Best practices in Starting TRT

[Chrisp83TRT]

Pro tip: Make sure you remember to switch the needle you draw with to the injection needle. I draw with an 18G and one day was in la-la land forgot to switch. Screamed bloody murder.

Holy flaming tits... that sounds awful man.

[Chrisp83TRT]

Self prescribed. I wanted to do a 12 week 400 mg per week cycle but when my cycle got cut short with high bp I am just looking for a way to finish out the cycle with a lower dose to keep getting some gains and keep my bp in check. I will only run it for 6 to 7 weeks or so just to finish up my original 12 week cycle.

I read and heard hawthorn supps helps reduce BP. Also cialis also lowers Bp.

[Windex]

That 18 GA to draw , is that disposed of every draw ?

Yup. One 18G needle per draw, one 25G needle per injection.

[*Admin*]

STUCK! Great thread thanks!

[ThisIsMyJamZ]

Bookmarked! Great thread. I'd probably also recommend this post for additional info, particularly re: some of the questions in this thread around age and safety etc. Just my $0.2c!

[Youthful55guy]

I'm glad so many people are fining this information useful!

For the newbies, a couple of general pieces of advice:

1) Be very cautious and questioning of ANYTHING you read on the internet, or even in this forum, regarding TRT. There is so much misinformation of there. As I tried to lay out in the original post, TRT is not all that complicated and people who try to make it complicated (or want to sell you something) generally have ulterior motives.

2) Understand and question the perspective of the person giving you advice. There are a lot of guys out there giving advice on TRT that is really anabolic steroid use . It's more appropriately called "Blast and Cruse". Where they alternate high doses of T with more normal TRT doses. THIS IS NOT TRT! The goal of a good TRT program is to maintain stable levels of T at all times and to keep you within normal physiological levels for T at all times. It needs to be sustainable for a lifetime.

3) Ask questions of the people giving you advice, understand their perspective, and be sure that their goals are compatible with yours.

Good luck!

[Wyatt 88]

Just wanted to add on some information from a Canadian perspective even though there aren't many of us here and the ones that are here hide in the igloos.

Depending on location, you can either get needles/syringes for dirt cheap ($12 box of 100) from the hospital or free from the health unit. Online is a great option as well.

Like the US, we have Test E / Cyp. The price seems to be exact same regardless of the pharmacy you go to (Walmart, Shoppers, Grocery Store, etc) so pick whatever your usual or closest is.

I didn't see the original post talk about needle length but I may be blind. I use 1.5" but 1" is also a great option.

As far as $$$ goes, expect to pay approx $45-50 for a 10ml 200mg/ml vial assuming no medical insurance.

Thanks for the tip!!!

They gave me a box of 200 syringes, 300 18g × 1.5" needles, 300 22g 1" needles, 600 alcohol pads, and a sharps container LOL!!!

Not exactly what I was looking for but I can make it work.
I was expecting a handful of needles LOL!

The strange thing is I can't find 28g 1" needle's anywhere around here. I've even tried to have Shoppers order them

[Ephemeral]

Youthful55guy, can I ask why you prefer to inject into the middle area (rectus femoris)? It's always painful for me to inject there, but when I use the outer region (vastus lateralis) I usually have zero pain.

Also, here they recommend to use the inner and outer heads as well (it's not for TRT though, with larger needles):

https://www.steroid.com/Steroid-Inje...nformation.php

[almostgone]

I'm glad so many people are fining this information useful!

Well, I totally dropped the ball on this one. I am usually fairly attentive to detail.

Really, really nice done, Y55G!

[Youthful55guy]

Youthful55guy, can I ask why you prefer to inject into the middle area (rectus femoris)? It's always painful for me to inject there, but when I use the outer region (vastus lateralis) I usually have zero pain.

Also, here they recommend to use the inner and outer heads as well (it's not for TRT though, with larger needles):

https://www.steroid.com/Steroid-Inje...nformation.php

Mostly because this is where my hormone doctor who is well respected in this area instructed me to inject. It have few nerve endings and no major blood vessels. I don't feel any discomfort at all, so I don't try to fix what isn't broken. Well, actually, I did try SC once again over a two week period. Big mistake. My stomach looks like someone punched me in the gut. For whatever reason I bruise easily with SC. We're all different I guess!

[Windex]

Just to add on...

