Scrotal TRT Cream Application - A Precautionary Tale

[Shawn M]

I had been on 50 md/l T Cream (applied trans-dermal to the inside of my forearms) since 6/2018, and at 9/2018 I noticed that I was feeling worse, and my Total and Free T and E2 went down below what they were when I started. I gave my doctor Dr. Crisler’s book, and finally convinced him to allow me to try HCG (300 IU EOD) beginning 2/2019. The main symptoms I was trying to address were lower back pain (I thought due to low E2, but likely another factor), Male Sexual Function (MSF – ED), and poor sleep patterns.

At my most recent Dr visit to discuss lab work, E2 appears to have crashed, and Total and Free T were down:

7/9/19
Testosterone, Free + Total, LC/MS 388 (Ref. 264.0-916.0 ng/dL)
Free Testosterone 13.6 (Ref. 6.6-18.1 pg/mL)
Estradiol Sensitive 5.6 (Ref. 7.6-42.6 pg/mL

This could have been a bad E2 reading but the total T reading supported it somewhat. Due to these low numbers that I somehow settled into (with 50 mg/ml and 300 IU HCG EOD), and persistent poor sleep patterns and MSF-ED, I convinced my Dr. to double the strength of my T cream from 50 to 100 mg/ml.

Other pertinent lab tests during my treatment period were:

4/4/2019
Sex Hormone Binding Globulin 58.9 (Ref. 10 to 57 nmol/L)
4/15/2019
TSH 13.7 (Ref. 0.450-4.500 uIU/mL)
Thyroid Peroxidase Ab 278 (Ref 0-34 IU/mL)
Thyroglobulin Ab 446 (Ref. 0.0-0.9 IU/mL)
Triiodothyronine (T3), Free 3.8 (Ref. 2.0-4.4 pg/mL)
T4,Free(Direct) 1.21 (Ref. 0.82-1.77 ng/dL)

I started using the new RX for stronger T Cream on 7/31/19. I had tried to research enhanced absorption of T Cream using the Atrevis ® cream base. A nationally known mail order pharmacy near Houston, TX told me that they wouldn’t supply their T cream with this base, and further, had few complaints from their customers about T absorption using their usual base (VersaBase). At this time the Excel Male forum was buzzing with discussion about scrotal application, so I tried the combination of 2 clicks to forearms am and two clicks to the scrotum pm. By mid-September (this month) I was feeling noticibly “jittery” with the following symptoms, and suspected the combination of higher T strength and higher absorption put me over the top:

* An unproductive shift of focus I can best describe as “sexual antsiness”, and obsession with my sexual functioning (ED didn’t improve)
* No aggression, but a lowered baseline of resilience and tolerance, eg, snapping at minor mishaps like dropping something in the kitchen
* My (systolic) BP seemed to spike from the lower 130’s to the lower-mid 140’s. Pulse rate seemed higher as well.
* Some nights of poor sleep were worse than ever.


I thought it best to have some tests done myself, as I’m trying the new application area on my own and don’t want to get in trouble with my MD (Thanks Nelson for the Discounted Labs discount codes!). I added DHEA-S and Prolactin to the mix to uncover those stones for ED, and also wanted to know if DHT had gone out of range (I had no previous test on it). Maybe not smart of me, but I also gave myself both doses (forearms and scrotal) two hours before the test. Sure enough, my numbers shot way too high (one of the forum’s worst over-titrations?):

9/9/19
Testosterone, Free + Total, LC/MS >1500 (Ref. 264.0-916.0 ng/dL)
Free Testosterone >50 (Ref. 6.6-18.1 pg/mL)
Estradiol Sensitive 49.8 (Ref. 7.6-42.6 pg/mL)
Dyhydrotestosterone 579 (Ref. 30-85 ng/100ml)
DHEA Sulfate 153.4 (Ref. 30.9-295.6 ug/dL)
Prolactin 16.6 (Ref. 4.0-15.2 ng/mL)


I think the high DHT caused most of my adverse symptoms. Luckily the androgenic compounds have a short half-life, and shortly after returning to 4 clicks on my forearms only AM, the jitters are gone. But I’m hoping the increased T-Cream strength will result in improvements for me vs. earlier this year. I plan to retest (always including DHT, even if my insurance won’t pay) in a couple of months.

I would appreciate any insight or feedback from forum members. I think we have to be careful with T-Cream and high DHT (DHT should always be checked on follow-ups, I feel).. Whereas good T-levels are beneficial for the heart, DHT levels out of range could be a serious problem. I encourage members trying this protocol to keep tuned in to their body and think of how out of range DHT might affect you.

