Seeking advice re "tapering down" (or countering Dr's lowering of doses)

[drewnLA]

I've used topical testo gels for more than 20 years, and have maintained a muscular strong body (with actual abs showing) up to age 62 thus far. My currently used product is an Upsher-Smith Testo Gel which delivers 12.5 mg/pump. I have already "tapered down" from 2 pumps per night to 1 per night, about 8 mos ago. My NEW endocrin. MD, after seeing test results on Total T and free T on the reduced 1 pump/night regimen, stated he believed I did not need to supplement at all... That I should taper down to no topical usage. When I remarked that a previous instance of going off the topical yielded a kind of depression (when total T dropped below 400), he said that the feeling had "nothing to do" with low T...

The new MD has so far limited my RX refills so that I am down to a theoretical "half a pump" per night...(which is technically a little difficult to judge/measure of course). It occurred to me a few nights ago that I could probably maintain 4 full pumps a week (1 pump each of 4 nights) on the more limited refill supply, and in my layman's ignorance have started favoring the night following a gym workout and the very next night (my resistance training in gym is twice per week). So, for instance, I dose with full pump on Mon., full pump on Tue., skip Wed, then full pump again Thu & Fri, then skip Sat. & Sun. (Mon. & Thur. being the workout days.)

So, any expert comments on "tapering down" by just NOT using the gel 3 nights a week, to stay within my allotted RX supply?

I am also considering just shopping for a better endocrinologist, one covered by blue cross anthem PPO preferably. Do you Know a more sympathetic sports med type endocr MD in Los Angeles, anyone?

 

[madman]

[QUOTE="drewnLA, post: 159379, member: 39459"]I've used topical testo gels for more than 20 years, and have maintained a muscular strong body (with actual abs showing) up to age 62 thus far. .My currently used product is an Upsher-Smith Testo Gel which delivers 12.5 mg/pump. I have already "tapered down" from 2 pumps per night to 1 per night, about 8 mos ago. My NEW endocrin. MD, after seeing test results on Total T and free T on the reduced 1 pump/night regimen, stated he believed I did not need to supplement at all... That I should taper down to no topical usage. When I remarked that a previous instance of going off the topical yielded a kind of depression (when total T dropped below 400), he said that the feeling had "nothing to do" with low T...

The new MD has so far limited my RX refills so that I am down to a theoretical "half a pump" per night...(which is technically a little difficult to judge/measure of course). It occurred to me a few nights ago that I could probably maintain 4 full pumps a week (1 pump each of 4 nights) on the more limited refill supply, and in my layman's ignorance have started favoring the night following a gym workout and the very next night (my resistance training in gym is twice per week). So, for instance, I dose with full pump on Mon., full pump on Tue., skip Wed, then full pump again Thu & Fri, then skip Sat. & Sun. (Mon. & Thur. being the workout days.)

So, any expert comments on "tapering down" by just NOT using the gel 3 nights a week, to stay within my allotted RX supply?

I am also considering just shopping for a better endocrinologist, one covered by blue cross anthem PPO preferably. Do you Know a more sympathetic sports med type endocr MD in Los Angeles, anyone?[/QUOTE]




No disrespect but you need to find a new doctor as trt is not only about numbers but most importantly treating symptoms.

What level of TT is needed to allow one to achieve a healthy FT level which will result in relief/improvement of low-t symptoms/improve overall well being.

You stated that you had been using 2 pumps per night and have recently tapered down to 1 pump per night.

Where did your TT/FT/E2.....let alone hemoglobin/hematocrit levels sit on 2 pump per night protocol.....do you have labs to post?

You stated that as of 8 months ago you reduced the dose to one pump per night and now because of where your most recent labs result regarding your TT/FT levels.....your new endo has told you to taper down and stop using the T gel as he believes you do not need to be on trt.

This is ridiculous as first off you clearly felt great on the first protocol (2 pumps per night) although we have no idea where your TT/FT/E2 levels sat and why you reduced the dose to 1 pump is beyond me as you did not say why and only mention that due to your most recent labs showing where your TT/FT levels sit on the most recent protocol (1 pump per night) that your new endo told you he wants you to stop trt as he thinks you do not need it.....again we have no idea where your TT/FT levels sit on the once per night protocol as you did not post labs.

Regardless you clearly felt great on the 2 pump per night protocol and most likely the 1 pump per night protocol ( as you had reduced to this dose 8 months ago).

Mind you it is hard to believe you achieved a healthy TT/FT level using 2 pumps.....let alone one pump per night as the strength of your gel is low "My currently used product is an Upsher-Smith Testo Gel which delivers 12.5 mg/pump"



2.1 Dosing and Dose Adjustment

The recommended starting dose of Vogelxo is 50 mg of testosterone (one tube, one packet, or 4 pump actuations) applied topically once daily at approximately the same time each day to clean, dry intact skin of the shoulders and/or upper arms.




Dose Adjustment

To ensure proper dosing, serum testosterone concentrations should be measured. Morning, predose serum testosterone concentrations should be measured approximately 14 days after initiation of therapy to ensure proper serum testosterone concentrations are achieved. If the serum testosterone concentration is below the normal range (300 ng/dL to 1,000 ng/dL), the daily Vogelxo dose may be increased from 50 mg testosterone (one tube, one packet, or 4 pump actuations) to 100 mg of testosterone (two tubes, two packets, or 8 pump actuations) once daily. The maximum recommended dose of Vogelxo is 100 mg once daily.