While having a TRT Protocol dialed in if you start at higher dose and determine a lower dose would be more beneficial, I would have a conservation with the doctor saying to keep the prescription the same but independently adjust the dose. My first endo wrote a new script every time my dose changed whereas the endo I have now has my prescription set up as 200 mg/week with an arbitrarily high number of refills. My protocol is only 150mg/wk split into 2 injections. The benefit to this is I get to "bank" 50mg of Test per week, which over a year is 2600mg. The vials are 5mL, 200mg/mL netting a total of 3 extra vials for the year. This accomplishes a few things

- No need to panic if I drop and smash a vial as it's essentially an extra (Happened once before)

- If I travel out of the country and for one reason or another I don't get my vial on the way back to the motherland it's an extra

- Extra reserve for any unforeseen circumstances (backorder of product, natural disasters [my pharmacy flooded once and got shutdown for awhile, they had to transfer everyone to another Pharmacy on the other side of town which was a process in itself], financial problems, etc

- Technically every 12 months I would have accumulated enough "extra" test for a "Free" 12 week cycle of 400mg/wk Test if I intend to blast at that dose.

[Youthful55guy]

Hey guys, please note that I edited the original post to include some graphs from that cool site that someone posted a link to. Here's the link in case you are interested in playing with the graphs yourself: http://steroidcalc.com/.

The site is oriented toward anabolic steroid use , but I have found it to be extremely useful in understanding hormone levels for medically necessary TRT.

[searay50]

I'm glad so many people are fining this information useful!

For the newbies, a couple of general pieces of advice:

1) Be very cautious and questioning of ANYTHING you read on the internet, or even in this forum, regarding TRT. There is so much misinformation of there. As I tried to lay out in the original post, TRT is not all that complicated and people who try to make it complicated (or want to sell you something) generally have ulterior motives.

2) Understand and question the perspective of the person giving you advice. There are a lot of guys out there giving advice on TRT that is really anabolic steroid use . It's more appropriately called "Blast and Cruse". Where they alternate high doses of T with more normal TRT doses. THIS IS NOT TRT! The goal of a good TRT program is to maintain stable levels of T at all times and to keep you within normal physiological levels for T at all times. It needs to be sustainable for a lifetime.

3) Ask questions of the people giving you advice, understand their perspective, and be sure that their goals are compatible with yours.

Good luck!

now that my doc has changed me to the e3d protocol, when should I do my HCG ? Should I break that up over multiple weekly doses as well? I don't know the conversion, but I fill my insulin vial to 50. Old protocol once a week, 3 days after my once a week cyp injection. I would presume that I should break the hcg up as well? Thanks for your help.

[Windex]

now that my doc has changed me to the e3d protocol, when should I do my HCG? Should I break that up over multiple weekly doses as well? I don't know the conversion, but I fill my insulin vial to 50. Old protocol once a week, 3 days after my once a week cyp injection. I would presume that I should break the hcg up as well? Thanks for your help.

You can pin HCG any time it doesn't matter. Most people just do it the same 2 days as their Test to make it consistent and simple.

[searay50]

You can pin HCG any time it doesn't matter. Most people just do it the same 2 days as their Test to make it consistent and simple.

thank you!

[searay50]

I really want to stress the benefits of e3d the OP talked about. I was having pretty bad parathesia when pinning once a week, IM in the glutes. After clearing it with my TRT doc, I have switched to e3d with an insulin syringe into my quad. What a difference it has made. I am now looking on Amazon to buy my insulin syringes b/c my clinic isn't very excited about giving me enough insulin syringes to keep up this protocol. Not sure why b/c they are inexpensive on Amazon. The one thing I am having issues finding, is the 1 inch needle. I can find 5/8's all day but not 1 inch. I really want to find 1 inch so I can ensure I get it IM in my quads. I have very little fat on my quads. Maybe 5/8's is okay?

[kelkel]

With the small amounts used for TRT it does not have to be one inch deep or IM. It really doesn't matter if it's a combination of both.

https://www.gpzmedlab.com/

[Chrisp83TRT]

5/8 or 1/2 inch are just fine for TRT ...

From experience only 5/8 and higher if doing more liquid as it can build up under the skin and can lead to not fun stuff ... I’m speaking on experience Hah.

If you are lean .... you can get away with 1/2 inch all over the body and the greatest part about it ... it’s basically painless.


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[JaneDoe]

This post is for both the Newbies who want a basic understanding of a “good” protocol to formulate questions for their perspective docs or TRT clinics. Guys with experience in TRT might also find this helpful to consider if they should modify their current protocol.

My general philosophy for TRT is that you want to make it simple and sustainable. You want to strive for consistency and minimize side-effects. I’ve been on my basic protocol for about 6+ years and have only made minor adjustments. It was prescribed to me by one of leading authorities in TRT. It’s simple and it works.

