T Nation

Switched to Injections from Compound Cream. Dose too High?

Was on compounded scrotal cream for 7 months (upping dosage every 2 months with labs trying to dial in the right dose). I felt great (libido, muscle, quality of life) on the compounded cream. My skin started having bad reactions to the cream so my doc suggested I switch to injections.

He started me off with 30mg daily subcutaneous injections. I had been on these injections for 30 days and I started having heart palpitations and anxiety and could only sleep for 1-2 hours at a time. I have never had these symptoms before in my life. I found this forum and several threads saying these symptoms are quite normal as your body adjusts to a new protocol.

After reading these forums and the stickies it sounds like my starting injection dose of 210mg/weekly (30mg/daily subq) is really high and the suggested starting point is 100mg/week.

I am pretty sure I want to lower my dose but now I’m afraid that doing so will just cause more anxiety, heart racing, insomnia, etc. However, it sounds like the symptoms might resolve if I just ride out my current dose for another 2 weeks. Should I lower the dose or stay the course for 2 more weeks?

If I decide to lower my dose I am thinking I will go with either 15mg ED or 30mg EOD to cut it roughly in half. Are there any advantages to one over the other?

From reading the forums it looks like most are on bi-weekly injections. I don’t mind injecting daily or EOD. Is there any benefit to injecting 2 times per week?

I will obviously work with my TRT doc to dial in my dose, but since I’m suggesting switching I figure I might as well try to start in a good place. BTW, my blood draw was yesterday so I will have labs in roughly 10 days.

That’s way too much testosterone and I expect estrogen to be in the stratosphere by now! You need to decrease the dosage to about 10-12mg daily, your doctor seems like a newbie at TRT.

Men with lower SHBG are best served injecting multiple times per week, midrange and high SHBG levels would see good results injecting twice weekly.

Do you have pre-TRT SHBG and estrogen labs?

I sadly do not have pre-TRT SHBG or estrogen labs.

All I have an estrogen lab from when I was on compounded cream, but I’m guessing that’s fairly meaningless as I’m no longer on that protocol and it’s pretty difficult to see how that compares to injections. It was 50.9 pg/mL (standard range 7.6-42.6 pg/mL).

If you are midrange or high SHBG, is it worse for you to inject daily or EOD than twice weekly?

I will definitely be ordering SHBG and estrogen labs moving forward.

Inject daily is never a bad idea, keeping levels more stable can improve the way you feel on TRT. Your estrogen while high in the ranges, symptoms is more telling. I always recommend more frequent smaller injections to those with higher estrogen, these smaller injections can greatly lower estrogen and keep it more controlled.

If I had a choice, I would inject daily because I feel better.

It’s strange because my doc is on the list of docs certified on the Dr Neal Rouzier website. I am definitely going to look for another doc though since starting me at the highest daily dose of 30mg seems like a really bad idea.

I skipped my dose yesterday and the racing heart and anxiety finally stopped around 4PM yesterday. I’m me again! 2 days straight of racing heart, anxiety, insomnia and wanting to crawl out of my skin was one of the worst things I’ve ever experienced!

Today, I decided to start a new protocol of 14mg daily. I know it’s higher than the 10-12mg suggested starting daily dose you mentioned, but I’m honestly deathly afraid of lowering my dose that drastically all at once. Plus, 14mg is roughly half of what I was on and is also 98mg a week which is less than the suggested starting point of 100mg/week mentioned in the stickies.

I am definitely scared of what the adjustment from 30mg to 14mg daily will feel like. Should I expect a horrible crash in the coming weeks?

I stopped TRT 3 weeks ago and the first week was the toughest, after that it calmed down quite a bit. You’re not stopping TRT, just lowering your dosage/levels and I believe you’ll just start feeling better rather than experience a crash.

You’re injecting daily so levels will decline smoothly and you should only feel a positive improvement. A 20mg daily dosage would put most men in the supraphysiological ranges.

The nice thing about daily injections is it doesn’t matter if pre-TRT SHBG is high or low or whether pre-TRT estrogen levels are high or low, daily injections fixes the estrogen issues and the guys with lower SHBG.

It also fixes a guy who has a problem with hypersecretion who has a difficult time keeping testosterone and estrogen elevated.

Kudos to you for starting TRT on daily injections, most would put up resistance.

Daily injections are not the greatest idea for high SHBG, actually. What are you injecting? Cypionate? Enanthate? Test Prop? Sustanon? It matters a lot. You probably need to be in the 150 - 170 range per week of whatever you’re on if 210 is doing that to you. And unless it’s Test Prop, less injections but bigger doses.

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Ok. Sounds like it might not be too bad then. Thanks so much for helping to put my mind at ease. It helps tremendously to have an idea of what to expect.

Even though I don’t have my pre-TRT or during TRT SHBG, I am guessing it is high since I had high total T but low free T. Here are my labs pre-TRT and while I was on the cream:

Pre-TRT:
Total: 718 ng/dL (264-916)
Free %: 1% (1.5-3.2)
Free: 72 pg/mL (52-280)

On Cream:
Total: 1014 ng/dL (264-916)
Free %: 1.7% (1.5-3.2)
Free: 172 pg/mL (52-280)

TSH: 1.620 ulU/mL (.45 - 4.5)
Free T4: 1.31 ng/dL (0.82-1.77)
Free T3: 2.9 pg/mL (2.0-4.4)
DHEA S04, Serum: 231.2 ug/dL (102.6-416.3)

I’m on Cypionate. The daily subq injections aren’t bad at all. And this is coming from someone who has hated needles his entire life.

