Made trip to see Dr. Crisler

[steroid.com 1]

This is very interesting. But in my opinion the only thing that validates a methodology is something that has been proven and documented. I agree Crisler seems as he is one of many on the leading edge of this - but if you say his recommended protocols validates something you are saying that all his previous recommendations were a validation as well. And, as you stated in another thread, you and your physician disagree with some of the levels Crisler uses as standards - so because you disagree with him does that make his beliefs/practice on that subject incorrect and therefor not validated?

You know me GD - nothing personal, just another view of statements made here.

I hope that this protocol works perfectly for the OP, and anyone else that is on it or moves to it.

J - Never take it personal man, it's stimulating conversation and good debate.

You may be reading to much into this post.

Crisler diagnosed the OP as E2 dominant.

His mode for Testosterone injection based on this diagnosis is SQ and not IM.

Possible Rational: SQ converts slower to E2 versus IM.

Crisler is not the only MD who subscribes to SQ for the same reason.

My point on "validation" was directed to the fact that Crisler has apparently adopted this mode of injection for the reason stated; that being the slower conversion to E2 via SQ opposed to IM.

[SlimmerMe]

This thread is one of the best ever. Keep up the great education! Learning learning learning.....

[SEOINAGE]

If you choose to inject SQ, do you need to start with AI or even have it on hand in case you feel sides? Or is it safe to start SQ even if you think you are prone to conversion without the ai? i don't see him mentioning ai in his protocol.

[Ibreakspawns]

If you choose to inject SQ, do you need to start with AI or even have it on hand in case you feel sides? Or is it safe to start SQ even if you think you are prone to conversion without the ai? i don't see him mentioning ai in his protocol.

At edited

[Swifto]

Seeing as adipose tissue is the largest of the extragondal sites of estrogen activity (aromotase), I'm struggling to work out how it will yield LOWER estrogen conversion...

[Swifto]

At first, he was talking about doing IM multiple times a week. Then, he was like wait "You're 23, that's a lot of shots for the rest of your life, IM is too invasive" Thus, reasoning for SQ. He said "We want to see if we can do it without an estrogen inhibitor, the less, the better"

So he didn't specifically mentaion "E2 conversion is lower SQ"?

[Ibreakspawns]

edit

[Ibreakspawns]

Edited

[HRTstudent]

I'm just curious, did Dr Crisler ever talk about gels such as androgel or testim? Or were options never talked about at all.

[ecdysone]

Seeing as adipose tissue is the largest of the extragondal sites of estrogen activity (aromotase), I'm struggling to work out how it will yield LOWER estrogen conversion...

I would really love to get a handle on this.

The two root papers on SQ were not in the first-tier literature, and no one seems to have anything other than abstracts.

I'm just thinking that SQ affords smaller doses/more frequency which might lead to less peak E2 production, although overall (AUC) is probably the same.

In theory, hourly doses would be perfect, but patient compliance (not everyone is a Steriod .com "nut") is the driving force and one has to be careful
of micro-mananging the pharmokinetics. Anything more frequent than every 48 hours is IMO, not the best therapy.

[Swifto]

The one full paper I have seen, they did not test estrogen at all.

I would really love to get a handle on this.

The two root papers on SQ were not in the first-tier literature, and no one seems to have anything other than abstracts.

I'm just thinking that SQ affords smaller doses/more frequency which might lead to less peak E2 production, although overall (AUC) is probably the same.

In theory, hourly doses would be perfect, but patient compliance (not everyone is a Steriod .com "nut") is the driving force and one has to be careful
of micro-mananging the pharmokinetics. Anything more frequent than every 48 hours is IMO, not the best therapy.

