Water Retention

[quote]If this is too harsh for you, just ignore it. But seriously dude? You can’t eat and exercise like a normal person for a month without wanting to kill yourself? That’s pathetic. You’re on a website filled with people who follow strict diets and exercise rigorously every single day. You aren’t going to find any sympathy here.

I agree that test c should be administered e3d, but 200mg of test cyp once is no where near enough to shut you down. Test C/E take weeks before you “notice” any kind of effect at all. Further, it’s fairly obvious when somebody has hypogonadism. If your bloodwork is normal, the problem is not your hormones, it’s in your head.

Sounds to me like you are overweight and depressed. Instead of blaming your doctor/hormones/every medical condition under the sun for your problems, why don’t you grow the fuck up, stick to a diet and get the results you want? [/quote]

No, I can’t. I’ve dealt with severe depression since I was 13. I’ve tried every anti-depressant known to man (or, at least, those that the FDA has approved). I’m currently on Welbutrin and Cymbalta, and that doesn’t do very much. The pros? I don’t generally feel as extreme ‘down’ periods like last night and… well, that’s the only pro. The cons? I never feel any ‘up’ periods, I’m losing interest in my SO (both sexually and emotionally, which both came back 2 weeks after I stopped taking the meds, the one time I tried to stop), I can’t orgasm from sex, it takes me 40 minutes to orgasm from masturbation, and I yawn incessantly and feel a bit more tired. So, basically, I’m stuck taking meds that have massive cons with the only pro being that I haven’t killed myself yet.

The reason I feel suicidal much of the time is a complete lack of energy and desire to do anything (including living). You know what eating food does? It releases endorphins. You know what feeling hungry does? Well, it certainly isn’t releasing any endorphins. I feel fairly constantly ‘hungry’ when I’m eating less than 3,000 kcal a day. Restricting myself to 1,800 kcal a day makes me feel hungry to the point of being in moderate to severe discomfort for most of the day (and don’t try to tell me that it’ll go away when you get used to it, I restricted myself to that diet strictly, not once going above 1800 calories, from Jan. 1, 2010 to March 1, 2010, and it never got any better… a full two months of feeling uncomfortably hungry all the goddamn time).

My bloodwork isn’t normal. I’m extremely hypogonadic. My TT at 8 AM was 151 ng/dL at my last test. My FT was at 36 pg/mL. My TSH is at 2.99, which is likely a problem. My cortisol levels are seriously low. My LH and FSH are seriously low.

I had an undescended testicle that wasn’t treated until I was 19 - shouldn’t that have been an alarm to my GP that maybe, just maybe, something’s wrong? A testosterone test is a fucking easy blood test to run. He never even checked my thyroid until I was 21. I had to bring up the topic of low T myself after looking in to it, and he told me outright that “you don’t have hypogonadism, it’s just in your head.” and only gave me the test after I insisted.

I recognize that it’s possible that my tiredness/depression/low energy over the past week could be nocebo, but I find it unlikely. I felt no improvement in mood from the shot, and a severe reduction in mood starting day 4. For the record, it is T cyp.

Grow the fuck up? Fuck you. I’m trying to deal with my issues, and the last fucking thing I need to hear is “grow up”. I’m in therapy to help deal with the physical and mental abuse and neglect I grew up with, I’m seeing a psychiatrist for meds, and I’m trying to get my hypogonadism and possible hypothyroidism treated. I’ve tried restricting myself to a reasonable and healthy diet (e.g. 1800 kcal/daily focusing on whole foods and protein) a bunch of times, and every time it ends with me feeling suicidal within a month or two. I’ve tried exercising every other day, and that just makes me feel even more tired and negatively affects my work performance. What more am I supposed to do?

I’ve managed to lose 35 pounds in the past year, but anything beyond that seems unattainable. I literally do not lose weight on a 2,300 kcal restricted diet. I’ve been on it for three months, and I’ve lost 5 pounds (maybe, weight fluctuates too much to be certain). How is that even possible? I’m 315 lbs, 5’ 10", I should be losing weight even if I were consuming 3,000 kcal/daily. My BMR is 2761.05 kcal/day, that’s if I were sitting in bad all day long. I don’t. I get up, I go for walks with my dog, I clean, I work, I have sex, I weightlift semi-regularly, etc. I should be burning at least 3,000 kcal/daily, and I’m clearly not. So fuck you, and anyone else (like my parents) that thinks that this is all in my head.

Dr. Big,

We know what works here and have the human wreckage wash up on the shore from weekly injections or longer. These people do a lot better with frequent injections.

I suggest that you self inject 200mg every two weeks and see if you feel better.

HRT is hormone replacement. The objective also include time profiles.

