Attention all those on Sub-q injections

[Vforcer2]

Marianco,
I am also a Shippen patient and his suggestion is to shoot into the belly fat. For me (unfortunately) that means bending over slightly as I sit in a chair to reveal a large roll of fatty skin to shoot into......and I can't be more than 20 lbs overweight. If you are not overweight you could pinch the skin to create a roll of fatty skin to shoot into in the belly. The alternate site is the upper thigh where there is usually ample fat. I am still experimenting with proper dosing and keeping E2 down but so far my worst E2 level was 60 pg/ml when I had a total T of 1135 ng/dl which was way too high. So once I get my dose right on the Tcyp I think the E2 should be in good shape. My goal total T level (set by Dr Shippen) is about 600 so if you extrapolate my E2 level down it would be about 30 or less since it probably goes down more the linearly.

Phil's post says Shippen likes to keep his own levels at 900, yet he is trying to keep you at a goal of 600? Of course this is second hand info so probably not accurate.

It is my understanding that 650ng/dl is the minimum goal for TRT. I have felt best on pellets when my levels were over 1000. My last blood test on pellets I was 792ng/dl with E2 of 28 with no AI or HCG. I think that HCG is driving your E2 way up which in my mind makes me think the cost outweight the benefits of HCG in some individuals.

 

[Vforcer2]

Here is a cut & paste of how Dr. Shippen does this. I think he shoots into the skin near the side of his body.

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I heard back from the patient of Dr. Shippen. He injects depo-testosterone 200mg/ml, .35 ml every 3 days into abdominal fat. He splits the injections into two .18 ml injections which is .36 ml, and says this is because a tiny amount will leak out of the injection site.

According to this patient, this dosing schedule leaves him with a stable 900 ng/dl total testosterone level and none of the high estrogen conversion associated with large intramuscular injection.

Apparently Shippen is convinced enough that this is now his preferred method of TRT. I know he starts by trying to get levels into the high normal range by trying to get the body to make its own, but if TRT is called for apparently subcutaneous injection is the first thing he prescribes.

Are these injections split into two .18 ml injections because of leakage? I am not clear on this.

 

[farmerjohn]

On the previouos test my total T was 750 and E2 was 35 so I was pretty good then. Not sure why I got up to 1150 on total T because I didn't change my dose. Maybe my testicles are starting to work better like Phils have done with the HCG. Anyway, my point is if I get back to a total T of 600-700 my E2 will probably be fine. But I agree HCG does push up E2 and that can cause problems.

Shippen determines a target total T for each patient individually based on their SHBG level. My SHBG is relatively low so my target is low. He determines what total T you would need to achieve a free T of 160 pg/ml. Lower SHBG means a lower total T level to achieve this. If Shippen is trying to get himself to 900 then it would tell me his SHBG is higher than mine.

 

[pmgamer18]

Phil, you don't know anyone using propionate subq do you? It appears to not be good for this.

No can't say I know anyone.

 

[pmgamer18]

Phil,

Who is the doctor you see?

Mac

I have a good Dr. and he treats a lot of men for low T. But I am his first that is Hypopituitary and we only found this out last yr. when I went on HCG. He now treats my low cortisol and Thyroid levels I have been at it about 8 months now. One good thing is this winter I did not get sick one them with bronchitis and this is a big plus.

I think I have been layed up to long and now out of shape bad. So I am pushing my self to get out and walk. I hope this helps I need to lose some weight also 2 yrs ago I was doing so good I lost over 65 lbs. Now being so dam sick after having bronchitis winter before last all I have been doing is sitting around the house. When my Dr. started me on Cortef my days of bronchitis are gone.

 

[pmgamer18]

Hmm. Have you thought about raising the cortef and or decreasing the armour?

Yes I have and started to add 2 pills of Isocort = 5 mgs of cortisol to my 20mgs of cortef just to use it up I have 3 bottles left over. But it's to soon to tell if it's helping.

 

[pmgamer18]

Are these injections split into two .18 ml injections because of leakage? I am not clear on this.

I can say that when I tryed this it was less of a buring and stinging problem. But dam 2 shots every 3 days hell I do a shot now everyday. Between the T and HCG.

