I was prescribed a course of AndroGel by my doctor and I distinctly remember him saying that the most efficient absorption occurs if you apply it to the scrotom. Interestingly enough when I was reading the patient guide insert from the box, it warns that it's not to be applied to the genitals. Does anyone here have experience with this stuff? Should I go with the patient guide or my doctor??
Follow the patient guide of the medication. Your doctor was wrong about applying androgel to the scrotum. You apply it to your upper arms and the flanks of your torso just as the pictures show you. You would absorb to much testosterone via the scrotum. I was prescribed androgel when I first needed HRT. Now, for expense sake, I have it compounded at a local compounding pharmacy. It is specific to needs and bloodwork.
I have read if applied to the genitals you will have less of the absorbed Testosterone converted via aromotase to estrogen. If estrogen is too high it can cause loss of libido and is suspected of other health problems when too high. This could be why his Dr specifically said to apply it there. However androgel will burn if applied there. If the Dr really want it applied to the genitals he should prescribe a compounded cream instead.
I was on Androgel for 4 years. Please be aware it will eventually atrophy your testicles and you will essentially be sterile while on it. It causes the pituitary to stop send LH and FSH which the testicles need to produce Testorsterone and sperm so the testicles shut down. Any testosterone replacement will do this. I was not told this and since you didnt mention your age I just thought you should be aware of this. If you might want children again you should investigate using HCG so your testicles do not atrophy.
Thanks for the responses. I requested HRT of my doctor because I did a testosterone test and the my results, while in the normal range, were on the low side for a guy my age. I'm 28, btw, and the total T was around 340. My lab work indicated that other hormones such as estradiol where also in the normal range.
Hayfarmer, your comments were interesting. Does the AndroGel cause permanent changes of the testicles or is just while you are on the stuff? Does the sterility reverse itself when you are off it? I took the liberty of asking my doctor if such effects were possible but he implied they were unlikely. Btw, what is HCG that your refer to?
In any case, I'll stick to what's recommended by the patient guide because of what you guys said.
Hayfarmer has some very good comments. However, in my own experience (I'm in my 60's) my testicles have not atrophied. The reason for my doctor prescribing TRT was because of a heart attack that I had several years. Testosterone is important for a healthy heart. The most sensors for testosterone are found in the heart. My libido before TRT was fine even though I had low numbers in the testosterone department. I had none of the classic symptoms of low T levels. I'm not sure why my levels dropped except for the fact that I had two head injuries (concussions) a few years before the levels were checked.
Incidentally, my compounded testosterone cost $18.25 a month. Androgel was costing me $65 per month after I went on my retirement insurance. I find the cream to be better than the gel. I don't get any skin irritation from the cream but with the gel I did.
In addition, my physcian monitors my T levels several times a year so that the compounding ingredients can be adjusted if need be.
If I were 28 I would ask my doctor if there were an alternative TRT for the androgel or why he/she thinks that my levels are low.
Check with you physician and also do some homework yourself.
Any testosterone replacement will do this [shut down the testicles].
Actually there is a pill that has been available in Canada and Europe for over 20 years, called Andriol. It does not turn off LH and FSH. Andriol does not pass through the liver and so isn't toxic like other testosterone pills. Andriol acts at a higher level than testosterone and so doesn't affect the testicles.
It cost about $1 pill and you usually take 2-4 pills per day. This is often given to older men to supplement their declining testosterone. They can start off at 1 pill a day and work up as they age.
A recent 10 year study showed it was effective and safe in that time period.
I found AndroGel and Andriol to be annoying because you have to take them on a regular basis. If you get up late and don't eat or shower right away, you can't use either product effectively (Andriol must be taken with fatty foods like milk). Since testosterone blood levels depend directly on time of day use, you can't get early morning testostereone rises like you normally would. I tried taking AndroGel at night before bed, but that isn't recommended because it can rub off onto the sheets and get on your partner. I didn't notice any dramatic improvement that I remember.
