HCG and Androgel - Dr. John
- 09-26-2006, 01:31 PM
HCG and Androgel - Dr. John
In a regimen of daily SubQ HCG and Daily Androgel, does the HCG provide a stable T level for 24 hours until the next HCG shot, or does it spike T levels after the shot and then cause T levels to decline very quickly thereafter? What has your experience been with this regimen?
- 09-26-2006, 04:37 PM
How do you feel on the Androgel and HCG. I was on on Gel but no HCG and found gel good am but not so good pm despite taking 5mg am and 2.5-5mg pm. I am trying injections but wondered if using HCG with the gel would have been a good combination. I was on Testogel but found Testim to be better for some reason. I am in UK and our gels may be different
- 09-27-2006, 08:02 AM
For some reason, I seem to recall reading in a thread on one of the message boards that with HCG test levels peak approximately 6-8 hours later. I have no idea how fast the levels would fall after that though.
09-27-2006, 10:35 AM
I don't know about that I feel my HCG shot in an hour.Originally Posted by smitty4
09-27-2006, 11:05 AM
I wasn't trying to say that your levels would not increase soon after the injection. Rather, I interpreted what I read as saying that your levels would keep increasing until they reached their peak some 6 to 8 hours later. Then, your levels would decline again.
09-27-2006, 11:12 AM
OK I feel I feel it so fast is because my cortisol levels are so low and HCG kicks up cortisol some.Originally Posted by smitty4
10-05-2006, 01:33 AM
10-05-2006, 03:24 PM
Originally Posted by pmgamer18
Interesting. I have been fighting fatigue for 9 months (just after my angiolplasty/stent). At first I was told that my Thyroids might be low (turned out they were borderline high). Then I had my Test checked and it was borderline low. I fought for TRT and had to undergo more tests but finally got on Androderm 3 weeks ago. During all the eother testing I was told that I have low cortisol levels.
Are you taking a cortisol product along with the HCG (which I am not on...yet)?
10-05-2006, 04:17 PM
Yes I am I take an OTC supplement called Isocort one pill = 2.5 mgs. of cortisol. I would do much better on HC but my Dr. will not give me a script so the Isocort works and the first little pill I took gave me this feeling of well being big time.Originally Posted by glg
VitaminMD - Search Results
read this link if your going to try this.
Stop The Thyroid Madness » How to treat adrenals–for the patient and their doctors
Can you post your Thyroid Tests the best tests are TSH, Free T 3 and Free T 4.
10-07-2006, 10:09 AM
I also had this feeling when I first started on Isocort for my low cortisol levels and when I started on Armour it lasted most of the day. Now I am finding this feeling is a lot less now that my Armour dose if up to 90 mgs. a day. Some one that the Hypopituitary site told me as I treat my low cortiosl levels and Thyroid this feeling will start to go away strange.Originally Posted by Dr. John
10-08-2006, 11:48 AM
Yes I am I do 60 mgs. in the morning and 30 mgs at lunch. Tell me is it best to take Armour before eating or after.Originally Posted by Dr. John
10-08-2006, 06:01 PM
I have been taking my armour sublingually. Have you tried that?Originally Posted by pmgamer18
This way it doesn't matter if you take it around a meal. Some of the time i finish eating and take one of my doses 10 minutes later.
The only downside is it take some time to dissolve.
10-09-2006, 10:29 AM
I am going to try this taking Isocort before eating is upsetting my stomach. The Generic Armour I got last week is giving me Diarrhera. They say take without food so I will try doing this.Originally Posted by magic8989
As for the Isocort I read at a site to cue them.
10-09-2006, 12:58 PM
Dr. John, do you have any input on the pharmacokinetics of HCG with regards to the above? Thanks.Originally Posted by 1cc
10-09-2006, 08:45 PM
I noted that Armour Thyroid is out of stock, just when I was planning to buy some.Originally Posted by pmgamer18
Buy Armour (Armor), Titre, Eutirox Thyroid Online
Where are you buying your Generic version, what is its name, any differences between the real thing an generic?
