Restarting TRT on Androgel

[DaRoq]

Dr. originally put me on 200mg depo-testosterone per month after TT test came in at 200 ng/dl (249-836). The results were great after the 1st shot, so I switched myself to every 2 weeks. But then the Dr. insisted I go back to 4 weeks between shots, after which tests came back at 90 ng/dl (348-1197) on day 28. So he put me back on every 2 weeks until I started to have symptoms of high e2. Then I went off for 5 weeks in order to get a baseline reading, and my levels came back even lower:

Testosterone, Serum 80 ng/dl (348-1197)
Testost., F+w Bound 20.3 ng/dl (40.0-250.0)
Testost., % Free+weakly Bound 25.40% (9.0-46.0)
Dihydrotestosterone 5.7 ng/dl
Estradiol 19.2 pg/ml (7.6-42.6)
Sex Horm Binding Glob, Serum 16.7 nmol/L (16.5-55.9)
Lh 2.3 miU/ml (1.7-8.6)
Fsh 2.8 miU/ml (1.5-12.4)
Prolactin 7.8 ng/ml (4.0-15.2)
Cortisol 11 ug/dL (2.3-19.4)

Do you think my Lh & Fsh levels are low? I don't know what they were pre-TRT, but it seems like I'm almost in total shutdown mode after only 3 months on TRT. What about the e2? Is that ok considering I haven't had much testosterone to convert? I'm worried it'll skyrocket once I'm on the Androgel... but at least it should raise my dht to more normal levels.

I'll be on 5g Androgel 1%, which I believe is only 35mg/week. Seems like too little considering I was averaging 100mg/wk with the cyp. My Dr. wants me to go back for bw after 8 weeks, but I'm thinking 4 weeks is long enough. Any feeback would be appreciated.

Thanks

[JD250]

Welcome, Was your estrodial test the "sensitivity assay"? Have you done much reading on this sight about the "typical" protocol? Everyone is different but there is what I would call a typical protocol.......your Doctor, the guy thats EXPERIMENTING with your health, doesn't know what he's doing and I think you can attest to that fact by the way you feel, yes? The sticky notes at the top of this forum are a good place to start learning and also checkout the following link and article, once you read this stuff and get a basic grasp of whats happening you will understand why I say your doc is uninformed and his protocol is a danger to your health.

http://www.allthingsmale.com/word_docs/TRT.doc

[kelkel]

^^^^^Exactly what JD said!

[DaRoq]

Welcome, Was your estrodial test the "sensitivity assay"? Have you done much reading on this sight about the "typical" protocol? Everyone is different but there is what I would call a typical protocol.......your Doctor, the guy thats EXPERIMENTING with your health, doesn't know what he's doing and I think you can attest to that fact by the way you feel, yes? The sticky notes at the top of this forum are a good place to start learning and also checkout the following link and article, once you read this stuff and get a basic grasp of whats happening you will understand why I say your doc is uninformed and his protocol is a danger to your health.

Thanks, JD. Yes, I've learned so much from this site already and actually showed my Dr. the list of tests ("Initial Labwork") from the document you linked to. He gave it to his assistant to look up the codes for the tests. However, I haven't seen a copy of the actual lab request. Do my e2 numbers look off?

The main reason I switched to Androgel was because my insurance doesn't cover Testosterone Cypionate, so I was paying $50 per injection. And at that rate, the typical weekly injections would end up costing me more than I cared to spend ($2600/yr). So I figured I could go on this stuff for a while, then make a case with my insurance to cover it due to the lower cost. Even if they wouldn't cover it, I'd happily come out of pocket for the test. to do subQ self injections. That's actually my preference, but my Dr. is very conservative and needs to try the "safer" methods first. In fact, I once asked him if I could try a Clomid restart after reading on PubMed about its efficacy and cost-efficiency, but he said he'd never heard of prescribing it to men and was afraid of "ending up like Michael Jackson's doctor". So my plan is to try this for a few months, then ask him to let me self inject if things aren't going well.

