New to TRT - First Protocol Results

[Kanoa]

New to posting but have been reading here for a while. 28 years old.

I got my blood checked earlier this year as I have been getting persistent lack of motivation, depression, anxiety, brain fog, unable to focus, memory problems, low libido etc. Worst ones being probably lack of "drive" and motivation. It sucks and is impacting my life.

Looking through the lens of long term commitment to feeling better, I chose hormone optimization before anti-depressants and things like Adderall. I am very active, workout 5 days a week, hike in the summer and snowboard in the winter. I feel like it's a chore to do the things I enjoy and have to force myself to do it most of the time. I never used to be like this about 5-7 years ago.

Pre-Labs
Total: 374 ng/dl (264-916)
Free: 16.2 pg/ml (9.3-26.5)
Estradiol: 16.8 pg/ml (7.6-42.6)

My doctor is a GP who used to work at and manage a hormone clinic. All of my other markers on the Life Extension full male panel came back stellar. On paper, outside of the T levels, I am a very healthy individual. He offered to put me on compounded cream.

Based on browsing forums and researching, I was wanting to just get on injections. After my doctor suggested creams I figured I would give cream a shot as it is not as invasive and it works for some men. He mentioned how he has other patients who wanted off injections for cream. The whole idea of following the body's natural cycle seemed to make sense to me as well.

The concentration is 250mg/ml (25%). Dosage was .2ml or 2 clicks once in the am. Have been doing this for 3 months and just got my next set of labs done.

Checkup Labs
Total: 379 ng/dl (264-916)
Free: 18 pg/ml (9.3-26.5)
Estradiol: < 5 pg/ml (7.6-42.6)

As a note, I asked why he didn't want me to test SHBG. Doc said he felt comfortable enough moving forward on what he was seeing but said we can definitely check if I want.

I was surprised to see no change. Bloods were drawn in the AM, 2 hours after applying cream.
I was expecting some sort of noticeable difference 3 months in and didn't get one. I am 100% sure I am applying it correctly to the back of my knee. I also feel the low estradiol symptoms. Overall feeling depressed still, lack of drive, brain fog, memory problems, etc. Maybe even worse than when I started.

Lab error might be a possibility on the second test, but overall my doctor agreed it is too low and needs to come up. It is worth mentioning the E2 was not taken with the sensitive test. Is it generally accepted that the Roche methodology measures high? Would it be beneficial for me to get a sensitive if that's the case?

Met with him today and said he is upping the dose to .6ml of the same 250mg/ml (25%) cream which is just over 1ml. So 6 clicks per day, in the am. He said I should be able to notice a "drive"/motivation this time around. E2 should raised as a result too. I feel this dose should be split into 2x per day but will try 1x per day.

Should I expect to see much of a difference upping the dose? How do you all feel about my dosing? I feel my original dose should have at least done something and to be honest I am not feeling the most confident about this new protocol.

Thoughts and insight are appreciated! Thank you!

 

[S1W]

If I'm reading this correctly, you said your dose was 0.2ml of a 250 mg/ml cream. Doesn't that equate to 50mg/day? If so, I agree that your dose needs to be increased.

However, I guess I'm confused by the clicks and cream strength as presented. With a standard topi-click dispenser, each click should dispense 0.25ml. So two clicks of 250 mg/ml cream should be giving you 125 mg/day. That should be enough to notice a difference.

250 mg/ml is an odd strength for a compounded cream - most creams are 200 mg/ml, and some are lower. I had heard that 200 mg/ml was the maximum concentration before absorption issues may be encountered...though I'm far from a pharmacist.

Regardless, and assuming you're using a topi-click which dispenses 0.25ml per click, I would recommend 2 clicks in the AM applied to the scrotum, then 1 click in the PM applied to the inner forearm/inner wrist. Just do it and see how you feel - you don't need to tell your doctor that you're changing up time of day/application sites. If you feel it's working for you, then tell him that's what you've been doing and it is working well and you'd like to continue doing it.

 

[Vince]

Would it just be easier to do injections twice a week along with hCG? It would also save you money. Most members here inject them selves and use an easy touch syringes.

 

[Kanoa]

If I'm reading this correctly, you said your dose was 0.2ml of a 250 mg/ml cream. Doesn't that equate to 50mg/day? If so, I agree that your dose needs to be increased.

However, I guess I'm confused by the clicks and cream strength as presented. With a standard topi-click dispenser, each click should dispense 0.25ml. So two clicks of 250 mg/ml cream should be giving you 125 mg/day. That should be enough to notice a difference.

