# STEROIDS FORUM > HORMONE REPLACEMENT THERAPY- Low T, Anti-Aging > "Before you start HRT- what your doctor probably hasn't told you or doesn't know!" >  TRT - Tostran Gel

## krugerr

Morning TRT'ers

I was prescribed Tostran gel (2%) [click] yesterday morning. With the direction to use 4 pumps a day, split morning and evening. 

*4 pumps = 2g = 40mg Testosterone*

I am to use this for a month, then I will have another blood test to check how I have responded. He wants to move me onto Nebido once blood levels are stable from the Gel. I couldnt quite understand this myself. Surely just using Nebido would have been the better option for stable levels?

Anyway, took the script to Pharmacist, but got no AI or HCG with this. Im assuming from the other threads in the TRT section I probably should have been prescribed some along side this gel?

-Krugerr

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## Bio-Active

There are many endo dr that try to keep your test levels within normal range and keep the estro in range as well without the use of an ai. Your next labs will make the next determination. It's pretty common

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## krugerr

> There are many endo dr that try to keep your test levels within normal range and keep the estro in range as well without the use of an ai. Your next labs will make the next determination. It's pretty common


Thank you! I should be on HCG though, as any exogenous will shut me down and cause atrophy?

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## Back In Black

You won't need an ai with the gel and shouldn't with the much more convenient nebido. Not sure why he would do this either but if you can get on nebido do it.

You won't be prescribed HCG but yes, you will be shut down from your trt. You will need to source it yourself and probably not tell your endo.

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## krugerr

> You won't need an ai with the gel and shouldn't with the much more convenient nebido. Not sure why he would do this either but if you can get on nebido do it.
> 
> You won't be prescribed HCG but yes, you will be shut down from your trt. You will need to source it yourself and probably not tell your endo.


Thanks BIB. I will push to move right onto Nebido at my next appointment. Ive got a bloodtest to check prostate stuff, then another to check the effectivness of the gel in a month.
Excuse my ignorance, but as well all know here, HCG is quite necessary. Why is it that they wont prescribe it? Is it just not on their radar?

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## Back In Black

Costs them money. My endo will only prescribe if I want more kids and I come off trt whilst I take HCG . The NHS see it as a fertility aid and nothing else.

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## krugerr

> Costs them money. My endo will only prescribe if I want more kids and I come off trt whilst I take HCG. The NHS see it as a fertility aid and nothing else.


Oh right, so basically you're destined to be shut down and atrophied, because the NHS wont front the cost on HCG . Bummer. Thanks though, I'll quix my Dr on it, but at least now I know not to expect too much from them!

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## Back In Black

It's pretty cheap anyway mate. I get my pins and barrels from the local health shop/needle exchange and a 10000iu vial lasts for months.

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## krugerr

> It's pretty cheap anyway mate. I get my pins and barrels from the local health shop/needle exchange and a 10000iu vial lasts for months.


I was just trying to be lazy, and hoping to get it from the Endo! How do you do yours? Long term use, do you draw it and freeze the pins with 250iu in each?>

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## Back In Black

Mix it with bac water in a sterile vial and keep in the fridge. 200iu's E3.5 days

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## krugerr

> Mix it with bac water in a sterile vial and keep in the fridge. 200iu's E3.5 days


Doesn't it degrade in the fridge? Anyway, thanks buddy! I'll do this  :Smilie:

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## Back In Black

> Doesn't it degrade in the fridge? Anyway, thanks buddy! I'll do this


Ga little. Not so much that it will make that much difference though.

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## krugerr

Only a few days in, and already im bored of having to rub bloody sticky gel onto my belly an wait 30 mins for it to absorb. Cant touch my kids or Mrs, or wear clothes after either. What idiot made this. 

Reading lots of user feedback on other forums and they're all claiming great results in a week. Suspicious much?! Ive a blood test next wednesday, and on 24th Feb. Im gonna tell him I want Nebido.

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## kelkel

You'll feel a difference with it soon. I actually liked the feeling I had on androgel just eventually could not maintain the levels I wanted, as well as slapping that crap on daily was killing me. Nebido is definitely the way to go though. Problem in the states is that they (FDA) reduced the dosage from 1000mgs to 750mgs, thus keeping everyone at a lower T level. Fvckers.

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## krugerr

> You'll feel a difference with it soon. I actually liked the feeling I had on androgel just eventually could not maintain the levels I wanted, as well as slapping that crap on daily was killing me. Nebido is definitely the way to go though. Problem in the states is that they (FDA) reduced the dosage from 1000mgs to 750mgs, thus keeping everyone at a lower T level. Fvckers.


