Official Natesto Thread

[TLawyer]

Maybe consider the Natesto brand. I am prone to headaches and Natesto is literally the only form of TRT that does not give me a headache. The ingredient list is quite small while the list of ingredients in Defy's version is quite large. The headaches could be from one of the ingredients specific to the Defy formulation.

Yeah, problem there is getting the prescription and the cost. The lowest total testosterone I've tested at prior to starting TRT and then changing over to Enclomiphene was 330, and I don't think I can get insurance coverage for TRT for anything above 300.

I went with 1/4 of the usual dose about half an hour ago. No headache, which usually kicks in by now at the higher dose. That's nice, although who knows if 1/4 of the dose will really cause any benefit. The problem is that no matter what I do, the cream seems to run down the back of my throat, and it's doing it now as well. The stuff is nasty.

 

[TLawyer]

As the OP, I should jump back into the fray. Yes, I did say that it is not great for libido. However, I also started the thread during a time I was doing a lot of protocol changes, which is not an ideal time to form a subjective opinion. For this very reason, I have been tracking subjective responses to TRT in a spreadsheet so I can learn from the experiences, rather than making gut-based judgements.

Nothing really compares to the first two weeks I was on cream. Crazy libido. But, all came crashing down shortly after that window. I would perhaps update my opinion to say that Natesto is "sufficient" for libido support.

Were you cream only for a period? At one point, Defy had me taking shots and supplementing with cream. Pushed my numbers shortly after the cream off the charts in total and free testosterone and DHT. It was just too much for me as I am low SHBG.

 

[madman]

Testosterone supplementation for hypogonadal men by the nasal route (2008)


Abstract

Although multiple forms of testosterone replacement therapy are available to treat hypogonadism, none is ideal. This article reports on the pharmacokinetics of an innovative nasal formulation of testosterone in hypogonadal men. The first study was undertaken in eight men with a baseline total testosterone (TT) of 130.8 ± 87.4 ng/dL and examined the pharmacokinetics of nasal testosterone given in a single dose of 7.6 mg, 15.2 mg, or 22.8 mg, respectively. The second study examined the pharmacokinetics of nasal testosterone (7.6 mg) given either twice or three times a day in 21 severely hypogonadal men (baseline TT in 20 patients <50 ng/dL, in one patient 152 ng/dL) for 14 days. The steady-state concentration of testosterone was within the normal range in all treatment groups, but only in the 3-times-a-day group was the 95% confidence interval completely within the physiological range. The average DHT level did not exceed the upper range of normal. The clinical global visual analog scale improved in the whole group receiving testosterone (p < 0.001). All adverse events in both studies were of mild to moderate intensity and were evaluated as unlikely or not related to the administered study drug. No patients dropped out during treatment.

Comparison with the normal circadian rhythm by computer modeling suggests that nasal testosterone can be used to mimic the normal diurnal pattern in eugonadal men. Thus, nasal testosterone can be administered safely to humans in doses that approximate serum concentrations in the normal physiological range.




Methods

*The test product (MPP 10, M et P Pharma AG) is a semisolid formulation containing testosterone. One applicator, intended for administration to one nostril, delivers 120 mg of a gel comprising 3.8 mg of testosterone in a proprietary formulation, consisting of castor oil, a mixture of glycerides and polyethylene esters, and a gelling agent. The product contains no preservatives and is filled into white unit-dose applicators that are formed using blow-fill-seal technology. One dose is given as one applicator per each nostril (i.e. a total dose of 7.6 mg of testosterone).




Study A

The objective of the study was to determine the pharmacokinetics of testosterone and DHT after single-dose administration of three different doses of MPP 10 and to determine the dose level for further studies. Eight hypogonadal men between 22 and 62 years (39.3 + 14.8 years), BMI 26.8 +5.4 kg/m2, were included and had morning serum TT levels at screening of 130.8 +87.4 ng/dL. Seven cases were with secondary hypogonadism (three prolactinomas, two non-functioning pituitary adenomas, one Kallmann’s syndrome, one with idiopathic hypogonadotropic hypogonadism); one case was identified as Klinefelter syndrome.

Design. Open, sequential, single escalating dose study (three treatment days, 7 days between the treatment days as wash-out period).

Dosing. Treatment Day 1: 7.6 mg testosterone; Treatment Day 2: 15.2 mg testosterone; Treatment Day 3: 22.8 mg testosterone.

Blood sampling. 0, 10, 20, 30, 40, 50 min and 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, 6, 8, 10, 16, 24 h post-dose.

Pharmacokinetic evaluation TT. Cmax ¼ maximum concentration, Tmax ¼ time of maximum concentration, AUC0–24 h ¼ area under the curve, estimated for 0–24 h using the trapezoidal rule, NAUC0–24 h ¼ Normalised AUC, i.e. AUC/dose. For statistical comparisons (dose-linearity), baseline correction was applied by subtracting the baseline from all measured TT values before calculating Cmax and AUC. The baseline was calculated as the mean of the pre-dose and the 24 h TT value unless these values differed for more than a factor 2. If the latter was the case, the lowest value of the pre-dose and the 24-h concentration was used as the baseline. Zero was substituted for those values that became negative after baseline subtraction.

Safety monitoring. DHT levels, ear-nose-throat (ENT) and prostate examination, adverse events, laboratory measurements, vital signs.




Study B

The objective of the study was to determine the optimum dose scheme for the treatment with MPP 10. Twenty-one hypogonadal men were included. The characteristics of the patients are given in Table I.