I'm so glad you are finding this all out now instead of years from now like what happened to me. Here is a quick primer on testosterone replacement. The hypothalmus and pituitary in your brain have receptors that sense how much testosterone you have. If its too low then they are supposed to send out more LH to increase it. If it is too high they send out less LH. If your testosterone is too low and stays low then something is broken and it is called hypogonadism. Primary Hypogonadism is when your LH is high but your testosterone is still low and indicates the testicles are not capable of making enough testosterone. Secondary hypogonadism is when your LH is too low even though your Testosterone is too low. This indicates something wrong with the hypothalmus/pituitary in the brain. Now if you start adding external testosterone into your body (like with androgel) then the hypothalmus/pituitary will sense testosterone is high enough and LH will production will drop. Interestingly FSH will also drop. FSH is the hormone the pituitary puts out to tell the testicles to make sperm. With very low LH and FSH the testicles basically shut down because they are no longer being stimulated. While shut down the testicles will normally shrink in size and become softer in texture. It is possible after a long period of time they will be permanently shut down. How long that is I think is unknown and probably different for each person. Its certainly at least a few months and possibly years so you dont have a concern with this yet.
If your LH and FSH are high now but your T is still low then its likely that androgel will not make you infertile as long as you dont take too much of it. But its also possible youre already infertile if that is the case, I dont know. The problem comes in when LH and FSH get too low while on androgel.
At your age of 28 you Dr should have discussed this with you and he should know that this is likely to happen. If he did not then I highly suggest you find someone who specializes in this. You may find that hard to do. I travel 3 hours to the Dr I finally found who is knowlegeable and interested in treating this the right way. You can try to find an endorcrinologist but even many of them are not up on treating this. They seem to specialize in diabetes and/or thryroid issues mostly. As I said previously I was on androgel for 4 years and my original Dr also did not discuss this with me. It took me a long time to figure this all out. Most Doctors are not interested in doing this correctly. They just want to prescribe Androgel and be done with you.
Now I'm on HCG. HCG (Human Chorionic Gonadotropin) is very similiar to the LH that your body produces naturally. It is a human hormone present in women when they are pregnant. I think there is synthetic HCG available but the natural HCG is derived from the urine of pregnant women. HCG must be injected but it can be done with an insulin syringe that is so fine that you honestly dont even feel it. It is very easy to give it to yourself. HCG is the standard protocol recommended by the American Association of Endocrinologists (I may have the name wrong) for hypogonadism when fertility is also desired to be maintained. I would give you a link to this but I'm not sure if we are allowed to post links.
What you need to determine is why your testosterone is low. By the way 340 is low but not terribly low. I assume you are suffering some symptoms though? Most Dr's probably would not even treat you at 340 (not that I'm agreeing with that) so maybe your Dr would be open to alternative treatments?
This is what my Dr would probably do for you:
1. stop androgel, after 3 days then start taking clomid for one week. At the end of 1 week test for testosterone, LH, and FSH
2. if LH and FSH high but testosterone low then you have primary hypogonadism and the only solution is to take testosterone replacement. In this case you may still be fertile but the replacement will not cause infertility unless you take too much of it causing LH and FSH to drop too low.
3. if LH and FSH are low and testosterone is low then you suffer from secondary hypogonadism and the treatment could be HCG or testosterone replacement. At 28 I would go with HCG so you will stay fertile.
4. if LH and FSH high and testosterone now normal or high then you suffer from secondary hypogonadism but you can be treated with clomid (a pill) due to the type of secondary hypogonadism. The clomid tricks your hypothalmus/pituitary into thinking T is too low causing it to send out more LH. This only works though for some people depending on exactly where the problem lies. For me it did not work.
If you end up on HCG, the amount you get is also important. If you take too much of it, the lyedig cells in your testicles can become desensitized to it and stop responding after a period of time. I started on 500 iu 3 times a week. The key is to be tested several times at the beginning and get your dose adjusted to the smallest amount possible. Its also better to give it more often in smaller doses than one big dose a week. I'd be happy to answer any other questions you have.