[Lemonada8]

Maybe what i mentioned earlier, about it being the release from the injection depot taking longer than the hydrolysis of the ester chain.. that when you go with SubQ you dont get that depot, it distrubutes faster in the body which allows it to be accessed easier than trying to get it out of a muscle belly?
That combined with more frequent injections, you dont have the 'knot' in the muscle issue so its much less painful, esp for life long injections...
Im with swifto on this issue, that adipose tissue is basically an endocrine organ w/ aromatization, how are you gonna get LESS estrogen issues vs IM injection?
Although, the estrogen conversion is basically a set thing, and that doesnt change with the amount of test you inject (this was in the book i mentioned earlier but that has to deal with repla***ent dosage, not 'cycle' dosages....)

Very interesting however that people seem to be having better results (when IM didnt work) going subQ. I know there are test pellets out there that go subQ and have proven decently effective in TRT.


Hey OP:
have you talked about using tamoxifen also? maybe so you wouldnt have to be on TRT your whole life, but use what ur doing now as a 'artificial puberty' where you can stimulate your natural system to proper effectiveness? This may be a case where your testes didnt fully develop due to the thyroid issue, and if that gets in check and using HCG can mimic your natural LH increase that occurs during puberty you could 'mature' your testes to be more proficient?
The reason i asked about Tamox, is that it is shown to increase Sensitivity to LH in males.. that may play a part in helping 'mature' your leydig cells? What do u think swifto about that idea?

IMO being on TRT at your age, where its lifelong shots would get very old. I even like injections but to have to do it all year long, for the rest of my life; i know i would definately try to get everything going good enough before i resort to that...

Ecdysone:
that is EXACTLY right.

In theory, hourly doses would be perfect, but patient compliance (not everyone is a Steriod .com "nut") is the driving force and one has to be careful
of micro-mananging the pharmokinetics. Anything more frequent than every 48 hours is IMO, not the best therapy.

the testosterone book i referenced eariler explains that exact point with reviewing testosterone preperations (basically the difference between esters) that anyting that has to be injected more than 2x a week has much lower compliance which, in dealing with these hormones, would lead to increased side effects and increase the risk of potential issues.

[flatscat]

Okay gotta jump in here one more time and say something I have said a couple of times before...

Our natural levels are NOT constant. They fluctuate based on MANY things. Time of day, nutrition, level of activity, type of activity, adrenaline, sexual behaivior exposure to sun light and on and on. Where am I wrong in stating that our bodies are at their best when they are adjusting and trying to regulate as they are supposed to with the NATURAL ups and Downs of our hormone levels?

We keep trying to get as close to a constant level of t as we can ... but this is trt and not cycling. I can see if you are cycling and ur whole goal is to add lbm and increase strength where this works. If we are trying to mirror how a natty endocrine system works it is crazy. Please, someone, tell me and show me that I am off my rocker. I am tiring of this debate.

Prove me wrong. Por favor.

[Lemonada8]

^ i cant actually say i know what you are trying to say?

Right our natural levels arent constant, thats due to the LH surge releases during the day so following that, our test raises and falls. Hence morning wood, night time is a big time for test making. Thats why they say sleep is very important, and being on a good circadian rhythm. But these level off, and become stable. The large changes is when issues occur (puberty for instance, acne, gyno, weight gain, etc) but these will level off as our bodies become accustomed to the hormones.

You really cant mimic the natural peaks/valleys of natural test production while on TRT, the injections would be insane or you would need something like the diabetics have to supply insulin through out the day. But this isnt necessary b/c of the long half life of test preparations which end up being a steady availablity of test. This, when adjusted to the appropiate level according to the individual person, will act like nothing is wrong and there wont be severe sides.
Typically the sides that one gets when starting TRT is that they have had such low test then when they get that injection it raises the level, which creates unbalance of hormones and in some this can cause sides similar to the ones you get on a cycle. However, since it is HRT/TRT, the body needs to naturally adjust to the level and it will if the injections are kept in a decent pattern with out a large drop in hormone levels. If there is a large drop off between injections, then usually they are moved closer together to minimize the drop off, making it 'side-less' while the body naturally adjusts to the change.

