T Nation

HRT - Injection Frequency?


#1

Hey guys,
Got my results back. After 2 weeks on 5g Androgel daily, my test went down from 277ng/dl to 126 ng/dl (holy s*@t!!!). Anyway, after talking to my doc on the phone for about 20 minutes, I finally convinced him that upping the dose to 10g is not the answer. He says that if I can convince him why injections are better, then he will prescribe it. He wants to do monthly injections because that is what his electronic notebook tells him, but I stated that 100 weekly was working better for people on the forums and in a study that I've read (less fluctuation). I've found 1 study that talks about injecting more frequently (rationale for 1x/week vs. every 2 weeks). OK, enough rambling. What I'm asking for is...does anyone have references on the frequency of test cyp injections. I believe I've convinced him for the injections, but do I need to worry about his prescribed frequency or just get the script and do it myself weekly? Also, when I go to the pharmacy tomorrow to pick it up, what size needles should I be looking to get? Its tough because I feel that I know more than him...but, at least he's willing to listen to my recommendations. Thanks, as always for your help.

Mike


#2

Where do you plan to inject?

For the glut's #23 1.5" 3ml works well. You do not want to have a smaller cap syringe as that may be more difficult to handle and aspirate when twisted around. For injections more than 1/wk, you do not want to go that route.

For the vastus lateralis, #23 1" will work, or perhaps #25 1".

I inject with #29 .5" .5ml insulin syringes EOD in the vastus lateralis.

Tell the doc that you want 100mg/wk and that the injection frequency should be whatever you determine your body does best on. Tell him it is irrational to go from a philosophy of transdermal every day because its a natural dose pattern to once a month because someone wrote that in the stone age. Tell him that the once a month dose will cause mood problems and elevate E and SHBG. The HTPA will shut down and for the last two weeks, the T levels will be lower than when you started and the remaining effects will be E and the elevated SHBG will soak up any remaining free T. Lager doses do not create larger 1/2 lives in a linear fashion.

You will need the syringes written on the script. In Kansas, no script is required for insulin syringes, but individual pharmacies or chains may have their own policies. Get boxes of 100, otherwise you may get charged $1 each.

Any discussion on anti-E or HCG? You can get the anastrozole on your own and probably would want to go that route in any case even if you get a script for arimidex. HCG will need a script and is injected SQ, 250-iu EOD with insulin syringes. If you are injecting HCG EOD, doing the same with T works out well as a routine. Here is the HCG research:

http://dspace.hsl.washington.edu/dspace/bitstream/2012/52/1/JCEM_2005_Low_Dose_Human.pdf

Best prices for T, syringes and HCG would be at Sam's Club (USA) if you have a Sam's business membership or someone will sub list you on theirs. 10ml 200mg/ml Watson's test cyp $42, 10,000 IU HCG $16.25, 100 insulin syringes $12, 100 #23 1.5" 3ml $18+. The above prices are for no insurance. Don't know what happens if on an insurance card, but then one might not care then in any case.


#3

Thanks KSMan...I knew I could count on you. I'm going to be injecting in the leg. I'll follow the website instructions from spotinjections.com. I'm hoping to get on HCG (even though I'm done having kids), but I won't press my luck this early in. An anti-E would be better. Do you have a good site for the liquidex? Thanks as always.

Mike

And, yes, I have insurance and they will pick up the injectible...cheaper for me vs. the gel by $10/month too!!!


#4

Mike -- if I were you I would try the 10mg of androgel first. I didn't and now I regret that I did not at least try it to see if it would have worked. It sounds like it did for a fair number of t-nationers -- crappy results at 5 and then great results at 10.

The advantage of the androgel is that you get a more or less steady dosage of testosterone, whereas with the shots you have peaks and valleys. If 10g of androgel works for you that would be great.


But at any rate, here is something to take to the Doc re frequency of injections -

http://www.aace.com/pub/pdf/guidelines/hypogonadism.pdf

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS
MEDICAL GUIDELINES FOR CLINICAL PRACTICE
FOR THE EVALUATION AND TREATMENT OF HYPOGONADISM
IN ADULT MALE PATIENTS 2002 UPDATE

see P 11:


For complete androgen replacement, the regimen
should be between 50 and 100 mg of testosterone enanthate or cypionate administered intramuscularly every 7 to 10 days, which will achieve relatively normal levels of testosterone throughout the time interval between injections (50). Longer time intervals are more convenient but are associated with greater fluctuations in testosterone levels. Higher doses of testosterone produce longer-term effects but also higher peak levels and wider swings between peak and nadir circulating testosterone levels; the
result is fluctuating symptoms in many patients (51).

The use of 100 to 150 mg of testosterone every 2
weeks is a reasonable compromise. Use of 300-mg injections every 3 weeks is associated with wider fluctuations of testosterone levels and is generally inadequate to ensure a consistent clinical response. With use of these longer interval regimens, many men will have pronounced symptoms during the week preceding the next injection. In such
instances, a smaller dose at closer intervals should be tried.(53).


#5

You get peaks and valleys with conventional injection protocols. One can inject 100mg/wk as 28mg EOD and get very steady levels. If one does not have insurance, injections are very inexpensive. The EOD injections provide steady levels and least cost. If one does not absorb or tolerate transdermals well, the EOD injections are there as an alternative while still providing steady T levels.

If one is on transdermals and injecting HCG, that situation seems quite irrational!

e-loo... You have heard all of that before, but I have to keep beating the drum.


#6

I don't believe that the transdermal T-gels provide a steady level of serum testosterone. I definitely could feel the daily ups and downs of 10 grams Testim. I'd apply it at about 6:00 am, hit a peak at 1-2 in the afternoon, and definitely start feeling the decline by bedtime. When I woke up, I definitely felt low and was looking forward to the next application. T-cyp injections every 5 days is working better.


