Empower Pharmacy - short at least 100mg of Testosterone in vial every time

[OLD]

Very satisfied with the quality of Empower Pharmacy's compounded products (Testosterone, HCG, GHRP2).

Only gripe is I am always short at least 100 mg in their Testosterone vials. Does not matter if its a 2,000 mg vial, or a 1,000 mg vial.

Anyone else have this problem?

Thanks,

Old

 

[CoastWatcher]

Welcome to Excelmale! How did Empower respond when you raised it with them?

 

[maxadvance]

Funny you bring this up because someone mentioned( I think it was Dr Saya) that compound pharmacies always put 11mls in their 10ml vials. I have since concluded this is absolute bullshit. My first 10ml vial from APS was right at 10, and the second one was barely 9ml. So things seem to have changed.

 

[Dr Justin Saya MD]

Funny you bring this up because someone mentioned( I think it was Dr Saya) that compound pharmacies always put 11mls in their 10ml vials. I have since concluded this is absolute bullshit. My first 10ml vial from APS was right at 10, and the second one was barely 9ml. So things seem to have changed.

Jasen mentioned that previously. We've been "advised" by APS that they overfill 10ml vials by 0.5-1ml to compensate for the loss (in needle and syringe dead space) with each injection over the course of the vial. Can't speak for other pharmacies. A few years ago we personally tested a couple of the office vials from APS by drawing out all of the contents AT ONCE (the only accurate way to tell the total volume - eliminates the factor of per-injection loss) and confirmed the vials were indeed overfilled by 0.5-1ml. We haven't repeated that experiment in the past few years, but have been "advised" several times since that they continue this practice. The 10cc syringe that comes with the HCG mixing kit can be used to verify total volume of a new vial, although I don't advise as it can pose a problem with sterility.

Guys who inject multiple times weekly often encounter the "running short" phenomenon. This makes sense when thinking about the numbers. Let's say a patient injects 0.35ml twice weekly, that would equate to approximately 28 injections from a 10ml vial. Now let's assume a moderate "loss" of 0.05ml per injection (1/20th of a cc or 1/2 of 1 tick mark on a 1cc syringe). This would equate to a total loss of: 28 x 0.05ml = 1.4ml lost over course of 28 injections from a 10ml vial. Further, there can be PERCEIVED losses from slight overdrawing for injections, especially inadvertently with the larger 3cc syringes. Even a SLIGHT overdraw with the 3cc syringes on a twice weekly basis would create a similar perceived loss as the vial simply wouldn't last as long. For this reason, 1cc syringes are typically more accurate and dependable for folks injecting smaller volumes multiple times weekly.

There is really no way to eliminate ALL loss, but certain steps can be taken to minimize losses - smaller length/gauge needle = less needle loss, 1cc syringe = less syringe dead space loss, drawing air into syringe BEFORE drawing the T cyp so that there is some air in back of syringe to *try* to push the last drops of T cyp out of the needle (easier said than done).

 

[Vince]

I use APS through Defy Medical, all my vials have been full. It seems all my T vials are over full.

 

[OLD]

yeah, but....

Jasen mentioned that previously. We've been "advised" by APS that they overfill 10ml vials by 0.5-1ml to compensate for the loss (in needle and syringe dead space) with each injection over the course of the vial. Can't speak for other pharmacies. A few years ago we personally tested a couple of the office vials from APS by drawing out all of the contents AT ONCE (the only accurate way to tell the total volume - eliminates the factor of per-injection loss) and confirmed the vials were indeed overfilled by 0.5-1ml. We haven't repeated that experiment in the past few years, but have been "advised" several times since that they continue this practice. The 10cc syringe that comes with the HCG mixing kit can be used to verify total volume of a new vial, although I don't advise as it can pose a problem with sterility.