[flatscat]

Yeah u missed it mostly. But it was a nice reply and good info for newbs.

[zaggahamma]

i know what flats is saying and i agree and is why you wont see me trying to pin several times a week to prevent the steep decline in test after day 5

[Corpsman]

I hope you don't mind me chiming in here. I started HRT when I was 26. I didn't go through puberty until I was 15 - 16 years old. I could not grow facial hair until after I started HRT. When I graduated high school I weighed about 118lbs. The only reason I knew to start HRT was because I was miserable, had no energy, just wanted to sleep all day. Doctor tried me on different AD's and they didn't work. As a shot in the dark I asked him to check my testosterone . After laughing at the suggestion he reluctantly agreed. Called me at home a week later and apologized. He said I had no testosterone. I am now 38 and have been on a routine of 200mg/wk to EOW depending how I feel. I inject hCG when my testicles get too tight and small. But I am still on AD and do have anxiety issues often. I take Ambien every night because I can't sleep. My pulse is always above 90bpm. I am basically undiagnosed as to what caused my testosterone deficiency. I did not do drugs and did not do steroids . But now I am taking vicodin for chronic pain. Wellbutrin, and Ambien every day. I want it all to stop! So if there is a alternate recommendation for my testosterone and hCG administration I am definitely willing to try it. I would love to hear some suggestions. I get my testosterone and hCG from the VA. i couldn't convince them to let me inject my hCG SQ so I had to buy needles from another source and lie to them about it. So I know asking them for alternative therapy is useless. But if you guys give me some advice for an alternate way to administer, I would live to try it.

I didn't mean to hijack. I just feel so stuck.

[jamotech]

I hope you don't mind me chiming in here. I started HRT when I was 26. I didn't go through puberty until I was 15 - 16 years old. I could not grow facial hair until after I started HRT. When I graduated high school I weighed about 118lbs. The only reason I knew to start HRT was because I was miserable, had no energy, just wanted to sleep all day. Doctor tried me on different AD's and they didn't work. As a shot in the dark I asked him to check my testosterone . After laughing at the suggestion he reluctantly agreed. Called me at home a week later and apologized. He said I had no testosterone. I am now 38 and have been on a routine of 200mg/wk to EOW depending how I feel. I inject hCG when my testicles get too tight and small. But I am still on AD and do have anxiety issues often. I take Ambien every night because I can't sleep. My pulse is always above 90bpm. I am basically undiagnosed as to what caused my testosterone deficiency. I did not do drugs and did not do steroids . But now I am taking vicodin for chronic pain. Wellbutrin, and Ambien every day. I want it all to stop! So if there is a alternate recommendation for my testosterone and hCG administration I am definitely willing to try it. I would love to hear some suggestions. I get my testosterone and hCG from the VA. i couldn't convince them to let me inject my hCG SQ so I had to buy needles from another source and lie to them about it. So I know asking them for alternative therapy is useless. But if you guys give me some advice for an alternate way to administer, I would live to try it.

I didn't mean to hijack. I just feel so stuck.

Don't think your gonna get a response to that in this thread, no worries, just make your own thread!

[zaggahamma]

I hope you don't mind me chiming in here. I started HRT when I was 26. I didn't go through puberty until I was 15 - 16 years old. I could not grow facial hair until after I started HRT. When I graduated high school I weighed about 118lbs. The only reason I knew to start HRT was because I was miserable, had no energy, just wanted to sleep all day. Doctor tried me on different AD's and they didn't work. As a shot in the dark I asked him to check my testosterone . After laughing at the suggestion he reluctantly agreed. Called me at home a week later and apologized. He said I had no testosterone. I am now 38 and have been on a routine of 200mg/wk to EOW depending how I feel. I inject hCG when my testicles get too tight and small. But I am still on AD and do have anxiety issues often. I take Ambien every night because I can't sleep. My pulse is always above 90bpm. I am basically undiagnosed as to what caused my testosterone deficiency. I did not do drugs and did not do steroids . But now I am taking vicodin for chronic pain. Wellbutrin, and Ambien every day. I want it all to stop! So if there is a alternate recommendation for my testosterone and hCG administration I am definitely willing to try it. I would love to hear some suggestions. I get my testosterone and hCG from the VA. i couldn't convince them to let me inject my hCG SQ so I had to buy needles from another source and lie to them about it. So I know asking them for alternative therapy is useless. But if you guys give me some advice for an alternate way to administer, I would live to try it.

