We’ve discussed this off and on but I wanted to share this study which would be applicable for men who want to (1) do TRT while preserving fertility OR (2) have done TRT and want to try and recover their HPTA/fertility while maintaining reasonable Test levels.
Approved by the FDA in May 2014, the nasal gel formulation of TTh (NATESTO®) is a product using a metered-dose pump delivering 5.5 mg of T per pump actuation, with the recommended dosing of 2 pumps (11 mg; 1 actuation/nostril) administered intranasally 3 times daily (total 33 mg/day) 6 to 8 h apart.77 Absorption occurs through the nasal mucosa, thereby avoiding hepatic first-pass metabolism, with approximately 75% of administered T entering the blood.78 Peak serum T levels were reached approximately 60 min post-application and declined to near baseline before the next dose.79, 80 In a randomized, dose-ranging, open-label phase 3 study of 306 men with TD (ClinicalTrials.gov NCT01446042), 11 mg nasal T dosed two times or three times daily resulted in between 71% and 91% of patients achieving serum TT concentrations within the defined range (10.4–36.4 nmol/L; 300–1050 ng/dl). At day 90, mean TT C avg values were 13.0 and 14.6 nmol/L (375 and 421 ng/dl) for 11 mg dosed two or three times daily, respectively.79 Compared with other routes of T delivery, nasal T gel administration results in rather low C avg and C max TT levels, as well as DHT and DHT:T ratios, even with administering 11 mg three times daily. While patients experience 3 C max peaks in 1 day because of the required 3 daily doses, only 3.3% of patients had a C max between 62.4 and 86.7 nmol/L (1800–2500 ng/dl). At day 90, the C max and C min were 32.4 nmol/L (934.9 ng/dl) and 7.0 nmol/L (200.9 ng/dl), respectively, with a peak-to-trough ratio of 4.7. Furthermore, an ongoing phase 4 clinical trial suggests that not only can T nasal gel increase serum T over time, but it can also maintain FSH, LH, and semen parameters.81
Love the nasal spray. I’d do it 3 times a day. If it’s a nice formulation could even help moisturize the nasal mucosa.
Also the E2 levels staying in range will finally help people who struggle with dosing frequency of i.m. because of E2. It’s a shame they didn’t show LH on Clomifene as that is usually high on CC but not so on Natesto.
Keeping fertility is great. I would likely start Natesto now if I could get it.
There’s also no way of proving you’re on self administered TRT that way by labs.
I’d like to add, welcome @tareload. There’s always great and productive discussions when you’re around. I’ve visited this forum a lot more since you are back…I mean here. Thanks for all of your contributions.
buccal troches are another compounded option and if you are very detail oriented like you are then you could probably also mimic same PH profile. Would need discipline to do it buccal and not swallow most of it. See the PK profiles above with different options.