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Old 10-02-2007, 12:23 PM   #1
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Blood v. Saliva test for T with Androgel?

Well, despite my reply to using Androgel in another thread, my doc has put me on the Androgel pump (co-pay $40 for a 3 month's supply). He's starting me at the lowest dose. After my sides from only 25mg Clomiphene Citrate he probably knows I am a sensitive guy. (see my "Do I need Free T" post for my T test and Clomid results).

He said that while I am on the gel he prefers giving me saliva tests. When I asked why he said that they have proven more accurate with the gels. He says if I go to pellets we will go back to blood tests.

Anyone ever heard of this?

I have to say that I am real hesitant about the Androgel from what with JustDave's and others comments in some of the other threads and on some of the BB sites. Most of those sites say that guys started with this and if it worked they stayed with it; if not, they "graduated" to injections. Also, I am not so sure that the gel will work well what with sweating here in the desert and this stuff has to stay dry for like 6-8 hours. I tend to sweat a lot in the morning due to that is when I run and my body seems to stay hot for hours.

Although I think that there might be a problem over time, with running out of pellet injection sites, I think I would still prefer them, a steady stream of T for 3-4 months being a definite PLUS. By next year, my new FLEX plan will kick in so I will budget the higher cost for them and the blood tests. Also, even though they are on my insurance Formulary and Preferred Drug lists, there is a memo stating that others must have been tried first. Now I will be able to say I tried Clomid and Androgel first.

I look at it this way, for 40 bucks I have nothing to loose (unless I get sides from this too!!).

Surprise me Andro!

 
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Old 10-02-2007, 02:57 PM   #2
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Re: Blood v. Saliva test for T with Androgel?

AZman, sorry I did not respond to your previous post. I just re-read it. It seems you did respond to the clomid but did not like the side effects from it. This tells me your problem is probably with your hypothalmus. THe hypothalmus has receptors for testosterone and uses the receptors to sense and judge if your T level is high enough or not. The T molecules can bind to the receptors in the hypothalmus energizing them. If it "thinks" T is high enough then it reduces GnRH which it sends to the pituitary. When the pituitary is stimulated with GnRH it sends LH and FSH to the testicles. LH stimulates the testicles to make T and FSH stimulates the testicles to make sperm.

Clomid will bind with the receptors on the hypothalmus and block T or estrogen (which is chemically extremely similar to T) from binding to the receptors. THis makes the hypothalmus "think" T is way too low. It sends out lots of GnRH which in turn makes the pituitary send out lots of LH which in turn makes the testicles make lots of T. This seems to be what happened to you although maybe not on such a grand scale as I have described. The problem with clomid is many people to have poor side effects from it so it is not uncommon that it can not be used long term.

There are other ways to effect the hypothalmus though. You could try tamoxifen for example. That is a drug in the same class as clomid but often works better. Maybe you wont have the side effects there. Also there is seligiline. It can also effect the hypothalmus. It is normall prescribed for Parkinson's disease but it can have healing effects on the hypothalmus and in many cases can cause a rise in T when the hypothalmus is the root cause of the problem.

Also, there is the possibility your estrogen is too high causing low T. Your estradiol looked slightly high but your total estrogen count can also be the cause. If that is the case there are various methods for reducing estrogen. Estrogen can bind to the same receptors in the hypothalmust making it "think" T is plenty high when in fact it is not.

Finally if you do end up on and/or decide to go with T replacement like androgel or anything else you should consider taking HCG along with it. HCG will stimulate the testicles like LH does so they dont shrink. You may find HCG is all you need. From my experience and readings very few men get T high enough to benefit satisfactorily from androgel.

Last edited by hayfarmer; 10-02-2007 at 03:00 PM.

 
Old 10-02-2007, 08:04 PM   #3
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Re: Blood v. Saliva test for T with Androgel?

Quote:
Originally Posted by hayfarmer View Post
AZman, sorry I did not respond to your previous post.
no prob, thanx for responding here. I think I understand (on a broad general level) your excellent response of how the various drugs/hormones interact with the HPTA.