It is possible if you are on a small dose of androgel your LH and FSH may remain high enough to continue stimulating your testicles. But my guess is if your dose is that low then your T wont rise anyway because your testicles will make less and wipe out any gain from the andorgel. You did say your other hormones were normal. Can you post your values for LH and FSH? Also did your doctor test your TSH to make sure you dont have hypothyroidism? That is also a common cause of low testosterone. Also, you should probably have your iron levels (ferritin, TIBC, iron, and saturation) tested to make sure you dont have hemochromatosis since that can cause pituitary problems causing low testosterone. I don't want to scare you with the hemochromatosis reference, its unlikely but if you have any european/irish heritage its worth making sure you dont have it anyway.
Sorry I'm not familiar with Andriol but sounds like its worth checking into anyway. Seems to me though that anything that increases the T in your blood is going to reduce the LH your pituitary puts out. By the way the amount of atrophy may vary from person to person. In my case it was so slow it was hard to tell if my testicles were really smaller or if it was my imagination. Whether or not they atropy though you will not be fertile (or at least will have a low sperm count) while on replacement. If you continue on androgel I assume it would be forever so at some point it seems highly likely you would experience atrophy. I should also say, dont count on not being fertile. Your sperm count will drop and may drop a lot but it may not be zero.
Seems to me though that anything that increases the T in your blood is going to reduce the LH your pituitary puts out.
It turns out there are several forms of androgens and only testosterone is used by the body to regulate LH. Andriol produces dihydro-testosterone which is a more potent androgen and to which ordinary testosterone is converted in peripheral tissues. Andriol simply bypasses the testosterone step and adds dihydro directly.
I thought of a couple other things about HCG to post. HCG is normally injected intramuscular which is a long larger needle then an insulin needle. But studies have shown it is just as effective injected subcutaneously (under the skin) with a short insulin needle. Many Dr's may be unaware of this. My doctor has also found anecdotally with his patients this works fine and is much easier to take this way.
The other thing is that the normal protocol for HCG is to give 2000 to 4000 iu once a week. As I said earlier its best to take it more often and in smaller does. 4000 iu a week would probably risk desensitizing the lyedig cells eventually.
Just wanted to get those points in because many Dr's may not be aware of this.
Thanks for writing such an informative post, hayfarmer. I went to my doctor's office today and got a copy of my lab work results. My LH is 4.6 (Range 1.5-9.3 mIU/mL), FSH is 3.4(Range 1.6-8.0 mIU/mL), estradiol <32 (Range <52 pg/mL), and my free testosterone is 69.3. My TSH is 1.57. These values are all located within the normal reference ranges.
Interestingly enough when I look at my lab report, I see there is a value for HCG, SERUM <5.0. The reference range is <5.0 mIU/mL. I am uncertain what this means in relation to what you talked about in your previous post, only that I have enough of it?
I did request TRT of my doctor, to see what life was like on the other side of the fence, so to speak. You're right, my T is low enough for me to notice some characteristics of hypogonadism. I'm tall, I've never been good at sports, and my upper body strength is not that great. My beard grows in very sparse and I have very little upper body hair. Also, I tend to lack self condfidence, and am mildly depressed. I wanted to see if having extra T would improve some of these things.
However, I'll give what you said a lot of consideration, especially the infertility effects of external testosterone. I'm supposed to have my hormones retested after two weeks on the Andro. If the Andro doesn't help or has detremental effects to my system, I'll discuss alternative treatments with my doctor, if any. I think I'll print out your post and have him look it over.
I'm not sure I understand the HCG test you had either. I have read that some tumors secrete HCG including testicular tumors and so they are sometimes measured as a marker for cancer. My guess is since the ref level was < 5 that they were checking you for testicular cancer and a level above 5 would be reason for more testing. But its only a guess.
My post was on a very simple level and was based on what I have learned for myself, not being a doctor. This all gets really complicated by many factors and its hard to go into them without knowing someones particular lab results. In addition I get over my head real fast with the complicating factors even knowing the lab numbers. The only thing that strikes me as odd in your lab numbers is that your LH and FSH are on the low side of normal even though your Testosterone at 340 is also on the low side of normal. Maybe for you, 340 is normal. Most doctors do not supplement until the level is below 200 unless there are a lot of symptoms or the patient requests it and they go along. Since your T is only slightly low maybe there are some other ways to increase it naturally. It might be worth looking into anyway. The good news is you DONT have primary hypogonadism (high LH, low T) so your testicles do work!
