T results w/Androgel 1.62%

I am a 60 year old male and have maintained the same TRT protocol since early 2015 with 2 pumps of Androgel each morning. All other labs are in a normal range and have remained the same with the free and total T being the exceptions. I frequent the gym 5 x week and have not had any major life changes. I've been taking 15mg DHEA daily to boost my usually low E2 above 18.
All things being equal, what are possible factors that would have my latest T levels fall off (402 & 6.03ng/dl) as seen in the labs dating back to 2015? The tests were all done in the morning. Thank you for any ideas you may have! I'd like to get back in the 20/800 range.

PS. Maybe not relevant but the only thing I cut out since my last test was a very small daily dose of Zoloft, an anti-anxiety SSRI.

My comment would be. Is there any chance of you switching to injections. I feel it's the best way to control your levels of testosterone and get properly dialed in.

Most guys in this situation that start comparing labs from one to the next think that they're being strictly compliant from one test to the next and how they apply every morning at the same time and they're not as compliant as they think they are, at least not nearly enough to stack tests side-by-side and compare them. IN order to do that you have to have no variables in there. Such as always apply gel at 0700. Always have blood drawn at 0900, and so forth. Most guys aren't ever going to be that committed, over time.

Saying that, gels do have some absorption issues and around here as a long term thing gels/creams just don't work out well.

It seems logical at this point to switch to injections. I have avoided this route only because of the frequent visits to the docs office that will be required as I doubt he'll enable me to self-inject. I have an appointment Thursday and will discuss it with him. I have come across many protocols on this forum and am still reviewing the options but are you aware of any approach that I can share with the doc that has worked for an avid gym going 60 year old male? Which T, how often, pinned where and with what syringe? Without this info my doc is likely to set me on a course of highs and lows with an ultra conservative schedule. It would be great to hand him a T protocol that has worked for other active men over 50. Thank you guys for answering my post!

I see guys all the time wondering why their levels are falling when using gels, it could be you body is just not absorbing well anymore. It seems gel do not work over the long term and I wouldn't be surprised at all if your levels continue on a downward spiral.

Scenmed said:

It seems logical at this point to switch to injections. I have avoided this route only because of the frequent visits to the docs office that will be required as I doubt he'll enable me to self-inject. I have an appointment Thursday and will discuss it with him. I have come across many protocols on this forum and am still reviewing the options but are you aware of any approach that I can share with the doc that has worked for an avid gym going 60 year old male? Which T, how often, pinned where and with what syringe? Without this info my doc is likely to set me on a course of highs and lows with an ultra conservative schedule. It would be great to hand him a T protocol that has worked for other active men over 50. Thank you guys for answering my post!

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Good afternoon, I would strongly suggest to try a compound cream prior to the injection option
I had similar issues early on using the gel. I have maintained these numbers for many years Total 1100 +/ Total 32+
My complete story is on this link below
https://www.excelmale.com/forum/sho...essful-Story-with-Testosterone-Cream-Protocol

Scenmed said:

It seems logical at this point to switch to injections. I have avoided this route only because of the frequent visits to the docs office that will be required as I doubt he'll enable me to self-inject. I have an appointment Thursday and will discuss it with him. I have come across many protocols on this forum and am still reviewing the options but are you aware of any approach that I can share with the doc that has worked for an avid gym going 60 year old male? Which T, how often, pinned where and with what syringe? Without this info my doc is likely to set me on a course of highs and lows with an ultra conservative schedule. It would be great to hand him a T protocol that has worked for other active men over 50. Thank you guys for answering my post!

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If you decide that injections are in your future, be sure you acquaint your self (AND YOUR DOCTOR) with this study indicating that injections of testosterone every two weeks doom the patient to failure. I draw it to your attention because, depending on your physician's familiarity with TRT, he may default and prescribe 200mg of testosterone every two weeks...an old and outdated approach favoured by far too many doctors. A reasonable, starting protocol would be 50-60 mg of testosterone injected every 3.5 days. Where does your SHBG sit? Why do you doubt he will object to self-injection?

CoastWatcher - When I discussed the TRT issue with my doc in 2015 he first suggested injections and it was my choice to go with gel after he said office visits would be frequent with injecting T. I appreciate your input and will show him the Hormone Profiles info. Of all the tests (thyroid, DHEA, Test, E2, PSA, Lipids) he has ordered I do not believe I've had SHBG done yet. Do you think SubQ is better than IM for injecting T? Thank you!

Scenmed said:

CoastWatcher - When I discussed the TRT issue with my doc in 2015 he first suggested injections and it was my choice to go with gel after he said office visits would be frequent with injecting T. I appreciate your input and will show him the Hormone Profiles info. Of all the tests (thyroid, DHEA, Test, E2, PSA, Lipids) he has ordered I do not believe I've had SHBG done yet. Do you think SubQ is better than IM for injecting T? Thank you!

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Which is a red flag right there as self injecting is easy and safe. IM vs Sub Q is strictly preference at this time. Either works well. I have not seen data demonstrating one to be superior to the other. No doc should require to come into the office for TRT injections in 2017.

Will Brink said:

Which is a red flag right there as self injecting is easy and safe. IM vs Sub Q is strictly preference at this time. Either works well. I have not seen data demonstrating one to be superior to the other. No doc should require to come into the office for TRT injections in 2017.

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Will couldn't have said it better. I only add that SHBG is not a "nice to have" value. It's of critical importance is designing a protocol. If low, multiple small injections over the course of a week are called for. If high, not simply higher, but really high, large, single doses are the ticket to success.

https://www.excelmale.com/forum/sho...-and-Urges-Testing-for-TRT-Patients&highlight=

This thread contains a link to a study on why SHBG testing is important. Something else to be sure your doctor reads if he resists your request for a test.