Quote:
Originally Posted by hayfarmer View Post
There are other ways to effect the hypothalmus though. You could try tamoxifen for example. That is a drug in the same class as clomid but often works better. Maybe you wont have the side effects there. Also there is seligiline. It can also effect the hypothalmus. It is normally prescribed for Parkinson's disease but it can have healing effects on the hypothalmus and in many cases can cause a rise in T when the hypothalmus is the root cause of the problem.
DO'H! I guess I should have pushed the doc further before agreeing to (and picking up!) the Androgel!

Isn't seligiline the drug that act's with dopamine that produces the "pleasant" side effect of male multiple orgasms each with an ejaculation?

Quote:
Originally Posted by hayfarmer View Post
Also, there is the possibility your estrogen is too high causing low T. Your estradiol looked slightly high but your total estrogen count can also be the cause. If that is the case there are various methods for reducing estrogen. Estrogen can bind to the same receptors in the hypothalmust making it "think" T is plenty high when in fact it is not.
Are you talking here about Aromatase Inhibitor's?

Quote:
Originally Posted by hayfarmer View Post
Finally if you do end up on and/or decide to go with T replacement like androgel or anything else you should consider taking HCG along with it. HCG will stimulate the testicles like LH does so they dont shrink. You may find HCG is all you need. From my experience and readings very few men get T high enough to benefit satisfactorily from androgel.
Reflecting back on my in-person consult, I do believe he mentioned HCG injects as the alternative to Clomid but the "inject" part threw me off. He may have, therefore, totally dismissed that option.

I have been on Andro, alas only 2.5g (that, according to the circular actually delivers only 2.5mg T) and according to the charts it would take at least 5g to even sustain my current Total T level. The chart shows an initial spike about 2 hours in and then a leveling off at 4 hours to a very slight increase up to 24 hours.

I had a spontaneous erection almost exactly at hour 4 and I am wondering if this is only a result of the Andro mixing with my current level and when my HPTA gets a clue and reduces or shuts down, I'll be in the same boat as JustDave.

Also, if I am hearing you correctly then, it is at that point that I need to call the doc and suggest we narrow down whether it is the E or the Hypothalamus that is really causing the issue and Rx appropriately?

Ever hear about the Saliva test due to using the gel? How can a doctor compare blood tests to saliva tests?

One last ? is that yesterday and especially today, at day 4 off Clomid, I am experiencing some forgetfullness and confusion. My brain feels "fuzzy" if that makes sense. I am wondering if it is because my T is lower now off of the C and if so, if this tiny bit of Andro will at least get me back to what I was at before the C? I hope that is not too confusing? there are just so many variables to this stuff.

Oh, got to go, "The Unit" is on and it is Part 2!
thanks again for all your help and everyone for your input!

Last edited by AZMan07; 10-02-2007 at 08:09 PM.

 
Old 10-02-2007, 08:56 PM   #4
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Re: Blood v. Saliva test for T with Androgel?

I think you are right that seligiline can increase the effects of orgasm and some people take it just for that effect even if it does not "fix" an unfunctional hypothalmus.

You are right, I am talking about aromatase inhibitors in regards to lowering estrogen levels if high estrogen is the real cause of the problem. Once on T replacement though any tests to see if that was the root cause are pretty useless. You would have to get all the exogenous T out of your system before you could accurately test for this if you don't already have a pre treatment test for total estrogen.

I have heard saliva tests can be more accurate but I have never heard they are more accurate specifically when using a gel versus T shots. I have a distrust of saliva tests but I have no real reason to distrust them. I guess if it were me I would rather use the same testing method all the time for better comparison purposes regardless of the treatment type I am on.

