T Nation

TRT: Protocol for Injections


#1

DO NOT POST YOUR CASE AND PERSONAL DETAILS HERE.
CREATE YOUR OWN THREAD.

Many guys ask for these details. Here is enough info to get started. You probably will not get your doctor aligned with this without a struggle [or a new doctor]. This is really a small part of what most guys need to know.

TRT: Protocol for Injections

  • 100mg test cypionate or ethanate injected per week with two or more injections per week.
  • 250iu hCG SC EOD [every other day]
  • 1.0mg Arimidex/anastrozole per week in divided doses.

Injecting testosterone once a week induces spikes in testosterone levels followed by lows. This can make many feel bad or worse at the end of the week than their pre-TRT state. As time goes on the dead zone gets wider and they feel no relief with injections. These feel much better injecting twice a week or even EOD [every other day].

Injecting every 2, 3 or 4 weeks is horrible. You need to self inject and inject frequently. With frequent injections the volumes are very small and one can inject in the quads [vastus lateralis] with #29 0.5ml 0.5" [50iu] insulin syringes.

These are slow to load but injection times are reasonable as the small plunger diameters create very high pressures. Do not use 1.0ml syringes. This same size syringe can be used for hCG injections, which are also SC.

EDIT: Injecting EOD [sometimes written as E2D] or E3D [every third day] can be a difficult schedule. You can set up reminders or appointments in calendar software, such as MS Outlook, for E2D or E3D etc.

Small needles will reduce muscle damage. Some use #25 1" needles, but this may not be any "faster" than the above 50iu insulin needles.

You do not need to inject into your gluts with 1.5" needles!

Canadian clinical research has demonstrated that TRT by SC [under the skin injections into body fat] produce steadier testosterone levels and improves sense of well-being. Feel free to find out what is more comfortable for you.

For those who train and sweat/shower a lot, transdermal T creams and gels are not appropriate.

Transdermal T creams [and patches] are expensive. At best, only about 10% of applied testosterone is absorbed. Transdermal delivered dose is a crap shoot. Guys who have low thyroid levels are typically non-absorbers. Some absorb transdermals at the start, but skin changes can shut off absorption after a while. With injections, there are no unknowns about drug delivery.

hCG is a water based peptide hormone can be injected to replace the lost LH hormone that TRT shuts down. Without hCG, the LH receptors in the testes are no longer getting activated. The results are:

  • The testes shrink. Over time for some the testes can eventually become small undifferentiated lumps of collagen. This is drug induced organ failure. The degree of shrinking varies from guy to guy and may be more of a problem for the older guys.

  • Fertility can be greatly reduced or eliminated. If making babies is important, you need to inject hCG. If hCG is not used, its use after a long time may or may not recover fertility.

  • When the testes get smaller, some feel an ache in their testes 24x7. hCG injections can eliminate that pain or avoid the whole episode.

  • When there is no LH or hCG, the scrotum pulls up tight to the body. This has the appearance of a pre-pubescent boy. This is not good for ones sexual self image and this also affects how women perceive you sexually. Some women get very upset when they see this maleness disappear, thus affecting their sexuality and interest in you.

  • The testes are the single largest producer of the hormone pregnenolone. Pregnenolone is important for proper mental functioning, and is the precursor to all of the steroid hormones such as DHEA, testosterone, DHT, estrogen, cortisol... Injecting hCG prevents a drug induced pregnenolone deficiency and helps support the other hormones. When guys are on T without hCG and then start hCG, they report a significant improvement in mood that many attribute to restored pregnenolone levels. [If that is not the case, hCG must have some direct effects in the brain.]

When injecting hCG, you inject into the fat under the skin just the same as diabetics inject insulin. The product literature is all about use a fertility drug for women with large IM [injected into muscle] doses. There is no need for men to inject hCG IM.

Research using SC injections in men has demonstrated the effectiveness of the 250iu EOD dosing. You can seek diabetic patient educational material for insulin injection techniques to use for hCG and/or testosterone injections.

