Levels dropped after HRT began - Please Help

[jabo]

New to the forum.

4 weeks ago my doctor ran blood work and determined that my T level was at 274. He prescribed me 1 tube of Tetim / day, which I have been taking since. I could tell an increase in libido between days 7-14, but after that I felt like my old 'normal' self. I theorized that my natural production of Test had decreased since I started receiving it artificially.

I went in for follow up blood work this morning to see how my levels have responded to the gel. To my doctor's surprise, my T level was at 148 (about half of what it was before even taking the gel). I did not use the gel before the blood work this morning, because I didn't want it to artificially spike up the reading (my blood was taken at approx. the same time I use the gel every day, and I will use the gel a few hours later than normal today rather than missing a dose).

Now I'm being referred to an endocrinologist and was told that I may be a prime candidate for injections since the 'typical' dosage of the gel hasn't helped my levels and doubling my current dosage of the gel probably will not help that much more either.

Any ideas / advice?

[Bulldog]

New to the forum.

4 weeks ago my doctor ran blood work and determined that my T level was at 274. He prescribed me 1 tube of Tetim / day, which I have been taking since. I could tell an increase in libido between days 7-14, but after that I felt like my old 'normal' self. I theorized that my natural production of Test had decreased since I started receiving it artificially.

I went in for follow up blood work this morning to see how my levels have responded to the gel. To my doctor's surprise, my T level was at 148 (about half of what it was before even taking the gel). I did not use the gel before the blood work this morning, because I didn't want it to artificially spike up the reading (my blood was taken at approx. the same time I use the gel every day, and I will use the gel a few hours later than normal today rather than missing a dose).

Now I'm being referred to an endocrinologist and was told that I may be a prime candidate for injections since the 'typical' dosage of the gel hasn't helped my levels and doubling my current dosage of the gel probably will not help that much more either.

Any ideas / advice?

I believe you are supposed to apply the gel 2-4 hours before your blood is drawn.

[hardasnails1973]

Before switching:

1. testim sucks
2. You have under lying adernal or thyroid disorder resuilting myodexemia (thicking of skin and water getting caught under the skin trapping testosterone in upper layer of skin)
3. switch to compunded gel 10% from good pharmacy
4. Getting it all over your hands and not on your body (lossing about 40%)
5. Body caused negative feed back loop and shut down your own production and low gel absorption is making lower T (had this happen to me)

[pmgamer18]

This happens your on 5 g's of gel your brain sees this in your body and slows down the message from your brain to your testis to make T so you end up with what the gel is doing. As for seeing an Endo I have yet to see one that is good on TRT or even hear of anyone that seen a good one.

All your Dr. needs to do is up your dose of gel for me it took 2 tubs. I put one on my upper arms and shoulders and down my back as far as I could reach then did the other side. Make sure you rub it in well using Testim.

Read the sticks above like TRT: A Recipe for success and others. Print it out and give it to your Dr. Endo's are not good Dr.'s for low T. Make sure your Dr. did a lot of labs it's all in TRT:

[jabo]

I believe you are supposed to apply the gel 2-4 hours before your blood is drawn.

That may be true, but it does not explain this:

The purpose of the gel is to add to my initial baseline reading (i.e. 274). Therefore, in my mind I should still be hovering around 274 even if I haven't used the gel today (and that's assuming that all of the previous day's dose is 100% absorbed and the test results today were only seeing the 'natural' test production level present).

Why is my reading only half of what it was before I even started HRT?
I think my natural production of Test must have shut down or dramatically dropped. I don't see how missing 1 day of the Testim would plummet my levels to half of the initial baseline reading prior to starting HRT. It doesn't add up.

[jabo]

I appreciate the feedback.

I'm not certain that injections wouldn't be the better option for me anyway. I told my doctor that I would only do the injections if they were weekly (I don't want to go through the roller-coaster ride with my levels). I'm also concerned about transfer to my wife and young sons, using the gel. Summertime is almost here, and we are active in the water alot. It just seems an easier solution to do injections (and cheaper too).

More advice / comments are greatly appreciated!

[hardasnails1973]

Compunded gels 30 bucks a month plus shipping and good base disappears in less then 2 minutes ..so transfer with wife and son would not be an issue. Could also apply on calf but best thing is non contact with fingers.

