No luck with TRT. HELP!

[KRutko]

Hello all and thank you in advance for your time and advice. I’m a 44-year old male, ht: 6’0”, wt: 178#. My ht/wt has been proportionate my whole life and I’ve always been extremely active./fit. I’ve been on TRT, without success, since March of 2011. A decrease in sexual function (libido and ED) along with depressed mood and cognitive function led me to have my testosterone level checked. The 2/18/2011 test result was 193 (normal = 240 – 1000 ng.dL). An Endocrinologist started me on Androgel 1.0% 50mg per day.
I’ve had many labs drawn over the last year and a half and have had my dose of Androgel increased along the way. I’m currently on 5 pumps of Androgel 1.62% (101.25mg) per day. Below are all the labs I have had since 2/2011. All labs were drawn at Quest Diagnostics and were drawn while fasting and before the day’s testosterone application.
I’ve had many ups and downs during this time frame. It seems that my sexual function/libido will be good for a few days following a change is dose of testosterone, and then fall off. I do have some nighttime & morning erections, although they never seem to be completely firm.


[2/18/2011 (Androgel 1% - 50mg/day)

Total Testosterone: 193 (240-1000ng/dL-normal)

6/16/11 (Androgel 1% - 50mg/day)

Total Testosterone: 392 (240-1000ng/dL-normal)
Prolactin: 4.6 (2.1-18.0ng/mL – normal)
FSH: 3.1 (1.4 - 18.0 Units/L – normal)
LH: 2.1 (1.5 - 9.3 U/L - normal)
TSH: 1.24 (0.50 - 5.00 uIU/mL – normal)
Free T4: 0.88 (0.93 - 1.70 ng/dL – normal)

11/16/11 (Androgel 1% - 50mg/day)

Total Testosterone: 409 (240-1000ng/dL-normal)
Dihydrotestosterone, serum: 78 (25 - 75 ng/dL – normal)
Estradiol: 30 (13 - 54 pg/mL – normal)
Prolactin: 7.7 (2.1-18.0ng/mL – normal)
SHBG: 19 (10-50 nmol/L – normal)
DHEA-S: 296 (45-345 mcg/dL – normal)
TSH: 1.33 (0.50 - 5.00 uIU/mL – normal)
Free T4: 1.00 (0.93 - 1.70 ng/dL – normal)

4/12/12 (Androgel 1% - 50mg/day)

Total Testosterone: 425 (240-1000ng/dL-normal)
Free Testosterone: 73.5 (46.0 - 224.0 pg/mL)
Bioavailable Testosterone: 167.5 (110 - 575.5 ng/dL)
Prolactin: 9.3 (2.1-18.0ng/mL – normal)
FSH: 4.3 (1.4 - 18.0 Units/L – normal)
LH: 1.8 (1.5 - 9.3 U/L - normal)
SHBG: 22 (10-50 nmol/L – normal)

5/22/12 (Androgel 1.62% - 60.75mg/day)

Total Testosterone: 400 (240-1000ng/dL-normal)
Dihydrotestosterone, serum: 59 (25 - 75 ng/dL – normal)
Estradiol: 28 (13 - 54 pg/mL – normal)
Prolactin: 11.5 (2.1-18.0ng/mL – normal)

7/11/12 (Androgel 1.62% - 101.25mg/day)

Total Testosterone: 851 (240-1000ng/dL-normal)

Endo wanted to change me to Testim as he said it had better absorption. Started on Testim 100mg/day on 7/10/12. Had Testotesrone lab drawn on 7/11/12 to see how Androgel was working before chaninging to Testim.