Type of Testosterone

• I only have experience with Testosterone Cypionate (T-cyp), and that’s what I recommend. Mine is blended with a small amount of Testosterone Propionate (T-prop), but I doubt that makes much of a difference.
• From what I’ve read, Testosterone enanthate (T-eth) has the pretty much the same absorption kinetics as T-cyp and can be used interchangeably.
• I do not have experience with gels or creams, but from what I’ve read they are messy and absorption is variable. Also, it’s just too difficult to absorb enough to help you if you have high SHBG.
• I’ve never used pellets or scrotal patches, but pellets sound like a pain in the rear (literally) and the scrotal patch belongs in a medieval torture chamber (I think a woman had to have invented it).

Dosing

• Small frequent dosing is the key to success. This keeps you within the desired range at all times. What folks (and many docs) just don’t get is that the more frequent you dose, the lower you can go on the overall dose, and the better you’ll feel because you eliminate that hormonal rollercoaster to hell.
• I suggest starting at a total of 100 mg/week divided into at least 2 injections (e.g. 50 mg twice per week). However, I find that Every 3 Day (E3D) dosing is much easier to administer, gives more constant hormone levels, and makes lab testing easier because you don’t have to pick a specific day to test (e.g., the 3-day or the 4-day interval). I recommend starting at 45 mg E3D.
  
• After 6 weeks, you should retest for a minimum of Total T, Free T, and E. Use the results of these tests to determine if you need a dose adjustment and/or need an AI.
• Most guys do not need to go over 120 mg per week if you use small frequent dosing.

Here's some comparison graphs of the amount of testosterone released from T-cyp per day using various protocols. Keep in mind, that the average adult male secretes about 7 mg of T per day. I'm guessing too that there is at least 30% variability about that (but I don't have a reference), so the range is probably around 5 to 9 mg per day. For argument's sake, let's say we naturally top out at around 10 mg per day, which not so coincidentally is where I begin to feel my best.

Here is a graph of my prescribed dose at 0.2 mL E3D of 200 mg/mL T-cyp = 40mg T-cyp E3D = 93mg T-cyp/week. Keep in mind too that T-cyp is only about 68% T. The rest is the cypionate ester. As you can see by the graph, this protocol delivers an average of about 9 mg T per day after stabilizing at about 6 weeks (Range 7.9 - 11.2 mg/day)
Attachment 174010

Compare this with an old but still used protocol of 100 mg/week in a single injection. This protocol delivers an average of about 10 mg T per day after stabilizing at about 6 weeks (Range 6.2 - 15.4 mg/day). Note that it is much more variable in both the peak and nadir T levels.
Attachment 174011

Now Compare this with the really archaic protocol of 200 mg/2 weeks sometimes still prescribed by dinosaur docs. Again, this protocol delivers an average of about 10 mg T per day after stabilizing at about 6 weeks (Range 3.4 - 22.3 mg/day). Note that it is much more variable in both the peak and nadir T levels. With this protocol too you spend significant amounts of time in both the superphysiological range (which define as over 15 mg/day) and in the suboptimal range (which I define as less than 5 mg).
Attachment 174012

How to Inject

• The great thing about small frequent dosing is that you don’t need a harpoon to get it into you. I recommend that you only use on-piece insulin syringes to draw up and inject. There’s no need to go bigger than a 25G needle. I MUCH prefer and recommend a smaller 28G needle.
• I recommend injection straight (no angling) into the upper middle quadriceps muscle (see diagram below). If you’re using small doses with an insulin syringe, there’s no need to aspirate. Chances of hitting a vein are remote to slim in the recommended quadriceps location using a short insulin needle.
• Some guys like to inject into the deltoids and/or rotate between 4 locations with the left/right quadriceps and left/right deltoids. I've tried deltoid injections with no problems, but I have a preference for the quadriceps, mostly because I live in a warm climate and wear shorts nearly year round, so they are easy for me to access. However, I do like to wear sweaters and long sleeve shirts in the winter, which requires some disrobing to access the deltoids. Again, it's just a personal preference.
• I do not recommend subcutaneous injections, though some have had success with this technique. I always seem to bruise and/or get lumps. Perhaps that's because my T has some T-prop in it. I've not tried it with pure cypionate ester. I've searched the medical literature and there's not a lot published on subcutaneous injections, but what is published (mostly using transgender subjects) is favorable both for maintaining stable hormone levels and for patient preference. The problem I have with these studies is that they use larger volume weekly injection, which I don't recommend. Here's one study that used hypogonadal men and showed they were able to achieve stable hormone levels with subcutaneous injections, but they don't discuss dosage or frequency of administration in the abstract (full paper unavailable): https://www.ncbi.nlm.nih.gov/pubmed/17143361. Here's an excellent video made by Dr. John Crisler that discusses the benefits of subcutaneous injections and demonstrates the technique: https://www.youtube.com/watch?v=UH1yTqt1sK8.