[Bulldog]

That may be true, but it does not explain this:

The purpose of the gel is to add to my initial baseline reading (i.e. 274). Therefore, in my mind I should still be hovering around 274 even if I haven't used the gel today (and that's assuming that all of the previous day's dose is 100% absorbed and the test results today were only seeing the 'natural' test production level present).

Why is my reading only half of what it was before I even started HRT?
I think my natural production of Test must have shut down or dramatically dropped. I don't see how missing 1 day of the Testim would plummet my levels to half of the initial baseline reading prior to starting HRT. It doesn't add up.

You probably are shut down. And you probably need more than one tube of Testim. But if you don't test after applying the gel you don't know how much is actually getting in and don't know how much more you would need to apply.

It sounds like you have some good reasons to explore shots.

Good luck with your treatment. I hope you figure out what will work for you.

[xxOz]

A. You should have applied your gel the day of your test. Gel is in and out of your system quickly, that is why it must be applied daily. You screwed up the test results by not putting it on.

B. Your own production of Testosterone is suppressed. If you did not put on your gel then you will get a lower reading. That makes perfect sense. The test results are as expected based on your description.

C. You should be doing a 24 hour urine test using gel. It will give you a more realistic idea of what you Testosterone is for the ENTIRE day, not just the point in time that they took blood. If you had put the gel on and had the test 2-3 hours later you would have seen the highest concentrations of test at that point. If you then waited until 8 to 10 hours after application, you would see a lot less, but most likely more than your original numbers.

The 24 hour urine test will give you an idea of your complete day as opposed to the spikes and valleys of blood testing with a gel.

D. If I were you I would get a 24hr urine done now. Use the gel like you were prescribed. Then get a 24 hr urine test done after 2 weeks of using the gel. They may need to up the dose a little to cover the effects of the suppressed natural production.

Disclaimer: This is all my opinion and I am not a doctor. However, I am on gel and my doc has explained why I do a 24hr urine and why I use the gel EVERY day even on test days.

[LeanGuy]

My story... TT was 418 when I started compounded gel (mainly on shoulders)... a month later it was 265 and DHT over the top. Apparently I have a lot of 5-AR activity when T is applied to the skin and it increased mainly DHT, shutting me down. I would have went to T shots next, but I tried HCG monotherapy and its keeping my TT over 700 and I am happy. Sometimes you need to try several things before you know what works best for you.

[pcgizzmo]

That may be true, but it does not explain this:

The purpose of the gel is to add to my initial baseline reading (i.e. 274). Therefore, in my mind I should still be hovering around 274 even if I haven't used the gel today (and that's assuming that all of the previous day's dose is 100% absorbed and the test results today were only seeing the 'natural' test production level present).

Why is my reading only half of what it was before I even started HRT?
I think my natural production of Test must have shut down or dramatically dropped. I don't see how missing 1 day of the Testim would plummet my levels to half of the initial baseline reading prior to starting HRT. It doesn't add up.


You can't add to base line. You add external T and body shuts down ceasing the 274 reading. External T is not absorbed properly or metabolized to quickly and your low reading is the result.

[silverwing]

This happens your on 5 g's of gel your brain sees this in your body and slows down the message from your brain to your testis to make T so you end up with what the gel is doing. As for seeing an Endo I have yet to see one that is good on TRT or even hear of anyone that seen a good one.

All your Dr. needs to do is up your dose of gel for me it took 2 tubs. I put one on my upper arms and shoulders and down my back as far as I could reach then did the other side. Make sure you rub it in well using Testim.

Read the sticks above like TRT: A Recipe for success and others. Print it out and give it to your Dr. Endo's are not good Dr.'s for low T. Make sure your Dr. did a lot of labs it's all in TRT:


Same here..I have been on Testim for over 2 years now..it is working great..but had the same experince as you at the beginning..after a couple of weeks natural production shut down..i had to go to two tubes daily and now all is good...

[JanSz]

New to the forum.

4 weeks ago my doctor ran blood work and determined that my T level was at 274. He prescribed me 1 tube of Tetim / day, which I have been taking since. I could tell an increase in libido between days 7-14, but after that I felt like my old 'normal' self. I theorized that my natural production of Test had decreased since I started receiving it artificially.

I went in for follow up blood work this morning to see how my levels have responded to the gel. To my doctor's surprise, my T level was at 148 (about half of what it was before even taking the gel). I did not use the gel before the blood work this morning, because I didn't want it to artificially spike up the reading (my blood was taken at approx. the same time I use the gel every day, and I will use the gel a few hours later than normal today rather than missing a dose).