Design. Open, randomized, multiple-doses, three arms, parallel-group study.

Dosing. (14 days): Group B1 – 7.6 mg testosterone two times a day (08:00 h, 14:00 h), Group B2 – 7.6 mg testosterone two times a day (08:00 h, 20:00 h), Group B3 – 7.6 mg testosterone three times a day (08:00 h, 14:00 h, 20:00 h).

Blood sampling. Days 1–13: pre-dose sample collection (between 06:00 and 07:00 h). Day 14: blood sampling at 0, 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 6.25, 6.5, 6.75, 7, 7.5, 8, 9, 10, 12, 14, 16, 18 and 22 h after the morning administration.

Pharmacokinetic evaluation TT. Cmin ¼ minimum concentration, Cmax, AUC0–24 h, NAUC0–24 h, Cav ¼ average concentration, calculated as AUC0–24 h/24, PTF ¼ peak-trough fluctuation, calculated as (Cmax7 Cmin)/Cav. For comparison with Study A and for between-group comparisons, AUC0–24h was calculated applying a baseline correction. As baseline values the individual pre-dose TT concentrations before first study administration were taken. This baseline was applied assuming that suppression in this study was minimal because baseline TT was virtually at castrating level for most men.

Safety monitoring. DHT levels, ENT and prostate examination, adverse events, laboratory measurements, vital signs.



Results

Study A

Serum T levels and pharmacokinetics. Mean concentration-time curves of testosterone after administration of the three different doses of MPP 10 are shown in Figure 1. The results indicate that physiological testosterone levels can be reached with all doses applied and that a dose of 22.8 mg does not produce supraphysiological concentrations. It must be emphasized that this latter dose was mainly investigated for safety reasons, and it is important to note that even with this dose concentrations did not substantially exceed those obtained with the 15.2 mg dose of testosterone.


Figure 1. Pharmacokinetic profile of TT (solid squares) and DHT (open squares) after single-dose administration of different doses of MPP 10 in study A. 7.6 mg T (squares), 15.2 mg T (circles), 22.8 mg T (triangles). The dashed line denotes lower limits of the normal range of TT based on morning serum samples. Error bars denote mean+SD.

The pharmacokinetic parameters are listed in Table II. The AUC did not linearly depend on the dose. The (baseline corrected) AUC 0–24 almost doubles with a dose of 15.2 mg as compared with 7.6 mg but only increases marginally when the dose is further increased to 22.8 mg. Also, the increase for Cmax is bigger between the low and medium dose than between the medium and the high dose. The maximum serum concentration is reached between 1 and 2 h after administration indicating a rapid absorption from the intranasal cavity.


Table II. Pharmacokinetic parameters of TT in study A after single escalating doses of MPP 10 in 8 men.

Serum DHT levels. The concentration of DHT is in the low physiological range for a short time, decreasing thereafter (Figure 1). The risk of supraphysiological concentrations is negligible.

Adverse events. Two adverse events (fever, nausea) occurred in one patient before the first administration. This patient was excluded from the study. There were no further drop-outs.



Study B

Serum T levels and pharmacokinetics. In this study, patients with very severe hypogonadism, virtually having castrated TT levels, were included. The pharmacokinetic parameters of testosterone for the three treatment groups are compiled in Table III, the corresponding serum concentration-vs.-time curves are shown in Figure 2.


Table III. Study B.

Group B1– 7.6 mg testosterone two times a day (08:00 h, 14:00 h)

time after administration (1h)




Group B2– 7.6 mg testosterone two times a day (08:00 h, 20:00 h)

time after administration (1h)




Group B3- 7.6 mg testosterone three times a day (08:00 h, 14:00 h, 20:00 h)

time after administration (1h)




The normalized baseline-corrected AUC values show that the extent of absorption of testosterone is virtually the same in each group. Cmin is low in all groups, but the patients started with very low baseline TT concentrations. The trough concentrations rise rapidly during the first two days from the initial low castrate TT levels to reach a new steady-state between *200 and 400 ng/dL.

The mean of average steady-state concentrations remains within the physiological range in all treatment groups, but only in group B3 (t.i.d. administration), the 95% confidence interval is also entirely within the physiological range. In all groups, Cmax values of individual patients sometimes slightly exceeded the upper limit of the physiological range. Excursions above the physiological range are short-lasting. Twelve of a total of 22 values higher than 1000 ng/dL were observed in a single patient, who started with a trough level of 900 ng/dL after 13 days of dosing with the three times daily dosing regimen.

Serum DHT levels. The pharmacokinetic parameters of DHT for the three treatment groups are shown in Table IV. These show that the average steady-state concentration of DHT did not exceed the upper limit of the physiological range (85 ng/dL), indicating no particular safety risk due to DHT pharmacokinetics. The corresponding serum concentration-vs.-time curves are shown in Figure 2. The curves show that even in group B3 the risk of a DHT level above the upper limit of the physiological range for a longer time is low. The larger standard deviations in groups B2 and B3 are caused mainly by the high concentrations in one patient each.

Adverse events. A total of 36 adverse events were observed during study B. All adverse events were of mild or moderate intensity. No serious adverse events were observed. The following organ systems were affected: psychiatric disorders, nervous system disorders, respiratory, thoracic, and mediastinal disorders, gastrointestinal disorders, skin, and subcutaneous tissue disorders, musculoskeletal, connective tissue, and bone disorders, renal and urinary system disorders, general disorders, and administration site condition. None of these events were evaluated as at least possibly related to drug treatment. No adverse values (i.e. improvement of condition) on day 14 compared with day 1 were observed. An important experience was that the AMS questionnaire was not fully compatible with the situation of the particular patients.




