Got Test results after 3 months 1% T-Gel . . . very rattled!

[Melody68]

I'm 68 and was diagnosed in December with lower T at 314, hematocrit at 47. I decided together with the Endocrinologist to go with his suggestion of 5gms 1% T Gel, the regular starting dose.

Fast forward to my first blood test taken yesterday after applying the gel regularly for 3 months. And my results are . . . 167 with a hematocrit of 50! That sounds pretty CRAPPY, and pretty shocking . . .

How do I feel? None of my low T symptoms have improved; the only things I feel at all are slightly sensitive nipples, a scrotum that seems tighter, and despite increased exercise and a modified diet, I haven't been able to lose any weight (in fact it's increased a few pounds).

How can this be? Maybe it's a lab test error? Maybe I don't absorb it well? But then how could my hematocrit go up? Help, really need some suggestions here . . .

 

[Systemlord]

Maybe I don't absorb it well? But then how could my hematocrit go up?

You’re supposed to run labs 6 hours after your dosing. Due to the short half-life of testosterone gel, levels will peak and drop rapidly so lab timing is critical!

Your trough levels seem a bit low, which suggests either your dosage isn’t high enough and/or you aren’t absorbing enough.

Why are you waited 3 months to draw labs is beyond me, because your levels should have stabilized after only 3 weeks.

Your endocrinologist is dropping the ball!

Endocrinologist’s are typically bad at TRT.

 

[Melody68]

I normally apply the gel at 9 am. His office said I could have blood drawn at 8 am, making it 23 hours since the last testosterone application. Could it vary that much in a 24 hour period? There was some literature on here recently that suggested Testosterone peaks 2 hours after application and then settles down to a relatively constant level soon after that. Maybe not?

Yes, I agree with you, waiting 3 months seems too long, but who am I to criticize the endo?

 

[Melody68]

I've been thinking more about this. Could it be that someone like myself, after 3 months on T gel, would have 400 when the lab draws the blood 6 hours after gel application and then have it drop to 167 twenty-four hours after application? Could it really vary that much from peak to trough?

My endo, in addition to waiting 3 months before doing the first lab test, only requested a CBC and Total Testosterone count; there were no other tests like free testosterone, estradiol and estrogen, PSA etc. Is that cause for concern?

 

[Systemlord]

His office said I could have blood drawn at 8 am, making it 23 hours since the last testosterone application.

That's wrong, you can be assured your doctors office, and doctor don't know what the hell they're doing! The half-life of T gel is 4 hours. I'm on Jatenzo, a new oral testosterone undecanoate with a half-life of 6 hour (PK profiles below), and I see a 100 ng/dL drop every hour and I dose twice daily.

Jatenzo peaks in 2 hours.

TRT is a field of medicine that few doctors truly grasp, the majority get it wrong and many doctors who learn about pharmacokinetics in medicine school fail miserably in the clinical setting.

Often doctors are into other fields of medicine and don't spend much of their time dabbling into TRT.

There's an old saying, if your medical problem isn't in your doctors top ten greatest hits, your experience is likely be a negative one.

My endo, in addition to waiting 3 months before doing the first lab test, only requested a CBC and Total Testosterone count; there were no other tests like free testosterone, estradiol and estrogen, PSA etc. Is that cause for concern?

Of course it is a concern because TT doesn't drive effects of TRT, the FT drives symptom resolution and the metabolites estrogen and DHT. It's too early to be testing for PSA. The sick care system is not a good place to get treatment for low-T, because your doctor works not for you, but your insurance company.

The doctor answers to your insurance company, and as long as that's the case, care will be substandard. A lot of guys pay out of pocket to get better care.

This is the kind of mediocre care you can expect from a sick care system.

after 3 months on T gel, would have 400 when the lab draws the blood 6 hours after gel application

Your dosage isn't high enough, you should be higher at your midpoint! On top of that you need twice daily dosing.

 

[Melody68]

Systemlord, thanks very much for your extensive thoughts on this very odd problem of mine. I don't doubt what you're saying, because in addition to your position, there have been others who also experienced a large difference between peak and trough throughout the day.

The manufacturer of the gel (it's a generic equivalent of Androgel) claims that there is only a very slight peak two hours after application, which then drops minimally, leveling out for the next 24 hours. The graph almost looks like a straight line, which would indicate that you could do a lab test anytime after 4 hours right up to the 24th hour after application. That's what they say . . . but maybe some people don't absorb the T the way they're supposed to, causing greater blood level variations?

