Pros and Cons of Sub-Q T
- 10-08-2007, 03:11 PM
- 10-08-2007, 03:20 PM
Just Found this on another board:
Saudi Med J. 2006 Dec;27(12):1843-6.
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, PO Box 35, Postal Code 123, Al-Khod, Sultanate of Oman. Tel. +968 99475401. Tel/Fax. +968 24413419. E-mail: firstname.lastname@example.org.
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 - in process]
- 10-08-2007, 03:51 PM
At first I used 31ga 5/16" long needle (it is smallest and shortest that I could find).
I found out tiny leakouts from time to time, nothing really big, most likely acceptable situation.
I use now 30ga 1/2" long needle.
They do not make 31ga 1/2" long.
I never tried IM test shots but am hearing that they are painfull.
There is absolutely no pain when doing SubQ shots, no leak outs (now with longer needle).
I started my T shots on 6/19/07, using accelerated schedule (to get to steady levels faster).
Blood draw 8/30/07
results and dose adjustments shown on my post #62
Jan's BloodTest April13/2007
I use SubQ shots because of pain considerations,
but I thing that there is additional benefit as I expect that testosterone
fat--->blood transfer is slower than
I pinch the skin on my belly and insert the needle 45 deg sideways.
No questions, my shots are SubQ shots, needle does not touch the muscle.
Sometimes I am curious how it would feel if I went 90 deg inti tihg musscle, but no thanks for the pain.
Soon I will go to get flu shots.
My doc does it with (probably) with 30ga 1/2" long needle to deltoid muscle straight 90 deg, not a big deal either but why bother.
Dr J may not like sub q, but Dr. Shippen does.
you are going to do that full bore,
instead of wasting more time.
I am so glad that I am priviledged, I do not work.
I tried to work but was newer succesfull at it, so I quit.
What a country, beautifull USA.
Between my son, daughter and son-in-law,
son and daugher worked
son-in-law had a free day, but he took my grandson to see his parents in Reading PA,
so wife had a day off too.
Just because I apparently need T cyp doesn't mean I have to like it.
Taking external T is akin to admitting defeat- I was unable to successfully ID the source of the problem and repair it. Now I'll be dependent on external meds, the supply of which can be cut off through no fault of my own (Remember Hurricane Katrina?). At the age of 44 I am saddened to be dependent on medicine at so young an age, but my options are, regrettably, few and far between. I resent my body's failure and inability to conduct basic repairs. We really are a poorly designed species, aren't we?
What is your SHBG?
My last known SHBG=26
my new dose =38units=177.3mg/week
Jan's BloodTest April13/2007
Your goal is
You say: "I will be starting .6ml of 100mg T cyp"
The higher the SHBG the more T you need.
Make sure that you use 200mg/ml Depo-testosterone.
But if you are forced to use the 100mg/mL kind, remember to double the volume.
The sooner you give up on "admitting defeat" the better for you.
Just be gratefull that you have way out.
I am starting at a lower dose at Dr S's directive. He wants to start low and work up.
My SHBG is quite low--around 12. Dr S wants me to start lower and work up as--and if-- needed. He is trying to keep as much of my testes working as is possible. We'll start at 6ml and work up after a 3 week blood test. He is of the opinion that my very low shbg allows for lower total and free levels. We'll see how it goes. Maybe I'll get lucky and start to feel a bit better. The weird part is that usually feel pretty good the later it gets. I am really irritable and even depressed in the earlyt morning, but get better as the day wears into evening.
I think Dr John doesnt reccomend it based on little reseach done about its effects and the fact that it is not common, and he doesnt want to push the envelope in the community
I wondered what to expect as far as pain goes as well, but through my first 3 IM shots I have felt absolutely no pain. The only "pain" I feel is when the needle initially breaks the skin. It doesnt hurt at all when going into the muscle and there is no soreness the next day for me.
By the way I'm using 25g, 1 inch needles into the quads.
To get that TT you need
100-125 mg/week testosterone, best on E3D schedule.
That 0.6mL testosterone may do the job if you use
Since your SHBG is real low, you may be better off using E2D schedule, every other day.
Assuming that you are going to be using 200mg/mL testosterone
you weekly dose =120mg/week
assuming E2D schedule,
each shot=0.6/7*2=0.17cc=17 units on syringe
at the same time do shots of hcg Novarel 250iu
consider your estrodial status
To arrive sooner at your average level of blood testosterone
first four days do T shots each day and then continue on E2D schedule.
Bottom line is blood test, T, E2 and DHT
do these tests at Quest, draw blood on day of the shot, time of the shot, before shot.
Estradiol, Free, LC/MS/MS (36169X)
Testosterone, Free, Bio/Total (LC/MS/MS)
Dihydrotestosterone, Free, Serum (36168X)
there is many many other tests that you should consider.
see my post #62
Jan's BloodTest April13/2007
I am describing my Test and Liquidex dose adjusment based on above tests.
Looking at my chart, E2D schedule,
you should be rather well stabilized at 3 weeks after change of schedule.
Possibly there is no need to wait the usual 6 weeks.
Post #23 of
Jan's BloodTest April13/2007
Do not eat anything that is known to lower SHBG.
To raise SHBG drink soy milk.