10-09-2006, 09:43 PM
I think you will find you do better taking isocort with food. I noticed that it is less effective if i take it with no food. Thats odd about the armour side effects. Maybe it is because it is generic. Mine is from Forest Pharmacutacles and have never had any problems with it. Well, it sometimes does smell a bit.Originally Posted by pmgamer18
10-10-2006, 10:44 AM
It is called Westhyroid here is a link to the generic brands that are good.Originally Posted by JanSz
Stop The Thyroid Madness » Armour vs. Other Brands
If you go to the Adrenal Forum Val. can help you find them.
10-10-2006, 01:42 PM
Originally Posted by pmgamer18Just realised on the bottom of that page, they are also selling another brand , the picture shows Westhroid, it happen to be in one size only.Originally Posted by JanSz
120mg tablet is equivalent to two grains of thyroid.
In the text they say that it is: Brand name Nature or Westhroid.
Is this what are you taking, Phil?
With one (larger) pill it will require cutting it when adjusting the doses.
10-10-2006, 02:01 PM
Yes this is what I have Westhyroid mine is 1 grain 60mgs. But I was taking my wifes armour for a time it was a 90mg. pill that I cut in half when I first started then she had some 2 grain left so when I went up to 60 mgs I cut them in half. I use a pill cutter.Originally Posted by JanSz
10-10-2006, 03:48 PM
Going by marianco's advice:Originally Posted by pmgamer18
MESO-Rx - View Single Post - Update on Using Isocort.
"Most people tolerate starting at 30 mg of Armour Thyroid a day (about 1/2 a grain). If in good health otherwise, many tolerate starting at 60 mg a day. If the person is fragile in health or has significant adrenal fatigue, then I may start at 15 mg a day. Then I may ramp up in dose by 15 mg or 30 mg every 2 weeks as tolerated (i.e. so long as significant symptoms of hyperthyroidism do not show up), to an initial plateau of 60 mg before getting lab tests, then if needed, gradually increasing the dose every 2 weeks to 120 mg a day."
Those pills, either Armour or Westhroid, can they be cleanly and evenly cut at least into quarters or maybe eights.
Since it is better to take them twice daily (because of T3 life) if I would start with 120mg (2grains) Westhyroid I would need two 1/8 pils daily. May be hard to make this fine cuts.
10-10-2006, 05:10 PM
I started on the Isocort working my way up to 4 pills in he morning and 2 at noon and dinner. I take my temp 4 times a day and chart the avg. See this link.
Temperature Patterns of low adrenal and thyroid function
Using this to take my temp.
I was doing this about a month before the start of Isocort and my temp avg. was all over the place 97 avg. one day then 98 the next. As I got up to 8 pills = 20mgs of cortisol and this is safe read Safe uses of Cortisol by Jefferies.
My Temp started to stay level from day to day but under 98.6
more like 97.8 to 98.2 this is when I started on Armour 45 mgs. After about 2 weeks my temp went up to 98.6 and about the 4th week went way down to 97 for 2 days this is when I upped the dose to 60 mgs. and in a day my temp was back up to 98.6. After a time this happened again and I went up 15mg and have been there now for 8 days. So when my Temp goes Down I feel like crap and was sweating a lot and it was cold out side. I don't know if this means anything but when you try this you will see what I am talking about. If your Adrenals are low you need to go up slow to much Thyroid will stress your Adrenals.
10-11-2006, 10:57 AM
Dr. John: is that Acetyl-L-Carnitine, or L-Carnitine?Originally Posted by Dr. John
10 g D-Ribose? Would that down regulate anything in a body's energy system?
10-11-2006, 01:58 PM
Phil when are you taking your vitamins? because fiber and minerals in your Food could bind the Armour thyroid. I feel so much better being on t-3 and cortisol then armour. Sleeping so much better and plenty of energy strength going up as well. Now I just have to titrate up slowly been at 6.5 mcgs for a week will increase it another few days. Testosterone @ 5% was shutting me down with out regular hcg. I am waiting to see dr get blood work down on 10% with the hcg. I may switch to a slow release t-3, but I do not know if it is really necessary except it may decrease stress from adrenals. But it it slow releases then vitamins and mineral could interfer even if taken with 4-6 hours because the pill is still in your stomach could it not ? What makes this so difficult ther eare so many conlficting sides of the story whether slow release and normal t-3 which one is better even by drs. Be easier just to flip a coin to solve problem. if i did not have these damn rt3 then armour be way to go and life be so much simpilar thats for sure
10-11-2006, 03:10 PM
Armour most be taken on an empty stomach I started this morning putting it between my gums and cheek. This is talked about a lot and most feel is the best way to take it. I read the other day about a Dr. that dose not test rt3 anymore he felt that once one was on enough Armour or slow release T3 the problem goes way. I put the link in my files and it did not take. I can't find the site but it was a google search. If I come accross it I will post it. Been reading about Isocort allday and it's dam hard to find anything with all the adds for sale.Originally Posted by hardasnails1973
10-11-2006, 04:25 PM
10-12-2006, 08:34 PM
Well I was on armour with cortisol and rt3 kept rising. I found forum where lady was treated with regular t-3 and she had before and after test lab results in which rt3 droped in 6 months and was able to continue with armour with out rt3 increase. You are right i know of that dr its because if the t-4 is normal and t-3 is low then rt3 is elevated ...
