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Androgel versus Testim: Who Delivers?

Androgel versus Testim
Androgel and Testim are both topical testosterone gels and, as such, they are often poorly absorbed in a significant percentage of men. Androgel has been well-recieved by many PCPs and endocrinologists, even though there are arguably much more powerful and reliable alternatives in my opinion.  However, these topicals are incredibly convenient for both the doctor and patient and thus have taken the market by storm.

The bad news is that I can tell you that I get complaint after complaint about Androgel on the Peak Testosterone Forum and have covered this in my link on Testosterone and Androgel. Testim is much less widely used, because of, undoubtedly, its higher cost and smaller sales force.  To date I have not received a positive comment regarding Testim and a few to the contrary.

In spite of their issues, every man on HRT owes a huge debt to Androgel and Testim. Androgel is produced by pharmaceutical giant Abbott and its sales force pushed its way into thousands of doctors’ offices around the country. Almost overnight HRT become widely accepted and considered and this was likely in large part due to the fact that a pharmaceutical giant like Abbott was willing to back the research, funding, sales and marketing of this product.

Testim is manufactured by a much smaller company, Auxilium. However, their rather small sales force did a remarkable job of jumpstarting sales, which I am partially piggybacked on the success of Androgel. And as fyi: they have now partnered with Glaxo Smith Kline and this will only accelerate adoption of Testim. [1]

So in a war of Androgel versus Testim, who would win?  According to one study it would be Testim. [2] This study gave 50 mg of each to a group of hypogonadal men and found that “total testosterone, dihydrotestosterone, and free testosterone were greater (30, 11 and 47%, respectively) following the application of Testim compared to AndroGel .”  Approximately, 10% of Androgel is absorbed on average according to one estimate. [3] Obviously, the “PLO” or delivery system of Testim is likely somewhat higher with more than 10% being absorbed on average.

Does this mean that Testim will always deliver the most testosterone?  Well, not necessarily.  The reason is that Androgel 1% delivered only 50 mg of testosterone with four pumps. This is a lot of pumps, because you only have so much surface area on which to apply the Androgel.  (It is applied on the upper body and focuses on areas where there is little body hair.)  So 50 mg is probably the best that you are going to do with Androgel 1.0% and, again, only about 10% was probably absorbed. [5]

However, in the spring of 2011 Abbot released its Androgel 1.62% product which deliverd 42.5 mg of testosterone with only 2 pumps.  Of course, no one seems to use just 2 pumps but rather 4 like they so often did with the Androgel 1%.  Here are a few examples from the Peak Testosterone Forum post-April 2011 (when the 1.62% was approved by the FDA):

“I have been on 3 pumps for almost 10 day (prior to that 2 pumps for 10 days at which time my PCP told me to go to 3 pumps due to a T level of 218L [250-890 dl range]) and just told to go to 4 pumps by my new doctor because my T level was 1.31ml [1.75 – 7.81]. He says to try the 4 and test again in 2 weeks. Also said he thinks I might have a problem absorbing the gel.” [6]

“What confuses me is that with the Androgel 1.62% I was taking 4 pumps (81mg total of testosterone) but my doc has me taking 4 pumps of Fortesta 2% which is only 40mg of testosterone. Is the difference between a 2% solution and a 1.62% solution so significant that taking 40mg less testosterone will still give me higher serum/total levels? ” [7]

You get the idea:  Androgel is very often poorly absorbed and so physicians correspondingly often prescribe 4 pumps. So how does this compare to Testim?  Testim still comes in a 1% solution as and thus one tube has 50 mg of testosterone and two tubes 100 mg.

So comparing the two standard max dosages head-to-head, Androgel 1.62% versus Testim 1% at 4 pumps versus 2 tubes, respectively, you get some interesting results.  In fact, I’ll run through the numbers below assuming the absorption rates given in the studies above.

To show this, let’s make the following assumptions based on total testosterone:

1.  Androgel 1.62%.  Let’s assume that is still absorbed at 10%.  Given that 4 pumps delivers 82 mg of testosterone, this means that 8.2 mg are actually absorbed.

2.  Testim 1%.  Let’s assume, per the comparative study mentioned above, that this is absorbed at a rate of 30% more than Androgel.  If a man rubs in 2 tubes, that 100 mg at 13% absorption, then 13 mg actually makes it into his system.

Of course, this is a substantially greater quantiy, so that means that Testim is the clear winner?  Unfortunately, Testim does not seem to be doing that well on our forum.  Look at these two quotes for example:

“It was about the same time frame of being treated for cholesterol that I started with some ED issues. That’s when I finally asked about my testosterone level. It believe was 299, so he agreed to put me on testim 1%. After about 6 months to my next visit to the doctor the testim raised it to around 325, so he told me to use two tubes of testim a day. So I ll have to see how that does.” [8]

“Make sure you hook yourself up with a reputable urologist who understands how to administer T while knowing that the guy wants to have kids down the road. Testim never worked for me but there are several other alternates out there. Compounded T can be an option in a gel or a cream and formulated at a higher dose than what’s in Androgel or Testim. ” [9]

And so one cannot help but ask if Testim supposedly delivers twice the testosterone that Androgel does, why hasn’t it taken the HRT market by storm?  From what I have seen, this is anything but the case.  Testim has clearly take a back seat in sales to its supposedly weaker brother Androgel.  This is shown by raw sales numbers.  2012 Testim sales were around $245 million, whereas Androgel was around 1.3 billion. [10][11]

So the bottom line is that you can very likely get a much greater quantity of testosterone into your system using a Compounding Pharmacy. And you can likely get it at a much lower cost. Testosterone is not that expensive of a molecule and compounding pharmacies can usually beat the Big Pharma companies by almost an order of magnitude.

Who would I pick in a war of Androgel versus Testim?  As you can tell, probably neither one.

CAUTION:  These topicals are incredibly convenient and popular right now.  One must be very careful not to allow the product or treated are to come into contact with women or young children.

REFERENCES:

1)   https://www.rightinginjustice.com/news/2012/05/26/ testosterone-wars-heat-up-as-testim-maker-allies-with-glaxosmithkline/

2) Biopharmaceutics & Drug Disposition, Apr 2003, 24(3):115-120, “Evaluation of the pharmacokinetic profiles of the new testosterone topical gel formulation, Testim, compared to AndroGel”

3) https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=4279

4)  https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=16411

5) https://www.abbott.com/news-media/press-releases/2011Apr29_2.htm

6) https://peaktestosterone.com/forum/index.php?topic=341.0

7) https://peaktestosterone.com/forum/index.php?topic=731.0

8) https://peaktestosterone.com/forum/index.php?topic=920.0

9) https://peaktestosterone.com/forum/index.php?topic=148.0

10) https://www.bizjournals.com/philadelphia/news/2012/08/01/area-drug-firm-gets-first-quarterly.html

11) https://www.drugs.com/stats/androgel

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