Daily Intramuscular injections.

[Charliebizz]

Hey guys I'm currently on m-w-f injections. Ive actually started to feel way better on shot days on Im vs sub q. However through years of testing my t levels drop off quite a bit 24 hrs post injection. I respond very well to lower doses. 90mg a week has my ft slightly over range. And TT around 900 8hrs post injection. The following morning around I drop about 50 points off free t and TT down to 490 24-26 hrs post injection.

I never really felt good doing sub q. I never used an a.i in my life but on sub q my e2 is well above range and i.m it's in a great spot on paper. So question is anyone doing daily I.m ? Not really a fan of all those injections. And I only really have done shallow I m in the Delts.

 

[Vince]

For about 4 years I did daily shallow IM injections. I just recently added that sub q. So now I use both, shallow IM and sub q.

 

[ivkonst2017]

I understand your point for sub-q, I meet more and more people who dont do well on sub q like me, sub Q JUST DOESNT WORK FOR EVERYONE.
Some people on this forum continue to claim that is not the case and people like us are some very rare exception. This can be a decisive misinformation for people just starting therapy.

As much as Im confident IM is the superior and more reliable delivery system, for me daily IM injections are not sustainable. I was rotating 8 injection sites and after 2 months I've had a lot of pain all over them. However IM NOT doing shallow IM, but deep IM with 3/4 inch needle. I think shallow IM also doesnt work for many people like sub q, and depending on your body fat percentage you may very well be doing sub q injection thinking you are doing IM.

However if you do your IM with 1/2 inch needles now and it works for you then shallow IM works for you and thats great. SUB Q works well for some people and great for them, if it works, doesnt cause nodules and other bad reactions it is definitely better long term than IM.

If you are going to do shallow IM daily I again suggest you use AT LEAST 4 injection sites, better 6 or 8. You can inject for example in delts, ventroglute, glute and quads and you have 8. Dont do pectorals(its too risky and dangerous). Some people do in biceps and traps, I think both of them are very painful. Some also do calves, it was too painful for me as well(I've tried injecting almost everywhere )

So if you are doing now 3 times a week, for how long have you been on this protocol and what ester are you using? I know there are people who find befits on daily injections with cypionate and enanthate, but I think most would feel the same on EOD or MWF. However yes, some do. On the other hand if you have started this protocol 2 weeks ago it would be totally normal to feel different on injection days, but that can settle in 2-3 more weeks.
For example when I started sustanon from enanthate injecting it EOD for a whole MONTH I was feeling better on injection days, but now really there is no any difference. Due to that when I've fully optimized my thyroid I will try to do the sustanon every 3rd day..

 

[ivkonst2017]

I never used an a.i in my life but on sub q my e2 is well above range and i.m it's in a great spot on paper

I think you shouldnt be worried about that, but if the e2 is really high IN RELATION TO THE T LEVELS you should be worried about the reason for that - liver, IR, metabolic syndrom, obesity or something else and address that. Adjusting the TRT protocol to reduce e2 is not fixing the root cause but avoiding it. I say that with the presumption you protocol is generally good and brings your t levels to a range that is good for you.

 

[Cataceous]

I understand your point for sub-q, I meet more and more people who dont do well on sub q like me, sub Q JUST DOESNT WORK FOR EVERYONE.
Some people on this forum continue to claim that is not the case and people like us are some very rare exception. This can be a decisive misinformation for people just starting therapy.
...

According to you the controlled scientific studies on hundreds of men are the misinformation while random anecdotes are not. Clearly the opposite is true. People just starting therapy should preferentially consider subcutaneous injections because they are simpler and less invasive, not to mention proven safe and effective. I would bet a substantial sum that most of the complaints about the effectiveness of SC injections would disappear under controlled conditions.

 

[Charliebizz]

I think you shouldnt be worried about that, but if the e2 is really high IN RELATION TO THE T LEVELS you should be worried about the reason for that - liver, IR, metabolic syndrom, obesity or something else and address that. Adjusting the TRT protocol to reduce e2 is not fixing the root cause but avoiding it. I say that with the presumption you protocol is generally good and brings your t levels to a range that is good for you.

I'm not worried about e2 at all. Just nothing I feel better on i.m and for some reason on sub q my e2 is much higher on paper. May not be causing issues at all.

