Testosterone issues - labs and dose

[Tman]

Hi -

I am new here and came here because I am desperate and need help. I lost my testicles 10 years ago and have been on T ever since. Started on cypionate shots, then cream,then gel. Over the last few years, I have had symptoms of hair loss, chronic fatigue, anxiety, waking through the night, poor appetite, cold hands/feet, low libido, brain fog, muscular fatigue...to name a few. Saw and endo...he thought anti-depressants would help, but I am not really depressed (expect for the symptoms!).

Currently, I am on 75mg compounded gel (25mg/gm) in the AM. I was taking 50mg in the AM and 25mg at night, but thought I would switch to try something different to see if it helped. I can't seem to find anything that helps.

Just got some labs back.....

DHT 176ng/dl (AM) 168ng/dl (PM) (25-75)
Free T 36.8 pg/ml .85% (AM) 13.8 pg/ml .57% (PM) (1.0-3.1%) (35 - 155pg/ml)
Total T 434 ng/dl (AM) 242 ng/dl (PM) (250-1100)
E2 32 pg/ml (AM) <20pg/ml (PM) (no reference range)
Estrogen 137 pg/ml (AM) 354 pg/ml (PM) (< 130)

I need help. Does T gel stop working well after a few years? Would shots possibly be more helpful? I haven't been able to find a doc that will take my T concerns seriously. My body is converting a lot. I know about Arimadex, but am wondering if the vehicle of administration or some other issue would help before adding another medication.

Any advice is appreciated.

[Michael112]

Does T gel stop working well after a few years?

I am guessing it shouldnt

Would shots possibly be more helpful?

Possibly


Why did you switch from injections?

Those numbers arnt all that helpfull without lab ranges and SHBG.

Have you had your thyroid(TSH, FT3, FT4) and adrenals(Cortisol) tested?

[Tman]

Thanks for the reply Michael -

I switched from injections because I wanted a more bio-identical form without the added esters and a more constant level that the gels allow. When I first was using the gel (up until about a year or two ago), the levels were in the 700 - 1200 ng/dl range for the same doses.

I have added the ranges to my original post. Thanks for the reminder.

TSH is 1.8 (.2 - 5.5)
Free T4 is 1.2 (.8- 1.7)
Free T3 is 288 (230-420)

I have done cortisol by blood and it has been in @ 20ug/dl depending on time of day. No reference given.

I look forward to your thoughts.

[stitch]

The T gel shouldn't lose effectiveness unless

something changes to effect absorbtion, the conversion of T to estrogen, the amount of SHBG (sex hormone binding globulin) your liver is producing, etc.
Make every effort to maintain your ideal body weight to minimize the estrogen and SHBG, (these both tend to rise with age and body fat percentage). As you mentioned, it would be a good idea to ask your doctor to prescribe at least a 3 month trial of Arimidex 1 mg every other day. I don't think you would benefit from switching back to shots. Make sure you apply your morning gel after your shower, let it dry as completely as possible B4 putting on your shirt to make sure you are absorbing as much as possible. As Michael112 has stated, taking 30 mg Optizinc per day helps with aromatization.
By the way, Michael, if you are also reading this I really appreciate all the time and effort you put into trying to help, inform, and encourage the men on this board. It can be very difficult most of the time for men to get any accurate info, (let alone help) from thier physicians regarding T therapy. It's really cool that guys like you take it upon themselves to try to help.
I myself finally was able to find an honest, knowledgeable physician who cared enough to help me, but only after many years of being lied to and denied treatment by several other doctors. I had to go to 2 independant labs and pay out-of-pocket for hormone profile tests because my regular GP lied to me about her own blood work results and refused to show me the lab report, so I know how difficult it can be for men to get help. Now, I want to do anything I can to help other men in my situation by providing support, encouragement, information, advice, prayer, or anything else I can.
Again, Michael, I think I speak for the rest of the board in saying we appreciate your time and efforts. I wish everyone a happy and healthy New Year. God Bless-Stitch

[Tman]

Hi Stitch and thanks for the reply -

I was taking zinc for a long time and will look at that again. I don't think it really affected my aromatizing, but I could be wrong.

As far as my weight - I am currently @105 lbs, about 15 lbs underweight, so fat isn't an issue at present.

I also am balding and finding a lot of T turning to DHT (as you can see). Anybody else have an issue with that?

Thanks to Michael and Stitch...please keep the thoughts and suggstions coming.

[Michael112]

thanks stitch, I have had more then my fair share of lies from doctors and they still continue even though I have started treatment.

