Consider starting TRT

[opus11]

I am 66yo, and am considering to start TRT.
My current TT (LC-MS/MS) is around 450 [270-648] ng/dL, and Calculated FT around 80 [47-244] pg/mL.

I have some questions, hopefully you knowledgeable members can help me.

1. How accurate is Calculated Free Testosterone comparing to equilibrium dialysis or ultracentrifugation?


2. I would like to have additional exogenous T without suppress/shutdown my own endogenous T production. Is that possible?


3. Once I start TRT and later stop, will my own endogenous T production recover to pre-TRT level? Will the shrinked testis regain the original size without the help from HCG?


4. Comparing testosterone enanthate and testosterone cypionate, what are the pros and cons for each?


5. what are the pros and cons of IM and subQ?


6. The carry oil: grapeseed, cottonseed, sesame, olive, castor oils, which one is best?

 

[Cataceous]

1. Depending on the study, both Vermeulen and Tru-T free testosterone calculations can correlate pretty well with equilibrium dialysis measurements. Things may get more questionable at the extremes, e.g. high and low SHBG. But also keep in mind that the equilibrium dialysis and ultrafiltration tests are complicated and therefore lack the robustness of the tests for measuring things like total testosterone and SHBG. For this reason I tend to favor the calculated methods.

2. Yes, there are options to avoid an undesirable HPTA shutdown. These include Natesto and enclomiphene. Natesto, a testosterone nasal gel, is so short acting that it interferes minimally with HPTA feedback. You get the boost without the suppression of regular TRT. Enclomiphene directly stimulates the HPTA. Results with enclomiphene often look great on paper, but subjectively the reports are mixed. It's still worth a go before TRT, and different protocols should be tried in case one needs to balance the anti-estrogenic effects against the need for some estrogenic activity in areas of the brain.

3. Most, but not all guys return to baseline testicular function after stopping TRT. It's possible hCG and/or SERMs speed up the recovery, but they are not essential.

4. Enanthate and cypionate are essentially interchangeable. You would not be able to discern a difference unless you had an unusual reaction to a carrier oil or other ingredient.

5. In general total absorption is nearly 100% with either IM or SC. SC leads to somewhat slower absorption, which can be a good thing if you're looking for less variation in serum testosterone. SC is good because you're not poking holes in your muscles. Guys may have not-so-nice local reactions to either method and choose the other as a result. SC works better for smaller, more frequent injections; with larger injections it's less practical to have a big bump at the injection site.

6. Individual reactions to carrier oils vary. Grapeseed oil has the advantage of lower viscosity, making it faster to load syringes. Higher-viscosity oils such as castor oil can slow absorption of the ester, increasing its apparent half-life.

 

[madman]

I am 66yo, and am considering to start TRT.
My current TT (LC-MS/MS) is around 450 [270-648] ng/dL, and Calculated FT around 80 [47-244] pg/mL.

I have some questions, hopefully you knowledgeable members can help me.

1. How accurate is Calculated Free Testosterone comparing to equilibrium dialysis or ultracentrifugation?


2. I would like to have additional exogenous T without suppress/shutdown my own endogenous T production. Is that possible?


3. Once I start TRT and later stop, will my own endogenous T production recover to pre-TRT level? Will the shrinked testis regain the original size without the help from HCG?


4. Comparing testosterone enanthate and testosterone cypionate, what are the pros and cons for each?


5. what are the pros and cons of IM and subQ?


6. The carry oil: grapeseed, cottonseed, sesame, olive, castor oils, which one is best?

I am 66yo, and am considering to start TRT.
My current TT (LC-MS/MS) is around 450 [270-648] ng/dL, and Calculated FT around 80 [47-244] pg/mL.

Post labs?

Although your TT 450 ng/dL is far from what would be considered low it is definitely not robust and although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

Keep in mind that knowing where your SHBG sits is critical as it will have a significant impact on your FT level.

Regardless even with a TT 450 ng/dL, your FT would be lowish/low.




1. How accurate is Calculated Free Testosterone comparing to equilibrium dialysis or ultracentrifugation?

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

This is even more critical in cases of altered SHBG!

Definitely would not rely on the most commonly used piss poor direct immunoassay let alone some of the older outdated calculated methods which can over/underestimate.




2. I would like to have additional exogenous T without suppress/shutdown my own endogenous T production. Is that possible?

I would look into Natesto or enclomiphene.




3. Once I start TRT and later stop, will my own endogenous T production recover to pre-TRT level? Will the shrinked testis regain the original size without the help from HCG?

In most cases, yes but no one can say exactly what your levels will bounce back to.




4. Comparing testosterone enanthate and testosterone cypionate, what are the pros and cons for each?

They are basically interchangeable other than the fact that some may have a bad reaction to the ester/carrier oil used but this is not common.



5. what are the pros and cons of IM and subQ?

For the majority of men, there should be no difference in absorption let alone blood levels achieved.

Sure some may have issues and claim that they achieve lower T levels when injecting sub-q but I would be highly suspect unless one had followed the proper protocol when comparing blood work (sub-q vs IM):

Keeping the protocol consistent (dose T/injection frequency), waiting for blood levels to stabilize (4-6 weeks) before getting lab work done, testing at the true trough, using the same lab, and more importantly same assays (most accurate) for TT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

Otherwise, you are wasting your time!

Blood work aside some men may not feel well overall when injection sub-q and prefer strictly IM.

