Low energy with compounding cream

[JD_LEO]

I started TRT on March 24 of this year. I was prescribed 50mg/.5ML a day which I take in the morning. I noticed a very small energy increase for the first 1.5 weeks. Now, I am dead tired anywhere between 4 to 6pm daily. This is usually the time I exercise but I have zero energy for it. I called my physician. Instead of increasing my dose, she wants me to break up my dosage to once in the morning 25mg/.25ml and the same in the afternoon. I am scheduled for blood work on May 12. No effects in the libido department (at the three week mark) except if it were there, I would have zero energy to perform. My last semester of law school finals is approaching along with the bar exam in July. Hindsight is 20/20, and now may have been a bad time to start TRT. However, I thought my energy would be better not worse. I understand getting the dosage right can be a long process but just trying to get as much information as possible.

Questions:

1. Is my overall daily dose normal or low?

2. Will her suggestion of dividing dose actually solve the problem?

3. Is this a result of my body starting to rely on the topical cream and the dose is too low?

4. For my blood test in May, exactly what should the lab work test for?

5. Is my daily dose (totaled) comparable to 100mg injection per week that so most people on this site recommend?

Thanks in advance to those who offer advice.

 

[GettingAnswers]

The following is met with much skepticism, but ZRT labs has addressed this issue with tansdermals. I have been on creams too and ran into issues. Keep in mind that natural production is like 7-10mg of testosterone a day. Many people think we do not absorb well from creams but certain folks think that it is much closer to 90%, it is just that traditional testing doesn't reflect it. I have included a link to their 'paper' on this and have also provided the response from the lab director when I asked him about my case.



This was a response from the lab founder on a public forum when I asked him about the difference. Also when I said closer to 100%, I was a little vague as I believe recall them saying 90+% absorption. Some is the same stuff, but also some other ideas

*****
Your blood spot testosterone (T) value is close to what I would expect it to be – about 10x what you found in venipuncture serum (7139 vs 500 ng/dL). If your estrogens did not go up with the 50 mg topical T then you will probably have few, if any, side effects. Estrogen tends to inhibit the beneficial actions of T. Higher conversion of T to estrogens (estrone and estradiol) occurs more in older men who are overweight.

That your hematocrit and hemoglobin are creeping up suggests the amount of T your body is exposed to is higher than indicated by the serum test.

Many men use the 50-100 mg dosing and feel good for a while, but then notice the positive effects wane. This can be caused by target tissues becoming less responsive to high levels of hormone. In science vernacular we call it tachyphylaxis – a decrease in response to a drug when it's present at high levels.

Men at their hormonal peak (late teens to early 20s) manufacture about 5-7 mg of T per day. Their serum T, as well as blood spot T, ranges from 500-1200 ng/dL. When older men with low T put 5 mg of T on their skin as a topical, it has little impact on serum T, as you saw with the topical dosing. . In sharp contrast the topical T raises blood spot T to 500-1000 ng/dL. Saliva levels also go up. When they use 10x more T (i.e. 50 mg), it slightly raises serum T but raises capillary blood spot T to 5000-10,000 ng/dL. Your T value of 7139 ng/dL on the higher dosing is what I would expect to see for the dosing you used.

Venipuncture serum T represents blood returning to the heart. Blood spot T represents capillary blood that is rich in oxygen and other small nutrients, which include steroids that are delivered topically. We believe that, like oxygen, steroids are distributed into the tissues adjacent to capillary beds, and the venous blood, from which serum is prepared, is depleted of the steroids. This is why T in capillary blood is so much higher than in venous blood, and why the capillary blood is more representative of T delivered to tissues.

Keep in mind that “feeling better” on a higher dose of testosterone doesn't necessarily mean it's better for you in the long run. An increasing hematocrit signals excessive dosing. Also, feeling better could reflect the impact T is having on neurotransmitters. Testosterone increases dopamine, which certainly would make someone feel better – and that's a good thing. But too much T will also eventually lower dopamine levels (tachyphylaxis kicking in), which may explain why men often say the “feel good” effect of topical T wears off. How testosterone is affecting you brain production of “feel good” neurotransmitters is not related to how it is affecting other systems in your body, such as production of red blood cells (hematocrit) or mitochondrial function (energy production).

