Major Reduction of T after Cream

[wannabefan]

Just started TRT, 200mg cream in AM to scrotum 6 weeks ago with 50mg DHEA and 100mg Pregnenolone.

At start my labs were, and frankly felt very “good” generally, mild libido issues, wanting to merely optimize overall health and vitality (active 55 YO), all other labs normal/optimal incl Thyroid, LipidC Metabolic and Renal:

Total T 502
Free T 96
Preg 43
DHEA-S 86
Estradiol 18
Total Estrogen 100
SHBG 32
LH 4.1
Prolactin 4.3
IGF-1 210
DHT 36
PSA 0.54
HCt 46

Now 6 weeks in per above protocol:

Total T 186
Free T 42
LH -0.2
SHBG 24
Estradiol 18
DHEA 310
HCt 50
PSA 0.71
Waiting still for balance of labs.

I feel good. Have put on 5# of what I believe is muscle.

Why and how can my T numbers drop from treatment so much, and yet HCt has gone up? Should I expect DHT will be very high? I have no signs or hair, body/face acne, etc. My am and through night erectile function is strong. I’m confused, and a bit concerned I’ll never get back to baseline. Attached is a snapshot.

 

[HarryCat2]

How many hours after your last application of cream was the lab draw?

 

[Systemlord]

Why and how can my T numbers drop from treatment so much, and yet HCt has gone up?

You should be checking levels 2-4 hours after your application of T cream. The topicals and oral treatments will have your hormone levels spiking high and dropping low in a short amount of time.

When I started Jatenzo, my doctor had me testing first thing in the morning, before my oral Jatenzo and always had a 289 low reading even after dosage increases. It wasn’t until I started testing at the correct time (4 hours after dosing) I started seeing high values.

To give you an idea, I have seen Total T at 1052 at 4 hours and as little as 289 at trough or 12 hours after dosing.

So lab timing is critical!

 

[wannabefan]

How many hours after your last application of cream was the lab draw?

Excellent question, and I had thought about trough but didn’t think it was parcel to cream application….it had been close to 22 hrs since prior AM application (meaning I applied the prior AM, then had an AM draw the next morning). TY.

 

[sammmy]

You measured your lower level before application in the morning. After you apply it, probably your testosterone spikes a lot, so your average level is somewhere in the middle. The fact that your LH is suppressed means that you do have external testosterone circulating.

 

[sammmy]

Applying to testicles leads to fast and increased absorption. At least in your case, it seems that the thin testicular skin is NOT acting like a long term reservoir like the skin in upper trunk or shoulders. How long have you been doing that and do you wash the previous cream before applying the new one? Testicles have very small surface area to be used as a reservoir.

 

[Systemlord]

it had been close to 22 hrs since prior AM application (meaning I applied the prior AM, then had an AM draw the next morning).

I understand you’re doing great, but any reason why you’re not dosing twice daily?

 

[SkiDaddy]

Most Doctors who prescribe Cream suggest getting tested 5 hours after application.

 

[wannabefan]

You measured your lower level before application in the morning. After you apply it, probably your testosterone spikes a lot, so your average level is somewhere in the middle. The fact that your LH is suppressed means that you do have external testosterone circulating.

Update on Labs:

DHT before T cream:

36

DHT after, lab at same time T measured:

95

So if the issue is trough was measured for Testosterone, is it not same for DHT?1

Or, am I over converting T too much to DHT, which is irreversible?

 

[wannabefan]

I understand you’re doing great, but any reason why you’re not dosing twice daily?

Actually, I feel good, but am concerned about numbers, meaning T levels 35%-45% lower than pre-treatment and DHT is 2.5X higher, while Estradiol and SHBG are very similar. The conversion to DHT is irreversible. Do DHT levels vary throughout the day like T, which people here are saying I captured a trough lab draw?

 

[wannabefan]

I understand you’re doing great, but any reason why you’re not dosing twice daily?

Doc said once in AM.

 

[Systemlord]

Doc said once in AM.

Due to the very short half-life of topicals and orals, the fast rise and fall of hormones, twice daily dosing is optimal to keep hormone levels more consistent.

I dose Jatenzo twice daily which has a very similar half-life of topical T.

As far as your numbers being low, you tested at the WRONG time. You never test at trough when using topicals or orals because you’ll always get a very low value, even if you jack to the dosage up many times over.

If your doctor told you to test at trough, then that would suggest your doctor is inept.

 

[wannabefan]

Due to the very short half-life of topicals and orals, the fast rise and fall of hormones, twice daily dosing is optimal to keep hormone levels more consistent.

I dose Jatenzo twice daily which has a very similar half-life of topical T.

As far as your numbers being low, you tested at the WRONG time. You never test at trough when using topicals or orals because you’ll always get a very low value, even if you jack to the dosage up many times over.

If your doctor told you to test at trough, then that would suggest your doctor is inept.

He did instruct me (looking at written directions here again), to have blood drawn before I applied cream that AM. Would the high DHT (up from 36 to 95) explain the trough issue with Testosterone Total and Free results being well below baseline (T down to 186 form 502)?

 

[Systemlord]

He did instruct me (looking at written directions here again), to have blood drawn before I applied cream that AM.

That’s just wrong! The doctor and the makers of the T cream are clueless. A lot of these ivy league people that write the labels for testosterone products are operating on very little knowledge pertaining to the optimal lab timing and in some cases dosing frequency.

Your low labs values and treatment being a success story should tell you something is off!

Your doctor is only good for the script of T cream, you can’t really trust anything your doctors tells you, because now you know he/she isn’t up to date on hormone therapies.

Welcome to the world of TRT, where few doctors actually know what they’re doing.

• For a topical hormone cream or gel applied once daily, testing should be done approximately 12 hours after the last application.
• If the topical cream or gel is used twice a day or every 12 hours, testing should be done approximately 6 hours after the last application.
• For oral Slow Release compounded capsules, testing should be done 4 to 8 hours after the last dose.

Interpretation of Hormone Testing - It's All in the Timing

With exogenous administration of hormones, the timing between hormone testing samples & prior therapy dose must be considered when results are interpreted.

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