Follow-up labs

[DaRoq]

I will have been on 5g Androgel 1% for 3 weeks as of tomorrow, so my plan is to go in for follow-up labs. I wasn't able to go by Dr. Crisler's recommendation of going back in by a "fortnight", but I think going in now should be soon enough to get the results back in time for a new prescription before I run out of the gel. I hope...

In any case, I just want to do enough to serve that purpose. Here are the LabCorp tests I'm planning to ask for:

Test # Test Name
004226 Testosterone, Total, Serum
144980 Testosterone, Free (Direct), Serum
143255 Testosterone, Free and Weakly Bound
140244 Estradiol, Sensitive
500142 Dihydrotestosterone (DHT)

I want to skip the other tests recommended in the sticky, "Finding a TRT Physician" because I did the full panel less than 6 weeks ago and I'm due again in a month. I added DHT because it was low last time and I'm curious what impact the Androgel might have made. Are these tests sufficient for determining proper dosing? And if I do need to increase, which would be recommended: 10g Androgel 1% (100mg) or 5 mg Androgel 1.62% (81mg)?

[sirupate]

You know...I have no idea where you should go next if you are still low. Applying 10gms of the 1% is a bit of a chore...as it takes quite a bit of body area to apply that much gel to. The 1.62% will take less of course. Some have alluded that the 1.62% absorbs better than the 1%, so you may need less than the strict mathematical ratio, but the literature supplied doesn't make any mention of absorbing better, so I am not sure.

My doctor dosed me down to 2 pumps of the 1.62% from 6 pumps of the 1% A-gel. I was feeling pretty good on the 6 pumps of the 1%. A strict ratio would have indicated 4 pumps of the 1.62% gel to be equal to 6 pumps of the 1% gel. Am seeing a new doctor on Thursday morning to get a second opinion on my treatment.

[kelkel]

^^^Agree with Sirupate. Make sure you do your BW 24 hrs after last application so you get your "Trough" or bottom level if you can. Then stay consistent with your draw time. If your still low switch to 1.62%, which you should do anyway quite honestly, or re-evaluate and consider injections along with hcg. Glad to see your monitoring DHT. Mine shot through the roof while on agel, switched to injections and it normalized quickly. When it comes to absorption applying moisturizer or sunscreen an hour or so after application will help. It's noted right in the 1.62% insert. There's also another thread here where the op seems to have dramatically increased absorption using dmso. I would recommend you stop the moisturizer, etc prior to bw.

[sirupate]

^^^^^ agree with Kel on bloodwork 24 hours after last application of gel. Mine showed some pretty weird and spikey numbers when I applied same day as bloodwork. Also, I think my doctor said that the 1% gel is going away at some point, so you won't have a choice between the two eventually.

The moisterizer after application is a neat trick. Problem is, I'm at work about 1 hour after application, so that strategy only works for me on weekends and vacation, but may work well for some guys. You should consider hCG even if you stay on the gel. You will feel better using it. You can source it yourself if your doctor won't consider writing the scrip...and many won't write that scrip. as it is an "off label" use of the drug in hypogonadal males.

[zaggahamma]

I will have been on 5g Androgel 1% for 3 weeks as of tomorrow, so my plan is to go in for follow-up labs. I wasn't able to go by Dr. Crisler's recommendation of going back in by a "fortnight", but I think going in now should be soon enough to get the results back in time for a new prescription before I run out of the gel. I hope...

In any case, I just want to do enough to serve that purpose. Here are the LabCorp tests I'm planning to ask for:

Test # Test Name
004226 Testosterone, Total, Serum
144980 Testosterone, Free (Direct), Serum
143255 Testosterone, Free and Weakly Bound
140244 Estradiol, Sensitive
500142 Dihydrotestosterone (DHT)

I want to skip the other tests recommended in the sticky, "Finding a TRT Physician" because I did the full panel less than 6 weeks ago and I'm due again in a month. I added DHT because it was low last time and I'm curious what impact the Androgel might have made. Are these tests sufficient for determining proper dosing? And if I do need to increase, which would be recommended: 10g Androgel 1% (100mg) or 5 mg Androgel 1.62% (81mg)?

not many i've heard stay on 5mg androgel...i had good results with double up androgel and have been hearing good things of late about the 1.62...guess its up to you and your doc and your bloodwork and symptoms or lack there of...have you considered the needle?

[kelkel]

Just pulled my HCG insert out of the trash to post this:

"Indications and Usage:

2. Selected cases of hypogonadotropic hypogonadism (hypogonadism secondary to a pituitary deficiency) in males."

I know there has been debate about it here before so I wanted to throw that out to all.

^^^^^ agree with Kel on bloodwork 24 hours after last application of gel. Mine showed some pretty weird and spikey numbers when I applied same day as bloodwork. Also, I think my doctor said that the 1% gel is going away at some point, so you won't have a choice between the two eventually.

