Subcutaneous Testosterone Injections Study
- 09-25-2006, 12:38 PM
Subcutaneous Testosterone Injections Study
STABLE TESTOSTERONE LEVELS ACHIEVED
WITH SUBCUTANEOUS TESTOSTERONE
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
(pĽ0.1). 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
- 09-25-2006, 02:13 PM
interesting. i was under the impression only suspension could be injected subq, as fat tends to affect absorbtion.
the real question is what gives you more bang for your injection. will 100mgs of TE subq boost test levels as much as IM. stable levels is one thing, but i want to get the most out of my 900mgs of so of test
09-25-2006, 04:30 PM
According to the study, SubQ shots cause higher T levels than IM shots. I don't think it would be practical to do 900mg of T SubQ.Originally Posted by jomi822
09-25-2006, 05:34 PM
09-25-2006, 05:42 PM
09-25-2006, 05:48 PM
09-25-2006, 05:55 PM
How much oil could you inject subq though? My HRT prescription has me injecting 1ML intramuscularly and THAT gives me a lump for almost a week. Wouldn't the lump be much more obvious if it's just beneath the skin? Or would it spread-out evenly?
09-25-2006, 06:27 PM
What journal is this abstract from? I'm trying to find the full-text.
(yes, I'm still alive, just busy as all get out)
09-26-2006, 12:13 PM
09-28-2006, 07:12 PM
I seem to recall that Dr. Shippen had some of his patients on Sub-Q T. I think he split it up into 3 30mg shots during the week. But I am not 100% sure. In any event, I know that it has been attempted by the Dr.'s in the know.
09-29-2006, 12:32 AM
Since I have extra Cypionate that I'm worried about Potentially going bad - I MAY consider giving this a shot just to see what would happen. But then this would probably be the wrong area to discuss that possibility.. Can we have this discussion moved?Originally Posted by Zero Tolerance
10-10-2006, 11:24 AM
Are you using 100mgs/ml that is a big dam shot not dose wise. I use 200mgs/ml and did .32mls with a 27g x 1/2" lg. needle into my thigh with no problems. The T comes out slow so I pull the plunger all the way down and hold it there until I get my dose. I read from one of Dr. Shippen's men that he give's him self a subQ shot but does it half on one side and the other half on the other side of his belly. So is doing .18mls on each side every 3 days = .36mls or 72mgs every 3 days.Originally Posted by Zero Tolerance
10-16-2006, 11:18 PM
I'm currently using 300mgs/ml per week of Cypionate. Actually, I just cut down to a 1/2 ml so that would be 150mg per week. But, when injecting into my thigh, I use a 25g 1" needle.
I just injected 1ml of Methyl B12 subcutaneously into my stomach. That seemed to go well.. I just don't know how Cypionate would react there.. Plus, I don't think the oil would go through the 29g slin pins I have..
Like I said, I'm considering giving all this a try but I'd like to see more feedback on it first.. Opinions, criticisms, etcetera...
10-19-2006, 06:46 PM
wait until the study comes out and they report the AUC (area under [the] curve) for both methods... I assume they will do this, as it would be retarded not to.
10-19-2006, 08:32 PM
Dr. John, I am sure you know this as well as anyone, but it annoys me to no end to hear that testosterone injections are problematic because they result in uneven levels of T. THAT'S BECAUSE THEY REFUSE TO INJECT MORE OFTEN THAN ONCE A FORTNIGHT! When, and why, the hell did that become common practice for something with a 5-6 day half-life? They are simply injecting once T falls below baseline, instead of acknowledging the widespread anecdotal evidence showing that falling/rising levels are hell for patients. I am glad that you are one of the only docs who will inject EW. I am sure there could be benefit from injecting twice EW for patients who can self-administer, as well.Originally Posted by Dr. John
200mg EOW (for the IM) is almost certainly what they are talking about. I suppose the study is far less useful than it could have been now... who reviews these things before they go to trial?
