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

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During the last year we have had an increase in reports from men stating that they are running out of their testosterone cypionate injections before the refill date. This article will hopefully help mitigate this problem. Lets first rule out those who over-draw the testosterone into the syringe, of course we must pay attention to detail when it comes to lining up the syringe plunger with the dosage line. If we are not paying attention, or have not been instructed properly, over drawing just a small amount of testosterone at each injection can result in running out of the medication prior to your refill date. There are other factors which can cause loss of testosterone as you inject regularly. If you notice at the base of your needle, where you attach the needle to the syringe, there is empty space which can trap the testosterone even after depressing the plunger completely. There always seems to be that little bit of medication that will not leave the needle space. In addition to the testosterone being trapped in the needle, there is also a small amount left behind on the internal syringe walls. This type of loss is unavoidable when using a 3ml or syringe with larger surface area for the medication to 'stick' to'. Over the course of administering ten to twenty injections using a 10ml multi-dosed bottle that little bit of lost testosterone adds up.

One of the reasons I believe we have noticed the rise in reports of men running out early during the past year is the result of increased regulations regarding the prescribing and dispensing of testosterone. It is a controlled substance which was previously overlooked by most regulators, and patients had the convenience of refilling earlier than due. I remember being able to refill 3 weeks early on a 10ml bottle. Now, with the regulations, it is 3 days to one week prior to being due depending on the pharmacy. This means we now have to be mindful of our dosage and injection technique.
There is one thing being done by manufacturers and compounders to mitigate the loss. There is also something you can do to make your testosterone last the entire time up to your refill time.
At least one brand of testosterone cypionate and most compounded 10ml cypionates are actually overfilled to help compensate for the expected loss. Pfizer's Depot Testosterone is filled over 10ML. As of 2010, if I remember correctly, close to 10.8ml. The compounding pharmacies we use all fill the bottle to 11ml, which will help compensate the unavoidable loss. We had the opportunity to confirm this in a pharmacy setting in 2010 (APS Pharmacy, FL). During this test we also were able to observe the variations in the loss of medication between different syringes. Three commonly prescribed testosterone cypionate 200mg/ml 10ml bottles were selected, including Pfizer's Depot Testosterone, Watson's testosterone cypionate, and compounded testosterone cypionate. First, using a larger 12ml syringe we drew the entire contents of each bottle to confirm they were at least 10ml. A separate syringe was dedicated to each bottle to ensure accuracy. Next, using a new bottle of each testosterone cypionate and using ten individual 3ml syringes dedicated to each bottle, we drew 1ml into each 3ml syringe. This phase confirmed that each bottle lost an average of 1ml using ten 3ml syringes to draw 1ml versus using a 12ml syringe to draw the entire contents. You must be careful to accurately measure your dosage prior to injecting your testosterone using a 3ml syringe.
If you are having trouble drawing a 3ml syringe, or if you are on a decimal dosage (such as 0.75ml), try using a 1ml Luerlock syringe. It looks similar to an "insulin" or tuberculin syringe but can be attached with any size/gauge needle. The 1ml Luerlock allows any standard needle to be secured onto the syringe. Two benefits to using a 1ml syringe: 1- You will draw your dose more accurately 2- There is less surface area on the internal syringe wall for the testosterone to adhere to when your weekly dosage is split into two injections using the 1ml Luerlock. I also find it easier to inject with proper technique when personally using a 1ml syringe.

2016 update:
I am currently working with another compounding pharmacy to perform testing including a similar test as mentioned in this article. I will post the details along with pictures/video when completed.

http://defymedical.com/blog/item/12...njectable-testosterone-before-the-next-refill
 
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Defy Medical TRT clinic doctor
Your welcome sir. I feel the need to educate since we are having a lot of guys run out early and not able to fill for 1-2 weeks!

I know that I would not be happy missing even one injection
 
It happened to me just a few weeks ago!

The problem here, however, was my Doc forgot to update my file on the increase in dosage from 100 mg to 120 mg weekly.

I never paid any attention to the script on the vial where it still said 100 mg weekly.

When I went to reorder the pharmacy said it was too soon and they wouldn't reorder for another 3 weeks which meant I was going to crash!!!

Of course my Doc is one of the best in TRT for men and he fixed it right quick so I didn't miss a shot but it just goes to show how things can happen.
 
I've seen greater loss with some of the syringes with removal needle.

I finally found a fixed needle syringe and my waste was reduced significantly, particularly when you inject very frequently (EOD for me)

I do sub-q but use a 27g 1/2" syringe/needle easier fill and injection then a really small pin like I use for HCG
 
The compounding pharmacies we use fill the bottle to 11ml, which will help compensate the unavoidable loss. We had the opportunity to test this in a pharmacy setting 5 years ago.

