T Nation

TRT Injection Support Thread

I have seen loads of info on scattered threads about injecting Cyp and others. I have loads of questions, as assume do others, maybe we can consolidate some of it here?

He goes:
I’m 42 6’2 300
Good blood PSI,166 cholest, very low Test readings.
I have a concentric disk bulge L5S1 that keeps my workout narrow in scope.
Just did Androgel 10gm daily, for 6 months. No real effect on body comp, did improve mood and strength to a small degree.
I asked to be placed on the injectable version. I just started first shot of Cypionate. One Ml intramusular every 2 weeks. Thats 200 mg total dose.
I’m using a 3ml 21g 1.5" needle.

I’m at the date of dose 2 today, will have my wife inject tonight. We squeeze my shoulder muscle and inject there, no pain at all.

Results:
Week 1 great energy at the gym, good mood.
Week 2 great energy,rash around my neck? Sweat at night smells like chemicals? Hard to descibe. Lower neck dull pain, like a very faint migraine?

Ok,
So thats my rundown. Leave your data here so we may all benefit by seeing what others are doing. I’ll update weekly.

35mg twice a week. 29 gauge needle, takes a while, but I don’t need to jab big holes.

Started at 200mg once per week.

More frequent injections are much better for me, better on my mood especially.

Other health items good except I would like to lower my BF% from 18 to something lower.

Use prescribed Arimidex for Estrogen management. 1mg per day was prescribed, but that’s too much. I take 0.25mg per day.

200 iu HCG every other day, mainly for maintaining testes size.

Also take transdermal pregnenolone and dhea. Absorbs better than oral.

Results: better mood, libido, strength and feeling of wellbeing than I had for years due to secondary hypogonadism.

RhodeIslander, I think your week 2 symptoms are due to being estrogen-high and testosterone low. When you inject, your T goes up, then estrogen climbs (unless you counter it with an aromatase inhibitor), then your T goes down and your E is still up.

Highly recommend divided-dose, more frequent injections.

Can I divide the dose on my own?
I will have blood work done and see what the E numbers are. I dont think my doc will suggest the medication to which your refer, I may need to present that information. My next shot is tonight and I have a dull headache currently and feel very tired.

Question about inject sites: I my wife fails tonight, can I inject myself in the thigh? Is there issues with this?
Thanks Bro.

You will want higher gauge (thinner) needles, and with more frequent shots, you might need less medicine overall, since the half-life of T (depends on which ester) is several days.

ABOUT INJECTING AT THE THIGH: Very Important… Be sure you do not inject anywhere in the inner (medial) part of your thigh. If you knick or poke an artery there, you’re good as dead.

Search the web for IM injection sites before you do this, or ask your doctor or nurse at the office.

If I’m reading your post correctly, you’re at 300 lbs which means to me that you’re carrying significant bodyfat. The problem with that in this situation is that fat produces estrogen, so knowing your Estradiol levels is very important. In my experience, if your T to E ratio is less than 15 or so, then you’re not going to feel or see much difference.

Getting in the 40 to 50 range is even better. The problem is that most doctors aren’t aware of ratios and only look to see if you’re “in range” which really doesn’t matter much if your ratio is bad. Testosterone is only half of the equation. You also need to get your Estradiol sorted out.

FWIW I use little insulin pins and they work fine for me.

I am on Testosterone Enan 200mg/1ML

My current dosage is 1ML every seven days. I just started that 1 week ago. It is too early for me to tell how this is going to work.

Previously it was 150mg every seven days.

I inject in the thigh – see this site for proper thigh sites:

http://www.spotinjections.com/


Divided dosages work great for some, but did not work for me.

I have experimented with dividing dosages and have found for me personally that I need to inject at least 200mg to get my levels up high enough to feel good.

When I was on 200mg every 10 days, I tried 100 every 5. I tried dividing into EOD. etc. I was listless and fatigued the whole time. My endo said that my test level was never getting high enough at those doses.

