TRT Dosing And Frequency Breakdown With Dr. Peter Attia

Summary

The video script discusses optimal dosing and injection frequency for testosterone replacement therapy (TRT). It highlights the importance of patient adherence and the impact of half-life on steady-state serum concentrations. The conversation explores different dosing strategies, including once weekly, twice weekly, and daily injections, and their effects on hormone levels and side effects. The script also touches on the use of different testosterone esters, administration routes (subcutaneous vs. intramuscular), and the benefits of more frequent dosing to mimic natural hormone fluctuations and reduce side effects.

Takeaways

• 😀 The script discusses the advantages of different dosing frequencies for hormone therapy, particularly for testosterone.
• 🤔 The half-life of a drug, such as testosterone cypionate with a half-life of 10 days, plays a significant role in determining dosing schedules for steady state serum concentrations.
• 💉 Injecting more frequently can be beneficial for patient adherence and achieving a more stable hormone level, but it also depends on individual preferences and habits.
• 📉 The script suggests that more frequent injections can lead to less hormone fluctuation and potentially lower side effects.
• 🚀 Daily injections, while difficult to administer, can result in less suppression of FSH and LH, indicating a possible link between peak hormone levels and suppression.
• 📚 The literature often assesses dose response a week after injection, which may not reflect the optimal dosing for hormone optimization.
• 🔍 Personal observations and experiences suggest that more frequent injections can reduce aromatization spikes and 5-alpha reduction.
• 🌡️ The script mentions the use of nesto, a nasal formulation of testosterone with a short half-life, requiring a tid dosing schedule.
• 🏥 The FDA-approved formulations, like nesto, are preferable for their safety and standardized dosing compared to compounding.
• 🌟 The goal of hormone therapy should be to replicate natural hormone fluctuations as closely as possible to minimize side effects and optimize health.
• 💊 Differences between cypionate and enanthate are discussed, with enanthate having a half-life intermediate between cypionate and propionate, and the convenience of pre-loaded pens for some patients.

Q & A

What is the main topic of discussion in the provided transcript?

The main topic of discussion is the dosing frequency and methods of administering testosterone replacement therapy (TRT), including the advantages and disadvantages of different dosing schedules and injection techniques.

What is the half-life of testosterone cypionate as mentioned in the transcript?

The half-life of testosterone cypionate is mentioned as approximately 10 days.

What is the significance of achieving steady-state serum concentrations in the context of TRT?

Achieving steady-state serum concentrations is important as it indicates a stable level of the hormone in the blood, which helps to minimize fluctuations and potential side effects, thus more closely mimicking natural hormone levels.

Why might a patient prefer a more frequent injection schedule for TRT?

A more frequent injection schedule can help maintain a more stable hormone level, reduce the spike in hormone levels that can lead to side effects, and potentially improve the quality of life by more closely replicating the body's natural hormone rhythm.

What is the 'sweet spot' for TRT dosing frequency according to the discussion?

The 'sweet spot' for TRT dosing frequency is suggested to be twice a week, which provides a balance between maintaining stable hormone levels and patient adherence.

What is the difference between daily injections and weekly injections in terms of hormone suppression?

Daily injections of testosterone can result in less suppression of FSH and LH compared to weekly injections, suggesting that the peak hormone levels associated with larger doses may have more impact on hormone suppression.

What are the potential side effects of a large, infrequent dose of testosterone?

A large, infrequent dose of testosterone can lead to super-physiological levels of the hormone and its metabolites, which may cause an aggressive spike in free androgenic signaling, potentially impairing sleep quality, increasing red blood cell production, and activating the sympathetic nervous system.

What is the significance of the FDA formulation of a nasal testosterone product mentioned in the transcript?

The FDA formulation of a nasal testosterone product is significant because it offers a short half-life, allowing for more frequent dosing and potentially fewer side effects. It also provides a convenient, pre-loaded option for those who are squeamish about injections.

How does the pharmacokinetics of subcutaneous (subq) injection compare to intramuscular (IM) injection according to the transcript?

Subcutaneous injection may provide a more sustained release of the hormone due to its absorption through fat tissue, potentially leading to higher total testosterone levels when measured a week after injection compared to intramuscular injection.

What is the difference between testosterone cypionate and enanthate in terms of dosing and administration?

Testosterone enanthate is considered to have a shorter half-life compared to cypionate, making it more suitable for more frequent dosing. It is also available in a pre-loaded pen, which may be more convenient for some patients, but may limit the ability to adjust dosages.

What is the potential impact of more frequent TRT dosing on aromatization and 5-alpha reduction?

More frequent TRT dosing can potentially lower the spikes in aromatization and 5-alpha reduction, which are processes that convert testosterone into other hormones, thus helping to manage side effects related to these conversions.