NOTE: Topicals, such as Androgel, may have a unique issue associated with them. See my on Testosterone (HRT) Risks for more information.
GUEST INTERVIEW: Regulus
Q. What were your starting total testosterone levels and can you describe any of the low testosterone symptoms that you were having?
A. When I finally got tested for it, my total testosterone level was about 160. I had a second test where I actually hit the 140’s. I am certain that I had been low for at least 20 years. Brain fog, inability to concentrate, daily anxiety attacks, depression, lack of energy and difficulty controlling my emotions. Severe social anxiety, inability to deal with conflict. I thought that I was on the spectrum of autism actually. Low libido (though no ED until things got really bad.) Also, inability to gain muscle mass (despite weight training attempts), lack of body hair, difficulty losing body fat, and no morning wood (didn’t know that was a symptom … I thought that was just a puberty thing, and so I took no note when it stopped happening in my early 20’s. Could have had a couple much more productive decades if had known about that.)
Things got progressively worse over the years, and finally the libido got so low that I started experiencing ED, and found my anxiety and depression getting so bad I was having trouble functioning at all. I’d wake up in the middle of the night crying for no reason. Based on internet searching I found that these were symptoms of low testosterone. If you had asked me I would have assumed that my testosterone levels were low, but I never realized that you could do anything about it or that it could be the cause of anything other than a lack of alpha-male characteristics.
I have juvenile diabetes and so I regularly see an endocrinologist. I inquired about low testosterone and he blew it off, gave me a Cialis prescription and told me to see a shrink. The Cialis did nothing, and I didn’t want to see a shrink, and so next visit I prevailed on him to order the test. When the results came back he called me and told me I absolutely needed TRT.
Honestly, the doc in question was generally speaking a pill-pusher, and so his choice of Androgel probably was mostly a matter of a recent visit from an Abbott sales rep. He didn’t offer or even mention any other options. I personally researched other options, but decided that the gel seemed most convenient way to start. Insurance covered it, and that’s what my doc was recommending, so try it out, see if it helps, and then maybe try something else down to road.
I’ve since fired that endo, but both my primary care physician and my new endo agree that since Androgel is working for me, that’s the way to go.
Q. What dosage did you start out with on Androgel and how much did it raise your testosterone levels?
I originally started at the minimum dose (4 pump depressions) of the 1% gel. That got my total T up to about 350. I must have been very low for a very long time because at 350 I felt like Superman. I gradually increased up to the max dose (eight depressions). That’s a lot of gel to spread around, and when 1.62% hit the market I went to that. Currently on max dose of that (four depressions) on which I’ve consistently tested between 600 and 850.Q. What is your current dosage with Androgel and what are your testosterone levels?
Q. How do you apply Androgel and to what part of body? Any tricks you’ve learned to increase absorption?
A. I apply it to my shoulders, always about five minutes after getting out of the shower. I do have problems with absorption when my skin is very dry. It varies seasonally. I have found that lotion (Lubriderm) or grape seed oil spread on the skin greatly increases absorption when skin is dry (based on how I feel when doing so).
I also have to occasionally shave my shoulders. I don’t grow much hair there, but if it grows too long it gets in the way I think.
Q. Have you had any side effects with Androgel? If so, what have you done about them?
A. Initially I had some interesting side effects. Basically, I went through puberty in my forties. My voice got deeper, started growing body hair, etc. Harmless stuff, but strange to happen at midlife! I experienced some breast swelling and nipple tenderness and for a while was showing signs of high estradiol, but I’ve dealt with that through diet and no longer have those symptoms. It took me a while to convince my doc to test estradiol (very resistant to doing so, I think because she didn’t want to be asked to prescribe anything off-label) but when I finally did get it tested it was on the low end of normal. (20)
I have experienced some testicular shrinkage, which took a while to get used to. But it’s not a big deal.
Q. How long after you started on Androgel before you started noticing improvements?
A. Honestly, within a day or two. I felt about a foot taller almost immediately. I don’t think I fully stabilized for about a year though.
Q. What symptoms has Androgel improved and by how much?
A. The biggest changes for me have been the cognitive ones. I can concentrate, I’m not fighting daily anxiety attacks, I can deal with interpersonal relationships and handle conflict constructively instead of avoiding it at all costs, I can sleep at night. I was able to hold things together over the years, and actually have been pretty successful in both my personal life and in my career, but I accomplished a lot less in life and in my career because of all the energy that got sucked up just by holding it together. With that energy freed up for actually accomplishing things, I’m actually accomplishing things.
I have also made huge changes in my physique. I always tried to be active, and worked out both cardio and strength training, but never lost much weight or built much muscle. I have lost 50 pounds and am now almost down to normal weight for my height, and have make staggering increases (off a very low base) in the amount of weight I can lift. I’m still in transition there. I’ve gotten from Stay-Puff Marshmallow Man to The Before Picture. Probably still a year or two of efforts left to get to my goal, The After Picture. May not get all the way there; I’m motivated by the sense of well being, and not so much the vanity.
The ED I experienced was solely due to a complete crash of libido. Once the libido came back, it took a little while to get rid of the performance anxiety that about a year of ED created, but that was 100% in my head.
Q. Of course, you have to really watch the topicals and make sure that none of the product is transferred to women or children? How do you handle this?
A. I apply the gel around 6 or 7 am every morning. It’s a pretty rare situation where my wife would be having any contact with my bare shoulders, or even any contact with them covered, earlier than 12-15 hours after that. If you look at the studies and do the math, the risk of any meaningful transfer risk under those circumstances is nil.
In the event of very extensive contact (like a shoulder massage) even after that time period I’d probably take a shower first to eliminate anything left on the skin surface. In the event of afternoon delight, just keep a shirt on.
I do have two kids (roughly at the age of puberty) but there are simply no circumstances where either of them would have contact with my unclothed shoulders. Still, they’ve both been clearly instructed that if Dad doesn’t have a shirt on, don’t touch him. It hasn’t been an issue.
In all the studies I’ve seen, transfer problems are rare and only occur when there is extensive contact with the application site within a few hours of application. The risks posed by transfer to women and kids are serious and have to be taken very, very seriously. We of all people should appreciate what happens when your hormones get messed up. But, I have not found it at all difficult to take reasonable, honestly even excessive, precautions to avoid it.
In short, you have to be very careful about this, but for most guys I don’t think the care you need to take would be all that difficult. That said, if those precautions are a problem, topicals aren’t for you.
Q. Would you recommend Androgel to other men interested in HRT?
A. I would not recommend any form of HRT to anyone who is just “interested” in it. If you don’t NEED it, if you can get your hormones in better shape by other means (lose weight, hit the gym, etc.) do that. It’s an inconvenience, an expense, and it’s something you become dependent on for life. If you go off, you’re shut down, and it will take a while for you to get back to even your previous lows.
That said, if you do need HRT, I really think Androgel is a good choice, provided (a) you are part of the 85% of men who absorb it OK, (b) the expense is not an issue (with my insurance it’s actually the cheapest option … go figure), and (c) you are not in a position where transfer to women and children is a risk.
Injectables, even if done frequently, put you through up-down swings far greater than you get with the gel. And the gel is reasonably convenient if you have consistent daily habits (showering every morning at roughly the same time.) I will consider Nebido/Aveed once it hits the market, as it provides more stable long term levels than other injectables, but for me at least Androgel or a similar topical is a very good fit.