Tuesday, 14 October 2014 15:04

Different types of injectable testosterone

The most common forms of injectable testosterone in the US include Testosterone Cypionate, Testosterone Propionate, Testosterone Enanthate, or a combination of different ester types (ester blend). An 'ester' is basically a chain composed of Hydrogen, Carbon, and Oxygen atoms which are attached to the testosterone molecule which must be broken down creating a 'timed release" in the body once injected. Even though the testosterone molecule remains the same no matter the ester, each one can yield different results by the way they are metabolised in the body once injected. For testosterone replacement therapy the ester does not matter as much as the timing and frequency of injections. The ultimate goal should be to restore total testosterone to a good range, or 'optimal' range, with about 2%-4% free testosterone. You can acheive this using any ester if the injection is timed correctly. The problem with using blended esters instead of a single ester is that blends can cause testosterone levels to become unpredictable or too erratic for replacement therapy. Blended preparations using multiple testosterone esters look great on paper, and they can be easier for a compound pharmaceutical rep to sell, but they are not as easy to work with clinically. One reason a doctor might include more than one ester, for example a combination of propionate and cypionate, is to provide a more aggrssive release pattern "spike" in those men who sometimes feel better due to the way they metabolize testosterone once injected. Since everyone responds differently you want to make sure you are following up until response is established. I have tried every combination of ester available (and not available) and still prefer testosterone cypionate by itself as it is predictable for me.

Always remember that each of these forms is simply testosterone, the hormone molecule remains unchanged, and the only difference is the attached "ester" which determines the half-life within the body. 'Cypionate', 'enanthate', and 'propionate' are all esters.

 

Enanthate: This is metabolized in roughly 4-5 days. It can even remain in the body (in very small amounts) for 2 weeks. 100mg of Testosterone Enanthate yields ~73mg of actual testosterone, the rest is ester weight. Injections can be administered every 5 days. As we all know everyone is unique in their response to drugs but from what I have seen in my experience the approximate starting doses which may bring a patient within optimal ranges (650ng-1100ng) is 100mg-200mg IM every 5-7 days. Of course many factors come into play including the patient's baseline levels and biology.

 

Cypionate: This ester has a half-life of 8 days resulting in the slow metabolism of hormone once injected. Providers commonly recommend injecting cypionate once to twice per week to maintain stable hormone levels. 100mg of Testosterone Cypionate yields~68mg of actual testosterone.

 

Propionate: This is a faster acting ester which can peak in the blood within hours and be fully metabolized over 3 days. Injections are commonly administered every 2-3 days. Since it metabolizes so quickly, and needs to be administered frequently, it is easy to stabilize levels and optimizes blood-testosterone-levels quickly. 100mg of Testosterone Propionate yields ~93mg of testosterone.

 

Other Esters found in TRT medicine may include;

 

Aqueous Testosterone Suspension: No-Ester. Requires frequent IM injections since it remains in the body only for a few hours. (Very painful injection). The risks outweigh the benefits when it comes to Testosterone Suspension and we do not recommend prescribing this particular ester.

Published in Defy Medical Blog
Wednesday, 01 October 2014 14:25

Subcutaneous administration of testosterone

Commonly prescribed injectable testosterone includes testosterone cypionate, enanthate, and propionate. All three are oil based injectables which have typically been administered by intramuscular injection (IM) using a 1” to 1.5” needle. Click here for more information on the different injectable testosterone esters. For a long time it was thought that these oil based testosterone medications could only be administered intramuscularly, however a few physicians who specialized in prescribing testosterone therapies noticed that testosterone levels appeared to be the same, even more stable, when patients administered their testosterone subcutaneously using a much smaller needle versus an IM injection. Over the years there have been more observations and studies supporting the subq administration of injectable testosterone, including the pilot study below. Normally when testosterone is administered by IM injection the entire weekly dosage is taken at one time, sometimes causing a peak in serum testosterone levels followed by a trough as the hormone metabolizes. When injecting testosterone by subcutaneous injection the dosage can be split into half, administering two smaller injections typically every 3 days (or twice per week). For many patients this method reduces the “peak and trough” effect and can keep serum testosterone levels more stable throughout the week. If you would like more information or direction on how to administer your testosterone subcutaneously please do not hesitate to contact the Defy Medical team for assistance. Subcutaneous administration of testosterone. A pilot study report. Al-Futaisi AM, Al-Zakwani IS, Almahrezi AM, Morris D. Source Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman. [email protected] 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.

UPDATE: Self-Administered Testosterone Injection Meets Main Goal In Late-Stage Study. Reuters (2/26/2015, Grover) reports that an experimental once-weekly testosterone injection, testosterone enanthate that is to be marketed as QuickShot Testosterone, met its primary goal in the ongoing late-stage study. The study involves 150 patients with less than 300 nanograms of testosterone per deciliter of blood. QuickShot is the only self-administered, subcutaneous treatment currently in late-stage
Published in Defy Medical Blog
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