If you google it you’ll find a bunch of studies from 2004 to present. It seems to be standard practice in Canada now. Also Dr Shippen has been doing it that way for several years.
My new Doc also just started me on T-cyp Sub-Q. 50mg E3D. He said no need for IM. Much less tissue damage this way.
I draw with a 20G and inject with a 5/8" 25G.
Now the HCG … that goes in with a 5/16" 30G.
I just started a new Doc, and new program which I will post complete program in another thread. So far, so GREAT. I really like this new Doc, and how he goes about making TRT a success!
I’m doing the same with a 29G 1/2".
[quote]rfish1966 wrote:
what dose of AI hcg and test are you taking?[/quote]
250 3x a week on the hcg
1.5 tabs of AI a week
I didn’t perform an exhaustive search, but within the first 5 pages I found only one actual study of subQ INJECTIONS from 2006 and all the rest were studies on IMPLANTS. The one study made it look very promising, but it isn’t all that well researched yet.
The chances of any given endo knowing about the technique is pretty slim unless he/she specializes in TRT and stays up to date. Let’s face it, most can’t stay all that much up to date; it’s virtually impossible.
…out of curiosity I tried one in the abdomen (just this morning - I do 35ml of 200mg/ml Delatestryl E3D), and ended up with a big red welt/lump. For the time being I’m just gonna stick to the standard IM injects…hebs
Here’s two studies on subQ Test injects:
1: Saudi Med J. 2006 Dec;27(12):1843-6.Links
Subcutaneous administration of testosterone. A pilot study report.
Al-Futaisi AM, Al-Zakwani IS, Almahrezi AM, Morris D.
Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman. alfutaisi@squ.edu.om
OBJECTIVE: To investigate the effect of low doses of subcutaneous testosterone in hypogonadal men since the intramuscular route, which is the most widely used form of testosterone replacement therapy, is inconvenient to many patients. METHODS: All men with primary and secondary hypogonadism attending the reproductive endocrine clinic at Royal Victoria Hospital, Monteral, Quebec, Canada, were invited to participate in the study. Subjects were enrolled from January 2002 till December 2002. Patients were asked to self-administer weekly low doses of testosterone enanthate using 0.5 ml insulin syringe. RESULTS: A total of 22 patients were enrolled in the study. The mean trough was 14.48 +/- 3.14 nmol/L and peak total testosterone was 21.65 +/- 7.32 nmol/L. For the free testosterone the average trough was 59.94 +/- 20.60 pmol/L and the peak was 85.17 +/- 32.88 pmol/L. All of the patients delivered testosterone with ease and no local reactions were reported. CONCLUSION: Therapy with weekly subcutaneous testosterone produced serum levels that were within the normal range in 100% of patients for both peak and trough levels. This is the first report, which demonstrated the efficacy of delivering weekly testosterone using this cheap, safe, and less painful subcutaneous route.
PMID: 17143361 [PubMed - indexed for MEDLINE]
STABLE TESTOSTERONE LEVELS ACHIEVED
WITH SUBCUTANEOUS TESTOSTERONE
INJECTIONS
M.B. Greenspan, C.M. Chang
Division of Urology, Department of Surgery, McMaster University,
Hamilton, ON, Canada
Objectives: The preferred technique of androgen replacement
has been intramuscular (IM) testosterone, but wide
variations in testosterone levels are often seen. Subcutaneous
(SC) testosterone injection is a novel approach; however,
its physiological effects are unclear. We therefore investigated
the sustainability of stable testosterone levels using
SC therapy. Patients and methods: Between May and
September 2005, we conducted a small pilot study involving
10 male patients with symptomatic late-onset hypogonadism.
Every patient had been stable on TE 200 mg IM for
41 year. Patients were instructed to self-inject with
testosterone enanthate (TE) 100 mg SC (DELATESTRYL
200 mg/cc, Theramed Corp, Canada) into the anterior
abdomen once weekly. Some patients were down-titrated
to 50 mg based on their total testosterone (T) at 4 weeks.