Now I'm being referred to an endocrinologist and was told that I may be a prime candidate for injections since the 'typical' dosage of the gel hasn't helped my levels and doubling my current dosage of the gel probably will not help that much more either.

Any ideas / advice?

You have got a number of helpfull answers.
Here is mine.

You did not used gel before blood work.
Dr John prefers to use gel about 3 hrs before blood draw.
I prefer to draw blood the way you did, 24hrs after last gel application.
Better way would be to have both draws.

From your experience I have following obserwations:
you feel good at first when you had higher TT levels, so there is a hope for you.
you are fast metabolizer, any future testosterone delivery need to be frequent, transdermal 2x/day, injections EOD
your testis shut down real quick in just couple weeks, help them (quick, quick) using HCG

If you read anything on this board, then you know by now that a trip to endo have a high probability of failure.
If you have a choice of endos, ask your doc to find out before hand that he would give you test injections.
Ask your doc if he would be willing to give you script for injectable test.
More important then script for test, ask your doc if he will be willing to give you script for thorough blood testing.
My list is on post #44 here, between blue lines,
http://anabolicminds.com/forum/male-anti-aging/66268-jans-bloodtest-april13-4.html

If you would do that test, please, do another 8 weeks of 2(two) tubes of Testim daily (apply them 1x/12hrs) and 250iu-HCG shots EOD.
Draw blood 12 hrs after Testim application, 24hrs after HCG shot.

If you can get a blood test but no testim or no HCG, do the best you can, we will sort the rest latter.
=========================================

Post all tests that you have done so far.
Analyte name, value, units, range, name of laboratory, date, medications prior to takig test.
.
.
.

[Bulldog]

You have got a number of helpfull answers.
Here is mine.

You did not used gel before blood work.
Dr John prefers to use gel about 3 hrs before blood draw.
I prefer to draw blood the way you did, 24hrs after last gel application.
Better way would be to have both draws.

From your experience I have following obserwations:
you feel good at first when you had higher TT levels, so there is a hope for you.
you are fast metabolizer, any future testosterone delivery need to be frequent, transdermal 2x/day, injections EOD
your testis shut down real quick in just couple weeks, help them (quick, quick) using HCG

If you read anything on this board, then you know by now that a trip to endo have a high probability of failure.
If you have a choice of endos, ask your doc to find out before hand that he would give you test injections.
Ask your doc if he would be willing to give you script for injectable test.
More important then script for test, ask your doc if he will be willing to give you script for thorough blood testing.
My list is on post #44 here, between blue lines,
http://anabolicminds.com/forum/male-anti-aging/66268-jans-bloodtest-april13-4.html

If you would do that test, please, do another 8 weeks of 2(two) tubes of Testim daily (apply them 1x/12hrs) and 250iu-HCG shots EOD.
Draw blood 12 hrs after Testim application, 24hrs after HCG shot.

If you can get a blood test but no testim or no HCG, do the best you can, we will sort the rest latter.
=========================================

Post all tests that you have done so far.
Analyte name, value, units, range, name of laboratory, date, medications prior to takig test.
.
.
.

Why would you test 24 hr. after applying a TD? Do you want to know your lowest level? It seems like it would be more important (at least at first) to find out if you are at the top of range 3 hr. after TD application. If not adjust dose and test 3 hr. after application again and go from there.

Jan, I'm curious, when you were on TD did you ever test 3 hr. after application or only 24 hrs after?

What is the half-life of transdermal T? Does it vary by product? Does it vary by each individuals absorption of cream/gel?

[silverwing]

Don't know about anyone else..but when i started this journey my levels were at 180 for TT...when I test after applying my levels are at 898 and at 24 hours out are at 478 now.

[JanSz]

Why would you test 24 hr. after applying a TD? Do you want to know your lowest level? It seems like it would be more important (at least at first) to find out if you are at the top of range 3 hr. after TD application. If not adjust dose and test 3 hr. after application again and go from there.

Jan, I'm curious, when you were on TD did you ever test 3 hr. after application or only 24 hrs after?

What is the half-life of transdermal T? Does it vary by product? Does it vary by each individuals absorption of cream/gel?

When I was using Androgel, it was curtesy of my GP.
I know him since about 1976, he told me that he is not doing TRT for his patients but was willing to give me Androgel scripts and any blood tests that I want until he finds suitable endo for me.