I've contacted the endo (he's not back to me yet); I'm thinking the first step is a blood retest. If that repeats the dreadful result, then it would seem I should move to injectibles. I'll stay in touch . . .

 

[Systemlord]

The manufacturer of the gel (it's a generic equivalent of Androgel) claims that there is only a very slight peak two hours after application, which then drops minimally

That would depend on absorption and the rate at which you metabolize testosterone. When I was on topicals, my levels would rise and fall rapidly, because while the Test was going through the skin into the bloodstream, my skin wasn't absorbing it.

Injections is the more effective treatment and the majority of men prefer it.

 

[Melody68]

For those following this, I spoke to the Endo and he seemed concerned about the long time between application and lab test (23 hours), the way Systemlord suggested. I just got back from the lab having done a second blood draw; this one 5 hours and 15 minutes after this mornings application. Will find out next week . . .

 

[madman]

I'm 68 and was diagnosed in December with lower T at 314, hematocrit at 47. I decided together with the Endocrinologist to go with his suggestion of 5gms 1% T Gel, the regular starting dose.

Fast forward to my first blood test taken yesterday after applying the gel regularly for 3 months. And my results are . . . 167 with a hematocrit of 50! That sounds pretty CRAPPY, and pretty shocking . . .

How do I feel? None of my low T symptoms have improved; the only things I feel at all are slightly sensitive nipples, a scrotum that seems tighter, and despite increased exercise and a modified diet, I haven't been able to lose any weight (in fact it's increased a few pounds).

How can this be? Maybe it's a lab test error? Maybe I don't absorb it well? But then how could my hematocrit go up? Help, really need some suggestions here . . .

Welcome to Nelson's domain!

Glad to have another fellow canuck on here.

Steady state is reached within the first 2-3 days.

Blood work should have been done 2 weeks after starting therapy not 3 months in as we need to make sure you are achieving a healthy TT/FT level let alone making sure you are a responder as many men never achieve the T levels needed to reap the beneficial effects of free testosterone due to absorption issues when using the transdermal formulations (standard application).

Scrotal application using a high-strength compounded T-cream is far superior!

When using Androgel/generic the manufacturer states that blood work should be done AM pre-dose morning blood draw.

T levels will peak 2-4 hrs (depending on the strength Androgel formulation 1-1.62%) post application and slowly decrease throughout the day as there should be a slow-sustained delivery of testosterone over 24 hrs.

The transdermal T-gel (Androgel/generic) should provide a steadier and more sustained release of T into the circulatory system.

Yes one can easily test at the peak or anytime after.


*Some manufacturers provide both options (Table 11.2). Most testosterone gel preparations are formulated as hydroalcoholic gel, others use other enhancers in lotions. When applied to the skin, testosterone is absorbed into the stratum corneum over time, which serves as a reservoir. Testosterone is slowly released into the circulatory system over several hours resulting in steady-state serum levels of the hormone [22]. The release of testosterone from the reservoir continues for about 24 h. Only approximately 10 % of the testosterone applied on the skin surface is absorbed into the circulatory system during a 24-h period.


*Long-term studies with testosterone gel have shown that steady and relatively consistent serum levels of testosterone levels are attained [7],


*Several formulations of testosterone gels are available on the market [1, 2, 27]. Currently available gels vary in testosterone concentration and are usually applied once a day. Their pharmacokinetic profiles are also similar: Androgel 1 %®/ Testogel 1 %® [7], Testim® 1 % [28], Axiron®2 % [29] Fortesta Gel® 2 %/Tostran® 2 % [30], and Androgel 1.62 %® [31]. These transdermal preparations have been proven to be efficient in normalizing serum levels, as well as the reversal of androgen deficiency symptoms for long periods of treatment [24], and have been considered an acceptable form of testosterone substitution by users [5]. The maximum concentration of testosterone achieved is variable depending on the preparation but usually within 2–5 h of application and is maintained for 24 h. When applied in the morning, a profile somewhat similar to the circadian rhythm in healthy men is maintained. Recent studies in older hypogonadal men have shown that after testosterone gel application there were large fluctuations in serum testosterone concentration both within and between patients [8]. Skin structural differences may be one of the causes of these significant variations in the bioavailability of the drug, which poses challenges in predicting the effectiveness of medication and determining an adequate dose, as well as an appropriate time for testing serum testosterone levels [8, 32]. Nontime-dependent pulses of serum testosterone also occur in relation to exercise and skin temperature. Both factors may be mediated through changes in dermal blood flow. Another important issue is the possibility of blood sample contamination when it is drawn at the gel application site, which has led to a spurious increase in measured testosterone levels [33]. A sampling of blood after testosterone gel applications should be done away from the application sites.