I wasnt even aware you had it across the pond. Is that a recent thing? Or am I confusing myself  :Wink: 

Its slapping the stuff on twice a day thats the pain. I just cant be bothered with that. Necessity though, i'll persevere until I get Nebido. Thanks for the feedback though, Im not sure if placebo effect yet or not, but morning glory is a new feeling for me! haha

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## Back In Black

Problem is, unless you continue the gel after you start nebido you are likely to suffer a mini crash. Ideally, if you do get on nebido, you'll want to extend the gel for a couple of weeks.

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## krugerr

> Problem is, unless you continue the gel after you start nebido you are likely to suffer a mini crash. Ideally, if you do get on nebido, you'll want to extend the gel for a couple of weeks.


I hadn't considered that point. Well spotted bro. 

Do you have regular blood tests stillBIB? Or once. They're happy with the dose (1g / 10 weeks) they leave it running?

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## kelkel

> Problem is, unless you continue the gel after you start nebido you are likely to suffer a mini crash. Ideally, if you do get on nebido, you'll want to extend the gel for a couple of weeks.



Agreed.

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## Back In Black

> I hadn't considered that point. Well spotted bro. 
> 
> Do you have regular blood tests stillBIB? Or once. They're happy with the dose (1g / 10 weeks) they leave it running?
> 
> Sent from my iPhone using Forum


My initial protocol was 'every 10-12 weeks' according to the endo. My GP receptionist sees that as 12 weeks so I have to argue every time that I want it at 11 weeks. Dr's receptionists have to deal with a lot of sh1t but I think that's because they are b1tches lol

I get a full blood test once a year.

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## krugerr

> My initial protocol was 'every 10-12 weeks' according to the endo. My GP receptionist sees that as 12 weeks so I have to argue every time that I want it at 11 weeks. Dr's receptionists have to deal with a lot of sh1t but I think that's because they are b1tches lol
> 
> I get a full blood test once a year.


Thanks buddy! And thanks for the help guys!  :Smilie:

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## krugerr

Getting rashy and itchy at the application sites. Bummer!

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## DSS

> Getting rashy and itchy at the application sites. Bummer! Sent from my iPhone using Forum


Would added moisturiser after gel has dried help?

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## krugerr

> Would added moisturiser after gel has dried help?


Ive read that helps with absorption, but I still get rashy when I put it on.  :Frown:

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## DSS

On every site? Do you apply to same place?

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## krugerr

> On every site? Do you apply to same place?


Been applying belly and chest, both sites get itchy and rashy

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## DSS

Why not try shoulder/ upper arm and inner thighs also. keep rotating everyday stop the alcohol from drying your skin out. May help a bit.

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## krugerr

> Why not try shoulder/ upper arm and inner thighs also. keep rotating everyday stop the alcohol from drying your skin out. May help a bit.


I'll give it a go brother. Thanks for the advice!  :Smilie:

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## krugerr

Well yesterday I got my first shot of Nebido (1g/4ml). I have a blood test in 4 weeks to check levels. After that blood test hes going to advise my next injection date. 
Glad to have finally gotten somewhere! 

Hoping to see improvments in the coming weeks to mood and libido, as well as my mental state.

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## kelkel

Interested in seeing how you do krugerr. You should be due a booster shot around the 6 week mark.

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## krugerr

> Interested in seeing how you do krugerr. You should be due a booster shot around the 6 week mark.


Fingers crossed, eh!  :Wink: 

Yeah Id suspect a booster shot around then as well. Its funny, obviously many here use Nebido (Aveed) and praise it. However there are many out there that claim it doesnt work, and in fact has a half life of approximately 16.5days. And due to its injection protocol of 10 weeks, you end up with some pretty steep peaks and troughs. Peaking at around 72 hours, and then ending up extremely low right before the next injection. 

I cant seem to find a difinitive answer to the half life of Test Undecanoate. Answers range from 16.5days, to 21 days, to 54 days. 

Thoughts Kel? Either way, I still prefer to be on injections than those bloody gels!

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## krugerr

Some stuff right from their page. 