I agree that my Dr. is uninformed. He once argued with me that testosterone cannot be converted to estrogen when I suggested that I needed more frequent injections to mitigate that conversion. All he could say was, "I'll check my text books". He's a decent Family Practice doctor, but I think I might switch to the Internal Medicine guy from the same provider. Or maybe ask to see the Endo they have there.

[JD250]

My doctor has been my family doctor for 25 years, he knows the names of my kids and when their birthdays are and several other things about us that only a friend would know but he is one of the most uninformed people when it comes to HRT....don't be afraid to find a good knowledgable doctor, yours is going to hurt you with his ignorance.

As far as your e2 goes, it looks OK, maybe a little low even, if those numbers are from a "sensitivity assay" if they are not then they mean nothing.

[HRTstudent]

You Lh & Fsh levels will be low because you are on T therapy. Not that they mean nothing now, but after 3 months on T therapy they will be affected and I don't know what meaningful input they offer unless they are extremely high or maybe 0.

[DaRoq]

You Lh & Fsh levels will be low because you are on T therapy. Not that they mean nothing now, but after 3 months on T therapy they will be affected and I don't know what meaningful input they offer unless they are extremely high or maybe 0.

The tests were taken 5 weeks after I stopped TRT. Are you saying that levels would now be affected indefinitely, even without exogenous T? My thinking about the lower Lh/Fsh is that if they were higher, my body might produce as much T as it could (at least pre-TRT levels). And if so, maybe it's possible to maximize the Lh levels via supplementaion so as to avoid total HPTA shutdown. In theory the effect would be the same as when you first start TRT and have higher levels of T because the HPTA hasn't shut down yet. An added benefit might be less/no testicle shrinkage since they are still working. In the end, I wish I had been more informed and tested my Lh/Fsh levels before going on TRT. Maybe I could've avoided it altogether?

[JD250]

A baseline reading would've been good, another reason to find a better doc or see if yours is open to reading up on this stuff. At 42 years old you can be fairly sure that your levels will never be optimal again so with that in mind do something about your doctor situation and proceed with the knowledge that you've gained. See if your doc will consult with Dr. Crisler, it's a minimal fee and you'll be getting advice from someone who knows whats going on.

[DaRoq]

My former Dr. is a DO, and was much more liberal in his choice of treatments. Once when i had a rash on my face he had no qualms giving me a corticosteroid injection, which I swear cleared it up right away. I think he would've been ideal for TRT if I didn't choose an HMO plan. I found out after this last open enrollment that he's now in-network for one of the PPO plans offered to us. So until I can change plans next year, I think I better read the "Finding a TRT Physician" sticky and get busy looking. Maybe I might get lucky and find someone sooner...

Thanks for the advice about the Dr. Crisler consult. I'd surely do that if I thought my guy wa willing.

[PPC]

You may do great on the androgel. Be sure to exfoliate in the shower before you apply the gel. Since he is starting you out at five grams, exfoliating will help you absorb more of it.

[kelkel]

Here's another tid-bit of info that may help your levels. It's directly from the 1.62 insert:

Effect of sunscreen or moisturizing lotion on absorption of testosterone
In a randomized, 3-way (3 treatment periods without washout period) crossover study in 18 hypogonadal males, the effect of applying a moisturizing lotion or a sunscreen on the absorption of testosterone was evaluated with the upper arms/shoulders as application sites. For 7 days, moisturizing lotion or sunscreen (SPF 50) was applied daily to the AndroGel 1.62% application site 1 hour after the application of AndroGel 1.62% 40.5 mg. Application of moisturizing lotion increased mean testosterone Cavg and Cmax by 14% and 17%, respectively, compared to AndroGel 1.62% administered alone. Application of sunscreen increased mean testosterone Cavg and Cmax by 8% and 13%, respectively, compared to AndroGel 1.62% applied alone.

