As my research has moved from understanding hypogonadism to treating it I am coming away with some impressions that seem to fly in the face of many of you on TRT. Heres my understanding.
Pellets: These seem like an okay option for some people but not really for initial treatment. There are too many variables to figure out in using pellets so it seems they are more suited for people that are successful on other forms of TRT that want the overall convenience of pellets. Also, E2 seems to not be as much of a problem with pellets. I do recognize how Swale feels about them but I just havent read much from anyone else that are critical of their use so I have to include them as being viable options for some people in some situations. I just dont think its good as an initial therapy for many of the reasons Swale mentions.
Patches: These are the best at mimicking the normal diurnal pattern of Testosterone production. Unfortunately, from what Ive read many people never are able to get high enough T with this system. Additionally, from what Ive read, as many as 2/3 of people using this system have to give it up due to skin irritation and rash. This doesnt seem like a good option for initial treatment due to the limited Testosterone replacement they seem to achieve and the low tolerance statistics.
IM Injections: These are by far the cheapest treatment but with that said Ive also read a lot about the problem this delivery system has with E2 conversion. I know that weekly injections are the only way to go with injects but even with that Ive read a lot about some people that have high E2 even with weekly injects. Many people then have to go on some sort of aromatase inhibitor (DIM) to deal with the E2 conversion problem. Aside from that many people have a hard time injecting themselves but Im sure that can be overcome. Also it takes around a month and a half before T levels stabilize and treatment adjustments can be made. So is this the best initial therapy?
Gels: Gels seem to have a good reputation. Although they are very expensive they also have good statistics as to the effectiveness of their use. Gels seem a little messy to apply but that doesnt seem like its that big of a deal. They seem to have good absorption characteristics and they seem to achieve adequate T levels in the upper half of normal with seemingly more limited problems with E2 from what Ive read (although E2 can be a problem with any form of treatment depending on the patient.) Also, Gels seem to steady T levels in about two weeks which is always good for people just coming onto T therapy.
So from what I can tell Gels are the best choice because of their effectiveness at raising T levels, ease of application, lower chance of E2 conversion problems and shorter time to achieve steady T levels. I know some dont like them because theyre messy but from what Ive read if you apply the Gel right after getting out of the shower and on wet skin, they have 20 to 40% better absorption and would solve the messy problem as everyones messy (wet) coming out of the shower.
Given that if Gels dont work doesnt seem like patches would have a chance of succeeding so I think patches actually dont make any sense after a failure of gels.
I dont think Pellets have any place in initial therapy setting and thus arent an option for me right now.
IM Injections seem to be the second best choice. I like the idea of only taking T every week but with all the variables dealing with E2 conversion and possibly adding hCG into the mix seems like its more complicated to get right.
So it seems to me that Swales recommendation to use Gels first and then IM and skip the rest of them is good advice. I just wonder how many of you believe that IM is a better first choice for treatement?
Pellets: These seem like an okay option for some people but not really for initial treatment. There are too many variables to figure out in using pellets so it seems they are more suited for people that are successful on other forms of TRT that want the overall convenience of pellets. Also, E2 seems to not be as much of a problem with pellets. I do recognize how Swale feels about them but I just havent read much from anyone else that are critical of their use so I have to include them as being viable options for some people in some situations. I just dont think its good as an initial therapy for many of the reasons Swale mentions.
Patches: These are the best at mimicking the normal diurnal pattern of Testosterone production. Unfortunately, from what Ive read many people never are able to get high enough T with this system. Additionally, from what Ive read, as many as 2/3 of people using this system have to give it up due to skin irritation and rash. This doesnt seem like a good option for initial treatment due to the limited Testosterone replacement they seem to achieve and the low tolerance statistics.
IM Injections: These are by far the cheapest treatment but with that said Ive also read a lot about the problem this delivery system has with E2 conversion. I know that weekly injections are the only way to go with injects but even with that Ive read a lot about some people that have high E2 even with weekly injects. Many people then have to go on some sort of aromatase inhibitor (DIM) to deal with the E2 conversion problem. Aside from that many people have a hard time injecting themselves but Im sure that can be overcome. Also it takes around a month and a half before T levels stabilize and treatment adjustments can be made. So is this the best initial therapy?
Gels: Gels seem to have a good reputation. Although they are very expensive they also have good statistics as to the effectiveness of their use. Gels seem a little messy to apply but that doesnt seem like its that big of a deal. They seem to have good absorption characteristics and they seem to achieve adequate T levels in the upper half of normal with seemingly more limited problems with E2 from what Ive read (although E2 can be a problem with any form of treatment depending on the patient.) Also, Gels seem to steady T levels in about two weeks which is always good for people just coming onto T therapy.
So from what I can tell Gels are the best choice because of their effectiveness at raising T levels, ease of application, lower chance of E2 conversion problems and shorter time to achieve steady T levels. I know some dont like them because theyre messy but from what Ive read if you apply the Gel right after getting out of the shower and on wet skin, they have 20 to 40% better absorption and would solve the messy problem as everyones messy (wet) coming out of the shower.
Given that if Gels dont work doesnt seem like patches would have a chance of succeeding so I think patches actually dont make any sense after a failure of gels.
I dont think Pellets have any place in initial therapy setting and thus arent an option for me right now.
IM Injections seem to be the second best choice. I like the idea of only taking T every week but with all the variables dealing with E2 conversion and possibly adding hCG into the mix seems like its more complicated to get right.
So it seems to me that Swales recommendation to use Gels first and then IM and skip the rest of them is good advice. I just wonder how many of you believe that IM is a better first choice for treatement?