10-15-2006, 09:42 PM
Weissman, A., S. Lurie, et al. (1996). "Human chorionic gonadotropin: pharmacokinetics of subcutaneous administration." Gynecol Endocrinol 10(4): 273-6.
The objective of the present study was to evaluate the pharmacokinetics of human chorionic gonadotropin (hCG) following different regimens of subcutaneous and intramuscular single-dose administration. Two hypogonadotropic hypogonadal volunteers received hCG injections without prior ovarian stimulation. The regimens included a single dose of 10,000 IU hCG either subcutaneously or intramuscularly, or 5000 IU hCG intramuscularly. Serum beta-hCG concentrations were measured periodically up to 13 days after hCG administration. Each of the three regimens exhibit a similar pharmacokinetic profile and the highest serum beta-hCG concentrations were achieved with a dose of 10,000 IU administered subcutaneously. Seven days after hCG administration beta-hCG was detectable only after subcutaneous or intramuscular administration of 10,000 IU, but not after a single intramuscular injection of 5000 IU. From the preliminary results of the study it is suggested that a single intramuscular dose of 5000 IU hCG might be sufficient to trigger ovulation, but for luteal-phase support a higher dose may be needed. Subcutaneous administration of hCG for the induction of ovulation or luteal-phase support in gonadotropin-induced cycles is feasible and might offer a better tolerance and cost-effectiveness of infertility treatments, leading to their further simplification.
Trinchard-Lugan, I., A. Khan, et al. (2002). "Pharmacokinetics and pharmacodynamics of recombinant human chorionic gonadotrophin in healthy male and female volunteers." Reprod Biomed Online 4(2): 106-15.
The pharmacokinetics and pharmacodynamics of recombinant human chorionic gonadotrophin (rHCG) were investigated in three studies of healthy volunteers. After single intravenous doses of 25, 250 and 1000 microg, rHCG and urinary HCG (uHCG) showed linear pharmacokinetics described by a bi-exponential model, although the area under the curve (AUC) for uHCG was ~29% lower than for rHCG. After intramuscular or subcutaneous administration (absolute bioavailability, 40-50% for both), rHCG pharmacokinetics could be described by a first-order absorption, one-compartment model. During multiple subcutaneous dosing, the amount of HCG increased by approximately1.7-fold. A comparison of liquid and freeze-dried rHCG and freeze-dried uHCG showed pharmacokinetic bioequivalence. In down-regulated male subjects, single doses of 125 microg rHCG, given intravenously, intramuscularly or subcutaneously, produced comparable increases in serum testosterone, inhibin and 17beta-oestradiol, with little further increase during repeated subcutaneous administration (in female subjects, this produced a sustained comparable increase in serum androstenedione and testosterone concentrations). In conclusion, the pharmacokinetics and pharmacodynamics of rHCG are similar to those of uHCG and are not affected by the use of different formulations. In healthy subjects, rHCG produces pharmacodynamic responses consistent with HCG physiology and is suitable for use in the same clinical indications as uHCG. The secured source and high purity of rHCG may offer important advantages.
Burgues, S. and M. D. Calderon (1997). "Subcutaneous self-administration of highly purified follicle stimulating hormone and human chorionic gonadotrophin for the treatment of male hypogonadotrophic hypogonadism. Spanish Collaborative Group on Male Hypogonadotropic Hypogonadism." Hum Reprod 12(5): 980-6.