[JD250]

^^^^ wow, that's some interesting info Kel, I've got a buddy on the weaker version, 1% I believe...whatever, I wonder if the same would apply to it?

[JD250]

Also DaRog, earlier when I said your levels would probably never be optimal again I was referring to your "natural" levels.

[DaRoq]

Thanks, everyone. I'll make sure to exfoliate before and apply moisturizing lotion after putting on the gel. But how should I exfoliate? Is scrubbing with a loofah enough? Or do I need to go as far as a salt scrub (daughter's suggestion) a few times a week?

[kelkel]

Don't remember if that was in the 1% insert or not but I can check. I must have 3 bottles of that and a couple 1.62's under the sink. It would make sense that it would help......I would just stop a few days prior to bw so as to not skew results.

^^^^ wow, that's some interesting info Kel, I've got a buddy on the weaker version, 1% I believe...whatever, I wonder if the same would apply to it?

[PPC]

You can just scrub with a loofah. My husband just uses a natural bristle one from the bath and body section in Walmart. You can also use a natural bristle hair brush. Some guys find they get better absorption wiping a little excess on their testicle area. The gel pamphlet does not recommend this but it is done. Interestingly, they used to make a scrotal T patch since that is a highly absorbent area but the patch would fall off and be too annoying.

Some have concern scrotal application may push DHT levels too high, anecdotally at least, libido is enhanced via this route.

[lvs]

I am waiting for GD to chime in with his Good God comment to this protocol....

Dr. originally put me on 200mg depo-testosterone per month after TT test came in at 200 ng/dl (249-836). The results were great after the 1st shot, so I switched myself to every 2 weeks. But then the Dr. insisted I go back to 4 weeks between shots, after which tests came back at 90 ng/dl (348-1197) on day 28. So he put me back on every 2 weeks until I started to have symptoms of high e2. Then I went off for 5 weeks in order to get a baseline reading, and my levels came back even lower:

Testosterone, Serum 80 ng/dl (348-1197)
Testost., F+w Bound 20.3 ng/dl (40.0-250.0)
Testost., % Free+weakly Bound 25.40% (9.0-46.0)
Dihydrotestosterone 5.7 ng/dl
Estradiol 19.2 pg/ml (7.6-42.6)
Sex Horm Binding Glob, Serum 16.7 nmol/L (16.5-55.9)
Lh 2.3 miU/ml (1.7-8.6)
Fsh 2.8 miU/ml (1.5-12.4)
Prolactin 7.8 ng/ml (4.0-15.2)
Cortisol 11 ug/dL (2.3-19.4)

Do you think my Lh & Fsh levels are low? I don't know what they were pre-TRT, but it seems like I'm almost in total shutdown mode after only 3 months on TRT. What about the e2? Is that ok considering I haven't had much testosterone to convert? I'm worried it'll skyrocket once I'm on the Androgel... but at least it should raise my dht to more normal levels.

I'll be on 5g Androgel 1%, which I believe is only 35mg/week. Seems like too little considering I was averaging 100mg/wk with the cyp. My Dr. wants me to go back for bw after 8 weeks, but I'm thinking 4 weeks is long enough. Any feeback would be appreciated.

Thanks

[kelkel]

^^^Damn funny Ivs!

[steroid.com 1]

I am waiting for GD to chime in with his Good God comment to this protocol....

LOL...luv ya bro!

I didn't need to say "Good God" you could have done that...but that being said...GOOD GOD!

The poor OP is all over the place.

Yes, LH & FSH are tanked because you were shut down and there has been no re-start attempt...you must feel horrible!

It takes very little to shut down or suppress HPTA and three weeks is more than enough time!

E2 is a tad low and can point to your extremely low Test levels for that.

E2 probably won't spike with the gel; it could with IM, however. Keep an eye for symptoms.

You can test BW on gels/creams within two weeks to get valid results there's no need to wait longer.

I feel for you man, I believe your Doc wants the best for you but it appears he doesn't know what he's doing and has you all over the place.