When T ester injections in oil first came out, disposable syringes and needles did not exist. Patients came to the office to get injected. Injecting often was quite impracticable, expensive and inconvenient. Today, office T injections are regarded as a poor standard of care that creates a steady income stream of medical expenses.

Today, with self injections, the patient should have the freedom to inject their weekly dose in a manner that they find most beneficial. The patient should be given enough guidance to prepare them to find the routing that is best for them.

Insulin needles can be used for IM or SC injections. There is no need for impaling one’s self with 1.5" needles and becoming a contortionist to inject into the glutes.

E2 can be managed with anastrozole. The half life dictates that EOD dosing would be best. But serum anastrozole levels need be balanced with FT or bio-T levels. If those are peaking and dropping, anastrozole dosing will never be right and E2 levels will not be manageable.

Only with steady T levels, one can manage E2 properly. And only frequent T dosing can deliver steady T levels. When one has a few overlapping absorption curves, T levels are quite steady.

When T levels are steady and anastrozole dosing is as recommended, then TT, FT and E2 levels are steady and lab numbers are meaningful. If TT, FT and E2 levels are changing, the results can sometimes be more a factor of lab timing than dosing; and then one really does not know what the reality truly is.

We know that the peaks of T levels have a disproportionate effect on E2 and SHBG levels. For the same average dose, frequent small deliveries that create steady levels will have less E2 levels than infrequent injections. In many T only TRT cases, with infrequent doses, FT can be lower at the trough compared to pre TRT and E2 can be higher. Then guys experience an adverse E2:FT ratio and often feel worse than pre TRT.

Hey guys, im new on this forum which is a help to me, as i recently started on trt in the beginning of novemeber 2010 after being diagnosed as being hypogonadal at 29, so i started on test undeconate(nebido) had a booster inj in december and now my injections are every 12 weeks so my next is in march now.
Anyone had any side effects off nebido such as water retention/odema?,
or anything positive to share about its use (have another thread which says a little more about me- (new on trt nebido anyone?)

keep up the good forum people

Cheers

miniarnold, please start a different thread for that question. Also include relevant labs, medications (including dosage), etc. Make sure you read the stickies first.

[quote]Dr.Bigleo wrote:

Most clients are 50+ years of age, so bodyfat is an issue too.

[/quote]

Im confused - You said 100 mg is a “joke” for athletes but your clients are 50+ years of age. So you are treating 50+ year old athletes with 200mg every 10 days?

Hello KSMan

I appreciate your feedback in this feed. You speak the medical community language, and its certainly prompted me to be more open minded about the suggestions made in this forum- honestly.

Once a patients lab results are back, and we’ve decided to move forward with the treatment, I provide the patient the option of either a dermal testosterone cream or an injection schedule. This is the only way that I’ve understood this treatment to be done, before this post.

Im not at all opposed to patients administering their own medication- but I can tell from experience, that quite a few patients are nervous about getting injections I administer!(People dont typically enjoy getting an injection.)

Im not sure how many would feel comfortable doing their own injections.

But, as I mentioned, I will be doing a much more thorough review with my lowT patients, and talk to them about this option too. If they are comfortable with it, and it improves the therapy- I have no problem with that. Id like to believe that were here to improve peoples lives, not needlessly run up a persons medical expenses.

Keep in mind gentlemen, that we (and now obviously mistakenly) sometimes need to rely on the drug literature to advise the correct dosage and index.

PureChance, may I ask where you find that graph.

Last night I found some medical journal studies that more closely correspond with what Pcdude was mentioning in terms of half lives for testosterone cypionate esters.

I find it incredibly frustrating that the drug companies would furnish erroneous information. We count on these references to effectively provide treatment.

I deal with more than 250 medications every week, and keeping tabs on the various dosages and durations is a full time job in itself!

My lunch is over, gotta back to it!

Thank you everyone!

1 Like

Hello Substance P,

None of my patients being treated for LowT are athletes (that I know of). With the exception of 1, they are all over the age of 50.

Moreover, based on what I’ve seen in the various posts concerning dosages used by athletes (500mg-2000mg of testosterone per week) it was my sentiment that the 200mg/10days may be seen by some athletes as laughable.

Ive seen more than enough legitimate feedback to suggest that the 10 days dosing schedule is NOT optimum.

I had saved that graph to my computer awhile back, but also found it by googling: testosterone blood level injection frequency (first result was medibolics or something like that) - but it reflects what most people experience. uncontrollable highs followed by getting way too low.

just check out my thread My HRT Journey (so far) with all of my blood tests and injection dates to see.

My advice is to offer it as an option, and moreover offer that they try doing it once while you supervise, and then decide. I hate needles, but I decided to go with the self-injection, and it turns out that it’s actually really easy and very low pain (I inject into my thighs, alternating sides - I inject somewhere in the top-right quadrant (from the top middle to the right middle of my thigh, if that makes any sense)).