The moisterizer after application is a neat trick. Problem is, I'm at work about 1 hour after application, so that strategy only works for me on weekends and vacation, but may work well for some guys. You should consider hCG even if you stay on the gel. You will feel better using it. You can source it yourself if your doctor won't consider writing the scrip...and many won't write that scrip. as it is an "off label" use of the drug in hypogonadal males.

[sirupate]

Just pulled my HCG insert out of the trash to post this:

"Indications and Usage:

2. Selected cases of hypogonadotropic hypogonadism (hypogonadism secondary to a pituitary deficiency) in males."

I know there has been debate about it here before so I wanted to throw that out to all.

I'll look at my insert too, but it is from India, so hard telling what it will say. Maybe hCG is now moved from off-label to OK for use in our situation. Wouldn't surprise me if my doctor didn't know that. He didn't seem to know about the 1.62% A-gel either until recently.

[DaRoq]

I apologize for coming back to this thread so late. There were personal and work issues to take care of shortly after posting, and I forgot about it. I also didn't have the time or wherewithal to actually make the appointment. I only remembered this post while making the appointment earlier today. The bloodwork will be taken 7 weeks after beginning treatment.

I was on 200mg Test Cyp. EOW before, but reading this forum made me realize that I needed to go to shorter intervals, and that would've cost $50/week for shots at the office. So I decided to try the Androgel, which my insurance plan covers up to 300g per 30 days at a tier 2 rate ($30 co-pay). So far the benefits have been very mild. The only thing I'd noticed is increased cognitive ability during the 2nd and 3rd weeks, but that went away for some reason. I'm already using my shoulders/upper arms, chest and flanks for 5g/day, so increasing to 10g is out of the question and probably a waste. I could go to the 1.62%, but the covered amount delivers less than the "standard" IM injection of 100mg/wk, so I'm skeptical of its effectiveness.

sirupate: How are you doing on the 2 pumps of 1.62%? isn't that only 40.5mg? My max would be 4 pumps.

kelkel: I'm really curious about my DHT because I began to lose some hair after starting the Androgel. I also have family history of mild male pattern baldness, which was probably kept at bay previously because of my low levels (5.7 ng/dl). I'm going in for bloods at 8:45 before applying the gel that morning, which will be close to 24 hours since the last application.

jpkman: I'll consider the needle again if the next course of treatment doesn't work. I'm just not sure I can stomach the cost though. Maybe I might be able to get insurance to pay...

[kelkel]

D-R I don't believe you should be applying the agel to your chest. Check your insert. Maybe it ultimately doesn't matter but I believe the insert says not to. Be good to know your DHT even though it won't be a baseline. It will still help for further testing and if you switch to injections in the future.

[zaggahamma]

D-R I don't believe you should be applying the agel to your chest. Check your insert. Maybe it ultimately doesn't matter but I believe the insert says not to. Be good to know your DHT even though it won't be a baseline. It will still help for further testing and if you switch to injections in the future.

i put it on my chest all the time

chest, abs, legs, shoulders

maybe it was testim that said to put on chest and thats where i got it from as i started with testim

agree about having baseline numbers...always good to see what numbers are changing if any

[DaRoq]

D-R I don't believe you should be applying the agel to your chest. Check your insert. Maybe it ultimately doesn't matter but I believe the insert says not to. Be good to know your DHT even though it won't be a baseline. It will still help for further testing and if you switch to injections in the future.

I could swear that I read that the chest was an alternate site they rotated between in clinical trials, with no difference in results.

I kinda hope my DHT is high because at least it would explain the hair loss. I mentioned it to a co-worker and she said she's been noticing it, but didn't want to say anything. I'll probably switch if it is high.

[kelkel]

It's possible your DHT is high. I did not have a baseline when I started gels either due to poorly informed docs. When I finally did get it checked it was way over the top. Switched to injections and within one month is was back to a normal level. Remember, T converts to DHT via the 5 Alpha Reductase Enzyme which is everywhere (except muscle) and has a high concentration in the scalp. So, if your prone to hair loss you may be shedding when dht goes up..... The meds to counter it, Propecia etc., all come with a large group of side effects. Google it.

[DaRoq]

Well, it's been a month since I started this thread and finally went to the Doctor to get bloodwork. Based on recent symptoms I described, he ordered the following:

Testosterone, Total, Serum
Testosterone, Free (Direct), Serum
Estradiol, Sensitive
Follicle-stimulating Hormone (FSH) and Luteinizing Hormone (LH)
Dihydrotestosterone (DHT)
Dehydroepiandrosterone Sulfate
Thyroid-stimulating Hormone (TSH)
Vitamin D, 25-Hydroxy
Metabolic Panel (14), Comprehensive
Lipid Panel

I wasn't able to get any of it done because the DHT test requires the samples be frozen, and the facility I go to isn't equipped for that. This ended up being a blessing in disguise because I noticed on the lab request that Estradiol, Sensitive & Follicle-stimulating Hormone (FSH) and Luteinizing Hormone (LH) is missing. So I'm calling them to redo the lab request and plan to go to the Lab this Saturday morning.