Discussion

The results of study A indicate that testosterone is well absorbed after nasal administration of different doses of MPP 10. The maximum serum concentration of testosterone is reached between 1 and 2 h after administration. The exposure to exogenous testosterone increases approximately linearly between 7.6 and 15.2 mg but levels off with the higher dose of 22.8 mg. At dose levels above 15 mg absorption may be limited due to the restricted volume for nasal application of 0.05–0.15 mL [27]; because of the low solubility of testosterone, the medium and the high dose had to be administered by increasing the application volume to 0.24 and 0.36 mL, respectively.

*Thus, the lack of a further linear increase of testosterone levels with higher doses may reflect a saturation phenomenon at the site of absorption.

 

[TLawyer]

Testosterone supplementation for hypogonadal men by the nasal route (2008)


Abstract

Although multiple forms of testosterone replacement therapy are available to treat hypogonadism, none is ideal. This article reports on the pharmacokinetics of an innovative nasal formulation of testosterone in hypogonadal men. The first study was undertaken in eight men with a baseline total testosterone (TT) of 130.8 ± 87.4 ng/dL and examined the pharmacokinetics of nasal testosterone given in a single dose of 7.6 mg, 15.2 mg, or 22.8 mg, respectively. The second study examined the pharmacokinetics of nasal testosterone (7.6 mg) given either twice or three times a day in 21 severely hypogonadal men (baseline TT in 20 patients <50 ng/dL, in one patient 152 ng/dL) for 14 days. The steady-state concentration of testosterone was within the normal range in all treatment groups, but only in the 3-times-a-day group was the 95% confidence interval completely within the physiological range. The average DHT level did not exceed the upper range of normal. The clinical global visual analog scale improved in the whole group receiving testosterone (p < 0.001). All adverse events in both studies were of mild to moderate intensity and were evaluated as unlikely or not related to the administered study drug. No patients dropped out during treatment.

Comparison with the normal circadian rhythm by computer modeling suggests that nasal testosterone can be used to mimic the normal diurnal pattern in eugonadal men. Thus, nasal testosterone can be administered safely to humans in doses that approximate serum concentrations in the normal physiological range.




Methods

*The test product (MPP 10, M et P Pharma AG) is a semisolid formulation containing testosterone. One applicator, intended for administration to one nostril, delivers 120 mg of a gel comprising 3.8 mg of testosterone in a proprietary formulation, consisting of castor oil, a mixture of glycerides and polyethylene esters, and a gelling agent. The product contains no preservatives and is filled into white unit-dose applicators that are formed using blow-fill-seal technology. One dose is given as one applicator per each nostril (i.e. a total dose of 7.6 mg of testosterone).




Study A

The objective of the study was to determine the pharmacokinetics of testosterone and DHT after single-dose administration of three different doses of MPP 10 and to determine the dose level for further studies. Eight hypogonadal men between 22 and 62 years (39.3 + 14.8 years), BMI 26.8 +5.4 kg/m2, were included and had morning serum TT levels at screening of 130.8 +87.4 ng/dL. Seven cases were with secondary hypogonadism (three prolactinomas, two non-functioning pituitary adenomas, one Kallmann’s syndrome, one with idiopathic hypogonadotropic hypogonadism); one case was identified as Klinefelter syndrome.

Design. Open, sequential, single escalating dose study (three treatment days, 7 days between the treatment days as wash-out period).

Dosing. Treatment Day 1: 7.6 mg testosterone; Treatment Day 2: 15.2 mg testosterone; Treatment Day 3: 22.8 mg testosterone.

Blood sampling. 0, 10, 20, 30, 40, 50 min and 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, 6, 8, 10, 16, 24 h post-dose.

Pharmacokinetic evaluation TT. Cmax ¼ maximum concentration, Tmax ¼ time of maximum concentration, AUC0–24 h ¼ area under the curve, estimated for 0–24 h using the trapezoidal rule, NAUC0–24 h ¼ Normalised AUC, i.e. AUC/dose. For statistical comparisons (dose-linearity), baseline correction was applied by subtracting the baseline from all measured TT values before calculating Cmax and AUC. The baseline was calculated as the mean of the pre-dose and the 24 h TT value unless these values differed for more than a factor 2. If the latter was the case, the lowest value of the pre-dose and the 24-h concentration was used as the baseline. Zero was substituted for those values that became negative after baseline subtraction.

Safety monitoring. DHT levels, ear-nose-throat (ENT) and prostate examination, adverse events, laboratory measurements, vital signs.




Study B

The objective of the study was to determine the optimum dose scheme for the treatment with MPP 10. Twenty-one hypogonadal men were included. The characteristics of the patients are given in Table I.

Design. Open, randomized, multiple-doses, three arms, parallel-group study.

Dosing. (14 days): Group B1 – 7.6 mg testosterone two times a day (08:00 h, 14:00 h), Group B2 – 7.6 mg testosterone two times a day (08:00 h, 20:00 h), Group B3 – 7.6 mg testosterone three times a day (08:00 h, 14:00 h, 20:00 h).

Blood sampling. Days 1–13: pre-dose sample collection (between 06:00 and 07:00 h). Day 14: blood sampling at 0, 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 6.25, 6.5, 6.75, 7, 7.5, 8, 9, 10, 12, 14, 16, 18 and 22 h after the morning administration.