 

[Vforcer2]

On the previouos test my total T was 750 and E2 was 35 so I was pretty good then. Not sure why I got up to 1150 on total T because I didn't change my dose. Maybe my testicles are starting to work better like Phils have done with the HCG. Anyway, my point is if I get back to a total T of 600-700 my E2 will probably be fine. But I agree HCG does push up E2 and that can cause problems.

Shippen determines a target total T for each patient individually based on their SHBG level. My SHBG is relatively low so my target is low. He determines what total T you would need to achieve a free T of 160 pg/ml. Lower SHBG means a lower total T level to achieve this. If Shippen is trying to get himself to 900 then it would tell me his SHBG is higher than mine.

Great info. Any idea what formula he uses to determine this target? Seems like when I had my SHBG checked a couple of years ago it was around 20. I seem to get the most benefits form
T when I am around 900-1000 ng/dl.

 

[pmgamer18]

Great info. Any idea what formula he uses to determine this target? Seems like when I had my SHBG checked a couple of years ago it was around 20. I seem to get the most benefits form
T when I am around 900-1000 ng/dl.

Dr. John says the lower your SHBG the lower you need to keep your E2. I was keeping it at 20 to 25 now I keep it at 15 to 20 and this is woking better.

 

[farmerjohn]

He has a graph he uses called a nomogram I think. Anyway, for SHBG of 20 your target total T would be about 600 to achieve free T of 160 pg/ml. At 900 total T your free T would be about 260 pg/ml. Shippen uses 160 pg/ml as an initial target but says you can go up to 250 if necessary. You are right around the max of the range he told me is normal. Also, the free T is an estimate and your actual free T could be different but from what I have seen the estimate is pretty damn close to the actual value for most people.

Phil what is your SHBG. MIne is 17 I think, just wondering what E2 level I should be shooting for.

 

[magic8989]

Yes I have and started to add 2 pills of Isocort = 5 mgs of cortisol to my 20mgs of cortef just to use it up I have 3 bottles left over. But it's to soon to tell if it's helping

Ok, well i hope it works out for you. I like your idea of using the isocort instead of the cortef because you are going over that 20mg mark that is suppose to cause suppression.

 

[JanSz]

Marianco,
I am also a Shippen patient and his suggestion is to shoot into the belly fat. For me (unfortunately) that means bending over slightly as I sit in a chair to reveal a large roll of fatty skin to shoot into......and I can't be more than 20 lbs overweight. If you are not overweight you could pinch the skin to create a roll of fatty skin to shoot into in the belly. The alternate site is the upper thigh where there is usually ample fat. I am still experimenting with proper dosing and keeping E2 down but so far my worst E2 level was 60 pg/ml when I had a total T of 1135 ng/dl which was way too high. So once I get my dose right on the Tcyp I think the E2 should be in good shape. My goal total T level (set by Dr Shippen) is about 600 so if you extrapolate my E2 level down it would be about 30 or less since it probably goes down more the linearly.

I thought that Shippen's priority was FreeT (or was it BioAvailableT), rather than TotalT ???

 

[farmerjohn]

His goal is free T but he arrives at what total T you would need to get to his goal of 160 pg/ml of free T using the nomogram he has. Then he just tests for total T and E2 routinely. I don't know why he doesnt just test for free T but there must be a reason. Maybe because the tests vary from lab to lab. I know Phils free T number is totally different from mine. It must be a different type of test, it has different ranges completely.

 

[pmgamer18]

I have a copy of this Nomogram and going by it with my SHBG at 22 and it saying my Total T should be 600. I don't buy this I can't live on 600 for Total T. I keep hearing this stuff about lower T levels will keep E2 down and Yes it does but I feel like crap at them low levels. Much worse then High E2.

On my last test we cut back on my HCG and my tests come in at Total T 636 range 181 to 758 ng/dl now this new level my lab come out with is for a man over 59 yrs. old. Yet LEF says to keep your T levels up into the upper 1/3 of your labs range for a young man so this range is 262 to 1593 so by how I feel at this 636 range I think LEF is more on the mark then Shippen. My Free T was 18.9 range 5.6 to 19 pg/ml also for a man over 59 yrs. of age. The range for a young man is 8.8 to 27 and I feel much better at 25. Doing the math my CFT is 171 pg/ml just a little over the 160 shippen uses. I see no use in using his Nomogram.

When my levels are up were I feel better my CFT is 291 pg/ml and this is just over the top of what Shippen calls the top number.

