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Suggest Remedy For High T Levels When On T Cypionate Injection

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Posted on Sat, 31 Jan 2015
Question: Im on 200mg T cypionate 1x weekly IM injection. T levels are 1250-1550 ng/dL, free T 263 pg/mL. Are these too high? My dr says not to worry.
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Answered by Dr. Binu Parameswaran Pillai (6 minutes later)
Hello.
Thanks for writing to us.
The levels are on a higher side but these can be corrected. These will normalize in few weeks.
I hope this information has been helpful for you.
Regards, Dr. Praveen Tayal .
For future query, you can directly approach me through URL http://bit.ly/Dr-Praveen-Tayal Click on thanks button if it is helpful.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Binu Parameswaran Pillai (5 minutes later)
They have been in this range about 6 weeks (12 weeks on HRT so far). Should i maintain the levels this hig, or is it advisable to back off a bit? Hemoglobin elevated to 18.2, just had a phlebotemy to reduce that. h
doctor
Answered by Dr. Binu Parameswaran Pillai (4 hours later)
Brief Answer:
Too high levels

Detailed Answer:
Good day,
Noted your concern. I agree. It is indeed a high level now. Beides, your Hb has gone up to 18 g. May i know what is your height and weight? What was the indication for Testosterone treatment?
When was the levels checked ( how many days after testo injection). Any history of prostate disease? How i your urine frequency now ?

You should skip the doses until Hb returns to normal range. After that, start with 200 mg once every 3 week.. It should be maintained between 400 to 600 ng/dl. Again the levels can be too high if you measure soon after the injections. The Testosteroone levels should be checked mid way between two injections.

It is essential to monitor the Complete blood count or CBC ( for Hb levels and PCV) and PSA levels for prostate.

I hope your testosterone replacement is being monitored by an endocrinologist or an XXXXXXX .

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Binu Parameswaran Pillai (12 hours later)
I'm 73", 229lb. My injection is weekly on Thursday, lab work occurs on Tuesday. Indication for HRT was (hypogonadism with T level consistently below 300, free T in the 30's, fatigue, anxiety, minimal progress on weight loss and strength gains despite 3 years of high intensity strength training and HIIT cardio, calorie restriction (whole organic foods), low libido). Since starting HRT, I've reduced to 20% body fat (weight has not changed but body composition changing from fat to lean body mass). Libido improved significantly, anxiety as well except it came back when Hb levels XXXXXXX Comprehensive lab work is being performed (3x so far since starting HRT). Two complications have surfaced: erythrocytosis (therapeutic phlebotomy to resolve this initially, will continue to monitor agressively) and high E2 (taking .25mg arimidex EOD to maintain E2 at appx. 30 pg/mL). I'm considering reducing T cyp to 100mg weekly. (Yes, working with an MD who specializes in HRT, would coordinate that change with him). You suggested 200mg every 3 weeks: that would be 1/3 the amount I'm taking now and would seem to make T levels vary significantly due to half life of T cyp. Clearly that would result in lower T and likely eliminate the complications I listed, and likely would put me in the 400-600 range. Is 3 weeks the typical dosing schedule you prescribe to your patients? If so, why not 1/3 of that every week vs. every 3 weeks?
doctor
Answered by Dr. Binu Parameswaran Pillai (30 minutes later)
Brief Answer:
Options

Detailed Answer:
Thank you for the reply. Noted your history. I typically give SUSTENON ( mixture of Testosterone enanthate/cypionate/propionate) 250 mg once in 3 weeks. This regimen is good in most patients, but occasional patient complain of low libido by the end of second week. In such patients, I give 200 mg every two weeks.
100 mg weekly once is another option. However, this will result in 4 injections a month. Quite painful isn't it ? Hence to reduce injections, I typically give either 200 mg once in 2 weeks or 250 mg once in 3 weeks.

There is one more long acting Testosterone available now ( once in 3 months). It is called NEBIDO which contain testosterone undecanoate . 1000 mg once in 3 months.

In your case, you have erythrocytosis. And prostate status is unknown. Phlebotomy is only symptomatic treatment but the cause( cause is high Testo levels), need to be treated as well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Binu Parameswaran Pillai (31 hours later)
Prostate is good (no enlargement or abnormalities, PSA XXXXXXX from .6 to .8 as expected). Have you used nebido on your patients with success? Is that also an IM injection? Thank you for your advice .
doctor
Answered by Dr. Binu Parameswaran Pillai (3 hours later)
Brief Answer:
IM injection

Detailed Answer:
Yes I have used NEBIDO in few patients. However, most of my patients are on SUSTENON 200 mg once in two weeks or 250 mg once in 3 weeks.

yes, NEBIDO is an IM injection.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1439 Questions

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Suggest Remedy For High T Levels When On T Cypionate Injection

Hello. Thanks for writing to us. The levels are on a higher side but these can be corrected. These will normalize in few weeks. I hope this information has been helpful for you. Regards, Dr. Praveen Tayal . For future query, you can directly approach me through URL http://bit.ly/Dr-Praveen-Tayal Click on thanks button if it is helpful.