7/17/12 (Testim 100mg/day)

Total Testosterone: 230 (240-1000ng/dL-normal)
Free Testosterone: 41.5 (46.0 - 224.0 pg/mL)
Bioavailable Testosterone: 92.5 (110 - 575.5 ng/dL)
Dihydrotestosterone, serum: 74 (25 - 75 ng/dL – normal)
Dihydrotestosterone, free: 7.79
Estradiol – ultrasensitive: 22 (< or = 29 pg/mL – normal)
Prolactin: 8.2 (2.1-18.0ng/mL – normal)
FSH: 1.2 (1.4 - 18.0 Units/L – normal)
LH: 0.6 (1.5 - 9.3 U/L - normal)
SHBG: 19 (10-50 nmol/L – normal)
DHEA-S: 214 (45-345 mcg/dL – normal)

9/13/13 (Androgel 1.62% - 101.25mg/day)

Total Testosterone: 266 (240-1000ng/dL-normal)
Free Testosterone: 40.3 (46.0 - 224.0 pg/mL)
Bioavailable Testosterone: 89.8 (110 - 575.5 ng/dL)
Dihydrotestosterone, serum: 85 (25 - 75 ng/dL – normal)
Dihydrotestosterone, free: 7.45
Estradiol – ultrasensitive: 18 (< or = 29 pg/mL – normal)
Prolactin: 4.7 (2.1-18.0ng/mL – normal)
FSH: 1.2 (1.4 - 18.0 Units/L – normal)
LH: 0.5 (1.5 - 9.3 U/L - normal)
SHBG: 25 (10-50 nmol/L – normal)

11/2/12 (Androgel 1.62% - 101.25mg/day)

Total Testosterone: 328 (240-1000ng/dL-normal)
Free Testosterone: 59.1 (46.0 - 224.0 pg/mL)
Bioavailable Testosterone: 131.9 (110 - 575.5 ng/dL)
Dihydrotestosterone, serum: 105 (25 - 75 ng/dL – normal)
Estradiol – ultrasensitive: 27 (< or = 29 pg/mL – normal)
Prolactin: 5.9 (2.1-18.0ng/mL – normal)
FSH: 2.2 (1.4 - 18.0 Units/L – normal)
LH: 2.2 (1.5 - 9.3 U/L - normal)
SHBG: 20 (10-50 nmol/L – normal)
Hematocrit: 51.5 (38.5-50.0% - normal)


Any input would be greatly appreciated.

[The Deadlifting Dog]

You should be testing your testosterone level around 2 hours AFTER you apply your gel/cream.
(That way you know how much your body is absorbing.)
You should be applying your cream in the morning after a shower. (assuming you have a regular sleep pattern. ex. you don't work the night shift)

The topicals will give you a testosterone level that closely mimics a normal body's testosterone cycle. After the topical is applied, testosterone levels will rise and peak about 2-3 hours after applying. The testosterone level will then decline as the day progresses. By the next morning, one needs to reapply the topical.

[JohnnyVegas]

You should be testing your testosterone level around 2 hours AFTER you apply your gel/cream.
(That way you know how much your body is absorbing.)
You should be applying your cream in the morning after a shower. (assuming you have a regular sleep pattern. ex. you don't work the night shift)

Even if he is being tested at the wrong time isn't it bad that he would dip down into the low 300s at ANY point of the day? I am not disagreeing with you, that is an honest question.

OP, have you discussed injections with your doctor?

[The Deadlifting Dog]

By the next morning, one's testosterone level will be back down to baseline. Hence the need to apply every day. The testosterone in topicals has a half life of something like 10-100 minutes.

[JohnnyVegas]

By the next morning, one's testosterone level will be back down to baseline. Hence the need to apply every day. The testosterone in topicals has a half life of something like 10-100 minutes.

Ahhhh, I forgot they have no ester. Another reason to consider injections? More constant levels?

[The Deadlifting Dog]

Sorry for the short replies. I was giving my son a shower. Attached is a chart showing testosterone levels on people using Axiron.

[The Deadlifting Dog]

JohnnyVegas,

More constant levels are achieved with injectables but the human body naturally has testosterone levels that peak in the morning and drop as the day progresses.
see attached from http://www.urologycentre.com.sg/hypo...ronelevel.html

[The Deadlifting Dog]

KRutko,

If your endo was instructing you to do bloodwork before applying the cream then I would get a new endo.
As far as erections go, testosterone levels may or may not be causing your problems. Many people high high test suffer from ED and many people with low test have no problems.