I didn't mean to hijack. I just feel so stuck.

sounds like you got it all under control how is it going dont see why /what you are stuck about

[ecdysone]

Okay gotta jump in here one more time and say something I have said a couple of times before...

Our natural levels are NOT constant. They fluctuate based on MANY things. Time of day, nutrition, level of activity, type of activity, adrenaline, sexual behaivior exposure to sun light and on and on. Where am I wrong in stating that our bodies are at their best when they are adjusting and trying to regulate as they are supposed to with the NATURAL ups and Downs of our hormone levels?

We keep trying to get as close to a constant level of t as we can ... but this is trt and not cycling. I can see if you are cycling and ur whole goal is to add lbm and increase strength where this works. If we are trying to mirror how a natty endocrine system works it is crazy. Please, someone, tell me and show me that I am off my rocker. I am tiring of this debate.

Prove me wrong. Por favor.

Well just to complicate issues more let me add this. Sublinqual routes of administration typically mimic IV routes where the test levels spike into the thousands and then baseline out in a few hours. Nevertheless, studies have shown the overall effect is not bad since E2 spikes and rapidly declines, same for DHT and so forth. Again, the few studies out there have shown very positive results, nice anabolic effect with all the normal attributes of other forms of TRT. The typical 2X/day dosing is a pain, but otherwise there seem to be a lot of pluses.

Just pointing out this type of TRT is totally opposite of a nice, smooth steady-state route, shouldn't work (at least according to theory) but in fact, does.

[Corpsman]

I have chronic pain. Anxiety. And insomnia. I know it is all related to my hormones and my endo is not on top of his game. So if the OP has gotten advice from an endo who is on top of his game, I want to know what he is telling him. Maybe I can benefit without having to fly to Florida, or wherever this doctor is. So what I am really asking is, what specific dosaging the endo has given the OP. I want to expirement with changing up to SQ testosterone and change up my hCG .

[steroid.com 1]

I feel so sorry for the OP: this thread is so badly hijack it's not even funny any more...

[ecdysone]

^ true, this. Sorry OP, I got into late and totally lost track of the original subject matter....my bad.

[kelkel]

Like Slimmer Me said, this is a great threat. Great info, albeit I'll have to read, re-read, print it out and post it on my wall to fully grasp all of it. Then routinely quiz myself and go to summer school.

Despite the this is exacty what this forum is for.....my .02 anyway.

[steroid.com 1]

I have always been under the belief that aromatization happens in the blood stream and not in tissue or organs.

Shippen has been fooling around with Testosterone SQ for years.

Crisler has been testing SQ from some time now as well (even stated today on his own board).

I am not a Physician and I don't think any of us here are as well.

These men are on the leading edge of TRT for men and I would think that if aromatization within fat tissue would increase E2 conversion we'd know about it.

I've been injecting SQ for almost 2 years now and my E2 has been in the low 20's since I started (as many of you know).

And yea kel, this is a great thread just don't want ibreakspawns to feel he lost control of his won thread.

He's a good guy and I want to show respect is all.

[Ibreakspawns]

No, no. I welcome it, it's all related, so it's fine! It will help the new people like me, or confuse the shit out of 'em. lol

I have lots of respect for Dr. Crisler, even spending an hour or so with him made me very comfortable.