Pharmacokinetic evaluation TT. Cmin ¼ minimum concentration, Cmax, AUC0–24 h, NAUC0–24 h, Cav ¼ average concentration, calculated as AUC0–24 h/24, PTF ¼ peak-trough fluctuation, calculated as (Cmax7 Cmin)/Cav. For comparison with Study A and for between-group comparisons, AUC0–24h was calculated applying a baseline correction. As baseline values the individual pre-dose TT concentrations before first study administration were taken. This baseline was applied assuming that suppression in this study was minimal because baseline TT was virtually at castrating level for most men.

Safety monitoring. DHT levels, ENT and prostate examination, adverse events, laboratory measurements, vital signs.



Results

Study A

Serum T levels and pharmacokinetics. Mean concentration-time curves of testosterone after administration of the three different doses of MPP 10 are shown in Figure 1. The results indicate that physiological testosterone levels can be reached with all doses applied and that a dose of 22.8 mg does not produce supraphysiological concentrations. It must be emphasized that this latter dose was mainly investigated for safety reasons, and it is important to note that even with this dose concentrations did not substantially exceed those obtained with the 15.2 mg dose of testosterone.


Figure 1. Pharmacokinetic profile of TT (solid squares) and DHT (open squares) after single-dose administration of different doses of MPP 10 in study A. 7.6 mg T (squares), 15.2 mg T (circles), 22.8 mg T (triangles). The dashed line denotes lower limits of the normal range of TT based on morning serum samples. Error bars denote mean+SD.
View attachment 18897


The pharmacokinetic parameters are listed in Table II. The AUC did not linearly depend on the dose. The (baseline corrected) AUC 0–24 almost doubles with a dose of 15.2 mg as compared with 7.6 mg but only increases marginally when the dose is further increased to 22.8 mg. Also, the increase for Cmax is bigger between the low and medium dose than between the medium and the high dose. The maximum serum concentration is reached between 1 and 2 h after administration indicating a rapid absorption from the intranasal cavity.


Table II. Pharmacokinetic parameters of TT in study A after single escalating doses of MPP 10 in 8 men.
View attachment 18898


Serum DHT levels. The concentration of DHT is in the low physiological range for a short time, decreasing thereafter (Figure 1). The risk of supraphysiological concentrations is negligible.

Adverse events. Two adverse events (fever, nausea) occurred in one patient before the first administration. This patient was excluded from the study. There were no further drop-outs.



Study B

Serum T levels and pharmacokinetics. In this study, patients with very severe hypogonadism, virtually having castrated TT levels, were included. The pharmacokinetic parameters of testosterone for the three treatment groups are compiled in Table III, the corresponding serum concentration-vs.-time curves are shown in Figure 2.


Table III. Study B.
View attachment 18899


Group B1– 7.6 mg testosterone two times a day (08:00 h, 14:00 h)
View attachment 18900
time after administration (1h)




Group B2– 7.6 mg testosterone two times a day (08:00 h, 20:00 h)
View attachment 18901
time after administration (1h)




Group B3- 7.6 mg testosterone three times a day (08:00 h, 14:00 h, 20:00 h)
View attachment 18902
time after administration (1h)




The normalized baseline-corrected AUC values show that the extent of absorption of testosterone is virtually the same in each group. Cmin is low in all groups, but the patients started with very low baseline TT concentrations. The trough concentrations rise rapidly during the first two days from the initial low castrate TT levels to reach a new steady-state between *200 and 400 ng/dL.

The mean of average steady-state concentrations remains within the physiological range in all treatment groups, but only in group B3 (t.i.d. administration), the 95% confidence interval is also entirely within the physiological range. In all groups, Cmax values of individual patients sometimes slightly exceeded the upper limit of the physiological range. Excursions above the physiological range are short-lasting. Twelve of a total of 22 values higher than 1000 ng/dL were observed in a single patient, who started with a trough level of 900 ng/dL after 13 days of dosing with the three times daily dosing regimen.

Serum DHT levels. The pharmacokinetic parameters of DHT for the three treatment groups are shown in Table IV. These show that the average steady-state concentration of DHT did not exceed the upper limit of the physiological range (85 ng/dL), indicating no particular safety risk due to DHT pharmacokinetics. The corresponding serum concentration-vs.-time curves are shown in Figure 2. The curves show that even in group B3 the risk of a DHT level above the upper limit of the physiological range for a longer time is low. The larger standard deviations in groups B2 and B3 are caused mainly by the high concentrations in one patient each.

Adverse events. A total of 36 adverse events were observed during study B. All adverse events were of mild or moderate intensity. No serious adverse events were observed. The following organ systems were affected: psychiatric disorders, nervous system disorders, respiratory, thoracic, and mediastinal disorders, gastrointestinal disorders, skin, and subcutaneous tissue disorders, musculoskeletal, connective tissue, and bone disorders, renal and urinary system disorders, general disorders, and administration site condition. None of these events were evaluated as at least possibly related to drug treatment. No adverse values (i.e. improvement of condition) on day 14 compared with day 1 were observed. An important experience was that the AMS questionnaire was not fully compatible with the situation of the particular patients.




Discussion

The results of study A indicate that testosterone is well absorbed after nasal administration of different doses of MPP 10. The maximum serum concentration of testosterone is reached between 1 and 2 h after administration. The exposure to exogenous testosterone increases approximately linearly between 7.6 and 15.2 mg but levels off with the higher dose of 22.8 mg. At dose levels above 15 mg absorption may be limited due to the restricted volume for nasal application of 0.05–0.15 mL [27]; because of the low solubility of testosterone, the medium and the high dose had to be administered by increasing the application volume to 0.24 and 0.36 mL, respectively.

