Injecting testosterone subcutaneously

[frankwhardy]

There are at least a couple of people on the forums who are apparently successfully doing their weekly testosterone (cypionate or enanthate) injections subcutaneously as opposed to the "recommended" intramuscular way. I'm wondering if there is a reason why subcutaneous injection might be suitable (apparently) for some people but not for others . . . is it a difference in physiology, vascularity, body fat levels, or what? Or is it really never a good idea to make a T injection subcutaneously? Is a subcutaneous injection more likely to cause an abnormally slow release of T, or an abnormally fast release? Is it more likely to cause tissue damage and/or pain? Why was it established that T injections should be made intramuscularly? Are there any studies proving one way is better than the other? Or is this just another case of well, it's always been done that way so that must be the way to do it? etc., etc. Thanks for any insight.
Frank

[cpeil2]

I think SWALE has said before that he has safety concerns about the SQ route, but he hasn't gone into it beyond that.

[LiquidGib]

I would like to know more about this too. I think the doctor I go to does T shots subq. I would really prefer to do it intramuscularly because that is the standard and I don't want to risk anything - I would rather do it the tried and tested way. Another reason I would like to do it this way is because I have alot of body fat and if I am correct, this could cause alot of aromatization into estrogen.

[cpeil2]

Originally Posted by LiquidGib

. . . this could cause alot of aromatization into estrogen.

I was wondering about that too.

[frankwhardy]

What I'm thinking, is that it is at least conceivable that the concept that T injections "have" to be given intramuscularly is something that was started and perpetuated by the developers (e.g., Upjohn) of the depot-type testosterones (i.e., the testosterone esters), because it may be that an IM injection does give a little better bioavailability and/or prolonged absorption profile over subQ and the drug company is wanting to squeeze every bit of extra duration of action out of each injection - simply because they were and are trying to market the T esters as being seemingly conveniently dosed once every 2 weeks or 3 weeks (or 4 weeks!), when in reality that is a bunch of bull for most men. So I'm very suspicious that subQ injections of T-cyp will work fine for most people, although perhaps a small dosage and frequency adjustment may need to be made.

I'm wondering about the possibility of greater aromatization with injections closer to the skin surface, too, but the question is whether that problem even comes into play with the ester derivatives of testosterone, which may not even fit into the aromatase receptor, i.e., the ester portion may need to be cleaved first and that may not happen until after the T ester has been absorbed into the blood stream well away from the skin surface.
Frank

[LiquidGib]

I actually was thinking about this the other day - small amounts of t injected subcutaneously more regularly. Maybe twice a week or even every day. Who knows maybe this will be the future of TRT?

[frankwhardy]

Found this interesting conversation on another website regarding subQ injection of Depo-T apparently being Dr. Shippen's favorite way to administer T - at least as of February 2004 . . . have any thoughts on this Dr. C?:

http://forum.avantlabs.com/index.php?showtopic=8130

[From the link above:]
[Initial posting:]
"I was corresponding with a patient of Dr. Eugene Shippen (THE TESTOSTERONE SYNDROME) about Dr. Shippen's protocol. Apparently his preferred method of testosterone replacement therapy in cases where he otherwise might have tried pellets, creams or gels is now SUBCUTANEOUS testosterone injection. According to this patient, unlike intramuscular injection, subcutaneous injection of a small amount three times per week results in ultra stable levels and low estrogen conversion. Apparently Shippen uses this method for his own testosterone replacement. Not only does it work better than even pellets apparently but it's dirt cheap compared to about any other method.

I was going to get pellets (hypopituitary) but now I wonder if I should try this. I have two questions though:

1) Are there any studies on this method? I couldn't find any.

2) I don't doubt Shippen; the lab work of who knows how many patients would not lie. But if it works so well, why the HELL wasn't this thought of and tested a long time ago?? It seems like there is a big "DUH" factor here."

[A second posting:]
"does he use free testosteorne? a suspension? does he used an oil based ester? specifics please

also, subQ injections are often more painful or lead to inflammation. if you ever have accidentally gotten a steroid injection into the subq instead of the muscle you would understand"

[A reply:]
"I heard back from the patient of Dr. Shippen. He injects depo-testosterone 200mg/ml, .35 ml every 3 days into abdominal fat. He splits the injections into two .18 ml injections which is .36 ml, and says this is because a tiny amount will leak out of the injection site.

