Subcutaneous Administration of Testosterone

[Gene Devine]

Here's the only study I found that supports the use of subcutaneous injections of Testosterone.

Subcutaneous administration of testosterone. A pilot study report. - PubMed - NCBI

Subcutaneous administration of testosterone. A pilot study report.



Abstract

OBJECTIVE:

To investigate the effect of low doses of subcutaneous testosterone in hypogonadal men since the intramuscular route, which is the most widely used form of testosterone replacement therapy, is inconvenient to many patients.
METHODS:

All men with primary and secondary hypogonadism attending the reproductive endocrine clinic at Royal Victoria Hospital, Montreal, Quebec, Canada, were invited to participate in the study. Subjects were enrolled from January 2002 till December 2002. Patients were asked to self-administer weekly low doses of testosterone enanthate using 0.5 ml insulin syringe.
RESULTS:

A total of 22 patients were enrolled in the study. The mean trough was 14.48 +/- 3.14 nmol/L and peak total testosterone were 21.65 +/- 7.32 nmol/L. For the free testosterone, the average trough was 59.94 +/- 20.60 pmol/L and the peak was 85.17 +/- 32.88 pmol/L. All of the patients delivered testosterone with ease and no local reactions were reported.
CONCLUSION:

Therapy with weekly subcutaneous testosterone produced serum levels that were within the normal range in 100% of patients for both peak and trough levels. This is the first report, which demonstrated the efficacy of delivering weekly testosterone using this cheap, safe, and less painful subcutaneous route.


Pharmacokinetic Profile of Subcutaneous Testosterone

 

[SuperDutyDave]

Been dosing via Sub-Q with T-Cyp for over a year now with good results. My opinion it is definitely the way to go

Dave

 

[Gene Devine]

Been dosing via Sub-Q with T-Cyp for over a year now with good results. My opinion it is definitely the way to go

Dave

For many men Dave it's a great option with many benefits.

Glade to see it working for you my friend

 

[SuperDutyDave]

Gene

We can compare notes next month in person. But yes compared to topicals whith high frequency it's been a much better fit for me

Cheers Gene

 

[robs2nd75]

It should be noted that for people with high bf% this is probably not the best method. From my understanding it has to do with conversion issues. Anyone that can provide peer reviewed studies please post.

 

[Gene Devine]

It should be noted that for people with high bf% this is probably not the best method. From my understanding it has to do with conversion issues. Anyone that can provide peer reviewed studies please post.

Dr John Crisler speaks to this and said while it was a fear that there would be higher aromatase synthesis that it never reared its ugly head and E2 was not adversely effected in men with high body fat composition...in other words it's not a serious concern.

That being said, no matter what type of Testosterone therapy one is on elevated E2 can happen so it must be monitored correctly and treated where necessary.

 

[Dr.V.P.C.]

I ´m on SC test enanthate for 8 months... just benefits, no mood swings, easier to pin, good lab levels,...
The best changes i did since begining trt.

 

[Dr. John Crisler]

Please don't squeeze the tissue first.

That just extrudes the Man Oil back out again.

 

[robs2nd75]

My TT tanked after SC e3.5d for 6 weeks. Wish it worked as there was almost no pain whatsoever.

 

[Brooksy Chuck]

i am wondering about the angle with injecting subq.. i have heard different things.. but noticed on Dr.Crisler's video and the image above that is 90degree..i thought there was supposed to be a bit more angle to it?

 

[Gene Devine]

i am wondering about the angle with injecting subq.. i have heard different things.. but noticed on Dr.Crisler's video and the image above that is 90degree..i thought there was supposed to be a bit more angle to it?

When I inject SQ I go straight in (90 degree) but if you were to go in on a slight angle I don't know why that would present as a problem.

 

[Dr. John Crisler]

My TT tanked after SC e3.5d for 6 weeks. Wish it worked as there was almost no pain whatsoever.

There must be more to this, as the test cyp has to be going somewhere.

 

[Dr. John Crisler]

It should be noted that for people with high bf% this is probably not the best method. From my understanding it has to do with conversion issues. Anyone that can provide peer reviewed studies please post.

Not that we have found; with labs. No one else has, either. Turns out my original concern the fat in the immediate area may increase conversion to E was without merit. In fact, E goes down with smaller, more frequent shots, as I report in the video.

