Newbie confused by prescription, help please
- Thread starter JimBob
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M
MarkM
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How large is your testosterone cream dispenser? I am assuming it is in a dispenser since you state it is a crea. Is the dispenser 30 ml? It should tell you on the side of the dispenser how much to dispense by how much/far you turn the top. Normally these are in 1/4 turn increments.
But no, you are no applying 400 mg per day.
But no, you are no applying 400 mg per day.
T
tareload
Guest
See my comments on T-Nation post. Welcome to the wonderful world of "TRT" or just good ole TRT in Rouzier's book. Make sure you watch his hand-waving video on erythrocytosis so in case your Hct shoots up (I hope it doesn't) you can feel comfortable that elevated Hct is just fine.
M
MarkM
Guest
Okay, let's work through this. Using testosterones creams and gels is not the same as injecting testosterone. I am not sure what the absorption percentage is on cream. It may be similar to gels. Androgel published an absorption percentage of 10% and Testim gel is 13%. If you use 100 mg a day of Androgel you are only actually getting 10 mg per day being absorbed by the body. With Testim it would be 13 mg per day.
So using Androgel absorption and 400 mg per day you would essentially be getting 40 mg of testosterone being absorbed by the body per day. With Testim it would be 53 mg per day. I would think the absorption of cream would be even higher especially if being put on the scrotum. Those are realty big number numbers.
As for me, I inject testosterone cypionate daily. I inject 24 mg per day which by most peoples standard is probably a high mg. Many injecting daily are injecting between 8 mg and 16 mg per day.
I would be curious as to what the absorption percentage is on the cream you are being prescribed. That would help you know what the true amount of testosterone is being absorbed by the body.
I am sure their are members using the testosterone cream that are much more knowledgeable than me. I used the gel, Androgel and Testim, for many, many years before injecting so I have a very good understanding of that relationship.
Systemlord
Member
You can't compare topical dosing with injectable T dosing, with injections 100% is absorbed while far less of the topical is absorbed.
I might add the half-life differences are hugely different, one measured in days and the other in hours.
T
tareload
Guest
Sure you can compare them once you understand the PK parameters which can be gleaned from using a 1-compartment model and you can throw in absorption along with elimination to fit experimental data:
forums.t-nation.com
forums.t-nation.com
Follow up with bloodwork for your peak/trough and voila you can estimate pretty accurately for either injections or creams.
Is This Prescription Nuts?
https://onlinelibrary.wiley.com/doi/full/10.1111/andr.12357 https://onlinelibrary.wiley.com/action/downloadFigures?id=andr12357-fig-0001&doi=10.1111%2Fandr.12357 Is it nuts? Depends on your goal. Applied to the scrotum you will likely be running much higher than true TRT replacement levels...
forums.t-nation.com
Is This Prescription Nuts?
Here’s more info if you’d like: In this paradigm they aren’t putting you back at replacement levels so not much care about peak/trough with your baseline. There seems to be this gulf between in network care where you are lucky to walk out with any T script and cash pay Docs that will put you...
forums.t-nation.com
Follow up with bloodwork for your peak/trough and voila you can estimate pretty accurately for either injections or creams.
I don't want to hijack this thread, so hopefully these comments and questions will be beneficial.
I have had some serious roller coaster rides on cream a few times. I vow not to try it again, only to grow curious and try it all over. However, I have been somewhat methodical about my approach and I have kept a log detailing how much I am using, where it's applied and how I respond to it. Looking at my log over the last months, I have tried cream a number of times, but with every attempt, I was applying at least some to the scrotum. But, it appears that I have not done exclusively trunk or arm application, and this might be significant.
@Cataceous has posted information on the average amount of testosterone a healthy male makes per day (can't remember the number, but it's single digits in mg). In theory, we should replace 7-10mg per day (roughly). The package insert for Androgel states the various strengths (5G, 7.5G and 10G) have 50mg, 75mg and 100mg of testosterone, respectively. They further state that about 10% of the applied testosterone is absorbed. Therefore, the patient is getting 5mg, 7.5mg or 10mg per day of testosterone.
This begs the question: Why are compounding pharmacies making creams that are twice as concentrated as Androgel, if Androgel's absorption numbers are accurate? The concept of scrotal application makes this even more confusing.