Doc called me today and told me that Testosterone level was at 544. I pleaded with him to raise me up a lil more, because I wasn’t feeling it. he said NO. Better than nothing I guess, heheheheehhe.

[quote]RhodeIslander wrote:
I have seen loads of info on scattered threads about injecting Cyp and others. I have loads of questions, as assume do others, maybe we can consolidate some of it here?

He goes:
I’m 42 6’2 300
Good blood PSI,166 cholest, very low Test readings.
I have a concentric disk bulge L5S1 that keeps my workout narrow in scope.
Just did Androgel 10gm daily, for 6 months. No real effect on body comp, did improve mood and strength to a small degree.
I asked to be placed on the injectable version. I just started first shot of Cypionate. One Ml intramusular every 2 weeks. Thats 200 mg total dose.
I’m using a 3ml 21g 1.5" needle.

I’m at the date of dose 2 today, will have my wife inject tonight. We squeeze my shoulder muscle and inject there, no pain at all.

Results:
Week 1 great energy at the gym, good mood.
Week 2 great energy,rash around my neck? Sweat at night smells like chemicals? Hard to descibe. Lower neck dull pain, like a very faint migraine?

Ok,
So thats my rundown. Leave your data here so we may all benefit by seeing what others are doing. I’ll update weekly.[/quote]

The best absorption is in the gluts. Thighs work well also. I use up to 800mg per week and inject it twice a week 400mg per dose. No need to jab yourself.

I learned from my acupuncturist that if you hold the needle against the skin, stretch the skin a little, and giggle the needle while exerting slight downward pressure the needle will slide right in no pain. works for me. Also use the 21 gauge to pull it up in the syringe then switch to a 23 gauge. Nice and sharp.

yep. Better to change pins and keep them sharp.

I have had night sweats at the beginning of a cycle. Takes a few weeks to settle down.

Many issues here.

Injections every two weeks will leave you crashing and as SHBG and E2 increases, many will feel worse than before TRT [as the T levels drop, with the now increase E2 levels, you will feel worse]. You have been prescribed 100mg/wk, you are in control and can inject with whatever feels best to you. You can load and inject with 1.5" #23 in the gluts and 1.0" #25 in the vastus lateralis. For every other day injections (EOD) you can use 1/2" #29 .5ml [50 unit] insulin syringes.

The 200mg every two weeks is something that comes out of a practice where the patient goes to the doctors office every two weeks. For self injections that is totally inappropriate.

More frequent injections of lesser amounts that add up to 100mg/wk will lower T spikes, and that will reduce E2, reduced E2 leads to less SHBG which leads to more free T. SHBG bound T does not do the work, only free T (FT) or weakly bound T.

You need to control E levels. You cannot expect to get significant changes to %BF and fat distribution patterns if your E2 is elevated. The range of 0-53, but that ‘normal’ lab statistic also includes men that have serious untreated hormone problems. Normal lab range does not in this case imply proper body functioning or health. Many doctors do not understand this. They will let a guy with E2=50 suffer, as they just do not understand the issues at all.

E2 blocks the action of T at T receptors and many parts of your body want to develop female characteristics or a lack of male characteristics. Elevated E2 can block your libido. In some cases, E2 in the 35-40 range can kill libido, create brain fog, lack of energy and all of the symptoms of low T, WHILE your total T (TT) is high [even at 1000pg/ml] and FT is good or above normal range. You need to be testing for E2 and should have E2 results from your pre TRT lab work as well. You need to get your E2 down into the lower 20’s for TRT to work best. It is thought that E2=17-20 provides optimal libido.

Elevated E2 levels can also block the sensitivity of your penis. It is possible for the penis to be numb with high T levels if E2 is elevated.

