Factors that Can Improve Testosterone Gel Absorption

[Nelson Vergel]

Most absorption of testosterone in testosterone gels happens during the first 4 hours. The 1.62 % Androgel package insert says this about showering after testosterone gel application and using moisturizers/sun block:

"Effect of showering

In a randomized, 3-way (3 treatment periods without washout period) crossover study in 24 hypogonadal men, the effect of showering on testosterone exposure was assessed after once daily application of AndroGel 1.62% 81 mg to upper arms/shoulders for 7 days in each treatment period. On the 7th day of each treatment period, hypogonadal men took a shower with soap and water at either 2, 6, or 10 hours after drug application. The effect of showering at 2 or 6 hours post-dose on Day 7 resulted in 13% and 12% decreases in mean Cavg, respectively, compared to Day 6 when no shower was taken after drug application.

Showering at 10 hours after drug application had no effect on bioavailability. The amount of testosterone remaining in the outer layers of the skin at the application site on the 7th day was assessed using a tape stripping procedure and was reduced by at least 80% after showering 2-10 hours post-dose compared to on the 6th day when no shower was taken after drug application.

Effect of sunscreen or moisturizing lotion on absorption of testosterone

In a randomized, 3-way (3 treatment periods without washout period) crossover study in 18 hypogonadal males, the effect of applying a moisturizing lotion or a sunscreen on the absorption of testosterone was evaluated with the upper arms/shoulders as application sites. For 7 days, moisturizing lotion or sunscreen (SPF 50) was applied daily to the AndroGel 1.62% application site 1 hour after the application of AndroGel 1.62% 40.5 mg. Application of moisturizing lotion increased mean testosterone Cavg and Cmax by 14% and 17%, respectively, compared to AndroGel 1.62% administered alone. Application of sunscreen increased mean testosterone Cavg and Cmax by 8% and 13%, respectively, compared to AndroGel 1.62% applied alone. "

This graph shows how applying on shoulders (treatment B) gets blood levels of testosterone higher than applying testosterone gel on abdominal area (treatment A). It is probably related to the lower amount of fat in the shoulders that makes it easier for testosterone to get to the blood stream.



Message:

1- Applying on shoulders gets more testosterone absorbed by abdominals.
2- Showering or sweating after 4 hours is OK.
3- Using moisturizers or sunblock after applying testosterone gels increases absorption by 8-13 percent.

 

[Nelson Vergel]

More information about testosterone treatment options:

Testosterone Replacement Treatment Options

 

[bruin]

@Nelson..........I was doing a search for some info for a friend who just got put on Testim, he knows of my background, it was my suggestion that he ask his Dr to be tested. I emailed this particular forum to him, my question is about the shoulder application site and abdominal absorption of T, how is this connected ?
Duane

 

[Nelson Vergel]

The T gel absorption data shows better uptake from areas that have less subcutaneous (under the skin) fat like shoulders. I speculate that T aromatisation to estradiol is also lower in lower fat areas.

 

[bruin]

Does it really matter site application for a gel like androgel, 1.62 the direction is for shoulder, the lower dose is in the midsection.
My first consult with the pharmacist with 1.62 rx she advised midsection application, I read the insert which stated shoulders.
Its all going the same place, no?

 

[Nelson Vergel]

Pharmacokinetics of Transdermal Testosterone Gel in Hypogonadal Men: Application of Gel at One Site Versus Four Sites: A General Clinical Research Center Study*


C. WANG, N. BERMAN, J. A. LONGSTRETH, B. CHUAPOCO, L. HULL, B. STEINER, S. FAULKNER, R. E. DUDLEY, AND R. S. SWERDLOFF

Division of Endocrinology, Departments of Medicine (C.W., B.C., L.H., B.S., R.S.S.) and Pediatrics
(N.B.), Harbor–UCLA Medical Center and Research and Education Institute, Torrance, California
90509; and Unimed Pharmaceuticals, Inc. (J.A.L., S.F., R.E.D.), Buffalo Grove, Illinois 60089

