After trying pellets a couple times I decided it wasn’t for me. I just last Friday got a testosterone injection for the first time. Urologist’s nurse showed me how to inject and put me on prescription for 200mg every two weeks. After reading posts on this forum, it seems unanimous that people are happier doing EOD, twice a week, or at worst - once a week. I haven’t gotten the prescription yet due to insurance issues but I think I will be getting a vial with the 200mg dose…my question is can I just decide myself to take whatever dose I want?
For example switch to twice a week and simply adjust the dose to reflect the difference? I don’t know how this works…once I draw up solution from the vial can I use what I don’t use later on or do I have to toss it? So basically for those on EOD or twice a week…are you prescribed this so you have vials just for that dose or are you all using the 200mg vials and calculating the correct amount to draw up? Thanks
This shows that your doctor will not be very helpful managing your TRT, it means you will have to figure out your protocol. SHBG should be considered before beginning TRT, if you don’t have this lab value, it’s difficult to know what protocol will show good results.
If it’s a 200mg vial, .5ml is 100mg, .4ml is 80mg .2ml is 40mg and .1ml 20mg. You will need 1ml 27-29 gauge insulin syringes and you should inject in the shoulders and quads rotating injection sites.
The 1ml 27-29 gauge syringes will make it easier to fine tune your dosage, otherwise doing 50mg twice weekly will not be easy.
I have low SHBG (14-22) and find I feel better on daily dosing, EOD works, I just feel less for doing it.
Thank you for your detailed response! So it sounds like I can simply use the 200mg vials and take little bits as needed…I don’t need a specific prescription for smaller vials if I wanted to do more frequently?
My SHBG is 10 and usually runs low. Half the time my free T is low and other half it’s normal but on lower side. Total T is consistently 190-250 before therapy. I’m 33 years old, 5’6, weigh 155 pounds. Initial blood work showed every single hormone tested was normal (LH, FSH, cortisol, TSH, and buncha other ones). CBC all came back normal. My low T is a bit of a mystery and I’ve been diagnosed with it since I was 26 but didn’t do treatment until I was done having kids. I have absolutely no support or help. I live in tiny Delaware and the doctors aren’t very good here, specialists are very few and takes months to get in. My wife is no help as she really looks down on these forums and thinks I should just do whatever the doctor/nurse says since they must know better than everyone else…
By the way, after second pellet procedure I felt very crappy. Doctor was never checking E2 and it had increased to 46. They decided to put me on 1mg arimidex three times a week(!!!). I didn’t know any better. For the last 4 months my E2 levels have been less than 5 and doctor/nurse seem pleased with this. Apparently I’m reading I should be taking 0.5mg twice a week…but plenty of variation between different people, however 3mg a week seems universally accepted as way too much. They’ve never mentioned HCG at all so I’m unsure of whether I should be taking that (KSman sticky said we should be).
And finally, again, I’ve read on here that once every two weeks isn’t recommended. I would love to move to 27-29 gauge needle. This 22 gauge needle wasn’t pleasant in my quad and the pain was pretty bad by the end of the day. It’s been exactly a week now since that first injection and I feel a little bit more energy and little bit more morning wood but otherwise no extra libido. I wonder if it’s due to my very low E2…
Sorry for the life history, it’s been a rough year trying different things and working with people who don’t seem to care or have much knowledge. The testopel was a miserable experience. Four weeks of horrible pain. I had an infection and also lost a pellet. They all just brushed it off when I called after three weeks and said I have a lot of pain still and see pus coming out. “Just take ibuprofen and lots of ice”
This pretty much dictates your next move, as you move injections further apart it will more than likely add negative symptoms and degrade how you feel.
So your estrogen is slightly high and now their plan is to see estrogen zeroed out, sounds like hell on earth! This is close to the dosage they prescribe for women with breast cancer with the intention of driving estrogen to zero.
These doctors sadly only know how to make things worse. I doubt you’ll ever find a TRT specialist in Delaware, you would be forced to travel.
A TRT specialist would be aware of a 2005 clinical study where men were injected with 200mg every 2 weeks and these men were all hypogandal the second week and estrogen dominate–> high estrogen and low testosterone like a women…
Inject 10-12 mg every day and retest labs in 6-8 weeks.