I am sure that soon some of the knowledgeable members on this site will tell you that you need more bloodwork testing more hormones/levels and they will be able to help you much more than I can.

Good luck and hang tight.

[bass]

i don't care what TRT you're on, levels must stay steady to achieve optimal health and well being. i agree with JV, injections is the way to go, but TRT doesn't stop with testosterone injections only, you also need,

AI
hCG
Donating blood as needed
proper diet and exercise

[Rusty11]

Hmmmm...not sure about all of that-a person's test level going back to baseline each morning before application. I've been on Testim for six months (2 packets). Each BW has shown an increase. I've gone from 209 to 589 last week (51 yrs old). ALL bw has been done in the morning before the day's application. I would find it strange that one's test level would go completely back to normal each morning before application. How would you justify those nice morning erections while still in bed. Anyway, OP, I don't know what to say. I'm sorry about such an up/down, flip-flop series of BW. It's got to be frustrating. This may not apply to you, or maybe it really makes no difference, but I have a scrub pad and scrub those shoulders/arms/back while in the shower. I could assume that, after a while, the pores might get plugged. I don't know, but it's something I do just in case. Wish I could offer some insight. Good luck.

[The Deadlifting Dog]

Bass,

I know I'll get flamed for this but I beg to differ.
Levels need not stay steady. The attached chart of a non-TRT male shows that a healthy man's test level can be over 100% higher during the morning than at night. (~650ish vs 270ish).
Many on this forum feel that an AI should be avoided and its need only shows that one's testosterone level is too high. More drugs not more.
hCG may not be needed if one is using topicals. Note that the OP's LH and FSH levels are non-zero and he is taking up to 101.25mg of topical test per day. (Since one's testosterone levels aren't at a constant state on gels, when the test level gets low the body will try to produce testosterone. Complete shutdown is avoided.)
Donating blood may not be needed since a lower average level of test exists in the body. (A person with 800 peak test with topicals has a lower average rate than someone with a trough level of 800.)

Just my thoughts.

[JohnnyVegas]

Bass,

I know I'll get flamed for this but I beg to differ.
Levels must not stay steady. The attached chart of a non-TRT male shows that a healthy man's test level can be over 100% higher duriing the morning than at night. (~650ish vs 270ish).
Many on this forum feel that an AI should be avoided and its need only shows that one's testosterone level is too high.
hCG may not be need if one is using topicals. NOte that the OP's LH and FSH levels are non-zero and he is taking up to 101.25mg of topical test per day. (Since one's testosterone levels aren't at a constatnt state on gels, when the test level gets low the body will try to produce testosterone. Complete shutdown is avoided.)
Donating blood may not be needed since a lower average level of test exist in the body. (A person with 800 peak test with topicals has a lower avergae rate than someone with a trough level of 800.)

Just my thoughts.

I have a question about this. Those of us that are trying to achieve more steady levels are doing so that there isn't a big bump at the beginning of the week and big plunge at the end of the week...we are not concerned with a natural hourly rise and fall.

With my TRT dose I am probably shut down, so my body probably doesn't have the natural 24 hour cycle, right?

[The Deadlifting Dog]

I am not claiming to be an expert and I already wish I had kept my mouth closed but I would agree that you probably are completely shut down and have no 24 hr cycle.

I do agree with Bass in that guys who are injecting should try to keep stable test levels. (Accomplished by frequent injections and hCG to a lesser extent.)

[TennTarheel]

Yeah I agree. I believe once on TRT, the natural rise and fall is no longer there since LH and FSH are bottomed out. At this point I believe it is totally dependent on the half-life of the exogenous Test source.