I just had my second injection yesterday (it had been 13 days, I couldn’t wait for 14 like my endo wanted me to). I accidentally injected 100mg rather than the 50mg that I meant to (I thought the solution was 200mg/mL, not 100mg/mL), so I’ll be waiting until next Tuesday to inject again - but at least I don’t have to go for 13 days without an injection again.

I am feeling a whole lot better today. No suicidal thoughts, a moderate boost in energy. Noticeably reduced hunger (I have serious weight issues largely related to almost always feeling ‘hungry’, no matter how much I eat).

I suspect, though I can’t be certain, that the massive dose (200mg) of Test-Cyp ended up aromatasing (is that a word?) quite a bit, and the T that actually stayed as T was used up within just a few days. This time around, I think my body isn’t in as much shock. Obviously, this is all conjecture, but I don’t really give a crap - I FEEL GOOD! For the first time in my whole goddamned life, I FEEL GOOD.

miniarnold:

Your post into this thread was hijacking it. You need to stay on topic and it is rarely appropriate to inject your personal concerns into someone else’s thread. Same goes for stickies.

You need one post/thread for your issues, labwork and updates. Always go back to that one thread. So not open multiple threads about your situation. We need everything together for context to do things properly. You will not want people injecting their personal concerns into your thread.

I do not candy coat these issues.

Hey Doc, it is really nice to see a practicing physician with an open mind participating in this forum.

While the subject has turned to self injection, I want to reiterate that a large portion of the active participants are injecting the T-Cyp sub cutaneously with the smallest insulin pins the oil will flow through.

I think that an issue is that doctors become doctors by having a good memory. That does not require that they be analytical, independent and critical thinkers. We we do expect is that doctors understand cause and effect and have a desire to understand things at a deeper level. Medical schools do not select for what we expect. Medical practice is complex fast paced, selecting the best cookie cutter for the patient.

So doctors are conditioned to accept information from “medical sources” which means they can be steered by drug reps etc. In all fairness, they cannot be deep thinkers about everything that they do unless it is a personal motivation or they are specialists. But we know that some specialists who think that they can TRT are very wrong and ignorant in their approach, which from an outside view, looks like conceit.

Thank you JRM.

KSman- As much as Id like to deny what you’re saying here…there is a good deal of validity. And, again, its for the reasons I mentioned earlier. Not too recently I was joking with a colleague about the various limericks and tricks we used to survive med-school. I’d like to believe that every physician has a genuine desire to contribute to their community by improving peoples lives-

I see hundreds of patients with a plethora of issues, and it would be nearly impossible to understand the exact mechanics on the most granular level of EVERY medication used in treatment- EVEN Specialists! In the vast majority of cases we HAVE to rely on the manufacturer to provide accurate information about the various narcotics.

Moreover, its very common to see conflicting results between researches as well.

Subcutaneous administration of a testosterone ester is also a new idea to me. It was my understanding the mechanics of the ester involves slow absorption from the lipid phase, so, I dont see why subcutaneous injection would be any less effective.

Best,

Dr.DT

Indeed, and it seems to have the added benefit of being absorbed and utilized by the body even slower than intramuscular injections. This way, we aren’t getting as huge peaks or as low valleys in our testosterone levels. It’s also a bit easier to inject than IM, but that’s just the icing on the cake.

[quote]Dr.Bigleo wrote:

I see hundreds of patients with a plethora of issues, and it would be nearly impossible to understand the exact mechanics on the most granular level of EVERY medication used in treatment- EVEN Specialists! In the vast majority of cases we HAVE to rely on the manufacturer to provide accurate information about the various narcotics.

[/quote]

And the real crime is that Physicians are forced to follow the recommendations or expose themselves financially.

[quote]KSman wrote:
miniarnold:

Your post into this thread was hijacking it. You need to stay on topic and it is rarely appropriate to inject your personal concerns into someone else’s thread. Same goes for stickies.

You need one post/thread for your issues, labwork and updates. Always go back to that one thread.

Im new to this forum, so very very sorry for hijacking this thread my intention wasnt to upset anyone as i dont know how this whole forum works didnt realise that you couldnt post on someone elses thread your qs and experiences without offending someone,i thought we were all in the similar situation around here, and were all trying to offer support and help for each other.
Still dont know what a stickie is and what it all means,there is no rules or guidelines that i can see anywhere, i thought one could just post on any thread when they wanted to contribute or ask something on that particular subject.
Cheers.

miniarnold:

  • A sticky is a thread that has been “stickied” to the top of the list of threads. Go back to this forum’s index and note that there are 6 threads with a small yellow sticker by them; these are the stickies. They contain excellent information, and should all be read thoroughly multiple times before you begin asking questions. Please also note that you should not post into a stickied thread unless you are posting something relevant to that sticky – e.g. do not post that you have high Estradiol and you want help with it in the Estradiol sticky; do post research articles that have not been posted yet pertaining to Estradiol and its affects on men in the Estradiol sticky.