> *Absorption*
> Nebido is an intramuscularly administered depot preparation of testosterone undecanoate and thus circumvents the first-pass effect. Following intramuscular injection of testosterone undecanoate as an oily solution, the compound is gradually released from the depot and is almost completely cleaved by serum esterases into testosterone and undecanoic acid. An increase in serum levels of testosterone above basal values may be seen one day after administration.
> 
> *Steady-state conditions*
> After the 1st intramuscular injection of 1000 mg testosterone undecanoate to hypogonadal men, mean Cmax values of 38 nmol/L (11 ng/mL) were obtained after 7 days. The second dose was administered 6 weeks after the 1st injection and maximum testosterone concentrations of about 50 nmol/L (15 ng/mL) were reached. A constant dosing interval of 10 weeks was maintained during the following 3 administrations and steady-state conditions were achieved between the 3rd and the 5th administration. Mean Cmax and Cmin values of testosterone at steady-state were about 37 (11 ng/mL) and 16 nmol/L (5 ng/mL), respectively. The median intra- and interindividual variability (coefficient of variation, %) of Cmin values was 22% (range: 9–28%) and 34% (range: 25–48%), respectively.
> *
> Distribution*
> In serum of men, about 98% of the circulating testosterone is bound to sex hormone binding globulin (SHBG) and albumin. Only the free fraction of testosterone is considered as biologically active. Following intravenous infusion of testosterone to elderly men, the elimination half-life of testosterone was approximately one hour and an apparent volume of distribution of about 1.0 l/kg was determined.
> 
> ...





> Because of the observed accumulation of testosterone when Nebido® is administered at intervals of six weeks, 7 of the 14 patients subsequently received another 5 injections at intervals of 7–11 weeks, followed by 5 injections at intervals of 12 weeks. In only two patients did the treatment interval of up to 12 weeks lead to testosterone concentrations below the normal range right before the next injection; in all other patients, concentrations were within the normal range (Figure 12).47
> 
> This study demonstrated that testosterone levels do not accumulate with an injection interval of 12 weeks.47


Source: NebidoÂ® Monograph - Nebido - Testosterone Undecanoate

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## krugerr

> In a following study (Nieschlag et al 1999) 13 hypogonadal men received 4 intramuscular injections of TU at 6-week intervals. T serum levels were never found to lie below the lower limit of normal, and only briefly after the 3rd and 4th injection were T serum levels above the upper limit of normal (Figure 1) while values peak and trough levels increased over the 24-week observation period. Serum estradiol and DHT followed the same pattern, not exceeding the normal limits. In order to better establish (von Eckardstein and Nieschlag 2002) suitable injection intervals for TU, 7 hypogonadal men received injections at gradually increasing intervals between the 5th and 10th injection (starting with 6-weeks injection interval) and from then on every 12-weeks. Steady state kinetics were assessed after the 13th injection. *Cmax was 32.0 ± 11.7 nmol/L and half-life was 70.2 ± 21.1 days*. The mean Cmax of 32 nmol/L seen during steady-state with TU administration was lower than that achieved by Testogel® (Bayer) 100 mg/day (37.5 nmol/L); however, it was higher than with Testogel® 50 mg/day (28.8 nmol/L) and Androderm® (Watson Pharmaceuticals, Inc.,) patch 5mg/day (26.5 nmol/L). Before the next injection, the serum levels for T and its metabolites DHT and estradiol were mostly within the normal (eugonadal) range and showed a tendency to decrease with increasing injection intervals. The study concluded that after initial loading doses at 0 and 6-weeks, injection intervals of 12-weeks establish eugonadal values of serum testosterone in almost all men. A later study (Yassin and Saad 2005) analyzing 58 hypogonadal men receiving TU treatment every 3 months did not report elevations of DHT levels exceeding the physiological threshold.
> 
> *Source: Testosterone depot injection in male hypogonadism: a critical appraisal*


Funny - Lots of different answers regarding its half life! The majority are siding with it having a much longer half life than suggested on many forums (16.5-21days)

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## kelkel

> Funny - Lots of different answers regarding its half life! The majority are siding with it having a much longer half life than suggested on many forums (16.5-21days)


I see no reason to not believe the package insert as well as the anecdotal information from other members using it. Only variable would be the person's metabolism.

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## krugerr

> I see no reason to not believe the package insert as well as the anecdotal information from other members using it. Only variable would be the person's metabolism.


I was just reading many variations on the half life of Test Undecanoate. I agree with you, no reason to disbelieve the manufacturer. It's an approved drug for UK and US. To pass both of these it must be doing something right!

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## Back In Black

Krugerr, I was told that due to the size of the injection, 4ml, that delays absorption/release; hence the long period between shots.

Your booster should be 6 weeks, not based on bloodwork.mits a standard protocol issued by nebido manufacturer. Don't get shafted by your endo, go armed.

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## krugerr

> Krugerr, I was told that due to the size of the injection, 4ml, that delays absorption/release; hence the long period between shots. Your booster should be 6 weeks, not based on bloodwork.mits a standard protocol issued by nebido manufacturer. Don't get shafted by your endo, go armed.


Oh, funny. As they state on their website that splitting it into 2ml x2 would cause no difference in absorption. Haha. 
Yeah I'll go armed. Thanks guys. I've just put together a spreadsheet and graph to track my results and visually. 

