Androgel Not working

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I heard oral t affects kidneys? And is very expensive?

You would mean liver.

When it comes to testosterone therapy methyltestosterone was the older original c-17 alpha alkylated oral formulation used which had been linked to such!

It is no longer used and was replaced by Andriol (oral TU) which bypasses the liver.

More recently there are 3 new oral TU formulations (Jatenzo, Tlando and Kyzatrex) which are much more effective then the older outdated Andriol testocaps and also pose no liver toxicity.

* [1]. Systemic delivery of oral TU occurs instantly (>97%) via the intestinal lymphatic system thus bypassing the liver completely.

Liver toxicity would be related to any of the c-17 alpha orals.

The use of exogenous T for testosterone replacement in men whether in the form of intranasal (Natesto®), patch, pellets, oral (Jatenzo®, Tlando®, Kyzatrex® ), buccal, transdermal (gel/cream), injectable (short, medium, or long-acting, mixed esters) does not cause any harm to the liver/kidneys.

It would be the use of AAS 17α-alkylated orals such as stanozolol, oxandrolone, methyltestosterone, methandrostenolone, oxymetholone, and fluoxymesterone as they are notorious for driving down HDL, increasing LDL, stressing the liver and hammering down SHBG.

Even then the dose/duration of use will play a big role.










































 
Defy Medical TRT clinic doctor
You would mean liver.

When it comes to testosterone therapy methyltestosterone was the older original c-17 alpha alkylated oral formulation used which had been linked to such!

It is no longer used and was replaced by Andriol (oral TU) which bypasses the liver.

More recently there are 3 new oral TU formulations (Jatenzo, Tlando and Kyzatrex) which are much more effective then the older outdated Andriol testocaps and also pose no liver toxicity.

* [1]. Systemic delivery of oral TU occurs instantly (>97%) via the intestinal lymphatic system thus bypassing the liver completely.

Liver toxicity would be related to any of the c-17 alpha orals.

The use of exogenous T for testosterone replacement in men whether in the form of intranasal (Natesto®), patch, pellets, oral (Jatenzo®, Tlando®, Kyzatrex® ), buccal, transdermal (gel/cream), injectable (short, medium, or long-acting, mixed esters) does not cause any harm to the liver/kidneys.

It would be the use of AAS 17α-alkylated orals such as stanozolol, oxandrolone, methyltestosterone, methandrostenolone, oxymetholone, and fluoxymesterone as they are notorious for driving down HDL, increasing LDL, stressing the liver and hammering down SHBG.

Even then the dose/duration of use will play a big role.










































Perfect. Thanks for the reply
 
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!







*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.
Looks like the study only discusses that Testim T rates are higher than Androgel. My issue is there is No increase in testesterone using Androgel. However, I assume, based on the 2007 study, Testim is better absorbed?
 
I heard oral t affects kidneys? And is very expensive?

 
Looks like the study only discusses that Testim T rates are higher than Androgel. My issue is there is No increase in testesterone using Androgel. However, I assume, based on the 2007 study, Testim is better absorbed?

Your best bet would be looking into a higher strength compounded T cream scrotal application which would allow one to easily overcome issues with absorption let alone hit high/very high T levels!

Otherwise I would try oral TU before moving on to injections.

Do what you feel is best for you!






 
Your best bet would be looking into a higher strength compounded T cream scrotal application which would allow one to easily overcome issues with absorption let alone hit high/very high T levels!

Otherwise I would try oral TU before moving on to injections.

Do what you feel is best for you!






Great advice
 
Your best bet would be looking into a higher strength compounded T cream scrotal application which would allow one to easily overcome issues with absorption let alone hit high/very high T levels!

Otherwise I would try oral TU before moving on to injections.

Do what you feel is best for you!






Madman, you’ve been a great help with your posts. I’ll probabkybteybteatim before the oral route. Have you been using the oral versions? If so, what’s your take? And, how about the elevated psa numbers?
 
And, how about the elevated psa numbers?
PSA lab testing produces the most false positives for diseases. This is what the guy that created the PSA test had to say. There are many different reasons why PSA would be elevated, age, prostate cancer, urinary tract infection, and the list goes on and on.

So the key takeaway here is an elevated PSA can be harmless. For the record TRT, testosterone doesn't cause prostate cancer, low testosterone is a risk factor for more aggressive prostate cancer, and reoccurrence.

TRT has been shown to prevent or delay the onset of prostate cancer.

