Ashim Matthan: Hi everyone welcome to the RhinoMight podcast, my name is Ashim and I’m with Dr. Kanishk.

Dr. Kanishk: Hi everyone.

Ashim Matthan: And this is episode six of the RhinoMight podcast. Today’s topic is how to calculate your TRT dose. Now we’ve seen clinically… in a clinical experience we’ve seen that there are people who are hyper responders as well as slow responders. The general guidelines for TRT doses is anywhere from 75 mg per week to 300 mg per week. And we’ve seen people who fall well within these general guidelines as well as people who are outliers, people who respond beautifully with just 50 mg a week which is nothing, and guys for whom 300 mg is too less. So when you’re going to go about selecting your TRT dose there is going to be a brief period in the beginning we can… you can call it a transitioning period where you’re going to have to feel your way through and we’re going to give you a list of guidelines on how to know clinically whether or not you’re falling into the right TRT dose spectrum.

Now with that being said I’m going to hand it over to Kanishk to go over what are the different frequencies at which you can inject yourself or administer TRT. Let’s actually talk about the different formats of TRT that we have, where we have got gels etc.

Dr. Kanishk: So there are various forms of Testosterone. Testosterone can be taken as gels. It can be taken as injections. It can be given as patches but those are not available to us here. But in worldwide use of Testosterone that you can use Testosterone as gels, the bio-availability of Testosterone as compared to injections is less. So the most preferred form of Testosterone Replacement Therapy with the least amount of side effects and the most benefits is by injections. So some of the frequencies that are there for Testosterone injections can be ranging from daily dosing to every alternate day dosing to three times a week which can be Monday, Wednesday, Friday or it can be twice a week, let’s say Monday and Thursday, split between three and a half days in frequency. And it can also go for once a week. But this is for long-acting esters which is especially Testosterone Enanthate.

Ashim Matthan: Right, so we have the next topic which is going to be the different compounds that you can use, the different esters. So if let’s say so, by and large we’re going to be discussing Testosterone injections in this video. There are creams. There are compounding pharmacies in the U.S. We don’t have this stuff available in India, so I’m not going to get into it because we’re speaking from Mumbai, India and this is about TRT in India. That’s where we practice.

With that being said you have got Testosterone Enanthate. You’ve got Testosterone Propionate. You’ve got Testosterone Cypionate and these are the three which are the least liver toxic, the least. It’s actually the easiest on the liver. These are the three esters that make Testosterone break down the metabolization of Testosterone the simplest, easiest for your liver. And of course there are other esters that can get added to it. You have Sustanon which is a group of Testosterone esters put together. You’ve got other customized, you know, there are various companies that manufacture Testosterone and each one has their own like Testosterone six esters, Testosterone eight esters, etc. So they like to bring all of that down. There is even a Testosterone suspension which is no ester. It’s pure Testosterone that’s been given to you. So there are people that sometimes inject Testosterone no ester three times a day. So you have got to measure certain things, you got to gauge. First you got to figure out what your dose is roughly. You got to figure out what your frequency should be. We’re going to get into how to calculate your frequency in the next bit and then you’ve got to figure out what type of Testosterone ester is available to you for you to use and which agrees with you like for example Testosterone Propionate is a very fast-acting ester. It is in fact the least difficult on the liver because it’s in and out very quickly and like theoretically you would think about it and say that this is actually going to be the best one to take, especially if you’re going to do something like daily dosing. But the thing is that Testosterone Propionate has ups and downs that take place within the course of 24 hours. So if you’re someone who enjoys having highs and lows and not a lot of us fall into that category. Most people would like to have Testosterone in very-very stable blood levels in your system. So if you have Testosterone that is ricocheting as up and down you’re not going to enjoy it. Some people don’t enjoy it. Some people look forward to it. So it just depends on what your preferences are and then you’ve got Testosterone Enanthate and Cypionate which are the next ones which are the best for you and what we like to work with. But theoretically if you’re going to do daily dosing you can play with any Testosterone ester and it’s just going to keep compounding on itself and giving you more and more stable levels down the line. With that being said we should hop into what are the types of blood tests that you should do.

