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TRT: Protocol for Injections
 

Jscott8220
Level 3

Join date: Sep 2009
Posts: 29

I think I may have dropped past the sweet spot in regards to E2 recently. My sex drive has dropped off a little, but still higher than before I started TRT. For a while I couldnt get enough of it. 3/8/10 will be the end of my 5th week. I get bloodwork covered by my insurance since my primary Dr. gave me androgel. He thinks Im using it so I can just call saying I want to check my levels. Im going have some blood work done at the end of this week mainly to get my E2 dialed in.

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KSman
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Join date: Aug 2006
Posts: 7883

Get serum E2 tested at LEF.org

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Jscott8220
Level 3

Join date: Sep 2009
Posts: 29

I my insurance uses Quest labs and its free. I just need to make sure they as for the right E2 test. Is it the sensatives or ultrasensitive E2 essay i need to ask for?

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KSman
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Join date: Aug 2006
Posts: 7883

Depends. You sort of need to know where your E2 is before you test it with Quest. The E2-Quest situation leaves me confused. Perhaps someone else has something useful to post.

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dan.desroches
Level

Join date: Aug 2009
Posts: 33

I'm hoping for some advice from you guys...I believe my doctor mentioned I'm primary hypogonadal, so does that mean I can never truly "cure" this? Is there anyway to restart my natural production?

My doctor has me on Andriol @ 4x40mg per day, but I told him I wanted to switch to injections because they are just the tried and tested method of administration. He keeps telling me that he doesn't want to because IM injections give such an unnatural response. How do you guys suggest I go about convincing him that it's not a big deal. I could just inject E3D or something like that with 75mg or something along those lines right?

My doctor also mentioned that at 160mg of Andriol, I don't need to worry about aromatization, HPTA shutdown or testicular atrophy. What do you guys think?

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KSman
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Join date: Aug 2006
Posts: 7883

IM injections only have unnatural T level profiles when injected infrequently. SC is better than IM in that regard. EOD injections create very steady levels and the small volumes involved can be injected with #29 0.5ml[50iu] 0.5" insulin needles. The issue is not injections, but how injections are done. The problem is that "practice" has been all wrong. This stems from the early premise that injections would be done at the doctors office and then every two weeks. When you self inject, the injections can be much more frequent. Docs have problems letting go of what has been written as protocol and learning to think about something so simple on their own.

Even if functionally primary, you may not want to have your testes shrink with permanent damage. You may be fertile and may not want your TRT making you sterile. You could get a semen sample for a sperm count. You would need hCG at a minimum.

With injections, you need to monitor serum E2 and control near 22pg/ml or 80pmol/L.

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turbospeed
Level

Join date: Apr 2010
Posts: 5

if i cant get arimidex is there any other AI that will do the job like clomid? i found it at a couple of pharmacys but they refuse to sell it because its an oncology medicine.

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KSman
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Join date: Aug 2006
Posts: 7883

Clomid is a SERM, not an AI. The have some overlap in use, but are not interchangeable. Clomid can be a bad actor, there are better SERMs.

Clomid is a SERM that was originally created to to treat breast cancer. It has many other uses and the pharmacist is off-base. You need a scrip in any case and your post does not provide much to go on.

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durak
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Join date: Apr 2010
Posts: 11

Headhunter wrote:
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.


Really? MY TRT doc has me on
200mg cyp (100 2x week),
250mg HCG eod
12.5mg Aromasin eod (or .25 arimadex eod)

I assume we cannot talk price so lets say it no where near what you are talking about.

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Hammerfists
Level

Join date: Apr 2010
Posts: 14

Where the hell do you guys find this stuff? I have friends that use different types but I'm afraid to take their advice. I live in Everett, Wa just north of Seattle. Any tips on a legal way to go about this is appreciated. PM please!!

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bigdawg011
Level 1

Join date: Jul 2006
Posts: 288

durak wrote:
Really? MY TRT doc has me on
200mg cyp (100 2x week),
250mg HCG eod
12.5mg Aromasin eod (or .25 arimadex eod)

I assume we cannot talk price so lets say it no where near what you are talking about.


Nice name (durak), but don't be one with this TRT stuff. Are you sure you want to take Aromasin? If you drive your estrogen too low, you could mess up your joints and libido.

Otherwise, seems like a good regimen if you can control E2.

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durak
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Join date: Apr 2010
Posts: 11

bigdawg011 wrote:
durak wrote:
Really? MY TRT doc has me on
200mg cyp (100 2x week),
250mg HCG eod
12.5mg Aromasin eod (or .25 arimadex eod)

I assume we cannot talk price so lets say it no where near what you are talking about.