I believe that venipuncture serum testing for testosterone and other sex-hormones (estrogens and progesterone), following topical dosing, grossly underestimates the tissue levels of testosterone, which are more accurately determined by measuring itin capillary blood (blood spot) or saliva. This marked difference in serum vs blood spot levels of T and other hormones only appears to occur when the hormone is delivered topically – not as a troche, sublingual, pellet, im, or sc route of administration. Excluding topically delivered hormones, serum and blood spot values are very similar.

It's possible that the 50 mg of topical T you're taking is the perfect dose for you and your unique body chemistry and androgen receptor status. We're all different, and respond differently to steroids. I'm a great believer in physiological dosing. It's what Mother Nature intended, and will be associated with the least number of side effects. Keep in mind that no amount of testosterone is going to have its potential benefits if you don't eat right, exercise, reduce stress, and get enough sleep.

 

[Gene Devine]

I started TRT on March 24 of this year. I was prescribed 50mg/.5ML a day which I take in the morning. I noticed a very small energy increase for the first 1.5 weeks. Now, I am dead tired anywhere between 4 to 6pm daily. This is usually the time I exercise but I have zero energy for it. I called my physician. Instead of increasing my dose, she wants me to break up my dosage to once in the morning 25mg/.25ml and the same in the afternoon. I am scheduled for blood work on May 12. No effects in the libido department (at the three week mark) except if it were there, I would have zero energy to perform. My last semester of law school finals is approaching along with the bar exam in July. Hindsight is 20/20, and now may have been a bad time to start TRT. However, I thought my energy would be better not worse. I understand getting the dosage right can be a long process but just trying to get as much information as possible.

Questions:

1. Is my overall daily dose normal or low?

2. Will her suggestion of dividing dose actually solve the problem?

3. Is this a result of my body starting to rely on the topical cream and the dose is too low?

4. For my blood test in May, exactly what should the lab work test for?

5. Is my daily dose (totaled) comparable to 100mg injection per week that so most people on this site recommend?

Thanks in advance to those who offer advice.

Your Doc is right about splitting up the dose to twice a day to help smooth out your serum levels.

Your next blood work is critical. On transdermals you need only about two weeks for next round of blood work.

Go to the blood work forum here and make sure your Doctor is pulling the right labs...this is very important.

Many men just don't absorb well with transdermals and you may be better off injecting twice a week and be done with it.

You should be better assuming you don't have any other underlying pathology.

How old are you and what were you diagnosed with when your Doc prescribed Testosterone to you???

 

[JD_LEO]

I am 39 years old. I first went to the doctor because of extremely low libido. After she told me the side effects of low T, she recommended to have some lab work done. She did not give the specific number, but she said it was below the normal range. This time, I plan on getting a copy of the blood work. I will go to the other forum and see exactly what lab work should be ordered.

Now , I did have a problem with energy before but I just chalked it up to getting old. However, the feeling of exhaustion was never this bad.

She offered the injections after I could not afford the androgel, but I have a huge fear of needles. I have never needed to get over that fear until now. I like the concept of the compounding cream, and I do not have any issues regarding the potential dangers of cross-contamination…so I am hoping it will work fine. I probably should have waited until I was finished with school and the bar exam, but the idea of feeling normal again was too tempting. It will work out in time. I am just trying to make sure I have the right person to treat me. I did not seek this physician out because of her reputation with low T treatment so I am very cautious when it comes to her advice.

 

[HarryCat]

Based on my own experience here's how I'd answer your questions:

1. Is my overall daily dose normal or low?

When I started compounded transdermal T my Dr. started me on 100mg/day, applying 50mg in the morning and 50 mg in the evening.

2. Will her suggestion of dividing dose actually solve the problem?

I think that you overall dose is a bigger problem.

3. Is this a result of my body starting to rely on the topical cream and the dose is too low?

Yes, that seems likely.

5. Is my daily dose (totaled) comparable to 100mg injection per week that so most people on this site recommend?

Can't make an apples to apples comparison because everyone absorbs the transdermal differently. It also depends on where you apply it. My Dr. recommended applying to the scrotum since the skin is thinnest there. I eventually got up to 200mg/day applied to the scrotum and that got my total T and free T numbers at the top of the range.

As far as the huge fear of needles goes, I was there, but desperation eventually got me over that fear and I was pleasantly surprised to find out how little pain is involved with injections. I'm currently injecting 50mg twice a week subQ.