So these blood tests are going to determine rough understanding of your dose as well as the frequency. You should get your total Testosterone levels checked. You should get your SHBG values checked. You get blood albumin levels and you should get free Testosterone level checked. And if you have a total Testosterone you will come, you’ll realize like if it falls within certain ranges you know if it’s in the say higher ranges of 600-800 and you still clinically feel that you need TRT then you’re not going to need a huge dose of it. At the same time if your Testosterone values are like really low I would say in the 200s or 300 then you know that okay if I push it, push my TRT my Testosterone dosage to 200-300 it’s not going to be that much of a jump. And since it’s going to be significant jump it’s not going to be something that’s way out of the reference range, that we want the total Testosterone to be at. SHBG is really significant because it’s going to determine whether or not your body is holding on to Testosterone or whether it’s releasing it feeling into the blood. If your SHBG value is very high or on the higher end of the spectrum of the reference range that they give you then it means that your body is holding on to too much Testosterone.

In this case taking frequent doses is not going to be the best solution for you initially. Your first phase would be to break this SHBG value down and we want to lower it. The lower it is it means that that much free Test is roaming in your body. These two are inversely proportional. If your SHBG value is high then your free Test is going to be low. If your SHBG is low your free Test is going to be high. Of course this is not an absolute statement. This comes with caveats. There is another chemical called Estrogen that’s also associated with it. You might be one of these unfortunate people who have low SHBG and you’ve got low free Tests and you got very high Estrogen. So there are various combinations and probably in a Q&A session we can go over each type of scenario but the overall trend is if your SHBG is very-very low you can do frequent dosing and frequent dosing is actually the way you should go because if you take a big dose of Testosterone just assume most of it is going to go to waste. All of it will get, the bulk of it will get converted to free tests. Your free Test is of course not going to get consumed by your body because it will reach super physiological levels and in that short interim of time and then is either going to get converted to Estrogen or just going to fizzle out because there is no need for it. So you want daily dosing and if you have no SHBG you want free daily dosing or like maybe every other day dosing and that’s going to be good. If you are someone who has high SHBG you want something like once a week or twice a week shots but big doses going in at that time to crash your SHBG and then of course once your SHBG lowers over time you can shift to daily dosing or every other day dozing and if your SHBG is well within the reference range even something like three times a week or two times a week that is convenient for you and with something that you can adhere to like a lifestyle practice you should roll with that. Sorry I have spoken a lot. I want to give hand it over to Kanishka because he wants to talk about albumin as well as the finer aspects of SHBG that I’ve skipped over.

Dr. Kanishk: So when you have SHBG. SHBG can be raised in certain conditions if you have a lot of baggage with you. Let’s say that you are somebody who’s suffering from autoimmune diseases like asthma or allergies as such. Your body is in a constant state of stress and that constant state of stress will raise the SHBG. So it may not just have to do with your Testosterone levels but the number of diseases that you are carrying for. One of the best signs of knowing that your Testosterone is working for you is when you start feeling those diseases and their effects to be completely reduced from what they are from their baseline. Let’s say that you are somebody who woke up every day sneezing. On Testosterone you should not be waking up sneezing that means that the Testosterone is working for you. Testosterone is one of the best healers in our body. It will work for you to fight diseases and illnesses that are holding you back.

So how do you know what are the good signs of ideal TRT dose like what are the signs of an ideal TRT dose. You would say that the first improvement you may notice is in mood. The second improvement may be in your libido. It may be in your exercise capacity where workout to workouts you will recover from recover very easily basically and your mood and your mental fog basically let’s say that you are having difficulty performing daily tasks you will be able to perform those tasks easily as well as remember. A lot of the things that people say about mental fog is you start out with a plan to achieve certain things in a day and during the day you lose track of the plan and you end up looking back at the day and saying that you barely achieved anything on your task list and this thing tends to get abolished when your Testosterone dose is good.

I would like to hand over to Ashim to talk about how to see the bad signs of Testosterone. So please Ashim.

