Anyman's personal journal: May it help me and others to follow

Diancecht · 12-16-2007, 12:07 PM

I have some suggestions that may or may not help:
First of all if you are going to take 1cc of test fill the syringe with at least 1cc of air. Then inject the air into the vial. This prevents a vacuum build up in the vial which can slow the filling process.

Then overfill the syringe ( eg. if needing a one cc of test, fill the syringe with 1 and 1/2 cc of test) Keeping the needle in the syringe push the plunger back up intill only 1cc is left in the syringe. Then withdraw the needle from the syringe. Then change needles and proceed to delivering the injection.

Also if you are an old fart like me, you might need some reading glasses to read visual the syringe markings and test levels well.

Always wipe the top of the syringe with alcohol before drawing from the vial. Then use a seperate alchohol swab to clean the skin.

Make sure the uncapped needles do not touch anything other than the vial or your preprepped skin prior to injection.

Dont be embarrassed about mistakes, I could tell you legions of stories of mistakes that other providers and myself have made learning these procedures.

I would expect your Dr. or his nurse would be glad to walk you through the procedure to make sure you have it all down pat. THERE ARE NO DUMB QUESTIONS!

Good luck.

anyman · 12-16-2007, 12:26 PM

Thought I had done most of the list, but apparently not entirely. I did inject air, but did not overfill. Seems the "wet" sides of the syringe tricked me into thinking it was filled. I had to hold it up to a light to see that it was only just starting to fill and would take some time due to the viscosity. I erroneously assumed that T would flow in the same manner as hcg.

Good suggestions on hygiene. Hadn't thought to wipe the needle as well, if I read your post correctly. My Dr (Shippen) is a good 4 hours away, so there is an element of DIY going on. I'm still embarrassed. I have a professional degree and am mechanically inclined, yet cannot read a damned syringe! I won't make the same mistake twice.

Curious- How do you and your patients get around the PO'd at dependence issue I have? Or, am I one of the few stupid enough to complain about it? This whole issue has got me thinking about many things, including the human spirit/soul, assuming there is such a thing. More specifically, I have begun to wonder how much of me is "me" and how much is merely the end result of random-and easily fouled up- chemical reactions over which I have little or no control? My personality, energy level and even will to live are all drastically affected by low T. Am I "me" or merely a result of whatever hormonal levels my body can produce? Is a person one might think to be less than nice or preoccupied a "bad" person as generations pst might have thought or might said person merely have a medical issue?

Quote:

Originally Posted by Diancecht

I have some suggestions that may or may not help:
First of all if you are going to take 1cc of test fill the syringe with at least 1cc of air. Then inject the air into the vial. This prevents a vacuum build up in the vial which can slow the filling process.

Then overfill the syringe ( eg. if needing a one cc of test, fill the syringe with 1 and 1/2 cc of test) Keeping the needle in the syringe push the plunger back up intill only 1cc is left in the syringe. Then withdraw the needle from the syringe. Then change needles and proceed to delivering the injection.

Also if you are an old fart like me, you might need some reading glasses to read visual the syringe markings and test levels well.

Always wipe the top of the syringe with alcohol before drawing from the vial. Then use a seperate alchohol swab to clean the skin.

Make sure the uncapped needles do not touch anything other than the vial or your preprepped skin prior to injection.

Dont be embarrassed about mistakes, I could tell you legions of stories of mistakes that other providers and myself have made learning these procedures.

I would expect your Dr. or his nurse would be glad to walk you through the procedure to make sure you have it all down pat. THERE ARE NO DUMB QUESTIONS!

Good luck.

cpeil2 · 12-16-2007, 12:50 PM

Quote:

Originally Posted by anyman

Hadn't thought to wipe the needle as well, if I read your post correctly.

Do not wipe the needle. The instructions were to not let the needle touch anything but the stopper of the multi-use vial, and your disinfected skin.

Diancecht · 12-16-2007, 12:56 PM

Quote:

Originally Posted by anyman

Thought I had done most of the list, but apparently not entirely. I did inject air, but did not overfill. Seems the "wet" sides of the syringe tricked me into thinking it was filled. I had to hold it up to a light to see that it was only just starting to fill and would take some time due to the viscosity. I erroneously assumed that T would flow in the same manner as hcg.