Libido can be the first thing to respond and can change quickly. You should use libido to act as your barometer of what works and what does not. Other changes do not have anything that you can sense and can be slow and progressive… difficult to use as a guide to wellness. If E2 is blocking libido, starting with Arimidex at 1mg/week can create a huge boost in libido in 7-10 days.

Elevated E2 is perhaps the biggest cause of prostate enlargement. Keeping E2 low is protective. In most cases, higher DHT levels are not a concern if E2 is low. But cancers can respond to T and DHT. You need to check PSA once or twice a year. And have a PSA number from before starting TRT. PSA should be checked at the first TRT lab work at 2 or 3 months.

Arimidex [aromatase inhibitor] interferes with T–>E aromatization. 1mg/wk is a typical starting dose. Originally developed to treat female E sensitive cancers [breast]. Some docs do not understand its use and will not prescribe or will read about its use for female cancers and will prescribe 1mg/day which will take E2 too low in some cases and otherwise is a waste of an expensive drug.

When E2 is reduced, libido will pick up. Other changes in thinking and attitude will be mostly in place in two months, and will be completed by 3 months.

When starting TRT without AI or HCG, things can feel great at first, but E2 and SHBG levels are increasing and FT is reduced. The down time before your next injection can become longer and longer until you are down all the time an feel nothing from your injections at all. Part of this are changes in the brain caused by E2. Those changes take time and your though patterns slowly adjust in a negative way. Libido, initially very strong, goes away. Some of the increase in libido in the beginning is not from the absolute level of T, but from the transient increase. That cannot be sustained and the long term effects often do not feel as good as when you started TRT.

If your doc is not testing for E2 or DHT, you have someone who really does not understand the issues and success factors.

TRT will shut down your HPTA and LH production will stop. You testes will shutdown and shrink in time. The scrotum will pull up tight like a little boy’s. The testes produce things other than T that are important. Much of the pregnenolone in the body is produced there. Injecting 250iu HCG SC EOD will keep the testes working near baseline. That will work if the testes are not damaged and are LH/HCG responsive. Pregnenolone is critical for for the nervous system and brain and is the starting point for neural steroids. Many note a improvement in mood with HCG. If you doc does not understand the HCG connection, you have a problem! There is also an issue of sexual self image and how ones mate sees you, a strong quality of life (QOL)issue.

You need TRT+HCG+AI, that is simply best practice. All are critical and not doing all of these will often lead to marginal results. Without AI, TRT often simply will not work. I strongly believe that HCG and AI should be started with TRT and not be added one at a time as symptoms develop. Younger men should not let their testes atrophy. Some older men will not care and some will have testes that will not respond to LH or HCG. If the testes are allowed to atrophy, in the long term, irreversible tissue changes will occur and the state cannot be reversed at a later date.

The big success factors in TRT seem to be gaining knowledge and finding the right doctor or educating your current doctor if [his/her] ego will allow that.

One can also have thyroid level problems and if TRT does not seem to be working right, low energy and mood, thyroid levels can be checked, TSH, FT3, FT4. If the thyroid levels are good, then one should consider depression as a factor. Some men get into a depressed state that does not have a factor of profound sadness or gloom, but a lack of energy, initiative, passiveness, apathy etc. That situation presents some difficulty in recognition.

TRT can greatly decrease total cholesterol while leaving HDL unchanged. In some cases statin drugs can be avoided, discontinued or reduced. Statin drugs can kill libido as well.

The odd thing is that so many men who have signs of hypogonadism do not seem to care and if you talk to an older friend about TRT/HRT they think that you are crazy or a drug addict or steroid junkie.

Your weight suggests a possible case of metabolic disorder aka syndrome X. That is a prediabetic state associated with low T, elevated E and fat patterns that create an apple shape in the long run. You need to have your fasting serum glucose levels checked and this should be part of your basic CBC panels. This prediabetic state is characterized by insulin resistance. That can be partly driven by dietary factors that reduce cell wall permeability. The reduces many aspects of cellular functioning. Improving that condition by diet and supplements can improve many aspects of health/aging. Adding TRT/HRT to a bad situation will alone not fix everything.