[The Deadlifting Dog]

Hmmmm...not sure about all of that-a person's test level going back to baseline each morning before application. I've been on Testim for six months (2 packets). Each BW has shown an increase. I've gone from 209 to 589 last week (51 yrs old). ALL bw has been done in the morning before the day's application. I would find it strange that one's test level would go completely back to normal each morning before application. How would you justify those nice morning erections while still in bed.

I stand corrected. Instead of saying back to baseline, I should have stated the testosterone level is approaching baseline after 24hrs. But since by 24 hours one's test level is approaching baseline, the medication has to be applied daily.

[Rusty11]

I stand corrected. Instead of saying back to baseline, I should have stated the testosterone level is approaching baseline after 24hrs. But since by 24 hours one's test level is approaching baseline, the medication has to be applied daily.

OK. I'll buy that.

[KRutko]

Thanks for all the valuable input. JohnnyV, I have discussed injectables but my Endo now wants to split my dose of Androgel so that I get 2 pumps in am and 2 pumps in pm. He is thinking that may be metabolizing the Testosterone too quickly.

[JohnnyVegas]

I am not claiming to be an expert and I already wish I had kept my mouth closed but I would agree that you probably are completely shut down and have no 24 hr cycle.

I do agree with Bass in that guys who are injecting should try to keep stable test levels. (Accomplished by frequent injections and hCG to a lesser extent.)

I hope you didn't think I was challenging you. You can probably tell that I don't know much about the gels and was just trying to learn more. Your point about naturally high and low levels during the day had never crossed my mind since I have been on injections from day one.

This was an informative thread for me. Hopefully for the OP as well.

[sparverius]

How and where on the body are you applying the gel?
Do you use a skin cream? The insert with Andogel mentions that. It increases absorbtion.

[bass]

I am not claiming to be an expert and I already wish I had kept my mouth closed but I would agree that you probably are completely shut down and have no 24 hr cycle.

I do agree with Bass in that guys who are injecting should try to keep stable test levels. (Accomplished by frequent injections and hCG to a lesser extent.)

Exactly bro, once on TRT you can kiss your natural cycle goodbye! We do expect a drop in levels of course but not to base line. Very good discussion.

[KRutko]

How and where on the body are you applying the gel?
Do you use a skin cream? The insert with Andogel mentions that. It increases absorbtion.

I've been applying to shoulders and upper arms. No cream application.

[KRutko]

I can understand the thought process about the natural cycles, but for some reason I can't seem to get my levels above 400, even while taking 100+mg of Test gel per day. Do some just not respond to topical applications?

[sparverius]

I did gel for years, then it lost effectiveness. Even 6 pumps of 1.62% wasn't enough, and I had to get special approval by insurance for that much. I switched to injections. That's not as normal feeling as gel, but if the gel doesn't work.....

The lab numbers are useful but how you feel is also important. When I was on gel all my labs were done post application. For me 450-500 total was enough to feel normal.

You were doing well right before switching to Testim. What happend after you switched to Testim and went back to Agel?

Your LH and FSH are normal instead of being shut down. Knowledgable Members, what does that mean?

[APIs]

I can understand the thought process about the natural cycles, but for some reason I can't seem to get my levels above 400, even while taking 100+mg of Test gel per day. Do some just not respond to topical applications?

Other people on here have responded well to gels. Some people just never get to the promised land using them. I'd say the majority of people we see here end up switching to injections eventually. With that being said, maybe your one that needs to make the switch? Don't fight it IMO if your Doc will let you. I know having to apply that stuff twice a day would drive me mad for sure. After almost two years with little results I'd say it's time for you to try something different...

[The Deadlifting Dog]

I can understand the thought process about the natural cycles, but for some reason I can't seem to get my levels above 400, even while taking 100+mg of Test gel per day. Do some just not respond to topical applications?

KRutko,

I strongly believe that you are getting your bloodwork taking at the wrong time.

