Official Natesto Thread

[tareload]

Whole thesis worth a browse but chapter 3 is pertinent to this thread plus some tips on proper administration in the discussion. Chapter 1 a nice review if you want more background.

Long story short, you probably aren't beating a WADA test on Natesto unless you know what you are doing (purely for informational purposes).

Detection of doping with testosterone Comparison of methods and evaluation of complementary matrices

 

[Nelson Vergel]

I seriously doubt that anyone can stick to a three times per day administration for a long time. Besides, the sinus issues I got were unbearable.

 

[FLguy123]

I will say that I had switched to natesto last year for a couple months and it inadvertently ended up being somewhat of a hpta restart as I had a knee surgery and got a awful cold after, in which I couldn’t administer the natesto for over a week, and decided to try a restart. On and off shots and cream for a few years and it felt like the restart was far easier than a typical clomid/hcg restart. For those wanting to do a restart but hesitant would be worth a look at doing the natesto for a couple months then proceeding with the restart to lessen the impact possibly.

 

[tareload]

I seriously doubt that anyone can stick to a three times per day administration for a long time. Besides, the sinus issues I got were unbearable.

Thanks for sharing your experience with Natesto on here (I believe you've mentioned the sinus issue a few times). I've got a few bottles so I may give it a try after I'm done coming off injectable (feeling really decent at the moment with hCG 500 IU twice weekly). Been off TC now for about 5 weeks. Will drop the hCG and add the AI. Talked with a provider yesterday and he was really touting the enclomiphene. It great guys have so many options now.

For the record, just received another vial of 10,000 IU Fresenius hCG from my compounding specialty (EDIT, hate it when I make dumb typos) pharmacy ($125 based on my insurance rate). All out of pocket till I hit the deductible. So they aren't marking it up. GoodRX shows up to $400 for same bottle.

 

[Nelson Vergel]

Has anyone had their LH and FSH tested while on Natesto three times per day? I just want to "verify" what Ramasamy's group reports.

 

[Cataceous]

Has anyone had their LH and FSH tested while on Natesto three times per day? I just want to "verify" what Ramasamy's group reports.

@Willyt tested while using two doses a day of the Empower product:

... I went cold turkey then started using nasal T gel again, this time with Empower's nasal gel pen 2x daily (8am & 4pm). ​

​

Went for my annual physical and tested 557 TT (300-890 range) at trough before morning application, nearly double my pre-TRT levels. In addition, my HPTA appears intact with FSH of 3.2 (1.6 - 9.7) and LH of 4.5 (1.5 - 9.3). The boys are back ​

My pre-workout Natesto experiment - Embrace your natural trough!

Great stuff. Is this compounded or commercial product? Where do you get it? Natesto is patented and manufactured by Acerus Pharmaceuticals here in Ontario, Canada. It is the only big pharma nasal T gel on the market. Any other nasal T gels/sprays would be compounded.

www.excelmale.com

 

[Nelson Vergel]

Thanks @Cataceous

 

[TLawyer]

I seriously doubt that anyone can stick to a three times per day administration for a long time. Besides, the sinus issues I got were unbearable.

Agreed. I stopped Enclomiphene and wanted to give the
Empower nasal gel another try at twice per day to see if I could see a benefit. Lasted one day. Every time is ends up down my throat. I don’t know if it’s just absorbing there or actually going down there, but it’s just awful. And then the buildup in my nose after only two applications in each nostril was annoying. Just wish there was another location to apply it.

 

[tareload]

Just wish there was another location to apply it.

Oxandrolone Troche Experience: Potential Atherosclerosis Marker WMD

None particular to AAS but some of these examples would partition similarly to 17-AA oral AAS. This is a nice review with examples. You have to give credit to @zeek1414 who already raised this possibility earlier in the thread. This was all tongue in cheek though. DRUG ABSORPTION BY...

forums.t-nation.com

Bioavailability of Intranasal vs. Rectal Diazepam

There remains an unmet medical need in the out-of-hospital management of seizure emergencies because older children and adults often refuse treatment …

www.sciencedirect.com

Assessment of pharmacokinetics and tolerability of intranasal diazepam relative to rectal gel in healthy adults - PubMed

Diazepam rectal gel (RG) is currently the only approved rescue therapy for outpatient management of seizure clusters in the United States. There is an unmet medical need for an alternative rescue therapy for seizure clusters that is effective, and more convenient to administer with a socially...

pubmed.ncbi.nlm.nih.gov

You've got options.

The applicator is smooth and curved a little to fit nicely

Curious if there would be any real difference with the pk profile nasal vs rectal.

