout the week.</p><p></p><p>The main reason one would choose transdermal over IM is fear/dislike of needles and those that have a better understanding of the PKs may prefer daily fluctuations in T levels as the daily transdermal application can somewhat mimic the natural endogenous 24-hour circadian rhythm of a healthy young male although you can poke holes in this.</p><p></p><p></p><p></p><p></p><p>[URL unfurl="true"]https://www.excelmale.com/forum/threads/does-patient-applied-trt-pose-risk-for-blood-pressure-elevation.26423/[/URL]</p><p></p><p><em><strong>Figures 2A-2F depict the TT 24 h pattern achieved by the 6 different solution and gel PA-TRTs, and Figures 3A-3D depict the TT 24 h pattern achieved by the buccal tablet, oral capsule, transdermal patch, and subcutaneously injected PATRTs</strong>. <strong><u>There are substantial differences between the therapies in the derived TT 24 h pattern; moreover, all but one of them differs either somewhat or greatly from the normative one of diurnally active young adult males, which is defined by</u>:</strong> <strong>(i) elevated and near peak TT level during nighttime sleep, (ii) peak TT level around the time of morning awakening, (iii) moderately elevated TT level during the initial hours of wakefulness, (iv) reduced TT level in the late afternoon, and (v) lowest TT level in the evening. <u>Based upon these criteria, only the Androderm® transdermal patch (Figure 3D), when applied in the evening (∼22:00 h) as recommended, closely mimics the TT circadian rhythm of normal young adult males</u>.</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*AndroGel® 1%, AndroGel® 1.62%, Axiron®, Fortesta®, and Testim® (and its biosimilar Vogelxo®) gel and solution preparations </strong>are recommended for application once daily in the morning to attain the highest serum hormone level 2 to 6 h following dosing and lowest, instead of highest, hormone level during sleep, that is, final hours of the 24 h dosing interval<strong> (Figure 2A-2E).</strong></em></p><p></p><p></p><p></p><p></p><p><strong><em>Accordingly, we characterized each PA-TRT according to its ability to simulate the normal TT circadian rhythm (Figure 1A). We developed five criteria for this purpose: (i) elevated and near peak TT level during nighttime sleep, (ii) peak TT level around the time of morning awakening, (iii) moderately elevated TT level during the initial hours of wakefulness, (iv) reduced TT level in the late afternoon, and (v) lowest TT level in the evening. <u>Because at this time it is unknown whether any one of these criteria, for example, circadian time of highest or lowest TT level, is of greater biological importance than the others, we weighted each one of them equally</u>.</em></strong></p><p><strong><em></em></strong></p><p><strong><em>*As shown in the graphs of Figures 2 and 3, the <u>PK of most FDA-approved PA-TRTs gives rise to TT 24 h patterns that deviate greatly from the normative one thereby failing to satisfy one or more of the five specified criteria</u>.</em></strong></p><p></p><p><em><strong>*AndroGel® 1%, AndroGel® 1.62%, Xyosted®, and Striant®, which <u>achieve relatively constant serum hormone concentration throughout the 24 h, seem to have been incorrectly conceptualized</u>, perhaps because of the presumed necessity to maintain nonvarying, that is, homeostatic, TT concentration to achieve consistency of biological effects.</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*The FDA-approved gel and solution PA-TRTs when applied as directed, that is, morning after awakening from nighttime sleep, while achieving TT levels within the normal range to remedy androgen hormone deficiency, <u>fail to restore the normal physiologic TT circadian variation</u>.</strong></em></p><p></p><p><strong><em>*The <u>temporal patterns of these PA-TRTs differ from normal, either in the timing of the peak and/or nadir TT concentrations, by achieving the highest hormone levels generally between midmorning and noon and lowest (rather than near peak) ones during sleep</u> (Figure 2A-2F).</em></strong></p></blockquote><p></p>
[QUOTE="madman, post: 269581, member: 13851"] [B][I]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.[/I][/B] Strictly sub-q or shallow IM using an LDS 27-31G (various needle lengths) insulin syringe with a fixed needle to draw/inject is where it's at. You are causing yourself much more grief than need be. Not only will you minimize any pain/scar tissue, especially when poking yourself frequently but you can also draw/inject using the same syringe (fixed needle) let alone minimize the loss of any wasted medication from using an LDS (low dead space) fixed insulin syringe. [B][I]“Fixed insulin type syringes have [U]no void space at the point where the needle joins the syringe[/U], and so are known as Low Dead Space Syringes, which is sometimes abbreviated in the literature to LDSS. They are made like this so that the [U]full accurate dose is delivered, and there is no waste[/U]”[/I][/B] [URL unfurl="true"]https://www.excelmale.com/forum/threads/principles-of-testosterone-and-hcg-injection-technique.20198/[/URL] [B][I]post#4[/I][/B] [URL unfurl="true"]https://www.excelmale.com/forum/threads/no-drawing-needles-is-this-normal-and-best-practice-for-subq-testosterone.28725/[/URL] [I][B]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?