Elevated normal [30pg/ml and up] serum E2/estradiol can block many of the benefits of testosterone replacement. Serum E2=22pg/ml is near optimal and one should dose anastrozole to get close to this level. Many who start TRT have some good results that soon vanish as E2 levels increase. My recommendation is to start anastrozole at 1.0mg per week [in divided doses] starting the day of the first injection. The let the first follow up E2 lab drive any needed anastrozole dose adjustments. It is not a good idea to wait and see how high E2 levels go before taking action. Dose anastrozole EOD if possible.

A few guys are anastrozole over responders. This is not known in the drug literature. These guys will get E2 in the single digits and will feel like crap physically and mentally. They may feel a spike of short lived libido as they fall through the E2 levels sweet spot. These guys need to take 1/4th or 1/8th of the expected anastrozole dose -something to watch for. If this is suspected, stop anastrozole for 6-7 days then resume at 1/4th the dose.

The 100mg dose of injected T should get guys into the 800-900 total testosterone [TT] range. That is nice to see, but one should be looking at free testosterone [FT] or bio-available testosterone [bio-T]. Some docs, who know what they are doing, will not bother checking TT numbers at all. SHBG levels increase with age and FT ratios drop.

A TT=1000 in a young man is not the same as TT=1000 in an older man with higher SHBG levels as the FT numbers will be well below that of the young man with the same TT. This may very well create TT levels that are above the youthful lab ranges and should not be a concern. Lab ranges shown on lab reports will be age adjusted. You need to be using the ranges for youthful men.

You need to know about PSA, prostate issues and DREs [digital rectal exam]. E2 is a large cause or aggravator of BPH [enlarged prostate]. Many find that lowering E2 to near E2=22pg/ml improves their BPH and urine flow is improved.

You need to monitor hematocrit levels as part of your routine lab work.


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#2

KSMan-- Thank you for this synopsis.

Since FT is apparently the more important number (vs TT), could you discuss more about those numbers in this thread? For example, what are good numbers/ranges/SHBG-ratios for given age ranges?


#3

That is a huge amount of topic. From a pragmatic point of view, you do not worry too much about the mechanics of things that you can't change. If you manage E2 at an optimal level, there does not seem to be much that you can do to lower your SHBG. SHBG is often never checked before or during TRT. SHBG can be inferred by TT:FT ratios. If your SHBG was higher, whether you know the numbers or not, there will be more of your TT that is SHBG bound T [SHBG-T]. SHBG-T is can be considered inert. It cannot be freed up to activate T receptors. You will read statements that SHBG transports T. That is misleading. SHBG-T really is a delivery service to the liver which clears it from your body. Estrogen also binds to SHBG [SHBG-E]. But T binds to SHBG more tightly than E.

You can find research papers and books that discuss how SHBG increases with age, but again, you can't really do much about that. My question, from what I have read, is how strong is the age related component of SHBG increase when we have many men with rising E2 with age that will create secondary SHBG increases. While we can actively manipulate E2 levels, in or out of a TRT context, we can reduce part of the increase of SHBG with age. The big problem is doctors who will not check or manage E2 levels... and that includes many endocrinologists who need to see a proctologists to get their heads extracted. When older guys are put on TRT with E2 levels out of control, they will have exaggerated SHBG levels.

So the next question is what FT number should one try to achieve. Apart from the practical difficulties of getting a doctor to walk this road. There are many different labs that test hormones. Some have FT ranges that go way higher than LabCorp [for instance]. You do need a FT number that removes all of your symptoms of low testosterone. My T cyp dose has increased 100-->125-->175 in pursuit of the higher ranges and strong libido and vitality. My FT had been dropping, so there may be more age related SHBG increase going on while on TRT. One thing that does bring down SHBG is androgens. So more T should reduce SHBG IF one does not allow E2 to increase. When increasing a T dose, one needs to increase the anastrozole as well. So if one increases T=100-->125mg then anastrozole should immediately be increase by 25% and refined with later E2 lab results.

Another often neglected variable is that one's T receptors also suffer with age and neglect. So an older guy can need more FT than a young guy just to feel normal. T receptors are embedded in cell walls and cell walls have their own heath issues an permeability. Perhaps the most important thing in this regard is ones intake of EFA's [essential fatty acids] and the best source for these is nuts and fish oil caps. The modern diet is very unhealthy from an EFA point of view. EFAs are also a large component of the brain. Numerous studies have connected the IQs of children with the EFAs in the mothers diet during pregnancy and nursing. After receptors in cell wall are activated, changes to or maintenance of otherwise different gene expression occurs and that requires that a cell be health and active enough to respond to these gene expression changes. As we age, there is more and more free radical damage and inflamation. Anti-oxidants help keep the cells healthy and able to respond properly to hormone levels.