Informed consent was obtained as SC testosterone administration
is not officially approved by Health Canada. T
levels were measured before and 24 hours after injection
during weeks 1, 2, 3, and 4, and 96 hours after injection
in week 6 and 8. At week 12, PSA, CBC, and T levels
were measured however; the week 12 data are still being
collected. Results: Prior to initiation of SC therapy, T
was 19.14+3.48 nmol/l, hemoglobin 15.8+1.3 g/dl, hematocrit
0.47+0.02, and PSA 1.05+0.65 ng/ml. During
the first 4 weeks, there was a steady increase in
pre-injection T from 19.14+3.48 to 23.89+9.15 nmol/l
(p¼0.1). However, after 8 weeks the post-injection T
(25.77+7.67 nmol/l) remained similar to that of week 1
(27.46+12.91 nmol/l). Patients tolerated this therapy with
no adverse effects. Conclusions: A once-week SC injection
of 50�??100 mg of TE appears to achieve sustainable and
stable levels of physiological T. This technique offers
fewer physician visits and the use of smaller quantity of
medication, thus lower costs. However, the long term
clinical and physiological effects of this therapy need further
evaluation.
Try the thigh area …
5/8" needle will be Sub-Q for MOST.
Unless you are extremely lean.
I use the abdobmen for HCG with 30G 5/16"
…I’m relatively lean, especially on the legs. Any particular place on the thigh, or just wherever I can “pinch an inch”?
Pinch an inch is good. STAY AWAY from the inner thigh. Major arteries there !
Ck this out:
http://www.spotinjections.com/
If you are VERY lean, worst case secenario it will be IM instead of Sub-q. Be sure to aspirate either way. With a 5/8" needle you are good to go.
well, I thought HRT would help with my depression issues, guess not. My number have improved since I started t shot, AI and hcg. I had blood work done by LEF.ORG , a reputable place. my new numbers are
Estrodiol 28 pg/ml 0-53 reference
DHEA 323 ug/dl 95-530
T SERUM 795 241-827
FREE T 35.5 HIGH 6.8-21.5
dozens of other reading in range, below are some non normal reading
my uric acid is VERY high , that explain my gout
WBC? 3.7 LOW 4.0-10.5 reference
c reactive protein , cardiac 4.5 high 0.0-3.0 range
bottom line, I thought correcting my T and E would help out with depression , clearly they have not. Frankly I do not feel ANY diferent now with T at correct levels as I did when my T was at 166.
Guess there no point going to DR Crisler at this point, other then high free T , numbers seem inline.
BTW High free T, what should I do about that?
Edit/Delete Message
Ditto Matt. If you find a Dr that fixes you let me know because my mess is exactly the same.
Be happy with the Free T.
I personally would maintain current regimen, recheck E2 in 30 days, and hold protocol for at least 90 days. It may take that long for you to feel the positive effects of your new corrected hormone levels.
It could take 90 or more to FEEL effects? I am fine with that, but I do not understand it, if my T and E levels are optimal now, that means they are in my tissue and bloodstream now, which means I should feel different / improved now,. I do not understand how waiting longer improves things… But if waiting longer MAY help. thats positive news
[quote]sxracer wrote:
Be happy with the Free T.
I personally would maintain current regimen, recheck E2 in 30 days, and hold protocol for at least 90 days. It may take that long for you to feel the positive effects of your new corrected hormone levels.[/quote]
It will take a while. Just because the levels in the bloodstream are up does not mean that the effects are 100%.
The hormones have to enter the cells and bind to the androgen receptors.
You might think of it as now that you have the hormone, it is going to take a while to saturate your body.
Our bodies can get “junked up”? with estrogen as well, from what I understand it takes a while to reverse that. Stands to reason that we did not get this way in just a few weeks and probably won’t get better in just a few. I am 3 weeks in to my new trt treatement but I finally have a good doc so I am just going to hang in there.