 

[SuperDutyDave]

Been a long term Sub-Q injector, with EOD frequency. Have seen good levels with no big E problems etc. 27G 1/2" fixed syringe works great fills easy and injects without excessive pressure

Thanks Dr.John

 

[robs2nd75]

You tell me Dr. Crisler. On 150mg IM day 3 TT = 1487 day 7 was 6xx. Dropped to 120mg split into 2 equal shots weekly but last few weeks before last test I was using 70-75mg e3.5d. TT = 4xx day 3. No changes to medications, not excessively exercising or dieting. I guess you could argue lab error but both of the labs done during IM were higher and I started having many symptoms of low T again. I have severe sleep apnea and MetS. Diabetes and apnea are well controlled. ?????

 

[JSayaMD]

The fact that subq injections do not seem to raise E2 levels more than IM injections (as you originally feared, Dr Crisler), is likely due to the fact that the ester (be it propionate, cypionate, enanthate) is mostly cleaved from the testosterone by esterase enzymes IN THE BLOODSTREAM. This means the testosterone, while sitting in the subq fatty tissue would still mostly have its ester attached. Thus, all of the aromatase sitting around in those adipose cells would be useless for converting the testosterone ester (in other words, the aromatase will convert testosterone (no ester) to estradiol (no ester), but will not convert testosterone cypionate to estradiol cypionate).

Once the testosterone ester is absorbed into the blood and the ester is cleaved off to release testosterone itself, then all is fair game whether it came from an IM source OR a subq source - ie: it may circulate and return to the adipose cells to then be converted to E, but this, in effect, removes the location of injection as a significant variable for affecting E levels. Since ester cleavage occurs primarily in the blood, the actual site of injection should have almost no DIRECT impact on E conversion, but may have an INDIRECT impact by way of differing pharmacodynamics of serum T levels in IM vs subq injections.

Dr Saya

 

[JSayaMD]

As an addendum to above, topical T preparations (non-esterified) are well known to disproportionately elevate DHT levels (as expected due to the 5 alpha reductase levels in the skin). Along these same lines, in theory although not always evident in practice, as these topical preparations are non-esterified and absorb and deposit in the fatty subq/adipose tissue as testosterone and not a testosterone ester, your concern for increased aromatization to E should theoretically be much more of a concern with the topicals..... topicals = TESTOSTERONE in the adipose tissue --> aromatization T to E. Subq injection = testosterone CYPIONATE/ESTER in the adipose tissue --> NO aromatization to E cypionate. No concern for aromatization until ester is cleaved in the blood and T (if or when) recirculates back to the adipose tissue.

Dr Saya

 

[Dr. John Crisler]

As an addendum to above, topical T preparations (non-esterified) are well known to disproportionately elevate DHT levels (as expected due to the 5 alpha reductase levels in the skin). Along these same lines, in theory although not always evident in practice, as these topical preparations are non-esterified and absorb and deposit in the fatty subq/adipose tissue as testosterone and not a testosterone ester, your concern for increased aromatization to E should theoretically be much more of a concern with the topicals..... topicals = TESTOSTERONE in the adipose tissue --> aromatization T to E. Subq injection = testosterone CYPIONATE/ESTER in the adipose tissue --> NO aromatization to E cypionate. No concern for aromatization until ester is cleaved in the blood and T (if or when) recirculates back to the adipose tissue.

Dr Saya

Not just a theory, it's well-proven TD's elevate E more than shots (for most men--anything is possible with hormones). They used to say it was the other way around, but that was when they were giving massive injections every few weeks. Doing so also increases the risk of polycythemia.

In fact, it has been shown the larger the area of distribution, more estrogen is produced. This is why more concentrated TD's help lower estrogen. Of note, I am not concerned about DHT conversion; for most patients.

Another concern I had was injecting an oil (fat) into fatty tissue. Haven't heard of a single case where that caused a problem, thankfully.

 

[JSayaMD]

Not just a theory, it's well-proven TD's elevate E more than shots (for most men--anything is possible with hormones). They used to say it was the other way around, but that was when they were giving massive injections every few weeks. Doing so also increases the risk of polycythemia.