CoastWatcher said:

https://www.excelmale.com/forum/sho...-and-Urges-Testing-for-TRT-Patients&highlight=

This thread contains a link to a study on why SHBG testing is important. Something else to be sure your doctor reads if he resists your request for a test.

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A whole other topic that drives us all bat chit crazy with irritation

It's my body, WTF do they care what tests I want done if insurance will cover it and or I'm willing/able to pay out of pocket if they will not cover it?

Ugh

Scenmed said:

CoastWatcher - When I discussed the TRT issue with my doc in 2015 he first suggested injections and it was my choice to go with gel after he said office visits would be frequent with injecting T. I appreciate your input and will show him the Hormone Profiles info. Of all the tests (thyroid, DHEA, Test, E2, PSA, Lipids) he has ordered I do not believe I've had SHBG done yet. Do you think SubQ is better than IM for injecting T? Thank you!

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Wow either he is just in this business for the money or he's just not living in reality, in either case is enough to seek another doctor. The fact that he expects you to be tied to his office multiple times a week is insane, you should be able to live your life without being tied to the clinic like that, a doctor's wet dream come true.

I believe the other reason why he is pushing gels is ($$$$) because he gets a ton of money prescribing them, if you chose injections that money goes away. Injections are by far the cheapest option and most effective.

I have had levels drop like that with Gel. Its from how you apply it. You get lazy or in a hurry. Put it on and spread it as far as you can. 2 pumps is not a lot so if you added 1 pump it would put it up if needed. You can also scrub the area of application with a rag a couple times a week and that will help as well. If you live in a cold climate that can effect it too. You can see that your levels are higher in the summer months in your results.

I just received further lab results and would like feedback. Please see DHEA and E2 sensitive below. Thanks! (By the way, my doc sent me a comment regarding the T readings of 402/6.3 saying things look good. I don't agree!)

Scenmed said:

View attachment 4348I just received further lab results and would like feedback. Please see DHEA and E2 sensitive below. Thanks! (By the way, my doc sent me a comment regarding the T readings of 402/6.3 saying things look good. I don't agree!)
View attachment 4347

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No, that's not an appropriate value for a patient on TRT, no matter what the mode of treatment. It seems to me that you have two options - the compounded T-cream that does work for a number of members, or injections. Actually, you have a third option: find a new doctor (that's the one I'd choose).

By the way, why was estrone tested? It offers no information that a patient or doctor can act on.

The lab in the doc's office was not familiar with E2 Sensitive and when I insisted they find it in the listings this is what they ordered. Estradiol looks better at 24 pg/ml vs. 6 months ago 15 pg/ml. The DHEA-S on the other hand seems high for a 60 year old man but doc says no problem.

Hmmmm
If you have the $$, and your state allows you to order your own test, look at discountdlabs.com and order a sensitive E2 to know where you are at.
If they tested you with a standard estradiol lab test you may be lower than what it shows.
When I run the sensitive E2 my results show up as:
Estradiol, Sensitive - ##- (8.0-35.0)
I ran BOTH the standard and sensitive last time I did blood work (both draws were done within a minute apart), Standard first and sensitive second:
Estradiol - 32.1 - (7.6-42.6)
Estradiol, Sensitive - 25.4 - (8.0-35.0)
Total T - 1059 - (264-916) -May have applied T cream in the AM
Free T = 12.5 - (6.6-18.1)
Time before was:
Total T - 778 - (264-916)
Free T - 10.2 - (6.6-18.1)
Have no idea how the Mayo test fits in between the labcorp standard and sensitive?
As far as compounded T cream, I would suggest giving EmpowerRX a try. You can get a 200mg/ml times 30mls for around $65.00 shipped. I use a 1/2ml per day and get constant results in the 700 to 800 for total T.
I have just recently been reading up on SHBG and just had blood work done yesterday to include SHBG, as my Free T appears to be a bit low.

Will Brink said:

A whole other topic about 888 casino promo codes that drives us all bat chit crazy with irritation

It's my body, WTF do they care what tests I want done if insurance will cover it and or I'm willing/able to pay out of pocket if they will not cover it?

Ugh

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I know right. Those effing doctors can be stubborn as fck!

An update after doc's office visit today. I asked him to review the latest T readings (402/6.03) and compare them to any prior readings over the last 2+ years since they are lower now than anytime after starting with 2 pumps daily of Androgel 1.62%. I mentioned that in addition to the lower numbers that subjectively, I'm not as energetic, not having great libido nor am I breaking records in the morning wood department. His response, "last time your numbers were too high (640/13.4) and now they look good." No matter to him that I don't feel as energetic, libidinal etc...
I asked if we could switch to T Cyp injects of 50mg 2x week done SC at home and he said not likely. 400mg per month as a start dosage is "way, way too much!" Of course, he insisted it would be too many office visits and I repeated I could do the injects at home with 29 gauge, 1/2" needles in the fat pad above the buttocks. He said I read too much online! He also said, "sure I can make you feel great for a month or two and high dose juice you but my job is to make certain your healthy in five years, not just next month."
Stick with 2 pumps of Androgel he ordered and of course I said okay. 60 years old going on 16 after leaving his office. Everything I cited he had a story to nullify my input. He's a good doctor but not well versed in the TRT department. Anyone know a decent to excellent T doc in the Minneapolis/St. Paul area??? I'm at the gym almost everyday and seem to be able to keep up with lifters of any age. My sense is that staying only on the gel will slowly but surely have me slowing down, getting weaker than is necessary. I believe my DHEA-S, Thyroid, E2 sensitive, Lipids, BP and bloodwork numbers are decent. SHBG was not yet tested. T/T & TFree are what's lower than usual.
Any help appreciated! Thank you.