Cells in the body cannot work properly without vitamin D that is converted to vitamin-D hormone. The cells do not know how to function without it. This seems to be a design error from my engineering point of view. This might have been a primitive control over metabolic rate of primitive life forms that we inherited. That would allow them to be active when there was sun light and dormant when not. Recent research is showing that we need 2000-3000iu of vitamin D per day. Some need a lot more. In higher latitudes, one needs more. Those with dark skin need a lot more as they cannot make as much Vit-D in their skin. When vitamin D levels are low, there are more infections, cancers, heart attacks and other CV accidents, MS, auto immune diseases [RA, lupis etc].

Thyroid and cortisol levels need to be right too.

So questions of the optimal dose need to be expanded to the optimal response and that opens up into a vast number of issues of nutrition, other hormones, diseases etc. We can't really explore that stuff, but we can argue that one needs to do many things to feel well, more the world of TRT basics.

TRT needs to be done right, that is necessary but not sufficient for good results if other things are not working right.

As we walk down the road that only goes to one place, death, we are suffering many declines. Some affect our mental health. I often talk about falling dopamine levels and falling numbers of dopamine receptors. There are things one can do to compensate for this that can make a vast difference in libido and ones ability to even feel satisfaction and pleasure. So in pursuit of feeling better, some of us need to explore brain meds and brain food. Some needing that will get ambushed by the medical system and be put on SSRIs that make things worse. Speaking of brain health, you need pregnenolone and DHEA, both of decline with age.


#4

Thanks KSman! You helped a great deal! I cannot thank you enough for your time in helping me! I feel now with studying this thread and the other advice you have shared I can go to my doc and hold my own in the discussion we will have. I will gently but firmly state that this is the way I wish my treatment to go unless he can prove that it is unsafe and I'm sure he will not be able to. I will remind him that E does follow T and I wish to keep my E2 in check from the start. I feel all that you have stated plays it on the safe side. I do hope my doc is better informed the most doctors. Hell it would be nice if he knows half of what you know on this issue! LOL!


#5

Then there is HGH. I'm curious about the connection between T and HGH. TRT did basically nothing for me in the libido department but TRT plus HGH fixed my function and libido 100%. HGH has been amazing. It's worth every penny in my opinion. This is month three and things just keep getting better. I'll be on it the rest of my life.

Also this marks the 1 year mark of injecting T SC. So far zero issues doing it this way. While we're on the subject of E2 I guess I'm an exception to the rule. My E2 was WAY to low at 27. I reduced my Adex dose from 1/4mg every other day to every three days and libido improved. My baseline E2 was 2/3 of range to start and I guess that's where my body needs to be. I suppose that can be a function of receptor sensitivity or something else.

You know another thing that really improves sexual function and sensation is Stablon. HGH seems to make drugs massively more effective and one Stablon a day is great now! My current protocol is:

-50mg T cyp, 300iu HCG, and 1/4mg of Adex every three days.
-4iu of HGH every other day. (Every other day works way better for me. The effect seemed to be reduced with every day injections.
-1 Stablon a day

If TRT alone doesn't do the trick throw in some HGH.


#6

HGH... Interesting and needs to be discussed.

What came first, GH or Stablon?

Stablon reduces serotonin and increases dopamine. Dopamine typically increases libido and serotonin typically lowers libido. Other dopergenic drugs also improve libido such as cabergoline and deprenyl. Deprenyl, 10-15 mg/week works well for middle aged persons. Deprenyl also improves sexual sensitivity and orgasms in a manner that other dopergenic drugs do not. DO NOT take the deprenyl doses in the product literature that are for treating Parkinson's disease.

[Low dose deprenyl </= 10mg/day does not have any MAO inhibitor 'cheese effect' risks.]

Deprenyl increases PEA/Phenethylamine which improves mood. You can also take Phenethylamine as an oral supplement with deprenyl - in responsible doses.