"To ensure proper dosing, serum testosterone concentrations should be measured after initiation of therapy to ensure that the desired concentrations (300 ng/dL-1050 ng/dL) are achieved. The Axiron dose can be adjusted based on the serum testosterone concentration from a single blood draw 2 – 8 hours after applying Axiron and at least 14 days after starting treatment or following dose adjustment."

http://www.drugs.com/pro/axiron.htm

NOTE: DRAW BLOOD 2 -8 HOURS AFTER APPLYING

also:

"AndroGel
Measure serum testosterone levels at 14 days and 28 days after initiation and then periodically thereafter

Testim
50 mg qAM applied topically to shoulders, upper arms; increase to 100 mg PRN [50 mg/5 g]

Axiron
Base dosage adjustment on serum testosterone concentration from a single blood draw 2-8 hr after applying and at least 14 days after treatment initiation or dose adjustment

Fortesta
Dose can be adjusted between a minimum of 10 mg of testosterone (1 pump actuation) and a maximum of 70 mg of testosterone (7 pump actuations) based on total serum testosterone concentrations 2 hrs post application
Dose should be titrated based on serum testosterone concentration from a single blood draw 2 hrs after application and approximately 14 days and 35 days after starting treatment or following dose adjustment


from http://reference.medscape.com/drug/a...topical-342796

NOTE: Axiron and Foresta specifically say to taste AFTER applying while Androgel and Testim are vague.

If you test before applying you will get your trough (low) level. If you apply 2-3 hours after applying you will get your peak (high) level.

also see attached chart for Testim's effects on testosterone levels.

[KRutko]

I did gel for years, then it lost effectiveness. Even 6 pumps of 1.62% wasn't enough, and I had to get special approval by insurance for that much. I switched to injections. That's not as normal feeling as gel, but if the gel doesn't work.....

The lab numbers are useful but how you feel is also important. When I was on gel all my labs were done post application. For me 450-500 total was enough to feel normal.

You were doing well right before switching to Testim. What happend after you switched to Testim and went back to Agel?

Your LH and FSH are normal instead of being shut down. Knowledgable Members, what does that mean?

I continue to feel the same. Depressed, lack of concentration, low libido, erectile issues. I have and have always had plenty of energy and have never experienced the lethargy often attributed to low T.
The Endo wanted to switch me to Testim because he felt it had better absorption. Also, my new insurance co would not cover Androgel , only Testim. After one month of Testim my total T went down to 230, I was having application site acne and pitting edema in lower extremities. My LH and FSH have been shut down in the past and only recently, 11/2/12 labs, have they come back up.?

I was on an anti-depressant way back before my first lab draw. Once I discovered my Testosterone was low and a side effect of that was depression, I thought I could come off the Anti-Depressant once I raised my Total T. (It's like a vicious cycle of which came first. Low T = depression, sexual issues. Depression = sexual issues. Anti-Depressants = sexual issues. Deciding what needs to be treated to fix the issues is mind boggling, but at a minimum I need to get my Total T up in the upper 1/3rd of normal to see if I can alleviate any of my issues. I've re-started anti-depressant therapy with Wellbutrin (minimal sexual side effects) to help me get through the trials of TRT. Once I can get my Total T up, and keep it up for a time, I will then try to taper off the anti-depressant again.

[KRutko]

Deadlifting Dog,

Right, but I see no change in any of my symptoms. So either my Serum T is not getting high enough, or I have some other process at work. I have historically been hyper-sexual and have never had issues with erections. The fact that these changes seem to correlate with my low T lab back in Feb of 2011 lead me to believe my issues are Testosterone driven. I'll try getting my next labs done after application; however, if they are up where they should be then that will bring a lot of new, unanswered questions. Thanks for all your input, greatly appreciated!

[Boscogto]

New to forum but not TRT.....

I tried gels for 6 plus months....at first levels came up some but soon there after they dropped into basement and stayed there. This was using 5% compounded gel at high doses twice per day.

Switched to sub-q t-cyp and HCG and have seen much better performance.

Some people just don't absorb well.

Shots are much easier too. Sub-q EOD is way to fly!