If you are experiencing fuzzy brain now it is most likely from T dropping off after stoping the clomid but it could also be from the clomid. I am not familiar with all the side effects of clomid. I don't think the small amount of androgel you are on will have almost any effect on you over the long term except to reduce LH and cause your testicles to shrink. The HPTA will adjust to the exogenous T and you will probably end up with the same T level you had pre-treatment or possibly even lower. The thing to realize is you can't take exogenous T to increase your total T level without taking enough to supply all your T. Your HPTA will just down regulate so your body makes less until your body is making almost nothing and LH is virtually 0 as you increase T dose. If you then continue to increase T dose you can get to a higher total T level but at that point your HPTA has shut down your testicles.

You seem to have a very good handle on how it all works. Do not be afraid of the HCG injections if that is the way you want to go. You can take them sub Q with a very fine insulin needle in the leg. Honestly once you get over the fear you realize it is virtually painless. That said I should say there was one poster here that said his doctor claimed HCG was dangerous and would fry your pituitary and possibly cause a pituitary tumor. He had no evidence or studies to back it up though and there are lots of men on HCG for this and I have never heard of anyone having a problem. I have taken it myself for 2 years now with no problems at all.

In your case your T was only marginally low at 340. Mine was at 98 when I was diagnosed so you can see what I mean. In your case I would try to see if I could get myself working thru aromatase inhibitors or tamoxifen or whatever works before I would resort to T replacement which is for life. My doctor uses a combination of clomid (tomoxifen could be substite I think) and HCG to try to re stimulate both the HPTA and testicles at the same time......or so I have heard from other patients. He then withdraws them over time to see if things get back to normal. Seligiline can also be worked into that mix but I don't know the exact formula. This seems like its worth a try to me if you responded to clomid. You can always resort to T replacement later if necessary.

In the end you have to do what you are comfortable with and can get a doctor to go along with. Your doctor does not sound too bad to work with if he has mentioned HCG.

Last edited by hayfarmer; 10-02-2007 at 09:03 PM.

 
Old 10-03-2007, 08:16 PM   #5
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Re: Blood v. Saliva test for T with Androgel?

So, where do you farm hay?
Thanks for the reply!

Quote:
Originally Posted by hayfarmer View Post
You would have to get all the exogenous T out of your system before you could accurately test for this if you don't already have a pre treatment test for total estrogen.
Well, my Estradiol was 32 on a range of 8 to 43. That is all I have to go on unfortunately.

Quote:
Originally Posted by hayfarmer View Post
I have heard saliva tests can be more accurate but I have never heard they are more accurate specifically when using a gel versus T shots. I have a distrust of saliva tests but I have no real reason to distrust them. I guess if it were me I would rather use the same testing method all the time for better comparison purposes regardless of the treatment type I am on.
I'm on the same page as you which is why I asked him. Perhaps after my 1st saliva I will know more.

Quote:
Originally Posted by hayfarmer View Post
I don't think the small amount of androgel you are on will have almost any effect on you over the long term except to reduce LH and cause your testicles to shrink. The HPTA will adjust to the exogenous T and you will probably end up with the same T level you had pre-treatment or possibly even lower. The thing to realize is you can't take exogenous T to increase your total T level without taking enough to supply all your T. Your HPTA will just down regulate so your body makes less until your body is making almost nothing and LH is virtually 0 as you increase T dose. If you then continue to increase T dose you can get to a higher total T level but at that point your HPTA has shut down your testicles.
Sadly, I am in agreement with you from what little I have read here and elsewhere any exogenous T will have that effect. We are complicated animals, indeed! Like I said before, I think I jumped into agreement with my doc way too soon.

Quote:
Originally Posted by hayfarmer View Post
Do not be afraid of the HCG injections if that is the way you want to go. You can take them sub Q with a very fine insulin needle in the leg. Honestly once you get over the fear you realize it is virtually painless.
From what I have heard, once you have poked yourself a few times, it is nothing. I would imagine that the HCG would produce positive results, in conjunction with some of the other possible options you discuss as I come off of the gel. That would be an adequate test, wouldn't you say?

I really was not aware that you were taking it long term. I have not heard of that.

