madman
Super Moderator
The main benefit of using a transdermal testosterone cream is that out of all the application methods regarding trt the patch or transdermal are the only methods which most closely mimic the natural endogenous 24 hr circadian rhythm of a healthy young male as testosterone levels (peak) in the early am and slowly decline in the late afternoon/evening (trough).
Even than the patch would take this title!
The new fad regarding transdermal testosterone creams is the application twice daily (morning/evening) to the scrotum which completely goes against mimicking natural endogenous production as T levels are constantly elevated 24/7 albeit there is still fluctuations.
Understand that testosterone can stimulate the CNS (central nervous system) and amp one up so applying transdermal in the evening can definitely have a negative effect on sleep.
Dr. Crisler felt transdermal applied once daily was the best method mainly due to it most closely mimicking the natural endogenous 24 hr circadian rhythm of T in a healthy young male.
The way I see it is if one is solely using the transdermal method than once daily makes the most sense.
Thanks for this.
It makes much more sense that the morning application only would mimic natural rhythms.
I had been scratching my head as to how/why applying 2x (especially the evening dose mimics natural rhythms)
From previous experiments I would apply once a day and my t levels were back to baseline the next morning. I may do an injection cream combo that I’ve seen in others. I actually benefit more from transcrotal cream as I feel better overall and finally have my libido back. May do 100mg scrotal cream per day and 100 mg cypionate per week. Or 50mg scrotal and 125 mg cypionate per week.
madman
Super Moderator
As we also know there are 1000s of other men who do just fine using transdermal once daily (am) with the added benefit of the natural ebb and flow of T.
To state twice daily is best for symptom resolution is misleading and again when using twice daily (am/pm) T levels are constantly elevated 24/7 albeit there is still fluctuations.
I would like to know who can actually sleep when applying it at night? It’s oretty much impossible and you’ll find yourself waking up constantly in the night.
Vince Carter
Banned
When I apply cream to the scrotum at night it does not affect my sleep one way or another that I can think of, def has not kept me up. I inject 16mg/D about 15 prior.
When Dr. Nichols stated that in his clinical experience, twice daily application offered the best symptom resolution, how was he misleading anyone? By the way, I'm not defending him or anyone else. Just reporting what was said.
"As we also know there are 1000s of other men who do just fine using transdermal once daily (am) with the added benefit of the natural ebb and flow of T."
How do we know this?
madman
Super Moderator
For him to state twice daily application offered the best symptom resolution comes across as if he is saying that it is the end all be all method when in fact men have been using the standard (once daily) transdermal application since the introduction of Androgel in 2000.
Again there are many men who have been using the standard transdermal protocol using a gel or compounded cream applied once daily (am) and feel great.....Dr. Crisler was known for treating many patients using transdermal and he prefered it over injectables as he felt it most closely mimicked the natural endogenous 24 hr circadian rhythm of a healthy young male as testosterone levels (peak) in the early am and slowly decline in the late afternoon/evening (trough).
https://www.defymedical.com/resources/health-articles/319-my-current-best-thoughts-on-
how-to-administer-trt-for-men
Dr.Crisler clearly states that:
TESTOSTERONE GELS AND CREAMS
The only way to go, in my professional opinion, if physician and patient agree on a transdermal (TD) delivery system. Or TRT at all. As I have gained knowledge and experience, my position is now that TD’s are vastly superior to other modalities in TRT medicine. They are easy to apply, usually well absorbed, and rapidly establish stable serum androgen levels (by the end of the third day). I recommend all practitioners first try a testosterone gel for their TRT patients. Gels are better than creams, as I want the rapid T uptake into the dermal layer, which serves as reservoir for distribution throughout the day. Men do better on lower serum T levels on TD’s than IM.
The constant variability of serum androgens provided by T gels mimic the hormones of a young man; the stable daily level provided by T injections mimic the hormones of an old man; those of implantable pellets mimic the hormones of no one. Entropic hormone levels are part and parcel of the process of youth. Much is made of the risk posed by accidental transferal of testosterone to others, such as children or sexual partners. Simply covering with a T-shirt has been shown to block transfer of the hormone. The testosterone sinks into the skin within an hour. One may shower, or even swim, without worry, usually after four hours. I remind my patients most of us have neither the time, nor the opportunity, for romance until evening (given the usual early morning application), and a quick shower is always nice for a gentleman to “freshen up” prior to same.
