Noodleface
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Health Problems
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Grabbit Allworth
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This is the first time I've ever visited this thread and I've only read a few pages (starting at the end and working backwards), but pellets are some of the least reliable/effective forms of TRT that you can utilize. Admittedly, I don't know anything about your situation and you may know that while having some circumstance that makes it necessary to go that route. Or do you just have an incredible aversion to pinning yourself?
The 'pellet guys' are always at every TRT convention and they're universally despised by the professionals whom actually have significant knowledge of TRT. I've done a tremendous amount of research regarding TRT because I have been considering it for about a 2 years myself (I'm 42 with ~450 average), but I am still not ready to pull the trigger despite the fact that I know with a knowledgeable doctor it is incredibly safe and beneficial. In fact, there's so much commonly spread misinformation about the effects of TRT (like potentially increasing the risk of heart disease), it's staggering.
I'm on the low end of normal, but I still suffer from the effects of Low-T and there are so many benefits of getting in optimal ranges. However, playing with hormones (which are incredibly powerful) is an inexact science and enough for me to hold off until I just feel that things can't get worse.
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moonarchia
The Scientific Shitlord
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There is no "pinning yourself" option. The injection method requires weekly or biweekly trips to the urologist to get the shots. The gel method means you shouldn't touch children or pregnant women. These are the options my urologist gave me. So pellets were an easy choice. My natural testosterone level was around 100. The pellets have been very effective for me personally, and
Synj
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Lanx
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moonarchia
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It doesn't all get absorbed into the skin, and can end up in clothing via sweat or direct contact, meaning you can potentially get it on others who for various reasons would not want the extra hormones.
Noodleface
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It seems like a disproportionate amount of people here are on trt. Is it because we're nerds who don't get sunlight or exercise or is it just a skewed result in some other way?
Synj
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I don’t think it’s all that disproportionate considering our demo. I’d guess that most people here are a) men, and b) either 35+ or getting real close. My patient population is varied but most of the guys I see are in that 40-50 demo and a lot of them are "masculine" guys aka cops and firefighters and athletes trying to maintain their level of activity.
Once you hit 35 it's basically downhill from there regarding your testosterone production regardless of "masculinity". Women get an extra 10 years or so of hormone production, which also accounts for the additional heart protection they get and the 7+ year life expectancy gap. Once their sex hormones stop (menopause) their risk of heart attacks, etc skyrocket up to male levels.
It's pretty fascinating.
Synj
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Why do you say that pellets are unreliable/ineffective? Based on what? I have blood work on probably 100 patients where I can see Free Testosterone at an increased level of 2-4x baseline. Furthermore, when we assess their cholesterol, blood sugar, BMI, waist circumference, weight, etc we see a fair decrease versus their baseline as well. I'd say about 70% of the patients I've treated have stated that they are satisfied with their results and notice improvement of libido, fatigue, insomnia, motivation and weight loss. That number matches closely with the studies I've seen.
The nice part about pellets is that it is consistent dosing based on cardiovascular need, ie you will use more if your body demands it (think high level athletes) and you only need to re-pellet every 4-6 months. I see a lot of the urologists using injections as a way to drive weekly visits and that doesn't seem feasible to me. Additionally, based on half lives of cypionate, you really should be getting injections every 4 days to avoid the troughs. And I know if you're consistent you can get to a point where the previous injection keeps the levels at a decently adequate level but that takes time and patience and you better not miss an injection. And even then you will have peaks and troughs with the injections. Pellets are much more consistent over time based on my reading.
If there's one thing I've learned about the medical community is that doctors typically like doing what they're comfortable with and what can make them money. Newcomers that threaten that tend to be shunned...until they become the next thing that they become comfortable with and start making money on it.
I don't make any more money doing this (I don't own the practice or get bonused on pellets), but I do the pellets myself, I've noticed an improvement in my QoL and in my patients. I wouldn't dismiss it out of hand. It's just testosterone in a different delivery.
Grabbit Allworth
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First, I'm not saying pellets aren't effective at all. Rather, they're just very sub-optimal. They have a huge potential for infection at the application point and massive-scale issues with rates of absorption that often leave patients in the finals weeks/days of the treatment cycle with absurdly low Test levels because their pellet is dry and the patient's body is not making its own hormone. It's very common for patients to report being in misery on the tail-end of a pellet cycle. I've never been on TRT, but I have zero interest in spending days or weeks (every few months) feeling like death when it can be completely avoided. The specialist I am talking to is open to giving me a months supply at a time and letting me handle all the pinning at home. Of course, all of this will be closely monitored and adjusted by regular blood screening. That's the way it should be, in my opinion.
I have no doubt your patients see a marked improvement in their QoL because improvement is improvement, but pellets are absolutely not the best method. However, as I mentioned in my previous post I understand that the 'best' ways to optimize Test are not always feasible. Some people can't/won't pin themselves, some doctors won't allow it, some people can't make it to the doctor that regularly, etc, etc. That said, it's true that pellets are more effective than creams/patches (basically worthless), but as stated, they're risky and the potential for a bad time is high.
I have no doubt your patients see a marked improvement in their QoL because improvement is improvement, but pellets are absolutely not the best method. However, as I mentioned in my previous post I understand that the 'best' ways to optimize Test are not always feasible. Some people can't/won't pin themselves, some doctors won't allow it, some people can't make it to the doctor that regularly, etc, etc. That said, it's true that pellets are more effective than creams/patches (basically worthless), but as stated, they're risky and the potential for a bad time is high.