Quote:
Originally Posted by hayfarmer View Post
In your case your T was only marginally low at 340. Mine was at 98 when I was diagnosed so you can see what I mean. In your case I would try to see if I could get myself working thru aromatase inhibitors or tamoxifen or whatever works before I would resort to T replacement which is for life. My doctor uses a combination of clomid (tomoxifen could be substite I think) and HCG to try to re stimulate both the HPTA and testicles at the same time......or so I have heard from other patients. He then withdraws them over time to see if things get back to normal. Seligiline can also be worked into that mix but I don't know the exact formula. This seems like its worth a try to me if you responded to clomid. You can always resort to T replacement later if necessary.
My Total T level, although it has come down in 4 years, was still at 511. It was my Free T 61.3 pg/ml (35.0-155.0) and its % Free 1.20 (Low) (1.5-2.2) in addition to I had every one (not just the "key" or more than just a few) of the symptoms that prompted my doc to say I needed to take some action.

What I may do is when the gel stops working, advise my doc I want to try the HCG option. With injections I would suspect that the "down time" would be minimal, no?

You have had no sides from it, at all? No "drugged" feeling like I had with the Clomid?

Quote:
Originally Posted by hayfarmer View Post
Your doctor does not sound too bad to work with if he has mentioned HCG.
Well, honestly, I think that there may have been a slight bias toward the pellets as he said he was on them, could live with the smaller testicles, etc., and the Andro group he is part of seems to push them. The office fee for injecting them a minimum of 3x year for life is certainly incentive over the typical miniscule co-pay for a general practitioner.

I have since discovered yet another local anti-aging doc whose initial exam and initial blood tests are much more extensive and he encourages T-cyp self injections for T patients. I don't yet know, of course, if he may require these extensive visits 3x year as well. In any case, I may give him a call after the 1st of the year if I don't see some improvement or if I am on a "roller coaster" or if I just don't like small nuts!

Thanx man!

 
Old 10-03-2007, 08:36 PM   #6
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Re: Blood v. Saliva test for T with Androgel?

Estradiol at 32 is a bit high considering your T was low at the time. Total estrogen can also be the culprit and we don't know that number. I would suggest going off everything for 7 days and then test for estradiol and total estrogen along with T, LH, SHBG, prolactin, TSH. Since you appear to be secondary I would also throw in an anemia panel which includes iron, ferritin, TIBC and saturation % just to be sure you don't have hemochromatosis.

If your estrogen or estradiol is high you could try other methods to fix the problem by lowering the estrogen. If prolactin is high then you need to look into why and resovle that. Once you are convinced you can not fix the root problem you could try HCG. I have no side effects at all from the HCG. It is almost identical to LH. It will only work for you if your testicles work of course. A good starting dose is 300 iu three times a week. You will need to get monthly blood tests to check total T and estradiol. The key is to take the smallest dose possible that you need to get your T to a reasonable level. IN any event do not take more than 500 iu per day 7 days a week. It may take some time to find the right dose. This is especially true if your testicles have been inactive for a while. It may take them some time to get going again.

If you can give me your SHBG level I can tell you about where your total T needs to be to get to a reasonable free T level.

Last edited by hayfarmer; 10-03-2007 at 08:37 PM.

 
Old 10-04-2007, 10:45 PM   #7
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Re: Blood v. Saliva test for T with Androgel?

Quote:
Originally Posted by hayfarmer View Post
Estradiol at 32 is a bit high considering your T was low at the time. Total estrogen can also be the culprit and we don't know that number. I would suggest going off everything for 7 days and then test for estradiol and total estrogen along with T, LH, SHBG, prolactin, TSH. Since you appear to be secondary
I would also throw in an anemia panel which includes iron, ferritin, TIBC and saturation % just to be sure you don't have hemochromatosis.
I am in complete agreement with you.

