Finally some success - but how to change regimen to keep it?? Daily injections?

[50BMGdoesitforme]

Hey all - long story short, I've been on TRT about 5 years. At age 38, total T was 230 and my symptoms were zero energy and terrible ED. I've been trying different regimens ever since and making slow progress. Finally got a great doctor and slowly improving. Erections have been about a 6 out of 10 - really not that great. Regimen is currently 70mg of T x3/week, 500 units of HCG x2, and 1/16th-mg of AI. As of three weeks ago free T is at 211, E2 at 29, and SHBG at 19.

A few weeks ago I took one of my injections 24 hours early in order to not have to fool with flying with needles on a short trip and was amazed. Never before had I felt any better or worse before/after injecting like some guys do - always about the same. But, just a few hours after this early injection, I had a 10/10 erection, and they happened all the next day as well. In 5 years on TRT it has NEVER been like this. The day after that things were back to normal. As an experiment, I waited one week and did the same thing again - did one injection 24 hours early - and while it wasn't as amazing as the first time, it was still MUCH better than usual.

I had a doctor's appointment and he encouraged me to experiment to see what could replicate this. First thing he suggested was to move up to 80mg x3, maybe with a free T of 250 as a target. I've done that for a full week now and while things are maybe a bit better, it's nothing special.

What was so unusual is how fast things improved the first time - so I'm wondering if maybe daily injections would replicate that. He suggested 30-40mg daily if I tried that and said I may not need the AI anymore with daily injections. I'm really hopeful that daily might be the ticket.

Have any of you had success with daily injections, and if so, any tips?

I am so grateful for you all reading this and for any wisdom you can share! Thank you very, very much.

 

[FunkOdyssey]

Regimen is currently 70mg of T x3/week, 500 units of HCG x2, and 1/16th-mg of AI. As of three weeks ago free T is at 211, E2 at 29, and SHBG at 19.

I'm sorry I don't have any advice, beyond trying your doctor's recommendation, which sounds reasonable. I'm curious though about your low lab values, given the high dose you're taking with hCG on top. By any chance do you inject subcutaneously?

 

[Systemlord]

A few weeks ago I took one of my injections 24 hours early in order to not have to fool with flying with needles on a short trip and was amazed. Never before had I felt any better or worse before/after injecting like some guys do - always about the same.

If you spend enough time on this forum, you’ll see a reoccurring theme among men who noticed improvements and how they feel after changing their protocol where the benefits are short-lived.

I had treatment failure on injections, no matter what my injection frequency was, daily, every other day, twice a week. It didn’t matter, I only experienced a positive benefit for a couple of days after that change in dosage and or injection frequency.

Then I found out about a new oral testosterone undecanoate, Jatenzo, Orlando and Kyzatrex. I’ve been on Jatenzo for three years, and now have dialed in everything else and I feel amazing.

On these relatively new oral testosterone options, the PK profiles are always changing, by the hour and I believe is the reason why response so damn good!

 

[50BMGdoesitforme]

Funk, you're absolutely right - I do inject SubQ! The late Dr. Crisler convinced me and my current doc approves as well. I think I respond slightly better than IM but it's definitely way easier if nothing else.

System, I too have noticed on several occasions that an increased protocol tends to create a "flash in the pan" that is unfortunately short-lived. What caught my attention about this one was first the speed at which it took effect, followed by the results, which were better than any point so far; truly, it was like things used to be before I had any ED. I will try both of my doc's suggestions but if they both end up as you've predicted I will absolutely try oral T. Is it just a pill? Any downsides? Not that I'd be easily dissuaded if it gets the job done!

Sure appreciate the replies, fellas!

 

[Systemlord]

Is it just a pill? Any downsides?

None that I can think of, advantages, very few cases of erythrocytosis. Higher DHT versus injections. Orals have less side effects across the board.

Perhaps the rapid peak within two hours of your dose might make all the difference in the world for some men as far as response to therapy. The injection peak is a bit more gradual, perhaps less able to overcome any low receptor or tissue sensitivity.

One theory for this spontaneous improvement after making a change, testosterone influences the kidneys absorption of sodium. A constantly elevated hormone level may exacerbate this issue where oral testosterone would not because hormone levels drop so quickly.