If you are having trouble drawing a 3ml syringe, or if you are on a decimal dosage (such as 0.75ml), try using a 1ml tuberculin syringe. It looks just like an "insulin" syringe but can be attached with any size/gauge needle. Two benefits to using a 1ml syringe: 1- You will draw more accurately 2- There is less surface area on the syringe for the T to stick to the sides, however you still have the needle head which can trap T. I also find it easier to inject using a 1ml syringe.






-

Jasen,

Is it still the case that the vials are a bit overfilled? I received 2x 5ml bottles today, and had about 0.1cc left in the tip of my Terumo 5cc syringe after my first injection.
 
EXCELLENT topic, Jasen. Thank you.

Another reason for an increase in the number of guys running out early is the shift toward split doses during the week. That multiplies that drop that is lost inside the syringe each time.

I encourage my patients to draw, and inject, with the same needle. Changing out the needle loses some, as well. Across a bottle, it really adds up.
 
Accurate drawing/dosing will become more important as many compounders start to only compound Cyp in 5ml instead of 10ml bottles. And with the increase in cost due to the change in pharmacy regulations the compounders are less likely to overfill the vials as they used to. When I worked at a compounding pharmacy 3 years ago we actually measured the volume of test cyp in two different brands- Pfizer and Watson testosterone cypionate. Both had measured 10.8ml and 10.6 respectively. This could of been specific to the batches we tested but I assume they overfill each batch. The compounding pharmacy overfilled by 1ml making a 10ml bottle actually 11ml to compensate loss. Overfilling a 10ml bottle by around 1ml appears to be the standard amongst the pharmacies I have communicated with. I have not confirmed yet but I suspect as the cost increases to compound sterile injectables like test cyp, pharmacies will be more than likely to not overfill bottles.

Even with overfilling there are many guys who still complain of running out early. The first thought is regarding the pharmacy under filling the bottle- this is a rare occurrence as everything is made in batches and would be caught if not measured properly. It is important to consider all factors and pay attention to detail when measuring and administering testosterone injections
 
Accurate drawing/dosing will become more important as many compounders start to only compound Cyp in 5ml instead of 10ml bottles. And with the increase in cost due to the change in pharmacy regulations the compounders are less likely to overfill the vials as they used to. When I worked at a compounding pharmacy 3 years ago we actually measured the volume of test cyp in two different brands- Pfizer and Watson testosterone cypionate. Both had measured 10.8ml and 10.6 respectively. This could of been specific to the batches we tested but I assume they overfill each batch. The compounding pharmacy overfilled by 1ml making a 10ml bottle actually 11ml to compensate loss. Overfilling a 10ml bottle by around 1ml appears to be the standard amongst the pharmacies I have communicated with. I have not confirmed yet but I suspect as the cost increases to compound sterile injectables like test cyp, pharmacies will be more than likely to not overfill bottles.

Even with overfilling there are many guys who still complain of running out early. The first thought is regarding the pharmacy under filling the bottle- this is a rare occurrence as everything is made in batches and would be caught if not measured properly. It is important to consider all factors and pay attention to detail when measuring and administering testosterone injections
That is very interesting.

Just today a patient told me he is taking more than he is prescribed in order to "make up for that lost inside the syringe and needle".

....as if the syringe is not built and calibrated to deliver a nearly exact dose.

Another thing I have heard, numerous times over the years, is they measure to the point on the rubber gasket, not the flat line edge. That adds about 20mg to their dose each time, and makes them run out too soon as well (besides the unapproved alteration in dosing).
 
The fixed tip 27ga 1/2" syringes of been using for nearly two years now have been excellent. They fill easy and evacuate nearly completely. Ran low previously with the removable tip ones (reservoir area would never void) but since switch no issues. Yes I fill to edge of rubber gasket and precisely the amount prescribed....too much T can be just and detrimental as too little Follow your docs orders based upon good labs


Ive been using Watson (big pharm) T-Cyp for last few scripts. Seems to be quite good and filled accurately
 
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The fixed tip 27ga 1/2" syringes of been using for nearly two years now have been excellent. They fill easy and evacuate nearly completely. Ran low previously with the removable tip ones (reservoir area would never void) but since switch no issues. Yes I fill to edge of rubber gasket and precisely the amount prescribed....too much T can be just and detrimental as too little Follow your docs orders based upon good labs


Ive been using Watson (big pharm) T-Cyp for last few scripts. Seems to be quite good and filled accurately
That's how to do it!
 
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