100mg 1x per week vs 50mg 2x per week

[shawncooke1]

Hi, I'm new to the forum and new to try. In 2023 I was diagnosed with low testosterone and was prescribed a topical testosterone gell which didn't work. In fact my counts got lower after using it. So I went to a urologist and he ran some tests and decided I was a candidate for trt via cypionate. I was prescribed 100mg 1x per week intramuscular injections. My starting t was 121 and estradiol was 17.7. My 6 week blood work was 873T and 49.7 estradiol 5 days after my last shot. So I would assume that at some point I may have gotten to around 1000T before it started to fall off. I have a couple questions.

1. Should my Dr test my sbgh, because he hasn't.

2. Should he check my free testosterone, because he hasn't. My previous NP did prior to the gell and it was 5.4.

3. I'm at week 8 and haven't had much change in mood, libido or energy. Would 2x per week help me there? Could I be getting too much at once? He said that the estradiol was not concerning.

4. I've decided to do 50mg every 3.5 days to see if it helps. What will that do to my testosterone numbers? Will I still get up to around 1000 doing it that way or will it keep me lower but without the peaks and valleys?

5. I am not on any kind of blockers because he didn't see any harmful side effects yet. Is the estradiol a concern at those numbers?

Thanks in advance for any info that you can give.

 

[Deleted]

Total T is not very helpful, Free T is THE number to focus on. Get the proper lab test, Total T LC/MS/MS with Free T equilibrium dialysis or ultrafiltration, and run your total T SHBG and albumin through the vermuelen calculator. So yes, SHBG is necessary as well. Albumin is from comprehensive metabolic panel.

Your estradiol should climb in proportion to your T. Do not worry about this, way too much anxiety happens because men get the message that estrogen is bad... IT IS NOT! It is only a problem if you start having symptoms, but this is unlikely unless you are on too high a dose. Your labs shows 49 which is considered hig, but mant men do fine at that level without intervention. Better treatment for high E2 in concjuntion with high T is to lower the dose of testosterone. Anastorzole is typically the choice for lowering estradiol, but it is a nasty drug that can come with serious consequences. Search and read this forum on this subject.

100mg/week may be fine or may be too much or too little. it is a reasonable dose to start. Only time will tell.

100 once a week can cause unpleasant symptomatic swings for some, and many do better on 50/50 two injections a week. This provides less of a swing between peak and trough, brings trough up. Other schedules are every 3 days, every other day or daily.

It takes 6-8 weeks for blood levels to stabilize after starting or changing dose. It takes longer for the body to actually adapt to the new level. For me, 2-3 months. Don't get tempted to chase numbers or symptoms prematurely.

You can also inject subcutaneous. Works very well for many and uses much smaller needles. It doesn't work well for some. Some of us take much smaller injections more frequently. I do tiny daily subQ injections which is an uncommon regimen, but it is painless and works great for me. Only one way to find out for yourself, but again beware of making changes prematurely give things time.

If you get testicular atrophy (Very likely, taking testosterone shuts down your testicular production of T), you may want to add HCG to the regimen later.

 

[Systemlord]

1. Should my Dr test my sbgh, because he hasn't.

2. Should he check my free testosterone, because he hasn't.

This is what I call a red flag! Free T is where the rubber meets the road. Your doctor is clueless,

Total Estrogens testing includes three different types of estrogens (E1/E3), the only one you should concern yourself with is E2.

Any doctor not testing Free T and estrogen (E2) doesn’t know how to manage male hormones! It’s not a good thing when you have to ask your doctor for tests he should be ordering to see how treatment is progressing!

I'm at week 8 and haven't had much change in mood, libido or energy. Would 2x per week help me there? Could I be getting too much at once?

Men have different types of androgen receptors, differing sensitivities at the T receptors and also receptor density, as well as the abilities for the tissues to respond. Some men respond very fast and others are slow responders.

You should have felt something by now, which may mean you have other issues going on besides low-T. For instance, if you have heavy metal toxicity, testosterone cannot reach the T receptors. If your bi lipid membrane is inflamed, testosterone cannot work to its maximum potential.

If either of the ladder to conditions are present, you would need frequent injections (daily/EOD) or short acting TRT formulations (topical/oral T) to bypass these issues.

 

[shawncooke1]

Thanks for the info folks! I have asked him twice about testing my free T and he says they have found that it's an unnecessary step without having issues first. He said he treats symptoms more than numbers or something like that. So how would I know if subQ is for me? How could I tell if it's working better or worse than intramuscular?

I've already told my urologist I research everything is why I've asked about the freeT and shbg. But he seems pretty firm on his stance. The last thing I want to do is make him mad and him not work with me anymore. My insurance is paying for this and I definitely don't want to have to go somewhere and have to self pay.