My Experience On Jatenzo (Oral TRT) Log

I wanted to start a thread detailing my personal experience with Jatenzo (oral TRT) which is remarkable in how quickly it has shown results when compared with injections. The first week on Jatenzo was very pleasant unlike my experience after dosing changes on injections, all with minimal swings...

www.excelmale.com

 

[Mastodont]

I think I respond slightly better than IM but it's definitely way easier if nothing else.

So how long were you doing IM, was it at this same protocol?

 

[FunkOdyssey]

Funk, you're absolutely right - I do inject SubQ! The late Dr. Crisler convinced me and my current doc approves as well. I think I respond slightly better than IM but it's definitely way easier if nothing else.

Thank you for confirming my suspicion. You probably think you are a poor responder to TRT, because you have to inject 210 mg weekly to hit those mediocre numbers. I suspect you are one of those people who, like me, would see 30-50% higher total and free testosterone levels if you were to switch to IM. Depending on how much you pay per vial, it may make sense financially to consider.

 

[50BMGdoesitforme]

Thanks, System - if I strike out after these experiments I will absolutely try oral. Only concern is that my hair began to thin rapidly in the last year or two, likely due to higher DHT from TRT, so I'd once again have to make a difficult choice.

Mast, I switched to subQ probably three or four years ago, when my labs were likely all over the place, so I've never tried this protocol IM.

I'm certainly not adverse to trying IM again - in addition to higher T levels, any chance I could expect it would help with ED? Also should have mentioned I'm on 10mg of Cialis daily, and starting that did make a substantial difference.

Thanks again for the replies!

 

[Vince]

Hey all - long story short, I've been on TRT about 5 years. At age 38, total T was 230 and my symptoms were zero energy and terrible ED. I've been trying different regimens ever since and making slow progress. Finally got a great doctor and slowly improving. Erections have been about a 6 out of 10 - really not that great. Regimen is currently 70mg of T x3/week, 500 units of HCG x2, and 1/16th-mg of AI. As of three weeks ago free T is at 211, E2 at 29, and SHBG at 19.

A few weeks ago I took one of my injections 24 hours early in order to not have to fool with flying with needles on a short trip and was amazed. Never before had I felt any better or worse before/after injecting like some guys do - always about the same. But, just a few hours after this early injection, I had a 10/10 erection, and they happened all the next day as well. In 5 years on TRT it has NEVER been like this. The day after that things were back to normal. As an experiment, I waited one week and did the same thing again - did one injection 24 hours early - and while it wasn't as amazing as the first time, it was still MUCH better than usual.

I had a doctor's appointment and he encouraged me to experiment to see what could replicate this. First thing he suggested was to move up to 80mg x3, maybe with a free T of 250 as a target. I've done that for a full week now and while things are maybe a bit better, it's nothing special.

What was so unusual is how fast things improved the first time - so I'm wondering if maybe daily injections would replicate that. He suggested 30-40mg daily if I tried that and said I may not need the AI anymore with daily injections. I'm really hopeful that daily might be the ticket.

Have any of you had success with daily injections, and if so, any tips?

I am so grateful for you all reading this and for any wisdom you can share! Thank you very, very much.

If you do want to try daily injections I would just go with 10 mg daily, keep the same HCG protocol and drop the A I. If you feel that you need to increase the dose after 12 weeks slowly increase it. With 12 weeks adjustments, that's usually how long it takes to feel the difference in protocols.

 

[50BMGdoesitforme]

Sounds like a good plan, Vince. I think I'm going to stick with my current protocol for another 11 weeks (so 12 total) and then evaluate. Then the question is should I try the same dosage but IM - or should I try daily injections starting at 10mg. Or oral...

I'm sure this is all painfully routine for many of you, but needing to wait 12 weeks to properly evaluate a protocol makes me feel like I will never get dialed in! Here's to hoping I start to get lucky soon.

 

[FunkOdyssey]

Sounds like a good plan, Vince. I think I'm going to stick with my current protocol for another 11 weeks (so 12 total) and then evaluate. Then the question is should I try the same dosage but IM - or should I try daily injections starting at 10mg. Or oral...