First off, I apologize for the thread jump?old thread revival.
I am new here, but not to HRT. I have been doing HRT for about a year and a half now. I am currently on 9 pumps of androgel. My T level response is good mid 800’s. But the effects are nothing to write home about. I originally started HRT to save my marriage. I am 33 y/o and my wife and I have been married for 9 years. We were high school sweet hearts. Our love life was spectacular when we were young.
But at about 21 or 22 I started losing interest in intimacy. We would still have it, but it was a chore for me. We have 2 children together. One is to be 3 next month the other 2 in May. We had no trouble conceiving at all. she went off the pill and we were preggers Ina month, and the second followed quickly since she did not resume birth control.
Anyway a little over a year and a half ago she came to mad and told me she was considering a divorce. I was not meeting her needs. I told her it wasn’t her, something was wrong with me. She agreed to stick around while I tried to figure it out. I had suspected for a while my T might be low, but I was afraid to talk to a Dr about it.
I just knew they would think I was drug seeking. I have a back ground in health care in the past and I knew how they think in their professional circles. Anyway the thought of losing my boys was not an option. Honestly if it we rent for them I would have let her go. I loved her, but I felt like I was being punished for something that wasn’t my fault.
I went to several Dr’s not knowing what to ask or do to get help with my problem. I got advice from look at porn to it’s normal to not desire sex after being married, and one time per week to maybe 1 time per month is fairly common. Well I disagreed with all of these suggestions and finally did a little research and had some labs drawn at a local clinic.
They did not even feel compelled to call me with the results that my total T was 75. they said it is low normal, we would have addressed it at your next appointment. I did not have another appointment scheduled. I figured if anything was off on the labs they would set one up. the only reason I found out was I called and requested it.
Anyway after much begging he agreed to a minimal dose of androgel. then I got him to increase it 2 times. I still really wasn’t getting results. I asked him for a referral to a DR that more specialized in the area, and he did. The new doc changed me to a higher dose of testim.
Apparently I am allergic to testim. I break out in a poison Ivy rash. WE want back to androgel and up to the current dose of 9 pumps. I felt really good, maybe up to 3 times a week with the wife, and it was less of a chore. but after a month my desire slowed again. not to the previous levels, but more chore like.
I went to the doc again we did labs. He said your T is at 800 your good to go. I told him I wasn’t good, he prescribed wellbutrin. That did not help either but it cost a fortune. I just ignored the problem for several months, but finally my wife came back to me not with divorce but begging me to get help. I did some research and found out the androgel can cause sterility. this explains why we haven’t had child number 3 yet.
I found out HCG can fix it. We got a sperm test. Sure enough rare low motile sperm or something to that effect. Back to the DR I go with a request for a switch to HCG from androgel, to fix count and hopefully still keep a little T. I did try prior to seeing the DR (had to wait a month for an appointment) to just stop the androgel. I got head aches and nauseous. I also had some blood work done to give him supporting evidence that I need to switch to HCG.
My T level went very low. I cant remember the actual number right now, but it seems like in the 50’s. I get the labs and post later today.
Well the Dr said he did not know anything about HCG. He said he thought it would be very expensive and have to be injected IM. He said he would look into it and call me back. I waited a week and nothing so I called him on 3 consecutive days. no call returned.
So now we are up to last Friday. I found this forum through a google search for HRT and HCG, it pulled up this very thread.
i have found a lot of good info in this thread which I have read this morning in it’s entirety.
I plan on going to a local clinic with a new younger DR, and giving them a list of labs I want drawn.
From this thread I surmise that would be E2, total T, free T, TSH, Free T3, Free T 4, PSA, DHT ( I really am not sure what DHT is but it seemed important from this thread especially for androgel users), also a CBC, and fasting insulin.
I plan to request HCG (which I now know cost about $16 per month) and some sort of AI. I am not sure if I should switch from androgel since My T level is quite good, but I really do hate putting 9 pumps on every morning. To do it i have to coat the entire front upper half of my body. I try to avoid the nipples, not sure why, but I read you should. One Dr even asked if I was rotating my application sites, I said where would I rotate them to?