He newer found suitable endo for me, even when there were at least two of them in a building where he have his office. One of them about 20 feet away.

Looking at data posted by Androgel I saw the spike in TT after 3-4 hours.
To my way of thinking it is exactly the time when I want to avoid blood draw.

That spike is short, it tells me nothing about testosterone levels thruout 24 hrs.

At that time I did not knew the word hyper-metabolizer.
But latter on that concept allowed me to not waste my time in trying weekly testosterone injections. I went for EOD schedule right after I had my injectable testosterone.
================================================== =====

Say that your goal is to fill bathtub up to a mark that you have made on side wall.

After experimenting you found that when you turn the valve 50% open it will take 24 minutes to get to that mark.

Nex time during one (1) of those 24 minutes you open the valve full (100%), your are going to fill bathtub little more, but that will be insignificant amount.
Location of that one minute is different for different people and significantly different for hyper-metabolizers.

On the other hand if you want to make measurement only during that one minute when the flow is high, you are prone to make large error if you are not exactly at the minute when indeed the flow is high.

My explanation is possibly not as clear as it is in my head.
It is about 1 in 24 bet to get it right.

================================================== =====

X of something got in
half life is a time that it takes for X/2 to remain

When injecting we know that the needle delivered all that we planned to deliver.

When applying transdermally number of variables is increased.
Those variables change in time and with changes in our health.

Transdermals differ by how much of X gets in.
After it got in I do not think there is a difference in half life.

In total, any theraphy is judged by:

results
ease of compliance
some other

.

[jabo]

My doctor only wants to manage a level of 350 (which barely makes it worth the effort, IMO), and I wanted to keep from having a spiked level. He appears to have limited knowledge of TRT, and even talked about only bumping me up to 1.5 Testim tubes / day when I told him how the effectiveness seemed to lessen after the first 2 weeks. I have not read whee anyone has been told to use half tubes. He is open to self injections if I can demonstrate that I can do it. I will probably push for 100mg T Cyp / week since I am concerned about transfer of the gel to my wife & kids. It just seems to be an easier solution than using 2 tubes / day.

[silverwing]

My doctor only wants to manage a level of 350 (which barely makes it worth the effort, IMO), and I wanted to keep from having a spiked level. He appears to have limited knowledge of TRT, and even talked about only bumping me up to 1.5 Testim tubes / day when I told him how the effectiveness seemed to lessen after the first 2 weeks. He is open to self injections if I can demonstrate that I can do it. I will probably push for 100mg T Cyp / week since I am concerned about transfer of the gel to my wife & kids. It just seems to be an easier solution than using 2 tubes / day.


just a note...I have a wife, and 10 yr old daughter and a 5 yr old son...taking normal precautions none of them have had any problems.

[jabo]

just a note...I have a wife, and 10 yr old daughter and a 5 yr old son...taking normal precautions none of them have had any problems.

I like to sleep without a shirt, so I have been showering before bed just to be safe. Their literature says that most of the T is absorbed during the first 8 hours or so, but it also says it continues to absorb for 24 hours. We like to swim a lot, and I don't feel like I can safely play with my kids in the water or get my wife to apply sunscreen. I know they say you can swim after 2 hours, but it does feel slimy when wet. It makes me worry that transfer is possible when it isn't dry.

[medgerton]

My doctor only wants to manage a level of 350 (which barely makes it worth the effort, IMO), and I wanted to keep from having a spiked level. He appears to have limited knowledge of TRT, and even talked about only bumping me up to 1.5 Testim tubes / day when I told him how the effectiveness seemed to lessen after the first 2 weeks. I have not read whee anyone has been told to use half tubes. He is open to self injections if I can demonstrate that I can do it. I will probably push for 100mg T Cyp / week since I am concerned about transfer of the gel to my wife & kids. It just seems to be an easier solution than using 2 tubes / day.

I started with Testim also. One tube and I was in the same place as you are now. My Doctor did not know much about HRT. I tested the same way you did. I was lower than when I started. Just like you. So I told my doctor to increase me to 2 tubes. That was too much for me. I was wired and tired at the same time. I couldn't sleep. My DHT was very high.

So I stepped down to one an a half tubes of Testim. Yes, half a tube.
That was right for me. But I didn't feel good until I started Arimidex, HCG and pregnenolone a few months later. I am 52 though. I say this because Arimidex may not be needed at your age.