Fat gain and low energy are also signs of possible hypothyroidism. It is not a surprise when an overweight guy with a need for TRT also has thyroid issues. One needs to be open minded to this possibility if TRT does not seem to work mentally or lead to fat loss and reapportionment when E2 levels are optimal.

Get copies of and retain all lab results. You need to have these for yourself. Do not simply leave these in your doctors hands. Understand whats there and demand that some things be added to lab work if needed. You cannot be passive about this.

There are a lot of things that need to stated about diet and supplements. These things can be found elsewhere and everything that has been discussed in this thread has been stated many times before. Use the search functions of this website and spend a few weeks or months educating yourself. You need to do some things on your own. Facts can be consolidated in this thread, but this thread will become history as they all do.

KSman, as usual you are the gold standard of HRT information and education to the masses.

Just a general comment with question.

HRT is of course a relatively new model of treatment, primarily but not exclusively for men, and having a rough go being accepted by the medical establishment and DEA.

Part of the acceptance and marketing of HRT is based on it being a "natural" replenishment of deficient hormones associated with "Andropause," with bioidentical hormones now available to replace whatever HPTA deficient hormone one has. The model seems simple, even elegant by design, and many men still benefit from just this original concept (what percent I have no clue, probably low but an intersting subset.)

But now, the collective experience of many here on T-Nation and elsewhere points out the two glaring weak points of the early model, the rising E problem, and the LH shutdown with resultant gonadal vanishing act problem.

So the current best treatment of those two problems is to use TWO medicines both derived from or designed for women. I know you are right about this situation, it is just that this "best practice" will continue to be a hard sell to many doctors and in some ways invalidate the original premise of a "natural" horomone replacemnt model.

Barring miraculous developments in alternative/herbal medicines to accomplish the same goals as A.I. and HCG, I predict a rough time ahead for critical acceptance of this HRT best practice model. 

The question is this. Do you believe a more male-specific approach to R@D in Pharma could result in a more cohesive solution to the two above problems? For instance, are you aware of anything that might specifically inhibit SHBG instead? Or target LHRH instead of using HCG? Other ideas?  Doc


KSman,
I truly appreciate the time it took for you to post your response. I will add the E2 test to my next set of blood work. Yes, I’m 300lbs. I do workout 4 day per week and the weight remains a constant, this for the last 2 years. My doctor was slow to react when I asked how it could be at 300lbs I could run without getting winded,lift 380lb benchpress, had 166 cholesterol and low blood psi?

Body fat: In 1991, I was in the municipal police acadamy.3 months of running and working out, 21 miles per week of just running. The trainers gave me a hard time as I was 255lbs, I looked thin at 255. They said we will get you down to your OPTIMAL weight. Well, I graduated at 246 and 16% Bodyfat. I dont know why I weigh so much, I dont judge my health by the scale. I do know my body, under the most rigerous circumstances refuses to release bodyfat. I wrestled in Jr High at 175 and took state champ. Played football in HS at 225 and ran over everyone.

Exercise and diet have proven ineffective, I did my research and asked my DR finally to test my T levels. Low and behold they were extremely low, she tested twice. I think I’m getting close to a resolution, well after 42 years of this shit I outta be!
I’ve included a photo. Me on the left, my daughter 8 and 5’2". My son 18, active duty army 6’2" 220.

[quote]Dr.PowerClean wrote:
KSman, as usual you are the gold standard of HRT information and education to the masses.

Just a general comment with question.

HRT is of course a relatively new model of treatment, primarily but not exclusively for men, and having a rough go being accepted by the medical establishment and DEA.

Part of the acceptance and marketing of HRT is based on it being a "natural" replenishment of deficient hormones associated with "Andropause," with bioidentical hormones now available to replace whatever HPTA deficient hormone one has. The model seems simple, even elegant by design, and many men still benefit from just this original concept (what percent I have no clue, probably low but an intersting subset.)