Nice name (durak), but don't be one with this TRT stuff. Are you sure you want to take Aromasin? If you drive your estrogen too low, you could mess up your joints and libido.

Otherwise, seems like a good regimen if you can control E2.


Thx bigdawg. My total test was at 240 before I started TRT. I also take a lot of time to educate myself about the whole process. So no fool here. As for the Aromasin, the arimadex was not getting the job done and on Aromasin my E2 is 24. I will get rechecked soon to make sure it is not too strong.

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KSman
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Join date: Aug 2006
Posts: 7883

Hammerfists wrote:
Where the hell do you guys find this stuff? I have friends that use different types but I'm afraid to take their advice. I live in Everett, Wa just north of Seattle. Any tips on a legal way to go about this is appreciated. PM please!!


This is medical use, not gear. Some here, who are also young men, need TRT because of misadventure with gear. Stupidity and ignorance see to be very synergistic. Help yourself!

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turbospeed
Level

Join date: Apr 2010
Posts: 5

i been injecting
250mg of testosterone enanathe (primoteston )a week divided in two 125mg( .5ml) shots + 1.5mg arimidex + 1ml hcg once a week

previously was on androgel and felt a lot better lost of libido and energy , with the injections felt good like the first week but after that i have started to go back to my low libido , low energy state.

i been self injecting at the thigh with .5ml insulin needles.

for reference

wait size 38 inches
heigth 185cm
about 105kg
lots of abdominal fat
little muscle on arms

pre trt testosterone levels

3.87ng/ml

range
1.5-11.38ng/ml


any ideas i would like to keep with the injections because of the price of androgel but they seem innefective



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KSman
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Join date: Aug 2006
Posts: 7883

Inject hCG EOD, 250iu EOD suggested. Do not state ml's that is not the dose. State in iu's.

You need to have current TT, FT and E2 results to know what is going on and what to do. Your estrogen levels may be too high. Your TT and FT levels may not be high enough IF you are hyper metabolizer of testosterone. There are some who need 300mg/week to have basic high-normal T levels. Elevated E2 can negate the effects of high T levels. E2 management is often mission critical.

You might also be feeling the effects of less DHT moving from transdermal to injected.
Please create your own post outside of this sticky.

Read this sticky some more to get recommendations about dose and frequency for Arimidex/anastrozole and T. Anastrozole once per week is not going to work properly. Make changes and then do lab work after 3-4 weeks. You can do tests on your own if need be.

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G-tone
Level

Join date: Nov 2009
Posts: 8

Hammerfists

If you want to know where to quote "get this stuff" first you need to be tested - blood test, this STUFF is not to be abused!
Pay attention to KSman.......... and others as well.

OK I said my say NOW -------- The best way to find out which doctors prescribe what, is to call the Pharmacy's around your area, pharmacist are more the willing to listen and divulge this information why not your a potential $$ maker for them, didn't I post this already?

Sorry KSman did I do it again -------- hyjack this thread? Y/N

G-Tone

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doctornorm
Level 4

Join date: Oct 2002
Posts: 42

Dear KSman:

After being on pellets(too expensive), now on T. Cyp. injecting 50 mg. twice per week(Mon/Thurs). Just got my recent labs and am a little puzzled. Would be most appreciative of your insights. TT = 921, FT = 21.1, E2 = 42.8 (when on the pellets it was 27), DHEA-S = 143.3
SHGB = 45.2. It's this latter that I don't really understand in view of my FT level.

I'm not on an AI, but obviously will be in short order(anastrozole). Any way to reduce the SHBG, or will it go down once on the AI and my estradiol level is reduced?

BTW, these are LabCorp values, so, of course, the T ranges are considered high based on their ridiculously low "normal" values, i.e., TT = 290-800 and FT = 6.6-18. My PCP's nurse told me I was way out of range on T and needed to do something about it. Well, yeah, I am--I'm going to increase it and try to get my FT up to around 25.

Many thanks for your kind help.

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KSman
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Join date: Aug 2006
Posts: 7883

TT does not matter as most of that is SHBG bound T that is functionally inert. Some docs do not even test TT once on TRT. Yes, you could aim for higher FT. First get E2 down and see where FT goes from there. You will feel reborn.

You can increase T dose later if you still have symptoms. Save higher doses for later when you are symptomatically less responsive. Remember that a higher dose of T will require a proportionate increase in anastrozole, when you have that stabilized.

You cannot lower SHBG unless you lower E2 or develop diabetes.