*Additionally, some gels include emollients that prevent skin drying and ensure better testosterone absorption. There are data to suggest that this may help achieve better bioavailability and higher serum concentrations [37]. Differences in gel formulations and their pharmacokinetic profiles are a reason why gels cannot be used and dosed interchangeably. Therefore, it is recommended to follow specific instructions on sites for application and dosing of the drug provided in the labeling. Dosing information and recommendations for some of the preparations are presented in Table 11.2. It should be noted that some gels are marketed in various countries under different names but are in fact produced by the same manufacturer.


*At day 90, peak T levels were reached after 4 and 8 hours with 5 g and 10 g T gel application, respectively.


Ridiculous that your doctor would make you wait 3 months as you could easily crash off the hop if you ended up having absorption issues.

You are most likely using the generic version of Androgel which would be the 1% Taro-testosterone gel.

Most men are started on the lower dose of 5 grams gel 50 mg T (5 mg T/day) as the bioavailability of transdermal T (standard application) is around 9-13%.

Say roughly 10%.

Unfortunately such a dose will not result in stellar T levels as most men will need the higher-end dose 100 mg T (10 mg T/day) to achieve stellar/high FT levels and that is if you have no issues with absorption!

You tested at true trough (23 hrs) post application but even then your T levels are absurdly low!

Looks as though you are a poor responder.

More importantly although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

Labs should always include TT, FT, estradiol, DHT, PSA and a CBC (complete blood count) which includes the critical blood markers RBCs, hemoglobin and hematocrit.

Unfortunately another downfall when it comes to testosterone therapy in Canada is that many of the endos, uros and GPs are still caught up on TT when FT is what truly matters.

Many end up only testing TT, PSA and CBC and ignore the most critical blood marker FT let alone estradiol, SHBG and DHT.

Novel administration methods for treating low testosterone

Novel methods for the treatment of low testosterone (2023) Julius Fink & Shigeo Horie Abstract Introduction Testosterone replacement therapy is a promising and growing field in modern healthcare. Several novel testosterone preparations aiming at providing an efficient drug without side...

www.excelmale.com

*Most of these preparations display a gradual increase, with a flat peak followed by a very slow decrease. Some ultimately increase slowly to peak a second time

Table 11.2 Characteristics of some testosterone gels (based on manufacturer’s label)

Androgel® Mechanism of Action

www.excelmale.com

Taro Taro RX product details | Pharmaceutical Industries Ltd.

www.taro.ca

New TRT user and frustrated on 1.62 Gel

I’m 47 and low T, low energy and no gym gains. I’ve had issue with ED and my libido at the moment is nonexistent right now. 2 months ago my TEST was 160 and my free T was 11 pg/ml! My PA started me on 1 pump per day alternating shoulders and then bumped me to 2 pumps per day (one pump each...

www.excelmale.com

Safe to try Androgel for a few months n stop it it doesn’t work?

I was wondering if I could get everyones opinion and ideas on this. Dr. Recommended Androgel to try for a few months and see if it helps with fatigue and brain fog. He said I could try it for a few months and if I see no improvement, I could stop and it shouldn’t cause any problems. I’m not...

www.excelmale.com

New TRT user and frustrated on 1.62 Gel

I’m 47 and low T, low energy and no gym gains. I’ve had issue with ED and my libido at the moment is nonexistent right now. 2 months ago my TEST was 160 and my free T was 11 pg/ml! My PA started me on 1 pump per day alternating shoulders and then bumped me to 2 pumps per day (one pump each...

www.excelmale.com

Testosterone Therapy in Canada

@Marcel https://www.excelmale.com/forum/threads/the-dea-wants-to-limit-your-access-to-trt-telemedicine.27274/page-6 We have always been far worse off than the US when it comes to the treatment of men for testosterone deficiency. Although there has been some improvement in certain areas we...

www.excelmale.com

Canadian Urology Guideline on Testosterone Replacement

Canadian Urological Association clinical practice guideline on testosterone deficiency in men: Evidence-based Q&A (2021) Ethan D. Grober, MD; Yonah Krakowsky, MD; Mohit Khera, MD; Daniel T. Holmes, MD; Jay C. Lee, MD; John E. Grantmyre, MD; Premal Patel, MD; Richard A. Bebb, MD; Ryan...

www.excelmale.com

 

[madman]

You’re supposed to run labs 6 hours after your dosing. Due to the short half-life of testosterone gel, levels will peak and drop rapidly so lab timing is critical!

