Injecting testosterone subcutaneously

Discussion in 'Men's Health Forum' started by frankwhardy, Sep 29, 2005.

  1. rlhall12

    rlhall12 Member

    Im in the medical field. SQ essentially becomes IM if you have low body fat and push slightly. If your in the muscle...your IM (intra-muscular).If you have fluff there may be concern. So its not an argument of SQ vs IM. Its about if you can get an insulin into the muscle. There are advantages to the insulin. It is less painful. You can dose more freq due to less irritation/pain/pip...thus keeping levels more even. You can get more accurate dossing. Bottom line in all this game...labs dont lie. Ive done a lot of this stuff and I know what it feels like when the stuff hits and is working. I can get the insulin in into muscle. And its the same but I have the advantages listed above. More freq injections=less aromatization as well. Plus my labs are same with either...so why torture myself with a big ass needle? Not trying to be a know it all...but I do this for a living bros.
     
    roastdawg likes this.
  2. Blazerone

    Blazerone Member

    Its the latest and greatest TRT protocol. I tried sq while I was doing test c & e and my T labs actually increase some and I had less ups and downs. But since I've switched to daily injections of propionate I've went back to IM. Definitely can't do prop sq.
     
    Last edited: Aug 5, 2013
  3. cvictorg

    cvictorg Member

    http://ipac.kacst.edu.sa/eDoc/2006/161440_1.pdf
    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 replacement 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 December 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.

    Evaluation of the efficacy of subcutaneous administration of testosterone in female to male transexuals and hypogonadal males -- Olshan et al. 34 (3): MON-594 -- Endocrine Reviews

    The initial 7 patients (5 FTM and 2 hypogonadal males) ranged in age from 18-58 (mean 28.2 ± 5.9SE). T enanthate or cypionate was administered at a dose of 50-60 mg sc once weekly using 5/8" 23g or 25g needles. Serum total T concentrations were measured by tandem mass spectrometry. T levels were well within the therapeutic range varying from 320-824 ng/dL (mean 608± 82SE).
     
  4. Michael Scally MD

    Michael Scally MD Doctor of Medicine

  5. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Antares Pharma Announces Positive Top-Line Pharmacokinetic Results From The Quickshot® [Subcutaneous Injection] Phase 3 Study In testosterone Deficient Men
    http://www.sec.gov/Archives/edgar/data/1016169/000119312515061057/d880836dex991.htm

    Antares Pharma, Inc. (NASDAQ: ATRS) today announced positive top-line pharmacokinetic results that showed that the primary endpoint was achieved in the Company’s ongoing, multi-center, phase 3 clinical study (QST-13-003) evaluating the efficacy and safety of testosterone enanthate administered once-weekly by subcutaneous injection using the QuickShot® auto injector in testosterone deficient adult males.

    In the study, 150 adult males with hypogonadism (low testosterone) and testosterone blood levels less than 300 ng/dL received a starting dose of 75 mg of subcutaneously administered testosterone enanthate (QuickShot® Testosterone, or QS T) once weekly for six weeks.

    Blinded adjustments to dose were made when necessary at week seven based upon the week six pre-dose blood level, and full pharmacokinetic (PK) profiles were obtained during the 12th week of treatment.

    The protocol for the study required that at the week 12 endpoint:
    (i) at least 75% of all patients’ Cavg are within the normal range of 300 to 1100 ng/dL, with a lower limit of a 95% 2-sided confidence interval of greater than or equal to 65%,
    (ii) at least 85% of patients’ Cmax are less than1500 ng/dL and
    (iii) no more than 5% of patients had a Cmax greater than 1800 ng/dL.

    The primary endpoint of the population that received one or more doses of QS T was met by 139 out of 150 patients, equating to 92.7% with a 95% confidence interval of 87.3% to 96.3%. Among the 137 patients that completed all 12 weeks of dosing and PK sampling, 98.5% were within the pre-defined range.
     
  6. foreveryoung

    foreveryoung Member

    why do you believe that sc is the same as im? I have very little body fat but if I follow proper techniques there is no way that my sc injection is im.

    SC can work, but it sucks for oil testosterone in my experience, partners will notice the evidence for one thing, absorption is more variable than IM for another.
     
  7. Mike9

    Mike9 Junior Member

    It looks pretty slick.

    [​IMG]
     
    Michael Scally MD likes this.
  8. MR10X

    MR10X Member

    Why do they look at TT levels for TRT,FT should be the guage.My last levels were TT 493 (348-1197) and FT was only 4.7 (6.6-18.1). Even with 493 TT test i have low test symptoms.I have an appointment with my Endo next month for my second 6 months check up on my Thyroid treatments...He is going to check F T4 and TSH but not T T4 which seems more logical than FSH and just T T4...I asked him about my high TT and low FT and said the ratio changes as you get older..im 68
     
  9. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Needle-Free Subcutaneous Self Injection for testosterone Supplementation Therapy
    http://www.aua2015.org/abstracts/abstractprint.cfm?id=PD37-06

    Introduction and Objectives - Various modalities for testosterone supplementation therapy (TST) are in wide use with an increasing frequency. Each has unique disadvantages with regard to fluctuating testosterone (T) levels, pain, or potential for unintentional topical transfer.