250 mg/ml is an odd strength for a compounded cream - most creams are 200 mg/ml, and some are lower. I had heard that 200 mg/ml was the maximum concentration before absorption issues may be encountered...though I'm far from a pharmacist.

Regardless, and assuming you're using a topi-click which dispenses 0.25ml per click, I would recommend 2 clicks in the AM applied to the scrotum, then 1 click in the PM applied to the inner forearm/inner wrist. Just do it and see how you feel - you don't need to tell your doctor that you're changing up time of day/application sites. If you feel it's working for you, then tell him that's what you've been doing and it is working well and you'd like to continue doing it.

Yes, I was doing 50mg per day.

After a quick Google search I discovered that I do not have a Topi-Click dispenser. Mine is a 3ml PreciseDose Dispenser - basically a syringe. So my new instructions from doc are to use .6ml which comes out to 150mg per day. I too, cannot speak for the cream's concentration. My doc has a specific compounding pharmacy he uses because he says they are the only ones who make it right. I trust his judgement.

Yesterday I started 100mg scrotally in the AM and 50mg scrotally in the PM.

Would it just be easier to do injections twice a week along with hCG? It would also save you money. Most members here inject them selves and use an easy touch syringes.

I think it definitely would be easier to inject 2x per week. In terms of money, my cream supply was $160 for 100 days. I think $50 a month is great. If injectables are cheaper, that's great too.

I want to give the cream an honest shot. But I do see potential lifestyle issues with it (namely sex with the girlfriend) and it is just kind of annoying to apply 2x per day.

Do either of you think that 50mg a day should have raised my levels more than it did? This was with back of the knee application. Seems to me like I don't absorb well there.. I think if I can show my doc that scrotal application is the only way for me to achieve optimal levels and how that is not a good fit, he will be ok with me getting injections. Seems like he is trying to "protect" me from it since he has other patients who the cream works with, who also switched from injections.

Should I notice a difference in bloodwork 2 weeks into new dosage? Doc has me down for Feb 3 for a consult and I don't want to wait that long to see if what I am doing is working.

Thanks for the responses.

 

[S1W]

Yes, I was doing 50mg per day.

After a quick Google search I discovered that I do not have a Topi-Click dispenser. Mine is a 3ml PreciseDose Dispenser - basically a syringe. So my new instructions from doc are to use .6ml which comes out to 150mg per day. I too, cannot speak for the cream's concentration. My doc has a specific compounding pharmacy he uses because he says they are the only ones who make it right. I trust his judgement.

Yesterday I started 100mg scrotally in the AM and 50mg scrotally in the PM.



I think it definitely would be easier to inject 2x per week. In terms of money, my cream supply was $160 for 100 days. I think $50 a month is great. If injectables are cheaper, that's great too.

I want to give the cream an honest shot. But I do see potential lifestyle issues with it (namely sex with the girlfriend) and it is just kind of annoying to apply 2x per day.

Do either of you think that 50mg a day should have raised my levels more than it did? This was with back of the knee application. Seems to me like I don't absorb well there.. I think if I can show my doc that scrotal application is the only way for me to achieve optimal levels and how that is not a good fit, he will be ok with me getting injections. Seems like he is trying to "protect" me from it since he has other patients who the cream works with, who also switched from injections.

Should I notice a difference in bloodwork 2 weeks into new dosage? Doc has me down for Feb 3 for a consult and I don't want to wait that long to see if what I am doing is working.

Thanks for the responses.

I guess I can't honestly speak to what 50mg/day of cream should do since I've never dosed that low and don't recall seeing anyone here who did either. Your results do not surprise me though considering the dose.

I now understand the method of dosing you are using. My first TRT prescription was for cream and I also used a dosing syringe. I have since used Topi-Clicks and can say that they make it way easier. One thing you'll want to be aware of while using the dosing syringe is to draw way more cream into the syringe than you need, then slowly inject it back in til you get to your dose marking. It's easy to get big air bubbles in the syringe and because of the opacity of the cream, it can look like you have a properly measured dose when in fact it might be half air.

The pharmacy your doc is using likely can give you Topi-Clicks, too. After months of fussing with dosing syringes, I asked my small local pharmacy if they had Topi-Clicks and they said "Yeah, but they cost a little more". The money was not an issue lol.