 

[ivkonst2017]

According to you the controlled scientific studies on hundreds of men are the misinformation while random anecdotes are not. Clearly the opposite is true. People just starting therapy should preferentially consider subcutaneous injections because they are simpler and less invasive, not to mention proven safe and effective. I would bet a substantial sum that most of the complaints about the effectiveness of SC injections would disappear under controlled conditions.

A lot of time the anecdotes especially of so many people who have tried both sub q and IM can be much more trustworthy than a very limited controlled study that has so many potential flaws, the basic of which is not being able to asses and describe how someone feels under a study.

I would bet a million dollars my complains of sub q injections and of at least a few friends of mine would still be there under all the controlled circumstances in the world.

There is a very high chance someone starting TRT for the first time on sub q wont be able to experience FEELING enough of the effects of therapy so I would strongly advise anyone against that. A person who is well optimized and feels good on IM I would NOT advice against experimenting the sub q route provided he has the right reference point already to asses whether sub q would work for him.

 

[Cataceous]

A lot of time the anecdotes especially of so many people who have tried both sub q and IM can be much more trustworthy than a very limited controlled study that has so many potential flaws, the basic of which is not being able to asses and describe how someone feels under a study.
...

A rigorous scientific method is all the more important in evaluating subjective results; people easily fool themselves. Without blinded testing you often have biases obliterating reality.

...
I would bet a million dollars my complains of sub q injections and of at least a few friends of mine would still be there under all the controlled circumstances in the world.
...

Let's make it $100,000 so that you'll have enough of your spare million left to afford a proper study. I'm thinking N>=100 with outside administrators, maybe testosterone undecanoate injected a couple times a week to ensure steady serum testosterone levels. It'll be a blinded crossover study with three phases: a loading phase where the method of injection is unimportant, then a phase with simultaneous subcutaneous and intramuscular injections in which one is only the carrier and the other is the carrier with the testosterone, then a phase in which the medications are reversed. Unfortunately the long half-life of undecanoate means that each phase should be at least five months—but it limits the number of injections. Even if money were no object it's hard to imagine that you and your friends and the other volunteers rounding out the 100 would be able to manage supervised double injections daily. These would be needed for a shorter ester like testosterone cypionate. We'll evaluate the results two ways: serum testosterone measured between injections three times near the end of each phase; a subjective evaluation by each subject.

If IM exceeds SC by both measures in a statistically significant manner then you win. If IM doesn't exceed SC by either measure then I win. If they're split then it's a draw.

...
There is a very high chance someone starting TRT for the first time on sub q wont be able to experience FEELING enough of the effects of therapy so I would strongly advise anyone against that. ...

There is absolutely no credible evidence for this. It's foolish advice that should be ignored.

 

[madman]

A lot of time the anecdotes especially of so many people who have tried both sub q and IM can be much more trustworthy than a very limited controlled study that has so many potential flaws, the basic of which is not being able to asses and describe how someone feels under a study.

I would bet a million dollars my complains of sub q injections and of at least a few friends of mine would still be there under all the controlled circumstances in the world.

There is a very high chance someone starting TRT for the first time on sub q wont be able to experience FEELING enough of the effects of therapy so I would strongly advise anyone against that. A person who is well optimized and feels good on IM I would NOT advice against experimenting the sub q route provided he has the right reference point already to asses whether sub q would work for him.

A 52-Week Study of Dose-Adjusted Subcutaneous Testosterone Enanthate in Oil Self-Administered via Disposable Auto-injector (2018)


Abstract

Purpose: This open-label, single-arm, dose-blinded, 52-week, registration-phase study evaluated the efficacy and safety of subcutaneous testosterone enanthate auto-injector (SCTE-AI) administered weekly to men with hypogonadism.

Methods: Patients (N=150) were initiated on 75 mg SCTE-AI self-administered weekly. Dose adjustments were made at week 7 to 50, 75, or 100 mg testosterone enanthate (TE) based on week 6 total testosterone (TT) trough concentration. If required, dose adjustments continued through the extended treatment phase. Pharmacokinetic (PK) and clinical laboratory parameters, treatment-emergent adverse events (TEAEs), and injection site reactions were captured.

Results: The primary endpoint was met: 92.7% of patients achieved an average TT concentration of 300– 1100 ng/dL (553.3 ± 127.29 ng/dL, mean ± SD) at week 12. A Cmax of <1500 ng/dL was achieved by 91.3% of patients, and no patients had levels >1800 ng/dL at week 12. Mean TT Ctrough was 487.2 ± 153.33 ng/dL at week 52. Most patients (>95%) reported no injection-related pain. The most frequently reported TEAEs were increased hematocrit, hypertension, and increased prostate-specific antigen, which led to discontinuation in 30 men. There was no study of drug-related serious AEs.