  • Each thread has a fairly general topic that should be easily discernable by the first post in the thread (or, in some long threads, but the general tone of the thread as it shifts). This post’s general topic is about water retention in older males undergoing TRT. Your question lacked context about your own personal issues (medical history, labs, current treatment, etc.) and would be much more contextually appropriate in your own thread. Your question added nothing to the discussion.

Hello Everyone!

Yes JRM80 ,the exposure is financial in terms of the potential malpractice lawsuit. Were discussing a schedule III controlled substance, which adds some legality too in terms of prescription and administration.

Honestly, I see my patients on daily basis, and give little, to no mind, to financial “value” of a patient.

We have a staff that bills insurance, and calculates office visit fees, and handles monthly expenditures, I simply love improving peoples lives. If a good living is a benefit to that hard work, so be it.

The only reason why patients are seen in office for regular administration of testosterone is simply due to the fact that this is the only way that I understood that it could be done. As I noted in the above posts, ALL of the literature available to me on the topic of Testosterone replacement provided by the medical community or drug manufacturers (prior to this thread and subsequent investigation) involved 10-day/bi-weekly treatment.

Based on some further investigation from research on these forums, and other sources, I have a very different view point on “Optimal” treatment for lowT patients.

Assuming patients are comfortable administering their own injections of Testosterone Cypionate, I will recommend the dosage provided by the index, BUT taken every 3-4 days (NOT 10 days). It will always be accompanied by a aromatase inhibitor(whether the patient shows signs or not - a fantastic way to optimize treatment as well as PREVENT those issues.)

Although the testostorone levels will peak roughly 36 hours after administration, there is strong case that optimal levels of testosterone cypionate drop significantly after 5 days from the initial administration, so frequent injections simply provide the most practical solution. I could not find a single study that identified any harmful short or long terms effects on hypo-males using TRT in this manner in the prescribed dosage range.

Those patients that do not feel comfortable doing self injection, I will prescribe the Testim cream.

Im sure some of you can imagine what a humbling experience this research has been; Most significantly, I will be taking more time in discussion with all of my patients, and researching medications and use thereof much more thoroughly. There is a real value to patient feedback and independent research from alternative sources outside of drug manufacturers and PDR’s.

I also couldn’t help but feel I need to spend more time exercising after seeing some of the athletes here!

Best,

Dr.DT

Sounds like a fairly good plan, DT. Regarding creams: keep in mind that some people do not respond well (or at all) to T creams, so those patients will definitely need to be monitored to make sure that their T levels respond appropriately. Also, regarding aromatase inhibitors, patients on AIs should have their E2 levels monitored so that they don’t drop below the ‘sweet spot’ of 18-30 pg/mL – though, that said, if they aren’t exhibiting any low/high E2 symptoms (ED, brain fog, water retention, fatigue, etc.) then their E2 level may be just fine even if it isn’t in that range.

You will need to teach your patients how to self-inject. Injections should be either SC or IM in the patient’s upper thigh, in the outside-top quadrant (I believe the muscles there are the vastus lateralis muscle and the rectus femoris muscle). While it’s possible to have patients self-inject in the upper arm, this tends to be moderately painful, and the pain lingers. Injections into the gluteals are possible if the patient isn’t comfortable self-administering but someone close to the patient is - proper technique is necessary to avoid hitting a nerve with IM, though.

On behalf of your patients, thank you for taking the time to look into this rather than just blindly accepting the manufacturers’ claims!

I am glad that things seem to be moving in the right direction.

When starting guys on anastrozole, you need to advise that they might be an anastrozole over-responder. An early E2 test would be valuable, sometimes the symptoms are enough.

Some guys will report that they have little penile sensation with TRT, described as numb. High normal T levels is not always enough. Part of this is insufficient levels of DHT, effects of aging and E2:T levels. Applying a small amount of 5-10% T cream to the [trimmed] scrotum can increase DHT. A small amount on the penis can wake up the nerves. Not all men will be seeking a busy sex life. Note that guys applying T transdermals for TRT will have a lot more DHT than those who inject. Libido can be better with transdermal T than injections, for those that are good transdermal responders. T=gels that cover large areas of skim will create more DHT [and E2] than strong creams that are applied to smaller areas.

If you have some guys who have elevated E2 on an existing TRT routine, get them near E2=22pg/ml and watch how things change.