This would tend to support the mechanism above of the non-esterified topical T directly aromatizing in the subq adipose tissue.

In fact, it has been shown the larger the area of distribution, more estrogen is produced. This is why more concentrated TD's help lower estrogen. Of note, I am not concerned about DHT conversion; for most patients.

This would make sense as the larger the area of distribution, the more adipocytes the T is distributed to = more aromatase exposure = more E

Another concern I had was injecting an oil (fat) into fatty tissue. Haven't heard of a single case where that caused a problem, thankfully.

From an organic chemistry perspective, the opposite should be more of an issue (injecting a hydrophilic -water soluble or "water loving" for forum members - substance into a hydrophobic medium - fat soluble or "water fearing"). Injection of a water-based substance into fatty medium usually will result in a depot (pocket) of the water-soluble material being formed (much like a micelle forms when a fat-soluble substance is put in water). This depot/pocket is often evident to patients in the form of a palpable nodule which may be felt for some time after a water-soluble injection into fatty tissue (ie: sermorelin, HCG, etc) - although part of this is a local inflammatory reaction as well - also partially attributable to the irritation from the basic chemical properties of oil and water not mixing.

A fat-soluble substance being injected into a fatty/oily substance will usually disperse/distribute more so than form a depot/pocket.

In reality, my only real concern with subq injections is injecting into significantly less vascular tissue. This should result in much slower absorption - although this will be somewhat counter-balanced by the increased dispersion/distribution as noted above. This slower rate of absorption, if it translates to less variability and more stable levels, may in fact be the principle benefit of subq injections. There are pros/cons to both IM and subq injections and patient preference is often the deciding factor for my patients. The default route, if no patient preference is indicated, is IM for me (with twice weekly or q5-7 day injections working quite well...and fairly predictable for the most part...at least in so much as hormones can be...)

Dr Saya

 

[Dr. John Crisler]

From an organic chemistry perspective, the opposite should be more of an issue (injecting a hydrophilic -water soluble or "water loving" for forum members - substance into a hydrophobic medium - fat soluble or "water fearing"). Injection of a water-based substance into fatty medium usually will result in a depot (pocket) of the water-soluble material being formed (much like a micelle forms when a fat-soluble substance is put in water). This depot/pocket is often evident to patients in the form of a palpable nodule which may be felt for some time after a water-soluble injection into fatty tissue (ie: sermorelin, HCG, etc) - although part of this is a local inflammatory reaction as well - also partially attributable to the irritation from the basic chemical properties of oil and water not mixing.

A fat-soluble substance being injected into a fatty/oily substance will usually disperse/distribute more so than form a depot/pocket.

In reality, my only real concern with subq injections is injecting into significantly less vascular tissue. This should result in much slower absorption - although this will be somewhat counter-balanced by the increased dispersion/distribution as noted above. This slower rate of absorption, if it translates to less variability and more stable levels, may in fact be the principle benefit of subq injections. There are pros/cons to both IM and subq injections and patient preference is often the deciding factor for my patients. The default route, if no patient preference is indicated, is IM for me (with twice weekly or q5-7 day injections working quite well...and fairly predictable for the most part...at least in so much as hormones can be...)

Dr Saya

Water does not dissolve fat; oil does. The remembrance of what dropping a used oil filter into a plastic garbage bag--and the mess my Dad "highly suggested" I clean up--has stayed with me.

In fact, we do see nodules forming with SC injections of oil, like we do water, sometimes. It's part of the body's natural inflammatory reaction.

It does not matter how the absorption is slowed, IF that is even true. After a few half-lives, it just wouldn't matter. Equilibrium is attained.

But the bottom line, from someone who has switched, literally, hundreds of patients over from IM to SC, is they overwhelmingly love the improvement.

Plus, one shot per week equals over 500 per decade. That could add up to thousands of holes in your muscles over a lifetime. SC means no holes in one's muscles. This, plus improved subjective report, is why so many of the top people do it that way now.

And variability is part and parcel of youth. As we age, even though the peaks and nadirs may stay the same, frequency declines....and so then does hormonal output. Smaller, more frequent injections produce a saw tooth pattern which really seems to work well for them.

Finally, we can not ignore the role of the lymphatics in absorbing these substances.