Discussion: Dose-adjusted SCTE-AI demonstrated a steady serum TT PK profile, with small peak and trough fluctuations. SCTE-AI was safe, well-tolerated, and virtually painless, indicating that SCTE-AI offers a testosterone delivery system that is a convenient weekly option for the treatment of testosterone deficiency.




The subcutaneous testosterone enanthate auto-injector (SCTE-AI) is a novel disposable drug-device combination that allows patients to self-administer a single, premeasured TE dose once weekly through a ⅝-inch, 27-gauge needle.12 Previously, treatment with SCTE-AI was found to provide T levels within the reference range (300–1100 ng/dL) over a one-week dosing interval, with steady-state T levels approached by weeks 5–6.12

*In this study, we assess the long-term efficacy and safety of dose-adjusted SCTE-AI in patients with HG to maintain TT within the reference range.




Pharmacokinetics

The primary endpoint was met as 92.7% (139/150) of patients overall and 100% (25/25), 90.4% (94/104), and 95.2% (20/21) of those titrated to 50, 75, and 100 mg, respectively, achieved mean TT Cavg0–168h within range at week 12. Secondary endpoints were also met as 91.3% (137/150) of patients achieved Cmax <1500 ng/dL and no patients had a measured Cmax exceeding 1500 ng/dL. Of the 150 patients, 13 (8.7%) had missing Cmax values (11 from the 75-mg and 2 from the 100-mg group). Baseline Ctrough (SD) was 231.6 (94.77) ng/dL and remained steady and above 300 ng/dL through one year; 501.9 (172.70) ng/dL by week 6 and 487.2 (153.33) ng/dL at week 52 (Figure 2A).


Treatment Adherence and Questionnaire Results

During the 12-week treatment titration phase, patients received a mean of 11.7 injections, with a mean exposure of 81.3 days. During the extended treatment phase, patients received an average of 33.2 injections, with a mean exposure of 235.3 days. Overall, mean compliance (calculated as 100 × number of injections/weeks of treatment) was 98.5%. Patients indicated satisfaction with self-injection (Supplementary Figure 6), and the PDQ demonstrated significant improvements in several areas, at both week 12 and week 26 (Supplementary Figure 7)




DISCUSSION

SC delivery of TE through an auto-injector resulted in a steady PK profile at week 12, without the higher peaks and troughs commonly associated with intramuscular T injection-. The peak-to-trough ratio in this study was 1.813. Most patients (92.7%) stayed within the physiologic T range for the entire dosing interval; no patients had measured T levels >1500 ng/dL. Ctrough also remained constant during the 52-week study. As fluctuations in T levels affect tolerability of T treatment used to alleviate symptoms of TD and have been associated with more side effects such as acne and mood disturbance, the steady PK profile of SCTE-AI may lead to better control of symptoms.16

*Although symptom resolution was not a primary endpoint in this study, improvements in the PDQ were observed. As expected, DHT and E2 increased from baseline to week 12; DHT remained within normal range, and E2 remained close to the upper limit of normal.




Again....although symptom resolution was not a primary endpoint in this study significant improvements in PDQ were observed.

Even then do you really believe N=139 would stick with the once-weekly protocol injecting strictly sub-q for 52 weeks.....basically 1 year of their precious time if there was absolutely no improvement in low-t symptoms/overall well-being?

LMFAO!

As I have stated numerous times on the forum.....yes some men may not do well when injecting sub-q.

It is far from common that one would not be able to achieve a healthy let alone high-end T level on such.

Again there should be no difference in the absorption/effectiveness of T when injecting strictly sub-q.

Are there outliers that may not achieve good numbers.....sure but again far from F**KING COMMON!

The men that lurk/live on the forums represent a small slice of men on trt/hrt!

You claim that sub-q is inferior to IM let alone make it sound as if everyone and their brother is having a bad experience on such and to make matters worse claim that the absorption/effectiveness is subpar compared to IM injections.....LMFAO!



The mean TT Ctrough @6, 12, 18, 26, 38....52 weeks in!

Ctrough remained constant during the 52-week study.

Who the F**K knew..... Mean TT Ctrough was 487.2 ± 153.33 ng/dL at week 52.