Ashim Matthan: Yeah so what I want to talk about and I want to touch upon again is that everybody’s TRT journey is going to be a little different. We all fall into the same pattern of lifestyle improvement but how it’s going to impact everybody is a little different from person to person. So you have got people who say for example they might come in with a good libido, they might have good exercise capacity but they’ve got mental fog and for them their TRT journey is going to involve a pivotal moment for them which is going to decide that oh yeah this is working for me is going to be that complete eradication of mental fog when they’re really on the ball dialed in mentally all the time wired. So this is how it works for them and everybody’s going to be really different. It just depends on how much baggage you’re bringing into your TRT like Kanishk mentioned if you’ve got allergies, if you’ve got other illnesses, you’ve got diseases, you’ve got IBS which is digestion issues etc. all of these things like, think of it as Testosterone is going to help you fight various battles that are going on. If you have many battles that are coming in with then A, your dose is going to also have to be adjusted for that and then also it’s going to be take time for each battle to be won and as you keep winning each battle you’re going to have qualitative improvement that’s going to take place. It’s up to you to be aware of it like one of the things that we talk about you know I think almost every single one of our podcasts is that when you enter this side of lifestyle of say even if it’s low-dose cycling or anabolic steroids or Testosterone Replacement Therapy or hormone Replacement Therapy you have to be hyper aware of yourself. So small-small changes that start you got to be aware of it and if it’s moving in the right direction you got to capitalize on that and be aware of it. And the second it’s not moving in that direction or it’s moving in the opposite direction you’ve got to be aware of that as well. So one of the things like several things that are there which are clinical signs of knowing that your TRT dose is not dialed in is when you have frequent headaches, when you have acne, you’ve got hair fall, you have a lot of restlessness that’s taking place you know that your dose is not good. So if your dose is very very low the problem is with high doses, the problem is with, sorry it’s the opposite. The problem is with high doses if your dose is really low guess what you’re going to probably still feel the same as you did before you started TRT that’s how you know that your dose is in right you got to increase it. So even if you start at say a conservative reference range of whatever value that you decide upon you will come to know that this is good for me or this is too low because you’re not going to feel any of the benefits of TRT and then if you start feeling signs of like headache, acne, hair fall, restlessness then you know that oh this dose is too high I got to cut it down a little bit. You could also start developing gyno. So when you come into all of this the bad aspects of Testosterone or rather the side effects that we don’t want and if any one of them starts popping up frequently then it’s going to mean that your dose is too high or maybe the frequency has to be adjusted etc. So there are times and I want to just reiterate how important frequency is. There are people who sometimes think that they need 400 mg of tests because they’re used to taking 200 and 200 basically 400 split into two doses, twice a week. And when they shift to something like daily dosing or maybe three times a week or every other day. So every other day and they read and every and three times a week is a little different because three times a week means like Monday, Wednesday, Friday or Tuesday, Thursday, Saturday where there are three fixed dates. Every other day means you are basically doing it three point five times because in week one you’ll be doing it same one day Wednesday, Friday, Sunday, and then week two is going to be Tuesday, Thursday, Saturday. So there is a small difference within these between these two and when they shift to something like that to a more frequent dosing they can overall lower their dose a little bit and they get better benefits. So it’s like you’re injecting less stuff into you you’re injecting it more frequently but you’re getting much more out of it. So it’s worth it for them. So you must keep this in mind. One of one of the things that we’ve noticed over all this time that we’ve been helping people and that we’ve been in this based on our clinical experience what we’ve noticed is the concept that people are a little unaware of as yet which is called pilot syringes. So a lot of times when you tell someone who’s used to taking heavy doses or say a bodybuilder or even someone who’s used to buying ampoules at a time they’re going to think that oh I’m going to be wasting it like you just if someone was to say that hey just take 100 mg three times a week and they’re going to be like oh but what about like in an ampoule you get 250 mg. So what am I doing with the remaining 150? am I just going to discard it? So here is where pilot syringes come in. The second you break an ampoule your first job is to take a 2ml syringe and that’s going to be a pilot syringe you draw out that entire 1 ml or 250 mg or 300 mg if it’s in some cases from that ampoule. Actually why don’t you dive into this more.

