Seeing as you have been using the TD gel for 12 months then you were clearly benefiting in some way as it is highly doubtful one would put up with feeling shitty that long!
Have no clue where your TT/FT level sits on such as you never posted labs but if you are dosing the 1.62% (4 pumps daily) and are not hitting a high enough FT then you are a poor responder.
The bioavailability of transdermal T (standard application) is around 9-13%.
*Only approximately 10 % of the testosterone applied on the skin surface is absorbed into the circulatory system during a 24-h period.
Most men using the standard 1% Androgel packets or 1% Testim tubes would need the higher-end daily dose of 100 mg T (10 mg T/day) to achieve stellar/high FT levels and again that is if you have no issues with absorption!
Some men can easily achieve a high-end/high TT and more importantly FT level when using the big pharma TD gels but the higher-end dose would be needed.
Unfortunately many men end up being poor responders due to issues with absorption of the transdermal T (standard body application).
In most cases this can be easily remedied by switching to a higher strength compounded T cream applied scrotally!
If anything you could give Testim a go before throwing in the towel as it has been shown to be more effective than Androgel possibly due to the addition of an emollient which can improve absorption.
Just keep in mind whether using Androgel or Testim the higher end dose would be needed in most cases in order to achieve a high-end/high TT/FT level.
If you do not fare well on such due to issues with absorption than a higher strength compounded T cream applied scrotally would be the most sensible move.
If you are ready to move on then oral TU (Jatenzo,
Kyzatrex or Tlando) or injectable TC/TE/TP/T-blend is where it's at!
I would give
Kyzatrex a go before jumping on injections as oral Tu would be a superior formulation when it comes to minimizing sides especially elevated hematocrit!
*Additionally, some gels include emollients that prevent skin drying and ensure better testosterone absorption. There are data to suggest that this may help achieve better bioavailability and higher serum concentrations [37].
[37] Evaluation of the Pharmacokinetic Profiles of the New Testosterone Topical Gel Formulation, TestimTM, Compared to AndroGel (2003)
T. Marbury, E. Hamill, R. Bachand, T. Sebree and T. Smith
2.2.2) Testosterone Gel
There is a wide range of topical products on the market: Tostrex (Tostran, Fortesta), Androgel (Testogel), Testim and Axiron (solution), and Testavan, which is a 2% testosterone gel, currently under registration in Europe and already approved in Australia in May 2017. In Japan too, a new 2% gel is being developed [16]. Androgel 1% (5 g for 50 mg of T) was the pioneer in topical gel applications. In the EU, it was marketed as Androgel 1.62 (2.5 g for 40.5 mg of T). Then came Testim (Testosterone 1%, 5g for 50 mg of T), followed Tostrex (Tostran), sold as a 2% gel with a starting dose of 3 g (60 mg of testosterone. Fortesta (40 mg of T applied to inner thighs) and Axiron (3ml for 30 mg of T applied to each underarm) are also both 2% testosterone solutions. Testavan, also a 2% testosterone gel, is made of a hydroalcoholic and highly viscous topical formulation (1.15 g for 23 mg of T up to 3.45 g for 69 mg of T). A metered dose dispenser including a hands-free cap applicator allows for minimizing exposure to the hands and potential contamination of other people.
Otherwise you would need to look into a compounded higher strength cream which can be applied standard body application or scrotally which would be superior when it comes to absorption of the T.
Look over the paper (pdf) in this post which is the most up to date paper on Transdermal androgens!
I’m 47 and low T, low energy and no gym gains. I’ve had issue with ED and my libido at the moment is nonexistent right now. 2 months ago my TEST was 160 and my free T was 11 pg/ml! My PA started me on 1 pump per day alternating shoulders and then bumped me to 2 pumps per day (one pump each...
www.excelmale.com
I'm 68 and was diagnosed in December with lower T at 314, hematocrit at 47. I decided together with the Endocrinologist to go with his suggestion of 5gms 1% T Gel, the regular starting dose. Fast forward to my first blood test taken yesterday after applying the gel regularly for 3 months. And...
www.excelmale.com
*Some manufacturers provide both options (Table 11.2). Most testosterone gel preparations are formulated as hydroalcoholic gel, others use other enhancers in lotions. When applied to the skin, testosterone is absorbed into the stratum corneum over time, which serves as a reservoir. Testosterone is slowly released into the circulatory system over several hours resulting in steady-state serum levels of the hormone [22]. The release of testosterone from the reservoir continues for about 24 h. Only approximately 10 % of the testosterone applied on the skin surface is absorbed into the circulatory system during a 24-h period.
*Long-term studies with testosterone gel have shown that steady and relatively consistent serum levels of testosterone levels are attained [7],
*Several formulations of testosterone gels are available on the market [1, 2, 27]. Currently available gels vary in testosterone concentration and are usually applied once a day. Their pharmacokinetic profiles are also similar: Androgel 1 %®/ Testogel 1 %® [7], Testim® 1 % [28], Axiron®2 % [29] Fortesta Gel® 2 %/Tostran® 2 % [30], and Androgel 1.62 %® [31]. These transdermal preparations have been proven to be efficient in normalizing serum levels, as well as the reversal of androgen deficiency symptoms for long periods of treatment [24], and have been considered an acceptable form of testosterone substitution by users [5]. The maximum concentration of testosterone achieved is variable depending on the preparation but usually within 2–5 h of application and is maintained for 24 h. When applied in the morning, a profile somewhat similar to the circadian rhythm in healthy men is maintained. Recent studies in older hypogonadal men have shown that after testosterone gel application there were large fluctuations in serum testosterone concentration both within and between patients [8]. Skin structural differences may be one of the causes of these significant variations in the bioavailability of the drug, which poses challenges in predicting the effectiveness of medication and determining an adequate dose, as well as an appropriate time for testing serum testosterone levels [8, 32]. Nontime-dependent pulses of serum testosterone also occur in relation to exercise and skin temperature. Both factors may be mediated through changes in dermal blood flow. Another important issue is the possibility of blood sample contamination when it is drawn at the gel application site, which has led to a spurious increase in measured testosterone levels [33]. A sampling of blood after testosterone gel applications should be done away from the application sites.
*Additionally, some gels include emollients that prevent skin drying and ensure better testosterone absorption. There are data to suggest that this may help achieve better bioavailability and higher serum concentrations [37]. Differences in gel formulations and their pharmacokinetic profiles are a reason why gels cannot be used and dosed interchangeably. Therefore, it is recommended to follow specific instructions on sites for application and dosing of the drug provided in the labeling. Dosing information and recommendations for some of the preparations are presented in Table 11.2. It should be noted that some gels are marketed in various countries under different names but are in fact produced by the same manufacturer.
*At day 90, peak T levels were reached after 4 and 8 hours with 5 g and 10 g T gel application, respectively.