*The primary endpoint was met as 92.7% (139/150) of patients overall and 100% (25/25), 90.4% (94/104), and 95.2% (20/21) of those titrated to 50, 75, and 100 mg, respectively, achieved mean TT Cavg0–168h within range at week 12.

*The primary endpoint was met: 92.7% of patients achieved an average TT concentration of 300– 1100 ng/dL (553.3 ± 127.29 ng/dL, mean ± SD) at week 12.

*Mean TT Ctrough was 487.2 ± 153.33 ng/dL at week 52.

*SC delivery of TE through an auto-injector resulted in a steady PK profile at week 12, without the higher peaks and troughs commonly associated with intramuscular T injection-. The peak-to-trough ratio in this study was 1.813. Most patients (92.7%) stayed within the physiologic T range for the entire dosing interval; no patients had measured T levels >1500 ng/dL. Ctrough also remained constant during the 52-week study.

*Patients may face barriers to adherence to TR, including inconvenience and discomfort. In this study, patients were highly adherent to the dosing regimen, indicated a virtually pain-free experience, and demonstrated a high degree of satisfaction with SCTE-AI, as measured by the SIAQ.




Conclusions

Overall, this study demonstrates the steady PK profile and safety of SCTE-AI. SCTE-AI dosing guided by TT Ctrough reduces peak and trough fluctuations, making SCTE-AI a convenient additional option for the treatment of TD.

 

[madman]

A lot of time the anecdotes especially of so many people who have tried both sub q and IM can be much more trustworthy than a very limited controlled study that has so many potential flaws, the basic of which is not being able to asses and describe how someone feels under a study.

I would bet a million dollars my complains of sub q injections and of at least a few friends of mine would still be there under all the controlled circumstances in the world.

There is a very high chance someone starting TRT for the first time on sub q wont be able to experience FEELING enough of the effects of therapy so I would strongly advise anyone against that. A person who is well optimized and feels good on IM I would NOT advice against experimenting the sub q route provided he has the right reference point already to asses whether sub q would work for him.

There is a very high chance someone starting TRT for the first time on sub q wont be able to experience FEELING enough of the effects of therapy so I would strongly advise anyone against that.

Piss poor advice!

Downright embarrassing to say the least.

 

[ivkonst2017]

within the physiologic T range for the entire dosing interval; no patients had measured T levels >1500 ng/dL. Ctrough also remained constant during the 52-week

No matter how many studies you quote, this wont change the simple fact: SUB Q doesnt work for everyone.

Personally experienced by me, and reported by enough people here. Since the short time Ive joined the forum I've read approxiamatelly 10 people reporting that including the OP.

 

[ivkonst2017]

A rigorous scientific method is all the more important in evaluating subjective results; people easily fool themselves. Without blinded testing you often have biases obliterating reality.

Let's make it $100,000 so that you'll have enough of your spare million left to afford a proper study. I'm thinking N>=100 with outside administrators, maybe testosterone undecanoate injected a couple times a week to ensure steady serum testosterone levels. It'll be a blinded crossover study with three phases: a loading phase where the method of injection is unimportant, then a phase with simultaneous subcutaneous and intramuscular injections in which one is only the carrier and the other is the carrier with the testosterone, then a phase in which the medications are reversed. Unfortunately the long half-life of undecanoate means that each phase should be at least five months—but it limits the number of injections. Even if money were no object it's hard to imagine that you and your friends and the other volunteers rounding out the 100 would be able to manage supervised double injections daily. These would be needed for a shorter ester like testosterone cypionate. We'll evaluate the results two ways: serum testosterone measured between injections three times near the end of each phase; a subjective evaluation by each subject.

If IM exceeds SC by both measures in a statistically significant manner then you win. If IM doesn't exceed SC by either measure then I win. If they're split then it's a draw.


There is absolutely no credible evidence for this. It's foolish advice that should be ignored.

Whats the point of setting up a study in a totally unrealistic in the real world scenario? Who would ever do such a protocol?

 

[madman]

No matter how many studies you quote, this wont change the simple fact: SUB Q doesnt work for everyone.

Personally experienced by me, and reported by enough people here. Since the short time Ive joined the forum I've read approxiamatelly 10 people reporting that including the OP.

No one stated that it works for everyone!

Again as I have stated numerous times on the forum.....yes there are men that may not do well when injecting sub-q but it is far from COMMON!

 

[madman]

No matter how many studies you quote, this wont change the simple fact: SUB Q doesnt work for everyone.

Personally experienced by me, and reported by enough people here. Since the short time Ive joined the forum I've read approxiamatelly 10 people reporting that including the OP.

