Can anyone solve my Testosterone puzzle

[Keepfit1]

Testosterone Puzzle?

Ive been on Androgel 1.6 Since 10+ years for Hypogonadism. I am 59.

I took 40mg at 9am, then 20mg at 2pm and 10mg 6pm ie 3 times a day. Ie 70mg /day

If I take it all in the morning it doesnt work, by 2pm I feel I need more, poor word retrieval and cognitive function and generally hypogonadic. I tried 5% and 10% cream no effect at all.

The problem with the Androgel is it gives me BPH and hairloss but not very high T , I feel okayish if I take it 3 times a day but it has to be 3 times a day ie every 5 hours or so. If I take a higher dose I feel better but more hairloss and BPH.

So to in order to try to avoid the BPH and hairloss I tried daily shots of Cypionate 15 mg/day Subc ie 105mg/week. I tried it for a few weeks but didn’t feel anything , very hypogonadic, very poor word retrieval, anxiety, poor cognitive function. If I then take a pump of the Androgel all those symptoms are gone. When I tested bloods on 15mg Cyp daily my Testosterone was near max range and FT was in upper range, oestradoil mid range but still felt the symptoms above.

One doc suggested I stay on Gel and the Daily Subc shots for 8 weeks and then drop the gel, I tried that ie 15mg Cyp shots daily and Gel 3 times a day as per usual giving total weekly of about 170mg.

I felt good on that regime but hairloss was a lot worse and BPH worse and PSA rose from 3 to 3.88.

I then tried dropping the gel and doing shots only and it still didn’t work, my blood work showed near max Testosterone and 75% Free T.

If I drop the gel I feel hypogonadic, very poor word retrieval and cognitive function and increased anxiety. Despite my blood level of T being max.

My Prolactin is 448mU/L with Range 86-324.

Previously I tried 100mg weekly shots and felt okay as long as T was rising but by day 3 I feel rubbish again despite high T in bloods, I tried twice weekly 50mg shots and that also didn’t work.

Any ideas on what is going wrong that I cant survive on shots only , any ideas on how to fix it.Or does anyone know a doc who can advise. I have asked multiple Hormone docs and nobody has heard of it before or know how to fix it. The Gel sort of works but I trying to find a TRT with lower DHT that works. I considered adding Fin to lower DHT but concered about the Fin sides although I heard its only people who are not on TRT that get them??

 

[Cataceous]

Are there any sexual symptoms when you feel hypogonadal? Unfortunately TRT is still far from being an exact science, and there's a lot of trial and error involved. One possibility that somewhat fits your description is an imbalance in favor of estrogenicity. DHT opposes estrogen in various ways, potentially explaining why you do better with topical testosterone. Estrogens tend to increase prolactin, and yours is elevated.

There are various treatments you can trial to see if they help. My first option would be to try daily injections of a blend of testosterone propionate and a longer ester such as cypionate. I'd also start with a mid-range dose such that daily testosterone intake is 6-7 mg. This would be 8-10 mg of the testosterone esters. If there's not improvement after trying various doses with enough stabilization time in between then I would try adding in occasional use of topical testosterone applied to the scrotum. Some guys find that infrequent DHT boosts make an injection protocol viable. You mention feeling good on weekly injections when serum testosterone is rising. The advantage of injecting a blend daily is that you experience rising testosterone daily, which is more in line with what's natural.

Other treatment options that might make an injection protocol tolerable are aromatase inhibitors, SERMs or cabergoline. I would not mess with an AI unless there's stronger evidence implicating estrogenicity. The same might be said for SERMs, but a trial with enclomiphene could be relatively safe because there's no risk of crashing estradiol. Cabergoline would attack the elevated prolactin in isolation. However, you haven't mentioned the typical symptoms seen with higher prolactin.

 

[Keepfit1]

Are there any sexual symptoms when you feel hypogonadal? Unfortunately TRT is still far from being an exact science, and there's a lot of trial and error involved. One possibility that somewhat fits your description is an imbalance in favor of estrogenicity. DHT opposes estrogen in various ways, potentially explaining why you do better with topical testosterone. Estrogens tend to increase prolactin, and yours is elevated.

There are various treatments you can trial to see if they help. My first option would be to try daily injections of a blend of testosterone propionate and a longer ester such as cypionate. I'd also start with a mid-range dose such that daily testosterone intake is 6-7 mg. This would be 8-10 mg of the testosterone esters. If there's not improvement after trying various doses with enough stabilization time in between then I would try adding in occasional use of topical testosterone applied to the scrotum. Some guys find that infrequent DHT boosts make an injection protocol viable. You mention feeling good on weekly injections when serum testosterone is rising. The advantage of injecting a blend daily is that you experience rising testosterone daily, which is more in line with what's natural.

Other treatment options that might make an injection protocol tolerable are aromatase inhibitors, SERMs or cabergoline. I would not mess with an AI unless there's stronger evidence implicating estrogenicity. The same might be said for SERMs, but a trial with enclomiphene could be relatively safe because there's no risk of crashing estradiol. Cabergoline would attack the elevated prolactin in isolation. However, you haven't mentioned the typical symptoms seen with higher prolactin.

No sexual symptoms if I dont take gel that day ie rely on the Cypionate, i have tried Cyp + gel and I feel okay on that but DHT is 88% up range and hair and BPH PSA rises, If I dont take the gel I am still fine sexually , certainly in short term and morning wood is as usual but feel anxious and poor cog function and word retrieval and slower typing, yes odd I know. Estrogen possibly but estradoile is alleg a bit low according to doc , we dont have access to sensitie estrogen here in UK.

Strangely I wondered about Propionate as its short acting, not sure I can get legit stuff in UK but will consider that. Gel on scrotum gives high DHT for sure and I am already high DHT on mix of Cyp and Gel.