Why not a more standard protocol with Test IM (100 mg/wk to start), hCG and test E2 after 6 weeks for an added AI if required?

[DaRoq]

LOL...luv ya bro!

I didn't need to say "Good God" you could have done that...but that being said...GOOD GOD!

The poor OP is all over the place.

Yes, LH & FSH are tanked because you were shut down and there has been no re-start attempt...you must feel horrible! I do feel horrible. There's nothing like the feeling when you're "on" with no sides.

It takes very little to shut down or suppress HPTA and three weeks is more than enough time! It's been 8 weeks since my last injection, and my "boys" have gone back to normal. What's your take on trying a re-start at age 42?


E2 is a tad low and can point to your extremely low Test levels for that.

E2 probably won't spike with the gel; it could with IM, however. Keep an eye for symptoms.

You can test BW on gels/creams within two weeks to get valid results there's no need to wait longer. I just might have to do that to allow time to get results back and adjust the dosage (if necessary) before I run out. Not sure if that requires a new script.

I feel for you man, I believe your Doc wants the best for you but it appears he doesn't know what he's doing and has you all over the place. In fairness to the good doc, he did mention that my DHEA might be low, but I was so focused on TRT (and Dr. Crisler's TRT doc) that we didn't get that tested. Now that I've read about DHEA being an integral part of the natural pathway to T production (CHOL->pregnenolone->DHEA->androsteien-dione->T), I think he might've been right.

Why not a more standard protocol with Test IM (100 mg/wk to start), hCG and test E2 after 6 weeks for an added AI if required? I'll probably switch back if my testosterone and overall well-being doesn't increase significantly on the gel, as I've already been "spoilt" by prior IM injections. As for the hCG, I'm looking at supplements instead.

Thanks for you input!

[steroid.com 1]

Thanks for you input!

It's been 8 weeks since my last injection, and my "boys" have gone back to normal. What's your take on trying a re-start at age 42?

This is somewhat surprising giving how low your LH/FSH assays present but it's possible; not enough to increase Test serum levels but get the boys back to some size.

In fairness to the good doc, he did mention that my DHEA might be low, but I was so focused on TRT (and Dr. Crisler's TRT doc) that we didn't get that tested. Now that I've read about DHEA being an integral part of the natural pathway to T production (CHOL->pregnenolone->DHEA->androsteien-dione->T), I think he might've been right.

Well, it's more than this. Yes, low DHEA serum levels can be one part of the androgen pathway that may be low BUT it's whats upstream from DHEA that needs to be looked at. Generally it's a function of low LH/FSH levels equating to low testicular function where LH binds with the leydig cells that activates the P450 side chain where CHOL converts to Pregnenlone than DHEA... What were your LH/FSH levels before your started your protocol?

I'll probably switch back if my testosterone and overall well-being doesn't increase significantly on the gel, as I've already been "spoilt" by prior IM injections.

Good!

As for the hCG, I'm looking at supplements instead.

Note, there are no supplements that can do what hCG can do...none. You may not need hCG on the gels but excellent chance with IM. Just keep that in mind.

[DaRoq]

This is somewhat surprising giving how low your LH/FSH assays present but it's possible; not enough to increase Test serum levels but get the boys back to some size.

So higher LH/FSH would increase Test serum levels even while on TRT?

Well, it's more than this. Yes, low DHEA serum levels can be one part of the androgen pathway that may be low BUT it's whats upstream from DHEA that needs to be looked at. Generally it's a function of low LH/FSH levels equating to low testicular function where LH binds with the leydig cells that activates the P450 side chain where CHOL converts to Pregnenlone than DHEA... What were your LH/FSH levels before your started your protocol?

Unfortunately, my Dr. never took my LH/FSH levels prior to starting TRT. I'll be experimenting with taking suplements (DHEA, Pregnenolone, D-Aspartic Acid) for the purpose of backfilling the upstream parts of the androgen pathway that are bypassed when exogenous testosterone is introduced.