Attachment 172723

Use of HCG

• I highly recommend that you do incorporate HCG into your protocol. It replaces the lost LH/FSH signal and that is important for several reasons.
  1) It helps to maintain normal testicular size. Yes, it’s a cosmetic benefit, but what guy want’s almond size testicles?
  2) For younger guys it helps maintain testicular function and preserve fertility.
  3) For all guys, it’s important for synthesis of intermediary steroid hormones (like DHEA and Pregnenolone), which have various health-promoting functions in the body.
  4) For all guys, it helps to maintain normal ejaculate volume. There’s good histological evidence that the seminal vesicles, which produce about 60% of the ejaculate, need both T and LH to function properly. HCG substitutes for the lost LH while on TRT.
• I recommend a dose of about 450 IU per week divided into at least 3 doses (e.g., 150 IU M, W, & F). Alternatively inject on an E3D protocol.
• If you desire to conceive a child while on TRT, consider increasing your HCG dose to 1000 IU per week. Here are two peer reviewed papers that support the use of 1000 IU of HCG per week to help maintain fertility while on TRT: https://www.ncbi.nlm.nih.gov/pubmed/15713727 and https://www.ncbi.nlm.nih.gov/pubmed/...t%3A+an+update. Both are available with free full text. The first one is particularly interesting. You have to do a little digging and interpreting the data to fully understand the implications. When I plot out the recovery to baseline Intratesticular Testosterone (ITT) levels in the groups receiving various doses of HCG (see graph below), I see that it crosses 0% suppression at a dose of about 1000 IU per week. That is in healthy adult male subjects receiving a whopping 200 mg T-eth per week, approximately 1000 IU of HCG was able to fully restore ITT levels (a known marker of fertility).
  Attachment 172740
• Even if fertility is not your goal, I do believe there are benefits to 1000 IU per week, but HCG is the most expensive part of your protocol and you can certainly get by with a lower dose.

Use of an Aromatase Inhibitor (AI) or Estrogen blocker

• If you stick to the recommended protocol of small frequent dosing, you should not need an AI or E blocker.
• NEVER start an AI unless you have the correct labs to show you are high in E. It’s a simple fact that in the human body, E is made from T. If you keep T within normal physiological ranges at all times, E should also remain within normal physiological range.
• GUYS NEED E TOO. Without it our dicks go limp with a bad case of ED. We also need it for normal libido and for growth hormone secretion. I’ve seen way too many guys crush their E with an aromatase inhibitor (AI) like Arimidex (anastrozole) and then wonder why TRT is not working for them.
• Guys get nipple erections too! Most guys who have low T also have low E and have forgotten what it’s like to have nipple erections when stimulated. When their T suddenly comes back into range and their E climbs back to normal, they start getting normal nipple erections and immediately think they are coming down with gynecomastia.
• If you have labs to support you need an AI, I strongly suggest you try the ‘Vodka/Eye Dropper’ method I previously posted. It’s the only way I’ve found to dependably dose small amount of anastrozole. Here’s a link to the method: https://forums.steroid.com/hormone-r...astrozole.html

The minimum Pre-TRT Labs you should have done

• If your doc won’t order them, get them done yourself. Here’s a source that I regularly use to supplement my doc’s once per year testing. https://www.discountedlabs.com/
• Minimum labs for screening for low T: Total T and Free T.
• Minimum follow up labs if either or both Total T or Free T (the more important) are low: SHBG, LH/FSH (first thing in the morning!), PSA, Estradiol (sensitive LC/MS/MS method), Lipids, CMP, CBC.
• Consider also: Prolactin, DHT, TSH, Free T3, Free T4

Follow Up Labs

• You should never do a dose adjustment or add in an AI without labs to support that you need it.
• I suggest you follow up at least twice per year with the minimum follow up labs discussed above.

Thank you for sharing your knowledge.

[Madcox]

Fantastic thread! My doc has me on 500mg every 3 weeks for my TRT so I'm definitely going to be switching that to 167mg per week split into 84mg (0.42ml) every 3.5 days... I will have to try the HCG later and see how that goes... Thank You Y55 and others for the great info!

[IronClydes]

Yes, you can ask, but I have to qualify the answer.