Why is that? Lots of high SHBG men injecting daily and doing great.

The bigger shot helps lower SHBG and will bind all of the receptors so that you have more free T swimming around. Lower doses are going to get bound to the SHBG as you go because of the steady production of it by the liver… More frequent is better for low SHBG guys like you.

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Why start with daily injections? That’s invasive And no need to in many cases.
I would def lower dose and do 2x a week.

Am sure your free t and everything else is way high. This is trt not a lifelong high

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I got my T labs back from when I was on 30mg daily subq. I only have total and free T, no E2 or SHBG. Here are the results.

My T levels on 30mg daily:
Total T: 1550 ng/dL (264-916)
Free T: 378 pg/mL (52-280)

Doc said my numbers are high but not insanely high and that he has seen many patients that had been higher without any side effects.

One improvement in sides is that my nuts were pulled up super high and tight until two days ago and now they are hanging normally. So that’s a plus.

Since my switch to 14mg daily almost 3 weeks ago I have had 5 nights of severe insomnia (1-2 hours of sleep total) and a few days of really mild anxiety. The symptoms are much better (no crazy heart racing, shortness of breath, bad anxiety), but I just can not sleep! A good night for me is 3-4 wakings roughly 30-45 mins apart and one block of 3-4 hours of sleep. I tried benadryl and started 400mg Magnesium Glycinate 30 mins before bed and 500mg tryptophan at bedtime. I think the Magnesium is helping me feel drowsy at bedtime, but I still am unable to sleep.

I finally gave up this week and took 5mg ambien on 2 different nights. Slept amazing (7 hours), but I am really afraid of becoming dependent or it messing up my body if I use it too often. How badly do I need to worry about becoming dependent on ambien?

My current hope is that once all the 30mg injections are out of my system I will finally be able to sleep. Looks like that will be another 3 weeks or so though.

If T levels were linear with dose (which I know they are not), it looks like I’d need 18mg-20mg daily to reach high normal ranges. My next labs will have E2, SHBG and Thyroid. If my SHBG is high will I do better on less frequent injections like @hardartery said?

This is bullshit. No they are not. Anyone with high SHGB needs to take one large dose per week to help bring there SHGB down so they will have more Free T which is all that counts.
This daily T shot BS you keep preaching goes against all the the proven data guys report with high SHGB.
In 3 years you have not been able to get your own protocol tuned in why do you think any of this advice you give in helping. Daily injections is not the answer to every problem. You are not helping anyone.

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Not to be rude but I 100% concur. Guys go crazy over this everyday stuff, it’s just not what works in the long run.

Double agree on the SHBG dosing schedule issue as well.

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Got my latest labs on 14mg subq daily. Here are the results…

Latest labs on 14mg daily:
Total T: 833 ng/dL (264-916)
Free T: 208 pg/mL (52-280)
Estradiol: 34.4 pg/mL (7.6-42.6)
SHBG: 30.2 nmol/L (16.5-55.9)
TSH: 1.020 uIU/mL (0.450 - 4.500)
Free T3: 2.4 pg/mL (2.0 - 4.4)
Free T4: 1.12 ng/dL (0.82 - 1.77)

Previous T levels while on 30mg daily:
Total T: 1550 ng/dL (264-916)
Free T: 378 pg/mL (52-280)

My doc wants my Free T closer to top of range so we are upping my dose to 20mg test cyp subq daily.

Racing heart, anxiety, shortness of breath are all gone, but I still have the insomnia. I was really hoping it would clear up after 4-6 weeks on the 14mg daily dose but it didn’t. I am now working with an insomnia clinic and have switched from the 5mg ambien to 6mg melatonin, 1500mg tryptophan, 1000mg GABA and 500mg magnesium glycinate every night. The insomnia is improving every day. I am now down to 1-2 wakings a night and I go back to sleep pretty quickly. Hopefully it continues to get better and the higher 20mg dose doesn’t make it worse.

Free T3 and Free T4 are both low, Free T3 isn’t even mid-range. You’re pushing Total T higher and need more Free T3 to put all that T to good use. Free T3 speeds up every process in your body and optimal levels are needed if going for optimal T levels and expecting optimal results.

That’s almost exactly what my doc said at my last appointment. He wanted to hold off on raising my Free T3 and Free T4 until my insomnia was resolved as he didn’t want to make any changes that might rev things up and make it worse.

Hypothyroidism increases risk of sleep disorders, it may be why you have insomnia in the first place.

Sleep apnea, sleep disorders, and hypothyroidism.

The symptoms of hypothyroidism are protean and include apathy, somnolence, lethargy, personality change, and intellectual deterioration. Many of these symptoms may be related to hypothyroid-induced sleep disorders. Hypothyroidism is associated with abnormal ventilatory drive, abnormal sleep architecture, and sleep apnea.

Central, obstructive, and mixed patterns of sleep apnea are commonly observed in hypothyroidism. A case of severe sleep apnea in a grossly myxedematous patient who improved dramatically following thyroid replacement alone is presented. Myxedema is a reversible cause of sleep apnea, and thyroid function testing should be considered in its diagnostic work-up.

Now that’s VERY interesting. I will definitely do some research on that. Thank you very much for letting me know that addressing my low free T3 and T4 might help solve my insomnia.