Libido happens in the brain. Optimal testosterone and estrogen levels are needed for a good sex life, but there are many other issues that sometimes need to be addressed with brain meds/supplements.


#7

HGH totally returned my sexual function within 2 months. It's been amazing. Combined with TRT it will make you as good as new. I just recently added Stablon back in and it's a great drug. It's a crime that it was never submitted for FDA approval.

If you try TRT and still have libido and function issues HGH will clear it right up. The problem is getting it. Doctors act like it's black magic.


#8

KSMAN
Are you a Doc, or just very, very well educated on this subject? That protocol is outstanding. I should print the thing off word for word for my Dr. !!!


#9

I have been studing this for years and have learned a lot from helping others.


#10

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#11

BBB
If I read you correct, you fill your "tubes" up from the back(keeping the needle sterile) ahead of time. Is this sanitary enough? How many ahead? I am relatively new to injections, so don't come down to hard on me!
Also, how do you load up when injecting more than one "medicine" at a time?

Thanks


#12

You do not mix oil based with water. So no T+hCG in the same syringe.

Bushy, "insulin monojects" is what? Basic insulin syringes?

I insert an insulin needle in a test cyp vial and pull back the plunger and hand the lot by the vial and come back in a few minutes.


#13

No doctor I've ever met will prescribe the ideal protocol listed above, unless you can fly to Florida or Vegas and set it up at one of the anti-aging clinics. Expect to pay thousands for this.

IMHO, if someone's got that kind of cash, they should try the ideal protocol laid out at the top, for a couple of months (didn't work for me). Unless you feel significantly better subjectively, its better to simply give up and accept fate.


#14

KSman I printed this an showed my doctor. He wasn't with me at first. I brought up what I have learn from you and others on this sight. I saved this to bring it home with him and he was impressed.I brought this out of my folder when I was finish speaking and he read and look things up in his text. He look up and said this sounds like a good starting point how much to you want I told him 200mg of cypionate and 30 arimidex at 1mg. I also got the needles you suggested. I am waiting on the 500mg hCG they didn't have.May have to shop around for that one.But, I do have the scrip. I mention this so that others will no that this does work with doctors. Mine wasn't going for it until I showed him this paper that KSman wrote. Good luck with all that are seeking treatment! This did work for me!


#15

I hope this is not off topic, but am I supposed to refrigerate any of this I forgot to ask doctor if I should or not.


#16

My doctor did with the help of this paper and it only cost $44.00 for the cypionate and arimidex. I just have a simple hmo from work. I am still waiting on how much the 500mg of hCG will cost my pharm didn't have it the have to order it or I may have to go else were.I just went to my primary doc.


#17

Wow, what a thread. THANK YOU KSMan &Brent. Not new to TMag but fairly new to male 'menopause', as I'm a 58 yr old male. Extremely meaningful for me, as I am gradually regressing in all of the youthful traits. Still lift real hard though. Well, to make a book short...I bought my first T supp, a 10 mg. vial of Test Eth. I believe it does have roughly 200 mgs/ml. Got 23 g. needles from him along w/the syringes. Was quite nervous the first time and likely got about .8ml in. Was surprised by ease of injection though. However, I really hurt internal to the injection a day after. So, I lay my butt on a bag of ice for 10 minutes and its helpful.

Now, I got a bit nervous as I read KS's note to definitely take An AI inhibitor and also HcG too. I do NOT want testicle shrinkage; would just one 10 ml. vial cause this? I doubt it but...want to make sure. I of course want to feel great but don't want to activate the hormonal feedback loop. THANKS a million KS and guys.


#18

Oh, wanted to add that I have bought Chrysin too. Does it work as an AI? Too weak? THX. I do take minerals, fish oil and eat a good lean protein, vegetable-filled diet.


#19

Scipio you are shut down shortly after running T. You NEED HCG upon starting TRT. I could go on and on but trust me on this one.

You also need an AI to some degree. From all of the labs that I've seen guys post I'm starting to think all men over 30 could use Arimidex at a low dose regardless of if they're on TRT.

Chrysin is a joke. You need a real AI. TRT in general should not be taken lightly. You really need to understand how your body works before messing with it. It may seem overwhelming at first but it's really quite simple. Get an understanding of hormones, the various feedback loops, and metabolites before messing with it.


#20

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