T Nation

Thinking of Returning to TRT

Hi All, I have been lurking around here and learning for the past month and wanted to ask for advice from the experienced.

50 yr old health white male here, 170lbs medium build, gym 5 days a week, semi-athletic physique, I look like I am in my early 40’s… blah, blah, blah… In general i feel just ok…, never like what I read here about people saying they feel like shit. My main issue(s) are libido which is almost all gone and I am loosing muscle strength and can’t even hold what I have. Each month in the gym I seem to get a bit weaker… also a little brain fog and difficult to sleep through the night.

I started TRT after hearing radio adverts back in mid 2016. My total T levels were not bad at all (557) but my free T was 7.51. Doc gave prescribed me compounded creme 200mg applied 2x daily on the forearms. my first blood test after starting, my levels came back lower than I started… Doc scratched his head and upped the prescription to apply on arms 3x daily and increase dosage. Next labs results were even lower… We tried switch from Creme to gel but no difference.

After 6 months of frustration I decided to give the pellets a try. The doc pushed pellets from day one. The pellets started to do the job! Sleeping good, brain fog down, much better sleep, losing body fat, muscle gains without even killing myself in the gym and libido returned to a ok level. Continuing on, the pellet reinsertion’s were happening every 3 months, besides being extremely expensive, I had lumps on my ass that hurt like hell if I touched them or laid on the ground to fix something. Further along on my treatment the doc was putting 21 pellets in and gentlemen, believe me that makes a lump on your rear. After my second, third and on applications in the same pockets / tunnels I started loosing pellets. All might be good and healed after 3 weeks then boom, one would pierce my skin… After a year I was done with it, pain, bleeding etc… I quit cold turkey.

So hear I am now. I just had my labs done and was surprised to see my levels higher than when I started years ago. This makes no sense to me. I would love to go and try the scrotal creme , but since I never absorbed any from the forearm creme I am not very confident it will work for me… Shots seem like the way to go, but I am terrified of sticking myself! The new way of using small subq insulin needles make me want to give it a try. IM is for now out of the question for me. I can’t do that for life… I have my appt… with Defy next week an don’t know what method I should push for. Creme / injection e3d, e2d??? Thanks for sharing your experiences

You should try T scrotal cream because the skin on the tesicles is 6x thinner than anywhere else on the body and I don’t think I have heard of a single case where absorption was an issue. If you reconsider injections, using 29G insulin syringes is painless and easy.

It requires so little effort and is not painful at all. I inject everyday and have no issues.

The pellets are a terrible idea for men, between the scars, the pain and hassle, the ineffectiveness for the majority of men it hardly seems worth it but is the most profitable version of TRT and any doctor doing it is doing so for the income that it brings.

Thanks for your input! I agree 100% on the pellets! RE: creme, I may give it a try, I am just baffled how my levels decreased before while on creme and fear wasting 6 months for nothing… I have a week to think about it.

Some men just don’t absorb T worth a damn on the forearms, I’m one of them.

IM injections really aren’t bad. The first time I freaked out and had my wife do it. The next couple times I also freaked out but just jabbed it in without thinking about it. After that, it wasn’t bad, and eventually I stopped worrying or thinking about it at all.

I would recommend against quad and thigh injections. It’s too easy to hit a vein or nerve. I started delts a while ago and it’s painless every time. If you’re lean enough, a 1/2” insulin need will be perfect. If your at or above 25% body fat you might have too much fat on the delts for a 1/2” needle to penetrate the muscle. I use a 1” to 1-1/4” needle for delts, depending on what I can find.

Ventrogluteal is another good spot. There isn’t a lot of fat their, even on bigger guys, so you might be able to get away with a 1/2” need as well.

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@scubadiver
There’s a few folks that have had good results with cream but there’s a gazillion that have had great results with injections. Using an insulin syringe it’s completely painless (literally no pain) and the needle is so small it’s not a frightening process. My total T was 575 pre-TRT and using injections my libido is now unbelievable. Previously I was in a relationship where when she wanted to have sex it felt like a chore I had to do. Now I’m like a 16 year old when he finds his first playboy. Plus girls comment about how hard it gets which is crazy because I didn’t realize until then that my dick wasn’t getting fully hard. It got hard but not like this. I’m talking perfectly perpendicular to my body. There’s been so many things like that I’ve gotten from TRT after a lot of trial and error. Get on injections. It’s the most consistent route of administration and once you’re dialed in you don’t have to think about anything. The mental effects are otherworldly. Easily the best I’ve ever felt /looked in my life.

