T Nation

Obesity, TRT, Subq/IM Questions


#1

1.25ml of a 200mg/ml bottle.
Zinc 50mg daily
Turmeric 500 daily
Vit D 50,000iu/week

Hey guys I’m totally new to the forum. I am a 30 y/o male who is morbidly obese. I have secondary hypogonadism due to obesity (which I am working on losing weight). So, when I was first diagnosed, my T level was 162. I have been on testosterone for a few years now. I started with Androgel which worked incredibly well for me, but I hated applying the gel. I switched to IM testosterone and I have good weeks and bad.

I have relatively complete control of my regimen as my doctor is very amenable to what we are doing. Right now, I take 1.25ml ( of the 200mg/1ml) per week. This has always seemed high to me, but after a lot of experimentation I seemed to have felt “the best” on this dose. I always injected it IM into my deltoid area.

I am unfamiliar when the best time to check my levels is post-injection. My last level was 1120 for serum (total) and 34.7 free. That was 3 days after my injection. This was in April 2018

So here is my biggest problem…some weeks I feel fantastic. Fully arousable, great mood, great spirits. Some weeks I don’t. I’ve often wondered if perhaps some weeks I am maybe going into a vein or something because I don’t always aspirate (bad I know). I decided to try the subq injection in order to split the dosing to make the feeling last. So far, I injected 0.6ml subq into my love handles which are large two Tuesdays ago and had 4 days of absolute bliss. Then I injected again on friday and felt like absolute garbage for the remaining 3 days. So, I was scared that maybe I was doing TOO much sub q and decided to wait until the next Friday (two days ago) and injected 0.6ml into my tricep fat. It has been about 48 hours and I feel no difference. I DID, however, get labs again the Thursday before the last injection to see where my levels were. My Estradiol was 55, which is lower than I’ve ever seen (I started Turmeric, dunno if that helped or not). It is still high though. I’m waiting for the testosterone result still as it had to get sent out and over the weekend they don’t read the results.

Guys, I’m just really mentally drained and upset. I do take Lexapro for depression/anxiety. However, ever since started TRT I’ve had erections and sexual arousals that have been missing for a year. They aren’t always great, but they exist now where a year before they did not. I’ve gone back and forth between asking to start the androgel again, going back to IM injection and remaining “status quo” or giving the subq more time. I’m worried that since I have so much fat, that maybe the absorption of the T is going to be worse than someone who only has an inch of it. I genuinely don’t know. My FSH and LH are < 1

I’m really questioning whether or not my testosterone injections are TOO high…but I’ve tried reducing them and feel like garbage. I’ve tried raising it and also feel like garbage…so I’ve stayed at the 1.25mg/ml of 200mg. Maybe its my E2, could be too high but maybe its also lower now since starting turmeric and THAT could be bad as well

Anyone have any advice? sorry everything is so scattered.

Thx for any input


#2

There’s no way for me to advise you without a full set of labs, we really need your pre-TRT SHBG levels because this is what determines dosages and injection frequency and I suspect you are on the wrong protocol. The only person who could benefit from injecting once weekly is a guy with very high SHBG. Any other guy is going to have problems and generally not feel well past 1000 ng/dL.

I seriously doubt you have the correct E2 sensitive labs, you need the LC/MS/MS method. You need to stop describing your protocol in volume and you need to tell us the mgs,

Without any labs I always recommend you need to inject 50mg twice weekly or .25mL twice weekly SQ or IM in the shoulders or outer quads using a 27-29 gauge insulin syringe.

You’re going to feel like garbage everytime you lower or raise your dosage for 4-6 weeks or until you testosterone levels reach a stable state. If you make even a small change in that 4-6 weeks, it starts all over again and another 4-6 weeks until a stable state is reached.

You require labs in order to know where you are so you’ll know where you need to go. Don’t worry about about LH being zero, it’s supposed to be. You may want to think about HCG togeter with your TRT protocol which will might help keep you testicles full and producing sperm.


#3

I started the TRT way before me or my doc knew anything about testing for SHBG so I don’t have a pre-trt SHBG. I also haven’t tested it yet at all. My E2 is not the sensitive assay, it was the regular estradiol test. I was debating on adding HCG. I’m gonna discuss this with my doctor. Would getting the SHBG help at this point, despite me already being on TRT? I could get the sensitive estradiol with it.

Thx

Edit: I just read another post where KS was saying that E2 at labcorp was ok. Thats the test I usually get. Thought i could order the sensitive assay too, it doesnt matter to me i have good insurance. Also, in regards to volume to mgs… 1.25mg/ml in a 200mg/ml would come out to 250mg a week IM if my math is correct… Extremely high I know now by looking at what other people take. But it has kept me sane for many months, just not sane the entire week. So naturally i need to cut this way down. Though my T levels havent been astronomically high it seems despite taking such a large dose.


#4

You need SHBG testing, it’s the only way you can know if your protocol is right for you…


#5

Lab timing affects results. If nothing else changes, changes to timing will create different results because your levels change during the week.

Injecting twice a week really helps keep levels steadier.
Subq absorbs slower and levels are steadier again.
Suggest twice a week and always do labs halfway between injections. Get lab order and do labs two weeks before you see your doc then discuss labs, target levels and game plan.

With your weight, we expect that you might have higher T–>E2 and your problems can easily be E2 related. Most need ~ 1mg anastrozole per 100mg T to get near target 22pg/ml where most guys do well. Anastrozole need is driven by actual FT or Bio-T levels and amount of aromatase that itself will be higher because of your greater fat.

Estradiol was 55: Should be near 22pg/ml or 80 pmol/L
55pg/ml would be horrible and that can increase SHBG that messes with free testosterone.