EDIT: And yes, I actually have no idea how one would go about sticking a 23g needle into abdominal fat... do you go close to parallel to the surface to avoid stabbing your liver or god knows what else?
10-20-2006, 11:49 AM
Did Dr. Shippen tell you why he does it? Is it just ease of use (no telephone pole injections)?
Originally Posted by Dr. John
10-20-2006, 01:30 PM
I am not sure which is worse, one huge shot per week (and 2 hcg shots), or 3 subq T shots (I believe that is what Dr. Shippen uses) and 2 hcg shots. I imagine it will be a lot more complicated as you will be dealing with 3 different half-lives of a smaller dose (or maybe it will be more like a gel).
Originally Posted by Dr. John
10-20-2006, 06:03 PM
I can attest to that. :dl: Q3D or bust for me!Originally Posted by Dr. John
MAN, I love those little guy's!
10-20-2006, 06:37 PM
Now I just have to lose this excess water, frequent tee teeing, & hot flashes.Originally Posted by Dr. John
That pregnenolone should be icing on the cake for my OCD/anxiety, so to speak.
You know, because I am a beefcake & you use pregnenolone cream & it is like icing... Ah never mind.
01-25-2007, 01:42 AM
This thread has turned into a discussion of getting steady serum levels. I was one of the guys who suffered on weekly injections, with down times getting longer and longer until down time was 7 days and I could not feel the lift from the injections. In some ways I was worse off than before starting TRT. (TT was almost 900)Originally Posted by Dr. John
When I later got onto HCG, 250iu EOD SQ, I tried injecting test cyp with the #29 .5" .5ml syringe. Slow to draw and injection time is not bad. I now inject 28mg (0.14ml) test cyp IM EOD (98mg/wk) at the same time as my HCG. That made me feel a lot better. With that steady level, I was then able to judge what other changes were making to my body that was not bouncing up and down on T anymore. I had a steady frame of reference. Things were better, but E2 was interfering with the TRT. (Treated symptoms, E2 levels were still in normal range.)
I inject in the vastus lateralis. Skin/fat needs to be thin. The 1/2" is deep enough for IM with the 0.14ml doses.
Later when I started anastrozole, 1mg/wk, I could really feel and evaluate the changes. Too bad that I was not on the anastrozole earlier.
I really do like my EOD routine and having my T injections harmonized with my HCG injections. This works very well for me.
01-25-2007, 01:33 PM
01-27-2007, 03:23 AM
Very interesting stuff. I would think that if things pan out, injecting test EOD using a much smaller needle, say a 1/2 inch insulin needle SQ would be much easier and user friendly. Basically the same protocol for hCG.
01-27-2007, 12:28 PM
When I first read Shippen was doing shots subQ every 3 days splitting the dose into 2 shots every 3 days. Here is a cut & paste on the post.
I heard back from the patient of Dr. Shippen. He injects depo-testosterone 200mg/ml, .35 ml every 3 days into abdominal fat. He splits the injections into two .18 ml injections which is .36 ml, and says this is because a tiny amount will leak out of the injection site.
According to this patient, this dosing schedule leaves him with a stable 900 ng/dl total testosterone level and none of the high estrogen conversion associated with large intramuscular injection.
Apparently Shippen is convinced enough that this is now his preferred method of TRT. I know he starts by trying to get levels into the high normal range by trying to get the body to make its own, but if TRT is called for apparently subcutaneous injection is the first thing he prescribes.
I told my Dr. about this one yr. ago and he said it's ok to try doing my T shots every 3 days but not subQ. He told me to use a 27g 1ml x 1/2" lg. needle and to shot into my thigh.
So I have been doing 50mgs every 3 days down from 64mgs. And my HCG 250 IU's the 2 days each in between. I feel I get the same results as Shippen my levels are more stable and my E2 is less of a problem. I tried doing supQ into my belly with the Depo T and it burns most to the day. Also doing my HCG into my belly I don't get that feeling of well being and don't sleep good that night. I feel it takes longer for the HCG to work and this is why the sleep problem.