Although I don't have Total Estrogen, I do have some of the other figures all pre diagnosis and treatment:
LH 4.2 miu/ml (1.7-8.6) 4 years ago it was 3.2
Prolactin 8.3 (2.5-17.0) 4 years ago it was 5.4
TSH 1.62 mu/l (0.45-4.50) 4 years ago 1.14

From research I see that people with early hemochromatosis (noncirrhotic) frequently have insulin resistance. That may be why he ordered a fasting insulin test, that and because of my high A1c and high glucose level but I will see if I can get him to order iron, but wouldn't that have shown up in the MCHC and MCV?
My MCV was 100 fL (78-100), my MCH was 34.7 pg (27.0-34.0) and my MCHC was 34.5 g/dL (31.0-37.0). Also, my WBC was low at 3.9 k/mm3 (4.0-11.0).

He didn't mention a thing about those perhaps because there were not that far out of line? Zinc, Vit. D and DHT were all in the middle of their range.

Quote:
Originally Posted by hayfarmer View Post
If you can give me your SHBG level I can tell you about where your total T needs to be to get to a reasonable free T level.
For SHBG all I have is the 4 years ago 41 nmol/l (7-50). That was 7% of my 585 T then and my T is down to 511 now.

I have the pre-printed order for my next tests with Cortisol, Fasting Insulin, etc. circled. Would it be acceptable (ethical?) to just circle those other tests as well? It is my money, right?

Finally, I am concerned about the auditory hallucinations I had with Clomid withdrawal. Should I order a test for this?
Thanks for your valuable input!

Last edited by AZMan07; 10-05-2007 at 07:28 AM.

 
Old 10-06-2007, 07:28 PM   #8
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Re: Blood v. Saliva test for T with Androgel?

Prolactin and TSH look fine. LH kind of low along with low T still indicates secnodary hypogonadism to me most likely. I don't think you can rely on MCV/MCH to rule out hemochromatosis. I would get the iron test. It is the smart thing to do if you have secondary. It's not likely you have it but if you do it's not something you want to miss. At your SHBG level you would need at total T of about 800-850 to get to a resonable free T level.

I have added tests before but also I know my doctor would not care. Think about whether or not your doctor would care. If not sure, call and ask him. Sometimes you need to check additional diagnosis codes so insurance will pay for it, so keep that in mind too. My logic was I knew the doc would not care and I knew if I asked him for it when he wrote the order he would give it to me.

No clue on the clomid. I would just not worry about it. If not taking clomid solves that then just figure you can't use clomid.

 
Old 10-06-2007, 08:38 PM   #9
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Re: Blood v. Saliva test for T with Androgel?

Quote:
Originally Posted by hayfarmer View Post
Prolactin and TSH look fine. LH kind of low along with low T still indicates secnodary hypogonadism to me most likely. I don't think you can rely on MCV/MCH to rule out hemochromatosis. I would get the iron test. It is the smart thing to do if you have secondary. It's not likely you have it but if you do it's not something you want to miss. At your SHBG level you would need at total T of about 800-850 to get to a resonable free T level.

I have added tests before but also I know my doctor would not care. Think about whether or not your doctor would care. If not sure, call and ask him. Sometimes you need to check additional diagnosis codes so insurance will pay for it, so keep that in mind too. My logic was I knew the doc would not care and I knew if I asked him for it when he wrote the order he would give it to me.

No clue on the clomid. I would just not worry about it. If not taking clomid solves that then just figure you can't use clomid.
Thanks Hayfarmer! I will be talking to the doc again in about a week. Based on what you say above, is there a standard treatment to lower SHBG or is the treatment to simply raise total T? I believe that is what my doc is currently trying to do, raise Total T.

P.S. I picked up Shippen's paperback book today in hopes of increasing my knowledge and understanding.

 
Old 10-06-2007, 09:09 PM   #10
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Re: Blood v. Saliva test for T with Androgel?

Interestingly raising T and lowering estradiol can both lower SHBG. It's a catch 22. As you age estrogen tends to rise which can lower T. At the same time lower T and higher estrogen can raise SHBG. Lower T and higher SHBG both contribute to lower free T so free T can drop a lot. Free T is the active T you do not want to drop. Its the T that gives you your libido and many other things T can do for you.

