During the last year we have had an increase in reports from men that they are running out of their testosterone cypionate injections before the refill date. Lets first rule out those who over-draw the testosterone into the syringe, of course we must pay attention to detail when in comes to lining up the syringe plunger with the dosage line. If we are not paying attention, or have not been instructed properly, over drawing just a small amount of testosterone at each injection can lose 1 milliliter or more. There are other factors which can cause loss of testosterone as you inject regularly. If you notice at the base of your needle, where you attach the needle to the syringe, there is empty space which can trap the testosterone even after depressing the plunger completely. There always seems to be that little bit of T that will not leave the syringe/needle. In addition to the T being trapped in the needle head, there is also a small amount of T left behind on the syringe walls. This type of loss is unavoidable when using a 3ml or larger syringe. Over the course of 10-20 injections using a 10ml multi-dosed bottle that little bit of lost T adds up.

One of the reasons I believe we have noticed the increase in reports of men running out early during the past year is the result of increased regulations regarding the prescribing and dispensing of testosterone. It is a controlled substance which was previously overlooked by most regulators, and patients had the convenience of refilling earlier than due. I remember being able to refill 3 weeks early on a 10ml bottle. Now, with the regulations, it is 3 days to one week prior to being due depending on the pharmacy. This means we now have to be mindful of our dosage and injection technique.

There is one thing being done by manufacturers and compounders to mitigate the loss. There is also something you can do to make your T last the entire time up to your refill.

At least one brand of testosterone cypionate and most compounded 10ml cypionates are actually overfilled. Pfizer's Depot Testosterone is filled over 10ML. I believe close to 10.8ml. The compounding pharmacies we use fill the bottle to 11ml, which will help compensate the unavoidable loss. We had the opportunity to test this in a pharmacy setting 5 years ago.

If you are having trouble drawing a 3ml syringe, or if you are on a decimal dosage (such as 0.75ml), try using a 1ml tuberculin syringe. It looks just like an "insulin" syringe but can be attached with any size/gauge needle. Two benefits to using a 1ml syringe: 1- You will draw more accurately 2- There is less surface area on the syringe for the T to stick to the sides, however you still have the needle head which can trap T. I also find it easier to inject using a 1ml syringe.

Jasen Bruce

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