The purpose of this article is to outline everything that is involved when it comes to beginning Testosterone Replacement Therapy (TRT). After reading this article you should feel confident about the TRT process and what to expect along the way.
Choosing a TRT Doctor
When it comes to choosing a TRT Doctor there are a few options that you can choose from. With technology becoming better every day this opens up more possibilities for treatment.
- Have your General Practitioner recommend an Endocrinologist. Endocrinology is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as hormones. They are licensed physicians who can recommend, administer, and monitor TRT.
- Find a reputable anti aging / wellness clinic. These clinics specialize in TRT. They are also licensed physicians who can recommend, administer, and monitor TRT.
- Use a completely virtual online clinic. These types of clinics are becoming more popular by the day. You can visit a site such as http://www.increasemyt.com and schedule a phone call consultation. During your initial call you can describe your current situation and what you’re hoping to achieve. This phone call usually lasts 10-15 minutes. After that they will ask you to fax/email them your most recent blood works. Once that’s approved you will have an online consultation with one of their licensed physicians. After you are approved for TRT you will select a plan which will be recommended to you. Medication is then express shipped to your front door. It’s that easy!
Deciding Whether to Use an Online Service or an In-person Service
Deciding which service to use can be a bit of a daunting task. I think the best way to decide which way to go is to use a pro and con list. Below is a list of pros and cons of each. I personally prefer the online approach because it saves me a lot of time and frustration. I can have my meds delivered straight to my door and I and administer them myself without having to go in for an office visit. If you are ever experiencing an kinds of problems along the way they are very easy to contact and are always willing to work with you.
Using an Online Service
- Ease of use and very convenient
- Medication is delivered right to your front door from the pharmacy. There is no need to go to a pharmacy and wait in lines.
- No in person office visits. You can have a consultation right from your very own home.
- You can have one of their labs do in home visits for blood work.
- You can administer your medicine from the convenience of your own home. Most of the time medicine needs to be taken 2x a week. This can become very cumbersome if you have to visit a physical location.
- Insurance may not be willing to work with you as much using an online service or a physical location.
- You have to take more initiative to monitor your progress.
- You will have to find a location where you can get rid of your sharps container that contains all of your used needles.
Using an In-Person Service
- Weekly visits will keep allow you and your doctor to monitor your progress very closely.
- Insurance is more likely to accept your claim.
- Weekly or even twice weekly visits can become cumbersome.
- While some doctors will all you to administer your own medicine at home, most want you to come into the office for them to do it.
Now that we have figured out what service we would like to use let’s talk about what drugs you are most likely going to be taking. The protocol that I’ll be discussing is one of many possible TRT protocols but it is the most effective. I will be writing a future article comparing the different types of TRT protocols.
The 3 most common drugs that are prescribed to treat TRT are Testosterone Cypionate, Human Chorionic Gonadotropin (HCG), and Anastrozole (Arimidex). I will go into a little detail about what these drugs are, how they are administered, and how often they should be taken. There will be a future article that will go into more depth as to what these drugs actually do.
There are many forms of testosterone and testosterone cypionate is one of them. Testosterone is the hormone that you are deficient in, so it will be administered in hopes to raise your total testosterone and total free testosterone to healthy and optimal levels. So why use testosterone cypionate instead of another version such as propionate? The difference among the different types of testosterone is usually their ester, which determines their half life. Some esters are slow acting and some are fast acting. The slow acting esters stay in your system longer and take a little longer for your body to start. The fast acting esters are used quickly by your system and leave your system quickly as well. Testosterone cypionate is a slow acting ester. It usually takes your body 1-2 days to recognize and use this ester and the half life is approximately 8 days. This is ideal for administering weekly injections. Testosterone cypionate is administered via intramuscular injection (into muscle) into one of these 3 major muscle groups: The shoulders, the glutes, or the quadriceps.
Human Chorionic Gonadotropin (HCG)
HCG is medically used to induce ovulation in females and to stimulate testosterone production in males. When you take exogenous testosterone it sends a message to your brain saying “hey I’m getting all the testosterone I need from an external source so I no longer need to create it on my own.” HCG will stimulate the luteinizing hormone (LH) which is sent from your pituitary gland to your testicles telling them to produce testosterone. This will keep your testicles active and keep them from atrophying (shrinking). This is especially important if you plan on having kids either now or some time in the future. Sperm is made in the testes and if they are no longer active then you will have trouble trying to conceive. By taking HCG you can help prevent this from happening. HCG is administered via a subcutaneous injection (into fat) usually into the stomach.