As for arimidex dosage would be .25mg every 2nd day not 1mg, the tablet needs to be broken up into quarters.

I switched from injections because I wanted a more bio-identical form without the added esters and a more constant level that the gels allow. When I first was using the gel (up until about a year or two ago), the levels were in the 700 - 1200 ng/dl range for the same doses.

Weekly or E3D injections provide the least aromatase after pellets, they also(after pellets) provide the most steady levels.
Gels provide the closest to natural testosteron rythem thus increasing aromatase. Try switching to a gel instead of a cream, or if you want to lower DHT use E3D injections or weekly injections.

Try Zinc, and also Indoplex DIM.
The lab ranges for free T dont look right although Free T looks fine in the morning but Total T is a little low.

[Tman]

Michael - you are a wealth of knowledge! Thanks so much for your input and thoughts on this. Is the info you give below from personal experience, or are there references you could share?

Weekly or E3D injections provide the least aromatase after pellets, they also(after pellets) provide the most steady levels.

I thought that because of the peaks and troughs of injections (even with weekly - what is E3D...every 3rd day? - injections) that gels provide more steady levels. Why are injections more steady?

Gels provide the closest to natural testosteron rythem thus increasing aromatase. Try switching to a gel instead of a cream, or if you want to lower DHT use E3D injections or weekly injections.

I am currently on a gel. Why do they increase aromatase? I thought the peaks of injections caused aromatizing....too much T converts to E. Also, why would DHT be lower with injections? Lastly, what is the difference between the absorption/aromatizing/etc. with gels and creams?

Also, about the alcohol gels (which is what I am currently on)...I have consulted with two different pharmacies regarding application frequency and location. One says rub it in really good, apply once per day, apply to fatty areas like buttocks, upper arms, thighs, and abdomen and that hair is no problem, but to rotate sites so you don't grow more hair. The other says apply but don't rub it all the way in (instead, let it dry on it's own), apply to upper and lower arms, and once or twice per day, preferrably on hairless sites. I feel like I am a guinea pig trying to figure out the best sites, frequency, surface area, etc. My doctor hasn't a clue about this. Any suggestions/thoughts?

Try Zinc, and also Indoplex DIM.
The lab ranges for free T dont look right although Free T looks fine in the morning but Total T is a little low.

I edited the ranges...I had only done the percentage before - sorry about that.

I have tried zinc....up to 75mg per day...and DIM.....and chrysin..and found that they seemed to increase the DHT. So then I added Saw Palmetto...all of this seemed to really wreak havoc with my hormones so I stopped everything to try to get back to some degree of normalcy.

I will definitely consider the zinc again. What I want is the most steady high normal levels, with minimal aromatizing or reductasing, and least impact on my liver and other organs. I realize that would be every guy's request, but thought I would put it out there!

Also, are pellets the ideal way to go? How about sublingual tablets - does anyone know about the absorption and conversion rates with those?

Michael - or anyone else - have you found any doctors that get this and can work with us about this?

[Michael112]

The info I give is from lots of reading on google and other forums.
The best source I have had on TRT has been Meso Rx mens health forum.
Yea E3D is every 3 days.

Injections are more steady because Androgel spikes within 2 hours of the application and then settles after 4 hours. Everytime exogenous(foreign) testosterone levels spike, it increases estrogen and dht levels more so then if they were steady.
If E2 and DHT is not a problem for you then biologically gels are ideal.

Testosterone cyp and enanthate has a half life of about 5-6 days, so during those 5-6 days your getting fairly steady levels.

Because creams are a higher concerntration then gel therefore taking up less amount of area on the skin it aromatases less then gels but the problem is because you physically use such little substance its hard to titrate the dose to reach optimum T levels, and from what I have come across it seems to drop off too much towards the end of the day.

Gels overall are better then creams.
See this graph : http://www.drugs.com/PDR/images/78/27802251.jpg to see how levels are on androgel, although based on what I have read with labs regarding androgel, it apears that with some(most?) people it aromatases more therefore creating levels in the 600s initially and then levels in the 200-300s before next application.
Creams drop off a lot quicker then gels although the advantage is some aromatase is prevented due to decrease area of the skin being used due to the higher T conerntration and they are less messy to use.

For how to apply Gels, see this: http://www.allthingsmale.com/word_do...lyAndrogel.doc
You should try use as little area as possible, if you are getting "frosting" then you would need to use a larger skin area. You shouldnt be rubbing it in too much, let it dry.