I'm sure this is all painfully routine for many of you, but needing to wait 12 weeks to properly evaluate a protocol makes me feel like I will never get dialed in! Here's to hoping I start to get lucky soon.

My vote is same dosage IM. If you switch to daily injections of 10 mg, your levels are going to come crashing down hard, ending up something like 30-40% of your current levels.

 

[Mastodont]

My vote is same dosage IM. If you switch to daily injections of 10 mg, your levels are going to come crashing down hard, ending up something like 30-40% of your current levels.

I vote a little higher than that, since we have seen amazing numbers from daily injections in small mg.

 

[carlweathers]

Maybe your dose is insufficient for your physiology. I supplement my own in between testing, works well.

 

[FunkOdyssey]

I vote a little higher than that, since we have seen amazing numbers from daily injections in small mg.

His trough values are not going to be that different on MWF versus ED. His trough free T is 21 ng/dL on 210 mg weekly. I don't see how this could play out any differently than <10 ng/dL trough at 70 mg weekly, unless he also switches to IM at the same time, and starts absorbing testosterone like a normal person.

 

[50BMGdoesitforme]

Thanks for the replies, all. I should have mentioned that I'm 5'11 and 270 lb, mostly muscle. I've been lifting or running every day for many years and even before TRT, with my total T at 232 (in my late 30s), I was very muscular. Let me assure everyone that I have never had any interest in abusing T for the purposes of muscle gain - I would gladly LOSE muscle to get my ED issues sorted out!

So - I'd really like to believe that my physiology simply requires higher levels that I've not yet had. Seems like my best plan is still to ride out this 12-week period at 80mg x3 and then reevaluate. If in fact higher levels end up working for me, I'd definitely be up for experimenting with IM or injection frequency to see if I can get the same levels with a lower overall dosage.

What I wouldn't give to simply know right now what my protocol should be...sigh...but I know this is the reality of TRT!

 

[madman]

Hey all - long story short, I've been on TRT about 5 years. At age 38, total T was 230 and my symptoms were zero energy and terrible ED. I've been trying different regimens ever since and making slow progress. Finally got a great doctor and slowly improving. Erections have been about a 6 out of 10 - really not that great. Regimen is currently 70mg of T x3/week, 500 units of HCG x2, and 1/16th-mg of AI. As of three weeks ago free T is at 211, E2 at 29, and SHBG at 19.

A few weeks ago I took one of my injections 24 hours early in order to not have to fool with flying with needles on a short trip and was amazed. Never before had I felt any better or worse before/after injecting like some guys do - always about the same. But, just a few hours after this early injection, I had a 10/10 erection, and they happened all the next day as well. In 5 years on TRT it has NEVER been like this. The day after that things were back to normal. As an experiment, I waited one week and did the same thing again - did one injection 24 hours early - and while it wasn't as amazing as the first time, it was still MUCH better than usual.

I had a doctor's appointment and he encouraged me to experiment to see what could replicate this. First thing he suggested was to move up to 80mg x3, maybe with a free T of 250 as a target. I've done that for a full week now and while things are maybe a bit better, it's nothing special.

What was so unusual is how fast things improved the first time - so I'm wondering if maybe daily injections would replicate that. He suggested 30-40mg daily if I tried that and said I may not need the AI anymore with daily injections. I'm really hopeful that daily might be the ticket.

Have any of you had success with daily injections, and if so, any tips?

I am so grateful for you all reading this and for any wisdom you can share! Thank you very, very much.

*Regimen is currently 70mg of T x3/week, 500 units of HCG x2, and 1/16th-mg of AI. As of three weeks ago free T is at 211, E2 at 29, and SHBG at 19

* I've been trying different regimens ever since and making slow progress


How long were you on this protocol (dose T/injection frequency)?

You are injecting a whopping dose 210 mg T/week split 3X/week.

Post labs with reference range/testing method used and throw in your TT!

What method was used to test your FT?

Keep in mind that when it comes to testing free testosterone you would need to use/rely upon what would be considered the most accurate assays (Equilibrium Dialysis or Ultrafiltration) especially in cases of altered SHBG in order to know where your FT level truly sits.