I started TRT because my free T was abysmal (7.1 pg/mL) due to high SHBG (67.5 nmol/L). My total was excellent (618 ng/dL), which made it look like I did not have a low T issues. SHBG is a two-edge sword. It binds T and keeps it from liver metabolism (good), but bound T does not pass through the blood-brain barrier, only Free T can do that. So the net effect is that SHBG pushes your Total T up while at the same time starving your brain of this vital hormone.

I initially went to a low T clinic after being turned down by several docs. They all wanted to put me on antidepressants. The Low T clinic, to their credit, recognized the problem but they had a one-size fits all stretcho weekly interval protocol that did not work well for me. After 4 months, I decided to spring for the high end male hormone specialist that cost an arm and a leg and did not take insurance. He put me on a protocol of essentially 40 mg T-cyp (it had a small amount of T-prop blended in) E3D. his goal was to saturate the SHBG protein so that enough T spilled over into Free T. This drove my Total T way up into the 1000 to 1600 ng/dL (remember SHBG bound T is protected from metabolism) and my Free T came up to a respectable 13-16 pg/mL range. Not ideal, but I felt normal again. This went on for several years.

The problem with this protocol is that SHBG bound T is still somewhat active in the peripheral blood. Due to the very high Total T, I was beginning to have difficulty controlling hemoglobin, even with the maximum allowable blood donations. That's when I decided to go off the reservation and treat my high SHBG with very low doses of a synthetic anabolic called Winstrol (Stanozolol ). I found some research to show that it was effective in suppressing SHBG production. My experience corroborated this research. I started at 15 mg per day, dropped it to 10 mg, and then again to 5 mg (2.5 mg PM & PM). My labs show this extremely low dose (bodybuilders typically take 40 to 100 mg by comparison) very effective in keeping my SHBG around 30 (normal being 19-76).

The net effect of dropping my SHBG was to lower my Total T to the 800-900 range with no dose reduction (more got metabolized) but raised my Free T to the 20-30 range. My current goal is to keep SHBG where it is with 5 mg/day Winstrol and refine my T dose to about get Free T in the 21-22 pg/mL (upper 75th percentile for a 25-35 year old male). I'll talk more about controlling SHBG in a future thread.

Complicating things just a bit is that I'm also slowly (very slowly) bringing my Armour Thyroid dose down. I read a couple of good peer-reviewed publications that indicate that thyroid supplementation can increase SHBG.

So, long answer to your short question is that I currently take roughly the equivalent of 45 mg T-cyp (you have to take into account that mg for mg, T-prop carries a bigger T payload than T-cyp) every 3 days and 2.5 mg instrol (Stanozolol) twice daily.

Very interested in learning some more about using your protocol to control SHBG as I have a consistently high hematocrit that requires donating more frequently than is possible. This obviously creates complications with my doctor always trying to drop my prescribed dosage as a result. Could you provide more specific information with how I would look to incorporate the Stan (dosage with EOD injections)? I currently pin about 50 test cyp eod, and am returning to an old protocol of supplementing it with 30 deca eod to alleviate joint issues, ongoing when on TRT or cycle.

Thanks in advance!


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[GreekCY]

Hey all,

just a 55y old newbie from Greece here wanting to start TRT. I have been a lot in these forums and got my knowledge up and running thanks to all of you. I still have some questions though:

for how long could someone do TRT? Are there any recommended cycles or is it perpetual, i.e. once you start you never stop?

I currently live in Germany and there is the possibility to get the 3 month injection covered by the health insurance but as I have read ion these forums it is not exactly the best or have I got it wrong?

Is it recommendable along with T-CYP and hCG to use something that accelerates fat burning? If yes which substance?

I am currently slightly overweight with 22% fat. I started a healthy diet again but is it recommendable to go on TRT to among other things help loose weight? Or is is better to start a beginner's cycle in AS? I am training for years and have more than a good basis but muscular development low fat % are still needy.

Thank you in advance for all you answers.

[Pbhill]

Great stuff here! I really appreciate all the info. What level estrogen would constitute using an AI. I’m currently on 140mg T, but the last time I had blood work done a few weeks ago, my E was around 30. I’m currently taking .75mg of AI from the TRT clinic. Is this acceptable, or should I back off the AI?

[Pbhill]

And cialis is also great for a pre workout. I’ve been getting the 5mg from my TRT clinic and they work like a charm

[SweetChicken]

Is IM or subcutaneous injections more effective for hcg ? Why?

How much would you suggest taking if you nuts were already shrunk from not using it? 250x2/wk then drop to 100x2/wk?