Men on TRT show a clear decreased risk of developing prostate cancer.
 
Last edited:
PSA lab testing produces the most false positives for diseases. This is what the guy that created the PSA test had to say. There are many different reasons why PSA would be elevated, age, prostate cancer, urinary tract infection, and the list goes on and on.

So the key takeaway here is an elevated PSA can be harmless. For the record TRT, testosterone doesn't cause prostate cancer, low testosterone is a risk factor for more aggressive prostate cancer, and reoccurrence.

TRT has been shown to prevent or delay the onset of prostate cancer.

Men on TRT show a clear decreased risk of developing prostate cancer.
Thank you for the response. My psa has gone from 3.2 to 5.6. Doesn’t this possibly lead to an enlarged prostrate?
 
Madman, you’ve been a great help with your posts. I’ll probabkybteybteatim before the oral route. Have you been using the oral versions? If so, what’s your take? And, how about the elevated psa numbers?

No I have been using injectable T from the get-go (Dec. 24/2016).

I had started on Depo-Testosterone (TC) for the first 3 months then moved on to Delatestryl (TE) for 6 years before switching back to Depo-Testosterone (TC).

I have always injected strictly sub-q twice-weekly (every 3.5 days) mind you for the past year I have been following a 4/3 weekly injection protocol!

Could be numerous reasons for the elevated PSA and seeing it is >4 you need to have this looked into by a urologist to pinpoint why!

Listen closely to Dr. Khera reply as he lays it out when it comes to testosterone therapy and PSA!


33:33 Testosterone…PSA will go up almost inevitably




Dr. Scholz explains what a normal PSA would be for a man that does not have prostate cancer!

3:15-6:09




post #13
















2.8. Prostate health and testosterone treatment

Recent data cast doubt on the dogma of Huggins and Hodges [142] regarding the dependence of CaP on androgens [143]. According to older population studies and a more recent meta-analysis, the incidence of CaP appears to be unrelated to endogenous T concentrations[144,145]. Men with CaP do not seem to have higher T concentrations than those without cancer; on the contrary, low T concentrations may predict more aggressive forms of CaP [146]. Moreover, CaP is more prevalent in older men, at ages when T concentrations decline.
Similar conclusions may be drawn regarding TRT in men with hypogonadism,which does not appear to increase the incidence of CaP compared either to the general population (incidence <1 %) or to controls [odds ratio(OR) 0.97, 95 % CI 0.35 to 2.69] [38,109,144]. These findings align with the “prostate saturation” hypothesis, according to which when all androgen receptors of the prostate are saturated, a further increase in circulating T cannot affect the prostate gland [147].

Questions have been raised about whether CaP survivors with symptomatic hypogonadism can safely undergo TRT. Meta-analysing observational data from retrospective studies shows that TRT does not increase the risk of biochemical recurrence or progression of CaP after radical prostatectomy [148]. Similar results were obtained for patients treated with external beam radiation therapy, brachytherapy, cryotherapy, or high-intensity focused ultrasound, though the recurrence rate was higher compared with radical prostatectomy [149]. Patients whose initial assessment demonstrated a low-risk localised CaP (Gleason score <7, pT1–2, preoperative PSA <10 ng/ml) and who have constantly undetectable PSA concentrations after radical prostatectomy seem to have a lower risk of recurrence [143]. Nevertheless, it should be stressed that no RCTs have been conducted on this issue, rendering the level of evidence low and, thus, patients should be informed accordingly, give informed consent before TRT, and undergo close monitoring.

Concerns have also been expressed about the ability of TRT to augment prostate volume and to worsen lower urinary tract symptoms (LUTS); thus, men with severe LUTS, as defined by an International Prostate Symptom Score (IPPS) >19, are usually excluded from trials on TRT. Accordingly, TRT in this population is contraindicated in most guidelines. However, this recommendation is not based on high-quality evidence [150]. Meta-analysis of studies of TRT in men with pre-therapeutic mild LUTS did not show either a worsening of symptoms or an increase in prostate volume after treatment [151]. A recent trial that included hypogonadal men with metabolic syndrome and benign prostate hyperplasia showed that TRT can improve indices of prostate inflammation [152].





Summary recommendation

TRT may be considered in hypogonadal men with a history of previous low-risk, localised CaP (Gleason score <7, pT1–2, pre-operative PSA <10 ng/mL) who have constantly undetectable PSA concentrations after a radical prostatectomy; however, close monitoring is mandatory .TRT should not be avoided in men with hypogonadism and benign prostate hyperplasia/LUTS; however, caution should be paid to those with severe LUTS (IPSS >19).
 