Although my doctor is not up to speed on TRT, I like that he's trying to discover the cause of my symptoms, rather than just focusing on making TRT work. Today is the 2nd day in a row without any Androgel, and I feel no difference. I'm actually hoping that I'm low on DHEA and Vitamin D since they can be changed fairly easily. Who knows...maybe that's the reason I was low to begin with.

[ecdysone]

If he ordered FSH/LH he must have little faith in his prescribed therapy: otherwise they will be near zero and worthless.

LabCorp doesn't require the DHT test to be frozen, so not sure why they are saying this, but for certain, this will be in the top tier of tests you will want.

If you not taking high-dose D vitamins now, your Vit D will almost for certain show low.

In any event, good luck, and keep us posted!

[DaRoq]

If he ordered FSH/LH he must have little faith in his prescribed therapy: otherwise they will be near zero and worthless.

LabCorp doesn't require the DHT test to be frozen, so not sure why they are saying this, but for certain, this will be in the top tier of tests you will want.

If you not taking high-dose D vitamins now, your Vit D will almost for certain show low.

In any event, good luck, and keep us posted!

He actually didn't order the LH/FSH test. I was planning to get that done based on the follow-up labs recommended in the stickies. You're right, though, about it not being necessary.

I was bummed about not being able to draw blood, so I looked at LabCorp's menu and, sure enough, it shows Specimen: Serum (preferred) or plasma, frozen for DHT.

I started taking 4,000-10,000 IUs a day of D3, but decided to hold off until I get a baseline.

Thanks for the kind words. I should get the results by late next week.

[ecdysone]

I was bummed about not being able to draw blood, so I looked at LabCorp's menu and, sure enough, it shows Specimen: Serum (preferred) or plasma, frozen for DHT.

Right, you are! Even though I go to a tiny drawing station, they must have capabilities for spinning down the specimens and freezing them.

I do recall it being a somewhat more costly test , so now I see why.

[DaRoq]

Just got my e2 results for bloodwork done at 08:45 on 3/11/2012:

37.9 pg/ml (no range given for male) Roche ECLIA methodology

Last pull on 12/27/2011 09:30 (no TRT for 5 weeks):

19.2 pg/ml (7.6-42.6) Roche ECLIA methodology

Estradiol levels just about doubled after 7 weeks on 5g of Androgel 1%. I guess that means I'm absorbing the T, but it's being converted?

I should receive the rest of the results soon.

[zaggahamma]

No range necessary with those measurements

answer to your question, YES..

question to you...how do u feel

[ecdysone]

FWIW the Roche Elecsys Estradiol 11 assay (Competitive Electrochemiluminescent Immunoassay (ECLIA) tends to run a little high on the low end (like maybe +30%), so your 37.9 would be alot lower if translated to say, LabCorp E2 sensitive.

[DaRoq]

No range necessary with those measurements

answer to your question, YES..

question to you...how do u feel

I actually feel pretty good right now, but I know I could feel better. I'd like to increase the dosage on the next refill. Would applying the gel only to my shoulders/upper arms help avoid conversion? If not, then I might need to go back to injections...

[DaRoq]

FWIW the Roche Elecsys Estradiol 11 assay (Competitive Electrochemiluminescent Immunoassay (ECLIA) tends to run a little high on the low end (like maybe +30%), so your 37.9 would be alot lower if translated to say, LabCorp E2 sensitive.

This is good to know. Thanks

[zaggahamma]

I actually feel pretty good right now, but I know I could feel better. I'd like to increase the dosage on the next refill. Would applying the gel only to my shoulders/upper arms help avoid conversion? If not, then I might need to go back to injections...

not sure if the theory of applying to less fatty regions prevents less aramotazation....i know me personally applied where you are saying to only apply and still went from 25 e2 natty to 78 on 2 packets of androgel

[DaRoq]

Test is still low, so I'm planning to bump up the dose. Also need to supplement Vitamin D and DHEA, and monitor my e2.


Test Name.............................................R esult......Reference Range
Testosterone , Serum...........................287 ng/dl......348-1197
Free Testosteron (Direct).....................8.2 pg/ml......6.8-21.5
Estradiol......................................... .37.9 pg/ml......7.6-42.6
TSH.............................................2. 320 uIU/ml......0.450-4.500
Dihydrotestosterone..............................5 2 ng/dl......30-85
Dehydroepiandrosterone.......................138 ng/dl......30-701
Vitamin D, 25-Hydroxy........................13.2 ng/ml.......30-100