[Swifto]

I have always been under the belief that aromatization happens in the blood stream and not in tissue or organs.

Shippen has been fooling around with Testosterone SQ for years.

Crisler has been testing SQ from some time now as well (even stated today on his own board).

I am not a Physician and I don't think any of us here are as well.

These men are on the leading edge of TRT for men and I would think that if aromatization within fat tissue would increase E2 conversion we'd know about it.

I've been injecting SQ for almost 2 years now and my E2 has been in the low 20's since I started (as many of you know).

And yea kel, this is a great thread just don't want ibreakspawns to feel he lost control of his won thread.

He's a good guy and I want to show respect is all.

Adipose tissue is the main extragondal site of aromotase. Estrogen is produced by the testes (15%), skin, bone, brain. If I remember correctly, around 60% was adipose tissue/skin (largest surface area).

http://erc.endocrinology-journals.or...2/131.full.pdf

[ecdysone]

These men are on the leading edge of TRT for men and I would think that if aromatization within fat tissue would increase E2 conversion we'd know about it.

Well, here's the thing. Most of the oxidative conversion of test occurs in the fat (adipose tissue), but it's true it's generally transported there via the circulatory system.

The wrinkle in all of this is what happens when you deposit an test oil reservoir directly into adipose tissue: is it bioavailable to the surrounding adipose cells, or must it diffuse into the circulatory system and then be transported back to them for oxidation conversion to E2?

It's the complicating issue of a physical process, the test diffusing from the oil, with a chemical process, it being metabolize by adipose tissue.

The makings of a good research project!

[flatscat]

No, no. I welcome it, it's all related, so it's fine! It will help the new people like me, or confuse the shit out of 'em. lol

I have lots of respect for Dr. Crisler, even spending an hour or so with him made me very comfortable.

You are right - it will be one or the other.... thanks for being a good sport about it and I really wish you the best bro. A lot of folks watching you and your results. Don't question yourself or your protocol because of these side bars. Stick with it and YOU will be our evidence!

Flats

[steroid.com 1]

Well, here's the thing. Most of the oxidative conversion of test occurs in the fat (adipose tissue), but it's true it's generally transported there via the circulatory system.

The wrinkle in all of this is what happens when you deposit an test oil reservoir directly into adipose tissue: is it bioavailable to the surrounding adipose cells, or must it diffuse into the circulatory system and then be transported back to them for oxidation conversion to E2?

It's the complicating issue of a physical process, the test diffusing from the oil, with a chemical process, it being metabolize by adipose tissue.

The makings of a good research project!

Excellent response ecdysone, thank you!

Agree, it would make a great research project!

[Lemonada8]

Or you could compare aromatization rates between muscle and adipose.


http://www.ncbi.nlm.nih.gov/m/pubmed/752017/

. If constancy of tissue aromatization throughout the body is assumed, the muscle accounts for 25-30% and adipose tissue for 10-15% of the total extragonadal aromatization of androgens to estrogens

[flatscat]

You guys are good. Nice data. I said one time to GD that I had read it all...... I have seen some new things these past few days .... so thank you... keep it up please.

Swifto, please repost the studies from the other board please for these guys to see. Thanks

[Corpsman]

Please PM me your exact script.

[Ryanmcd]

Please PM me your exact script.

LOL, go spend the money yourself, also Dr C has stopped seeing people before that post what he tells them to use, just a fyi.

[JD250]

^^^^^^^Really!!?? This whole forum is based on sharing information in order to better understand our own individual health, he must hate this site since we discuss him quite often..........I have my doubts about that statement considering that he posts much of his research on the WWW for all to access.

[Swifto]

You guys are good. Nice data. I said one time to GD that I had read it all...... I have seen some new things these past few days .... so thank you... keep it up please.

Swifto, please repost the studies from the other board please for these guys to see. Thanks

Sure.