Grabbit Allworth
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I don't think it's unique to us here, it's Western men as a whole. There is a lot of recent literature that shows average Test levels in men have been dropping for decades. One of the studies I read even suggested that the average Test level of a man today is half what it was 100 years ago. I'm inclined to believe that. There are a lot of factors that contribute to hormone production suppression. Our diets have become such science projects that what we eat hardly resembles the more simple foods of decades past. Also, we're a sedentary society. Minimal physical strain has a significant impact on test levels. There's also some research on how our bodies are being constantly bombarded with radio, electromagnetic, microwave signals, etc and we just don't quite understand the effects of those factors quite yet. I also believe that culture (nurture) is having an impact too. Modern men are largely being subjected to emasculation and it has more of an impact than people realize.
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Synj
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Fair points but I still have an issue with your wording here.
Very sub-optimal. That's just not true. Personally I have gotten great results. Clinically I have gotten great results. No sub-optimal about it. Serum levels are what they are and I know from experience what my patient's serum levels are. Those aren't made up results. They generally return in 4-6 months (about 3 months for women) and I don't think they 'feel like death', just more fatigued/achy than they were on the testosterone.
There is just as much risk of infection from daily/weekly IM injections, patients can and do develop abscesses from repeated injections. I'm not saying there is no risk of infection from any procedure but you cannot overstate one and understate the other when they are both a risk. At the very least, our procedure is sterile and done twice a year, vs. 52 injections/year minimum?
I have absolutely zero issue with testosterone injections or having alternatives for different people. I'm glad you've found something that will work for you but I think you're being overly critical of a perfectly valid alternative and one that I find easier and just as effective. I wish you luck and I hope it works great for you.
iannis
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What synj already said and I would add that TRT is a quality of life therapy that has been emerging just very recently. You didn't hear of this ten years ago outside of sports medicine. For better or worse it's been mainstreamed. Almost entirely for the better, but i'm sure there are some horror stories out there too. There always are.
The only thing that I would be concerned with, and it is a very small concern, is that if we remember synthetic estrogens turned out to be carcinogenic. ERT was mainstreamed quite some time ago and they very quietly switched types. I mean it's a very small concern... it's more like "if i have to think of an argument against" sort of thing. And even that isn't an argument against the treatment, only a potential caution against some forms of it.
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sleevedraw
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Do note that prostate CA tends to be hormone-sensitive, so I'd probably swap out "potential caution" to "strong caution" if someone has it or a strong family history of it. Dad has low-grade Gleason 6 cancer, and stopping his hormones was enough to cause his PSA to drop back to normal levels.
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jayrebb
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There is no "pinning yourself" option. The injection method requires weekly or biweekly trips to the urologist to get the shots. The gel method means you shouldn't touch children or pregnant women. These are the options my urologist gave me. So pellets were an easy choice. My natural testosterone level was around 100. The pellets have been very effective for me personally, and
Should you decide to pin yourself, assuming you are officially diagnosed with at least 1 blood result (that's the insurance standard set typically, you need 1 lab) you will have no trouble being given the self-pin option at virtually any anti-aging or TRT clinic-- just to let you know. My health insurance worked for my doctor/clinic, but I'm sure a lot of clinics aren't as legit. They make you sign a release contract and a multi-page agreement that declares you are not under the care of any other doctor for TRT, you are not presently prescribed TRT for any purpose, and so forth. I had to sign several times.
Granted, not everyone cares to acquire the knowledge on how to pin yourself. I remember being a virgin and it takes some serious game to make sure you are doing everything correctly, and even then, your nerves are pretty rattled.
My clinic did not demonstrate or instruct on it. Your TRT doc calls your script in (you actually order it off the website of the clinic is how this particular clinic works, so you aren't necessarily obligated to buy testosterone from them, but their system makes you buy it from them if you want the most convenient option. If you asked "Why do I need to buy X brand of testosterone" the doctor would most likely ask what is wrong with it? They def make money off their own compounding pharmacy manufacturer being pushed) , you go pick up the vials for the month and you figure out the pins yourself. Then its youtube videos + reading in-depth descriptions on do's and don't's and details on the finer things you should know. Figure it out yourself may be the norm with clinics, but I've only dealt with 1 major clinic.
That said I've been pinning for years without any problems while adhering to strict protocols. Can I do this for life? IDK, but there is always Nebido that I can look into which theoretically would reduce the total number of pins from 52 to around 12ish. Nebido is mostly considered a "European" thing, so I haven't actually researched it all that much.
Nebido sounds nice, but I have serious concerns about the ester size and length. I just don't believe that ester is the best ester for a bio-identical hormone replacement experience. My current protocol at least mimics the natural ebs and flows a little bit which I believe is healthy. Nebido on paper seems like it would maintain an exact level over periods of weeks/months once built up in therapeutic concentrations after a few months of using it.
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jayrebb
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At the bleeding edge right now experiments are being done with DAILY sub-Q cypionate. I believe the dose cited was 10mg cyp per day sub-Q.
The results have been very promising and at least 1 TRT doc is using the method on himself, since he had the means at his disposal to track his blood level.
No one ever thought sub-Q would or could be a thing, but it may very well be the next big thing. And who is going to be afraid of insulin pins sub-Q? Nobody.
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moonarchia
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Good info. Still probably going to stick with the butt pellets. They are effective for me, and I already have to jab myself every day with insulin, so making more of my body become needle resistant would not be optimal.
Noodleface
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Synj
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Low Testosterone: 9 Signs in Men
Fatigue, weight gain, muscle loss, loss of libido, erectile dysfunction, depression, bone loss, joint pain, loss of bone density.
Careful though because there are a lot of symptoms that can be attributed to other causes too but testosterone helps regulate just about everything in men.
Noodleface
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