10-12mg a day…that’s about 140mg over two weeks, so you’re saying I don’t need to take a daily dosage that would be equivalent to 200mg over two weeks?
Also now that you’re doing daily, do you find that you need an AI? I know Highpull mentioned above not to take until proven that it’s needed…but I did have that one reading around 45 a few months ago. Should I just take less AI or cut it out completely and wait for blood work?
Lastly, I know Highpull mentioned HCG and conceiving. I think KSman mentioned something about that in his sticky, but there were several other reasons to take HCG…apparently LH gets shut down and several other things get messed up. How do I know if I should be taking HCG?
When you inject once weekly, your levels peak in 36-48 hours and begin to decline and 7 days later your levels are 50% less requiring more testosterone to get levels elevated again. By injecting daily you almost completely eliminate this decline is levels between injections and therefore need less T to achieve a desired level which lowers estrogen because you are not in excess.
I started daily injections knowing I wouldn’t need an AI, this is why someone chooses to inject T daily or because they over-respond to AI’s and have no other choice. I happen to feel better on a daily protocol and the added bonus is estrogen has never been lower on any protocol before it.
If you are relatively sensitive to T, 10-12mg daily will be about optimal for you. There are some who have needed less, some more. I seem to be one who needs less, less than 10mg daily.
When I started 7 mg daily, by the second week I was sleeping like a baby, getting leaner by 2.5 weeks and felt great!
You should take hCG if you are actively trying to conceive. You could also take it if testicular atrophy is of concern to you.
Keep in mind that the vast majority of guys on TRT take 150-200mg once weekly. You will see a fluctuation in levels, but not symptoms. A few guys are outliers that are overly sensitive to those fluctuations. I think it is important to note that in men under 45, total testosterone levels fluctuate by 140-200 ng/dL per day on average, which is why, for insurance purposes, they want early morning labs when levels are typically higher. The larger diurnal fluctuations are not seen in older men, perhaps because there is not as much to work with anyway. It might be interesting to see if older guys on TRT have more difficulty with their levels not being “steady” than younger guys whose levels are not as steady naturally.
Given the half life of most esters, levels will drop over the week, which is why you do not want a two week protocol. As long as the dose is adequate, the drop over one week is symptomatically insignificant. As an example, I take 200mg once weekly. At six days post injection, my total testosterone is at 880-920ng/dL, while free test is 200-220 pg/mL. Last SHBG was 19. Most guys, even with lower SHBG, report doing fine with once weekly injections. Most gym rat meatheads are doing 200mg once a week and they do not even get blood work and have no idea what their levels are, and they state they are feeling great so they do not care.
While more frequent dosing will not hurt you, it is usually not necessary.
Again THANKS for both of your responses. I guess I’ll bring up HCG with the nurse as I’m not interested in having testicular atrophy hah. Also I think I’m going to have to go down a long path of trying different injection intervals and different dosages to see what’s best for me. Systemlord - even taking 10mg daily, how on earth do you draw up that amount from the vial. Based on a 200mg vial, that’s 0.05mL…do they make syringes that small to draw up 0.05? Again I’ll probably start with once a week and then may move to twice a week etc. Just curious how you draw up such a tiny amount. And lastly, where are you buying these 27-29 gauge needles and syringes?
This is no good, your SHBG is 10 and large dosages will hammer SHBG down to almost zero! Large infrequent injections is the protocol for men with high SHBG because large dosages do a good job of suppressing SHBG, you need to opposite or you’ll be dealing with excess T and E2 causing symptoms.
Men with low SHBG need multiple smaller injections because low SHBG men tend to be hyper-excreters and will not need high levels to achieve good Free T levels, actually high levels will cause problems. The only way to maintain mid-normal levels and keep levels from declining quickly is smaller frequent dosing.
HCG is just going to cause you massive problems, you have no natural buffer to bind up estrogen, super low SHBG men considering HCG should realize you are in for one hell of a time.
You’re more than likely going to struggle on TRT anyway, most low SHBG men do and the last thing you need is a compound creating more estrogen.
Sure you want to prevent testicular atrophy, would you prefer to have massive debilitating symptoms or small testicles?
Pick your poison wisely.