If you do not have access to such (highly doubtful) if you live in the US then you would need to use/rely upon the linear law-of-mass action cFTV using the online calculator which is free!

Judging by the 211 you posted it was most likely Quest's calculated FT or Equilibrium Dialysis or Labcorps Equilibrium Dialysis.

Your FT would be 21 ng/dL which is on the high-end.

If you had blood drawn at the proper time which is true trough then you would be hitting a high-end trough FT which means your peak TT, FT will be higher.

Better yet you are hitting a very high FT for someone with lowish SHBG!

Again how many days post-injection was blood work done.

True trough when injecting 3X weekly would be 72 hrs post-injection!

Post up your RBCs,hemoglobin and hematocrit.




*First thing he suggested was to move up to 80mg x3, maybe with a free T of 250 as a target. I've done that for a full week now and while things are maybe a bit better, it's nothing special.

This is an absurd dose of T as you are already hitting a high-end FT injecting 210 mg/week.

This may very well be your trough too!

Highly doubtful bumping it up from 21-25 ng/dL is going to make a big difference!

Too late now as you already jumped in head first!

I would tread lightly when it comes to that more T is better mentality being pushed by those dime a dozen run of the mill T clinics, so called men's health forums littered on the internet loaded with those blast n cruizzzers and those so called HRT gurus polluting gootube!

Hope you understand the more T is better mentality can easily backfire on you in the long run especially when it come to llibido/erectile function!

 

[madman]

Thank you for confirming my suspicion. You probably think you are a poor responder to TRT, because you have to inject 210 mg weekly to hit those mediocre numbers. I suspect you are one of those people who, like me, would see 30-50% higher total and free testosterone levels if you were to switch to IM. Depending on how much you pay per vial, it may make sense financially to consider.

Mediocre for the dose of T/injection frequency sure.

A trough FT 21 ng/dL mediocre give your head a shake!

He has lowish SHBG and is hitting a high-end FT going off the cFTV or better yet a high FT based on Quests Equilibrium Dialysis reference range.

Age-stratified reference ranges for directly measured (ED LC-MS/MS) serum free testosterone in healthy men

Just to be clear up any confusion this is Fiers camps data for mFT reference ranges not the harmonized reference range being worked on by the CDC. *Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies * mFT...

www.excelmale.com

Age category (years)	Median mFT (ng/dl)	95% mFT reference range (ng/dl)
25-29 (n=148)	10.3	5.6 - 17.1

 

[50BMGdoesitforme]

Thanks for this detailed reply, MadMan - I've read a LOT of your posts in this forum!! It's an honor to welcome you to the rollercoaster of my TRT.

All good questions - I'd been on 70mg x3 for 6 months prior to my appointment where I upped to 80mg x3. My labs weren't exactly at trough for logistical reasons - it had been ~40 hours since my last injection. I do my blood work at Quest, so your theory was dead-on.

I am currently a Defy patient, so I am under quality medical care, but my doc there is also scratching his head as to why I'm not responding better, and he's open to me experimenting a bit to try to figure out what works.

I certainly do understand that more is often NOT better in TRT, but after my ED completely disappeared for the FIRST time after two close injections, my doc and I are up for trying a range of things in the hopes of figuring out what will work for me. Doc has always said he'd like me near 200 FT and between 25-35 E2, but that there's a chance I might need to be closer to 250 FT, which is what we're aiming for with this protocol change.

This doc did move me from injecting x2/week to x3 early in my treatment, and that did make a positive difference. And I hadn't recalled that until just now, so that might mean that I'd have some success with daily injections...who knows.

Here are those other labs:
RBC: 6.09 (4.20-5.80)
Hemoglobin: 17.6 (13.2-17.1)
Hematocrit: 52.2 (38.5-50.0)

I saw the hematocrit was high so I gave blood between getting my results and my appointment. I've had to do that once before to keep me under 50.

I just looked some of my records and just before I started TRT my SHBG was 25 - interesting.