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Scrotal creams are reportedly absorbed two to three times as well as gels and other creams, 70% vs 30%. Of course, injections are 100%.

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Yeah you have high SHBG so free T is low despite reasonable total T. I think the increase in Total T from the first 2016 reading and the most recent test is the time of day. Your most recent test was at 7:19am. The original test from 2016 was at 11:15. T is highest when we first wake and slowly drops throughout the day.

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I was fearful of injections before I started, too. I had built them up as this awful thing to dread. I’m serious - I dreaded the thought. For the record, I deal with vasovagal syncope almost every time I get my blood drawn. I’ve never actually passed out, but I sweat, become dizzy, my ears ring, I get nauseated, etc. It’s rough.

I’m now four injections in and it’s just not a big deal at all. I was pretty nervous for the first, but by the second it already seemed routine. I use 29g insulin needles SubQ in the abdomen. Sometimes I feel a pinch when the needle pierces the skin, sometimes I feel nothing at all. Once the needle is through you literally can’t feel anything. Maybe the oil gives a burning sensation if you’re close to a nerve, but that’s only happened once so far.

All that to say, if needles are your only issue, I would encourage you to address your fear straight on. Dive in. Make the jump. My low T symptoms are already beginning to abate and I’m only two weeks in. If this continues getting better, I’ll inject myself happily for the rest of my days.

Thanks for this… If I had no issues getting 21 pellets in my rear I should be able to do the shots… I just need to get over the sweaty hands even thinking about it, and also thinking how many shots I will be committing to over my lifetime. Are you doing e2d or e3d?

Thanks, this makes sense. My other levels seemed pretty stable when I was on a high dose of pellets. My libido never got to what I remember when I was in my teens, so this time I had my DHT and prolactin checked… I have no idea how these correlate yet…

Monday mornings and Thursday evenings.

By your post, I am going to assume you are on TESTOPEL or some locally compounded pellet that is both ineffective and under strength. NO ONE should be inserting 21 pellets – ESPECIALLY every 3 months. That is ludicrous.

Your doctor must be using 25- or 50-mg pellets. That is the only explanation. And if he is inserting 21 of those, he is likely NOT a pellet user himself and doesn’t know what he is doing, which is probably why you had an extrusion – too many pellets and not inserted deeply enough under the skin.

I am the only vocal pellet user on this forum. I use BioTE pellets. 21 pellets would add over 4000 to my current T … so I can not comprehend the low-dose pellets that your doctor must be using … I’m 2 years in to pellet use btw.

And insertion every 3 months is only for problem patients (like I was). Nothing in your labs indicates problems.

Your SHBG is NOT that high; higher than many; but NOT that high.

You should not have sensitivity to the insertion site after 7-10 days of healing. But then I have never had a serving spoon of rice size granules inserted in my ass.

You even admitted that it was working

the pellets started to do the job! Sleeping good, brain fog down, much better sleep, losing body fat, muscle gains without even killing myself in the gym and libido returned to a ok level.

Something is not right here.

Can you attach your pellet documentation? A qualified doctor should be giving you an insertion summary telling you how many pellets were inserted, at what strength. Your T numbers are unbelievable.

Systemlord has spoken, but has said nothing new. I’m interested to see if his love-affair with Defy changes now that Defy is beginning to prescribe privately compounded testosterone pellets. Oh, the horror.

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That was interesting.

I’ve attended quite a few conferences over the years and they are attended by all kinds of practitioners, GPs, of course, but also, endocrinologists, OB/GYNs, psychiatrists, even oncologists. Of those I met, almost all state the desire to get out of the insurance game as the main reason for their interest in BHRT. Obviously, money is part of it. Of course, if you do not make money, you won’t be able to help anyone.

Here is the issue I had with pellets, and there were some doctors that were hugely into pellets, even one who Neal Rouzier stated implants more pellets than anyone in the country. They flocked around her during breaks, so there was heavy interest.