Several here reference an article published in Andrology that demonstrates an estimated 8-fold increase in absorption of cream when applied to the scrotum compared to other areas. Admittedly, I am not sure if this is a calculated estimate or a direct measurement. That said, if this is true, wouldn't that suggest that with scrotal application, you would absorb 8x5 (40), 8x7.5 (60) and 8x10 (100)mg respectively? That's up to ten times what you are trying to replace. And, this is not considering a hydrogel carrier, which supposedly improves absorption even further (I don't think that study used hydrogel, but can't confirm with certainty).
Someone smarter than me please tell me, are my numbers correct? Even if some assumptions are not totally accurate, numbers even remotely close to being that high would explain why I got so over the top every time I tried cream. Maybe I need to simply apply 75mg to the shoulders to get my 7.5mg and call it a day?!?!
I have had some serious roller coaster rides on cream a few times. I vow not to try it again, only to grow curious and try it all over. However, I have been somewhat methodical about my approach and I have kept a log detailing how much I am using, where it's applied and how I respond to it. Looking at my log over the last months, I have tried cream a number of times, but with every attempt, I was applying at least some to the scrotum. But, it appears that I have not done exclusively trunk or arm application, and this might be significant.
@Cataceous has posted information on the average amount of testosterone a healthy male makes per day (can't remember the number, but it's single digits in mg). In theory, we should replace 7-10mg per day (roughly). The package insert for Androgel states the various strengths (5G, 7.5G and 10G) have 50mg, 75mg and 100mg of testosterone, respectively. They further state that about 10% of the applied testosterone is absorbed. Therefore, the patient is getting 5mg, 7.5mg or 10mg per day of testosterone.
This begs the question: Why are compounding pharmacies making creams that are twice as concentrated as Androgel, if Androgel's absorption numbers are accurate? The concept of scrotal application makes this even more confusing.
Several here reference an article published in Andrology that demonstrates an estimated 8-fold increase in absorption of cream when applied to the scrotum compared to other areas. Admittedly, I am not sure if this is a calculated estimate or a direct measurement. That said, if this is true, wouldn't that suggest that with scrotal application, you would absorb 8x5 (40), 8x7.5 (60) and 8x10 (100)mg respectively? That's up to ten times what you are trying to replace. And, this is not considering a hydrogel carrier, which supposedly improves absorption even further (I don't think that study used hydrogel, but can't confirm with certainty).
Someone smarter than me please tell me, are my numbers correct? Even if some assumptions are not totally accurate, numbers even remotely close to being that high would explain why I got so over the top every time I tried cream. Maybe I need to simply apply 75mg to the shoulders to get my 7.5mg and call it a day?!?!
T
tareload
Guest
Correct in qualitative if not completely quantitative way. If you go to the thread I linked above the OP even states the Provider is shooting for 1500-2000 ng/dl TT (he actually provided a copy of the Provider notes) right off the bat. The PK data linked in that thread implies T absorption is not linear with dose and falls off slightly as you go to higher dosages.
Nevertheless, your point is clear and these creams are compounded this way obviously to mimimize the cream applied per application for Providers who like to do "TRT" instead of TRT.
Behold! Doesn't everyone win with the Rouzier/Keith Nichols "TRT" experience? No tradeoffs, just run your TT high.
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This is good stuff. I need to dig into these graphics a bit. Do you mind giving context? Where is the dosing strategy graph from? All I can glean from it is that there is significant variation in serum testosterone from peak to trough and that the delta is reduced by dosing twice a day. That said, I don’t know what dose this is looking at, how many subjects, etc.
I am ok with fluctuations (I have used Natesto for a long time, which is supposed to have significant changes over a short period of time). My goal is to run physiologic, not supraphysiologic, without an unpleasant roller coaster ride, in a convenient way without significant side effects. Isn’t that what everyone wants??!! In any case, I am still exploring whether or not cream can do this. Thus far, although I have not gotten levels drawn on cream, I can tell I have been way overboard on doses that are very typical in the TRT community.
T
tareload
Guest
Estimate of OP's TT profile on the rough Rx he was given. 1 compartment model with absorption (assume 1 hr half life) and elimination (10 hr half life) and estimating volume of distribution from literature data above. From that you can get rough PK profile for a given dosing regimen (and if you have your data you can create your own model).