No I have been using injectable T from the get-go (Dec. 24/2016).

I had started on Depo-Testosterone (TC) for the first 3 months then moved on to Delatestryl (TE) for 6 years before switching back to Depo-Testosterone (TC).

I have always injected strictly sub-q twice-weekly (every 3.5 days) mind you for the past year I have been following a 4/3 weekly injection protocol!

Could be numerous reasons for the elevated PSA and seeing it is >4 you need to have this looked into by a urologist to pinpoint why!

Listen closely to Dr. Khera reply as he lays it out when it comes to testosterone therapy and PSA!


33:33 Testosterone…PSA will go up almost inevitably




Dr. Scholz explains what a normal PSA would be for a man that does not have prostate cancer!

3:15-6:09




post #13
















2.8. Prostate health and testosterone treatment

Recent data cast doubt on the dogma of Huggins and Hodges [142] regarding the dependence of CaP on androgens [143]. According to older population studies and a more recent meta-analysis, the incidence of CaP appears to be unrelated to endogenous T concentrations[144,145]. Men with CaP do not seem to have higher T concentrations than those without cancer; on the contrary, low T concentrations may predict more aggressive forms of CaP [146]. Moreover, CaP is more prevalent in older men, at ages when T concentrations decline.
Similar conclusions may be drawn regarding TRT in men with hypogonadism,which does not appear to increase the incidence of CaP compared either to the general population (incidence <1 %) or to controls [odds ratio(OR) 0.97, 95 % CI 0.35 to 2.69] [38,109,144]. These findings align with the “prostate saturation” hypothesis, according to which when all androgen receptors of the prostate are saturated, a further increase in circulating T cannot affect the prostate gland [147].

Questions have been raised about whether CaP survivors with symptomatic hypogonadism can safely undergo TRT. Meta-analysing observational data from retrospective studies shows that TRT does not increase the risk of biochemical recurrence or progression of CaP after radical prostatectomy [148]. Similar results were obtained for patients treated with external beam radiation therapy, brachytherapy, cryotherapy, or high-intensity focused ultrasound, though the recurrence rate was higher compared with radical prostatectomy [149]. Patients whose initial assessment demonstrated a low-risk localised CaP (Gleason score <7, pT1–2, preoperative PSA <10 ng/ml) and who have constantly undetectable PSA concentrations after radical prostatectomy seem to have a lower risk of recurrence [143]. Nevertheless, it should be stressed that no RCTs have been conducted on this issue, rendering the level of evidence low and, thus, patients should be informed accordingly, give informed consent before TRT, and undergo close monitoring.

Concerns have also been expressed about the ability of TRT to augment prostate volume and to worsen lower urinary tract symptoms (LUTS); thus, men with severe LUTS, as defined by an International Prostate Symptom Score (IPPS) >19, are usually excluded from trials on TRT. Accordingly, TRT in this population is contraindicated in most guidelines. However, this recommendation is not based on high-quality evidence [150]. Meta-analysis of studies of TRT in men with pre-therapeutic mild LUTS did not show either a worsening of symptoms or an increase in prostate volume after treatment [151]. A recent trial that included hypogonadal men with metabolic syndrome and benign prostate hyperplasia showed that TRT can improve indices of prostate inflammation [152].





Summary recommendation

TRT may be considered in hypogonadal men with a history of previous low-risk, localised CaP (Gleason score <7, pT1–2, pre-operative PSA <10 ng/mL) who have constantly undetectable PSA concentrations after a radical prostatectomy; however, close monitoring is mandatory .TRT should not be avoided in men with hypogonadism and benign prostate hyperplasia/LUTS; however, caution should be paid to those with severe LUTS (IPSS >19).
Went tomorrow. He was concerned with the increase in my psa. Weird since my tester one never went up while on it. Took me off androgen. Wants blood test in 3 weeks to see if osa goes down below 4.7. If not, he’ll send me to a urologist. Should i be concerned? Will it go back down?
 
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Went tomorrow. He was concerned with the increase in my psa. Weird since my tester one never went up while on it. Took me off androgen. Wants blood test in 3 weeks to see if osa goes down below 4.7. If not, he’ll send me to a urologist. Should i be concerned? Will it go back down?
Went “to doctor,” not “tomorrow”. typo
 
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