Any suggestions on how to handle these things, or just wait it out and see what's to come? Doing 2x per week scares me for the long haul. I've heard plenty of people get a few years in and have to stop because of scar tissue and things like that. What happens if you alternate back and forth from intramuscular and sunQ? Is that a bad idea?

 

[captain]

Sub Q and more frequent lower doses allows you to use a smaller syringe. More frequent shots may allow you to use less T. That becomes important when you drive up your hematocrit and hemoglobin.

 

[Melody68]

I have a physician that has the same attitude as your doctor. You might opt to get private testing at a fee, then work with the members here on the board to analyze the results and act accordingly. Not ideal, but that's what some of us have to do.

 

[shawncooke1]

Yeah, it sucks to have to do so, but I feel you are right. If I want it done correctly, I'll have to take matters into my own hands.

So let's say I get outsourced testing and my shbg and or free test are low but my total T is still in the upper 800's or better, what are my next steps in getting those into range? Is there different meds for that? And how do I explain to my Dr that I've went on my own because I don't feel he is doing the job correctly? Is he going to prescribe my the things I need at this point or is he going to keep things the same?

 

[Melody68]

Ha! You are EXACTLY in the same position as me, and I'm fairly new to the whole thing, been taking T for about six months.

And how do I explain to my Dr that I've went on my own because I don't feel he is doing the job correctly?
That's the 64,000 dollar question, and I don't have an answer for that. My doctor would NOT take that well, I already tried to lead him a bit in that direction with regard to estradiol - he tells me it doesn't matter, blah, blah, blah, and when I asked him something else by email, then he just doesn't answer.

Is he going to prescribe me the things I need at this point or is he going to keep things the same?
If I tested things and found that other factors were out of whack, I'm certain my guy would NOT prescribe me other drugs, like an aromatase inhibitor or HCG or something like that. Which means I better hope to find a T dose and injection schedule that works perfectly without the need for anything else. I think that's directing me towards a very conservative lower dose.

Did you say you're being attended to by a urologist? Perhaps you have a family doctor who would be a bit more sensitive and open to your attitudes about learning on your own. Mine seems to be a bit and will help me with additional tests, but I'm quite sure he wouldn't prescribe any T related drugs. Not an easy path we're on . . .

 

[Systemlord]

My insurance is paying for this and I definitely don't want to have to go somewhere and have to self pay.

Insurance based healthcare is not a good fit for TRT or for optimizing your health. The guidelines are inadequate, and most of the doctors are into other areas of medicine, and so their knowledge will be seriously lacking.

This fits the bill for every single endocrinologist I’ve ever had trying to manage my TRT.

 

[Deleted]

Ha! You are EXACTLY in the same position as me, and I'm fairly new to the whole thing, been taking T for about six months.

And how do I explain to my Dr that I've went on my own because I don't feel he is doing the job correctly?
That's the 64,000 dollar question, and I don't have an answer for that. My doctor would NOT take that well, I already tried to lead him a bit in that direction with regard to estradiol - he tells me it doesn't matter, blah, blah, blah, and when I asked him something else by email, then he just doesn't answer.

Is he going to prescribe me the things I need at this point or is he going to keep things the same?
If I tested things and found that other factors were out of whack, I'm certain my guy would NOT prescribe me other drugs, like an aromatase inhibitor or HCG or something like that. Which means I better hope to find a T dose and injection schedule that works perfectly without the need for anything else. I think that's directing me towards a very conservative lower dose.

Did you say you're being attended to by a urologist? Perhaps you have a family doctor who would be a bit more sensitive and open to your attitudes about learning on your own. Mine seems to be a bit and will help me with additional tests, but I'm quite sure he wouldn't prescribe any T related drugs. Not an easy path we're on . . .

If you guys are able to recreate the wheel, more power to you. We've been doing this for years here. Perhaps just the newness of the environment, but your stories are history repeating itself again.

Use telehealth doctors that have a clue and pay out of pocket, or go rogue, get what you can from your doc and the rest overseas. Reliablerx for HCG, AI, ED meds... and there are other pharmacies.

And as usual a plug for Defy Medical. Now that my own protocol is stable it's just the cost of one consult per year, plus the cost of Testosterone that I order through Defy. I source everything else for TRT independently. My PCP orders most labs (covered by medicare), and I order a few independently from Nelson's Discounted labs. My total cost per year is under $1000 for everything.

And @Melody68 , best to get aromatase inhibitors out of your head. Get your T dosage right so you don't need to go there. There are circumstances where guys need it, but ideally just focus on a good dosing regimen of T.