Is This Prescription Nuts?
Here’s more info if you’d like: In this paradigm they aren’t putting you back at replacement levels so not much care about peak/trough with your baseline. There seems to be this gulf between in network care where you are lucky to walk out with any T script and cash pay Docs that will put you...
forums.t-nation.com
As I shared with OP, as a first approx 25 mg of Test applied to scrotum twice per day or 50 mg of Test once per day should get you there:
You wouldn't have the nice pulses you get with the Natesto though and that seems to be key to miminize the HPTA negative feedback.
Last edited by a moderator:
I see the reference now. I’ll take a look at the pharmacokinetics.Estimate of OP's TT profile on the rough Rx he was given. 1 compartment model with absorption (assume 1 hr half life) and elimination (10 hr half life) and estimating volume of distribution from literature data above. From that you can get rough PK profile for a given dosing regimen (and if you have your data you can create your own model).
Is This Prescription Nuts?
Here’s more info if you’d like: In this paradigm they aren’t putting you back at replacement levels so not much care about peak/trough with your baseline. There seems to be this gulf between in network care where you are lucky to walk out with any T script and cash pay Docs that will put you...
As I shared with OP, as a first approx 25 mg of Test applied to scrotum twice per day or 50 mg of Test once per day should get you there:
View attachment 16108
You wouldn't have the nice pulses you get with the Natesto though and that seems to be key to miminize the HPTA negative feedback.
I emailed the nurse about the massive dose she was prescribing. This was her response:
"
Actually that is not a massive amount of testosterone to optimize levels. I actually start low and go up when we do the 6 week follow up.
But if you would feel more comfortable even starting lower you can do the testosterone 1/2 ml twice a day that will give you 200 mg a day.
I have several men that have started where you are and now take about 1000 mg a day. Bio-identical testosterone does not compare to synthetic testosterones like Androgel, Testim, or Fortesta. The bio-identical is identical to the hormones your body produces and does not have the side effects that synthetics have."
So, apparently she considers 400mg daily to be low. Does anyone here know of anyone using 1,000mg per day? I don't know that I believe Rouzier teaches this. I'd need to see some proof.
"
Actually that is not a massive amount of testosterone to optimize levels. I actually start low and go up when we do the 6 week follow up.
But if you would feel more comfortable even starting lower you can do the testosterone 1/2 ml twice a day that will give you 200 mg a day.
I have several men that have started where you are and now take about 1000 mg a day. Bio-identical testosterone does not compare to synthetic testosterones like Androgel, Testim, or Fortesta. The bio-identical is identical to the hormones your body produces and does not have the side effects that synthetics have."
So, apparently she considers 400mg daily to be low. Does anyone here know of anyone using 1,000mg per day? I don't know that I believe Rouzier teaches this. I'd need to see some proof.
Her advice and rationale are insane, in my opinion. Those doses are ridiculous. I would not follow her advice. I would find a new provider.
T
tareload
Guest
From one of Nichol's big fans (or used to be):
jayccampbell.com
150 - 200 mg Test via cream twice daily for that optimal feeling.
Testosterone Cream Vs Injections: Which is More Effective?
Is trans-scrotal testosterone cream a superior way of administering testosterone compared to intramuscular injections? Find out!
jayccampbell.com
150 - 200 mg Test via cream twice daily for that optimal feeling.
Jay Campbell is still a close friend and big fan of Dr Nichols. He mentions him on just about every podcast he does on testosterone including the most recent with Dr Anthony Jay (who is also a big supporter of Dr Nichols) concerning gynecomastia.From one of Nichol's big fans (or used to be):
Testosterone Cream Vs Injections: Which is More Effective?
Is trans-scrotal testosterone cream a superior way of administering testosterone compared to intramuscular injections? Find out!
150 - 200 mg Test via cream twice daily for that optimal feeling.
Dr Nichols typically starts men on 2 clicks (100mg) twice per day and adjust dosage based on symptoms and levels (free T). He has a few on 4 clicks 2x per day but anything more than that is cost prohibitive and instructs patients they would be better off doing injections. Nichols is the one that brought scrotal application to the forefront and probably has more experience with it than anyone. He prescribes injections or cream for patients. Daily application of either is ideal in his medical opinion. Dr Nichols does not have anyone on more than 4 clicks twice per day.
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