As if anyone here needed more evidence that most docs have no idea what they're doing, my first doc immediately put me on 100mg x2/week, and when that didn't work, he gave me 1mg of AI/week. When that didn't work, he raised it to 1.5mg/wk. Thankfully by that time I'd discovered this place, so I got rid of the AI and lowered my own dose to 60mg x2 and slowly worked up from there.

Sorry this is long - Madman, do you think there's a chance that my physiology would be one of the few that needs to be around 250 FT? Basically, is it worth sticking it out for the next 11 weeks on 80mg x2? Or am I just barking up the wrong tree? I'm getting intrigued about daily injections, but there's just so many other options out there...sigh. I appreciate any feedback you might have!

 

[madman]

Thanks for this detailed reply, MadMan - I've read a LOT of your posts in this forum!! It's an honor to welcome you to the rollercoaster of my TRT.

All good questions - I'd been on 70mg x3 for 6 months prior to my appointment where I upped to 80mg x3. My labs weren't exactly at trough for logistical reasons - it had been ~40 hours since my last injection. I do my blood work at Quest, so your theory was dead-on.

I am currently a Defy patient, so I am under quality medical care, but my doc there is also scratching his head as to why I'm not responding better, and he's open to me experimenting a bit to try to figure out what works.

I certainly do understand that more is often NOT better in TRT, but after my ED completely disappeared for the FIRST time after two close injections, my doc and I are up for trying a range of things in the hopes of figuring out what will work for me. Doc has always said he'd like me near 200 FT and between 25-35 E2, but that there's a chance I might need to be closer to 250 FT, which is what we're aiming for with this protocol change.

This doc did move me from injecting x2/week to x3 early in my treatment, and that did make a positive difference. And I hadn't recalled that until just now, so that might mean that I'd have some success with daily injections...who knows.

Here are those other labs:
RBC: 6.09 (4.20-5.80)
Hemoglobin: 17.6 (13.2-17.1)
Hematocrit: 52.2 (38.5-50.0)

I saw the hematocrit was high so I gave blood between getting my results and my appointment. I've had to do that once before to keep me under 50.

I just looked some of my records and just before I started TRT my SHBG was 25 - interesting.

As if anyone here needed more evidence that most docs have no idea what they're doing, my first doc immediately put me on 100mg x2/week, and when that didn't work, he gave me 1mg of AI/week. When that didn't work, he raised it to 1.5mg/wk. Thankfully by that time I'd discovered this place, so I got rid of the AI and lowered my own dose to 60mg x2 and slowly worked up from there.

Sorry this is long - Madman, do you think there's a chance that my physiology would be one of the few that needs to be around 250 FT? Basically, is it worth sticking it out for the next 11 weeks on 80mg x2? Or am I just barking up the wrong tree? I'm getting intrigued about daily injections, but there's just so many other options out there...sigh. I appreciate any feedback you might have!

You drove down your SHBG from 25 nmol/L (pre)--->19 nmol/L (post TTh).

You have lowish SHBG and your TT will not need to be that high in order have a healthy/high FT.

Labs were drawn almost 40 hrs post-injection which still means your peak TT/FT will be higher.

There is a burst release of T within the first 2 hrs post-injection and peak will be achieved 8-24 hrs post.

I would say more like 8-12 hrs post-injection.

TE has even been shown to peak as early as 6 hrs post-injection.

Your RBC, H/H are elevated due to your high FT.

As has been stated numerous times on the forum the cut-off for hematocrit is 54%.

Most doctors in the know would recommend donating or reducing your weekly T-dose and bringing down your trough FT once you hit 54%.

Some will be more cautious and take measures once hematocrit hits 52%.

As long as you have no underlying health issues and you are not experiencing any negative sides I see no issue with running a hematocrit 50-54%.

Keep in mind you need to tread lightly when it comes to donating to try and manage elevated hematocrit as many tend to get caught up on the donating too frequently merry go round only to end up crashing their iron/ferritin which is not healthy in the long run!

You already upped your weekly T dose from a whopping 210--->240 mg/week.

No point in going back now just need to understand that driving up your already high FT further is going to drive up your RBCs, hemoglobin and hematocrit.