*Thus, the lack of a further linear increase of testosterone levels with higher doses may reflect a saturation phenomenon at the site of absorption.

This is great, thanks @madman!

So my takeaway would be that the lower dose is still going to give me a boost (just not as high as the larger dose) and it will take about the same amount of time for it to return to baseline (6-8 hours)? In which case, it may just be a matter of finding the right dose with the nasal testosterone to supplement my enclomiphene usage.

What are your thoughts on using both at the same time (nasal and enclomiphene)?

 

[Fortunate]

For anyone interested, I strategically got a set of labs today almost exactly an hour after my morning Natesto dose. A while back, I had labs while on Natesto, but I have never timed it to specifically try to look at peak or near-peak values.

In any case, hopefully I'll have them by late week or early next week and will post results.

 

[pyater]

Very curious to see the results, particularly Hematocrit and RBC

 

[Fortunate]

Were you cream only for a period? At one point, Defy had me taking shots and supplementing with cream. Pushed my numbers shortly after the cream off the charts in total and free testosterone and DHT. It was just too much for me as I am low SHBG.

I tried cream several times. I think your experience is why so many people don't last long on it. I felt way, way over the top. I can't understand now the published data is so different from what many people experience. I suspect that some people are hyper absorbers, while others are not?

 

[Fortunate]

Yeah, problem there is getting the prescription and the cost. The lowest total testosterone I've tested at prior to starting TRT and then changing over to Enclomiphene was 330, and I don't think I can get insurance coverage for TRT for anything above 300.

I went with 1/4 of the usual dose about half an hour ago. No headache, which usually kicks in by now at the higher dose. That's nice, although who knows if 1/4 of the dose will really cause any benefit. The problem is that no matter what I do, the cream seems to run down the back of my throat, and it's doing it now as well. The stuff is nasty.

I am not familiar with the applicator from Defy, but Natesto is simple. The applicator is smooth and curved a little to fit nicely. You are supposed to apply it to the lateral wall of the nose. I insert to the desired depth, pump and use the inserter to wipe the medication a little on the wall of the nose. As I remove it, I use the tip to sort of smear the medicine on the nose wall. I think this spreads it out a bit, making it less thick. Then, when I remove the inserter, I pinch the nose a bit to further spread it. It all takes about ten seconds.

I have found that I "feel" the medicine more if I don't insert it deeply. On the other hand, when you insert it deeply, you kinda taste it. Oddly, I don't mind it.

If you really want to give the experiment a try, I recommend exploring ways to get Natesto. It's now covered by many insurance plans. If not, sometimes you can find a local pharmacy that will help you with a coupon or assistance program to make it affordable. CVS may not take the time to help you, but local pharmacies that do a lot of TRT tend to be more aware of the assistance programs out there.

Also, regarding cream, for a long stretch, I used a little cream to supplement Natesto. It actually worked pretty well. But, I had trouble with feeling crappy when I used the cream as my primary TRT. So, for a bit, I tried to go back to using a small amount to supplement Natesto. Still felt crappy. No idea why, since I did it for a long stretch in the past. TRT can be really tricky.

 

[Fortunate]

Very curious to see the results, particularly Hematocrit and RBC

I will post when I get them. For context, I have been on hCG and Natesto together for a long time. I held hCG for the two weeks prior to the labs I got. So, the labs may look lower than what I normally run, but we will see. This morning, I restarted hCG.

 

[Fortunate]

So, I got my lab results back. Note, these were drawn almost an hour after my AM Natesto dose. Also, I had been off hCG for two weeks prior to the labs (I normally injection 100IU daily). See below for results and comments:

Total Test: 497 ng/dl
Free Test: 67.5 pg/ml (46.0-224.0)
Estradiol: 30
HGB: 16.6 (13.2-17.1)
HCT: 49.5 (38.5-50)

Notes:

• Labs done at Quest
• I am not sure, but don't believe Estradiol was LCMSMS
• These labs were done after running about fours weeks of Natesto
  • But, just prior to this four week period, I was using Xyosted at various doses
  • During the four week period, I used Xyosted once, and decided not to go back to it
  • Therefore, this is not a "pure" four week run with no other exogenous sources
• Had I waited a bit longer, ie 90 minutes instead of 60 minutes, it is possible my peak would have been higher
• As above, I held hCG for two weeks prior to these labs. I normally use 100IU/day

Six months prior to these labs, I got labs drawn one day after injecting with 25mg of enanthate, but while not using Natesto that day (not enough time to see much of a rise in test from the enanthate). Those labs would be a reasonable estimate of what a trough looks like on Natesto. My total test was 174.77 (264-916) with free test at 3.30 pg/ml (4.80-25.70). Caveat: that were are two different labs with different reference ranges on free T. I don't fully understand why the numbers and ranges are so different since they both report pg/ml.

I was hoping that T would have been a bit higher, but, as above, I suspect my peak is a bit higher than the number here, and, I further suspect hCG bumps me up a bit more.

I am the odd duck around here, as the only guy (that I know of) who consistently uses Natesto, and who happens to use hCG with it. As @Cataceous pointed out elsewhere, using hCG in the context of Natesto does not make great physiologic sense. However, having been on and off hCG several times, I am pretty confident in saying that overall, I feel better when on hCG. I don't know if it's a direct effect or indirect due to some small bump in test.