    While IM testosterone cypionate (Tc) has an abundance of clinical experience, subcutaneous (sc) injections of Tc has not been adequately studied. Similarly, needle-free therapy has not been evaluated as an option despite decades of use.

    We investigated the feasibility, pharmacokinetics, and efficacy of self administered needle-free sc injection of Tc as a viable treatment for TST.

    We hypothesized that needle-free delivery of TST would reach efficacious T levels, be well tolerated, improve symptoms and be self administered with negligible pain.

    Methods - Informed consent and IRB approval was obtained to enroll 24 symptomatic hypogonadal men in two consecutive proof-of-concept prospective studies.

    In the first 30 days, 14 men injected 25mg/day (QD25) and 10 men injected 50mg Monday, Wednesday, and Friday with weekends off (MWFWO50). Serum T levels were obtained at close intervals to determine both optimal Tc dose and injection frequency.

    In the second study, data was combined from QODWO50 dosing at Day 60 and Day 90. Validated pain scores and the Aging Male Symptom (AMS) score were recorded Day 0 and Day 30.

    Results - Twenty-four total hypogonadal men enrolled in the studies with an average T level of 171ng/dL.

    Phase I of the study demonstrated therapeutic levels in all men both QD25 and MWFWO50 dosing by Day 14. Mean T levels at Day 30 for QD25 and QODWO50 dosing was 846ng/dL and 585ng/dL, respectively. Four of 14 QD25 men were supraphysiologic at Day 30.

    To mitigate this observed trend of rising T levels 10 men from the Phase I QD25 cohort were converted to QODWO50 at Day 30. All men in the QODWO50 program were eugonadal at Day 60 (616ng/mL ± SD 179) and 90 (586ng/mL ± SD 159).

    In addition, (20/20) men had statistically significant improvement in AMS score and reported minimal pain (p≤0.001). Estradiol and free/total T levels increased in accordance with historically published Tc IM treatments. No adverse events occurred.

    Conclusions - Needle-free delivery of commercially available testosterone cypionate is efficacious and provides physiologic ranges of T serum levels in men whom self inject subcutaneously three times weekly with 50mg.

    The benefits of flexible dosing, self administration, maintenance of more consistent T serum levels, minimal pain, and reduced risk of interpersonal transfer makes this novel approach worth evaluating on a larger scale.
     
  10. Handle2

    Handle2 Member

    They call their program TST, yet also state that by day 60 all men were eugonadal, so they're not supplementing testosterone, they're replacing it!
    One of the downsides of sub Q T shots is that it needs to be done more often than IM shots. A larger dose also needs to be administered than with IM shots to achieve the same level of testosterone.
     
  11. virginian

    virginian Member

    There was a small study in a medical journal that said the subQ was effective and resulted in more level test concentrations in blood than IM. My doctor recommends subQ for that reason.

    I did subQ with a 1/4 inch 31 gauge needle and it worked fine. Now I use a 29 gauge 1/2 inch needle and inject in my quads. It's relatively easy and painless. I think that is a shallow IM injection for me. Blood results showed both were about the same effectiveness. I prefer a small needle because I don't have enough courage for big needles.

    My doctor recommends 60 mg (0.3 cc) E4D. That amount puts my TT troth at about 850 ng/dL (range 250 - 1100) and my FT a little above 200 pg/mL (range 30 - 135).

    When I want a little enhancement of the effects I use 90 mg E4D. That puts my TT troth at about 1300 and my FT a little above 300. By the way, I weigh 150 lbs and am 72 years old.
     
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  12. kawilt

    kawilt Member

    I don't know how you get that oil through a 31 gauge needle. I can barely get it though a 27. Is pharm grade that much thinner than a ugl?
     
  13. virginian

    virginian Member

    It loads slowly and it takes a lot of pressure to inject, but it works. The short 1/4 inch length of the needle works to reduce the friction.
     
  14. MR10X

    MR10X Member

    The small size of the syringe has more pressure and suction than a large one,this is why it works with such a small needle.
     
    Volley_Fire likes this.
  15. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Kaminetsky J, Jaffe JS, Swerdloff RS. Pharmacokinetic Profile of Subcutaneous testosterone Enanthate Delivered via a Novel, Prefilled Single-Use Autoinjector: A Phase II Study. Sexual Medicine. http://onlinelibrary.wiley.com/doi/10.1002/sm2.80/full

    Introduction Hypogonadism is one of the most common male endocrine problems. Although many treatments are currently available, unmet need exists for new testosterone (T) replacement therapies that are simple to administer and use, are safe, and mimic physiologic T levels.

