Short:
1st doctor put me on trt injection (200mg every 2 weeks) BUT no HCG prescription.
2nd doctor said he will give me HCG but wants me to go on cream. 140mg of mixture every day, applied on testicles. (I don’t know how much of that mixture actual testosterone)
Should I stick to my injections and just implement HCG or try this cream/ HCG?
Long: Had T problem since 2005, Lived with 250-300 level for years.
Recently went to a lot of not very good doctors and got 1 to prescribe cream.
Cream dropped me from 275 to 75 (turned off my natural production)
(Cream was 2 pumps of 1.62% gel)
Same urologist put me on Testosterone Cypionate 200mg every 2 weeks.
Instead I injected into muscle 50 mg into muscle twice a week.
After month tested 450.
Started injecting daily into fat with insulin needle (that does not have much medicine waste) (injecting 0.07ml AKA 0.7 mg. So 0.07ml x 14 = 0.98ml)
Needle is 1/2" 30Gauge (I do not switch to draw needle, just use injection needle)
My test went from 450 to 600. (Not saying it’s due to injecting daily or due to injecting into fat)
SO vent to HCG doctor who gave me prescription for HCG, but wants me to stop injections and start applying Testosterone cream on my balls.
**Option 1: Continue with my injections and implement HCG injections **
Option 2: Listen to new doctor and try HCG and cream
Any other options?
What is his reasoning behind stopping the injections? Check out this article in the Urology times where injections, over other applications, earn high marks for safety and effectiveness.
“that intramuscular injected TRT produces greater musculoskeletal benefits and lower cardiovascular risk compared to transdermal TRT"
Injected TRT earns high marks for safety, effectiveness
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It’s no mystery what’s going on here, your doctors are in over their head and are tapping out going for the easy to manage T-creams because they don’t have any clue what they are doing.
I’m sorry but none of your doctors specializes in TRT, not when a 14 year old study shows you how not to do TRT. Your doctors are following guidelines because they don’t know what to do, that’s what guidelines are for, to instruct doctors on a course of action which happens to be wrong.
What you need to do is test your SHBG levels, this is the centerpiece of every hormone evaluation.
If SHBG is on the lower end very frequent injections may be needed. My SHBG is 14-22 and I inject daily. When you change something about your protocol, it takes 6 weeks for your body to adapt and for levels to stabilize, during the first couple of weeks you may not feel your best.
Hormone profiles after intramuscular injection of testosterone enanthate in patients with hypogonadism
In fact, the present study confirmed serum levels of T which were lower than pre-ART value levels on day 14 after administration. Therefore the further decrease in serum T levels on day 14 after administration is considered to relapse of hypogonadal symptoms and to reduce the patients quality of life.
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This is after a single injection and does not account for when levels reach steady state.
Doc said that injectable T is very potent and last line of defense that should be used only by older men (i’m 37), so that’s why he wants me on cream.
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I will test my SHBG asap, probably this week. But last August it was 14 nmol/L.
I’ve been injecting daily into fat just because thinking it will minimize aromatization.
So you think that I will have to continue with daily injections?
Well if we are talking about “potency” technically cream would be more potent, androgenically speaking, because it converts to DHT at a much higher rate than injectable T does, ESPECIALLY when you rub it on your balls.
DHT is about 10 x more androgenic than testosterone if my memory serves me correctly.
Unfortunately, your doctor has no clue what he or she is talking about when it comes to testosterone replacement therapy.
Doc said that cream will create more hi and low instead of my daily injections that maintain semi-high constant level.
That’s hi/low is more preferred because it mimics body production, producing during night and having high during morning. Instead of slow release of injectable oil. Not my words, but Docs.
Thats not how it actually works though, total T levels only fluctuate 10% per day. Cream would mimic a large rise and fall in TT. It does not have nearly as pronounced effect on FT as injections do.
Free T does move up and down a little and there is some truth to what your doc says, about keeping free T too high for long periods, I just recently wrote a very in depth article on this and am waiting for it to published on a website before I share the contents.
So although your doctor is on the right track, he or she sounds inexperienced and were never able to dial in people on injections. And although injections do not mimic your body’s natural production, the right dosage allowing for a proper swing in free T over a period of 5 to 7 days instead of 24 hours works much better.
I would argue that cream is actually less reliable, so much as you cannot always guarantee it will hit the peak, one day the patient can rub it on and get x amount absorbed and then the next day rub it on and absorb a completely different amount. So you could wind up having a detrimental health effect because of low T, and this is shown in studies. On the manufactured brand really hard to get TT over 400 ng/dl
Plus the fact that it creates way too much DHT, getting a swing in free T over a period of 5 or 7 days not only works just as good, it can easily be replicated long term because of the efficiency of the delivery method.
I take back what I said about your doc, maybe he/she understands just a little 
Hope this makes sense.
To add notice in the study it points out T injections were much better at increasing LBM. This is why proper testosterone levels decrease your risk of all-cause mortality by 50%, so if your not getting the increased LBM and decreased android fat, your not getting the beneficial effect that decreases risk.
The anabolic effect
Gel and cream are two different things. Are you sure you know what he wants you to switch to?
This is the biggest nonsense I’ve heard in awhile, creams are easy and your doctor knows it and this is justification for creams.
Injectable T isn’t very potent if the dosage is low, injectable T requires most skill and knowledge from your doctor. If your SHBG really is 14, this limits you to daily injections and T- cream.
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So I followed your advice and got SHBG tested.
It came back with 7 nmol/L. So sounds very low. You said your is in 12-22 and you have to do it daily.
BUT from lab description I understood that it’s better to have it low because SGBG binds to T and renders it useless. Did I misunderstand lab explanation?
Search low SHBG here. I don’t think there’s anyone that would love to have low SHBG for TRT. Some would like low-er SHBG but not low. Obviously you don’t get to choose so you make the best of what you’ve got. Luckily for you though there are plenty folks here with low SHBG that are doing well. Read their journeys.
This is very low, you need daily injections. You should use the search function for low SHBG men on TRT and see what happens when injecting less frequently. Scrotal T cream has been known to work well for some men.
TRT lowers SHBG, to mitigate this daily injections is appropriate.
Read this interesting article on SHBG the other day.
Seems bound androgens aren’t as inactive as once thought.
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