Study: Injection Frequency, Not Dosage, Indicates Risk of Polycythemia

Twice a week. Usually Sunday/Wednesday or some derivation thereof. I’ve been on twice weekly since I started and it’s been pretty good, HCT issues notwithstanding.

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We see that a lot with guys who go from once per week to twice per week injections. Thats actually one of the reasons I started this thread. For years the internet has been going back and forth about stable levels, and although this works for a lot of guys, it doesn’t work for a lot of other guys. Usually the older guys.

This is because they are more prone to changes in HCT due to testosterone. I bet if you went to once per week injections your HCT would be less affected, I have personally seen this many many times.

That doesn’t mean you can’t do twice per week injections and not have HCT issues, it just means that you will probably have to lower your dosage in comparison to what you could take weekly.

So keeping levels super stable, hasn’t worked for us very often, and eventually guys tend to go back to a every 5 day or every 7 day schedule.

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Yeah, I’m now in the phase where I’m lowering the dose and we’ll see what happens. I’ve never done once a week injections, so I have no idea if it would be good or bad for me. But I never grow tired of being a human guinea pig.

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This is why I think its best people start TRT on a once weekly schedule then move to more frequent injections if they wish, I wish more would recommend this.

One reason is because no matter what your levels are going to go up and down at the beginning, until they reach steady state. This could take a full 10 weeks. So injecting more frequently during the first couple months doesn’t really have a benefit.

It can be overwhelming to tell new guys that they need to inject every single day, it is better to let them get comfortable with injections first, then go more frequently if they wish.

This gives them a better perspective as well because they get to see how they feel on all schedules, if you build up your levels with really frequent injections, then try to switch to weekly, your not going to notice a difference because of all the depots you have created in your SC tissue emitting consistent levels of testosterone. It would take 6 weeks for them to be on par with the weekly injections. But if you go from weekly to more frequent, you can tell right away what the difference is, as long as you have waited long enough to reach steady state before manipulating the dosing schedule.

This, for us, has been the fastest way to get dialed in.

Just my 2 cents.

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4 different dosages and 4 different schedules did nothing for me. Started at once a week for the first 3 months. Then 2 months each on every new schedule. HCT kept going up and up.

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Up to what? Cause it sure sounds like if it went up and up then your more frequent injections compounded the problem.

Serious question: who is not recommending this? I don’t know that I’ve ever seen someone come on here whose doctor recommended they do more frequent injections. What you’re describing is the basic layout that almost every doctor is using today.

My doc wanted daily if I wanted to do sub q, 3x a week intramuscular.

Should note though my doc also first wants you on cream

Most places I see are recommending at least twice per week injections.

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Really? Wonder why we see so few of those on here. Maybe the only people that show up here are self-selecting and have lousy doctors. Either way, that’s an interesting little anecdote.

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That is exactly what it is lol. Honestly over the years once a client gets dialed in, we very rarely ever see them on the boards.

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About 85% of those on TRT use weekly injections. I think there are many who split the dose without the doctor’s knowledge. While I think there are some who are sensitive to the fluctuating levels (hyperexcretors, hypermetabolizers, etc.)and do better with every five day, twice weekly, or more, dosing, most do fine with once a week.

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I’ve tried all protocols. ED, EOD, E3D, weekly, biweekly.

Currently running 220mg test a week once. I still feel nothing. I may as well be injecting water… and yes, it’s pharmacy test.

The only protocol I felt a little bit good on was 30mg EOD where my Test/e2 ratio was around 16%.

I may go back at some point.

I’m doing 40mg EOD and most recent bloods had my TT at 1192 and sensitive E2 at 41.

@roscoe88 - would I just divide the two to get the ratio you mentioned above? So mine would be 29??

Yes just divide TT with e2

Yours is 29%. I feel best around 15-18%. I think Dr Marciano was the one touting the ratio as a good indicator or bench mark to shoot for.

You would need to get your TT down or your e2 up to get that percentage down a bit if that’s what you want to do.

When I was 30mg eod, I was about 750 TT and e2 was 49.

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Well I definitely agree that out of all the people on TRT 85% are on weekly, or bi-weekly injections, I would argue if you look at the population that browses the forums that number is nowhere even close to that.

I have yet to see someone on this forum doing a once per week injection schedule.

Thank you @roscoe88, I appreciate it. I dunt recall if you mentioned it, but have you had bloods yet on 220 a week?

Something I find interesting is I’ve been on 40mg EOD for 6 straight months. Maybe I take 42 or 44mg with an accidental over draw, but it’s been consistent at 40mg EOD since January.

In March, my TT was 604. Same protocol, independent bloods from 1.5 weeks ago had TT at 1192…and bloods at urologist today had bloods at TT at 1080.

I have no idea why TT jumped that much while doing the same thing.

I guess it takes me 6 months to reach a stable state?

@increasemyt - HTC today was 47 and PSA was 0.43. doctor didn’t seem concerned about anemia/Ha1C or my numbers… But I’m wondering if I should get the tests in my own?

Nah everything looks good if you feel good I wouldn’t change anything.

Remember just because higher basal trough levels increases your risk of polycythemia doesn’t mean everyone will get it, even with supra-physiological trough levels. It just means it increases your chances, thats it.

So only if you were having trouble with your HCT, or not feeling great, would I recommend trying an Q7D or Q5D schedule.

I will say your schedule is putting your numbers in supra range for the entire week, so your numbers expand on my point here, that more frequent injections increases basal trough readings.

So if your 40mg QOD that means your weekly dosage is 40x3.5= 140mg per week. If you were to take that in a single injection, your trough would come back at roughly 700 ng/dl. You can figure this out by using the rule of 10, your TT levels would peak around 1400 and drop to around 700 within about 7 days.

Also another point to remember is younger guys tolerate supra-physiological T levels much better than older guys.

Hope this helps.

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That’s bizarre that your TT changed that much given you were on the same protocol. Perhaps your SHBG was at a different number at each test?

I doubt i’ll get bloods with my 220mg/week protocol. The only reason I am going so high is to see if I can trigger any sort of sexual response. As of yet, being on TRT for over 2 years and trying all the protocols, I haven’t felt sex drive.

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@increasemyt - very helpful, thank you.

When I started, I was injecting 50mg e3.5 days. Levels were too low still so doc upped to 60mg e3.5 days.

I seem to “feel” the test about 12-16 hours after the injection. I inject around 10:30pm. While taking 60mg e3.5 days, the day after the injection was too intense for me.

I moved to 34mg EOD and started to feel a lot better, the intense feeling was gone the day after the injection and I was left with a good sense of well being… But, I was dragging ass the latter part of injection day…and still having issues with libido, etc… So I decided to try 40mg EOD and after about 6 weeks started feeling really good 70% of the time… But starting in June, I can say I feel great pretty much every day now, injection day or not.

Seems strange it took me so long to get to these levels though… I’ve been doing 40mg EOD for 6 months. Could my body just be slower to reach homeostasis?

Thanks again, appreciate the time and great information!

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