I feel labs today do a much better job with Free T then doing this CFT from the Nomogram. I just wish I could show the Nomogram here but I am not setup with my equp. yet to do this. Maybe some one can find it on the web doing a search. It's from "Androgen Deficiency in the Adult Male", Taylor & Francis 2004 with permission from the author, Dr. Malcolm Carruthers.
J Clin Endocrinol Metab 1999,84"3666-72

I just don't feel we are all the same that we can use something like this and say you need to be at this level.

 

[farmerjohn]

Phil,
I think you are right, we are all diff. That is why Shippen's range for free T is from 100 to 250 pg/ml and I bet your free T is close to the 250 pg/ml when you feel good. I think he is very aware that diff. people need diff. treatments and he accomodates that based on how you feel. The 160 pg/ml for free T is just a starting point he tries to get you to and then based on how you feel he goes from there. Why he tests for total T instead of free T I don't know. I'll have to ask him next time I see him.

 

[pmgamer18]

Phil,
I think you are right, we are all diff. That is why Shippen's range for free T is from 100 to 250 pg/ml and I bet your free T is close to the 250 pg/ml when you feel good. I think he is very aware that diff. people need diff. treatments and he accomodates that based on how you feel. The 160 pg/ml for free T is just a starting point he tries to get you to and then based on how you feel he goes from there. Why he tests for total T instead of free T I don't know. I'll have to ask him next time I see him.

Don't get me wrong it's just guys read this stuff and go off half cocked and end up sicker. Take Shippens book and his T to E2 ratio I have not seen this work for me or anyone for that matter. Guys read his book and mess around trying to get to this ratio and end up sicker. We just can't put a number on TRT. I will be set up to scan soon and will scan this on this site.

 

[farmerjohn]

I agree with you and I bet Shippen does too that we can't just put a number on every person. If I made it sound like that I didn't mean to. He has a starting point and then goes from there. Thats why just reading his book is not any where near like being treated by him. To be honest he is the best doc I have ever had at listening to how you feel and adjusting your treatment based on that. My previous doc said "well, my job is to get your T above 300....after that if it doesnt work you need to find someone else". And that is an exact quote.

I have the nanogram too but have no way to post it and not sure if it has a copyright or what either.

 

[smitty4]

Did I read somewhere that Dr. Shippen suggested using a small amount of cream on the scrotum to raise DHT levels? I could have sworn I saw that in a thread someplace, but I cannot find it for the life of me.

 

[Vforcer2]

Those of that have been on TRT for years and have actually been in the "sweet spot" with our protocol and levels know that we really can't trust a number or a chart. For me that "sweek spot" it has been a pellet protocol with Total T levels at about 900-1000+ and free T at and over the top of the range.

My T Cyp will be in today from Solutions Pharmacy so I will give the subq a try and see if I can achieve the same desirable benefits that I have had with pellets. In theory they should be similar since the whole idea is to use a slow acting ester to prevent a spike that causes E2 and DHT to get out of control, and then inject again just as the levels start to turn down into a valley, except that this method would allow more consistant levels all the time. Pellets peak very at the end of the first 30 days and then decline slowly thereafter.

It is worth a try at $42 for 10ml of 200mg/ml with 3 refills. This should last me about 4 months or so per vial. So at my current prescription with refills I have about a years supply.

If I am to inject 50mg of T every 3 days that would be .25 ml of T, correct? Double check my math.

 

[smitty4]

Those of that have been on TRT for years and have actually been in the "sweet spot" with our protocol and levels know that we really can't trust a number or a chart. For me that "sweek spot" it has been a pellet protocol with Total T levels at about 900-1000+ and free T at and over the top of the range.

My T Cyp will be in today from Solutions Pharmacy so I will give the subq a try and see if I can achieve the same desirable benefits that I have had with pellets. In theory they should be similar since the whole idea is to use a slow acting ester to prevent a spike that causes E2 and DHT to get out of control, and then inject again just as the levels start to turn down into a valley, except that this method would allow more consistant levels all the time. Pellets peak very at the end of the first 30 days and then decline slowly thereafter.

It is worth a try at $42 for 10ml of 200mg/ml with 3 refills. This should last me about 4 months or so per vial. So at my current prescription with refills I have about a years supply.

If I am to inject 50mg of T every 3 days that would be .25 ml of T, correct? Double check my math.

Your math looks correct to me. Hope it turns out well for you.