I put it everywhere I can reach.
Anyway I read on here you should not ask the DR for an AI, why is that? Where else would one get it? is there any thing else I should insist on from the new Dr.
Keep in mind I am 33 y/o, 6’1" and currently 285. I have been dieting for 2 months (I thought it may help as well, I gave up soda all together 2 l per day habit there)so I am actually down from 309 Jan 1st. I want to level out my hormones and be more available to my wife, while enjoying that time more. She, if you haven’t figured it out already, has a pretty big appetite for intimacy.
I thought it was a curse, but it is in the end what got me to take control of my health, making me a better man, hopefully. I love my family, and I just want to be healthier for them. i don’t want to be the next great power lifter, or body builder. I just want to be normal, and healthy. From what I have read on this thread that seems to be the common sentiment among most of you.
I avoided these types of forums in the past because I did not think I would have any thing in common. I stereo typed. Sorry for that. This has been a wealth of great knowledge, and the advanced members hear seem well versed in this, more so than any DR I have spoken with. That is a shame, it it a disservice to men who don’t know where to go or what to do. Because they would all go to a DR before coming here. And most wont have a high needs wife pushing them so when the Dr gives them bad advise they will just give up.
I am greatly thankful for this resource and the advice I have received and will receive here.
Sorry for the extended long post especially for my first one. I just wanted to share my whole story, because it is pertinent to the advice I might get. As stated Ill post my labs from just over a month ago later today.
by the way mathewt I hope you are doing better now. You last post in this thread was in august, and did not sould all that positive.
OK as I said in my first post here are some of my labs. Take into consideration, I had been off the androgel for 5 full days prior to this lab. The reason for quitting the androgel at that time was I had just found out I was infertile because of it. After the labs I went back on it because I could not stand being that low on testosterone.
FSH 2.4 scale 1.27-19.26
lh 1.4 1.24-8.62
T 44 400-1080
Free T 10 47-244
SHBG 15 11-80
%free and total T 2.4
TSH 1.76 .34-5.6
glucose non fasting 79 74-118
estradiol 12.3 10-42
Total E 21.8
Any help is appreciated. IS it likely that my fertility would return, if I stay on the gel and add HCG to the regimen? is an AI indicated with these labs? IF I ask for one did I read correctly that it will be in pill form, but the pharmacy will convert it to liquid form for me? Do I even need a DR for AI?
Honestly I haven’t searched these answers anywhere else. I have been reading this thread which seem pertinent, and trying to get the info together to give you a full picture. I will now research on my own as well. But this is the first resource I have found to be helpful, and I was trying to exhaust it first.
KS I would appreciate your comments as well. I will base my conversation with my new DR tomorrow on the guidelines you posted earlier in this thread.
DOOD!
Sorry if it’s INCONVENIENT to to travel but this DR. is treating you like shit and he’s getting paid to as well!
Find a new DR. and fast three more months of felling like shit??? Do you want that?!?!?
It’s soooo worth it even if you do have to go outside the area/town/city.
We expect Doctors to care for our health but we need to educate ourselves as well( cause there are soooo many arrogant know nothing MD’s out there, second opinions are also a good thing.
For YOUR needs Androgel IS shit, find a compounding pharmacy, better still get injectables ( takes practice though LOL).
And finally, educate yourself HERE.
[quote]KSman wrote:
Some do not absorb well. Those who are hypothyroid are famous for that. Low thyroid can mean low energy and weight gain.
Some absorb good in the start, then the skin changes from the effects of the T (gets better) and that for some means the end of absorption.
TDs also lead to more T–>E aromatization than injections. For some the E increases, the increased E suppresses the HPTA and the natural T production fails. If the TD was absorbed well, then the HPTA would be completely shut down.
You doctor is a jerk, a steroid phobic republican or misinformed. I don’t know what is worse. He was not going to do anything right. You may need to go out of town.
