Just Started testosterone replacement therapy (TRT) - Injection Frequency Disagreement - Insight?

[Next Level]

Just Started TRT - Injection Frequency Disagreement - Insight?

Hey Everyone,

I've been reading and posting on the TRT forum in addition to others here on 'ology for most of this year and have gotten great insight, guidance, and support. After a year long battle with GP's and after waiting 6 months to see an Endocrinologist, I have been, at 31, prescribed a 3 month trial run of Testosterone to see how I respond.

My prescription, which was emailed to me so I did not have a chance to speak with the Endo as he wrote it, is for 200mg Test E every 2 weeks. Below is an excerpt of an email I sent bringing up the injection frequency necessity I hear time and time again here, then my Endo's assistant's response.

My Email:

Thanks for the quick turn around. Quick question: I was under the impression that weekly injections provide much more stable serum testosterone levels as well as minimize aromatization. Is it OK if I inject every week instead in order to minimize the highs and lows?


Endo's Assistant's Response:


The Dr. usually starts patients with injections every two weeks. It could be one of the following reasons:
1. Most patients go to there GP’s office to initialize the injection so biweekly dose is just to minimize the trips and await time in GP’s office
2. It reduces skin trauma by reducing the frequency of injection
3. For self-inject patients, it's just easier for him to draw more medication into the tiny syringe than the lesser amount.
If there is cycling before the end of two weeks, then he will switch the patient to the weekly dose.
Hope this make sense and let us know how you feel after you start the injection.



I did my first injection yesterday of 100mg, should I keep on that course (100mg a week) or follow the Endo's protocol and risk what seem to be the inevitable hormonal peaks and valleys that so many seem to get with injecting every 2 weeks?

 

[Megatron28]

50mg every 3.5 days would be better, especially since it sounds like you don't have an Aromatase inhibitor (AI) prescribed.

 

[halfwit]

50mg every 3.5 days would be better, especially since it sounds like you don't have an Aromatase inhibitor (AI) prescribed.

x2.

Skin trauma hah! They read the pamphlet that comes with testosterone vials, which still provides that dosing. They seriously need to update that stuff as it's just archaic.

 

[Megatron28]

x2.

Skin trauma hah! They read the pamphlet that comes with testosterone vials, which still provides that dosing. They seriously need to update that stuff as it's just archaic.

You probably have to go through hoops to get the FDA to approve an update.

 

[Next Level]

x2.

Skin trauma hah! They read the pamphlet that comes with testosterone vials, which still provides that dosing. They seriously need to update that stuff as it's just archaic.

I know, I thought that was ridiculous as well. Inconvenience about doctor visits, skin trauma risk (ha) and perceived difficulty drawing 0.5ml instead of 1ml are not valid reasons to risk hormonal fluctuations if you have ever experienced them, that's for sure.

I'm pretty surprised that he started on injections every 2 weeks instead of one and doesn't test for E2 after some time on the treatment to verify that I am in a healthy range. Based on some of the papers of his that are online in medical journals, you'd think he'd be more progressive than that, if you're up for a read, check this paper of his out: http://www.bcmj.org/articles/testosterone-deficiency-practical-guidelines-diagnosis-and-treatment

 

[Megatron28]

I know, I thought that was ridiculous as well. Inconvenience about doctor visits, skin trauma risk (ha) and perceived difficulty drawing 0.5ml instead of 1ml are not valid reasons to risk hormonal fluctuations if you have ever experienced them, that's for sure.

I'm pretty surprised that he started on injections every 2 weeks instead of one and doesn't test for E2 after some time on the treatment to verify that I am in a healthy range. Based on some of the papers of his that are online in medical journals, you'd think he'd be more progressive than that, if you're up for a read, check this paper of his out: http://www.bcmj.org/articles/testosterone-deficiency-practical-guidelines-diagnosis-and-treatment

I only skimmed it, but this guy sounds bad.

Stop treatment for high hematocrit? You can just donate blood.

I didn't see any mention of aromatization. Did I miss that?

 

[halfwit]

I only skimmed it, but this guy sounds bad.

Stop treatment for high hematocrit? You can just donate blood.

I didn't see any mention of aromatization. Did I miss that?

He actually seems to have his shit together for the most part, but I don't agree with his dosing (I'd like to know where he gets this from where 100mg is okay weekly, but 200mg should be every 2 weeks?) nor the fact that he's missing ESTRADIOL completely from his paper. He does bring up some good points and I like how he gives symptoms docs can look for to help determine if there is a case of hypogonadism. That and he has the whole LH/FSH being used to determine if there is a pituitary issue, which I feel many docs are missing.

I'd definitely bring these three (my two plus Mega's HCT issue, which is true) points up with him as it seems he's completely neglecting the whole negative feedback loop, which is sometimes completely responsible for hypogonadism in the first place! I think if he were to fix those glaring problems with his protocols, he'd be one hell of a TRT doctor in my humble opinion.

In short; could be better - but could also be MUCH worse. Hopefully he does listen to your concerns and is able to address them. Oh, if he brings up how 200mg/2wks is somehow superior to 100mg/wk, I'd love to hear that reasoning as it is just creating a larger spike in E2 and could cause some problems.

My .02c

 

[Next Level]

I only skimmed it, but this guy sounds bad.

Stop treatment for high hematocrit? You can just donate blood.

I didn't see any mention of aromatization. Did I miss that?

I guess I have the lowered expectation of not expecting specialists to be completely cutting edge on this issue. I did notice the hematocrit issue and, if it became an issue, would mention the effectiveness of donating blood. It does concern me that he does not mention aromatization and the bloodwork requisition I have that is to be used after 3 months of treatment does NOT test for E2. I emailed him asking about it yesterday and have yet to hear back. After only one shot (100mg two days ago), I feel damn good, whether that's a placebo, remains to be seem.

He actually seems to have his shit together for the most part, but I don't agree with his dosing (I'd like to know where he gets this from where 100mg is okay weekly, but 200mg should be every 2 weeks?) nor the fact that he's missing ESTRADIOL completely from his paper. He does bring up some good points and I like how he gives symptoms docs can look for to help determine if there is a case of hypogonadism. That and he has the whole LH/FSH being used to determine if there is a pituitary issue, which I feel many docs are missing.

I'd definitely bring these three (my two plus Mega's HCT issue, which is true) points up with him as it seems he's completely neglecting the whole negative feedback loop, which is sometimes completely responsible for hypogonadism in the first place! I think if he were to fix those glaring problems with his protocols, he'd be one hell of a TRT doctor in my humble opinion.

In short; could be better - but could also be MUCH worse. Hopefully he does listen to your concerns and is able to address them. Oh, if he brings up how 200mg/2wks is somehow superior to 100mg/wk, I'd love to hear that reasoning as it is just creating a larger spike in E2 and could cause some problems.

My .02c

From my research, he's is much more knowledgeable than many others I have heard of, Endos included. I had to wait 5 months to see this guy and he did make the call to start me out on TRT which is a tough call (being 31) when you fall within lab ranges most of the time. I have to agree, barring hemotacrit and E2 issues, he seems pretty kick ass and I feel better already.

 

[Megatron28]

I only skimmed it. Maybe I am being too hard on him. I hope he treats you well.

 

[Next Level]

I only skimmed it. Maybe I am being too hard on him. I hope he treats you well.

No worries, you were fair for having skimmed it. His initial dosing schedule of 200mg/2 weeks screams lack of knowledge, or at least someone who has never experienced a peak and valley that would inevitably cause.

Other than that and E2 and hematocrit negligence, I am happy with him. I wish he was all over everything and I didn't feel the need to be a patient who has to bring up things he should already know.