Finding a Clinic That Will Pin You More Than Once a Week

I’m in Austin, Texas. Tested with PCP for low T (250), but it took a week to get first results, it’s going to take a week to get a confirmation test, and then 2-3 weeks to get in to see urologist because everyone is booked.

I’m checking into local clinics as they can get me started quicker… but I’ve visited three clinics and here is the rap I’m getting:

-What’s your protocol?
**You come in for one shot a week
-I’ve heard two shots a week (min) is much better so I don’t have ups and downs.
**We like to start you on once a week and then adjust if needed
-What about if I want to just start out on the preferred protocol so I can preempt needing adjustment
**Well, we like to do once a week.
-I understand you sell in-office shots, what if I want to pay for more for twice a week.
**Our protocol to start is once a week
-Can I pin at home
-What if I decide to pin at home twice a week
**Well if you aren’t going to follow our protocol, we probably won’t treat you and you should go somewhere else

Does anyone have a referral to someone in Austin who “gets it”? I know I can do online, but I’d like to have the comfort of meeting with someone in person who I trust to review my numbers as I go through this process. I have a problem establishing trust with a provider if right away I’m questioning their protocol, and it seems mutual.

What makes you think you need twice a week shots?
Why don’t you just do the shots at home and tell the clinic you are doing them once a week?

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What makes you think you need twice a week shots?

Everything I’m reading, including on this site, says that once a week is long enough between pins that you are going to have bigger ebbs and flows of T levels and that twice a week is proven to level that out as well as make it less likely est will be out of range, and many will even pin more often if they can tolerate it. I also posted a query in another forum asking for big red flags when looking for a clinic. I got many answers and the top two that came up over and over as red flags were 1) want to pin you only once a week and 2) want to start you on AI from the very beginning.

Why don’t you just do the shots at home and tell the clinic you are doing them once a week?

Two reasons: One, I want to be honest with them so I can get their best advice. I feel like if I have to lie to my provider right off the bat, it’s just not a good scene and I just go online, get the gear I need and do whatever the f I want. Second, when I ask clinics about this, they suggest they don’t want me doing that behind their back, and I understand why because it’s the same trust issue in reverse. Legit clinics don’t want you experimenting on your own and will cut you off if they think you’re messing around instead of receiving their prescribed treatment.

I don’t know… I guess I just expected the local clinics to be “ahead of the curve” on protocol. So far, I’m having trouble finding one that is any better than my GP.

Tier1 and Defy. Defy being the preferred choice for most.

These two would be concerns, but 1x a week will suffice for most. What is your SHBG? If it’s low, you may need to pin more often (I pin daily because my SHBG is very low).

Most clinics will let you pin at home as no one wants to deal with the volume of patients that would need to wait for hours when it takes 30 seconds to inject.

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Doubtful you would know unless you can see the numbers on a page.

Once a week is plenty for most TRT candidates, try it 1st i would


So you do their protocol for 6 weeks or whatever then take off the training wheels and pin at home ever hour if that is what gets you excited. RX plus insulin pins and you can pin every 15 min.

Long term you want to be injecting at home anyway. Try the once weekly protocol and learn/collect data as you go. Not a given twice weekly is the way to go.

Not sure where you are getting that. There is peak and trough with twice weekly as well. Try every day and see how old that gets quick.

You are going backwards in terms of what you are seeking. You want a longer leash not a shorter one (unless you are into that). No judgment.

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I still dont get this. SHBG has nothing to do with how rapidly one absorbs or eliminates free testosterone. Myth. Is it associated sometimes with rapid clearance? Sure. Correlation vs causation. You could try pinning once a week and test free testosterone using equilibrium diaylsis to prove this for yourself.

SHBG sets your TT based on your fT level (which is a function of clearance and distribution volume, neither of these depend on SHBG).

Low SHBG guys look at their TT and think there is something amiss. There is nothing amiss with their fT once they take exogenous T. Their TT appears low (relative to a higher SHBG guy normalized by dose) because their SHBG is low.

I guess I’m not seeing the difference between these two, but I’m going with what Dr. Mike at Defy directed me to do. As someone trained by Dr. Saya, I imagine there is good reason to this, and it seems common practice in TRT clinics which are known to be well-versed.

Weak correlation vs causation. From a mechanistic standpoint, a world of difference.

But from a practical standpoint - the method of treatment is the same, right?

Yes, it makes guys feel better when they see their Total T level at trough. Getting their money’s worth so to speak.

Depends on you at the individual level and whether your clearance is 95%tile with a 5%tile SHBG (example). The experiment i gave out above would answer that.

But if I was them i would probably do the same. Working with humans is hard and few want to be lectured on the finer points of pharmacokinetics. Losing battle. Carry on and enjoy the higher TT level at trough.

Also note Defy uses direct RIA fT assay which is at best an approximation. That is the other issue…guys dont want to pay for more expensive equilibrium dialysis test.

I mean, it sounds like you do get this then. Most providers (“most” meaning “standard/not versed”) go on the metric of TT alone with no thought towards fT. As a result of this, most patients over-emphasize TT when it really has little applicability to treatment.

Get all doctors to look at fT with harmonized ranges, perhaps even by age group, and treat accordingly. Then low SHBG patients will stop looking at low TT thinking they’re getting ripped off.

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Yes I do and I dont. The academic in me cringes but the practical side of me does get it. And now that we have gone through the exercise i am hopeful you have something to consider as well. Once the CDC Host work is done perhaps things will change. As a details person I thought you might appreciate all this.

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Well said. Good job. Would be asking a lot of humans.

See in an ideal world we would never say …we pin ED because our SHBG is low…ever again. But I doubt that will happen.

The idea that free testosterone is eliminated not Total T really needs to be emphasized.

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Not a given twice weekly is the way to go.
Not sure where you are getting that.

When I search this forum, the #1 topic with most view is TRT: Protocol for Injections. It begins:

An Initial Protocol for Injections

  • 100mg test cypionate or enanthate per week, divided into two or more injections per week.
  • 250iu hCG subcutaneously EOD [every other day]

Injecting testosterone once a week induces spikes in testosterone levels followed by lows. This can make many feel bad or worse at the end of the week than their pre-TRT state. As time goes on the dead zone gets wider and they feel no relief with injections. These feel much better injecting twice a week or even EOD [every other day].

Thanks for sharing where you got it. Good job reading up. We should also disclose what else is in that post…

Good luck finding what works for you.

There is also this in the 3rd place thread:

Be careful out there.

It’s not about elimination of test, a lot of guys with low SHBG are overweight and are metabolic emergencies and injecting smaller doses more frequently can greatly diminish side effects.

I’ve read posts from high SHBG guys which seem to eliminate test very quickly, so I don’t see the SHBG levels effecting the clearance rate of test.