Anastrozole is an aromatase inhibitor (AI). Anastrozole was originally designed to treat breast cancer in women who have gone through “the change of life” (menopause). When testosterone levels rise, your body wants to convert some of that extra testosterone into estrogen. This is where Anastrozole comes to the rescue. Anastrozole can help set off a number of positive effects like boosting the body’s natural testosterone production, keeping water retention levels very minimal as well as preventing gyno. Anastrozole is also seen to have positive effects on the levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) in the system, which are needed by the body to naturally produce testosterone. Anastrozole is usually administered in 1mg tablets.
TRT Dosing and Frequency
Dosing and frequency will vary from person to person but injections are usually taken 1-2x a week and pills are taken 1-2x a week as well.
Most doctors will prescribe a patient 100-200mg of testosterone cypionate to be taken every week. Some doctors will suggest to take the full dosage 1x a week or split the dosage in half and to be taken 2x a week. So for example if you are prescribed 200mg a week, you would take 100mg every 3-4 days if you are splitting the dosage into 2x a week.
Why would you want to split the dose? When you take testosterone your body’s testosterone levels will spike and then fall. This causes what’s known as the rollercoaster effect. When your testosterone levels are high you reap all of the benefits of TRT. You feel great. You have a lot of energy, your mood is elevated, sex drive is up, and overall life is good. Once the testosterone starts to wear off and your levels start to drop you will possibly start to feel like you did before taking testosterone. You may become lethargic, lose libido, and become irritable. By splitting the dosage into 2x a week you help prevent this rollercoaster effect and help keep your testosterone levels at a happy and consistent medium.
Most doctors will prescribe a patient 500-1000 IU’s of HCG to be taken every week. Usually the higher the dosage of testosterone, the higher the dose of HCG. HCG should be taken the day after your testosterone injection. So if you are prescribed 1000 IU’s weekly, you’ll want to take 500 IU’s the day after your testosterone injection.
If you are responsible for your own injections you will receive 1 vial of bacteriostatic water a 1 vial of HCG powder. You draw up the water in a needle and then insert it into the vial with the powder. This will come with directions on how much water to use.
Most doctors will prescribe a patient to take 1mg of Anastrozole weekly. It should also be taken on the same day that you take your HCG. The reason you take the Anastrozole a day after your testosterone injection is because it takes a day or two for your testosterone levels to rise. Anastrozole acts fast so as your levels are rising it will help prevent testosterone from turning into estrogen.
Needles and Equipment Used
There will be 2 types of needles being used when it comes to administering testosterone cypionate. There will be 1 needle to draw the oil into the needle and 1 needle to inject the oil into the muscle. The reason for this is that a lower gauge needle is used to draw the oil and a larger gauge needle is used to inject the oil into the muscle. The lower the gauge the thicker the needle. The oil is a thick solution and the lower gauge needles are better at drawing up the solution. The large gauge needle is better for injecting into the muscle since it’s a lot thinner causing less discomfort. A typical syringe volume is 3ml. The drawing needle is typically a 21g and the injecting needle is typically 25g. The needles are typically 1 inch in length. Gauges and needle length may vary but these are typically what you can expect to see.
A common misconception when first starting out you may think that there will be two separate syringes for drawing and injecting. This is not the case. There is 1 syringe and 2 different sized needle heads. The needle part of the syringe is interchangeable and you replace the thicker gauge needle with the thinner needle before injecting.
There will be two types of syringes being used when it comes to HCG. There will be a drawing syringe to mix the solution and then there will be another syringe that is used for the injection. Drawing the water solution is much easier than the oil solution because it’s not nearly as thick. HCG drawing needles are usually 5-10ml. HCG injection needles are your standard insulin syringes.
A sharps container is usually a red plastic container with a white top that you use to store used needles. This is considered a hazardous waste container. Be sure not to close the lid until the container is full because you won’t be able to open it after it is closed.
How and Where to Inject Testosterone Cypionate
Before you can inject the testosterone you must first draw the oil into the syringe. Learning how to draw the oil properly takes a little practice. Because it’s such a thick solution it takes a little time for the syringe to fill. Be sure to wipe off the top of the testosterone vial with an alcohol wipe before drawing out the oil. If you were prescribed 200mg per 1ml, and you are injecting 2x a week, you will want to fill the syringe to 0.5ml.
Before you insert the needle into the vial draw back on the thumb plunger to the desired dosage you will be taking. Insert the needle into the vial and press down on the thumb plunger. This will displace the exact amount of air in the syringe that you will be replacing with oil. By doing this you create a vacuum like effect and it makes drawing the solution much easier.
When it comes to injecting testosterone cypionate you have some choices for the injection site. The most common injection sites are the shoulder, glute, and the quadricep. You really need to figure out what works best and is most comfortable to use. It is usually recommended to inject into the quadricep because it’s easy to see and is a low risk injection site. The injection site is on the lateral part of the quad. Usually you can measure a hands width from your hip and the same from your knee. An easy way to find the sweet spot is to sit down, take your forearm and put it lengthwise down your leg. Your hand should be facing your knee. Your forearm should be on the side of your leg not on the top. Bring your hand about halfway between your knee and your glute. This is usually a pretty good injection site. I have found that the further you get away from the knee, the less painful the injection.
