T Nation

24 Yrs Old. Started with Gel, Stopped After Side Effects. Advice?


#1

Hey guys,

So been on here before. 24 year old guy, 170cm height, 63kg weight, active and otherwise healthy. Blood sugar, cholesterol, thyroid, oestrogen etc all within healthy ranges, but total testosterone hovering around 15mnol-17mnol which is low for my age. In addition, I have ALL the symptoms of low testosterone; everything from loss of morning erections to complete disappearance of libido, reduced muscle bulk and the dreaded ED!

GP put me on Testo Gel, as given the absence of a credible alternative diagnosis combined with my sub-optimal readings and symptoms, we both agreed TRT may be what I need. I applied a sachet of 50mg 5g gel daily, and shortly after began getting severe headaches and raised blood pressure, with NO IMPROVEMENT at all in relation to any of my symptoms. GP advised, given bad headaches and the dangerous rise in blood pressure, to stop the gel. I am now on no TRT at all, still suffering with the symptoms I was before. My latest total testosterone reading again came in at a mere 15mnol. GP has referred me for an endocrine opinion to test for potential Cushing’s Syndrome, thyroid disease or prolactin issues.

Question to guys on here really are as follows: Any guys on here who began TRT with gel and had to switch to another method? Any of you use the gel and actually get real symptom improvement from it? Also, might it be that my levels are low because of some other hormonal problem, and that correcting that first might negate the need for me to use TRT?

Given my age, and the risks associated with the treatment, I am determined to try and avoid TRT unless it is absolutely essential. However, having ED, no libido, man boobs and general depression at my age is completely unbearable, and I am very eager to resolve these symptoms.

Would welcome thoughts or advice from you guys as to how to go forward.


#2

Gels did nothing for me, it was like wiping on water. Gels have some serious side effects for some and have heard of others having your symptoms, surprised your doctor didn’t switch you over to injections. Gels generally have poor absorption rate and those that do absorb only do so for a little while until their body stops absorbing altogether.

Injections are by far the most effective form of TRT, don’t allow your doctor to give you a protocol where you are injecting every 2-3 weeks, these terrible protocols are still in practice today. Don’t be at all surprised if your new doctor comes back with your T levels are fine, we see it all the time and it’s a clueless doctor.

At 24 years old you should be significantly higher than you are, below 15 nmol/L is where the symptoms begin. If going through the NHS don’t waste your time, you may need to go private.


#3

Hello,

Thank you for your reply. Yes, I have heard that of all the TRT methods gels are usually the least effective and that as a rule injections are the gold standard. My GP told me that a guy of my age should have a total testosterone of around 21mnol-25mnol, is this the sort of level that should be aimed for with the treatment?

Unfortunately many of the specialists I have seen have been NHS ones, and as you say cite the binary reference charts to me and tell me that my levels are “normal”, even though a level of 15mnol is probably what your average 70 year old man has!

What would your advice be? Would you suggest I ask my doctor to put me on injections, or Tostran which is a cream I believe? Tostran has been suggested as an alternative to the gel, and I understand that Tostran is a higher dose product?

Given my age and the risks of the treatment, I want to be absolutely sure that I need it and, should I be taking it, naturally I want it to actually relieve my symptoms and improve my quality of life!

Look forward to hearing back from you.

Joe.


#4

NHS doctors are terrible, just do a search NHS doctors and you’ll see what I mean. State provided healthcare of any country end up being sub standard. You had a bad experience with tropicals and now you want another go at it, I’m assuming you are afraid of needles. Whenever a guy comes down with sexual dysfunction, that’s the first sign that his heart is to follow suite.

You should share your labs, perhaps there’s something your doctors completely overlooked.


#5

Hello,

Yes, unfortunately NHS doctors, especially GPs’ seem pretty clueless and adopt a one size fits all approach to issues relating to low testosterone. Telling me, at 24, that a level of 15mnol is normal may be correct, but normal does not mean healthy!

In terms of my options going forward, do you think asking my GP to do further testing for thyroid disease or liver problems might be worthwhile? TRT is for life as you said, and I am keen to establish why I have the issue,e.g. am I primary hypogonadism or secondary? If we cannot ascertain the cause of my symptoms and I need TRT, would you say injections are the way to go? Also, what sort of numbers should my treatment be aimed at attaining?

Joe.


#6

Also, SHBG has always been hovering around 48 on a reference range 10-50. Might this be binding up my free testosterone? Would getting the cause of the elevated SHBG established potentially aid my doctor in finding out what is causing my problems?