Ask the local pharmacies what doctors are prescribing testosterone ethanate or cypionate. Explain that you have T levels down through the floor and are seeking a doctor who will deal with your situation. You could show them your lab results!
Many guys struggle to get proper care. It is sad. Some get the testosterone and can’t get their doctors to prescribe arimidex/anastrozole to control E2 levels. Many of those are driven to underground supplies. You need to get your E2 levels checked. Do not test for total estrogen. The LabCorp serum E2 (0-53) works well. You may be very high. You will feel best with E2 in the low twenties.
Test for total T, free T, TSH, free T3, free T4, PSA.
If all of that is working right, you may not want to have shrinking testes.
Do you know anyone who has a Sam’s Club business membership? You can get a sub card under theirs. The primary card holder will never see what you purchase. 10ml 200mg/ml test cypionate Watsons costs $42.50, 10,000iu HCG APP costs $16.25, 50iu insulin syringes are $12.42 per 100 at Sam’s or Walmart.
You can inject T cyp with an insulin syringe into the vastus lateralis. Injecting every week or every two weeks is completely wrong, even though that is mainstream practice. That creates T spikes that lead to E spikes and increased SHBG that reduces your %FT. I inject 28mg EOD. My HCG is 250iu SC EOD.
Elevated E is a main feature of metabolic disorder, the E reduces LH and that means less T. I think that all men in that state would profit from arimidex. Metabolic disorder is also pre-diabetes. Your CBC will cover that. Some might test for fasting insulin.
You can get your own lab work done via LEF.org, for about 1/2 of what the doctors and clinics will bill for. The ‘male panel’ will do the TT, FT, E2. Add thyroid labs to that.
A trial dose of hCG is 1mg/week. At $9/mg that gets costly. There are non-drug sources of anastrozole that many turn to, even if they have a prescription. With your weight, you might want to scale up the 1mg/wk by your weight against a 160lb reference. Depending on your E2 lab results, you may need more again. I would not exceed 2mg/wk.
Do not get onto injected T without the anastrozole. That would make your E2 worse! If you get lab work and have a cooperative doctor, you could take some anastrozole for relief before you get on T. You should still push to get onto the AI (aromatase inhibitor) from the very start and front load with 1mg/day for 2 or three days then start you dosing after that. The non-drug anastrozole comes in a liquid, 1mg/ml (60 ml $50.00), which allows for good dosing options other that breaking up a tiny expensive pill.
Get the script for arimidex, and take the prescribed amount with the liquid. Do not tell the doctor about what you are doing. Follow his changes based on blood work. Then you can make changes later based on the lab work yourself. You doctor will not understand dosing changes of .4mg/wk as he thinks your are using pills. Your doctor does not want to know about this.
With the elevated E2 that you probably have, you might have some female fat deposition patterns and perhaps some degree of gynecomastia. If any signs of gyno, all the more info to present to a doctor in support of the AI. TRT without AI would then make things real bad.
You need to learn all about this stuff, because chances are your doctor will not explain things.
Go to that other doc and get good copies of ALL OF your lab results. Always obtain good copies and never loose them. Have them in hand when you see another doctor. Have an androgel prescription label to document what you have been taking.
Tell the doc that TD test has been useless, your lab results will substantiate that, and ask to be put on 100mg test cyp per week, 250iu HCG EOD [I can supply research material to support that], and arimidex to get E2 under control with a target level in the lower 20’s - the E2 levels of a young lean male. You need all three items to get optimal results. Without the AI, I would expect quite poor results.
If you take 100mg test cyp per week, you are under control of how you do that. Injecting EOD or twice a week will be better for you. You do not need to inject into the gluts with 1.5" needles!
Cut and paste this into a file for future reference.
I will work with your via PMs through the doctor things and details of getting started.
PM me and tell me where you are located and I will try to help you located a TRT or age management doctor.[/quote]
Shoot, I want my hand held too…