I would go with ZMA(zinc + magnesium + b6) and a multivitamin containing 2-3mg of copper(zinc depletes copper, idea ratio is 10:1) and 1-2mg of manganese(magnesium depletes manganese). If you want the least aromatasing therefore easiest on your liver that would be pellets, wich are done roughly every 5 months and also take milk thistle daily. You shouldnt haveto worry about Saw Palmento with that.

Gels or Injections are the ideal way to go if you were to follow a proper protocol (wich means including hcg) and if E2 and DHT isnt a problem. Oral testosterone is rubish I wouldnt bother with those, and I know from 1st hand experience.

Dr. John at www.allthingsmale.com is regarded as one of the best doctors for male TRT, you can go see him in lansing michigan or he can work with your local doctor, he knows a hell of a lot more then what endos know about TRT.



Wich DIM were you using? I havent heard much about Chrysin, but Zinc and Indoplex DIM theoreticly should lower DHT.

Indoplex DIM should be split up into twice a day doses, starting off at half a tablet with breakfast and half with dinner.


What are you on exacly at the moment? a 1% gel or a compounded cream(5%-20%)?

[Tman]

Hi Michael - thanks for the explanations. I have some follow-up questions...Thanks for your patience.....(I am VERY detail-oriented..with a side dose of OCD)...I understand if I have reached my limit of your time, but if not....thank you.

Injections are more steady because Androgel spikes within 2 hours of the application and then settles after 4 hours. Everytime exogenous(foreign) testosterone levels spike, it increases estrogen and dht levels more so then if they were steady.

This is very interesting. My understanding of conversion is that it occurs when a spike is too high for the body's level. Therefore, if applied a couple of times a day at a much lower level than 1 per week shots, you wouldn't have as high of a peak. Are you saying that anytime T peaks, no matter how high the peak is, it converts to aromatase?

I think conversion is a big issue for me....so maybe gel isn't ideal...

Testosterone cyp and enanthate has a half life of about 5-6 days, so during those 5-6 days your getting fairly steady levels.

You mentioned before doing shots every week or 3rd day (is this enanthate/cypionate or propionate?). What is it about the 3rd day versus the 5th, 6th, or 7th that is useful?

Because creams are a higher concerntration then gel therefore taking up less amount of area on the skin it aromatases less then gels but the problem is because you physically use such little substance its hard to titrate the dose to reach optimum T levels, and from what I have come across it seems to drop off too much towards the end of the day.

I tried a cream once (PLO). I had MAJOR hot flashes and never went back. After reading your last reply, I contacted College Pharmacy about their gel (they are the one's that say to use the forearms and thin skinned areas). They said theirs is different than something like Androgel because it has less alcohol in it. I get mine from Women's International Pharmacy. Theirs is clear and seems to have a lot of alcohol.

Creams drop off a lot quicker then gels although the advantage is some aromatase is prevented due to decrease area of the skin being used due to the higher T conerntration and they are less messy to use.

I have read different studies about the surface area of the skin to use. I have been rubbing my gel into a very small area because I thought that would help prevent aromatase/reductase conversion.

For how to apply Gels, see this: http://www.allthingsmale.com/word_do...lyAndrogel.doc
You should try use as little area as possible, if you are getting "frosting" then you would need to use a larger skin area. You shouldnt be rubbing it in too much, let it dry..

Thank you for this. I wonder when something is considered a gel vs a cream....how much alcohol it would need to have to be a gel and if that would make a difference as to what areas and how much surface area to apply to?

If you want the least aromatasing therefore easiest on your liver that would be pellets, wich are done roughly every 5 months and also take milk thistle daily. You shouldnt haveto worry about Saw Palmento with that...

So...it sounds like you are saying that the vehicle that is applied the least frequently is the least aromatasing. My understanding was that which was applied the most frequently was least aromatasing. I thought that was one reason that it is recommended to do shots every 3 or 7 days versus every 10 to 14.

Is this info also from Dr. John and Meso RX? Also, how does one find a doctor willing to do the pellets? Are they bioidentical hormones?

Gels or Injections are the ideal way to go if you were to follow a proper protocol (wich means including hcg) and if E2 and DHT isnt a problem. Oral testosterone is rubish I wouldnt bother with those, and I know from 1st hand experience....

Okay...I am a bit confused. I thought the gels were great if E2 and DHT weren't an issue, but that injections might be good if they were an issue...

About sublinguals...what is wrong with those? They aren't the same as the methyltestosterone that wreaks havoc on the liver....

Dr. John at www.allthingsmale.com is regarded as one of the best doctors for male TRT, you can go see him in lansing michigan or he can work with your local doctor, he knows a hell of a lot more then what endos know about TRT.

I have read about him before...thanks for the reminder. Have you met with him?