[/B][/I] [B][I]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?[/I][/B] Choose one formulation. IM or transdermal. The majority prefer intramuscular injections. Again the starting dose for IM is 100 mg T/week. Always best to start low and go slow. To be honest you would be far better off starting on 100 mg/week split into twice-weekly injections (50 mg every 3.5 days). If you want to jump in on 125 mg T once weekly do what you feel is best for you. If your goal is to minimize fluctuations then you would need to inject more frequently which will clip the peak--->trough and result in more stable blood levels throughout the week. The main reason one would choose transdermal over IM is fear/dislike of needles and those that have a better understanding of the PKs may prefer daily fluctuations in T levels as the daily transdermal application can somewhat mimic the natural endogenous 24-hour circadian rhythm of a healthy young male although you can poke holes in this. [URL unfurl="true"]https://www.excelmale.com/forum/threads/does-patient-applied-trt-pose-risk-for-blood-pressure-elevation.26423/[/URL] [I][B]Figures 2A-2F depict the TT 24 h pattern achieved by the 6 different solution and gel PA-TRTs, and Figures 3A-3D depict the TT 24 h pattern achieved by the buccal tablet, oral capsule, transdermal patch, and subcutaneously injected PATRTs[/B]. [B][U]There are substantial differences between the therapies in the derived TT 24 h pattern; moreover, all but one of them differs either somewhat or greatly from the normative one of diurnally active young adult males, which is defined by[/U]:[/B] [B](i) elevated and near peak TT level during nighttime sleep, (ii) peak TT level around the time of morning awakening, (iii) moderately elevated TT level during the initial hours of wakefulness, (iv) reduced TT level in the late afternoon, and (v) lowest TT level in the evening. [U]Based upon these criteria, only the Androderm® transdermal patch (Figure 3D), when applied in the evening (∼22:00 h) as recommended, closely mimics the TT circadian rhythm of normal young adult males[/U]. *AndroGel® 1%, AndroGel® 1.62%, Axiron®, Fortesta®, and Testim® (and its biosimilar Vogelxo®) gel and solution preparations [/B]are recommended for application once daily in the morning to attain the highest serum hormone level 2 to 6 h following dosing and lowest, instead of highest, hormone level during sleep, that is, final hours of the 24 h dosing interval[B] (Figure 2A-2E).[/B][/I] [B][I]Accordingly, we characterized each PA-TRT according to its ability to simulate the normal TT circadian rhythm (Figure 1A). We developed five criteria for this purpose: (i) elevated and near peak TT level during nighttime sleep, (ii) peak TT level around the time of morning awakening, (iii) moderately elevated TT level during the initial hours of wakefulness, (iv) reduced TT level in the late afternoon, and (v) lowest TT level in the evening. [U]Because at this time it is unknown whether any one of these criteria, for example, circadian time of highest or lowest TT level, is of greater biological importance than the others, we weighted each one of them equally[/U]. *As shown in the graphs of Figures 2 and 3, the [U]PK of most FDA-approved PA-TRTs gives rise to TT 24 h patterns that deviate greatly from the normative one thereby failing to satisfy one or more of the five specified criteria[/U].[/I][/B] [I][B]*AndroGel® 1%, AndroGel® 1.62%, Xyosted®, and Striant®, which [U]achieve relatively constant serum hormone concentration throughout the 24 h, seem to have been incorrectly conceptualized[/U], perhaps because of the presumed necessity to maintain nonvarying, that is, homeostatic, TT concentration to achieve consistency of biological effects. *The FDA-approved gel and solution PA-TRTs when applied as directed, that is, morning after awakening from nighttime sleep, while achieving TT levels within the normal range to remedy androgen hormone deficiency, [U]fail to restore the normal physiologic TT circadian variation[/U].[/B][/I] [B][I]*The [U]temporal patterns of these PA-TRTs differ from normal, either in the timing of the peak and/or nadir TT concentrations, by achieving the highest hormone levels generally between midmorning and noon and lowest (rather than near peak) ones during sleep[/U] (Figure 2A-2F).[/I][/B] [/QUOTE]
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Wondering if my TRT prescription schedule makes sense at all
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