Rectal drug administration: clinical pharmacokinetic considerations - PubMed

The human rectum represents a body cavity in which drugs can be easily introduced and retained and from which absorption is well possible. There are important therapeutic reasons why it is sometimes preferable to give a drug rectally rather than orally, e.g. in cases of nausea and vomiting...

pubmed.ncbi.nlm.nih.gov

 

[Willyt]

Long story short, you probably aren't beating a WADA test on Natesto unless you know what you are doing (purely for informational purposes).

Very interesting! I have been wondering how/whether athletes could beat the doping tests with fast acting T without shutting down HPTA.

 

[Willyt]

Agreed. I stopped Enclomiphene and wanted to give the
Empower nasal gel another try at twice per day to see if I could see a benefit. Lasted one day. Every time is ends up down my throat. I don’t know if it’s just absorbing there or actually going down there, but it’s just awful. And then the buildup in my nose after only two applications in each nostril was annoying. Just wish there was another location to apply it.

Empower seems to recommend slightly different application technique for T nasal gel than Nasteto. Both have you apply the gel to the lateral nasal wall. See below

However, Natesto instructs you to pinch the nostril after application (see the guy in the 2nd video in link below). I hate this. It drives the gel up your nasal cavity which makes it more likely it will run down your throat. Feels like giant booger.

Support & Resources | Natesto® (testosterone) nasal gel patient website

Get the details on the Natesto® (testosterone) savings program and support from a dedicated case manager through NATESTO At Home. Please see safety information.

www.natesto.com

I definitely prefer Empower's method - just let it absorb on the lateral wall. Don't pinch it. Empower's gel also smells a lot better and has more creamy consistency which I find more agreeable (probably because it has 29 non-medicinal ingredients yikes!)

 

[Fortunate]

Has anyone had their LH and FSH tested while on Natesto three times per day? I just want to "verify" what Ramasamy's group reports.

I may, but they would not be helpful for a few reasons. After being on Natesto for a while, I have recently jumped around a lot. I also use Natesto with hCG, which makes no sense from an HPTA standpoint.

I tend to tolerate Natesto fine (in fact, more tolerable than most forms of TRT). I am not currently on it, but if I wind up back on it, I may try to see if I can do it without hCG and still get the same benefit. I have tried this in the past, but not more than for a few weeks to a month at most. If I went my CNS to recover, I suspect I have to be off hCG longer.

If I go this route, I will post labs.

 

[ZALEMAX]

Hi all, my Dr. just recently prescribed Natesto nasal gel 3 times a day. I was doing TRT injection but it spiked my BP bad. Since I am new to this nasal gel can anyone here tell me if the good/bad side effects can this spike my BP too!
all responses are appreciated
Thanks

 

[Fortunate]

Hi all, my Dr. just recently prescribed Natesto nasal gel 3 times a day. I was doing TRT injection but it spiked my BP bad. Since I am new to this nasal gel can anyone here tell me if the good/bad side effects can this spike my BP too!
all responses are appreciated
Thanks

I have been on Natesto, on an off, for several years. I don't think it raises my BP, but, in full disclosure, I have noticed some mildly raised pressures. However, I have also been trialing several other forms of TRT. My sense is that it will not spike your pressure.

I personally have enjoyed Natesto. I find it is well tolerated and may even have a positive benefit on mood that I may not get with injections. While inconvenient to apply three times a day, it takes seconds to do it.

Some don't like the residue in the nose. I would mildly agree. It's not terrible, but it can build up after a while. While I felt it beneficial, there are times when I question if I am getting the full dose. Over the last two years, I have been exploring alternatives to Natesto, mainly for convenience.

Bottom line: I highly recommend trying it. Please report back if you do.

 

[tareload]

Update on my HPTA recovery:

When does natural production return when stopping TRT?

No, I doubt that my urologist is familiar with that. I do wonder if it is worth it. At least with the injections (80mg/2x/week), I can control my testosterone level. If your protocol is working for you probably best to stick with it given what you went through. What was it like being that...

www.excelmale.com

May go ahead and trial Natesto and watch what happens to LH and TT.

 

[BigBeard411]

Does anyone else notice the pump on the natesto is inconsistent? sometimes it moves smoothly, but other times you have to press down so hard and the gel comes out very slowly. Have to hold the pump down like 30 seconds. This results in very inconsistent dosing if you are not aware. I began depressing the pump and watching how much gel comes out to ensure i get a full dose.

 

[Fortunate]

Does anyone else notice the pump on the natesto is inconsistent? sometimes it moves smoothly, but other times you have to press down so hard and the gel comes out very slowly. Have to hold the pump down like 30 seconds. This results in very inconsistent dosing if you are not aware. I began depressing the pump and watching how much gel comes out to ensure i get a full dose.

Actually, yes. While I have been a big proponent of Natesto, this very issue is one of my motivations to try other forms of TRT. For me, it seems like it may be specific to a specific applicator - like the medicine doesn't come out as it should. I have on occasion bailed on an applicator and started a new one for this reason. In general, I think it's pretty uncommon to get a tube that does this. But, even with tubes that seem to dispense normally, I sometimes wonder if the dose is inconsistent based on circumstances: how far up the nostril you had the tip, do you have any congestion, did any leak out, etc.