Wich DIM were you using? I havent heard much about Chrysin, but Zinc and Indoplex DIM theoreticly should lower DHT.

My mistake...I checked the bottle...I was taking I3C 400mg. 2 - 3 3x per day.

I had read that zinc, chrysin (which seemed to help somewhat), DIM, and I3c were helpful for E2 and that saw palmetto was helpful for DHT.

What are you on exacly at the moment? a 1% gel or a compounded cream(5%-20%)?

I am on a 2.5% (25mg/gram) compounded gel from Women's International. I apply 2 grams in the am (50mg) and 1 gram at night (25 mg). When I started, I was going 100mg am and 100 mg pm (in a 5% gel). But the gel crystallized, so I was concerned about the T falling out of the gel. Then, over the years, I moved the dose down as I saw that I was staying @ 1000ng/dl throughout the day (and pretty good free%).

I am considering consulting with Dr. Crisler. I will read more about him. Do you have any opinion on whether enanthate or cypionate is a better way to go if I was to switch to injections? Do you think I have anything to gain from switching to injections?

I appreciate all your help. So much of what you said is different than what I have read other places, like books by Carruthers and Shippen. I am so confused..... I will check out the links you posted. And the other supplements.

[stitch]

If I could add one thing...

sublinguals are a poor choice (and orals should not be considered at all due to liver toxicity and poor bioavailability). From what I've read, it's difficult with buccal or sublingual preparations like Striant (sorry to pick on a particular brand, its the only one I'm familiar with), to get your T up into the optimal range even if you follow the directions perfectly (ie: keeping the dose under your tongue until disolved without swallowing it, etc). I think in general, gels or creams twice per day on clean, dry, hairless skin is tough to beat.

[Michael112]

Hi Michael - thanks for the explanations. I have some follow-up questions...Thanks for your patience.....(I am VERY detail-oriented..with a side dose of OCD)...I understand if I have reached my limit of your time, but if not....thank you.

Join the club, I know exacly where your coming from, this is why I know abit about anything I am interested in, I am also unemployed.

This is very interesting. My understanding of conversion is that it occurs when a spike is too high for the body's level. Therefore, if applied a couple of times a day at a much lower level than 1 per week shots, you wouldn't have as high of a peak. Are you saying that anytime T peaks, no matter how high the peak is, it converts to aromatase?

If you have an E2 problem, by increasing dosage you are only going to make it worse, but you wouldnt decrease dosage below a TT of 650ng/dl.
I dont think its possible for gels to beat injections on aromatase even with twice daily applications, there is still a small spike each time you apply the gel followed by a bit of a decline.
I cant find it now but if you were to look at a graph of the natural rythem of testosterone it goes up and down every 30 mins, with it being higher around 6am-10am then a decline and a slight jump at around 1pm, and lower in the afternoon and night.

My theory based on what I have read and heard:
The body is extremely complex, it senses when a hormone needs to be increased or decreased and it does it quick, so any exogenous testosterone is gonna aromatase more then endigenous testosterone, because at one time or another its gonna be too much, or another theory is that the body isnt prepared, it never sent out the signal so it aromatases it to estrogen, I am not sure if anyone at all knows the correct answer to this yet, these are just theories, if you were to ask a doctor, one doctor will tell you one thing and the other doctor will tell you something diffrent, until I come across proof of the mechanism for aromatase then I will leave these as theories.

Keep in mind Arimidex is a last resort to control E2, you usually want to try let your body do it naturaly by methods such as changing testosterone methods, losing bodyfat, and using natural suppliments.
E2 above 30pg/ml would mean needing arimidex.

Protocols I have come across look like this:
.25mg arimidex If Needed.
D1 100mg Test cyp/enth
D2
D3
D4
D5
D6 250IU HCG
D7 250IU HCG


.5mg Arimidex every 2nd day was the dose for this 1 person who personally uses this protocol
D1 40mg Test cyp/enth (Although PROP would be ideal)
D2 200IU HCG
D3 200IU HCG
D4 40MG Test cyp/enth (Although PROP would be ideal)
D5 200IU HCG
D6 200IU HCG
D7 40mg Test cyp/enth (Although PROP would be ideal)
D8 40mg Test cyp/enth (Although PROP would be ideal)
D9 200IU HCG
D10 200IU HCG
D11 40MG Test cyp/enth (Although PROP would be ideal)
D12 200IU HCG
D13 200IU HCG
D14 40mg Test cyp/enth (Although PROP would be ideal)
D15 200IU HCG
etc


D1 androgel +250iu HCG
D2 androgel
D3 androgel +250iu HCG
D4 androgel
D5 androgel +250IU HCG
D6 androgel
D7 androgel


because HCG also raises testosterone it contributes to aromatase. It isnt used every day and it isnt used on the same day as injections.