Depending on whether one is injecting sub-q or IM (shallow/deep) or what syringes they are using:

Rare one would get lumps when injecting strictly IM (shallow/deep) unless you were not injecting properly or possible sensitivity to the ester/excipients.

Mild pain at the injection site can be common when injecting IM but in many cases, it would be from using larger needles 22-25G.

Lumps may be more common when injecting strictly sub-q due to injecting too large a volume of oil or improper injection technique.

Pain at the injection site should be minimal/non-existent when injecting strictly sub-q especially as most are using fixed insulin syringes 27-31G (6MM/8MM/12.7MM needle length).

The main benefits of using LDS (low dead space) fixed insulin syringes are a minimal waste of medication (esterified T), virtually painless, minimize scar tissue/trauma, easier to read for accurate dosing especially when injecting lower volumes of oil more frequently.




6. The carry oil: grapeseed, cottonseed, sesame, olive, castor oils, which one is best?

There is no best and I would not get too caught up in this.

Sure there may be a possible sensitivity to the ester/excipients but this is far from common.








This is the overall gist of things and regardless of all the feedback you may get the only way to truly know would be to try both protocols (sub-q/IM) but even then you better plan on giving each protocol a fighting chance and I truly mean it!


*This should be hammered into every patient's head before starting trt or tweaking a protocol (dose T/injection frequency).

Keep in mind many fail to realize that when starting trt or tweaking a protocol (dose T/injection frequency) that hormones will be in flux during the weeks leading up until blood levels stabilize (4-6 weeks when using TC/TE) and it is common for many during this transition to experience what we call the honeymoon period where there may be a strong increase in libido/erections and overall euphoric feeling due to increasing T levels/dopamine.

Unfortunately, this is temporary and short-lived for most as the body will eventually adjust.

It is also very common for many men to experience ups/downs in energy/mood/libido/erections/recovery during the transition as the body is trying to adjust which can be very misleading.

Even then do understand that once blood levels have stabilized (4-6 weeks) it will take another 2-3 months for the body to fully adapt to those new levels and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-t symptoms.

When looking at the big picture the first 4-6 weeks is very misleading for most!

 

[madman]

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[madman]

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[Systemlord]

I would like to have additional exogenous T without suppress/shutdown my own endogenous T production. Is that possible?

No, whether its 10mg or 100mg your HPTA is shut down. The same goes for HCG, the HPTA is suppressed but testicles remain functioning.

Regardless even with a TT 450 ng/dL, your FT would be lowish/low.

A Total T is inert, the Free T is where the rubber meets the road. There is no way for anyone to tell you if this Total T or Free T levels are normal for you or adequate simply because it is in the normal range.

Once I start TRT and later stop, will my own endogenous T production recover to pre-TRT level?

It's far more common to see men return to baseline.

 

[madman]

opus11 said:
I would like to have additional exogenous T without suppress/shutdown my own endogenous T production. Is that possible?


Yes!

​

​

With Natesto, T levels return to near baseline between doses, maintaining HPG axis function1,15,16​

Natesto is an innovative, intranasal therapy for T deficiency. Due to its pharmacokinetic profile, T levels peak rapidly after each dose, then return to near baseline between doses.1,15

​

​

Natesto demonstrated improvements in symptoms and RESTORED T LEVELS TO THERAPEUTIC RANGE1-3,*​

In a phase 3 trial, Natesto helped men achieve an average daily T concentration within therapeutic range after 90 days, with similar Cmax (800 ng/dL) regardless of baseline T levels. Natesto was also found to have statistically significant improvements in sexual function and mood.1-5

 

[opus11]

1. Depending on the study, both Vermeulen and Tru-T free testosterone calculations can correlate pretty well with equilibrium dialysis measurements. Things may get more questionable at the extremes, e.g. high and low SHBG. But also keep in mind that the equilibrium dialysis and ultrafiltration tests are complicated and therefore lack the robustness of the tests for measuring things like total testosterone and SHBG. For this reason I tend to favor the calculated methods.

2. Yes, there are options to avoid an undesirable HPTA shutdown. These include Natesto and enclomiphene. Natesto, a testosterone nasal gel, is so short acting that it interferes minimally with HPTA feedback. You get the boost without the suppression of regular TRT. Enclomiphene directly stimulates the HPTA. Results with enclomiphene often look great on paper, but subjectively the reports are mixed. It's still worth a go before TRT, and different protocols should be tried in case one needs to balance the anti-estrogenic effects against the need for some estrogenic activity in areas of the brain.

3. Most, but not all guys return to baseline testicular function after stopping TRT. It's possible hCG and/or SERMs speed up the recovery, but they are not essential.

4. Enanthate and cypionate are essentially interchangeable. You would not be able to discern a difference unless you had an unusual reaction to a carrier oil or other ingredient.

5. In general total absorption is nearly 100% with either IM or SC. SC leads to somewhat slower absorption, which can be a good thing if you're looking for less variation in serum testosterone. SC is good because you're not poking holes in your muscles. Guys may have not-so-nice local reactions to either method and choose the other as a result. SC works better for smaller, more frequent injections; with larger injections it's less practical to have a big bump at the injection site.

6. Individual reactions to carrier oils vary. Grapeseed oil has the advantage of lower viscosity, making it faster to load syringes. Higher-viscosity oils such as castor oil can slow absorption of the ester, increasing its apparent half-life.

Thank you very much.