The efficacy and safety of highly purified follicle stimulating hormone (FSH) associated with human chorionic gonadotrophin (HCG) was studied in 60 men with hypogonadotrophic hypogonadism. Of these men, 16 suffered from Kallmann's syndrome, 19 from idiopathic hypogonadotrophic hypogonadism and 25 from hypopituitarism. Basal testosterone concentrations were found to be far below the normal range. At baseline, 26 patients were able to ejaculate and all of them showed azoospermia, while the remaining patients were aspermic. All patients self-administered s.c. injections of FSH (150 IU x three/week) and HCG (2500 IU x two/week) for at least 6 months and underwent periodic assessments of testicular function. Testosterone concentrations increased rapidly during treatment and all but one patient reached normal values. Testicular volume showed a sustained increase reaching almost 3-fold its baseline value. At the end of treatment, 48 patients (80.0%) had achieved a positive sperm count. The maximum sperm concentration during treatment was 24.5 +/- 8.1 x 10(6)/ml (mean +/- SEM). The median time to induce spermatogenesis was 5 months. Eleven patients reported adverse events, generally not related to treatment. Three patients experienced gynaecomastia. No local reactions at injection site were observed. In conclusion, the s.c. self-administration of highly purified FSH + HCG was well tolerated and effective in stimulating spermatogenesis and steroidogenesis in these patients.
Jones, T. H., J. F. Darne, et al. (1994). "Diurnal rhythm of testosterone induced by human chorionic gonadotrophin (hCG) therapy in isolated hypogonadotrophic hypogonadism: a comparison between subcutaneous and intramuscular hCG administration." Eur J Endocrinol 131(2): 173-8.
When human chorionic gonadotrophin (hCG) is used to stimulate testosterone synthesis and release in males with hypogonadotrophic hypogonadism, it is administered two or three times weekly by intramuscular injection. We have compared the pharmacokinetics of a twice weekly standard dose of hCG (5000 U) given for the first week by intramuscular injection and in the second week by self-administered subcutaneous injection. The patients studied had Kallmann's syndrome, isolated idiopathic hypogonadotrophic hypogonadism or post-traumatic isolated hypogonadotrophic hypogonadism. Salivary testosterone was collected twice daily at 08.00 h and 20.00 h, and serum testosterone was collected after 0, 24 h, 72 h, 120 h and 168 h each week. The cumulated serum and salivary testosterone levels were comparable on both intramuscular and subcutaneous hCG. In normal males there is diurnal variation in testosterone, with peak serum levels in the morning falling to a nadir in the evening. The exact nature and controlling factors of this circadian rhythm have not been established. In four of the subjects, the twice weekly hCG injections, either subcutaneous or intramuscular, produced a regular testosterone diurnal rhythm. The other four patients had fluctuations in testosterone but with no strict diurnal pattern. This study provides evidence that the luteinizing hormone-like action of hCG is necessary to prime the circadian rhythm but only a single bolus of hCG is sufficient to induce the rhythm in the absence of endogenous gonadotrophin production. In conclusion, self-administered subcutaneous hCG is safe and produces comparable levels of serum and salivary testosterone to that administered by the intramuscular route. Moreover, it was very well accepted by the patients and was preferred to conventional treatments. Human hCG in some patients with hypogonadotrophic hypogonadism produces normal physiological changes in daily testosterone levels.
Saal, W., H. J. Glowania, et al. (1991). "Pharmacodynamics and pharmacokinetics after subcutaneous and intramuscular injection of human chorionic gonadotropin." Fertil Steril 56(2): 225-9.
OBJECTIVE: The pharmacokinetics and efficiency of human chorionic gonadotropin (hCG) after subcutaneous (SC) injection was to clarify in comparison with the intramuscular (IM) mode of administration. DESIGN: In a prospective study, the pharmacokinetics of hCG and the response of serum testosterone (T), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) after an IM and SC injection of 5,000 IU hCG were evaluated up to 144 hours in two randomized groups. SETTING: The study was carried out in a clinical dermatology department providing tertiary care. PARTICIPANTS: Twenty-four healthy male volunteers with a mean age of 22.7 +/- 4.3 years were divided into two groups. INTERVENTIONS: Human chorionic gonadotropin (5,000 IU) was injected IM or SC. MAIN OUTCOME MEASURE: Serum concentration of /b-hCG, T, LH, and FSH were evaluated after IM and SC administration of hCG. Differences between the two groups were determined by t-test. RESULTS: Compared with IM administration of hCG, peak serum drug concentration was significantly delayed (P = 0.01) and serum half-life was prolonged (P = 0.01) after SC injection; however, T, LH, and FSH responses were identical. CONCLUSIONS: Subcutaneous application of 5,000 IU hCG is as effective as IM administration in terms of steroidogenesis.