From time to time, I explore alternatives to my Natesto/hCG combination, and always come back to the conclusion that Natesto with hCG is the most tolerable form of TRT. I have virtually no side effects (other than acne, that is likely hCG) and I think I feel "good enough". I think I feel most "at home" mentally on this regimen. There are times that I have been on injections, and I for sure feel more energy, but I don't feel like myself. I suspect I have a narrow therapeutic range: my body may want a little more test than it's willing to make, but not a lot more. I also suspect many guys on this forum may be in the same boat. I therefore continue to recommend trying Natesto with hCG.

My rationale for repeatedly trying other forms of TRT has typically been driven by a desire to find something more convenient (although, I now have Natesto down to a science and it's very easy); but, I also think I have a bit of FOMO. I have experienced a few honeymoon periods on injections and I hear guys saying: "I fine tuned things, and my sweet spot is to inject X every Y days. I feel great on this protocol." That sweet spot may exist for me, but I certainly haven't found it. Like @readalot, it does not take much for me to feel like my heart is working harder than it should when using injections. It's an odd combination of feeling energized and charged up, but also feeling like the heart is pumping a bit harder than it's meant to.

A little while back, I supplemented my Natesto/hCG regimen with a small amount of cream on the upper arm. I did it for several months and actually felt pretty good on it. I tried to go back to that recently, and now, if I use even a small dose of cream, I feel over the top for a few hours, after which I feel a major crash. TRT can be a really slippery situation.

So, while I can't promise I won't get curious about some goldilocks regimen I haven't yet tried, I am pretty content knowing that my Natesto/hCG regimen works pretty well. See my other posts on what I believe are the benefits of Natesto. As a parting thought, I will add one (unproven) theory: I think things have the potential to improve over time while on Natesto. I think the longer you use it, the more your own exogenous hormones normalize and stabilize. Now, being on hCG probably negates that effect, which is why I tried to hold it for the few weeks recently. I suspect to really answer the question, I'd have to go off hCG for a longer period of time while staying on Natesto.

Bottom line: Natesto is very safe and sufficiently effective. I think it keeps me closer to my normal physiology than most other forms of TRT. I encourage more guys to trial it and report back here.

 

[TLawyer]

So, I got my lab results back. Note, these were drawn almost an hour after my AM Natesto dose. Also, I had been off hCG for two weeks prior to the labs (I normally injection 100IU daily). See below for results and comments:

Total Test: 497 ng/dl
Free Test: 67.5 pg/ml (46.0-224.0)
Estradiol: 30
HGB: 16.6 (13.2-17.1)
HCT: 49.5 (38.5-50)

Notes:

• Labs done at Quest
• I am not sure, but don't believe Estradiol was LCMSMS
• These labs were done after running about fours weeks of Natesto
  • But, just prior to this four week period, I was using Xyosted at various doses
  • During the four week period, I used Xyosted once, and decided not to go back to it
  • Therefore, this is not a "pure" four week run with no other exogenous sources
• Had I waited a bit longer, ie 90 minutes instead of 60 minutes, it is possible my peak would have been higher
• As above, I held hCG for two weeks prior to these labs. I normally use 100IU/day

Six months prior to these labs, I got labs drawn one day after injecting with 25mg of enanthate, but while not using Natesto that day (not enough time to see much of a rise in test from the enanthate). Those labs would be a reasonable estimate of what a trough looks like on Natesto. My total test was 174.77 (264-916) with free test at 3.30 pg/ml (4.80-25.70). Caveat: that were are two different labs with different reference ranges on free T. I don't fully understand why the numbers and ranges are so different since they both report pg/ml.

I was hoping that T would have been a bit higher, but, as above, I suspect my peak is a bit higher than the number here, and, I further suspect hCG bumps me up a bit more.

I am the odd duck around here, as the only guy (that I know of) who consistently uses Natesto, and who happens to use hCG with it. As @Cataceous pointed out elsewhere, using hCG in the context of Natesto does not make great physiologic sense. However, having been on and off hCG several times, I am pretty confident in saying that overall, I feel better when on hCG. I don't know if it's a direct effect or indirect due to some small bump in test.

From time to time, I explore alternatives to my Natesto/hCG combination, and always come back to the conclusion that Natesto with hCG is the most tolerable form of TRT. I have virtually no side effects (other than acne, that is likely hCG) and I think I feel "good enough". I think I feel most "at home" mentally on this regimen. There are times that I have been on injections, and I for sure feel more energy, but I don't feel like myself. I suspect I have a narrow therapeutic range: my body may want a little more test than it's willing to make, but not a lot more. I also suspect many guys on this forum may be in the same boat. I therefore continue to recommend trying Natesto with hCG.

My rationale for repeatedly trying other forms of TRT has typically been driven by a desire to find something more convenient (although, I now have Natesto down to a science and it's very easy); but, I also think I have a bit of FOMO. I have experienced a few honeymoon periods on injections and I hear guys saying: "I fine tuned things, and my sweet spot is to inject X every Y days. I feel great on this protocol." That sweet spot may exist for me, but I certainly haven't found it. Like @readalot, it does not take much for me to feel like my heart is working harder than it should when using injections. It's an odd combination of feeling energized and charged up, but also feeling like the heart is pumping a bit harder than it's meant to.

A little while back, I supplemented my Natesto/hCG regimen with a small amount of cream on the upper arm. I did it for several months and actually felt pretty good on it. I tried to go back to that recently, and now, if I use even a small dose of cream, I feel over the top for a few hours, after which I feel a major crash. TRT can be a really slippery situation.