Guys who inject multiple times weekly often encounter the "running short" phenomenon. This makes sense when thinking about the numbers. Let's say a patient injects 0.35ml twice weekly, that would equate to approximately 28 injections from a 10ml vial. Now let's assume a moderate "loss" of 0.05ml per injection (1/20th of a cc or 1/2 of 1 tick mark on a 1cc syringe). This would equate to a total loss of: 28 x 0.05ml = 1.4ml lost over course of 28 injections from a 10ml vial. Further, there can be PERCEIVED losses from slight overdrawing for injections, especially inadvertently with the larger 3cc syringes. Even a SLIGHT overdraw with the 3cc syringes on a twice weekly basis would create a similar perceived loss as the vial simply wouldn't last as long. For this reason, 1cc syringes are typically more accurate and dependable for folks injecting smaller volumes multiple times weekly.

There is really no way to eliminate ALL loss, but certain steps can be taken to minimize losses - smaller length/gauge needle = less needle loss, 1cc syringe = less syringe dead space loss, drawing air into syringe BEFORE drawing the T cyp so that there is some air in back of syringe to *try* to push the last drops of T cyp out of the needle (easier said than done).

All that may be true, but I've never had an issue with quantity on the Watson or Pfizer testosterone vials. I've used one other compound pharmacy and there was no issue with quantity there either. I suppose other facilities over fill by enough to compensate for this expected loss.

 

[Dr Justin Saya MD]

All that may be true, but I've never had an issue with quantity on the Watson or Pfizer testosterone vials. I've used one other compound pharmacy and there was no issue with quantity there either. I suppose other facilities over fill by enough to compensate for this expected loss.

We haven't confirmed the process with Empower pharmacy to determine if they overfill, only APS pharmacy, but again that was a couple years ago that we tested the vials (although they've confirmed verbally more recently they still overfill). All pharmacies vary in their practices. I can say that on the clinical side the guys that tend to run low with their T cyp vial tend to be the guys that inject twice weekly or more frequently (vs the once weekly guys) by a ratio of at least 10:1...this alone lends credence to the accumulation over time of the small amount of waste with each injection.

 

[CoastWatcher]

We haven't confirmed the process with Empower pharmacy to determine if they overfill, only APS pharmacy, but again that was a couple years ago that we tested the vials (although they've confirmed verbally more recently they still overfill). All pharmacies vary in their practices. I can say that on the clinical side the guys that tend to run low with their T cyp vial tend to be the guys that inject twice weekly or more frequently (vs the once weekly guys) by a ratio of at least 10:1...this alone lends credence to the accumulation over time of the small amount of waste with each injection.

As one who injects daily, I can confirm Dr. Saya's point. I do run short every so often, far more frequently than I did when injecting twice weekly.

 

[maxadvance]

We haven't confirmed the process with Empower pharmacy to determine if they overfill, only APS pharmacy, but again that was a couple years ago that we tested the vials (although they've confirmed verbally more recently they still overfill). All pharmacies vary in their practices. I can say that on the clinical side the guys that tend to run low with their T cyp vial tend to be the guys that inject twice weekly or more frequently (vs the once weekly guys) by a ratio of at least 10:1...this alone lends credence to the accumulation over time of the small amount of waste with each injection.

I get what you're saying, and got it when y'all originally posted this as well. But my first vial was 10ml on the money, and i did run a bit short likely because of the 3ml vials that you guys sent me to use. But this second time when I compared my 11ml HCG vial that I just filled to the unopened Test vial the fill line difference was significant. The level was barely over the label and at least a 1/4 inch beneath the bottom of the neck. It is what it is. I would love to inject daily, but worried about syringe waste.

 

[Dr Justin Saya MD]

But this second time when I compared my 11ml HCG vial that I just filled to the unopened Test vial the fill line difference was significant. The level was barely over the label and at least a 1/4 inch beneath the bottom of the neck.

That's actually an inaccurate comparison. The HCG vial and the T cyp vial, although at first glance appear similar, are actually DIFFERENT size vials. The T cyp vial is a larger vial - if it isn't apparent to the naked eye, put the base of each vial up to each other...you'll see that the T cyp vial is a larger diameter (larger vial) and consequently even the same volume in each vial would appear lower in the larger T cyp vial. Now if you run low on injections reach out to us so we can work with you to minimize injection loss or certainly if you draw all of the T cyp out of a new vial and it measures out to less than 10ml - CERTAINLY inform us as we will not only have the pharmacy replace your vial but will also need to discuss with pharmacy management.