10-22-2006, 01:38 PM
I believe the acetyl-L-Carnitine is more bioavailable. Take it on an empty stomach. I buy raw powder form from earth links nutrition 888-279-8577, otherwise its terribley expensive (more terribley than my spelling)Originally Posted by wildfox
10-25-2006, 08:10 AM
Basically reverse t3 is very simlar to thyroid antibodies except it effects the t-3 receptors instead of the t-4. On urine test i have eliminating alot of xylene and wondered what it was. I finally researched it and it is a byproduct of xenoestrogens. Since xenoestrogen mimic estrogen and attatch at the same receptors sites as estrogen would a blood test give a false reading. Could I possible be estrogen dominant with out having elevated estrogen levels in the blood. My dr said my estrodial was high at 30 and i told him that was with out TRT and he was a little concerned. I am waiting him to order more compounded testosterone but I ran out for 4 days. Could this cause a pretty severe crash from 10 grams to nothing? Right now I am using calcium d glucurate to help remove the bad estrogenOriginally Posted by Dr. John
10-28-2006, 01:10 PM
I like the taste of armour. Sicko, huh? LOLOriginally Posted by Dr. John
Sublingual is very popular in the alt.support.thyroid group.
11-06-2006, 10:25 AM
Thanks Dr. John I am now doing 60mgs in the morning before eating and 60mgs at 1pm before eating. Just got up to this dose last Sunday so far no problems. Just got back from FL. drove what a trip. We got to see the best fall colors on the way there and back.
11-06-2006, 03:09 PM
Yes and I have to say better we came back through south and north Carolina in the Smokey Mountains. My E2 must have been up it took my breath away it was so beautiful.
11-14-2006, 02:05 PM
How long after testosterone creme can one take a blood test to be accurate to give a reading. 2 weeks or 4 weeks would be best. All i know is that I stopped all antiestrogens and just using testocreme 10% per 1 gram just to get a true reading of estrodial free test and total testosterone. Since 2 weeks stopping antiestrogen I can feel the difference such as more pronounced symptoms of estrogen dominance. Let time i got tested a while ago estrodial was 30 with out any testosterone replacement so be interesting to see what it is now. Last testosterone reasing was total was 230 and free test was 8.1 plus I was pissing out xylene which is a xenoestrogen so hopefully it estrogen should be off the charts.
11-14-2006, 02:20 PM
Testocreme is made using a PLO gel base, which absorbs too quick and may cause estrogen problems. If you use a T creme, then use one made with a vanishing creme base, which absorbs much slower and leads to more stable T levels. You can get this at Women's International Pharmacy - Natural hormone replacement therapies - compounding specialists for women/men, and it's much cheaper than Testocreme as well. Labs can be done after 2 weeks on T creme.Originally Posted by hardasnails1973
11-14-2006, 02:29 PM
Yes i am using testocreme one from testocreme.com said that it suppose to be the best on the market. Would seperating the dosages help relive the estrogen increase. All variables stayed the same except i stopped the arimdex (.5 mgs 2 times a week) and a week later been getting bad bloating brain fogg, and tits hurt, constipation. exercise intolerance as well.
11-15-2006, 12:28 PM
It is best to dose the T creme once daily in the morning. Testocreme is not a good T creme because of the PLO gel base.Originally Posted by hardasnails1973
11-15-2006, 01:16 PM
so any compounding pharmacy will do then? as long as it is not PLO. I wish I would have known this in the beginning. You recommended the women's international pharmacy is this the one DR john goe through as well? When I take the blood test should I apply the creme about 2-3 hours prior the test. Since Plo releases fast would this cause testosterone levels to be altered due to rapid absorption giving a false high. SO this would probably explain why stopping the armidex my tits were killing me and joints hurting, bloating (all wonderful signs of estrogen excess). So just simply swithcing to a creme with out PLO would make all the difference and may be no anti estrogen would be needed then.