 

[Deleted]

I've heard plenty of people get a few years in and have to stop because of scar tissue and things like that. What happens if you alternate back and forth from intramuscular and sunQ? Is that a bad idea?

If SubQ works for you, there is NO WORRY ABOUT SCAR TISSUE. I've been on SubQ for about 6 years every other day and the last couple years daily. I use 5/16" 30g insulin syringe and know the sites that produce no reaction on my body. It takes a minute or two to draw the dose, but is painless. I've also learned a couple tricks that help if you decide to try SubQ.

Many clinics are still in the dark ages regarding injections. Big needles that would cause scarring and Deep IM is UNNECESSARY for cypionate or enanthate. 1/2" 29 or 27g insulin syringes work for about everyone who tries them for shallow IM

Valid SubQ worries are:

1- Less effective than IM: clinical data suggests SubQ is indeed just fine. Part of that evidence is xyosted which is a subQ autoinjector for enanthate. There is a fair bit of anecdote that IM works better FOR SOME PEOPLE. My own labs show how effective it is for me. I have zero reason to go IM.

2- Some people react to SUbQ, it can cause injection site lumps in fatty tissue. It does for me a little bit as well, so I avoid anatomical locations with more of a fat pad, rather go for just thin skin areas of the abdomen and butt, using a pinch technique to avoid injecting into those fat pads.

 

[Melody68]

If you guys are able to recreate the wheel, more power to you. We've been doing this for years here. Perhaps just the newness of the environment, but your stories are history repeating itself again.

Use telehealth doctors that have a clue and pay out of pocket, or go rogue, get what you can from your doc and the rest overseas. Reliablerx for HCG, AI, ED meds... and there are other pharmacies.

And as usual a plug for Defy Medical. Now that my own protocol is stable it's just the cost of one consult per year, plus the cost of Testosterone that I order through Defy. I source everything else for TRT independently. My PCP orders most labs (covered by medicare), and I order a few independently from Nelson's Discounted labs. My total cost per year is under $1000 for everything.

And @Melody68 , best to get aromatase inhibitors out of your head. Get your T dosage right so you don't need to go there. There are circumstances where guys need it, but ideally just focus on a good dosing regimen of T.

Hello Blackhawk, if it turns out that I need more extensive attention to TRT, then I'll have to go with one of the telehealth services. I haven't looked into that yet, but I'm not sure Defy provides services to Canada?

I've always been a good responder to meds. I'm only taking 60mg/week enanthate and have done little testing so far, but I had a TT blood test a few weeks ago with a result of 23.4 in the trough (when I was at 70mg/week). I can't honestly believe that I'd have E2 concerns at that small 60mg dose, but I'll know better soon since I'm scheduled for a more complete bloodwork set in July, some of the tests covered by me out of pocket.

 

[Deleted]

Hello Blackhawk, if it turns out that I need more extensive attention to TRT, then I'll have to go with one of the telehealth services. I haven't looked into that yet, but I'm not sure Defy provides services to Canada?

I've always been a good responder to meds. I'm only taking 60mg/week enanthate and have done little testing so far, but I had a TT blood test a few weeks ago with a result of 24.3 in the trough (when I was at 70mg/week). I can't honestly believe that I'd have E2 concerns at that small 60mg dose, but I'll know better soon since I'm scheduled for a more complete bloodwork set in July, some of the tests covered by me out of pocket.

24.3 E2? or Free T? If E2, that is perfect, but it also should be taken in consideration with Testosterone levels.

Thanks for the reminder about Canada. I am not sure about Defy and Canada. I am relatively certain they will consult, but probably can't prescribe.

 

[Melody68]

That was a Total Testosterone result of 24.3 or 701 in US numbers. The only thing my doctor here tests is TT and a CBC. But I can purchase the other tests, which I'll do in July.

 

[Deleted]

That was a Total Testosterone result of 24.3 or 701 in US numbers. The only thing my doctor here tests is TT and a CBC. But I can purchase the other tests, which I'll do in July.

Thanks. Test names and reference ranges are helpful. Random numbers obviously can be misinterpreted! ;>)

 

[Melody68]

Thanks. Test names and reference ranges are helpful. Random numbers obviously can be misinterpreted! ;>)

Of course, you're correct, I must remember to include the reference ranges. In checking the figures right now I see that I had 23.4 nmol/L; I got the numbers mixed up. The reference range is 8.4-28.8 nmol/L.