So, while I can't promise I won't get curious about some goldilocks regimen I haven't yet tried, I am pretty content knowing that my Natesto/hCG regimen works pretty well. See my other posts on what I believe are the benefits of Natesto. As a parting thought, I will add one (unproven) theory: I think things have the potential to improve over time while on Natesto. I think the longer you use it, the more your own exogenous hormones normalize and stabilize. Now, being on hCG probably negates that effect, which is why I tried to hold it for the few weeks recently. I suspect to really answer the question, I'd have to go off hCG for a longer period of time while staying on Natesto.

Bottom line: Natesto is very safe and sufficiently effective. I think it keeps me closer to my normal physiology than most other forms of TRT. I encourage more guys to trial it and report back here.

Very informative, thanks for sharing Fortunate. I have been using enclomiphene and Empower nasal gel for the past 5 days (I’ve been using enclomiphene for a year and a half). I have been playing with either twice or three times per day on the gel. With Empower’s delivery method, I can adjust the gel dosage and cut it in half from the Natesto dosage because early on in its usage it felt like it was putting me too high. Thus far, this has been much better. I don’t feel over the top and have felt good for the last few days. Libido is up. We’ll see. No labs to back anything up yet.

 

[TLawyer]

Very informative, thanks for sharing Fortunate. I have been using enclomiphene and Empower nasal gel for the past 5 days (I’ve been using enclomiphene for a year and a half). I have been playing with either twice or three times per day on the gel. With Empower’s delivery method, I can adjust the gel dosage and cut it in half from the Natesto dosage because early on in its usage it felt like it was putting me too high. Thus far, this has been much better. I don’t feel over the top and have felt good for the last few days. Libido is up. We’ll see. No labs to back anything up yet.

Other benefit is that less gel has resulted in less issues for me with the gel running down my throat. Also, I haven’t had the headaches I had originally with the higher dose.

 

[TLawyer]

Other benefit is that less gel has resulted in less issues for me with the gel running down my throat. Also, I haven’t had the headaches I had originally with the higher dose.

And while I don’t have labs, my skin has also been oily while using the gel. To me, that’s a sign that my DHT level has shot up.

 

[Strengthandlibido]

So, I got my lab results back. Note, these were drawn almost an hour after my AM Natesto dose. Also, I had been off hCG for two weeks prior to the labs (I normally injection 100IU daily). See below for results and comments:

Total Test: 497 ng/dl
Free Test: 67.5 pg/ml (46.0-224.0)
Estradiol: 30
HGB: 16.6 (13.2-17.1)
HCT: 49.5 (38.5-50)

Notes:

• Labs done at Quest
• I am not sure, but don't believe Estradiol was LCMSMS
• These labs were done after running about fours weeks of Natesto
  • But, just prior to this four week period, I was using Xyosted at various doses
  • During the four week period, I used Xyosted once, and decided not to go back to it
  • Therefore, this is not a "pure" four week run with no other exogenous sources
• Had I waited a bit longer, ie 90 minutes instead of 60 minutes, it is possible my peak would have been higher
• As above, I held hCG for two weeks prior to these labs. I normally use 100IU/day

Six months prior to these labs, I got labs drawn one day after injecting with 25mg of enanthate, but while not using Natesto that day (not enough time to see much of a rise in test from the enanthate). Those labs would be a reasonable estimate of what a trough looks like on Natesto. My total test was 174.77 (264-916) with free test at 3.30 pg/ml (4.80-25.70). Caveat: that were are two different labs with different reference ranges on free T. I don't fully understand why the numbers and ranges are so different since they both report pg/ml.

I was hoping that T would have been a bit higher, but, as above, I suspect my peak is a bit higher than the number here, and, I further suspect hCG bumps me up a bit more.

I am the odd duck around here, as the only guy (that I know of) who consistently uses Natesto, and who happens to use hCG with it. As @Cataceous pointed out elsewhere, using hCG in the context of Natesto does not make great physiologic sense. However, having been on and off hCG several times, I am pretty confident in saying that overall, I feel better when on hCG. I don't know if it's a direct effect or indirect due to some small bump in test.

From time to time, I explore alternatives to my Natesto/hCG combination, and always come back to the conclusion that Natesto with hCG is the most tolerable form of TRT. I have virtually no side effects (other than acne, that is likely hCG) and I think I feel "good enough". I think I feel most "at home" mentally on this regimen. There are times that I have been on injections, and I for sure feel more energy, but I don't feel like myself. I suspect I have a narrow therapeutic range: my body may want a little more test than it's willing to make, but not a lot more. I also suspect many guys on this forum may be in the same boat. I therefore continue to recommend trying Natesto with hCG.

My rationale for repeatedly trying other forms of TRT has typically been driven by a desire to find something more convenient (although, I now have Natesto down to a science and it's very easy); but, I also think I have a bit of FOMO. I have experienced a few honeymoon periods on injections and I hear guys saying: "I fine tuned things, and my sweet spot is to inject X every Y days. I feel great on this protocol." That sweet spot may exist for me, but I certainly haven't found it. Like @readalot, it does not take much for me to feel like my heart is working harder than it should when using injections. It's an odd combination of feeling energized and charged up, but also feeling like the heart is pumping a bit harder than it's meant to.

A little while back, I supplemented my Natesto/hCG regimen with a small amount of cream on the upper arm. I did it for several months and actually felt pretty good on it. I tried to go back to that recently, and now, if I use even a small dose of cream, I feel over the top for a few hours, after which I feel a major crash. TRT can be a really slippery situation.