Good suggestions on hygiene. Hadn't thought to wipe the needle as well, if I read your post correctly. My Dr (Shippen) is a good 4 hours away, so there is an element of DIY going on. I'm still embarrassed. I have a professional degree and am mechanically inclined, yet cannot read a damned syringe! I won't make the same mistake twice.

Curious- How do you and your patients get around the PO'd at dependence issue I have? Or, am I one of the few stupid enough to complain about it? This whole issue has got me thinking about many things, including the human spirit/soul, assuming there is such a thing. More specifically, I have begun to wonder how much of me is "me" and how much is merely the end result of random-and easily fouled up- chemical reactions over which I have little or no control? My personality, energy level and even will to live are all drastically affected by low T. Am I "me" or merely a result of whatever hormonal levels my body can produce? Is a person one might think to be less than nice or preoccupied a "bad" person as generations pst might have thought or might said person merely have a medical issue?

I dont wipe the needle. It should be sterile. Just dont let it touch anything other than your pre-swabbed skin or the pre-swabbed vial. Use a bigger needle for the draw. Change needles and use a smaller gauge needle for the injection.

Frankly probably a majority of the population has dependency on one medical device or the other as you age. It can be glasses,injectable meds like test and insulin, oral meds such as for BP, depression, thryoid, etc. We are all human and have our weakness from an emotional standpoint and so do our bodies. Its a part of our humanity. Welcome to the human race!

anyman · 12-28-2007, 04:55 PM

Well, now that I realized I was indeed loading the syringe wrong (wow-was that ever dumb...) I have been on 160mg of T cyp per week for the last 4 weeks or so broken down into 80mg (.4mL of 200mg/mL) twice per week. HCG is added in at 300units 2x/week. Additional meds include a compounded T3/4 supplement and various 5htp, etc supplements.

First blood work drawn only 1-11/2 wks into it saw a rise to 427. E was still under 32. More blood was drawn the other day and I await more detailed results.

So far, I feel a bit better, but not any thing like I was hoping for. Occasional bouts of depression have been replaced by a more present than not malaise and lessened, but still persistent fatigue. So far, the only product guaranteed to help is, of all things, Ritalin. Yes, Ritalin. In low doses it can do wonders and greatly improves mood and energy. Weird.

Not sure what else to look at. I keep reading of others feeling amazing when they start TRT and wonder why I haven't got there yet.

MarkLA · 12-28-2007, 05:35 PM

FYI: If you did not double-up on the first dose, it will take about a month for you to hit a steady-state level... 160 is a pretty decent dose. In my non-expert opinion, I think you'll end up quite a bit higher once you hit steady-state. I'm curious to see what your new bloodwork shows.

I'm on 100mg/week and while I feel OK, I think I am still low. Tests will tell, but I don't go for them until two more weeks and won't have the results until almost a month from now. (Damn ultrasensitive estradiol takes Quest 10 days to analyze and report)

Mark

Diancecht · 12-29-2007, 11:33 AM

A couple of ideas for you to discuss with your doc.

First individual response to testostone is variable. You may need a higher testosterone level to feel better. Also what is your free testosterone. It may take several months to get the full effect of the testosterone. Not everyone gets an immediate response. Discuss with your doc.

Secondly unless you are taking Ritalin for what is was approved (ie. ADD etc) you might just consider stopping. In essence Ritalin is a stimulant like methamphetamine just not as potent. However long term use can result in symptoms of decreased mood, energy etc during withdrawal of the med. Your neurotransmiiters maybe be depleted with the long term use. At first you may feel worse stopping the Ritalin but later will feel better naturally.
Discuss with your doc and gets agreement however before you stop!

Good luck and have a happy new year.

anyman · 12-29-2007, 01:58 PM

Thanks for taking the time to respond. Much appreciated. Allow me to respond.

Quote:

Originally Posted by Diancecht

First individual response to testostone is variable. You may need a higher testosterone level to feel better. Also what is your free testosterone. It may take several months to get the full effect of the testosterone. Not everyone gets an immediate response. Discuss with your doc.

Good point. I recall from Jan's postings that it took him 9 months for his depression to lift. As for free T, Dr Shippen has not yet focused on it. This puzzles me as he is well regarded in this field. I will discuss with him during our next consult, which is in another 3 weeks or so. I may know more when I get the results from last Wed's blood draw.