 

[Vince Carter]

What is your application and testing time line, you should be having a blood draw about 3hrs after application.

 

[BigBamBoo]

Are those thyroid numbers correct? If so, you have some major thyroid issues.

 

[Shawn M]

What is your application and testing time line, you should be having a blood draw about 3hrs after application.

Application is generally about 6 am. Nearest Labcorp is about 8 miles away in morning rush hour traffic, so yes, I'll try to get there by 9 am. Threre is also a morning queue at the draw office.

 

[Miironleg]

How are you not addressing a thyroid autoimmune disease?

 

[Dr Justin Saya MD]

Are those thyroid numbers correct? If so, you have some major thyroid issues.

^^^ This requires attention. Discuss with your doc.

Agree with your cautionary tale. As I’ve noted multiple times on this forum, particularly for patients applying full replacement TRT doses (or close to it) directly to the scrotum, it is not uncommon for DHT levels to go quite high (500s as you’ve experienced is surprisingly common). Unfortunately, many who utilize this technique also advocate NOT routinely monitoring DHT. That may be convenient, but sadly is not a case of “what you don’t know won’t hurt you”.

 

[Gman86]

So if my math is right, each click is 25mg? So you’re currently doing 100mg all in the am, and all to the inner forearms? Are you doing all 4 clicks in the am, or 2 in the am and 2 in the pm?

So you didn’t notice a much greater libido when DHT was super high on the half scrotal, half forearm applications?

Has your BP gone down now that you stopped the scrotal application?

 

[Nelson Vergel]

Like some other guys have mentioned, why are you not addressing your high TSH and antibodies? You may have Hashimoto's. Hashimoto's excelmale.com site:www.excelmale.com - Google Search

 

[Dr Justin Saya MD]

What will very high dht do over a longer period of time? Say 2x-4x normal high lab ranges.

I know of potential problems with the prostate and such, but I didn’t think there was any solid proof it would lead to issues??

In this case it’s closer to 7x upper reference range, though we all know the limitations of “reference ranges” this is still undoubtedly quite “supraphysiologic”. To your point, we don’t know...uncharted waters. At some point, however, we have to use common sense and follow the most fundamental law of hormones (okay not an actual law, but the primary tenet that guides me) - balance is key. Too low or too high = problems (whether symptomatic or health-wise). Where is that line? We don’t know. Folks in uncharted waters must be aware and know that the risks are unknown, but should not be accepted as non-existent. Risk tolerance dictates how comfortable patient and provider are in those uncharted waters.

To be clear, I am NOT bashing scrotal T application. In fact, I have been selectively (in select patients/cases) utilizing that technique for many years before it became the buzz in the forums. I credit the great Dr Shippen for that wisdom. Most often relatively small dose as adjunct to injections or as partial (not full) transdermal T dose. However, never without monitoring DHT.

 

[Joe Sixpack]

Let us know what comes out of the thyroid discussions w/ your doctor. You have a super interesting case that we can all learn from.

 

[Vince Carter]

I can't get the labs to pull up so I couldn't see those Thyroid values but if others are strongly saying it then it's a real thing to delve in to.

 

[BigBamBoo]

I can't get the labs to pull up so I couldn't see those Thyroid values but if others are strongly saying it then it's a real thing to delve in to.

Hi Vince.
Here is what he posted for his lab values:

TSH 13.7 (Ref. 0.450-4.500 uIU/mL)
Thyroid Peroxidase Ab 278 (Ref 0-34 IU/mL)
Thyroglobulin Ab 446 (Ref. 0.0-0.9 IU/mL)
Triiodothyronine (T3), Free 3.8 (Ref. 2.0-4.4 pg/mL)
T4,Free(Direct) 1.21 (Ref. 0.82-1.77 ng/dL)

 

[Vince Carter]

OK yep I'm in agreement with my friends above, need to be evaluated for what is called Hashimoto's (or "Hashis") Disease as indicated by the antibodies.

 

[Shawn M]

Thanks, responders to my post, and noting the peculiar high numbers on some of my thyroid tests. This came about when I first ordered just a TSH on my own from Discounted Labs, and when it came back high, I had incentive for my Doc to order a full panel. This shows the great value of both this forum and being able to order tests at a reasonable rate on our own when we need to check what other conventional MDs might not check.