You need 250iu hCG subq EOD to prevent sterility. If your testes are quite small now, could be too late. Get semen analysis.

Post all labs in list format with ranges.
TT
FT
E2
CBC
SHBG
fasting glucose
A1C
AM cortisol - at 8AM or 1 hour after waking up

Thyroid: May be able to skip these if iodine intake and body temperatures are good.

  • TSH
  • fT3 - not indirect indexes, be clear about what you want.
  • fT4

See “oral body temperatures” below and post both sets of temperatures and discuss your history of using iodized salt.

With TRT, LH/FSH–>zero, testing was a waste of time+$

Zinc 50mg may be too much. Try 25mg. And use anastrozole to manage E2.


Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#6

What? OP said his estradiol was 55. We don’t know what units and what assay. And his protocol not right. So why would he need an AI at this point?

And you say most feel good at 22 and need 1mg per 100 mg of testosterone. Please review this language and change sticky. I just don’t see the evidence.

We have a thread started a couple of days ago and 90 percent of users that voted believe the language for an ai in the standard protocol sticky should be amended.


#7

That’s my fear. Like I dont know precisely what to do. I scheduled an appointment with a new endocrinologist on july 9 but I dont really know if he is great with testosterone or not. I’m scared of being sterile and I’m scared of changing my dosing at this point because I have more good days than bad. Trying to change my dose these past few days has been the worst i’ve felt in a year. Extreme depression, extreme anxiety. Like unliveably bad. Today I decided to just dose myself with my usual 1.25mg/ml dose in order to go back on my once weekly regimen to see how I feel because i literally cant handle feeling so badly. Then I can perhaps get all of the appropriate labs in like 4-5 days and see where I am and then adjust my dosing from there, and at least I’ll know my start point and to make sense of an actual transition point. If I’m doing once weekly dosing, is 4-5 days after injection a good time for labs? I’m not sure what the halfway point is in a 7 day week…im assuming day 4


#8

I think testing on day of injection. The low point. So if you are injecting today you take labs today before injection.

So you are injecting 1.25 ml. That would be 250 mg of testosterone per week??
Seems like a lot. Until you get more labs I suggest do 50 mg 2x a week. So if you are using 1ml/200mg vial. That’s .25 ml 2x a week.


#9

So my concern is, because I weigh a lot (over 400) my adipose cells are producing estrogen naturally. so im wondering if my body would naturally need to produce MORE T in order to help offset ( for lack of better term) all of that extra production? Hence why I feel pretty decent taking such a high dose? I’m not sure. I drive myself freaking crazy thinking about it ;( sometimes im on the verge of tears because i just want to be normal. I know weight loss is a huge huge thing and im working diligently and have dropped about 40lbs, but it takes time x_x


#10

Where do you live?
Typically the more T you inject the more estrogen you make. So the theory inject more to to offset the estrogen conversion is not good.

Ask the Endo office if they have testosterone replacement patients and how they handle injections. This is just to get a sense of what they think. They may not give much information. But try.

Try to get labs now from any doctor that is willing to order labs.

Get
Total t
Free t
LH
Fsh
CBC
CMP
Lipids
TSH
Free t3
Free t4
Reverse t3
Prolactin
Am cortisol
Insulin
A1c
Vit d3
Estradiol sensitive the LC MS assay

Being just on injections WILL make your sperm count plummet.
Also any protocol change you need to Continue a protocol for 4-6 weeks to judge most of the time. Because as your body adjusts to the change you may temporary feel worse.

Btw sometimes urologists are better at trt . Maybe a reproductive urologist or one that does trt.


#11

PA USA. Getting labs for me is no problem at all. My family doc will order me whatever labs I want. i’m very lucky in that regard. I’ve checked my t4, t3,vit d. My a1c is 6 (borderline). My vit D3 is normal as I am on d3 supplementation. Lipids are good, cholesterol is 170 and triglyc are 150. T3 and t4 were in normal ranges, same with TSH. Never got a reverse t3 or prolactin or cortisol I work in medicine so i am familiar with most of these, so I can certainly get them.

As for the increase in estrogen…you are totally right. Thats why i attempted to cut back and do subq. I’m not sure I can survive the 4-6 weeks of feeling that way. Today, after injecting yesterday, i can feel all that anxiety is reduced and I feel almost human again. But i am willing to change for the better. Since i injected yesterday, should i wait until next monday to redo all my labs then? Wait for everything to be at its lowest point? Should i also get the shbg


#12

How many milligrams did you inject yesterday? I think you can take labs in a couple of days.

Also since a1c is boderline you must check fasting glucose (part of CMP lab) and insulin. You may be pre diabetic. Depending on insulin and glucose level you may need some diabetic medication like metformin.

Take all the labs in the am fasting.


#13

I am borderline diabetic. Been following that up with doc. I’ve been controlling it decently well with low carb diet. No metformin yet. I injected the 1.25ml of 200mg/ml. So if I’m doing the math it’s 250mg. Now this morning I had a morning erection when I woke up which I haven’t had for the two weeks I tried to decrease the dose. And even on my current dose I don’t have them every day. I had a cmp the other day which looked good. Fasting glucose was like 108 which is indicative of insulin resistance from obesity. I feel more aroused today and in better spirits overall. I am also off work for the next 5 days and can get labs any day of the week. Thx for all ur help so far man.

Edit:I got my results of the free and total testosterone from the time I mentioned above where I had injected 100mg on Tues subq then on Friday 100mg subq and waited about a week for labs. (skipping the following Tuesday subq) that was when my estradiol (e2 not the sensitive) was 55. The test came back 613 total, 126 free.they just resulted today. This is not from the injection I did two days ago of the 250mg IM.