There are several different versions of TRT (Testosterone Replacement Therapy) that someone with Klinefelter’s Syndrome / 47 XXY can choose from. This choice is normally made by your Endocrinologist (endo) when you are first diagnosed (should you need / want TRT).
Typical TRT therapies are Gels (Androgel, Testim, Testogel, Tostran), injectables (Nebido, Sustanon, Cypionate, Enanthate), implants (Testopel) and capsules (Jatenzo).
Gels are provided in various strengths depending on what has been prescribed. All are prescription medications, and all are applied topically to either the shoulders, upper arms, or the stomach area.
Gels carry similar risks to that of injectables and capsules; however, gels also carry the risk of being transferred to other people such as women and children.
These risks can be very serious in that a child could have abnormal sexual changes and women could have an increase in body hair in unwanted areas. Gels are also more dangerous to women who are pregnant as it may damage the unborn baby. You should also not consider gels if your partner has or had Her2 positive breast cancer.
Nebido is a registered intramuscular injectable testosterone (undecanoate) and is a very long chain fatty acid. The dose is 1000 mg in 4 ml of castor oil. This version of TRT is designed to be injected every 8 – 14 weeks (dependent on T levels / regime). Nebido is a depot injection given by your GP or Nurse, into the muscle in your buttock, which provides a reservoir which slowly releases TRT into your bloodstream. This injection is designed to be injected slowly over a period of 2 minutes.
As with all bioidentical TRT side effects are common but not everyone will experience any or all the adverse side effects. When I was on Nebido the main side effects I had were Acne, Red Blood Cell count increase and change in sex drive.
- Acne
- Weight gain
- Breast pain, gynaecomastia
- Increase in red blood cell count
- Depression, anxiety, nervousness
- Soreness / Pain at the injection site
- Persistent painful erection (priapism)
- Prostate problems – increased PSA levels
- Mood changes
- Change of sex drive
Sustanon 250 is a blend of short, medium, and longer chain fatty acids made up of 4 different versions of testosterone (30mg propionate, 60mg phenyl propionate, 60mg isocaproate, 100mg decanoate) in a 1ml vial with Arachis oil (peanut). Anybody allergic to peanuts or soya should not take Sustanon.
Sustanon is injected every 2 – 3 weeks depending on regimen. The dose can be split and taken as 125ml dose weekly.
The side effects of Sustanon mimic those of Nebido and as this version of TRT is smaller is dose, injection times are lessened – max 30 seconds injection time. Most people who take Sustanon opt to self-inject as 2 – 3 weekly visits to the doctors are unviable / unsustainable.
Cypionate is a single medium length fatty acid testosterone ester. Dosages vary from 12.5mg injected daily via subcutaneous injection (which means much smaller differences in peak and trough levels and much less T is converted to oestrogen) to 80/100 mg every 4-6 days or 100mg every 4-7 days injected intramuscularly.
It is recommended that Cypionate is dosed with HCG (Human Chorionic Gonadotropin). Traditional TRT suppresses Luteinizing Hormones (LH) and Follicle Stimulating Hormones (FSH) which leads to infertility, testicular atrophy, and lower libido.
Cypionate is suspended in olive oil which makes it ideal for people who are allergic to peanut and soya oil.
Enanthate is a TRT very similar and interchangeable with Cypionate. However due to the carrier oil that Enanthate is suspended in (Sesame oil), it is less suitable for subcutaneous injection.
Dosage is 12.5mg injected daily via a shallow intramuscular injection.
Propionate is a short length fatty acid testosterone ester. Dosages are everyday or every other day. The half-life is approx. 19 hours after a single injection. Dependent on the GP and patient Propionate is sometimes combined with Cypionate or Enanthate to combine both faster acting and slower acting esters.
Dosage levels are 20mg – 25mg per day or every other day. 20mg daily injections have been known to give 40 nmol/L blood trough levels on the day or next morning before the next injection.
Testopel (USA) / (Testo – 100 (UK)) is an implant that is inserted under the skin under local anaesthetic. The dose is normally between 100 – 400 mg and each implant lasts 4 – 6 months.
Side effects mimic those of Nebido. Implanted testosterone pellets also carry risks of infection at the site of insertion and can also come out of the skin.
Jatenzo is an oral testosterone capsule which is designed to be taken twice a day. This form of TRT is made in the USA and has after many years, been approved by the FDA.
HCG (Human chorionic gonadotropin) is a hormone normally associated with pregnant women as it is produced by cells that surround a growing embryo.
Bodybuilders take HCG to restore testicular function and recovery from a steroid cycle. In people with Klinefelter’s Syndrome injecting with HCG alongside their TRT reverses testicular atrophy and mimics luteinizing hormone (LH) levels and Follicle Stimulating Hormones (FSH) which are typically suppressed from taking TRT on its own.
HCG is also known to increase penile length and girth 1