The lesson that is "on topic" for this sticky is that the nurse is a slave to lab ranges and does not understand much else. You need to be prepared to simply state that her interpretation is wrong and explain why. If she has a problem with that, she would be better leaving her ego at the door.

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doctornorm
Level 4

Join date: Oct 2002
Posts: 42

Many thanks. Am looking forward to getting that E2 level down to around 23.

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doctornorm
Level 4

Join date: Oct 2002
Posts: 42

KSman:

Just a quick follow-up. How long might it typically take using anastrozole eod to drive the level down from 42.5 to the 22-23? Also, in your opinion, how long would it be before I subjectively "felt" the change in E2 level?

Thanks again for your assistance.

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KSman
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Join date: Aug 2006
Posts: 7883

Feel good results in 10-14 days. Depending on how long one has had estrogen poisoning and how much E2, it may take two months to fully recover mood and personality. But most will be well in place by 1 month.

Anastrozole is a competitive drug. Its effects are immediate and it absorbs very well and fast. With its ~36 hour half life, EOD or ED doses will take 6-7 days to reach static serum levels. So fast response to any given serum level, but takes time to build serum level. The answer used to be to front load. But I cannot recommend that now as there are a lot more over-responders that were previously thought. Had one guy front load who became profoundly depressed, not willing to socialize at all. That was extreme. The effects of way too low E2 can be very unpleasant.

Lets assume that you could instantly go to a good serum level of anastrozole. E2 production rates would go to a new lower level within one hour, perhaps in minutes. Does that mean that your have the target level of E2? No. There is a production rate of E2, which you just lowered. And there is a removal rate controlled by the liver. The balance of this 'source' and 'sink' takes a few days to be reached.

So as you start anastrozole, it takes a while for the serum levels of anastrozole to build and it take time for the body to reach a balance of the reduced source production and liver elimination. So there are few processes that do seem to make sense in terms of a 7-10 day delay.

After you reach a final E2 end point, brain and other tissues need to respond physically to the change. Then patterns of thought need to change and your sexual pursuit areas of your brain can become more intent.

Starting from E2=42.5, you should feel profound changes and those around you may find you a better person too.

One should take 1mg/week per 100mg test ester per week. Just had one guy taking around 1mg/week with 160mg test cyp. He got to E2=30pg/ml. His new dose calculated to 1.5mg/week. Very close to the rule of thumb's 1.6mg/week. But, always start with 1.0mg/week in divided doses and if your T dose is higher than 100mg/week, then you can increase as suggested AFTER you demonstrate that you are not an over-responder.

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Diver1066
Level

Join date: May 2010
Posts: 5

KSman,

Brilliant article - thanks.

Just a question, can Test E be substituted for Sustanon 250 or is there a greater benefit from using Test E or Test C?

I currentkly inject Sust 250 Sub Q every 7 days 125mg. Would I be better to switch to Test C or test E?

Thanks buddy,

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KSman
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Join date: Aug 2006
Posts: 7883

If you want more T, you could simply inject more. So cost per mg comes up as an issue. Sustanon is an attempt to get a more even level of T over a week. Injecting twice a week, E3D or E2D/EOD is the obvious method to get steadier levels. Eth has more T than Cyp on a mg-T/mg-ester basis. I assume by your question that you are self medicating your TRT.

Many suffer with weekly injections and do better with EOD. That difference is greater

Steadier T levels leads to lower E2 and thus lower SHBG, allowing for better FT.

Overall, getting E2 controlled is often a greater success factor important than one level of T VS another.

If docs would adjust T doses to get to high normal or high youthful FT levels, then the doses would be changed to get there and then the end point would not be an issue of Cyp VS Eth. However, in doing that, Eth might be a more cost effective method. In the USA, T Cyp seems to be the mainstream drug and may be cheaper than Eth. If you get a Business Membership at Sam's 10ml 200mg/ml T cyp costs $42. Similar prices perhaps at Costco [with a regular membership]. To get those prices, you pay out of pocked and do not attempt to use your med insurance, as that will be more costly.

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Diver1066
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Join date: May 2010
Posts: 5

Thanks KSman.

I understand what you are saying about Sust providing a even level of T over a period, would you suggest following the twice weekly injection protocol with Sust in the same fashion as Test E? Or do you believe that Sust is fine for weekly SQ injection?

Thanks.

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KSman
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Join date: Aug 2006
Posts: 7883

Sust is attempting to do what it cannot do. If you feel fine with weekly sust SC injections, do that. SC also provide a more level response [VS IM].

If not sure, try more often and see what that does for you. You can always return to weekly injections later.

That is all that really matters - choice. We have a choice other than the once every week or every two weeks dogma and 1.5" needles in the arse.

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