 

[madman]

Hi, I'm new to the forum and new to try. In 2023 I was diagnosed with low testosterone and was prescribed a topical testosterone gell which didn't work. In fact my counts got lower after using it. So I went to a urologist and he ran some tests and decided I was a candidate for trt via cypionate. I was prescribed 100mg 1x per week intramuscular injections. My starting t was 121 and estradiol was 17.7. My 6 week blood work was 873T and 49.7 estradiol 5 days after my last shot. So I would assume that at some point I may have gotten to around 1000T before it started to fall off. I have a couple questions.

1. Should my Dr test my sbgh, because he hasn't.

2. Should he check my free testosterone, because he hasn't. My previous NP did prior to the gell and it was 5.4.

3. I'm at week 8 and haven't had much change in mood, libido or energy. Would 2x per week help me there? Could I be getting too much at once? He said that the estradiol was not concerning.

4. I've decided to do 50mg every 3.5 days to see if it helps. What will that do to my testosterone numbers? Will I still get up to around 1000 doing it that way or will it keep me lower but without the peaks and valleys?

5. I am not on any kind of blockers because he didn't see any harmful side effects yet. Is the estradiol a concern at those numbers?

Thanks in advance for any info that you can give.

My starting t was 121 and estradiol was 17.7. My 6 week blood work was 873T and 49.7 estradiol 5 days after my last shot. So I would assume that at some point I may have gotten to around 1000T before it started to fall off.


100 mg TC/TE is a common starting dose.

Downfall when injecting once weekly is there will be a big difference in the peak--->trough and blood levels will not be as stable throughout the week.

Your T level will be at its highest point during your peak (8-12 hrs) post-injection/during the first 2-3 days every week only to be followed by lower levels come weeks end.

For many this can have a negative impact on mood, energy, libido and erectile function due to the rollercoaster type effect.

Easy way to remedy this is to split your weekly dose and inject twice-weekly (every 3.5 days) which will clip the peak--->trough and blood levels will be more stable throughout the week.

Also keep in mind depending on the dose of T some men following a once weekly injection protocol may not hit a high enough trough TT/FT 7 days later whereas others may still be hitting a healthy/high trough FT.

Unfortunately your blood work was done at the wrong time as you always want to test at the true trough (lowest point) before your next injection.

Seeing as you are injecting once weekly then your true trough would be 7 days post-injection.

Your blood work was done 5 days post injection and your are hitting a high-end TT 873 ng/dL which means your peak would easily be over 1000 ng/dL.

The shitkicker here is not only did you have your blood work done at the wrong time but you are missing one of the most important blood markers free testosterone.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effect.

Bottomline here is TT means nothing without knowing where your FT level sits.

Even then if you are hitting a very high TT almost 900 ng/dL 5 days post-injection you would still be hitting a descent true trough TT (7 days) post-injection.

One could still end up hitting a healthy trough FT with a trough TT 700 ng/dL.

Again this means nothing without knowing where your FT and SHBG sit.




4. I've decided to do 50mg every 3.5 days to see if it helps. What will that do to my testosterone numbers? Will I still get up to around 1000 doing it that way or will it keep me lower but without the peaks and valleys?


Would not get to caught up on this needing to hit a TT 1000s especially if you are talking trough here!

One can easily hit a healthy/high trough FT with a trough TT <1000 ng/dL.

Again where your FT sits is what truly matters.

If you already jumped the gun and are going to switch over to injecting twice-weekly then you will need to start over again and wait 4-6 weeks for blood levels to stabilize before getting blood work done let alone a more thorough set of labs which will include your trough FT let alone other blood markers such as SHBG, DHT, prolactin and CBC.

Top it all off that every protocol needs to be given a fighting chance 12 weeks to claim whether it was truly as success or failure.

As I have preached numerous times on the forum over the years whether starting TTh or tweaking a protocol (increasing/decreasing T dose) hormone will be in FLUX during the weeks leading up until blood levels have stabilized (4-6 weeks TC/TE) and it is common for most to experience ups/downs during the transition as the body is trying to ADJUST.

Even then once blood levels have stabilized (4-6 weeks TC/TE) it will still take time as in a few more months for the body to ADAPT to its new set-point and this is the critical time period when one needs to gauge how they truly feel overall regarding relief/improvement of low-t symptoms and overall well-being.

Most do not understand how exogenous T works and start tweaking their protocols 6 weeks in because they do not feel good!




5. I am not on any kind of blockers because he didn't see any harmful side effects yet. Is the estradiol a concern at those numbers?

Tread lightly when it comes to use of an AI let alone the need for one!

Ts metabolites estradiol and DHT are needed.

Having healthy levels of estradiol is critical!

Ts metabolites estradiol and DHT are needed in healthy amounts to experience the full spectrum of testosterones beneficial effects on (cardiovascular health, brain health, libido, erectile function, bone health, tendon health, immune system, lipids, and body composition).