This is why I ask my doctor to prescribe 100mg/10ml vials, I can dose mg by mg.
Very interesting stuff. This all seems familiar as my first testopel shot me to 1100 and I had a lot of symptoms such as insomnia, fluid retention, and very excessive energy as well as random boners. My chest was also itchy. I had read that testopel can sometimes be good for 4-6 months. In my case, after two months I started feeling tired again and by 2.5 months I was totally shot, needed energy drinks to help me function in the day. Felt much worse than before therapy. I attributed it to the high E2 levels…but you mentioned that we are hyper excreters so perhaps that’s why that failed so much. I just got my lab results from the one week blood draw after my first injection. Total T was 803, estradiol was less than 5. How can I bring up my E2 to the sweet spot again?
This is unusual, normally we see estrogen very high in low SHBG men with a high Total T, can you confirm when labs were done in relation to your injection.
If your doctors are this lousy at managing TRT, I wonder if they are equally as uninformed about proper thyroid testing and treatment, I’m willing to bet small town doctors are not as well informed as those in the big cities.
If you want to increase estrogen, then stop crushing estrogen using that insane AI dosage. In other words inject 10-12mg daily and do not use the AI.
Any doctor prescribing an AI 1mg 3x weekly is incredibly incompetent, this is the dosage for those on steroid doses of Test.
Injection was last Friday (8 days ago), bloodwork was yesterday. Since injection, I took 1mg arimidex last Friday, this past Monday, and this past Wednesday.
Also right before injection I had bloodwork which showed low t and low E2…so maybe the arimidex is keeping it low.
Checked my thyroid values and they seem fine: T4 was 1.35, ref range is 0.82-1.77
TSH was 1.01, ref range is 0.45-4.5
Not maybe, the AI “is” suppressing estrogen because that’s what is does, it blocks the aromatase enzyme in fat tissue from converting T → E2.
Those do look good, but without testing the active thyroid hormone you can only guess about things. You more than likely do not have a problem. Your numbers are actually similar to my own, my last TSH was 1.01 on TRT, drops to .6 when I stop TRT.
Do to an iron deficiency I lost the metabolizing boosting properties of thyroid hormones even though levels were good.
So if you haven’t have mineral testing, I suggest you do and anyone about ready to undertake TRT. TRT can use up more minerals, TRT depleted many of my minerals, vitamin C, potassium and vitamin D.
TRT sounds like a massive pain in the ass (no pun intended). It’s like you said, pick your poison. Either have low T and be tired and feel crappy all the time or do TRT and throw everything inside your body out of whack just to feel normal
What makes TRT a major pain is the doctors who claim to be specialists and are less knowledgeable than a regular guy on a forum who had to figure out everything on his own. Any doctor prescribing 200mg every 2 weeks has their head in the clouds and don’t really care to do things the right way.
Clinical studies show these protocols only create estrogen dominance in men and you doctor is unaware.
This doctor of yours is going to cause real harm to his patients! Your doctor is useless in managing your TRT and I doubt the next one will be any better. This stuff isn’t taught in medical school, so you need to find someone who does TRT all day every day, these guy usually figure things out.
Hopefully last question! Since you administer every day, you must be rotating through a lot of sites. What sites do you use? I mentioned I’m 5’6 and weigh 155. My arms and legs are pretty skinny, chest and belly are kinda big in a bad way. Nurse told me to do IM in vastus lateralis with one inch 22 gauge. Not sure your body type but what gauge are you using for subcutaneous? And how long is your needle?
I use shoulders and quads middle outer. Most insulin syringes are half inch, I’m 32% BF and have no trouble hitting muscle. A 22 gauge is unnecessary, my doctors started me out on 18 gauge syringes, boy those hurt!
I watched that YouTube video you sent as well as another by Dr. Crisler on sub Q injection administration. Just like what you’ve been saying, frequent doses are better and can even decrease estrogen. In my case I need to increase for now. I’m completely stopping AI but should I take a big 200mg dose to help increase estrogen or just try the frequent injections and hope E2 goes up
One more thing: I remember the urologist said testosterone therapy may not improve my erections. Is this because they treat all patients the same versus managing each case individually? So theoretically if done correctly EVERYONE should have better erections?