The following was written by Peak
Youtube by the University of Pennsylvania: https://www.youtube.com/watch?v=lLeEQTt25QE
Please feel free to ask questions within this thread: we have many guys using cypionate on the forum, both subQ and IM (intramuscular).
CAUTION: This is not a substitute for the training your doc (should) give you on the subject.
---The following was written by Kierkegaard
Most symptoms from TRT probably come from too much estradiol (E2), and more rarely too much DHT; both of these hormones are metabolized from testosterone, such that the more you increase one the more the other two increase. The question then becomes: how can we increase T to a level we want while minimizing its conversion to E2? The following is a metaphorical "formula" I created for understanding this problem:Total T --> T metabolites (E2, DHT) = injection method + injection schedule
Please don't take this formula literally. The idea is that the amount of T you convert to E2 and DHT is a function of your injection method (intramuscular [IM] or subcutaneous [subq]) as well as your injection schedule (how often you inject).
There are a lot of possibilities to consider. You could inject IM weekly, subq weekly (rare for some reason, perhaps because it's not wise to inject more than .5 ml at once when utilizing subq), IM every three days, subq every three days, and so on. Why IM? Because that's the traditional method for injecting testosterone. Subq has four very good studies to support it (see Peak's page: http://www.peaktestosterone.com/SubQ_Testosterone_Injection_Studies
), but it's still a relatively new treatment; however, it has the clear advantage of making it much easier to inject more often, you don't have to aspirate, and you have no risk of muscle scarring with IM. The vast majority of guys who have transitioned from IM to subq shots notice significant reductions in E2, something on the order of 40% according to the studies I've looked at; this might be due to something inherent about injecting into fat (slower absorption?), or simply because you're able to inject more often. Either way, subq injections mean much lower peaks and higher troughs. Check out this fascinating study that compares HCG (not cypionate, yes, but it should generalize to testosterone) injections on obese and non-obese women comparing subq and IM shots (notice the difference in peaks): http://humrep.oxfordjournals.org/content/18/11/2294/F1.expansion
Here's a hint: injecting less often than weekly IM or subq will very likely not work, and many guys have told the perennial story of doctors who don't know basic pharmacokinetics and regurgitate the "200 mg every two weeks" rule for cypionate, leading to big rollercoaster reactions because levels of T and therefore E2 and DHT shoot into the stratosphere for the first few days around the peak and then reach hypogonadal levels (unless perhaps your SHBG is relatively high) the last few days approaching your next injection. This stuff doesn't work, and if you have a doctor who insists it does, it's either time to find another doctor or take things into your own hands by injecting more frequently -- which isn't something this site recommends you do.
Pay attention to your body. Estradiol and testosterone ranges are pretty huge, and a big philosophical limitation of statistics is it looks at large groups of people to determine ranges, but you're a particular individual, so your sweet spot could be anywhere along the range, although it probably should be somewhere at least at the 20th percentile, and you should be cautious about going into supraphysiological (i.e., above the range) levels because that's just not, you know, natural, dude.
So say you've tried multiple schedules and methods, playing with, e.g., E3D, EOD, subq, IM, and other combinations, and you still
don't feel your best. This very likely means that your problem is something other than (just) testosterone, and I would highly recommend checking out thyroid (free T3, free T4, antibodies, TSH, reverse T3, also ferritin, iron, selenium, iodine), cortisol (blood: cortisol, cortisol binding globulin, ACTH, DHEA-S; salivary: 4x/day salivary test, which you can order through www.canaryclub.org
, DHEA-S might be unreliable because of complicated flow-rate considerations), insulin (fasting glucose, A1C, insulin), growth hormone (IGF-1), and remember to make sure you're getting the right tests pulled for testosterone (free T, total T, E2). Don't forget the basics, such as diet and exercise. If you're wanting a big picture that's a superb value (don't let the price intimidate you), check out Life Extension's excellent comprehensive male hormone panel: http://www.lifeextension.com/vitamins-supplements/itemlc100010/male-comprehensive-hormone-panel-blood-test
. Feel free to message me (Kierkegaard) about cortisol stuff, because it can get a bit complicated (i.e., cortisol:ACTH ratio might be more important than just cortisol, testosterone-only TRT seems to lower cortisol just a bit and therefore can cause problems in guys "on the edge" with cortisol, ACTH stim tests can be insensitive, and some guys only get better with a trial of hydrocortisone).