Even then although you may notice a boost in libido/erections this will most likely be temporary and short-lived as the body will eventually adapt to its new set-point.

Do not get caught up on chasing what we call that honeymoon period!

Still doubtful bumping up your FT from 21-25 ng/dL will have a big impact in the long-run.

Only time will tell.

Bottomline here is do what you feel is best for you.

If you want to keep driving up your FT in the hopes of finding that magical level you may end up chasing your tale until the cows come home especially when it comes to libido/erectile function as they are multifactorial and having healthy T levels is only one piece of the puzzle!

Some key points here:

*Testosterone plays a permissive role in erectile function. However, the amount of androgen necessary for normal erectile function is relatively low

*The male sexual response cycle is complex and the exact role of testosterone in mediating libido, arousal, erection, ejaculation, and orgasm is multifactorial

Truth About Testosterone and Your Libido

https://www.yahoo.com/lifestyle/truth-testosterone-libido-185000725.html?soc_src=social-sh&soc_trk=tw&tsrc=twtr As an expert on andrology and sexual dysfunctions, urologist Andrew Y. Sun, M.D., sees plenty of patients who’re struggling with low libido. And most are pretty sure they already...

www.excelmale.com

*The male sexual response cycle is complex and the exact role of testosterone in mediating libido, arousal, erection, ejaculation, and orgasm is multifactorial

*This hormone isn’t the only biological factor with clear, substantial power over our libidos

Male erectile dysfunction

Sexual dysfunction is a common, almost expected, consequence of autonomic dysfunction. Neurogenic sexual dysfunction may present with decreased erectile rigidity in the male, decreased clitoral and vaginal blood flow/lubrication in the female, or absent or delayed orgasm in either sex. Secondary...

www.excelmale.com

*Age and physical health are the most important predictors of the onset of erectile dysfunction. Smoking was the most important lifestyle variable. Erectile dysfunction does not correlate well with male hormone levels

*Testosterone plays a permissive role in erectile function. However, the amount of androgen necessary for normal erectile function is relatively low

*Testosterone replacement rarely restores erectile function in those with mildly decreased serum testosterone levels (225-300 ng/mL) and should not be routinely given for that indication. Testosterone supplementation is never indicated for patients with normal circulating androgen levels

Effect of aerobic exercise on erectile function

Abstract Background: The health benefits of regular aerobic exercise are well established, although there is limited high-quality evidence regarding its impact on erectile function. Aim: To determine the effect of aerobic exercise on erectile function in men and to identify factors that may...

www.excelmale.com

Testosterone Therapy and Erythrocytosis - the most common dose-limiting effect of testosterone therapy

https://www.thebloodproject.com/cases-archive/testosterone-therapy-and-erythrocytosis-2/ Introduction Androgens play a crucial role in the development and maintenance of: Male reproductive and sexual functions Body composition Erythropoiesis Muscle and bone health Cognitive function...

www.excelmale.com

*hematocrit of ≥54% appears to be consistent threshold to discontinuing or reducing treatment utilized by major urologic governing bodies, while the evidence for this specific cutoff is lacking

*There is no compelling evidence that testosterone therapy or testosterone therapy-associated erythrocytosis are associated with increased risk of cardiovascular events or venous thromboembolism

*However, clinical practice guidelines generally recommend intervention if hematocrit of ≥54% while taking testosterone therapy; interventions include stopping testosterone therapy altogether, changing the dose or route of administration or instituting a phlebotomy regimen

 

[50BMGdoesitforme]

Thanks for all this, madman - I've read through all the articles and although a lot of it is still over my head I got the jist of each one. I'm fully prepared to find that my body adjusts to this new protocol and things don't improve, even though it would be great if it were that simple. I do understand how complicated ED is, but my chance experience last month did give me hope that I will be able to find a protocol that works.

I do lift heavy 4x/week and do HIIT sprinting 2x/week, but I've been taking my dog with me, and he prefers to lightly jog, so I've really not been getting decent cardio for a few years now. Let me try to step that up since apparently that's particularly important.

So if you were me, what would you do? Maybe finish out this 12-week trial and then try daily injections, starting low and working up from there?

Thanks again for all the great info!