ABSTRACT

Testosterone (T) in a hydroalcoholic gel has been developed as an effective and convenient open system for transdermal delivery of the hormone to men. Because the gel can be applied either to small or large areas of skin, it was important to assess whether the skin surface area on which the gel was applied was an important deter- minant of serum T levels. To answer this question, the pharmacokinetics of a transdermal 1% hydroalcoholic gel preparation of T was studied in nine hypogonadal men. The subjects applied in random order a 25-mg metered dose of T gel either four times at one site (left arm/shoulder) or at four different sites (left and right arms/shoulders and left and right abdomen) once daily (6 – 8 min) for 7 consecutive days. After 7 days of washout, each subject was then crossed over to the opposite regimen for another 7 days of treatment. Serum samples were collected for measurements of T, 5a dihydrotestosterone (DHT), and estradiol before, during (days 1, 2, 3, 5, and 7), and after (days 8, 9, 11, 13, and 15) application of T gel. Multiple blood samples were drawn on the 1st and 7th day after gel application; single samples were obtained just before the next T gel application on other days (24 h after the previous gel application). The T gel dried in less than 5 min, left no residue, and produced no skin irritation in any of the subjects. Mean serum T levels, irrespective of application at one site or four sites followed the same pattern: rising to 2- to 3- and 4- to 5-fold above baseline at 0.5 and 24 h after first application, respectively. There- after, serum T levels reached steady state and remained at 4- to 5-fold above baseline (at the upper limit of the normal adult range) for the duration of gel application and returned to baseline within 4 days after stopping application. The application of T gel at four sites (ap- plication skin area approximately four times that of one site) resulted in a mean area under the curve (AUC0 –24h) for serum T levels on the 7th day (868 ± 72 nmol*h/L, mean ± SEM), which was 23% higher but not significantly different (P = 0.06) than repeated application at one site (706 ± 59 nmol*h/L). This could be due to the limited number of subjects studied (n = 9). Mean serum DHT levels followed the same pattern as serum T, achieving steady-state levels by 2 days. The mean concentration of serum DHT on the 7th day was significantly higher after application at four sites (9.15 ± 1.26 nmol/L, P < 0.05) than at one site (6.9 ± 0.77 nmol/L). These serum DHT levels were at or above the normal adult male range. Serum DHT:T ratio was not significantly altered by T gel application. Serum estradiol levels followed the same pattern as serum T and showed no significant difference between the one- or four-site application. We conclude that transdermal daily application of 100 mg T gel resulted in similar steady levels of serum T. The surface area of the skin to which the gel was applied had only a modest impact on serum T and DHT levels. Mean serum levels of T and DHT was higher by 23% and 33%, respectively, despite application of the gel to four times the skin area in the four sites compared with the one site group. Because of the greater dosage flexibility provided, hydroalcoholic T gel application over multiple sites seems to be an effective and nonskin-irritating method of trans- dermal T delivery for hypogonadal men. Dose-ranging studies are required to determine dosage regimens for T gel application as a replacement therapy in hypogonadal men. (J Clin Endocrinol Metab 85: 964 –969, 2000)

 

[MountainLiving]

Thank you Nelson for this awesome information and graphs. I just started t-gel stuff. It is the 1.25, 2 pumps per day. Doc will check my t-levels in 5 weeks, then he will decide if I need to increase the dosage.

I want to get as much absorption as possible. So it looks like my workouts need to be in the afternoon since I apply the t-gel in the morning. Don't want to have sweat effect the t-gel. Also, I will start using lotion on the area I applied the t-gel, an hour after it is applied. Anything to help absorption is a plus in my book and will allow me to get my money worth of the product.

This study you posted is awesome!

Thank you.

 

[keithc2485]

question about lotion application times?

so , ive read in a few foums that , you dont have to wait the full hour to apply sunblock? and just to do it within 10 minutes after it dries?

what ive been doing is applying the generic 12.5mg 1% gel to my sholders and upper arms / not rubbing it in, rather just letting it soak in and very gently patting it in....is that good"? and then 6-10 min later when its completely dry i put on a medium layer of lotion mixed with sunblock...... dos that sound ok? or is waiting the hour actually make a difference? right now im on 50mgs qd... .waiting for approval to get on 100mgs qd........

thanks
-K

 

[Dr. John Crisler]

Don't waste that good Man Gel by applying it with your hands. It won't soak through the thick skin on the palms to reach the bloodstream.

Instead, apply directly to the forearms, and rub them together. Then finish off by going up and down the flanks.

Absorption is improved by doing so within a few minutes of showering.

Using a good emollient (not petroleum based, or containing parabens, etc!), about 12 hours off will help keep the skin soft and supple. This especially helps in the Northern latitudes in the dry Winter months.