Dr. Kanishk: Let’s say that you have ampules of Testosterone each ampule is reconstituted as 250 mg per ml. You take one 2 ml syringe, you attach an 18 gauge needle to it. You break open the vial. You load the whole of the 1ml in that 2ml syringe. Now this 1ml syringe is your pilot syringe. This will be used to load your injections based on your dosage. So if your dose is 100 mg you will load one cylinder 100 mg and the remaining 150 mg can be stored in a fridge or somewhere where there is no sunlight in the temperature between 30 to 35 degrees or room temperature and that Testosterone will last you for a month. It will not get spoiled. That way you can prevent wastage and you can keep your cost of TRT also down.

Ashim Matthan: Yeah so when you look at TRT it’s not supposed to be a pit stop in your life. It’s supposed to be part of your lifestyle. It’s something that’s going to be a part of who you are so to say. So the way we would like to do it is you take, you build up maybe one or two pilot syringes and then you have a kit you have a TRT kit that is there. You’ve got syringes lined up for every day of the week or whatever your frequency of dosage is say Monday, Wednesday, Friday you got three syringes lined up and then you pre-fill each of them. You either back load or front load depending on the thickness of the oil. With some companies you can pass it through an insulin syringe and with some of them you can pass it through a 1ml tuberculin syringe. So depending on what is available to you what the thickness of your oil the density of it you line it up accordingly. In fact this leads me to my last point that we want to make which is subcutaneous versus intramuscular injections and a lot, in the middle for a brief period of time everybody was really obsessed with SubQ shots but based on our clinical experience looking at the data that we have blood reports that have come in, etc. We can tell you that for the overwhelming I won’t say everybody because I don’t want to make absolute statements but I will say that an overwhelming majority of people do not do well on subcutaneous shots. SubQ shots always end up leading to more Estrogen formation. So we don’t want aromatization of Testosterone to Estrogen to take place. So don’t do SubQ you can do intramuscular shots. If you want information on how you can do more and more intramuscular shots and there are so many sites on the body we suggest that you go to a website called spotinjections.com and there are 14 sites that we have. You’ve got two sites on the glutes. You’ve got your pecs. You’ve got your delts. You’ve got your lats and you’ve got your quads and you’ve got your biceps. So you’ve got 7 sites and on each side of your body so that’s 14 sites in total and you can exhaust all of them. I think Kanishk will also reiterate this and he’s going to definitely emphasize this that if you’re going to get into certain dangerous sites like your biceps, triceps, etc. because theoretically you can inject into any muscle that is there. It’s intramuscular every muscle is like is game for it but you should not venture into these things without medical supervision because it can get dangerous sometimes for example the inside of your bicep closer to your torso your arm that entire side of your arm that is closer to your torso there is a lot of various nerves and veins that are passing through it very-very critical blood vessels. So you don’t want to mess around with that nick something that you don’t need to nick. So we should be very very careful with that stuff but yeah overall you can safely play within like six to eight injection sites and that way you shouldn’t have an issue because you’re not going to be injecting huge amounts of oil or Testosterone into any muscle. You don’t need a very very long syringe. So if your oil is really good then you can just take an insulin syringe and you can hit iron shots even with that and it’s going to cause the least amount of intrusion into the body so the least amount of damage which is going to be and it will heal. One of the other practical things that we’ve noticed is that if you whichever muscle you hit, whichever muscle that you inject into you should probably train that muscle for like 50 to 100 reps that day. This seems contrary to what a lot of medical textbooks will say but based on our experience if you inject in a particular area and you train that muscle later on I’m not saying immediately maybe like over the course of the day what’s going to happen is you’re going to dissipate all of the oil that may even have gathered in that spot. So you’re going to force it to A, get you the site the local benefits that you wanted and it does happen that way and too it’s also going to get dissipated into the rest of the body and broken down faster. So that’s one aspect. We should also be discussing on like healthiness and cleanliness. I am going to hand that over to Kanishk because we’ve seen, I mean Kanishk will know much more about this.

Dr. Kanishk: So in our clinical experience what we see is most of the bodybuilders like not most but some of them like to take their shots in areas which are not clean you know like in bathrooms, in locker rooms. These are the gym rats that you see taking these shots in dirty areas where there is no cleanliness. So we tell you that when you are opening a vile you are making an injection try to do it in clean areas, use proper precautions, use alcohol swabs to clean your skin. If you are taking a bath after the shot that’s very good. It is advisable that heat and the hot water bath will allow the oil to be absorbed smoothly in the body and it will not cause any blebs. If you get any blebs make sure to clean them every single day and apply cortisol creams or Betnovate or Beta-methylsome creams on it and make sure that those heal up as quickly as possible. At the first sign of infection don’t wait for that infection to fester and become into an abscess. Make sure that it is attended by a physician or if you have access to antibiotics which have worked for you in the past for these blebs you start those antibiotics immediately. Do not allow these injections to cause any side effects of these kinds which are which can be prevented by using clean measures, sterile measures basically.