So the answer I suppose is you have to raise T. By raising T you may find SHBG will drop some so the total T you need to achieve may not be quite so high as it seems now. But getting to a total T of 800-850 is not crazy high. That said, gels probably wont' get you there. It will probably take some other form like T injections.....that is unless HCG or some other method works for you.

But don't worry, some doctors find treating a man with low SHBG is harder than one with normal/high SHBG. Why this would be true I have no idea except that low SHBG can be an indication of other serious hormonal issues beyond low T.

Last edited by hayfarmer; 10-06-2007 at 09:11 PM.

 
Old 10-08-2007, 07:45 PM   #11
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Re: Blood v. Saliva test for T with Androgel?

I'll have to get back to you with test results (iron, etc.) as I realized I am not due for testing for another week and then won't talk to the doc for a week after that.

I have to say though. I think I am extremely sensitive with T. The Clomid seemed to work almost overnight, I was hard as a rock and my testicles even got larger but the sides were unacceptable.

7 days on Androgel and I think I had 1 real good day and a few so, so days but yesterday and today are just like the reason I saw the doc in the 1st place. I see that in another thread you experienced many of the same on Andro. But was it that fast?

I know there is no way to tell what is really going on (aromatization, etc.) without further testing but I think I am in agreement that there is probably no way to get above a certain point with Andro, not if it is going to act like this.

So far, I've only read up to P-43 in Shippen's book but I think I have made up my mind to have the doc put me on HCG at least for Nov & Dec. I am just not convinced that long term therapy with it is the way to go. I am still leaning toward pellets due to reading other boards and guy's experiences showing it keeps T real stable albeit is real expensive and forces expensive office procedures (Hell, that is what a FLEX plan is for, right?)

I'm thinking that pellets with HCG to keep my testicles working may be the plan. I am sure that will take some experimentation too. Roller coasters were fun as a kid but I can do without them now.

Last edited by AZMan07; 10-09-2007 at 07:59 AM.

 
Old 10-09-2007, 05:18 AM   #12
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Re: Blood v. Saliva test for T with Androgel?

I think it took a little longer for the androgel to kick in for me. It may have been a couple weeks. WHen I was having a bad period on androgel I would also not have morning erections. That told me my hormones were off, it was not just poor libido.

By the way, its HCG (human chorionic gonadotropin)

 
Old 10-09-2007, 08:02 AM   #13
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Re: Blood v. Saliva test for T with Androgel?

Quote:
Originally Posted by hayfarmer View Post
I think it took a little longer for the androgel to kick in for me. It may have been a couple weeks. WHen I was having a bad period on androgel I would also not have morning erections. That told me my hormones were off, it was not just poor libido.

By the way, its HCG (human chorionic gonadotropin)
Corrected, must be the lack of T yesterday!

What is your HCG regimen, how much and how often?
Do you notice any "peaks and valleys" between shots?
That is all you are on now, right?

 
Old 10-09-2007, 08:42 AM   #14
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Re: Blood v. Saliva test for T with Androgel?

No I'm on Tcyp shots and HCG. For me the HCG alone did not get my T high enough. Probably because I was on androgel for 4 years and testicular atrophy was too severe when I finally tried HCG. I take T cyp on Wed each weeek then have been taking 400 iu of HCG on Sat, Sun, Mon, Tue. My doctor just changed me to 300 iu on Sun, Mon, Tue. Taking HCG the days before the next T cyp shot keeps my T level from getting too low at the end of the cycle. My doctor thinks it is better to have T levels go up and down like they do naturally when you are healthy. When on androgel the level stays constant all day, every day. This may be another reason it does not work that great for some people.

I don't notice any huge valleys with this regimen. Some weeks I feel better the few days right after the T cyp shot, other weeks I feel better the days I'm taking HCG. I don't know why that is.

 
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