    Aim The study aim was to determine the pharmacokinetics (PK), safety, and tolerability of T enanthate (TE) administered via a novel single-use autoinjector system, which was designed to eject high-viscosity solutions from a prefilled syringe fitted with a five-eighths-inch 27-gauge needle.

    Methods Thirty-nine men with hypogonadism entered this dose-finding, open-label, parallel-group study. Patients were washed out of their topical T regimens and randomized to receive 50 or 100 mg of subcutaneous (SC) TE weekly. The reference group were patients with hypogonadism who were maintained on standard 200-mg intramuscular (IM) TE.

    Main Outcome Measure The primary outcome measure was the PK profile of SC TE, analyzed in reference to T levels used by the Food and Drug Administration to approve T products. Secondary outcome measures were safety and tolerability assessments.

    Results Both doses of SC TE achieved normal average concentrations of serum T within a 168-h dosing interval after injection. Concentration ranges were similar at all time points following 50-mg SC TE injections and following the third injection in the 100-mg arm. Mean steady-state T concentration at week 6 was 422.4 and 895.5 ng/dL for the 50- and 100-mg SC TE arms, respectively. SC TE demonstrated PK dose proportionality. SC TE restored normal serum T with low variation relative to 200-mg IM without clinically significant adverse events.

    Conclusions Administration of TE via this novel injection system restored T levels to normal range in men with hypogonadism. SC TE dosed weekly demonstrated steady, dose-proportional measures of exposure and was well-tolerated.
     
    retpsd likes this.
  16. virginian

    virginian Member

    Dr. Scally has posted a really good study. It compares testosterone enanthate weekly sub Q injections of 50 and 100 mg with 200 mg injected every 2 weeks. The study measures what is happening in the body at frequent time intervals. I read the study carefully and it answers a lot of questions. My conclusions are below.

    Sub Q injections are just as effective as IM injections:

    The subjects getting 100 mg SQ weekly (with a 5/8 inch needle) had the same average concentrations of testosterone in their blood as subjects getting 200 mg IM every 2 weeks. This result (which confirms a previous study) shows that SQ injections put just as much testosterone into the blood as IM injections.

    Concentrations of testosterone in blood are proportional to injected dose:

    The subjects getting 100 mg/week had 2x the concentration of testosterone in blood compared to those getting 50 mg/week.

    Injecting weekly is better than injecting once every 2 weeks:

    The range from peak to trough was much less with weekly injections. Biweekly injections often had testosterone concentrations out of range. But we already knew that.

    Peak testosterone levels occur between about 12 to 36 hours after injection:

    That is consistent with what most people have been assuming.

    50 mg sub Q once a week is not enough for most people:

    Range of average testosterone concentration over the week: 257 – 673 ng/dL
    Range of peak testosterone concentration: 388 – 825
    Range of minimum testosterone concentration: 182 – 372

    Maybe the guy at the highest end of the range is OK, but the others are pretty low. I suspect that weight difference accounts for much of the large range. Weight range for the study group seems to be roughly 150 to 250 pounds. For most drugs, a bigger person needs a proportionally larger dose to achieve a specific concentration than a smaller person.

    100 mg sub Q once a week looks about right for many people:

    Range of average testosterone concentration over the week: 406 – 1368 ng/dL
    Range of peak testosterone concentration: 624 – 2120
    Range of minimum testosterone concentration: 236 – 860

    The high and low ends don't look so good, but it looks good for those closer to the middle of the range.

    200 mg IM every 2 weeks is not often enough:

    Average testosterone concentration over the 2 weeks: 1267 ng/dL
    Range of peak testosterone concentration: 787 – 4840
    Range of minimum testosterone concentration: 203 – 780

    The average is so high because the levels for the first week after the 200 mg injection are so high. The ranges are too extreme. Peak concentration too high. Minimum concentration too low. But we know that injecting only once every 2 weeks is not frequent enough.
     
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  17. 25 mg daily of exemestane should counter the chance of that.... I've been running 250 test cyp a week since may, started out pinning around 35% bf and am down to 26%, with no adverse effects
     
  18. GarageLifter

    GarageLifter Junior Member

    I have been using .15 mg of 100 gram prop. ED
    Site injection with occasional sub q.
    If I go beyond .15 sub q, area gets inflamed.
    I like how I feel with the every day injection.
     
  19. LW64

    LW64 Member

    Yeah? Labs?
     
  20. lab results Monday. But stopped pinning almost 3 weeks prior to the draw, because I finally found a doctor that would be willing to give me a valid prescription. Thus I'm not sure if they'll show you the numbers you're wanting to see. Sorry.

    On an island, nowhere to get discreet bloods done. But I do know my body comp (progression) and bp have been great.