Your trough levels seem a bit low, which suggests either your dosage isn’t high enough and/or you aren’t absorbing enough.

Why are you waited 3 months to draw labs is beyond me, because your levels should have stabilized after only 3 weeks.

Your endocrinologist is dropping the ball!

Endocrinologist’s are typically bad at TRT.

Stable T levels I would say!


With single daily applications of AndroGel®, follow-up measurement 180 days after starting treatment have confirmed that serum concentrations are generally maintained within the eugonadal range. Figure 1 summarizes the 24-hour pharmacokinetic profiles of testosterone for patients maintained on 5 g or 10 g of Androgel for 30 days. The average (± SD) daily testosterone concentration produced by AndroGel® 10 g on Day 30 was 792 (± 294) ng/dL and by AndroGel® 5 g 566 (± 262) ng/dL.

When AndroGel® treatment is discontinued after achieving steady-state, serum testosterone levels remain in the normal range for 24 to 48 hours but return to their pretreatment levels by the fifth day after the last application

 

[madman]

That's wrong, you can be assured your doctors office, and doctor don't know what the hell they're doing! The half-life of T gel is 4 hours. I'm on Jatenzo, a new oral testosterone undecanoate with a half-life of 6 hour (PK profiles below), and I see a 100 ng/dL drop every hour and I dose twice daily.

Jatenzo peaks in 2 hours.

TRT is a field of medicine that few doctors truly grasp, the majority get it wrong and many doctors who learn about pharmacokinetics in medicine school fail miserably in the clinical setting.

Often doctors are into other fields of medicine and don't spend much of their time dabbling into TRT.

There's an old saying, if your medical problem isn't in your doctors top ten greatest hits, your experience is likely be a negative one.


Of course it is a concern because TT doesn't drive effects of TRT, the FT drives symptom resolution and the metabolites estrogen and DHT. It's too early to be testing for PSA. The sick care system is not a good place to get treatment for low-T, because your doctor works not for you, but your insurance company.

The doctor answers to your insurance company, and as long as that's the case, care will be substandard. A lot of guys pay out of pocket to get better care.

This is the kind of mediocre care you can expect from a sick care system.


Your dosage isn't high enough, you should be higher at your midpoint! On top of that you need twice daily dosing.


View attachment 42373

Androgel/generic is dosed once daily!

 

[Melody68]

Madman, thank you for the very informative write-up, I'm learning at a great rate.

How did you guess I was in Canada? I converted the test results to American units just to simplify the presentation. And yes, it is 5g Taro 1% Testosterone Gel, terrific knowlege.

I'm not too happy with the way things are going right now, but I'll have to stick it out for a while. I've known the endo for at least 15 years when he treated me on another matter, and one would think an endo would know TRT better than most. He's sincere, and together with this forum I'm hopeful I can steer this in the right direction. You are correct; he only tests for TT and a CBC.

I don't have much faith in the trans dermal approach and readily accept the conclusion that I'm a poor responder. Needles don't bother me, and I'd like to go with injectibles. Before I started TRT, my hematocrit (H) varied between 47-49 and the endo said that the gels, applied daily, would lessen the impact of TRT raising the H over 50, versus the once a week T injection. I believe him . . . but I'm also hopeful that a conservative dose of enanthate or cyp injected every 4 days will benefit me without necessarily raising my H into the danger zone, which he says is over 52. I'd propose injecting 50mg every 4 days and seeing where that takes me. Hopefully with that conservative dose I would notice some benefits without running the risk of throwing estradiol and other markers out of whack. I don't want to start taking more drugs to counteract side effects.

I retested bloodwork today, drawn 5 hours and 15 minutes after application; hopefully that will shed light on some of these things, I'll report back.

PS I read with interest your attachments - I'm a little concerned now that I may have applied the gel down as far as the point where blood was drawn, which might also skew the results . . . I wouldn't have that problem with injectibles!