As a side note, I would say go into this optimistically - injections are definitely more popular, but I managed to feel very good on the cream and still think it was one of the better overall protocols I've had.

It is very likely that you would see some changes to your blood work in 2 weeks, but it may/may not be indicative of where you would land with this protocol long-term. Additionally, blood work without subjective notes on how you have been feeling is not very useful and two weeks isn't enough time to evaluate that. Don't fall into the trap of feeling like blood work is some kind of report card and that you're trying to get good grades. Instead, focus on how you've been consistently feeling before you get the blood work, then use the blood work as some sort of metric for where you feel good. The lab numbers where people thrive are wildly different for everyone.

With that, I'd say skip the blood work in 2 weeks, save your money and time, be consistent with your new dosing, and just do the blood draw that would be required for your next appointment. Take notes about how you have been feeling before your get your blood work done. Those notes may be useful down the road.

 

[Kanoa]

I guess I can't honestly speak to what 50mg/day of cream should do since I've never dosed that low and don't recall seeing anyone here who did either. Your results do not surprise me though considering the dose.

I now understand the method of dosing you are using. My first TRT prescription was for cream and I also used a dosing syringe. I have since used Topi-Clicks and can say that they make it way easier. One thing you'll want to be aware of while using the dosing syringe is to draw way more cream into the syringe than you need, then slowly inject it back in til you get to your dose marking. It's easy to get big air bubbles in the syringe and because of the opacity of the cream, it can look like you have a properly measured dose when in fact it might be half air.

The pharmacy your doc is using likely can give you Topi-Clicks, too. After months of fussing with dosing syringes, I asked my small local pharmacy if they had Topi-Clicks and they said "Yeah, but they cost a little more". The money was not an issue lol.

As a side note, I would say go into this optimistically - injections are definitely more popular, but I managed to feel very good on the cream and still think it was one of the better overall protocols I've had.

It is very likely that you would see some changes to your blood work in 2 weeks, but it may/may not be indicative of where you would land with this protocol long-term. Additionally, blood work without subjective notes on how you have been feeling is not very useful and two weeks isn't enough time to evaluate that. Don't fall into the trap of feeling like blood work is some kind of report card and that you're trying to get good grades. Instead, focus on how you've been consistently feeling before you get the blood work, then use the blood work as some sort of metric for where you feel good. The lab numbers where people thrive are wildly different for everyone.

With that, I'd say skip the blood work in 2 weeks, save your money and time, be consistent with your new dosing, and just do the blood draw that would be required for your next appointment. Take notes about how you have been feeling before your get your blood work done. Those notes may be useful down the road.

My pharmacy gave me all of the syringes pre-loaded. Visual inspection shows the cream is packed in there nicely and is quite literally perfect. I just pop the cap off and dose, it's really easy.

I truly am optimistic! I've read many reports here, on Reddit and in some FB groups of men having great results with the cream. Specifically the higher DHT I hear makes you feel awesome and you don't really get that on injections. Like I said I am committed to making it work before deciding if injections are what I want.

In regards to the bloodwork, thanks for the insight on the long term settling level likely being different. That makes sense as I would assume the body takes time to balance out over a period of a few months.

My thought process with getting in done in 2 weeks is to simply see if the cream is being absorbed and working into my system. I guess I just have a fear of my cream not being dosed properly, I don't absorb well, etc. and prolonging feeling the symptoms I have, even if by only a couple of months.

I have been taking daily inventory on how I feel since upping my dose & applying scrotally. I 100% agree that I am more focused on how I feel than what my "number" is. No sense in hitting a number if I still feel bad there. How I feel is what started this journey for me - I have taken great care of myself and for being 28 years old I think I should feel much better than I do.

Thank you for your time and advice so far, S1W! I will report back here as things unfold and progress.

 

[Fortunate]

Waking this thread back up to query readers about using a dosing syringe. I have the Empower topi-click for 200mg/ml cream. I am one of the rare people in whom cream may absorb too well, if that's possible. I feel can "over the top", even with 50mg once a day.

I would like to try to re-introduce cream, but at even lower doses. The simple solution is to have the pharmacy make a lower dose cream and use the topi-click. But, I already paid for what I have, so I managed to transfer some cream into a 1cc syringe. It was a messy business and I lost a lot of cream in the process.

I am thinking of asking if the pharmacy can preload the cream into small syringes. Alternatively, I can get a new Rx for a lower dose and keep using the topi-click.

Would love feedback. Has anyone else used pre-filled syringes?