#7

Keep it up! I know you are right about that injection protocol -- I am still working towards convincing myself to take the EOD plunge.


#8

Do it! Its the best way. I know its the way Im gonna go.

Ive been taking supps every day for years now. Whats a min or two in the morning EOD to inject? Big deal.


#9

Does anyone have any experience with both injections and transdermals at the same time? I went on 10g Androgel a few weeks ago and so far I'm a little underwhelmed with the results. Doc is happy to switch to injections but only if I go to his office, which pretty much rules out injections EOD. What do you think of weekly or semi-weekly injections plus Androgel to help smooth out the peaks and valleys?


#10

Ask your doc why self injections are an issue for him when so many other docs encourage that.

Started a few weeks ago? There should be some good results in 4-6 weeks. I do not think that health insurance would go for that. Doc may be trolling for fees with injections in his office. Blood levels stabilize quickly with transdermals and blood tests can be done in 2 to 3 weeks. But E levels need to be checked later than that. So this early test serves to adjust dose or abandon transdermals.


#11

According to him it's because they are controlled substances (he's fine with self-injection of HCG). Personally I think you're right, I think he's trolling for fees. But the fact that he's not afraid to treat low-T aggressively makes me willing to stick with him. I don't think my insurance covers shots, but they do cover Androgel. So it wouldn't cost much more to do both than for shots alone.

I'm supposed to go back for tests after the first month (I'll give it at least another month before I consider adding injections). Thanks for the info about the E test--I didn't know an early test would be inconclusive. Before I started, my E tested at 39. I can only assume it's gone up since then. His plan is to cycle the Androgel with HCG and Nolvadex every four months.


#12

Thanks everyone for your responses. E-loo, thanks for the reference...just what I was looking for. John Crisler has some good stuff that I'll be bringing as well.

In regards to trying to 10md/day...I've read that if I'm not absorbing the 5mg to cause any changes, the changes from the 10 would be minimal at best (at least that's what I'm reading from the various forums I've been reading!!!).

I'm not afraid to inject and at 37, I'm too young to be feeling this lousy. I think I'll try every 5-7 days, then try KSMan's ritual once things get moving along. I'll let everyone know how the appointment goes this morning.

Mike

And KSMan, thanks for the pm.


#13

Hey Mike -- every 7 days has been working pretty well for me. I would say it is just about perfect. But I'm a guy, so I gotta see if I can make it better!

Just a heads up -- you will get some relief from the very first shot. but at least for me it took a little over a month in to start feeling more like myself. Still feel like there is a little ways to go to be @ 100%, but I am getting there.

A doctor friend told me those first few weeks after I started injections -- "Testosterone isn't a hormone like adrenaline. Takes a while for the body to get saturated and feel it, especially if you have been w/o it for so long"

Keep us posted.


#14

I don't follow you.


#15

The only reason to use transdermals is to avoid injecting. If one is doing transdermal TRT, then needing to inject HCG, then one should probably drop the transdermals and inject T & HCG. So transdermals seem to rule out HCG and then you have shrinking nuts and fertility problems... if the transdermals are delivering a reasonable dose. HCG requires small insulin syringes. Test cyp can also be injected with those tiny needles. So big needle phobia is not necessarily a criterion.


#16

I have been on hrt (test cyp) for about six months. For me, at the end of 4-5 days I really start feeling a drop in my levels, so I inject twice a week.

Believe me, I wish I could inject only once a week, but the difference in how I feel makes the second shot worth the trouble. I would not be happy on a bi-weekly schedule.

From the research and reading I have done (and I have done a ton), it seems that:

a) the true half-life of test cyp is 4-5 days and not the 6-8 commonly cited;
b) everyone metabolizes the ester and the testosterone differently; and
c) KSMan knows his shit.

I know this isn't the cited research you wanted, but...


#17

a) The half life stats were developed in the stone ages during clinical trials and research when injections were every 2,3,4 weeks.

The half life does vary with the size of the dose. Nothing published seems to address this issue of half length varying with amount injected. And some confuse half life with "when the elevation of T is totally gone/depleted".

Then some read that and repeat erroneous figures of 10-14 days for half life which makes things more of a muddle.

And one needs to have overlapping half lives to get a reasonably steady level. Injections every two weeks or even once a week is totally insane. I would be like putting a woman on HRT dosed once every two weeks so she could spend half of her time having hot flashes.

c) I am still learning. I am guilty of repeating my self and trying to help others through some of the crap that I had to go through. Thanks for your words.


#18

Well, I'm on Test Cyp 100mg/week. Did my first injection Friday night...no issues. The MD would not perscribe HCG despite the research that I presented...we both agreed for me to see an endocrinologist due to my doc's lack of knowledge. That appointment is on the 17th of January, so we'll see how it goes. Thanks again everybody.

Mike


#19

LOL, and this guy went to med school eh?

Such a shame when everyday people like us can learn in a few months online what alot of doctors never learn in a lifetime.


#20

Hi All - after 4 + months on 10g (mg?)
androgel with little relief of depression/anxiety/fatigue, today,I am going
for my first T shot of 100g/weekly.
Questions : My Agel #s were between 450 and 500 on average, free T was between 13
and 16, is it likely that getting my numbers over 700 or so would make a big difference or am I barking up the wrong tree with HRT ? Can I use Agel to smooth the bumps between shots ? I have also been on Zoloft for a few months and thats doing very little as well. Hoping to really up the T, feel better and lose the meds.

I guess my big question is : with my Agel #s and no relief, does it seem possible that shots could actually
make a difference ? E-loo, are you still improving ? thanks- PV