Your Dr. is not doing this right he needs to retest you in 2 weeks why let you suffer did you know your levels can go down if the gel is not getting through your skin. Some men can't us gels and others that have a bad Thyroid there skin get thicker and gels don't work. Here is a cut and paste on what Dr. M says about this.
==========================================================
DrMariano
Physician, Psychiatrist
Join Date: Mar 2009
Location: Carmel, California
Posts: 611
|
Transdermal Hormone Replacement
[HR][/HR]Quote:
Originally Posted by chaos 
What is your opinion as to the steadiest release from a transdermal. I used them prior to injectibles, but my testosterone never increased, just DHT. I used androgel and a 10% PLO.
People on the boards told me I didn't absorb (since T didn't increase), but my doc said the increase in DHT was proof something absorbed, though he was uncertain as to why all of it seemed to go to DHT.
Speaking to your comment, he postulated I absorbed it "in one shot" as opposed to a steady release, so I therefore had a spike in DHT, similar to the spike the day after an IM injection.
|
Ideally, for hormone replacement therapy, the transdermally based hormone is transferred into the fat layer of the skin. From there, the hormone can be released gradually into the bloodstream, producing stable level.
Alcohol-based gels are more useful for hormone replacement since they allow the hormone to be absorbed into the skin fat and to be slowly released into the blood stream.
Oil-based transdermal gels or creams - such as the PLO gels - are good for rapidly introducing substances into the system. They aren't as useful for hormone replacement therapy because they cause the hormone to bypass the skin fat and allow the hormone to directly go into the blood stream. This causes a large peak and a rapid fall in blood levels.
Both alcohol-based and oil-based gels or creams will result in good absorption generally. They generally result in predictable blood levels of hormones and medications. If the blood level does not go up, then it is not being absorbed. Thus if a testosterone transdermal does not result in an appreciable increase in testosterone it is not well absorbed.
Some people will have difficult absorbing a transdermal preparation. For example, people with hypothyroidism, can develop mxedema. This is a thickening of the skin due to the accumulation of mucin - a glue that holds cells together. This prevents transdermal absorption. In my patients, if a person develops lower thyroid hormone levels from either transdermal testosterone or estradiol, testosterone and estradiol levels fall. When I address thyroid hormone, testosterone and estradiol will again be abssorbed and levels rise. Other reasons for non-absorption include possible ethnic differences or genetic differences in skin such as oilier skin, etc.
One other reason a hormone level does not go up is that the dose used is too low. For example, many patients are given one 5 gram packet of Androgel to use. This is too low for many men. Since there is negative feedback controlling testosterone production, at a certain dose, the dose is too low to make up for the loss of one's testicular testosterone production, when exogenous testosterone is added. Testosterone level actually will decrease when only 1 5-gram pack is used in many men. The percentage of men where testosterone will be low rather than high decreases when two 5-gram packs of Androgel are used. This would be the starting dose I would use. In these men, there is evidence of absorption - such as DHT (dihydrotestosterone) levels going up. But testosterone is either the same or LOWER. In these men, testosterone in Androgel IS absorbed. But the dose is too low.
__________________
-
Romeo B. Mariano, MD, physician, psychiatrist
Any information provided on www.definitivemind.com is for informational purposes only, is not medical advice, does not create a doctor/patient relationship or liability, is not exhaustive, does not cover all conditions or their treatment, and will change as knowledge progresses. Always seek the advice of your physician or other qualified health provider before undertaking any diet, exercise, supplement, medical, or other health program.
|
-----------------------------------------------------------------------------------------------------------------------------------
Here is a copy of a file I make about going on Gels.
=======================================================
Starting on Androgel, Testim or Creams.
Yes this happens a lot you start on a low starting dose 5 grams when your brain sees the testosterone in your blood even just a little it slows down even stops sending the LH and FSH message to your testis to make the Testosterone you were making. So let’s say your labs for Total T were 350 you add this dose of gel your brain sees this and you lose the base level you had before the gel.
Now lets say you need more then 5 grams most do so now all you left with is what the gel is doing so lets say it's doing 200 so you lost 150.
The reason you feel good is your levels go up that 200 the gel is doing in the first 2 weeks so your levels go up to 550 in theory. The brain sees this and you fall back.
Why can this happen it might be how your putting on the gel, with Androgel you need to spread it over your upper arms and shoulders and down your back as far as you can reach this is half of your dose then do the other side. Just spread it over the area but don't rub it in.
The other thing is it's not getting through your skin good so you need more. If you have a thyroid problem your skin will become thicker and gels and creams don't get through the skin and you need to switch to shots.
I tell men when they go on Gels to retest in 2 weeks because you can end up feeling worse. Most men just need more gel. Dr.'s that tell men to go on 5 grams of gel and come back in 8 to 12 weeks for labs don't know much about the use of gels. Dr.'s that treat a lot of men for low T on gels see this happen and test them again in 2 weeks.
When you go to do labs get up and shower that morning go do your labs and then put in the gel after your blood test so you don’t spike up your labs. If you can’t do labs in the morning shower put on the gel but don’t get any gel on the spot they take the blood from. Do your labs about 6 hrs later.
Call your Dr. and tell him this and that your not feeling good you were but fell back.