Al-Futaisi AM, Al-Zakwani IS, Almahrezi AM, Morris D.

Subcutaneous administration of testosterone. A pilot study report.

Saudi Med J. 2006;27(12):1843-6.

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 repla***ent therapy, is inconvenient to many patients. METHODS: All men with primary and secondary hypogonadism attending the reproductive endocrine clinic at Royal Victoria Hospital, Monteral, Quebec, Canada, were invited to participate in the study. Subjects were enrolled from January 2002 till De***ber 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 was 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.




Full study, here.





STABLE TESTOSTERONE LEVELS ACHIEVED WITH SUBCUTANEOUS TESTOSTERONE INJECTIONS

M.B. Greenspan, C.M. Chang

Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada

Objectives: The preferred technique of androgen repla***ent has been intramuscular (IM) testosterone, but wide variations in testosterone levels are often seen. Subcutaneous (SC) testosterone injection is a novel approach; however, its physiological effects are unclear. We therefore investigated the sustainability of stable testosterone levels using SC therapy. Patients and methods: Between May and September 2005, we conducted a small pilot study involving 10 male patients with symptomatic late-onset hypogonadism. Every patient had been stable on TE 200 mg IM for 41 year. Patients were instructed to self-inject with testosterone enanthate (TE) 100 mg SC (DELATESTRYL 200 mg/cc, Theramed Corp, Canada) into the anterior abdomen once weekly. Some patients were down-titrated to 50 mg based on their total testosterone (T) at 4 weeks. Informed consent was obtained as SC testosterone administration is not officially approved by Health Canada. T levels were measured before and 24 hours after injection during weeks 1, 2, 3, and 4, and 96 hours after injection in week 6 and 8. At week 12, PSA, CBC, and T levels were measured however; the week 12 data are still being collected. Results: Prior to initiation of SC therapy, T was 19.14+3.48 nmol/l, hemoglobin 15.8+1.3 g/dl, hematocrit 0.47+0.02, and PSA 1.05+0.65 ng/ml. During the first 4 weeks, there was a steady increase in pre-injection T from 19.14+3.48 to 23.89+9.15 nmol/l (p¼0.1). However, after 8 weeks the post-injection T (25.77+7.67 nmol/l) remained similar to that of week 1 (27.46+12.91 nmol/l). Patients tolerated this therapy with no adverse effects. Conclusions: A once-week SC injection of 50–100 mg of TE appears to achieve sustainable and stable levels of physiological T. This technique offers fewer physician visits and the use of smaller quantity of medication, thus lower costs. However, the long term clinical and physiological effects of this therapy need further evaluation.

[ecdysone]

As I eluded to upthread, these studies would have never been accepted by a main-stream endo Journal, so we have to be a little careful when citing them.

I LOL when visualizing the patients putting the test vial under one armpit and the syringe under the other to warm them up. I could just see their wife's walking in and saying: "what the hell???"

[zaggahamma]

how cold is everyone's house that the vial needs to be warmed i never get that one

[steroid.com 1]

^^^^^^^Really!!?? This whole forum is based on sharing information in order to better understand our own individual health, he must hate this site since we discuss him quite often..........I have my doubts about that statement considering that he posts much of his research on the WWW for all to access.

JD - Crilser doesn't like his patients posting thier protocols' on the Internet for just this reason; he doesn't want copycats. Each protocol is individual and custom tailored in his opinion so he asks that patient refrain from this activity.

I understand that he's even resigned some patients for doing this in the past!

Makes sense in a way...

[flatscat]

As I eluded to upthread, these studies would have never been accepted by a main-stream endo Journal, so we have to be a little careful when citing them.

I LOL when visualizing the patients putting the test vial under one armpit and the syringe under the other to warm them up. I could just see their wife's walking in and saying: "what the hell???"

Agree but with the lack of studies they are what we have in addition to ever changing new best protocol trials by physicians and personal experiences.