11-15-2006, 01:41 PM
Women's International is one of the largest in the country and has the best prices. You can order 100mg/gram T creme and use 1/2 a gram which will be 50mg of T.Originally Posted by hardasnails1973
The fact that it absorbs too quickly will cause a higher conversion to Estrogen.Originally Posted by hardasnails1973
For most guys 50mg T Creme is sufficient to raise T levels to the upper quarter of the normal range. If you use more than this (more than you need), then it will more likely convert to Estrogen.Originally Posted by hardasnails1973
11-15-2006, 07:39 PM
The vanishing cream I use actually absorbs very quick. With the PLO gel there is a concern with the rate at which the medication gets to the blood which can be too quick. I have highlighted the following text.Originally Posted by Dr. John
Topic: Creams, Gels and Lotions
Not quite the same ring as trains, planes and automobiles but creams, gels and lotions are an important component to the success of the therapy you prescribe for your patients. Have you given this much thought? I know doctors and most pharmacists in my community do not. The docs write a prescription for a transdermal (whether that be pain medication or bio-identical hormone replacement medications, etc)-tell the patient to go to a compounding pharmacy and have the prescription filled. The patient calls the practitioner in the middle of the night because she is having hot flashes due to her “medicine” not working. Is it the dose, the time of administration…OR is it the base used? The issue occurs when the doc is not specific on what base to use and/or the pharmacist is not knowledgeable or proficient enough in compounding to adequately inform the physician on the best vehicle to use.
This topic will be discussed in detail at our upcoming seminar in Las Vegas. For now, however, let me discuss some practical issues on this subject. Medaus Pharmacy has both anecdotally and quantitatively determined the following:
Lipoderm or PLO bases are alcohol based and has a high rate of absorption. This high rate drives the medication through the layers of the skin and at times through the fat (lipid soluble) resulting in peak-valley pharmacokinetic results. With Bio-identical hormones for example, depending on when (what time) samples are taken for lab purposes (versus when the base is applied) can affect the concentration reading of the hormone. With BHRT this is not the goal so we do not recommend PLO unless testosterone is the active ingredient.
Vanishing cream as well as Medaus Cosmetic HRT base has less “force” of penetration of hormones for instance, resulting in slower release than other creams and by default results in more consistent levels for the patients. More appropriate pharmacokinetic characteristics for BHRT.
Emollient Cream bases have been around for ages…they are effective but tend to leave an oily/sticky feeling on the patients skin.
Vanishing Cream bases are effective, light and more “cosmetically” appealing than the other bases but is not as consistent as the Medaus Cosmetic Cream HRT base.
In addition, different skin types, among other things, plays a major role in the decision of which cream to chose. At Medaus, we have found that the Medaus Cosmetic HRT cream base or vanishing creams deliver the best results regardless if the patient has dry skin, oily or leathery. Also, age considerations should be noted due to thickness of skin or lack thereof due to aging.
At this point, Medaus Pharmacy is recommending Medaus Cosmetic HRT base for water soluble hormones.
Please do not overlook this important variable. It will keep you and your patients happy.
I hope this information is helpful and for more detailed information please feel free to contact the Medaus Pharmacy at 800-526-9183. I also encourage each of you to exchange ideas on Home: Welcome to Medaus Compounding Pharmacy - Medaus Pharmacy and Compounding Center pharmacy forum.
11-16-2006, 01:31 AM
Yes, I noticed the testosterone exception Dr. John. I don't even know why they have it as an exception, since the primary objective of any good delivery method is "slow and steady". It's the only reference I have for how PLO gel works and I wanted to post the article in it's entirety. I have spoken to a number of compounding pharmacists in the past and they all echoed similar concern regarding using PLO gel as a base.Originally Posted by Dr. John
As you know, with a TD, the base that is used, the concentration of the cream/gel, where you apply it, as well as the surface area of skin that it is applied to, are all factors in the pharmacokinetics. The vanishing cream bases need to be applied to thin hairless skin like inner bicep or inner forearm area. Applying it on thicker skin will slow it down too much. Androgel needs to be applied on the thicker skin of the shoulders. If it were applied to the inner bicep, it would probably deliver too quick. With PLO gel (Testocreme), I believe that the creater Dr. Kryger actually includes chrysin in the formula (last I spoke to him), so I guess Estrogen must have been a concern for him. He applies it to the rib area a couple inches under the armpit to an area the size of a soda can.
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