So I do both T and HCG with a 27g needle. I have started treating my low Cortisol levels with 5mgs of Cortef 4 x's a day and my low Thyroid with Armour. Doing this my last test came back very high my Free T is over the top of the range and my T levels went to the top of the range. My DHEA went over the top so we cut back on this from 50mgs to 25mgs a day. My Dr. never changes my does by one lab test we have got to many bad test in the last 15 yrs. So if my levels are still high on my next test we will be lowing my dose on T and HCG.
01-27-2007, 01:29 PM
Are you saying that you find that HCG IM works better than HCG SQ?Originally Posted by pmgamer18
I take 25oiu EOD for 875iu/week. What is your weekly dose?
01-27-2007, 02:10 PM
Very cool. EOD is the route Im going to go if/when I start. After reading Ksman's posts on another board(and here as well) he has me convinced its the way to go. It makes the most sense. I mean is it really that much difficult taking a couple of minutes out of your day to self inject a few more times a week? Plus, the added bonus of using smaller insulin needles.Originally Posted by Dr. John
BTW, I'll be seeing you Dr Crisler on the 20th
01-27-2007, 02:32 PM
Yes I am saying that for me it works much better. Lets says I start on Monday.Originally Posted by KSman
M= 50mgs of Depo T shot.
T= 250 IU's of HCG
W= 250 IU's of HCG
T= 50mgs of Depo T shot.
F= 250 IU's of HCG.
S= 250 IU's of HCG.
S= 50 mgs of Depo T shot.
So in a week you can say I do 1000 IU' of HCG.
01-27-2007, 03:43 PM
Just remember, if you tested at LabCorp, their FreeT is bunk.Originally Posted by pmgamer18
If you tested at Quest Diagnostic and used
Free and Total Testosterone
▪ Total: LC/MS/MS
▪ Percent free: equilibrium dialysis
▪ Free: calculated based on total and percent free
▪ Aliases: testosterone index, dialyzable testosterone
▪ CPT Codes*: 84403, 84402
That is also not good.
The test that you want at Quest diagnostic is
Free, Bioavailable, and Total Testosterone
if you cannot get that one, then you can calculate FreeT youself,
but you need
TT, SHBG and Albumin from the same blood draw.
01-27-2007, 04:42 PM
Most of the bad tests I have had are from Quest I only use Quest for my E2 test the rest I get done at a loco lab called BioTech. My Free T has a range of 8.8 to 27 pg/ml and is the best lab test for Free T out. After all I have been at this for over 23 yrs.Originally Posted by JanSz
01-27-2007, 04:51 PM
Whatewer makes you happy.Originally Posted by pmgamer18
If you have a time read this:
LETTER TO THE EDITOR
An Extraordinarily Inaccurate Assay for Free
Testosterone Is Still with Us
To the editor:
Perusing the November 2000 issue of JCE&M, I noted an article in
which one of the outcome measures was serum free testosterone (1). The
method used to measure serum free testosterone, a direct RIA that
purports to, but does not, measure the free testosterone concentration is
one whose use I decried in a letter to the editor published more than 3
yr ago (2). Not long after, Vermeulen et al. (3) published a side-by-side
experimental comparison of methods for determining the concentration
of free testosterone in serum. Those experiments conclusively show that
the direct RIA of free testosterone is seriously inaccurate, underestimating
its concentration by many-fold. To my knowledge, there are no
data that contradict these conclusions. Hence, I was surprised to find that
the direct assay method not only was still being used for investigative
purposes, but also was being published in what is among the foremost
endocrine journals in the world.