When I double-checked my numbers, it turns out the first test I reported was repeated in July with similar results:

4/15/2019
TSH 13.7 (Ref. 0.450-4.500 uIU/mL)
Thyroid Peroxidase Ab 278 (Ref 0-34 IU/mL)
Thyroglobulin Ab 446 (Ref. 0.0-0.9 IU/mL)
Triiodothyronine (T3), Free 3.8 (Ref. 2.0-4.4 pg/mL)
T4,Free(Direct) 1.21 (Ref. 0.82-1.77 ng/dL)


7/9/19
TSH 6.6 (Ref. 0.450-4.500 uIU/mL)
Thyroid Peroxidase Ab 275 (Ref 0-34 IU/mL)
Thyroglobulin Ab 361 (Ref. 0.0-0.9 IU/mL)
Triiodothyronine (T3), Free 3.1 (Ref. 2.0-4.4 pg/mL)
T4,Free(Direct) 1.05 (Ref. 0.82-1.77 ng/dL)

At my April visit when the numbers were first discussed, a Thyroid problem was dismissed when the the most important T3 and T4 numbers were in the reference range. We both agreed that the TSH value was off due to my HCG protocol.

I checked Hashimoto's disease, and rest assured, I have none of the symptoms, only an earlier nagging lower back pain that cleared greatly during my program when I started HCG. My back felt even better when I went off Hydrochlorothiazide that was used out of caution by my MD to check BP in the high 130's and low 140's. I'm confident that the diuretic was flushing key nutirients out of my body and causing more problems for me than helping anything. I feel so much better without it, as I've posted elsewhere in the forums.

I will call my high numbers to my Dr's attention at the next visit in a month or so and report back.

 

[fifty]

Tsh off due to hcg? I don’t know about that one.

 

[Shawn M]

So if my math is right, each click is 25mg? So you’re currently doing 100mg all in the am, and all to the inner forearms? Are you doing all 4 clicks in the am, or 2 in the am and 2 in the pm?

So you didn’t notice a much greater libido when DHT was super high on the half scrotal, half forearm applications?

Has your BP gone down now that you stopped the scrotal application?

Yes, each click is 25 mg, and I usually apply in the AM, except on workout days, I apply after showering. I got the idea of inner forearms from Dr. Crisler's book - no wasting by spreading with your rough-skinned hand.

Yes, I would also describe the "sexual antsiness" from before as "over-the-top batshit crazy"

Yes my morning BP is now back in the low 130's and sometimes mid-120's. Another MD has advised me that the Omron home devices such as I use are +- 5-10 pts and generally read high due to liability concerns of the manufacturers. The MD checks are with a wall manometer and stethescope to my inner elbow area.

 

[Shawn M]

Tsh off due to hcg? I don’t know about that one.

It's reported by Nelson elsewhere in the forum. Check his material on HCG.

He also referenced the attached excellent article on the meaning of TSH values.

 

[falconberg]

Maybe not smart of me, but I also gave myself both doses (forearms and scrotal) two hours before the test.

Maybe I'm missing something, but you gave yourself a double dose (a full day's worth of your current protocol, which is normally split into two doses), then got tested two hours later, and are now using that as a cautionary tale for high DHT? That would be like someone on 200 mg of testosterone giving themselves 400 mg, then testing at the peak concentration, then being surprised that their lab results were far out of range.

 

[fifty]

It's reported by Nelson elsewhere in the forum. Check his material on HCG.

He also referenced the attached excellent article on the meaning of TSH values.

Lots of guys on hcg. Not many tsh scores of 14.

 

[madhacker]

This is basically the impression I had which you confirmed. We really don’t know. Some doctors are risk averse, and some are just the opposite. Same goes for the patient.

Sticking within lab ranges where millions of people have theoretically been healthy appears safest. Truth is it’s possible that the higher lab ranges are EVEN healthier. I’m playing devils advocate here. We all made that same leap deciding to do TRT for the rest of our lives(most have this mindset I believe). The data for a proper TRT regimen of 30-50 years isn’t there. I knew this and made peace w it.

Hi there,

I understand there’s a lot of uncertainly and even distrust since this “rise of scrotum cream” has trended by some of these doctors that have strong bias. One thing for sure though is that lab ranages do matter, you’re lab ranges for prolactin are high which coordinates with your ED. Honestly, testosterone therapy is figured out, what isn’t is metabolism. I would do everything to fix your metabolism and that’s where you’re going to see results. Like everyone has said before improve your thyroid, autoimmune and prolactin.