Many of these doctors are new to this, or still considering it, and I’ve been doing it a while. So I get asked what we do, which is injections for most men and creams for most women. The response almost comes down to questioning that approach because the “margins” are so much better with pellets, so I have a bad business model.

I just do not believe treatment decisions should be based on profits. What is best for the patient, regardless of practice profits, is the way to go. We do what we do, and referrals to the practice already know what I do and that is what they are interested in considering, so I don’t see patients wanting pellets, they do not show up in the office.

However, we do see those on pellets who for various reasons are looking at other options and they are coming from pellet only practices. Typically, they are overdue for new implants when presenting. Always, always, they report no lab follow up since initial labs. Often, when I check their levels they are high even though overdue for new ones, especially with the women. I wonder where their levels are mid, or early, in the implant cycle. It can be an issue, I think, because we may not be running their levels up to where the were, so they aren’t feeling as well (or maybe I could say, as jacked?), but sometimes side effects are the reason for switching.

@traveling-man

Any thoughts on this?

I am pretty confident I was on pellets from a local source, the gels / creams I tried were from Hallandale and Tampa Florida, and like I mentioned my levels went lower when on the creams so I don’t think the scrotal cream will work well either… The initial pellet insertions held in place but were always sensitive to touch. I think I started with 16 or 18… My issues with loosing pellets began with the 3rd and so on insertion back into the pockets made from the previous insertions.

My Doc was a TRT clinic in S Florida and I did not get any documentation other that what I was told. Also after the last two / three rounds where I was losing pellets the doc did mention that he was going to switch be to cholesterol based pellet, but I never gave that a chance. I was feeling good but it was not worth the pain, I asked for injections and was told to find another doc, so I just quit. Apparently, It was all about the $$ and he was not structured to make the money on the injections.

I am now giving Defy a try as I have not found anyone around that will prescribe me the TRT.

FWIW here are some photos of the pellets that popped through my skin, some within two weeks and the other was around the month mark… my apologies, it is a little gross.

I think you are trying to talk about applies while holding an orange in your hand.

  1. This is a problem board. It is where guys (and gals) come to discuss their problems with T and doctors that do not understand; and dosages; … and yada, yada.

  2. The official number of BioTE clinics is not public; but search for them. They are all over. GP’s are adding BioTE insertion to their available services after certification. And they are inserting pellets daily. How many people are using pellets form BioTE?

Estimated number of clinics at one thousand: with one pellet customer a month , 1000 pellet users per month. Two customers a week … 8000 pellets users per month.

How many of those pellet users are on this — or any other board complaining?

2? 4? 10? Why? If pellets are SO BAD, why don’t we see volume of complaints on this and other boards.

And that is you. My doctor became a pellet user before he added it to his practice. He could come on this board and make the same statement that “he has been doing it a while” and even more, he “has been a pellet user for x years”.

He also prescribes injection for those who can’t afford pellets. But pellet patients make up a larger percentage of his practice than injection. [BTW - his practice is as a GP; not a “men’s doctor” or “t-clinic” or “pellet mill”]

That is my thought. Is it for everyone? No. Is it more expensive? Yes. Are body builders going to go to pellets? Never

I have said a hundred times – cost along does not determine treatment. And if you followed my thread, you would be able to guess that I spent 2-3 times as much on blood work as I did on pellets.

I am sorry that you experienced a bad situation from a doctor who obviously didn’t know what he was doing.

Good luck with Defy. As I said, they are now starting to prescribe private compounded pellets.

I just looked. There are 13 clinics in Tampa and 1 in Hallandale that are certified BioTE clinics. If you ever look into it again, call every one of them and ask if any of their doctors are BioTE PATIENTS. If they are – that is who you make your appointment to see.

@scubadiver there are bad TRT (injection) doctors; there are bad TRT (pellet) doctors. Read this board and you will see that there are more bad Urologists than good ones. It is all about finding the right doctor.

Good luck.

Man, OK, thanks. I actually ate both an apple and orange today. I’m also aware of this board and what it is. There are several pellet clinics in my area, the largest two hormone clinics are pellets only, and I know both doctors. I wasn’t trying to start an argument. I perfectly understand that there are literally thousands of patients using pellets and very happy with the results. It was not my intention to come across as I apparently did.

There is just no possible way you could convince me to pay someone to insert pellets under my skin. I would buy Test C from a UGL before I put up with that.

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