 

[keithc2485]

just a clarification , doc?

i did not know it was safe to put on the forearms .... its so hard to find any doctors who know anything about testosterone ..besides how to write it....thanks

but just to clarify, should I rub it in , or let it soak in ? i had read rubbing to hard can break the drug up or something?

also 12 hours off? meaning dont follow up right after with lotion?

thank you

 

[Nelson Vergel]

Genetic Mutations May Explain Wide Variation in Testosterone Blood Levels in Men Using the Same Dose of T Gel


Interesting study to find polymorphisms (genetic mutations) that may explain wide variations with T gels.
https://www.ncbi.nlm.nih.gov/m/pubmed/28981994/

Contributors to the substantial variation in on-treatment testosterone levels in men receiving transdermal testosterone gels in randomized trials.
There is substantial inter-individual variability in serum testosterone levels in hypogonadal men treated with testosterone gels. We aimed to elucidate participant-level factors that contribute to inter-individual variability in testosterone levels during testosterone therapy. An exploratory aim was to determine whether polymorphisms in genes encoding testosterone-metabolizing enzymes could explain the variation in on-treatment testosterone concentrations in men who were randomized to testosterone arm in TOM Trial. We used data from three randomized trials that used 1% transdermal testosterone gels and had testosterone levels measured 2-4 weeks after randomization for dose adjustment: Testosterone in Older Men with Mobility Limitation (TOM), Effects of Testosterone on Pain Perception (TAP), and Effects of Testosterone on Atherosclerosis Progression (TEAAM). Forty-seven percent, 38%, and 9% of participants in TAP, TEAAM, and TOM trials, respectively, failed to raise testosterone levels >400 ng/dL; 6, 8, and 30% of participants had on-treatment testosterone levels >1000 ng/dL. Even after dose adjustment, there was substantial variation in on-treatment levels at subsequent study visits. Baseline characteristics (age, height, weight, baseline testosterone, SHBG, hematocrit, and creatinine) accounted for only a small fraction of the variance (<8%). Polymorphisms in SHBG and AKR1C3 genes were suggestively associated with on-treatment testosterone levels. To conclude, baseline participant characteristics account for only a small fraction of the variance in on-treatment testosterone levels investigated. Multiple dose titrations are needed to maintain on-treatment testosterone levels in the target range. The role of SHBG and AKR3C1 polymorphisms as contributors to variations in on-treatment testosterone levels should be investigated.

 

[DragonBits]

The T gel absorption data shows better uptake from areas that have less subcutaneous (under the skin) fat like shoulders. I speculate that T aromatisation to estradiol is also lower in lower fat areas.

I am bald.

I speculate that one of the best areas to apply gel/cream is the scalp of a bald head. Great blood supply and very little fat.

 

[Match]

question about lotion application times?

so , ive read in a few foums that , you dont have to wait the full hour to apply sunblock? and just to do it within 10 minutes after it dries?

what ive been doing is applying the generic 12.5mg 1% gel to my sholders and upper arms / not rubbing it in, rather just letting it soak in and very gently patting it in....is that good"? and then 6-10 min later when its completely dry i put on a medium layer of lotion mixed with sunblock...... dos that sound ok? or is waiting the hour actually make a difference? right now im on 50mgs qd... .waiting for approval to get on 100mgs qd........

thanks
-K

After that time, what does your results and time of use say? I'll still start

 

[Nelson Vergel]

New Atrevis Hydrogel Based Testosterone Cream from Empower: Surprising Results!

After a month of using the new hydrogel cream from Empower Pharmacy at 1 ml per day (4 clicks of 0.25 mg each) my testosterone increased dramatically higher than it was even on 200 mg per week of injectable testosterone cypionate. and this was after using the cream plus pregnenolone 100 mg...

www.excelmale.com

 

[Bennytrt]

I wanted to try out test cream with my test/hcg injections. I was prescribed test cream 50 mg/ml, 1 click (0.25ml) which equals to 12.5mg if I did my math correctly. Is the hydrogel better than test cream?

 

[Nelson Vergel]

I wanted to try out test cream with my test/hcg injections. I was prescribed test cream 50 mg/ml, 1 click (0.25ml) which equals to 12.5mg if I did my math correctly. Is the hydrogel better than test cream?

In my experience, it has better absorption. You won’t need injections.

 

[wisppp]

what lotion or moisturizer (brand and type) do you use to increase Androgel absorption? I tried CeraVe moisturizing lotion, but the blood tests after a week were worse than without it. I also tried 4 drops of 99% DMSO And my trt level was 2* higher

 

[granger]

its best to use it AFTER a shower.. while fatty cold areas(backs of arms/shoulders) provide nice even levels, one would think putting on a warmer area (more blood supply) would absorb much 'better'

but ya using cream before the gel of course will slow absorbtion as your adding an extra layer of moisture. as would diluting its transdermal properties using lotion after.

wonder if adding some hand sanitizer a few hours later would drive more absorption aswell..

 

[Melody68]

When you use gels, success is dependent on absorption, and absorption will always be a huge question mark. When you inject the T is delivered directly to its target, bang, DONE. Except for the irrational fear of needles, I can't imagine why anybody would choose gels over injections. The best thing to do is holster your di-k and inject.