But now, the collective experience of many here on T-Nation and elsewhere points out the two glaring weak points of the early model, the rising E problem, and the LH shutdown with resultant gonadal vanishing act problem.

So the current best treatment of those two problems is to use TWO medicines both derived from or designed for women. I know you are right about this situation, it is just that this "best practice" will continue to be a hard sell to many doctors and in some ways invalidate the original premise of a "natural" horomone replacemnt model.

Barring miraculous developments in alternative/herbal medicines to accomplish the same goals as A.I. and HCG, I predict a rough time ahead for critical acceptance of this HRT best practice model. 

The question is this. Do you believe a more male-specific approach to R@D in Pharma could result in a more cohesive solution to the two above problems? For instance, are you aware of anything that might specifically inhibit SHBG instead? Or target LHRH instead of using HCG? Other ideas?  Doc[/quote]

Aromatase was develop to save women’s’ lives were stricken with breast cancer. The drug reduces estrogen. Works for guys too and the original motive to create the drug then does not matter anymore. If HRT is to restore a natural balance of hormones and not just increase T levels, then using AI to restore E2 levels to an optimal or youthful level are totally consistent with the founding values of HRT, where the Therapy can include restoring Balance.

HCG was commercialized as promote ovulation as part of treating infertility. It is a natural hormone that treats a condition of low LH. The low LH in this case is induced when increasing T levels above the bodies age diminished set point.

I think that all of this is justifiable.

“”"
The question is this. Do you believe a more male-specific approach to R@D in Pharma could result in a more cohesive solution to the two above problems? For instance, are you aware of anything that might specifically inhibit SHBG instead? Or target LHRH instead of using HCG? Other ideas?
“”"

Nothing that I have ever read reduces SHBG other than reducing E2. SHBG otherwise seems to increase with age, which requires higher amounts of T to get good results. LHRH might be good, but it is extremely expensive and used in research. The hypothalamus creates LHRH to trigger LH production in the pituitary. It is a very small targeted amount and is not systemic in the body. Injecting this peptide systemically in dose high enough to cause LH release might have some unintended consequences. And some are hypogonadic because of damage to the pituitary which might make such a treatment futile for some.

More SHBG: Women on BC often have a loss of sex drive. The BC drives up SHBG. BC is mostly a long term thing. When BC is stopped, for some, libido NEVER returns in some cases as SHBG will never recover to lower levels. All of this robs women of their free/bio-active testosterone levels. And consistent with that, many/some women have libido problems after been soaked in hormones with during 9 months of pregnancy. As with the BC, some are never the same. (And the prolactin while nursing can kill libido for some.)

Edit: The effects of SHBG can be reduced by saturating it with other molecules that then reduce the action of SHBG on T which increases FT. It also has an anti-aromatase action and reduces T–>E conversion. A few things do this. The best known and perhaps most effective drug is Proviron, which is not available as a drug in the USA or great white north. Proviron has a high affinity for SHBG. It can be had as gear. It has a nice side effect of increasing libido and spontaneous erections. It is available in Europe. And guess what, developed to treat women’s cancers.

Maybe I’m helping hijack a thread opened about site injection, but just a closing thought on the last couple posts.
It appears to me that the story of SHBG as it relates to HRT and “Age Management Medicine” is very symbolic of many disparate problems in medicine today. For example, an increasingly common problem is identifed, and studied enough to provide data to establish it as a “syndrome,” but not yet a disorder or disease. Then, theories are developed to explain the causes and statisticaly significant symptoms. Major biochemical “players” are identified, either intrinsic chemical imbalances or external toxins, infectious agents or other factors. Then, medicines are developed to target those major players, sometime to absurd degrees to fill the pockets of Big Pharma.
This sequence may be the best we have, but many times it leads to false conclusions and missed key players. Such is the case with SHBG.
Now we are seeing the next phase of this medical paradigm in action. SHBG is commonly ignored, it’s rise with age dismissed as normal, or reluctantly treated as the best remedies are meds approved for female cancers.
To end more upbeat, think about cholesterol. All of the above processes occurred with cholesterol, first it was considered a symptom of obesity, then it was a serious issue affecting possibly anyone, then we learned it was not just from dietary intake, then we learned that HDL was a key player on the good side, then we developed a plethora of meds to reduce it, and then we found that those same meds are sometimes toxic and other methods (including HRT and niacin) can reduce total cholesterol and LDL.
Eventually, we approach truth. Doc