To see how pervasive this situation was, I undertook to examine the
frequency with which those publishing in the journal were using this
Methods. I conducted a full text, online search, of the JCE&M (January
1998-November 2000) using the term “free testosterone.” Then, I evaluated
each retrieved citation containing the term and ascertained
whether it revealed the use of a direct RIA for free testosterone, an
alternate method for measuring free testosterone, or was not applicable
(e.g. free testosterone mentioned in an editorial, a comment, a discussion,
a bibliography, etc.). In addition to the foregoing, there were a number
of publications in which no reference was given.
Results. A total of 116 citations were retrieved: 49 were not applicable;
11 contained no reference for the method cited; 24 used a method other
than direct RIA; and 32 used the direct RIA. Of the 116 citations, 67 were
suitable to address the question at hand. Thus, 48% (32 of 67) of the
applicable papers used a seriously inaccurate method for estimating free
testosterone and, almost as serious, 16% (11 of 67) cited no method at all.
Why would anyone choose to use this methodology? Perhaps the
answer can be found in the technical bulletins of one of the companies
that manufacture and sell kits that use this method. The relevant citations
reveal that kits made by two companies, Diagnostic Products and
Diagnostic Systems Laboratories, Inc. (DSL), account for almost all the
inappropriate measurements of free testosterone in papers published in
the journal during the period in question. A DSL technical bulletin
(cPanel®. dslabs.com/techlit/4900tb2.doc) advertises: “Historically,
free testosterone levels were determined by a method known as
equilibrium dialysis. . . . The method is cumbersome, time-consuming,
and equipment intensive.” Conversely, we are told, the DSL direct
method is simple and rapid. The only difficulty is that “the equilibrium
dialysis method gave values approximately 4 times higher than did the
DSL kit.” As if to compensate for the inexcusable inaccuracy, the technical
bulletin and accompanying X-Y plot of RIA vs. equilibrium dialysis
makes the point that the correlation coefficient is 0.92. Even this is
deceiving. The points at the upper end of the DSL method are the major
contributors to the fitted line. Visual examination of the plot indicates
that a line through the lower points (17 of 21 points below the fitted line
and 2 points above it) would have a substantially different slope than
that indicated by the published fitted line. Thus, in addition to being
inaccurate, this observation indicates that, compared with equilibrium
dialysis, the assay is not linear. Yet, the kit remains on the market
because it is easy to use.
Almost one half of the publications dealing with free testosterone, in
the period under consideration, used an inaccurate assay for its measurement.
Even if the (somewhat more time-consuming) procedure of
equilibrium dialysis were the only alternative, the literature of science
ought not to use a method so grossly inaccurate when better ones exist.
We all know that there are numerous assays for hormones in serum that
are method specific. However, I know of no other that has been demonstrated
to be so egregiously incorrect. The journal might choose to
return manuscripts that use it without further evaluation to discourage
Department of Endocrinology
St. Luke’s-Roosevelt Hospital Center
New York, New York 10019References
1. Brown GA, Vukovich MD, Martini ER, et al. 2000 Endocrine responses to
chronic androstenedione intake in 30- to 56-year-old men. J Clin Endocrinol
2. Rosner W. 1997 Errors in the measurement of plasma free testosterone. J Clin
Endocrinol Metab. 82:2014–2015 (Letter).
3. Vermeulen A, Verdonck L, Kaufman JM. 1999 A critical evaluation of simple
methods for the estimation of free testosterone in serum. J Clin Endocrinol
Metab. 84:3666 –3672.
Received November 29, 2000. Address correspondence to: William
Rosner, M.D., Department of Endocrinology, St. Luke’s-Roosevelt Hospital
Center, 1000 Tenth Avenue, New York, New York 10019.
0021-972X/01/$03.00/0 Vol. 86, No. 6
The Journal of Clinical Endocrinology & Metabolism Printed in U.S.A.
Copyright © 2001 by The Endocrine Society
Downloaded from jcem.endojournals.org by on January 27, 2007
02-27-2007, 04:17 PM
Are there any blood results available from somebody who's done T injections subcutaneously? I'm curious about trying this while on my HRT program...
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