My 24/02/16 results 
Testosterone - 4.4 nmol/L (normal range is 10-25)
Free Testosterone - 72 ng/dl (Normal range 300-950)

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## krugerr

For anyone interested in visuals. I've plotted the blood levels and Nebido. 

The Nebido is forecast right now using the exponential decay formula (half life of 90 days). 

I'll add my actual blood tests to it and hopefully it will reflect the Nebido levels.

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## krugerr

ood test from the 1st April 
After 4 weeks since my Nebido shot. Things are going in the right direction! Booster shot in two weeks. 

Testosterone - 9.8 nmol/L (normal range is 10-25) 
Free Testosterone - 225 ng/dl (Normal range 300-950) 



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## krugerr

So just got the results back from my latest blood test, 19 weeks after starting TRT. And they've dropped again... below are the figures. Ive attached a graph, because Im an excel geek and visually it makes more sense. 
I had a full blood panel done with the blood test, so i'll post up all the results once I have them. Is there anything obvious though that would cause my levels to still be this low?



1st Blood Test (Before) - 24/02/2016- Free Test 4.4nmol/L // Total Test 72 ng/dl
First Nebido - 03/03/2016 - 1000mg
2nd Blood Test (After 4 weeks) - 01/04/2016 - Free Test 9.8nmol/L // Total Test 225 ng/dl
Second Nebido - 02/06/2016 - 1000mg
3rd Blood Test (After 6 weeks) - 14/07/2016 - Free Test 7.1nmol/L // Total Test 201 ng/dl

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## hammerheart

B***r recommends a "loading" pin of Nebido at week 6, repeated a second time if needed. It's even reported in the leaflet.

Did you go this route or are you sticking to a fixed ten weeks interval since the start?

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## krugerr

> B***r recommends a "loading" pin of Nebido at week 6, repeated a second time if needed. It's even reported in the leaflet.
> 
> Did you go this route or are you sticking to a fixed ten weeks interval since the start?


Unfortunately my Doc wouldnt do the booster, Im also on a 12 week interval.
Im going to discuss bringing this forward to a 10 week protocol, and possibly get him to sign off on a booster.

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## krugerr

Got full blood results back. Bare in mind that LH/FSH is low due to TRT for a while. Attached is the image, for anyone unable to see the table. 

*Free Testosterone*
*201 pmol/L*
*225-9999 pmol/L*

Serum TSH Level (XRCC)
3.5 mu/L
0.35-4.5 mu/L

*Serum Testosterone*
*7.1 nmol/L*
*10 - 35 nmol/L*

Serum Sex Hormone Binding Globin
17 nmol/L
10 - 70 nmol/L

*Serum Cholesterol*
*4.9 mmol*
*<5.2 mmol/L*

*Serum Triglycerides*
*2.11 mmol/L*
*0.28 - 2.2 mmol/L*

Serum HDL Cholesterol
1.02 mmol/L
1 - 10 mmol/L

*Calculated LDL Cholesterol*
*2.9 mmol/L*
*<3 mmol/L*

*Serum Cholesterol/HDL Ratio*
*4.8*
*<4*

*Serum LH Level*
*<0.3 u/L*
*2 - 9 u/L*

*Serum FSH Level*
*0.8 u/L*
*1 - 18 u/L*

Serum Oestradiol Level (XRCC)
102 pmol/L
0 - 146 pmol

*Haemoglobin Estimation*
*183 g/L*
*130 - 180 g/L*

Total White Cell Count
5.3 (10*9/L)
4 - 11 (10*9/L)

Platelet Count
182 (10*9/L)
150 - 500 (10*9/L)

*Red Blood Cell Count*
*6.28 (10*12/L)*
*4.5 - 6.5 (10*12/L)*

*Haemocrit*
*0.52 L/L*
*0.38 - 0.54 L/L*

Mean Corpuscular Volume (MCV)
82.8 fL
76 - 103 fL

Mean Corpusc Haemoglobin (MCH)
29.1 pg
27 - 32 pg

Mean Corpusc Hb Conc (MCHC)
352 g/L
310 - 360 g/L

Red Blood Cell Distribution Width
12.8 %CV
11 - 16 %CV

Percentage Hypochromic Cells
0.1 %
0 - 2.5 %

Neutrophil
2.86 (10*9/L)
1.5 - 8 (10*9/L)

Lymphocyte Count
1.8 (10*9/L)
1.3 - 4 (10*9/L)

Monocyte Count
0.32 (10*9/L)
0.2 - 0.8 (10*9/L)

Eosinophil Count
0.16 (10*9/L)
 0.0 - 0.8 (10*9/L)

Basophil Count
0.05 (10*9/L)
0.0 - 0.3 (10*9/L)

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## krugerr

Closed. New thread in appropriate forum.

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