Ashim Matthan: All right. You think we should run through a wrap-up and just summarize everything because this has been a very long podcast. I think this might be the longest podcast that we’ve had. We’ve also been MIA for a while and I’m just so I’m making the light of this like I know it’s a like sense of humor is different for everybody but generally when we drop off the radar with our podcast you should assume that we’re working very hard. It’s not like we’re lazy and we don’t want to put out content. There is a lot of content that we should be talking about. We’re still waiting right. We still have a whole backlog of Q&As that we should get to but yeah when we’re not making podcasts you should assume that we’re very busy and we apologize for that and when we are making podcasts it’s the opposite that we have time and therefore dedicate ourselves to doing hopefully doing a good job in conveying all this information to you.

Dr. Kanishk: Or we have had some canceled appointments.

Ashim Matthan: Yeah. That as well. So we have, this is the scenario and now let’s wrap up this entire podcast. So we had, this topic of episode 6 was how to calculate your TRT dose. We went over the different, the guidelines of your TRT dose which is 75 mg to 300 mg per week. We talked about other factors that are very very dependent on this which is your frequency of dosing and how different frequencies can alter how you feel which leads us to talk about the blood test that you’re supposed to be doing which is your total Testosterone, SHBG, blood albumin and free Testosterone and this should tell you roughly what your dosage frequency should be. It will also tell you how much what your dose dosage should be in terms of theoretically because what is there in theory and what is in practice is not always the same and we all know that. And then we should talk about what are the signs of an ideal TRT dose which is your good libido, good exercise capacity where you have good recovery from your workouts as well. One of the things that Kanishk and I joke about is that when you’re on TRT you don’t need pre-workouts the second you touch the dumbbell or barbell or whatever the second you set foot in the gym and start anything your body is going to start responding very-very quickly that’s how also you know that your TRT dose is dialed in. Point number three would be mood upliftment and the last one would be a clearing of your mental fog and then these are all the benefits of TRT dosing. Let’s talk about the negatives that you know that your dose is too high. If your dose is too high you are going to know that you’ve got headaches, you’ve got acne you’ve got hair fall and you’ve got restlessness. Then if your dose is too less you’re just not going to feel any of the benefits of TRT. So you know that that’s too little you’ve got to dial up the dose a little. Now that leads us to the next point which was pilot syringes and how the concept of building pilot syringes from ampoules and storing them in and creating your own TRT kit in a sanitized and clean environment. I mean it doesn’t have to be like clinically sanitized not everybody has that luxury but it should be clean in general. You shouldn’t be doing it in locker rooms or bathrooms where there is a lot of bacteria and infections floating around in the air.

Dr. Kanishk: Yeah and because of COVID and corona virus there is a lot of access to sanitizers everywhere. So please use them. Make sure to clean your kits. Make sure that your syringes are kept in a clean and dry place so that you don’t risk any life-threatening infections like flesh eating bacteria’s which can happen if they are kept in dirty places. And don’t use reuse needles. That is very important.

Ashim Matthan: Yeah. Basic hygiene parameters that sometimes we take for granted and we overlook well we shouldn’t and the last point was, actually no I think that we covered everything. We have that’s the whole. This is how this you go around calculating your TRT dose. There are a lot of videos online about Testosterone Replacement Therapy. There are videos on Testosterone that break it down we just wanted to play within what is practical stuff like what we refer to as actionable intelligence stuff that you guys can put into practice immediately. So yeah please contact us on Instagram or YouTube because that’s where this podcast is. If you have any questions regarding Testosterone Replacement Therapy,

Dr. Kanishk: Please do let us know.

Ashim Matthan: Yeah. And thanks a lot for watching this video, listening to our podcast. We appreciate it and we’ll see you soon.