Secondly unless you are taking Ritalin for what is was approved (ie. ADD etc) you might just consider stopping. In essence Ritalin is a stimulant like methamphetamine just not as potent. However long term use can result in symptoms of decreased mood, energy etc during withdrawal of the med. Your neurotransmiiters maybe be depleted with the long term use. At first you may feel worse stopping the Ritalin but later will feel better naturally.
Discuss with your doc and gets agreement however before you stop!

Interesting-and a good warning to heed. I thought Ritalin was safer than that based on my admittedly limited Google research. I use it rather sparingly- a few times per week at the most and at half the recommended dose. I find it calms me and, more importantly, lifts the veil of nasty/cranky attitude that all too easily permeates me as of late. Makes me much more patient with my kids--and the father they deserve.

Your point on the neurotransmitters is also well taken. I had them tested by "Neuroscience" over the summer. Both serotonin and dopamine were exceedingly low. I've been taking 5htp, l-theanine and now dopamine support supplements, but have no noticed anything different. AFAIK, Ritalin works on dopamine levels. How else can I get them up?

Good luck and have a happy new year.

Thank you--and the same to you and your family!

Diancecht · 12-29-2007, 02:12 PM

In addition to supplements make sure you have a well balanced healthy diet

Another factor would be exercise. Its known to work fairly well at helping cope with and in some cases get thru their depression. The key here is regularity. What type of weekly exercise program do you follow? Of course the problem here is if you are depressed you dont feel like exercising. However if you start out slow and be consistant most people can get a good program going.

anyman · 12-29-2007, 02:25 PM

Again, I appreciate the time. Here ya go--

Quote:

Originally Posted by Diancecht

In addition to supplements make sure you have a well balanced healthy diet

I generally eat well. balanced meals, good protein intake and an occasional "Designed whey" protein shake

Another factor would be exercise. Its known to work fairly well at helping cope with and in some cases get thru their depression. The key here is regularity. What type of weekly exercise program do you follow? Of course the problem here is if you are depressed you dont feel like exercising.

I exercise regularly, no matter how I feel, although on my "worst" days it can be a struggle. It can help somewhat, but is no panacea. I usually lift weights 4-5 days per week and do some cardio 2-3 of those days as well. Just came from the gym now. Did shoulders (3-4 exercises with 3 sets each) and 30 mins on the elliptical at a good clip. I'm actually in decent, but not perfect, shape for a guy in his mid 40s. I'm 6' and about 210lbs. I am increasingly convinced that my issues arise from continued chemical issues, since depression and irritability were not something I experienced prior to a few years ago. I want to be a better father and not so easily annoyed by my kids. They deserve better. When I do take the Ritalin I become the person I am inside and want to be. Calmer, not PO'd at everything, no sense of wanting to just crawl into a hole and at peace. It'd be easy to take that stuff every day, but I limit it to infrequently. The last was xmas day, when the family came over. Half a tablet made a big difference, even though I cursed my weakness for relying on it. Couldn't ignore the hard real world changes, however.....

Diancecht · 12-29-2007, 02:33 PM

Quote:

Originally Posted by anyman

Again, I appreciate the time. Here ya go--

You certainly have a good work program! Although I doubt much liklihood is present are you having any symptoms of overtraining such as muscles staying tired and stiff, frequent injuries, sense of well being after laying off the program or greatly reducing it for a week or so.

The program I follow usually mandates about 1 week about every 3 months to reduce the liklihood of overtraining.

Regarding the Ritalin it may be ok to use just check with your doc. What you dont want to do is yo yo the med. In other words use it consistantly or not at all if possible. But again check this with your doc.

I am just an aging trauma doc who is learning about this HRT stuff myself so take it with a big grain of salt.!!

Bye the way I am 6ft with a mesomorphic build and I need about 200 mg per week to get to where I want to be with the Testosterone levels (about 1000)

anyman · 01-05-2008, 09:25 AM

Now that I've gotten some one month blood results I see some and feel some improvements, but am still puzzled. Been on 160mg/week of T cyp for about a 4+ weeks in addition to 2x/week hcg. Not quite what I expected at that dose. Here is what I got:

Total T: 566 (241-827 scale)
DHEAS: 247 (45-345 scale)
Estradiol: <32 (<52)
SHBG 11 (9-45)
Cortisol: 22.2 (AM ref 4-22)
DHT: ----- (pending)

This is weird. 160 mg/week of T sure seems like alot, yet all I see is 566? Plus, Cortisol is STILL high. My gut tells me that the consistently elevated Cortisol plays a factor in all of this, but my research isn't giving me a clear cut way to reduce it. My weight is good and I exercise. My Thyroid levels were a bit low, so Dr S has me on a T3/4 supplement plus topical selegiline.