Use the following steps to help administer your medicine:
- Wipe off the top of the vial of testosterone with an alcohol wipe.
- Find the injection site using the instructions above.
- Wipe the injection site with an alcohol wipe.
- Insert the needle into the quadricep in a smooth motion.
- When the needle is fully inserted into the quad, draw back on the needle. This is called aspirating the needle. If there is any blood that comes back into the syringe this means that you hit a vein. Remove the needle from the quadricep and move the injection site an inch towards or away from the current injection site and try again. You NEVER want to inject into a vein so this step is extremely important.
- We are now ready to inject. Push down on the needle’s thumb plunger slowly. You will have to apply a little pressure because of the thick oil solution.
- Once all of the oil has been injected remove the needle as straight as possible.
- Sometimes some blood may come out of the injection site. This is normal. Most likely you hit a blood vessel on the way out. Wipe it with an alcohol swab and apply a band aid if needed.
- This step is optional but you can massage the area of the injection site. This will help the oil to disperse within the muscle and prevent it from sitting in one spot.
- After you are finished with your syringe and needles be sure to dispose of them into your sharps container.
- It is also important to note that you may feel a little pain within the muscle in the next few days. This is perfectly normal and is a minor side effect of the medicine working.
Storing Your Medication
Testosterone should not be refrigerated. It should be stored at room temperature and in a dark dry place.
HCG needs to be stored in a refrigerator. The reason for this is to keep bacteria from growing in the water based solution.
So this is why we started TRT in the first place right? How long does it take to start reaping the benefits? Like many things in life this will vary from person to person. Most people start to see positive changes within the first month of TRT. This includes an increase in energy, and increase in strength, a decrease in fat and an increase in libido. If you suffer from anxiety and or depression you will should start to notice your mood starting to lift. Each week that goes by you should start to feel more like your normal self. For some people this happens sooner than later. If after a month or two you aren’t noticing significant changes then your doctor may adjust your protocol. They will most likely increase the amount of testosterone that you are currently taking. If you don’t notice immediate effects hang in there! It will get better.
When you begin treatment you will be getting blood work done probably once a month. This is to make sure that your hormone levels are balancing out and to keep other areas of your blood work in check. After you’ve been on TRT for a few months you might get blood work done twice a year. Every doctor is different but this is usually the norm.
By increasing your testosterone you will increase your red blood cell count. This is a good thing! But what we don’t want is too much of a good thing. Most TRT doctors will recommend giving blood once quarterly to help reduce your red blood cell count. By giving blood once every 3-4 months you will lower your overall red blood cell count. You get to reap the benefits of TRT and you will also be helping to save lives at the same time.
Preventing an Infection
You run the risk of an infection anytime you are injecting a foreign substance into your body. Use the following steps to help prevent from having an infection.
- Wash your hands with antibacterial soap before handling your medication and equipment.
- Always wipe off the top of the vials with an alcohol wipe before use.
- Always wipe the injection site with an alcohol wipe before and after injecting your medicine.
- Store your equipment in a safe and clean place.
It is important to note however that no matter how careful you are there is always a risk of infection. The symptoms can range from minor discomfort to possibly being deadly. If you think you are experiencing an infection it is best to seek medical help as soon as possible.
As with taking any type of medication there are always the risk of side effects. Below is a list of the most common side effects that may occur. If you do experience any of the following be sure to bring it up with your doctor and they can help you find a way to minimize the side effects you are experiencing.
- Acne or oily skin
- Mild fluid retention
- Stimulation of prostate tissue, with perhaps some increased urination symptoms such as a decreased stream or frequency
- Increased risk of developing prostate cancer
- Breast enlargement
- Increased risk of blood clots
- Worsening of sleep apnea (a sleep disorder that results in frequent night time awakenings and daytime sleepiness)
- Decreased testicular size
- Increased aggression and mood swings
- May increase risk of heart attack and stroke
- Changes in cholesterol and lipid levels
- Increase in red blood cell count
- Decrease in sperm count, producing infertility (especially in younger men)
- Increase in PSA
There you have it. That’s the end of the beginners guide to TRT. I hope that you were able to find this information useful and that it will help to benefit your life.
TRT Dosing Cheat Sheet
The following protocol is pretty common amongst TRT patients:
- 200mg testosterone cypionate every week
- 1000 IU HCG every week
- 1mg Anastrozole every Week
100mg Testosterone Cypionate
0.5mg (½ pill) Anastrozole, 500 IU HCG
100mg Testosterone Cypionate
0.5mg (½ pill) Anastrozole, 500 IU HCG