When using injections more frequently you are providing smoother T levels therefore less aromatase, the downside to TRT is the conversation to E2, E2 is to blame for most the side effects of poorly administered TRT.

I have read different studies about the surface area of the skin to use. I have been rubbing my gel into a very small area because I thought that would help prevent aromatase/reductase conversion.

You shouldnt be rubbing it in much, I guess this is because it would provide a bigger spike in initial levels, just let it dry with your shirt off while you have breakfast.

Thank you for this. I wonder when something is considered a gel vs a cream....how much alcohol it would need to have to be a gel and if that would make a difference as to what areas and how much surface area to apply to?

From what I have read, gel = 1% T, and cream = 5, 10, 20 or greater % T. From what I know creams are usually applied on the inside of the wrist.

So...it sounds like you are saying that the vehicle that is applied the least frequently is the least aromatasing. My understanding was that which was applied the most frequently was least aromatasing. I thought that was one reason that it is recommended to do shots every 3 or 7 days versus every 10 to 14.

That does seem to make sense and I did wonder about it for a while myself, but the reason shots every 14 days isnt ever recomended is because by the 2nd week your T level are way too low, so its not E2 wich is the problem its the halflife of the injection, and longer esters provide uneven levels still, even with injections every 2 or 4 weeks.
The reason pellets are rarely done is because its a surgical procedure and also, from what I have been told by an endocrinologist(keep in mind endos dont have much credibility when it comes to TRT) it doesnt allow the receptors to ever desensitize, because its just such a constant level, although I havent heard any other doctors or literiture confirming this, so for now its just a theory.

You get prescribed gels 1st because its better to try simulate natural T rythem and be fortunate enough to be able to keep E2 in range, rather then have a weekly T rythem to haveto keep E2 in control.

This info isnt directly from Dr. John, but a lot of it is based on what he teaches and the rest is from what I have consistantly come across from multiple sources including google, medical literiture and speaking to other people on TRT and doctors.
Even 2 of the best doctors in TRT cant agree on each other with some things (Dr. John and Dr. Shippen) re: SubQ(below the skin and not into the muscle injections).

As I am sometimes particular about how I word things, I am sure your particular on reading and that you would understand, but for others reading this I hope some people dont misunderstand my posting, when I say something is a theory I mean it, and when I say "based on" doesnt mean he neccasarily will agree on it.

If you really want to go about things the right way, you shouldnt be looking for a doctor who is willing to do pellets, but rather a doctor who is willing to work with Dr. John, btw for some reason he does not recommend pellets, not sure why though.

Every common form of TRT is bioidentical testosterone, rarely compound creams may not be, and methyltestosterone is what you need to stay away from.

Okay...I am a bit confused. I thought the gels were great if E2 and DHT weren't an issue, but that injections might be good if they were an issue...

Thats true, If you can use Gels and get away with it without too much E2, then thats good, but if E2 becomes a problem then when switching to injections your E2 will drop abit.

I assume it should go like this:
As soon as you start TRT you take Arimidex-preventative measures, meaning you start Zinc, Indoplex DIM if your pre TRT E2 levels are on the highish size, etc.

androgel ----- E2 a problem, goto injections
--------E2 not a problem, start HCG

injections-----------E2 still a problem, goto pellets, increase frequency or start arimidex(at lowest dosage, most likely .25mg E3D?)
E2 not a problem, start HCG

HCG-------E2 a problem change protocol, androgel to injections, injections to pellets or add arimidex, or if you feel HCG is doing nothing for you, you could(or shouldnt?) stop it(dont know Dr. Johns view on this.)

Dont know but I havent heard much of them for a reason, mostly probly for the same reason Andriol isnt available in the US, because it would be a poor choice.

I have read about him before...thanks for the reminder. Have you met with him?

No I havent met him, I'm in Australia.

My mistake...I checked the bottle...I was taking I3C 400mg. 2 - 3 3x per day.

I3C isnt recomended, cant remember why, all I can remember is theres a good reason or 2 for it.
Saw palmetto hasnt been shown to stop hairloss if its gonna happen.

Personally, if I was you I would switch to injections for the time being before seeing Dr. John or Dr. Shippen.

What have you read thats diffrent to Shippen? maybe the Androgel application? Preference of injections and protocols? He uses some diffrent methods to Dr. John, but both of them are years ahead of endos and GPs.