If I were in your shoes I would go ahead and give the androgel a try and see if you get the benefits you want. If you get the benefits you want from a higher testosterone level then you can consider what is the best long term approach to raising your T level later.
When you get your numbers tested again watch in particular for your LH and FSH to make sure they do not drop too much. If they do, then you will know that eventually your testicles will shut down and you can decide how to proceed from there. Also, be aware once they do shut down it can be tough when you stop the androgel. You will feel tired and have all the effects of low T until they start up again. HCG can speed up the process if your doc willing to prescribe it for a few weeks during that time.
Maybe you should try lifting weights to gain some upper body strength and gain some self confidence. I can understand why you would want to raise you T level while you try to gain muscle since yours is on the low side. If you are embarrased to go to a gym then get some cheap dumbells for $30 and do it at home. Get a good book on weight lifting and start out slow. I was also weak in upper body strength and started lifting weights while on androgel. I gained a significant amount of muscle and concentrated on my upper body only since I cycle to exercise my lower body. Youre in the prime of your life at 28. Take advantage of it.
A couple other things to note. Since you mention depression, I have heard that many anti depression drugs can have sexual side effects. I dont know if youre taking any or not but if you are it could be the real cause of anything going on there. Also, from my experience with androgel I got the best absorption when I put it on totally dry skin. The instructions say to use it after a shower. Well you dont want to use it right before you shower of course, but I found it absorbed better several hours after a shower and not right after one. Also it seemed to absorb better if it was warm. In the winter I would put the packets in my pocket for a few minutes. If you use the pump you cant really do that but let it sit in the palm of your hand for a few seconds and you will notice it get more watery. Then apply it.
Be prepared if you show my post to your doctor. I asked one of my first doctors about clomid and HCG after reading about them on the internet. He just dismissed it and said there was no evidence it worked. In my opinion he was wrong but what you will find is a lot of doctors just dont know about this and so they tend to dismiss it. I can forgive not knowing but if you dont know, why not just say so. My goal now is to inform anyone I can of what I have learned and then let each make up their own minds what they want to do. Please also do your own research too. All too often we let the doctor tell us what to do and instead I think we should become informed on our own and with the help of our doctors and then they should listen to what we want because we can then make an informed decision.
Hayfarmer has done his homework to the best of his ability. Welldone and wellsaid! As he has implicated, we are the ones hiring the doctor as the consultant. There are many physicians who are VERY competent but we must remember that we and the consultant are working on health issues together. My compliments, Hayfarmer.
Thanks for your compliments, I appreciate that. Although I think you worded what I was trying to say better than I did. You're right, I have done my homework and I have because as many of us have found out, if we dont do it no one will. I agree there are many very competent doctors out there but finding the right one for a specific problem can be costly and time consuming. Most doctors that I have encountered for this particular issue are not that knowledgeable and are too busy or in some cases too closed minded to take the time to figure it out. So....you are left to figure it out for yourself.
One more suggestion for you that I forgot to post earlier. You should talk to your Dr about getting an MRI to determine why your LH is low even thought your T is low. This can indicate a pituitary issue. Normally you should have your prolactin level checked and have an MRI done. The prolactin if too high can indicate a prolactin secreting pituitary adenoma (a very small tumor, usually benign). The MRI can rule out a non-prolactin secreting pituitary adenoma. Also there are other possible pituitary injuries that could be found in the MRI. For example, there is a condition called empty sella syndrome where spinal fluid enters the space where the pituitary is, putting pressure on the pituitary. This can eventually cause all your hormones to get out of sync and is important to know if you have it. Again, I'm not trying to give you something to worry about but this is or should be standard procedure for someone with secondary hypogonadism. My first doctor didnt run the MRI either but on a second opinion the Dr did and nothing was found.
Actually you may not be considered hypogonadal yet since your level of T at 340 is above the minimum reference range so this may not be necessary at this point. But, if you are treating yourself for low T then you will never know if this problem is getting worse (assuming there is a pituitary problem), because your treatment will mask the symptoms.