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I seem to convert T to DHT. At mild-moderate doses of 100-150mg T cream/day, my DHT levels run around 200. T levels range from 650-800, E2 30, SHBG 30. I have no clinical signs or symptoms to the negative whatsoever. What is the short and long term impact of running such “high” DHT levels? HCt...

It sounds like you may actually need a metabolic workup and a complete insulin resistance challenge test, some monitoring, etc. before you tackle TRT.

Intermittent fasting and a CGM would help.

It’s unclear if at the time of your serum labs if you had washed out prior TRT. You have LH so I assume you were either “coming down” from TRT or had fully washed out prior use. DHEA is upstream Testosterone, and feeds T. You have shown the metabolite “S” of DHEA. I would want a fuller picture...

You appear to be supplementing with DHEA. You might stop. You might get a Pregnenolone lab. You might get a urine metabolite (DUTCH) test, and see if you are a responder/converter. You might get a DHT lab.

FWIW after 6 weeks of 200mg QD cream, HCt went from 46 to 50, and back down after stopping. It’s not the cypionate.

Not knowing your baseline levels isn't ideal, but it would appear something is off with lab values and I would have redrawn. A Hct of only 48 would indicate T isn't being pumped as much as they go hand in hand. I assume your LH is 0.

Wow you are a hyperresponder to DHT conversion pathway. What are your E2 levels, baseline and post-cream application as measured? What has happened to your SHBG levels? Assume your LH went to 0?

My SHBG dropped in half after 6 weeks of cream, then measured at 4 weeks off. All other labs mostly came back, except DHT, so I will test again in 6 weeks or so.

I felt good on T cream, 6 weeks (didn't feel bad really prior, just wanted to optimize). I am off now, 4 weeks+. My levels returned for most part, although DHT and SHBG are below baseline. T back to within 90% and LH back 100% (happy for that). I will consider going back on again. PSA stable...

The peer reviewed data I have read showed PK for nasal is 40m-60m peak concentration, don't recall half life. Typically anything that peaks that soon, clears the body more slowly. I don't have either primary or secondary, per se, albeit my baseline T is 375-500, Free T 2% and LH 4.1.

FWIW, my E2, 18, did not change whatsoever, DHT up 250%, SHBG dropped 20%, and now that I am off, it is at 45% of what it was pre-T, too low.

Scrotal levels peak at 5 hours according to a PK study done in 2017 (tested 50 mg and 2 lower doses but curve to trough is similar). If I split doses, 7A and 4P, was thinking that could work, perhaps 150mg, 2 clicks scrotal, 1 arm as DHT was 95 at 4 clicks. 3 clicks may also work and keep my...

200mg Cream QD in AM. To your point, it appears, at 50mg, peak levels are within 5 hours, and we begin to see troughing down to 16 hours as measured. https://onlinelibrary.wiley.com/doi/10.1111/andr.12357

https://pubmed.ncbi.nlm.nih.gov/28334510/ PK levels for T and DHT via scrotal cream delivery.

4 clicks for me on scrotum for 4 weeks, the labs drawn 22 hours post last application resulted in: DHT 36 to 94 Testosterone 502 to 186 (u read that right) Free T 96 to 41 Estradiol 17 to 18 SHBG 32 to 24 HCt 46 to 50 LH 4.1 to 0 Felt very good. But that’s quite a troughing! And confusing...

Honestly, I felt very good before T, very little symptoms of any, lower libido than I’d like at 55 and fit for life. On the troughing, if I have that low T overnight and hours into waking. It would seem T is being “soaked” up by testes, converting to DHT (I don’t convert to estrogen naturally...

Who is the endocrine expert here? What is the clinical rationale as to why and how my T levels would drop within 1 month on 200mg transcrotal cream, YET DHT nearly tripled, LH went to 0 (as I’d expect), and HCt went up from 46 to 50? Clearly the T cream was “working”, but T went from 502 to...

You need a Cortisol panel. Saliva or urine, measured at waking and 3-4 more times over the day. Dutch is one option, Genova another. I would consider having you’re pituitary gland further examined and rule out a benign issue, regarding IGF-1. What is your fasting insulin level (hopefully <5)...

One of best, accurate and comprehensive reply posts I’ve read in months. That said, cannot explain my 6 weeks of trans scrotal 200mg QD AM cream: Pre-TRT: Total T 502, Free T 96, LH 4.1, SHBG 32, Estradiol 17, DHT 36, DHEA-S 86, HCt 46 Post 6 Weeks TRT: Total T 188, Free T 45, LH O, SHBG...

Would seem your issue is high prolactin levels causing you to feel not so terrific. Thyroid as mentioned and benign issues in the pituitary should be ruled out. I don’t see DHT but assume it’s in the tank as well as DHEA-S. I’d want to go further upstream before starting T, and get fullest picture.

To your point, I don’t see baseline and after prolactin and estradiol levels; curious what DHEA-S level was/is. I just stopped daily cream after a short 6 week course as my T levels actually dropped 60% and LH shut down to 0. It’s been 5 days and not sure if I will need a clomid kick...

Prolactin and all other levels were normal-optimal before starting the T cream. UPDATE: It’s now been 5 days and I cannot say I’m having noticeably significant issues, perhaps low energy, but it is also that I’m in my own head now. I decided to add 25mg DHEA back to try and backfill E and T, but...

With respect to LH recovery, for short term course of T cream (200mg/day) of just 6 weeks, what data or insight might anyone have on LH recovery (when it begins to kick back in and from 0) after ceasing application? My free is at just 45, have high DHT at 95, high DHEA-S at 386, estradiol...

He did instruct me (looking at written directions here again), to have blood drawn before I applied cream that AM. Would the high DHT (up from 36 to 95) explain the trough issue with Testosterone Total and Free results being well below baseline (T down to 186 form 502)?

Doc said once in AM.

Actually, I feel good, but am concerned about numbers, meaning T levels 35%-45% lower than pre-treatment and DHT is 2.5X higher, while Estradiol and SHBG are very similar. The conversion to DHT is irreversible. Do DHT levels vary throughout the day like T, which people here are saying I captured...

DHT went from 36 to 95 over same period. Does cream have trough issue if it had been nearly 24 hours since prior application when measuring T (but trough doesn’t apply to DHT levels, or estradiol or SHBG, only T)?

Update on Labs: DHT before T cream: 36 DHT after, lab at same time T measured: 95 So if the issue is trough was measured for Testosterone, is it not same for DHT?1 Or, am I over converting T too much to DHT, which is irreversible?

Excellent question, and I had thought about trough but didn’t think it was parcel to cream application….it had been close to 22 hrs since prior AM application (meaning I applied the prior AM, then had an AM draw the next morning). TY.