In December, I received a letter from my health insurance company that they would not pay for Testim anymore. They would pay for Androgel. I was disappointed. However, Androgel has turned out to be just as effective. And it has an important advantage. It absorbs very quickly and there is no film left on your skin after a few minutes. It is much better than Testim in this aspect. You can put a shirt on after a few minutes and no sticking . I also think that the transfer issue is reduced with Androgel as your skin doesn't have that sticky film on it. Androgel also comes in a pump dispenser. You can dispense in 1.25g increments. So, 7.5g of product is easy to apply.

There are good posts in this thread. HCG monotherapy is interesting. HCG providing a baseline with a bit of TD T topping off and offering DHT boost if necessary is also interesting.

Do not give up on TD yet. It offers great flexibility if you absorb it well.

Also , the 24 hour urine test is best by far for those using TD T.

[silverwing]

I like to sleep without a shirt, so I have been showering before bed just to be safe. Their literature says that most of the T is absorbed during the first 8 hours or so, but it also says it continues to absorb for 24 hours. We like to swim a lot, and I don't feel like I can safely play with my kids in the water or get my wife to apply sunscreen. I know they say you can swim after 2 hours, but it does feel slimy when wet. It makes me worry that transfer is possible when it isn't dry.

I apply first thng in the am...both wife and I sleep nude...I shower before coming to bed and use a scrubbie thing with pears soap..
as for swimming..we have a pool in the back yard...i wait at least 4 hours on average before swimming..more if I can..after applying..but shower before i get in the pool with the kiddos.

[jabo]

I apply first thng in the am...both wife and I sleep nude...I shower before coming to bed and use a scrubbie thing with pears soap..
as for swimming..we have a pool in the back yard...i wait at least 4 hours on average before swimming..more if I can..after applying..but shower before i get in the pool with the kiddos.

Thanks for that info. Even though the manufacturer claims that the T is absorbed over a 24 hr period, it appears that the majority of the T is absorbed during the first 6-8 hours. Therefore, showering before swimming at least 4 hours after the gel has been applied should do the trick, as well as showering before bed. I know some of the T may be washed away, but that amount is probably trivial, and is not going to be taking take on a daily basis (except for showering before bed).

UPDATE:
I saw the endo guy today, and I am going to be on 2 tubes Testim / day for the next 30 days. I set up my bloodwork at 4PM in 30 days, so that should help prevent a spiked reading from taking place due to a morning application. We are going to evaluate the level in 30 days, and talk about whether or not I want to stick with the Testim or go to injectible at that time.

He also mentioned other methods of taking the T (i.e. oral - both pills and the thing you put in your gum). I believe I have read previously that there are greater health risks with these methods of TRT. Time to do more research.

Am I correct in my current understanding that transdermal gels & injectibles the 2 preferred methods?

[Bulldog]

Thanks for that info. Even though the manufacturer claims that the T is absorbed over a 24 hr period, it appears that the majority of the T is absorbed during the first 6-8 hours. Therefore, showering before swimming at least 4 hours after the gel has been applied should do the trick, as well as showering before bed. I know some of the T may be washed away, but that amount is probably trivial, and is not going to be taking take on a daily basis (except for showering before bed).

UPDATE:
I saw the endo guy today, and I am going to be on 2 tubes Testim / day for the next 30 days. I set up my bloodwork at 4PM in 30 days, so that should help prevent a spiked reading from taking place due to a morning application. We are going to evaluate the level in 30 days, and talk about whether or not I want to stick with the Testim or go to injectible at that time.

He also mentioned other methods of taking the T (i.e. oral - both pills and the thing you put in your gum). I believe I have read previously that there are greater health risks with these methods of TRT. Time to do more research.

Am I correct in my current understanding that transdermal gels & injectibles the 2 preferred methods?

Yes.....and in that order as well. TD first and IM if TD does not work or causes other problems like super elevated DHT.

[chilln]

I don't see how missing 1 day of the Testim would plummet my levels to half of the initial baseline reading prior to starting HRT. It doesn't add up.


The HRT causes HPTA suppression, which means your natural production of testicular produced testosterone has been greatly diminished.

When you stop taking supplementary testosterone for one day, your body will not restart your testicular testosterone production of testosterone within one day.

Your body will only gradually restore your previous testicular testosterone production over the period of around 2 weeks, assuming you were fully suppressed in the first instance.