Any thoughts or ideas? I do feel a bit better, but still prone to fatigue on a slightly lesser amount and a sense of malaise, although not as bad. Seems a higher dose may be in order. I hear that some guys need 200mg/week just to feel "OK". Perhaps I am one of them.

I will be asking Dr S why we aren't testing for Free T and await the DHT results. Might explain much is still way too low as has historically been the case.

JanSz · 01-05-2008, 09:56 AM

Quote:

Originally Posted by anyman

Now that I've gotten some one month blood results I see some and feel some improvements, but am still puzzled. Been on 160mg/week of T cyp for about a 4+ weeks in addition to 2x/week hcg. Not quite what I expected at that dose. Here is what I got:

Total T: 566 (241-827 scale)
DHEAS: 247 (45-345 scale)
Estradiol: <32 (<52)
SHBG 11 (9-45)
Cortisol: 22.2 (AM ref 4-22)
DHT: ----- (pending)

This is weird. 160 mg/week of T sure seems like alot, yet all I see is 566? Plus, Cortisol is STILL high. My gut tells me that the consistently elevated Cortisol plays a factor in all of this, but my research isn't giving me a clear cut way to reduce it. My weight is good and I exercise. My Thyroid levels were a bit low, so Dr S has me on a T3/4 supplement plus topical selegiline.

Any thoughts or ideas? I do feel a bit better, but still prone to fatigue on a slightly lesser amount and a sense of malaise, although not as bad. Seems a higher dose may be in order. I hear that some guys need 200mg/week just to feel "OK". Perhaps I am one of them.

I will be asking Dr S why we aren't testing for Free T and await the DHT results. Might explain much is still way too low as has historically been the case.

Your SHBG=11

You should need just 115mg/week
115 861 10.8 300 20.7 250
120 889 xx13 300 xx23 250

What is your injections schedule.
Change it to

(T + Liquidex) one day

(380iu hcg) the next day

draw blood on day of the shot, time of the shot, befor shot.

do these two tests, so you can get control of T & E2

Estradiol, Free, LC/MS/MS (36169X)
Testosterone, Free, Bio/Total (LC/MS/MS)

goal

FreeE2(0.45 - 0.6)
BAT~575
=============================================

Anyman,
forgive me, sorry for asking,
but we already had a case of injecting air instead of actual testosterone.

Get better eye glases.
Have your wife do the shots.
Make dam sure that you are actually getting in what you are planning.

=========================================

OldGator · 01-05-2008, 11:14 AM

Anyman - I'm glad your test came back and your #'s are better.
Per your (our) Dr.'s chart, it shows that your Free T is approx 200 pg/ml. That is well within normal range (per Dr. S's chart) so I'm surprised your aren't feeling alot better.
My Total T at my last test was almost identical to yours (599) but because my SHBG is up at 40 (yours is 11), my Free T calculates out at only 100. Wish I could get my SHBG lower! Was yours always low? I started out at 57!!

anyman · 01-05-2008, 12:37 PM

Quote:

Originally Posted by JanSz

Your SHBG=11

You should need just 115mg/week
115 861 10.8 300 20.7 250
120 889 xx13 300 xx23 250

What is your injections schedule.

Estradiol, Free, LC/MS/MS (36169X)
Testosterone, Free, Bio/Total (LC/MS/MS)

FreeE2(0.45 - 0.6)
BAT~575
=============================================

Anyman,
forgive me, sorry for asking,
but we already had a case of injecting air instead of actual testosterone.

Get better eye glases.
Have your wife do the shots.
Make dam sure that you are actually getting in what you are planning.

=========================================

I am now virtually certain the amounts are correct. For 200mg/mL I use a 1mL syringe and fill to .4, which I triple verify and had my wife check.

Dr S has me injecting .4mL on Th and Sun PM. HCG (300i) is done Wed and Sat Pm. I am already injecting 4x/week, which I know Dr J has said is too often for most. He generally does T 1x/week.

Could Estrogen be an issue? It's still under 32.

I am indeed puzzled. Dr S mentioned to me that some people are "fast metabolizers" who need more and more often. Says it is not common, but it can happen. I still await the DHT, which takes Quest at least 10-14 days to get to me. It has always been under range. I suspect that and the high cortisol are possibilities.