Gels and creams, like all transdermal delivery systems, provide a greater boost in DHT levels, compared to injectable testosterone preparations. As DHT is responsible for all the things of manhood--literally, AllThingsMale--the transdermals are better at treating sexual dysfunction than are injectables. However, issues of hair loss (which I treat with a compounded topical DHT blocking mixture) and possible prostate morbidity (a contentiously debatable point, to be sure, but resolved in the negative to my mind) then come into play. This might be a good time to mention I vehemently oppose adding finasteride or similar medication
To end the debate on this topic, transdermal T gels/creams are more likely to elevate estrogen than injections, as long as the shots are properly administered once per week. That is because aromatase lives in the skin, along with higher concentrations of 5-AR, which converts T to E. Even so, the benefits of TD TRT outweigh the weekly convenience of shots.
Some have reported an increase in hair growth over the application area(s). All physicians who administer TRT must be prepared to disappoint their patients at this time by pointing out, sadly, this same effect cannot be achieved upon the scalp.
Vince try applying 100mg at night. It’s a different story when you’re doing 25mg. I am trying the trendy 100mg/ml BID. It’s clear that method won’t work for me. The cream is extremely activating compared to the shots. I like the morning application because it makes me feel good (better than shots) but I think I’ll wind up doing a combination shots /cream. The cream has also given me my erections back and higher libido (still not the best but better than injections).
Vince Carter
Banned
Im quite interested in the exclusive cream method, Ive (we) have never come up with a reason why I aromatase so very much even with just 16mg/D and a lot of Aromasin and/or Anastrozole.
madman
Super Moderator
I would say not only the higher doses but more importantly the application site as we know transdermals not only increase DHT levels better than injectable but transdermal cream applied to the scrotum will provide a much higher conversion of T----->DHT as oppose to the transdermal gels which are commonly applied to the shoulders/arms/chest/abdomen/thighs.
Higher levels of DHT derived from scrotal application of the T cream are most likely a big part of the beneficial effects (negating the effects of high e2, boosted libido).
I will not deny the fact that twice daily application can be beneficial to many but to say it is best or needed for everyone using transdermal.....highly doubtful!
Jason Sypolt
Administrator
Some feel best with a more natural fluctuation in testosterone and some feel best with constantly elevated testosterone. Others find wlevated teatoaterone to be over-stimulating.
The simple answer is to work with your doctor to find something that helps you feel well, and to talk to them about change in your protocol if something isn’t working for you.
Raising awareness about different protocols is great in discovering new things to try, but we should all keep in mind that the only thing that is certain about them is that none of them work well for everyone.
The simple answer is to work with your doctor to find something that helps you feel well, and to talk to them about change in your protocol if something isn’t working for you.
Raising awareness about different protocols is great in discovering new things to try, but we should all keep in mind that the only thing that is certain about them is that none of them work well for everyone.
It seems that creams are preferred now over gels, yet, Crisler seemed to prefer gels, presumably non-scrotally.
Here's a question I have. If you apply your once daily cream, scrotally, at noon, but you go to the gym at 8AM, daily, how will your energy level be at 8AM given it's been 20 hours since your last testosterone application?
Here's a question I have. If you apply your once daily cream, scrotally, at noon, but you go to the gym at 8AM, daily, how will your energy level be at 8AM given it's been 20 hours since your last testosterone application?
I wouldn't call it a new fad, I saw a doctor 8 years ago who prescribed this and he had already been doing it for many years, said he learned it from Dr Shippen I believe.
madman
Super Moderator
When Shippen first started using transdermal scrotal application it was only once daily (low dose) and as far as scrotal application in general the Testoderm (scrotal) patch was approved for use by the FDA in 1994.
For years Dr. Crisler was using the standard (non-scrotal) once daily (am) transdermal application method for patients that did not want to use injectables and he favoured the once daily (am) application because "The constant variability of serum androgens provided by T gels mimic the hormones of a young man"
For some of his patients using injectables he eventually started having them apply a low dose cream once daily scrotally.
As far as transdermal cream (high dose) being applied twice daily (am/pm) sure it was being used but it was far from common and now because of certain doctors raving about it as if it is the next best thing it seems as if everyone and their brother wants to jump on it.....hence the new fad!
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