Guys don’t feel your Hijacking this thread. I started this thread for this reason, to support those of us needing to inject TRT to become normal. Its not about inject sites.
This is some of the best discussion I have read on these boards.

I have been prescribed Diazepam, Wellbutrin, Zoloft, Etc… for what I feel are symtoms relevant to low T. I have suffered with bouts of anger, rage, confusion, depression. I was told, well your a cop, you see bad things. Its in your head, heres a pill.

TRT replacement has helped get some of my life back, I want to see what may happen when ALL the chemicals in my body are at correct levels.

My current Doc seems to be onboard, she at least knows I’m on her to produce a result.

Again,
thank you for your time in producing these responses. Maybe other will read these and become inspired to ask thier DR to help them as well.

Other than Tom Cruise and the scientologists, I think the world is generally on board with the idea that many of us have chemical imbalances, some transient, some more permanent. The trick now is properly diagnosing WHICH chemicals are out of whack, and then agreeing on a model of treatment. For many years my gut would tell me…“I think this person might have endocrine factors related to their psychiatric symptoms,” but never once did a referral to an endo doc result in help.

They, like many docs are stuck in a paradigm where labs must not only be “out of normal range” for them to take interest, they have to believe those abnormal chemicals tested are related to the symptoms. Fulfilling those two criteria with low testosterone, or high estradiol, is something they are still very uncomfortable with.

And the shrinks can always justify a trial of psych meds based on life experiences…I heard the same line about my job and my anger, depression,etc…“You see and hear a lot of bad things…” Doc

Something I have been thinking about recently . . .

My quads are very lean so early on in my treatment I asked my nurse if I could switch from 1.5 inch long needles to 1 inch long ones.

I am wondering – would I be getting more out of my injections if I went back to a 1.5 incher?

e-loo,
the smaller the needle the better.

Many inject T right into the fat(subQ).

So as long as its getting in there, and you don’t notice post site leakage, your good to go.

Great post above there Ksman, hows the protocol going? Whats your current regimine? Still EOD?

Ok,
New issue. I’ve been injecting once every 2 weeks for over a month. I notice lack of energy 3 days prior to my shot due date. The day of the shot I’m done, depressed…

nyone else notice this?

[quote]RhodeIslander wrote:
Ok,
New issue. I’ve been injecting once every 2 weeks for over a month. I notice lack of energy 3 days prior to my shot due date. The day of the shot I’m done, depressed…

nyone else notice this?[/quote]

Anyone else notice the math problem here…?
Regardless of which T ester you are using, your life can only really suck injecting every 14 days. It takes your body about 3 or 4 days to peak on the T shots, and then fades out 7-9 days later.

Why are you not injecting at least once a week, if not every 3-1/2 days? I’m guessing you don’t understand half-lives of Test and that’s okay, but if you are doing your own shots you’re not doing yourself any favors by waiting so long between injections.

My doc prescribed me 100mg every 3-1/2 days and that works for me. I also give myself an HCG shot the day before the T shot to keep my nads happy, and my doc also put me on 2mg/adex a week too.
Needless to say, my doc rocks. If you can make smaller more frequent injections, do yourself the favor and improve the quality of your life.

cheers

EDIT: I initially missed you were doing your own injections.