All in all, I think dosing is mostly consistent, but likely less consistent than injections.

How long have you been on Natesto and how is it going (besides this issue)?

 

[Fortunate]

Gents, I know we have had some discussion on 2x/day vs. 3x/day. From what I recall, there is some data that shows 2x/day is less suppressive than 3x/day.

I quickly re-scanned through most of these posts looking for reference to this data, but can't quite find what I am looking for. @madman, do you know if there is data that specifically compares LH/FSH suppression with 2 vs 3x per day?

Also, can we draw conclusions on 3x/day of Natesto vs. other modalities? In other words, although 3x/day is more suppressive, does it still allow the axis to function and/or recover based on available data?

 

[madman]

Gents, I know we have had some discussion on 2x/day vs. 3x/day. From what I recall, there is some data that shows 2x/day is less suppressive than 3x/day.

I quickly re-scanned through most of these posts looking for reference to this data, but can't quite find what I am looking for. @madman, do you know if there is data that specifically compares LH/FSH suppression with 2 vs 3x per day?

Also, can we draw conclusions on 3x/day of Natesto vs. other modalities? In other words, although 3x/day is more suppressive, does it still allow the axis to function and/or recover based on available data?

When looking at the bigger picture it is not going to make a shitlick of difference regarding suppression of gonadotropins/HPTA as this is temporary and short-lived due to Natesto's half-life (short-lived peak)/dosing schedule (2-3X daily) which results in long trough times between doses.



*Nasal administration of T (4.5% testosterone nasal gel, Natesto) allows for rapid absorption through the nasal mucosa such that serum T levels reach a peak concentration in ∼40 min. Once in the circulation, the T is quickly metabolized, with a return to near baseline T levels in 3–6 h

*HPG axis is active and there is temporal suppression when TNG doses are administered. This suppression appears to recover completely, on the basis of consistent trough values over time

*Thus, an ultradian, pulsatile PK profile allows maintenance of the endogenous feedback mechanism when treated with TNG





Efficacy of Nasal Testosterone Gel (Natesto®) Stratified by Baseline Endogenous Testosterone Levels (2019)


3. Discussion

TNG maintains the endogenous HPG axis. This is clearly evident in single-dose PK profiles in healthy men and those with TDS for whom the predose value (t = 0), which corresponds to the patient’s endogenous TT level, was found again at the bottom of the trough between peaks and was maintained through 90 days of treatment (for twice- and thrice-daily doses). Additional evidence of active HPG when receiving TNG treatment is found in a recent trial showing unchanged sperm counts after 6 months of TNG treatment (thrice-daily dose only) [17]. In larger trials, LH and FSH measurements were made proximal to a peak of TNG and were somewhat depressed, but they remained in the normal range [16]. Our interpretation of these observations is that the HPG axis is active and there is temporal suppression when TNG doses are administered. This suppression appears to recover completely, on the basis of consistent trough values over time. Thus, an ultradian, pulsatile PK profile allows maintenance of the endogenous feedback mechanism when treated with TNG, which serves multiple purposes. First, very high peaks of TT are only rarely observed [3.3% of patients had a Cmax of 1800 to 2500 ng/dL (63.0 to 87.0 nmol/L) in the phase 3 study], because the active feedback mechanism provides a control mechanism keeping the TT levels in check. Second, troughs between peaks reduce overall exposure, helping to limit adverse effects of testosterone treatment, such as hematocrit overproduction (no patients had hematocrit values of 54% in either the phase 3 or phase 4 studies) [22]. Third, troughs allow for the secretion of gonadotropins that maintain active testicular testosterone production, as well as sperm. Last, as shown here, the combination of peaks and troughs is sufficient to achieve symptom efficacy even for patients with the most severe TDS in this study. Overall, there are positive benefits to a treatment approach that is compatible with HPG physiology.



Look over my reply!

post #95

Official Natesto Thread

Data point for anyone interested. Natesto has been the most tolerable form of TRT for me. Typically, I get headaches with other forms. I have also noticed a more forceful heartbeat than normal after injecting. I can even feel it in my abdominal aorta (I know, that sounds really weird). I have...

www.excelmale.com

post # 7

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

My reply:

Looking over the Natesto study there was a statistically significant decrease in LH/FSH but far from the decrease seen in men taking injectable T where sometimes LH/FSH becomes undetectable.

Natesto has the advantage of short-lived peaks/long trough time.

In the Jatenzo study, LH/FSH levels were significantly depressed.

Oral TU (BID) resulted in a 70% decrease in LH/FSH.

 

[Fortunate]

I will reread through this stuff. You’re the man.