How to Titrate

[OingoBoingo]

In a couple weeks I’ll be going back to the doctor for my first blood test after beginning TRT. My current protocol is 105mg Testosterone per week (15mg injected subcutaneously daily), and 100IU hCG injected subcutaneously daily.

Odds are the initial dose wasn't perfect. Maybe it was too low, or maybe it was too high. We’ll see when the blood work comes back.

But the question is, how much should T be increased (or decreased) depending on the results?

[spacemon]

I have been on TRT for a few months and inject 200mg once a week. my T went from 191 to 600 after a month between tests. Just figured I would chime in to help get the thread movin

[kelkel]

how much should T be increased (or decreased) depending on the results?

Not to be redundant but it depends on the results. Hang in there, it's normal to be anxious. Make sure you test free T and E2 Sensitive, not standard estradiol.
Did your doc start you on this protocol on his own or was it suggested by you?

[OingoBoingo]

I have been on TRT for a few months and inject 200mg once a week. my T went from 191 to 600 after a month between tests. Just figured I would chime in to help get the thread movin ;)

Thanks spacemon.

It was not my intention to start another "how much do you pin" thread, as the forum has a few of those already.

I'd like to better understand the logic of titration so I'm prepared when meeting the doctor after my blood work.

[OingoBoingo]

Not to be redundant but it depends on the results. Hang in there, it's normal to be anxious. Make sure you test free T and E2 Sensitive, not standard estradiol.
Did your doc start you on this protocol on his own or was it suggested by you?

Thank you for your comments kelkel.

It's not that I'm so anxious, well, maybe a little bit. I think you correctly guessed that my protocol was suggested by me. The doctor was suggesting between 200mg and 250mg per week because of my size.

My observation is that his bread and butter is probably gels and Nebido. We had an email conversation before my appointment, and he understood I was really only interested in self-injecting T and hCG . His position is basically, "I will help you do whatever you want to do to reach 80% of your age adjusted maximum, as long as it does no harm." So, so far so good. I'm one of his few patients that self-inject, and his only patient that injects subcutaneously, and his only patient that does so every day.

The doctor's eagerness to start me off at a higher dose has me concerned for the next appointment. I may have done myself a disservice by setting up an appointment only 24 hours after my blood draw, and giving the community here just 15 hours to respond to my blood work before meeting the doctor. (If all goes well, I should have my results about 8-9 hours after the draw.) I don't want to have the doctor say, "Of course, your levels are low, because I told you to start off at 250."

I'd rather go in there knowing my levels are low (if they indeed still are), and have an idea of what the next dose should be.

I did google a bit before posting the question, and haven't yet found any useful information about injectables. I did find some information on an Androgel site that said (IIRC):

350 < Add one pump
350 - 750 = Make no change
750 > Reduce one pump

And I noticed that for many different drugs they might start at a low dose, and then just add another dose; for example, 15mg, 30mg, 45mg, 60mg, and so on. I was hoping there might be some similar logic or plan for T injectables.

Now, if I read between the lines of your post, I'm guessing if my level increases just a little, I would add more than if it increased a lot. That makes sense. But the amount to increase (or decrease) is where I'm stuck.

The doctor is keying on Free Test, so that's good. But the Sensitive E2 Assay is not available in Thailand, which is the reason I went with daily shots. With daily shots I figure I am doing the most I can to keep E2 spikes down.

I've read on this forum that the standard E2 test is basically useless, but that's the only test available here. Originally, I was going to get another standard E2 assay when I went back, but crossed it off my list after reading more on the forum. Considering it's the *only* test available to me, do you think it's worth keeping on the list? I'm a little torn on that.

Other than the standard E2 test, all I've got to go by is symptoms. Not ideal, but it's all I can do.

[OingoBoingo]

Changes in IM dosing are made in small increments, as response to same is not linear. It is convenient and practical to increase, or decrease IM dosing by 20mg at a time, as this is one “tick mark” on the side of the syringe (for the 200mg/mL concentration) for the patient.

-Copyright 2009 John Crisler, DO

I'm guessing the same applies to SQ.

[Lifted1]

Changes in IM dosing are made in small increments, as response to same is not linear. It is convenient and practical to increase, or decrease IM dosing by 20mg at a time, as this is one “tick mark” on the side of the syringe (for the 200mg/mL concentration) for the patient.

-Copyright 2009 John Crisler, DO

I'm guessing the same applies to SQ.

thats what im seeing also as far as increases go. 20mg is a 20% increase from your current 100mg/wk dose. it sounds like he might suggest more than 20mg if he wanted to start you out with 250mg/wk, but just like your currently doing, you can use what you think is best. gL