I am going to try Cabergoline .25mg twice week to see if lowering Prolactin helps , i have no high Prolactin symptoms I am aware of , no ED etc and fairly muscley chest.

the puzzle continues for now

 

[Systemlord]

Previously I tried 100mg weekly shots and felt okay as long as T was rising

Same here man, 1-2 times weekly I felt nothing. I only feel something when hormones are on the rise, but can’t handle rock steady flat hormones.

Jatenzo was the cure because levels peak within two hours after dosing and dosing is twice daily.

Jatenzo is very similar to the topical treatments.

A new oral testosterone undecanoate therapy comes of age for the treatment of hypogonadal men​

 

[Keepfit1]

thanks for the graphs. how do you feel on it, it looks like to me like it goes up and down pretty quick and dips below "normal", 200 is pretty damn low, I need Gel three times a day ie every 5 hours or so to feel functional. Maybe taking Jatenzo 3 times a day would be better, any idea how the DHT looks on Jatenzo, thats my beef with the Gel it puts DHT and my BPH too high and hairloss. I am in UK so I dont think Jatenzo is here yet and it was I think it would be pretty expensive, hwo much does it cost you a month

 

[sammmy]

What does "generally feel hypogonadic" mean to you?

 

[Systemlord]

how do you feel on it

I feel amazing on it.

Maybe taking Jatenzo 3 times a day would be better

Not necessary. I don’t feel low before my dosing.

any idea how the DHT looks on Jatenzo

Jatenzo is in second place for highest DHT.

 

[Systemlord]

I am in UK so I dont think Jatenzo is here yet and it was I think it would be pretty expensive, hwo much does it cost you a month

It’s only a matter of time before another brand becomes available in the UK. My insurance company is billed $3000 every 90 days, so I’m sure the actual cost is lower.

 

[Keepfit1]

I feel amazing on it.


Not necessary. I don’t feel low before my dosing.

Jatenzo is in second place for highest DHT.

thanks for detailed info, is there a DHT chart for different delivery systems, its odd that you feel good even when T is down around the 200 mark

 

[Keepfit1]

What does "generally feel hypogonadic" mean to you?

it means as if I have not had any T, anxiety, poor cognitive function and word retrieval, if I then take a pump of Androgel those symptoms go away, but if I do bloods in the trough when feeling hypogonadic my T will be 800-900 and FT about 75% up range and DHT 90%, its odd for sure

 

[Keepfit1]

What does "generally feel hypogonadic" mean to you?

t means as if I have not had any T, anxiety, poor cognitive function and word retrieval, if I then take a pump of Androgel those symptoms go away, but if I do bloods in the trough when feeling hypogonadic my T will be 800-900 and FT about 75% up range and DHT 90%, its odd for su

 

[sammmy]

It sounds like you are trying to use Androgel as a stimulant (they improve cognition and word retrieval) but it is odd that it decreases anxiety, since excess testosterone is well known to increase anxiety, irritability and sleep problems, which are all due to too much stimulation of the nervous system.

Were you diagnosed as hypogonadal before taking any testosterone, by lab tests?

 

[Keepfit1]

It sounds like you are trying to use Androgel as a stimulant (they improve cognition and word retrieval) but it is odd that it decreases anxiety, since excess testosterone is well known to increase anxiety, irritability and sleep problems, which are all due to too much stimulation of the nervous system.

Were you diagnosed as hypogonadal before taking any testosterone, by lab tests?

Yes diagnosed with hypogonadism about 15 years ago , T on the floor, started on Androgel, for the first two weeks I felt like I was on rocket fuel then the effect tiled off to feeling normal

 

[sammmy]

You are chasing some off-label effect of frequent dosing of Androgel, which could be the (1) frequent change of T level after dosing, or (2) the larger coversion to DHT. It is not the T level itself, as your experience with injectable T shows.

If it's (1), try the same frequent dosing of Androgel but decrease the dose i.e. half a pump instead of a full one, to decrease your overall DHT exposure. You can also try formulations with frequent peaks and troughs as suggested before, such as oral or nasal T.

If it's (2), you are out of luck because high DHT exposures are not healthy for you. In that case you should keep the normal recommended dosing of Androgel and try something else that addresses the problem - anxiety and word retrieval are not standard problems for which TRT is prescribed. Maybe try adaptogenic herbs like Red Ginseng - it's a stimulant but in some people stimulants decrease anxiety by allowing them to feel better.

 

[sammmy]

Actually, American Ginseng should be better if you are bothered by anxiety.
Reg Ginseng is too stimulatory and it may increase anxiety.

 

[Keepfit1]

You are chasing some off-label effect of frequent dosing of Androgel, which could be the (1) frequent change of T level after dosing, or (2) the larger coversion to DHT. It is not the T level itself, as your experience with injectable T shows.

If it's (1), try the same frequent dosing of Androgel but decrease the dose i.e. half a pump instead of a full one, to decrease your overall DHT exposure. You can also try formulations with frequent peaks and troughs as suggested before, such as oral or nasal T.

If it's (2), you are out of luck because high DHT exposures are not healthy for you. In that case you should keep the normal recommended dosing of Androgel and try something else that addresses the problem - anxiety and word retrieval are not standard problems for which TRT is prescribed. Maybe try adaptogenic herbs like Red Ginseng - it's a stimulant but in some people stimulants decrease anxiety by allowing them to feel better.

thanks for your thoughts on the situation, taking half the dose of Gel doesnt get me up enough, my DHT onGel nly is about 44% up range ie takiing about 70mg/day, when I was on 100mg Cypionate + Gel DHT was 90% up the range but still in range