 

[EmpowerPharmacy]

Like almost all injectable medications you get from a big pharma company we also overfill our injectables to make up for the losses due to priming and administration. Common reasons for running out of an injectable prematurely are:

1. Using large bore (18G-23G) draw needles.
2. Not drawing out the liquid from the draw needle before swapping with an administration needle.
3. Overdrawing the syringe.
4. Drawing medication from a vial more often than recommended. Each time you do an injection there is some liquid caught in the hub of the syringe and needle that goes to waste.
5. Not being able to draw out all the liquid residue since a lot of it clings to the inside of the vial.

If you're running out of your injectable too soon it's a good idea to see if any of the reasons above may be the culprit. Regardless, we're here to help out our patients, so feel free to request a refill from your doctor if you run out early and we'll be more than happy to accommodate.

 

[Jasen Bruce]

Why some men run out of their injectable testosterone before their next refill

During the last year we have had an increase in reports from men that they are running out of their testosterone cypionate injections before the refill date. Lets first rule out those who over-draw the testosterone into the syringe, of course we must pay attention to detail when in comes to lining up the syringe plunger with the dosage line. If we are not paying attention, or have not been instructed properly, over drawing just a small amount of testosterone at each injection can lose 1 milliliter or more. There are other factors which can cause loss of testosterone as you inject regularly. If you notice at the base of your needle, where you attach the needle to the syringe, there is empty space which can trap the testosterone even after depressing the plunger completely. There always seems to be that little bit of T that will not leave the syringe/needle. In addition to the T being trapped in the needle head, there is also a small amount of T left behind on the syringe walls. This type of loss is unavoidable when using a 3ml or larger syringe. Over the course of 10-20 injections using a 10ml multi-dosed bottle that little bit of lost T adds up. One of the reasons I believe we have noticed the increase in reports of men running out early during the past year is the result of increased regulations regarding the prescribing and dispensing of testosterone. It is a controlled substance which was previously overlooked by most regulators, and patients had the convenience of refilling earlier than due. I remember being able to refill 3 weeks early on a 10ml bottle. Now, with the regulations, it is 3 days to one week prior to being due depending on the pharmacy. This means we now have to be mindful of our dosage and injection technique. There is one thing being done by manufacturers and compounders to mitigate the loss. There is also something you can do to make your T last the entire time up to your refill. At least one brand of testosterone cypionate and most compounded 10ml cypionates are actually overfilled. Pfizer's Depot Testosterone is filled over 10ML. I believe close to 10.8ml. The compounding pharmacies we use fill the bottle to 11ml, which will help compensate the unavoidable loss. We had the opportunity to test this in a pharmacy setting 5 years ago. If you are having trouble drawing a 3ml syringe, or if you are on a decimal dosage (such as 0.75ml), try using a 1ml tuberculin syringe. It looks just like an "insulin" syringe but can be attached with any size/gauge needle. Two benefits to using a 1ml syringe: 1- You will draw more accurately 2- There is less surface area on the syringe for the T to stick to the sides, however you still have the needle head which can trap T. I also find it easier to inject using a 1ml syringe.

http://defymedical.com/blog/item/12...njectable-testosterone-before-the-next-refill

 

[PAUL-E]

I just wanted to add that I noticed my BD 3cc syringes have been off up to .5cc because the black plunger part wasn't straight and was lopsided, if you have a few in a row it can add up.

 

[Vinnie Mancuso]

Love empower products and service. However I have noticed some differences in oil volume in the 5 cc testosterone bottles when sealed and standing next to each other. cypionate bottles are pretty consistent, but upon receiving some enanthate I put two 5 ml bottles next to each other and the amounts of
Oil volume in each were very noticeable.