Note, there are no supplements that can do what hCG can do...none. You may not need hCG on the gels but excellent chance with IM. Just keep that in mind.

I mentioned taking supplements in place of the hCg with only keeping the testis active in mind. I really need to read your "The Use of HCG to Increase Testicular Size and Sex Drive While on TRT" again.

[steroid.com 1]

DaRog - I may have missed it; will your Doc write for hCG?

If not, there are a number of very legit online overseas pharmacies where you can purchase hCG; it's not cost prohibitive and reliable product to boot.

Crisler loves to use gels and hCG to get optimal levels...may be something to consider.

Read the sticky my friend and this post again:

http://forums.steroid.com/showthread...TRT&highlight=

We only want the best for you man!

[DaRoq]

That was a good read, GD. I really would've liked to have taken the Chorionic Gonadotrophin Stimulation Test if I had the time. I read about it before in the AACE guidlines, but discounted it thinking it'd be cost-prohibitive. I'll have to ask my Dr. for a script now that I know it isn't.

$70 for 10,000 IU powder is very affordable. How do you make use of it on a 500 IU/wk regimen if the shelf life is only 6 weeks?

[sirupate]

That was a good read, GD. I really would've liked to have taken the Chorionic Gonadotrophin Stimulation Test if I had the time. I read about it before in the AACE guidlines, but discounted it thinking it'd be cost-prohibitive. I'll have to ask my Dr. for a script now that I know it isn't.

$70 for 10,000 IU powder is very affordable. How do you make use of it on a 500 IU/wk regimen if the shelf life is only 6 weeks?

If possible...get the 5000iu. vials rather than the 10,000iu vials. Given the small amount you will be injecting and the approx. 6 week refridgerated life of reconstituted HCG, some of the 10,000 iu. vial will go to waste.

[steroid.com 1]

^^^^ Exactly!

DaRog, there are no established protocols for the use of hCG in men. Read the stickies and the link I posted above.

For me, I like smaller doses more frequently.

That means for me 250 iu EOD.

Some men can do 250 iu twice a week and their testicles function and remain healthy.

Do some research and figure out what works for you and than discuss with your Doctor.

As I mentioned, with gels/creams hCG doesn't seem to be an absolute necessity but for IM injections it almost always is.

But I know some Docs, like my own, who do prescribe it together for guys who are low normal and relatively young...shooting for more natural produciton with some Test lift via the gel/cream.

[DaRoq]

Finally picked up my prescription, so tomorrow will be the first day of this 5g/day Androgen 1% protocol. I plan to go back for labs on the 21st day, which should give enough time to make adjustments before I need to refill.

I also used the FIND A DOCTOR tool on the the Androgel website and found 2 doctors from the same office; 1 is an Endo, the other Internal Medicine. Can I ASSume that since they are listed by the company that they might also be more up-to-date on TRT, especially with Androgel?

[lovbyts]

Go for the Endo, they seem to know more. That's what I'm using although he does not feel there is a need/benefit beyond fertility for HCG.

As far as the androgel goes if you really want to get a little boost from it try a little DMSO with it.

[DaRoq]

Go for the Endo, they seem to know more. That's what I'm using although he does not feel there is a need/benefit beyond fertility for HCG.

As far as the androgel goes if you really want to get a little boost from it try a little DMSO with it.

I'm gonna ask my PCP for a referral to the Endo and tell him I need to stay fertile.

First time applying the Androgel was a breeze. It dries up quickly, and there was no stickiness at all. I was worried about having to slather it on like others have reported, but it was like using hand sanitizer. For now I'm sticking with moisturizing lotion on top of the gel, 1 hour after application.

[lvs]

Go for the Endo, they seem to know more. That's what I'm using although he does not feel there is a need/benefit beyond fertility for HCG.

As far as the androgel goes if you really want to get a little boost from it try a little DMSO with it.

Can you explain?