• Recommended starting dose for adult males: 50 mg of testosterone (one tube or one packet or 4 pump actuations) applied topically once daily at approximately the same time each day. (2.1)

• Apply to clean, dry, intact skin of the shoulders and/or upper arms. Do not apply Vogelxo to the genitals or abdomen. (2.1, 2.2)

• If morning pre-dose serum testosterone concentration is below the normal range, increase dose to 100 mg. (2.1) • Pre-dose serum testosterone concentration should be assessed periodically. (2.1)




Also why are you applying the gel before bed as it needs to be applied once daily and in the morning.....let alone blood work needs to be done at the proper timing!


You need to post lab work for your previous protocol (2 pumps before bed) and most recent protocol (1 pump before bed).....let alone pre-trt labs so we can truly see where your TT/FT/E2 levels sat pre-trt and where it ended up on such protocols (2 pump/1 pump application).


Forget tapering or only using 4 days per week as transdermals need to be applied daily at the same time in order to achieve/maintain healthy TT/FT levels let alone benefit from trt!


Find a NEW doctor as this is ridiculous.....your health and well being are what matters not whether some doctor thinks your testosterone levels may be too high or questioning if you really need to be on trt!

 

[madman]

Multiple Dose With single daily applications of testosterone gel 50 mg and 100 mg, follow-up measurements at 30 and 90 days after starting treatment have confirmed that serum testosterone and DHT concentrations are generally maintained within the normal range.
Figure 1 summarizes the 24-hour pharmacokinetic profile of testosterone for patients maintained on testosterone gel 50 mg or testosterone gel 100 mg for 30 days.

 

[drewnLA]

Dear Madman, I am grateful that someone at last responded to my question.

When I feel out a new dr, using the helpful HCG dr list on the site, shall I simply phone up and ask if they are indeed sympathetic to TRT for "normal" males in early 60's perhaps? Or shall I even ask if they are aware of the Excelmale site and that someone suggested they are a helpful dr. on this site?

More background. *Something else* happened between my testing on the 2 pumps/nite protocol and my testing on the 1 pump/nite. I retired (early) and devoted myself in true OCD fashion--which comes naturally--to an intermittent fasting and Keto diet regimen, starting in May 1, 2019. By the time of my latest hormone blood draw testing, June 28, I had lost inches and lbs, including modestly some muscle but-- most importantly-- visceral fat. (So the new diet was followed simult. with continuing the 1 pump/nite TRT regimen started in Jan. 2019)

THEN: My numbers in the OLD pre-Keto/double pump era tended to around 650 to 800 ng/dL for testosterone. Estradiol, meanwhile, had been out in the stratosphere, around 80 or higher, for more than a decade previous. My old Kaiser endocr MD had never tested for free T, so I don't know about that number... (Also, I recite Kaiser #'s from memory; I have them in paper only *somewhere*). I took exemestane and the cheaper anastrozole twice per week for the elevated e, for years.

MORE RECENT: My reaction to the test results in the post-Keto/single pump new era was initially that "my results must've got mixed up with someone else's in the lab". The estradiol was slightly below ideal, 18 (where < 39 pg/mL is considered normal) for the first time ever... And my testosterone, despite the halving of my gel applications, showed a slightly upward value, to 920 ng/dL. The free T value was 58.3 (for which I've no historical contrast due to Kaiser deficiencies).

So I remain astounded that a little change in body composition made a huge difference in hormones. I believe I understand that visceral fat has a role in generating estradiol in men. Didn't know T could "naturally" improve due to fat loss though...

One could get a fluke-ish set of blood results, of course, right? And maybe it would be good to get new results now that I've moderated the miracle diet a bit.

( I have ENJOYED coming off exemestane and anastrozole. Bad side effects all along. I abandoned these oral RX's once I got the late June test results.)

Is there another thread--or formal study-- I should read now that I'm SWERVING OFF into a new sub-topic?

 

[drewnLA]

RE use of gel in the pm before bed. This had been my practice for yrs and yrs. Use in the am at a consistent time was problematic because I bathed/showered at unpredictable intervals. The only time I knew I wouldn't be counteracting application somewhat by bathing was just before bed (allowing time to dry). And it lent me a contented feeling...

 

[Systemlord]

Your doctors suggestion that you don't need TRT is shown to be false for the fact you say you feel worse since tapering down on the dosages.

I fail to understand why your doctor believes you don't need TRT, I would love to hear his reasoning. There is a lot of stigma in western medicine with regards to TRT, which is strange considering it prevents and treats the diseases of aging.

It almost seems like these healthcare institutions don't want us too healthy and are creating a consumer of health problems for the future. If we become too healthy these healthcare providers stand to lose.

Just look at the wonderful job they are doing, look around at how unhealthy the adult populations are and is seems like they want to keep us in a diseased state using reference ranges that are normal but far from healthy.

I wouldn't want this doctor incharged of my health.