There is a very high chance someone starting TRT for the first time on sub q wont be able to experience FEELING enough of the effects of therapy so I would strongly advise anyone against that.

Yet you continue to spew this bullshit on here!

 

[Charliebizz]

No one stated that it works for everyone!

Again as I have stated numerous times on the forum.....yes there are men that may not do well when injecting sub-q but it is far from COMMON!

What would be the reason guys wouldn't do well on sub q

 

[Charliebizz]

According to you the controlled scientific studies on hundreds of men are the misinformation while random anecdotes are not. Clearly the opposite is true. People just starting therapy should preferentially consider subcutaneous injections because they are simpler and less invasive, not to mention proven safe and effective. I would bet a substantial sum that most of the complaints about the effectiveness of SC injections would disappear under controlled conditions.

No matter how many studies you quote, this wont change the simple fact: SUB Q doesnt work for everyone.

Personally experienced by me, and reported by enough people here. Since the short time Ive joined the forum I've read approxiamatelly 10 people reporting that including the OP.

What do you mean by " doesn't work"
Sub q resulted in almost identical numbers of tt and free t for me. Cat is most likely right about controlled conditions too. My e2 was higher on sub q last run but I also had more body fat so who knows. Way to many variables to actually know for sure if sub q was the problem. The one thing I'm still pretty confused by is why my tt and free t drop so fast on enanthate

 

[Cataceous]

Whats the point of setting up a study in a totally unrealistic in the real world scenario? Who would ever do such a protocol?

You isolate the variables as much as possible to see if there really is a difference. Without carefully controlling the conditions you probably don't learn anything.

What would be the reason guys wouldn't do well on sub q

So far the only semi-plausible reasons I've seen for differences are the longer half-lives of SC injections and their hypothetical greater likelihood of leakage. The studies show basically the same overall absorption. This makes it easy to dismiss claims to the contrary when they lack rigorous support. There are a few cases where guys are reporting unusually low testosterone measurements on SC compared to IM. It would be interesting to know what's going on, but for now there's nowhere near enough evidence to support any conclusions, let alone ones contradicting existing published work.

 

[ivkonst2017]

What do you mean by " doesn't work"
Sub q resulted in almost identical numbers of tt and free t for me.

You said above you didnt feel as good.

Ive seen two types of sub q doesnt work - first type, the total t is lower; second type - the guy has similar numbers but he doesnt feel as good. One of my friends on top of having lower t levels and feeling like shit on sub q had higher blood counts. Since he transferred to IM he feels better, his total t rose on average of 500ng/dl and his blood counts lowered. He will never do sub q again.

Whatever it is it seems sub q distorts the normal pharmacokinetics of the medication. I dont know why, maybe its with the nodules that build up that would make a lot of sense. But also the simple fact in the pharmacological books it says to inject oil in muscle. And this is what I advise people doing - using the medication the right way.

I personally am not interested in investigating why sub q doesnt work, Im interested in sticking to what works.

 

[ivkonst2017]

You isolate the variables as much as possible to see if there really is a difference. Without carefully controlling the conditions you probably don't learn anything.

This doesnt bring enough practical value, if you cannot apply it to a real world protocol. Man, it seems to me you are interested in exploring theories and studies, but I think most people writing in this forum who have issues with a protocol just want to start feeling good. Im also interested in that when someone asks for advice - to give him a solution that would resolve his issues, not theories and IFs.

Such study would be much more worthy with some practical protocols - 150mg of enanthate, cypionate and sustanon split in bi weekly and EOD injections for example in IM and sub q. The other problem here is you cannot make IM and sub q blind so you gotta find people without bias.

 

[ivkonst2017]

As I have stated numerous times on the forum.....yes some men may not do well when injecting sub-q.

I remember in my first opinions here when I asked how to inject IM EOD in the same muscles and stated sub q doesnt work for me you had put that under doubt and suggested that the reason may be something else.

If I were a person more willing to follow outside advise without first adhering to my own experience I would probably start again a sub q protocol BASED ON YOUR OPINION which would do only harm for me - more time wasted in feeling bad.

Do you see how careful should one be when giving advice to people especially when he has some position in a forum? What good would make a person, who claims sub q mskes him feel bad receive advice from you that this is very unlikely and the problem must be somewhere else? Then this person continues to struggle to make sub q work. Ive wasted a few week like that but Ive also seen in fb groups people receiving such advice and wasting much more time