So, while I can't promise I won't get curious about some goldilocks regimen I haven't yet tried, I am pretty content knowing that my Natesto/hCG regimen works pretty well. See my other posts on what I believe are the benefits of Natesto. As a parting thought, I will add one (unproven) theory: I think things have the potential to improve over time while on Natesto. I think the longer you use it, the more your own exogenous hormones normalize and stabilize. Now, being on hCG probably negates that effect, which is why I tried to hold it for the few weeks recently. I suspect to really answer the question, I'd have to go off hCG for a longer period of time while staying on Natesto.

Bottom line: Natesto is very safe and sufficiently effective. I think it keeps me closer to my normal physiology than most other forms of TRT. I encourage more guys to trial it and report back here.

Very informative, thanks for sharing Fortunate. I have been using enclomiphene and Empower nasal gel for the past 5 days (I’ve been using enclomiphene for a year and a half). I have been playing with either twice or three times per day on the gel. With Empower’s delivery method, I can adjust the gel dosage and cut it in half from the Natesto dosage because early on in its usage it felt like it was putting me too high. Thus far, this has been much better. I don’t feel over the top and have felt good for the last few days. Libido is up. We’ll see. No labs to back anything up yet.

Thank you both for sharing. I am considering nasal gel and enclomiphene next, but have been wondering about nasal gel combined with hCG too.

And the recommended Natesto dosing did strike me as a bit on the high side, so I'm not surprised to see @TLawyer feels better on a lower dose.

 

[Fortunate]

@TLawyer, appreciate your sharing your experience on Empower’s nasal gel. I have considered trying it before in order to get a slightly higher dose than when I get from Natesto, but haven’t done it yet. Still on the table for me to consider, though. Please keep us in the loop. I might give it a try sometime down the road.

 

[Fortunate]

Thank you both for sharing. I am considering nasal gel and enclomiphene next, but have been wondering about nasal gel combined with hCG too.

And the recommended Natesto dosing did strike me as a bit on the high side, so I'm not surprised to see @TLawyer feels better on a lower dose.

I hear you, but as you can see from my labs, it doesn’t necessarily raise my levels very high. Take that with a grain of salt with all the caveats I mentioned.

Thanks.

 

[TLawyer]

@TLawyer, appreciate your sharing your experience on Empower’s nasal gel. I have considered trying it before in order to get a slightly higher dose than when I get from Natesto, but haven’t done it yet. Still on the table for me to consider, though. Please keep us in the loop. I might give it a try sometime down the road.

Yeah, Defy offered to prescribe a stronger concentration of T per application, but I went with the same concentration as in Natesto. But even with that, the ability to control the dosage with Empower for me is pretty key. Allows for a lot of trial and error.

 

[TLawyer]

Thank you both for sharing. I am considering nasal gel and enclomiphene next, but have been wondering about nasal gel combined with hCG too.

And the recommended Natesto dosing did strike me as a bit on the high side, so I'm not surprised to see @TLawyer feels better on a lower dose.

I do wonder what the impact would be if I dropped Enclomiphene. Maybe I’d do better with the higher dosage in that case since I wouldn’t have the Enclomiphene already propping my levels up. I probably need to sit down and figure out a plan on how to approach this and figure out which combination will work best. I’d like to lose the Enclomiphene eventually, but using it as a security blanket at the moment.

 

[pyater]

New Natesto user, switched from Test C injections. Curious as to when to get blood labs when using Natesto? I did shots on trough day but it is 1-2 hours after gel application?

 

[madman]

New Natesto user, switched from Test C injections. Curious as to when to get blood labs when using Natesto? I did shots on trough day but it is 1-2 hours after gel application?

We want to test at peak when using Natesto.

Maximum concentration (Cmax) is achieved within approximately 40 minutes.

I would have blood drawn 1 hr post-dose.

Even then if you just started I would give it some time to see how your body reacts before rushing to get labs.


Figure 1: Mean Serum Total Testosterone Concentrations on Day 90 in Patients Following NATESTO 22.0 mg Daily Administered at 9 p.m. and 7 a.m. (N=122) and 33.0 mg Daily Administered at 9 p.m., 7 a.m. and 1 p.m. (N=151)

Recommended Dose and Dosage Adjustment

The recommended starting dose of NATESTO (testosterone) is 11.0 mg of testosterone (1 actuation per nostril) administered intranasally twice daily for a total daily dose of 22.0 mg.

To ensure proper dosing, serum total testosterone concentrations should be measured after initiation of therapy to ensure that the desired concentrations (300 to 1050 ng/dL) are achieved. The NATESTO dose can be adjusted at least 30 days after starting treatment based on the serum total testosterone concentrations from a single blood draw, taken 20 minutes to 2 hours after morning administration of NATESTO. If the total testosterone measurement is less than 300 ng/dL, the daily testosterone dose may be increased from 22.0 mg (twice daily administration) to 33.0 mg (thrice daily administration), as instructed by a physician.

Serum total testosterone concentrations should be checked periodically. The following rules should be applied:

* For patients on 22.0 mg (twice daily administration): If the measured serum total testosterone concentration from the single morning blood draw is less than 300 ng/dL, the daily dose of NATESTO may be increased from 22.0 mg (twice daily administration) to 33.0 mg (thrice daily administration);

*For patients on 33.0 mg (thrice daily administration): If the measured serum total testosterone concentration from the single morning blood draw is consistently less than 300 ng/dL, or if a desired clinical response is not achieved, NATESTO should be discontinued and an alternative treatment should be considered.

*If a post-dose morning total testosterone concentration consistently exceeds 1050 ng/dL, NATESTO should be discontinued.