 

[joemorgan]

I'm 68 and was diagnosed in December with lower T at 314, hematocrit at 47. I decided together with the Endocrinologist to go with his suggestion of 5gms 1% T Gel, the regular starting dose.

Fast forward to my first blood test taken yesterday after applying the gel regularly for 3 months. And my results are . . . 167 with a hematocrit of 50! That sounds pretty CRAPPY, and pretty shocking . . .

How do I feel? None of my low T symptoms have improved; the only things I feel at all are slightly sensitive nipples, a scrotum that seems tighter, and despite increased exercise and a modified diet, I haven't been able to lose any weight (in fact it's increased a few pounds).

How can this be? Maybe it's a lab test error? Maybe I don't absorb it well? But then how could my hematocrit go up? Help, really need some suggestions here . . .

Have your doctor check for polycythemia vera, usually with a bone marrow test. And, 1% gel is next to water as far as T therapy goes, in my experience. Even 5% is not very strong for a gel. A cream at 15 or 20% and apply 100mg daily to clean scrotal tissue which has no fatty layer and allows full absorption.

 

[Melody68]

Well, just to bring things up to date, recall that on Wednesday last week I tested at the 23rd hour after gel application at 5.8. I retested Friday 5.25 hours after application and measured 21.7(!). I think this means that I'm absorbing too quickly, leaving myself T starved for the 16 hour balance of the day. Guidance from the gel manufacturer suggests that levels should remain relatively constant for the whole day until the next application. Worse, my endo says this is fine and that I should continue with it, especially disappointing since it hasn't even done anything to alleviate my symptoms . . . not too happy about it.

 

[joemorgan]

1% gel will never get you where you need to be.[10 years experience in mens health]
When you add exogenous T your testicles will slow what they are doing and you will lose
some of your innate production and depend mostly on externally applied or injected T.
I have seen so many specialists, especially endocrinologist who have never worked in a mens cinic to see what happens to lots of men over a period of time. Relying on an endo is mediocre at best unless you have a prolactin issue or a pituitary tumor.
You must apply enough T to fuel the day and some left over for the next days.
Alternatively, if you did apply enough T then the problem might be fast converting of T to Estrogen. That does not seem to be your problem as your T levels are dropping due to suppression in the presence of inadequate dosing of the T.
Your description of starving for 16 hours a day reminds me of the weekly T shot that peaks around 4-5-6 and drops quickly at day 6-7, run out of T. Your dose is inadequate.
BTW, I have not heard of anyone using 1% T gel in several years for the reasons stated above.

 

[Melody68]

Hey Joe, I know that you are correct, especially when you say that "you must apply enough T to fuel the day and have some left over for the next days". I do believe that this T is going through me too quickly; maybe not surprisingly I've had sensitive nips while on this gel, something that I found hard to believe up until now. If it peaks so early, maybe I'm having the accompanying aromatization. I'm going to see about getting on injections, something like 80mg per week, split between two shots in the week. But who knows if the endo will agree? Maybe time to look to a private clinic . . .

 

[Systemlord]

Worse, my endo says this is fine and that I should continue with it, especially disappointing since it hasn't even done anything to alleviate my symptoms

I noticed my doctors could care less whether or not my symptoms are resolved, they are obsessed with the lab ranges and most don't have a clue how to manage, balance male hormones.

They are uninterested in TRT.

 

[Seagal]

I noticed my doctors could care less whether or not my symptoms are resolved, they are obsessed with the lab ranges and most don't have a clue how to manage, balance male hormones.

They are uninterested in TRT.

They are mostly uninterested in optimizing mental health because they don't have an objective measure on paper and no guidelines and because there is another 'specialist' aka psychiatrist to deal with it.

 

[madman]

Hey Joe, I know that you are correct, especially when you say that "you must apply enough T to fuel the day and have some left over for the next days". I do believe that this T is going through me too quickly; maybe not surprisingly I've had sensitive nips while on this gel, something that I found hard to believe up until now. If it peaks so early, maybe I'm having the accompanying aromatization. I'm going to see about getting on injections, something like 80mg per week, split between two shots in the week. But who knows if the endo will agree? Maybe time to look to a private clinic . . .

Well aware of your outcome here.

Replied to your PMs.

Time to find a new doctor and get on injections!

 

[Seagal]

Well aware of your outcome here.

Replied to your PMs.

Time to find a new doctor and get on injections!

Can you explain the reason for the difference to the study data you referenced?