According to this patient, this dosing schedule leaves him with a stable 900 ng/dl total testosterone level and none of the high estrogen conversion associated with large intramuscular injection.

Apparently Shippen is convinced enough that this is now his preferred method of TRT. I know he starts by trying to get levels into the high normal range by trying to get the body to make its own, but if TRT is called for apparently subcutaneous injection is the first thing he prescribes."
[This appears to be 70mg every 3 days for a total of 163mg/wk]

[mranak]

At this time, there isn't much data on the long term effects of injecting oil sub-q.

[frankwhardy]

I know that it's routine to inject laboratory animals with subQ oil preparations. I don't know how many of them get to hang around to see what effect repeated injections over the long term has, though. With repeated IM injections that aren't properly rotated amongst different sites, there's the possibility for muscle necrosis (and other types of damage), and I imagine the same is true for subQ - that you might have fat necrosis/damage if the injections are properly rotated. Question is, is it likely to be any worse or more dangerous? From a chemistry point of view, "like dissolves like," so injection of an oil (fat) into the subcutaneous area (fat) might have the potential to cause more (bio)chemical "disruption," but it would seem that an oil injection into muscle (protein) might have the potential to cause more physical "disruption."

All I know is that the drug companies' main deference is to their bottom line and not to the patients' benefit, and if an IM injection means that they're better able to tout (sell) their product as lasting for weeks, versus days, so that the patient is led to believe that he only need visit the doctor relatively infrequently to get his shot, then they're likely going to go that route.

[SWALE]

I'm just not ready to go there.

[frankwhardy]

A member on the Hypogonadism2 forum was kind enough to post the following info (which I hope he won't mind me posting here):

"I'm still doing T-cyp subQ, now at 120mg/week, plus 0.25mg Arimidex 2xweek. It's working very, very well for me.

Last year I switched to a new doc who prescribed T-cyp, and showed me how to inject subQ. I said I could do IM, he said subQ was fine and easier. He was the first TRT doc I had who seemed to know what he was doing.

I looked up prescribing info. for T-cypionate & T-enthanate, and all the instructions I found said to go intramuscular. I think most docs who read today's prescribing info. will say that. However, my doc's been practicing medicine for over 50 years, and my results are very good. That's all I need to know.

120mg of 200mg/mL formulation means I only inject 0.6cc at a time, so there's
very little "bump". I used to do 200mg/10days, the bump was bigger but no real problem. There's a little burning sensation, no big deal.

I've heard that subQ (which goes into the fatty layer) can cause more E2
conversion than IM. I'm on low-dose Arimidex to control E2 conversion. IMO switching to IM wouldn't eliminate the need for E2 management."

[pmgamer18]

I have tryed them both ways and feel better subQ.

[frankwhardy]

Originally Posted by pmgamer18

I have tryed them both ways and feel better subQ.

Hi Phil,

Could you elaborate? Have you actually done your weekly 150mg T-cyp injection subQ? How long have you done it for? Did you use your thigh or abdomen? When you say you feel better, do you mean that there is a better intensity of feeling good or do you seem to get a better (more even) profile of absorption or do you have less side-effects, or what?
Frank

[frankwhardy]

Here is another recent posting from the Yahoo! Hypo forum (and I hope again they don't mind me posting here):

"My son just started testosterone treatment by injection with an experienced
and respected endocrinologist. I do the injections subQ in the arm or leg
with a tiny insulin type needle. There is virtually no pain. He says subQ
is just as effective as intramuscular although there are no studies to
confim that. He and his colleagues have found it to be true over years of
experience."

[LiquidGib]

good posts frank, as you can tell, I find this topic very interesting

It seems as though all those who have tried subq have nothing bad to say about it. I am quite curious though, as to why SWALE is shying away from this topic. Perhaps it is because he has not tried it as yet and would not feel right discussing something he does not have substantial experience in. I respect that. I wonder if someone does get good benefits from subq injections (just as good or better than IM), is there any reason not to do them? I guess the main question here is the long term effects.