[DaRoq]

I don't know what's going on, but my overall well-being was great today. I had more energy, complete focus at work, and my thoughts were very clear. This is much better!

[Ashop]

I think if I were you I would see another doctor for a second opinion.

[lovbyts]

Can you explain?

Google DMSO and it should be pretty self explanatory but basically it will help transmit most any chemical into your body via your skin by mixing the two. Many people still use it with Fina instead of injections.

[DaRoq]

Well, it's been a little over 8 weeks since I started the Androgel. I've been pretty good about applying the stuff every day, but there was actually a whole weekend and several single days that I missed. Surprisingly, I felt perfectly fine without. My last set of labs was taken a week ago, so I'll know soon where I stand with this test-only protocol. I'll probably switch to the 1.62%, for an increase to 81mg/day (~52mg/wk net) if DHT isn't too high. Otherwise, I'll switch back to test-cyp injections.

[kelkel]

No real problem missing a day here or there. Takes 4-5 days to clear you system anyway. Very curious how your labs turn out. Post them up please!

[HRTstudent]

looking forward to the blood results...

how do you feel overall? mentally?

[DaRoq]

I was anxious to see the results, so I called the office and they told me it's ready. I plan to swing by and pick them up on my way home from work. Will post them up when I get home in a few hours.

Overall, I feel pretty good. No libido or related issues, and my mental and cognitive ability is back to normal or even enhanced. And the few times when I doubled-up the dose to 100mg, I felt even better, albeit somewhat jittery. So I plan to ask for a dose increase to 81mg/day of Androgel 1.62 as a compromise, which should be enough. I believe my insurance only covers two bottles anyway.

[kelkel]

Great to hear. Definitely post up when possible!

[HRTstudent]

It's good that you're feeling better again.

That is by far the most important thing here. TRT is a well-being therapy. We've got to remember that and try to put less emphasis on pure numbers when we get caught up in that. Some people feel better at 650 than they do at 1,000.

[DaRoq]

Finally got the lab results.

Test is up, but still below the range and only 87 points above my pre-trt levels. Now I can justify increasing the dose.
DHT is up considerably, but still within range. Probably why my libido is good despite the low T. I'll probably be at the top of the range on 81 mg/day.
DHEA & Vitamin D is low, so I'm going to start supplementing.
Need work on CMP & Lipid panel. Triglycerides doubled since starting TRT.

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

Glucose, Serum...................................88 mg/dl.......65-99
eGFR If NonAfricn Am.....................70 ml/min/1.7......>59
BUN............................................... ...19 mg/dl.......6-24
eGFR If Africn Am..........................81 ml/min/1.7......>59
Creatinine.......................................1 .25 mg/dl.......0.76-1.27
BUN/Creatinine Ratio....................................15....... 9-20
Sodium, Serum................................141 mmol/L.......134-144
Potassium, Serum.............................3.7 mmol/L.......3.5-5.2
Chloride, Serum...............................100 mmol/L.......97-108
Carbon Dioxide..................................26 mmol/L.......20-32
Protein, Total, Serum............................7.9 g/dl.......6.0-8.5
Albumin, Serum....................................4.4 g/dl.......3.5-5.5
Globulin, Total.....................................3.5 g/dl.......1.5-4.5
A/G Ratio............................................. ....1.3.......1.1-2.5
Bilirubin, Total...................................0.9 mg/dl.......0.0-1.2
Alkaline Phospate...................................63 iu/l.......25-150
AST (SGOT)..........................................20 iu/l.......0-40
ALT (SGPT)...........................................5 1 iu/l.......0-55
Calcium, Serum..................................9.4 mg/dl.......8.7-10.2

Cholesterol, Total..............................189 mg/dl.......100-199
Triglycerides..................................... 205 mg/dl.......0-149
HDL Cholesterol...................................46 mg/dl.......> 39
VLDL Cholesterol Calc...........................41 mg/dl.......5-40
LDL Cholesterol Calc...........................102 mg/dl.......0-99