Increase fiber intake to 35-40 grams majoirty of 70% soluable SHBG will come up and lower fat intake a bit. Go on a vegan type diet shbg will rise..
shbg is mainly driven by insulin and as i stated before insulin is a big factor...it makes sense more fiber reduces amount of insulin needed to handle the glucose. Less fiber speeds it up. am putting this theory to the test and my next blood report will reflect it.. shbg and insulin are antagonists. unless there is receptor damage give this a try and if it does not work then metformin may be necessary.
It is working for me very well.
I have been left for dead by head of sex department in major hospital in Manhattan NYC, at least the sex part.
I described my story many times on this board.
What I am advising to others is what I do for myself.
I am looking for all kind of angles of good health so I am reluctant to call what I do TRT or HRT,
anti-aging would be more like it..
See my story/diary/research here:
Jan's BloodTest April13/2007
If you are injecting into where there's a lot of aromatase activity, maybe the expectation would be increased E2.
I wonder if those posts were about people applying the transdermals to their abdomens; I understand that we don't usually apply to areas where there is fat because of that concern.
No, the threasd involved (and it was on more than one occasion - at MESO, I believe) was specifically about doing Test via subQ injection.
And Dr. Crisler was very much set against it... and specifically for the reason of that aromatase activity being higher in the fat cells and that when you do Test via subQ that you are injecting into the fat cells - thereby causing (or at least creating a higher potential to cause) higher Total Es and higher E2.
The threads were NOT about transdermals, just in the one thread Dr. Crisler used transdermals as at example as how you are in effect (if you have fatty application areas) inserting the Test into the fat layers where aromatase factor can be of greater impact...
I believe in the one post he said something along the effect of " ... so we don't inject Testosterone subQ as you're putting it into fat cells and that is where aromatase factor lives... " (or something to that effect.
I am not saying that this is what I believe 100% one way or the other - and still am waiting on some conclusive evidence in that regards. Just pointing out what I definitely recall from more than one posting of Dr. Crisler's.
There is THE $64,000.00 question.
What are the arguments on the other side of the fence?
What I have heard mainly is that subQ shots are easier to do - true, except I don't know about drawing from a vial with that thin of a needle - if that is what they do with subQ... and less "painful" (though the way that I do them with quads they are almost 100% painfree) - but true basically, and almost never have bleeding - true, etc.
Those are all nice advantages - plus the advantages of using same set-up of syringes rather than mutiple types. But if this process has anything more than a very remote chance of increasing E2 abd Total Es, then I personally would tend to shy away from it.
I believe (but not fully sure on this as I am trying to recall a quote from a Shippen patient - or so he claimed), but something was stated in the post I am vaguely recalling to the effect that Shippen was primarily concerned that E2 and Total E levels were simply "in range", not that they necessarily be in an "optimal range" as Dr. Crisler desires (at least at one time).
So maybe that accounts for the difference between Dr. Crisler's viewpoint and Dr. Shippen's viewpoint.
Also, is there anyone on this forum who very specifically a patient of Dr. Shippen's and is on Test via subQ specifically per Dr. Shippen? I have heard lots of comments about how Dr. Shipen not only thinks subQ is "okay", but that it is "better"... yet when I try tracking it down it turns out that the poster "knew of someone" or had "heard about one of Shippen's patients" or etc., etc., etc.
Unfiortunatley Dr. Shippen is not open with his viewpoints to the extent that Dr. Crisler is. In fact, as far as I know he doesn't even have a web site! Nor publish openly (articles, online commentaries, etc.) what protocols he is using, looking into, etc., etc.
Yes, he did write a book (which many consider "THE Bible" for TRT / Male HRT)... but the fact is that the book was initially written in 1998, with the most recent printing being in 2001 - with basically NO new information in the later printing. So we are talking about data that is 9 - 10 years old (and older).
So people going by that protocol and those regimens are following protocols that dated from the mid 90s to late 90s (seeing as how it takes at least a few months to write a book). And in addition to that, Dr. Shippen himself has since changed these protocols dramatically (from what one hears) and even reversed his position on some areas.
Well, I am a patient of Dr S. I'll have to ask him why he favors sub q vs im (m)
I am taking .6ml of 100mg T cyp 1x/week and 300iu hcg 2x/week (m)
I believe Dr Crisler's main objection to sub-q was the fact that he felt that injecting oil into fatty tissue produces unknown long-term consequences to that tissue.
Many lab results (including my own) have shown that sub-q delivers Test in a slower and steadier fashion. Many guys (including myself) note that E2 is lower on sub-q.
I think sub-q dulls the sharp spike in Test levels seen with IM injections. As a result, the response by E2 and DHT is less pronounced.
Why didn't these fools ALSO test for Total Estrogens, Estradiol, and DHT to see if any of those were affected by injecting subQ???
I have also heard about Dr John's feeling on subQ injections and read posts he has filed concerning his opposition to them. I have also heard that Dr Shippen will closely monitor subQ injection patients to see if estrogen levels rise noticeably and that if they do he switches them to IM injections before looking at any "estrogen control" regimens like AIs. Heard that often switching them over to IM injections will cure up moderate rises in Es due to subQ injections.
This study "could" have answered that right off the bat!
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