#7

A high SHGB with a TT of 15nmols clearly indicates a problem. If your SHGB was at the bottom of the range (like mine is), your TT would be very low. I know that is probably of no help however I just thought I should point it out. Have you gotten your free testosterone checked? Many guys with high SHGB and low “normal” TT readings will have absurdly low free T (if you can even call 15nmol normal, I certainly don’t think it is normal for someone of your age). I am 16 and on TRT so I am in a similar boat as you and I know it really sucks to have low testosterone, I hope you get better. If fertility is an issue for you, you can check into using HCG alongside TRT as it should maintain adequate sperm production. You could try a restart with clomiphene however clomiphene seems to make many people feel shitty. Have you gotten your thyroid hormones, cortisol or prolactin checked?


#8

whoops nevermind, saw you are going to an endocrinologist to get prolactin checked. You say your thyroid was in “healthy ranges”. However the reference range for TSH is very wide, if your TSH was 2.5 or above I would be reasonably concerned. Did you have a full thyroid panel such as free and total t3 and t4 or just tsh?


#9

Hello,

Yes my SHBG has consistently hovered around 43-48 on a reference range that goes 10-50, so definitely high. I am hoping the endo I see next month can conduct the tests for prolactin and cortisol. My total T has come in at 17mnol at the latest reading, which is still extremely low for a guy my age. Anyway, as I have learned throughout this tough process,symptoms sometimes are way more an indication for treatment than numbers on a sheet; same doctors don’t adopt this rationale also sometimes!

I am shocked to hear you are on TRT so young. If you don’;t mind me asking, what method of TRT are you on? Do you take HCG or similar to retain testes size? Unfortunately getting HCG in the UK at present is very difficult, so I am likely to be on testosterone only, hence seeking advice from guys on here about possible alternatives as don’t want almond sizes nuts! :wink:

I would be interested to know what your levels were when you were diagnosed, how you have responded to the treatment, and whether you used gels or injections?

It’s good to know I’m not the only young guy here going through this.


#10

I was at 9-10nmol when I was diagnosed, felt like garbage, no libido, no motivation or drive to do anything. Now I am on testogel, I do not take HCG to retain fertility as I live in Australia and HCG is also hard to get here. It seems as if the cause of hypogonadism may have been testicular failure, so I have noticed no shrinkage in my testicles. I have only been on for a few weeks and so far my levels are at 14nmol, which surprisingly is still enough of an increase for me to feel an increase in libido, however I am still very lethargic. My doc wants me at 20nmols at the BARE minimum. In March I go to see an andrologist who specializes in TRT, so I may switch over to injectables then, however I do not like the idea of the Australian protocol of 1 injection of Testosterone enanthate every 3-4 weeks as the peaks and valleys would be exceptionally rough. Too further complicate matters, testosterone enanthate in Australia comes in a prefilled syringe with a 19 GAUGE needle. I have no problem with needles however a 19-gauge needle will cause excess scar tissue in the long run, therefore I would try opting for sustanon if given the opportunity for injectables and I would inject sub Q on more frequent intervals. The reason I was put on TRT so young was because I had precocious puberty (hit puberty at age 9 which is on the border of abnormal) and had testosterone levels of 36nmol when I was fourteen (a diagnosis of delayed puberty was totally out of the question) I was getting my testosterone levels tested because from age 14 I was given anastrozole (the aromatase inhibitor) to combat the premature closure of my growth plates (still ended up being short, endo last year said I might get another 1cm of growth… Haven’t grown since) so my testosterone levels were monitored before and after therapy with the AI). When I went off the anastrozole (terrible joint pain), my TT plummeted to 15nmol, I then got a repeat test at 14nmol, one year later my levels had dropped down to 9nmol. The probable cause is testicular failure as I had my prolactin, thyroid, LH, FSH checked etc and all were within normal range. My fertility is not an issue for me however I would rather not disclose the information as to why. I am aiming for a level of 25nmol (my SHGB is low, at 20-23). The gel works for me so far, at a mere 2.5 grams per day (half a satchet) I had my testosterone levels at 14nmol, I believe I absorb the gel very well as I was expecting 2.5 grams per day to actually lower my testosterone levels, but it nearly doubled them. An interesting note is that after anastrazole, my e2 levels never came back to normal, last test I had they were like 14pg/ml (I think, haven’t looked at those labs in a while). I started getting low T symptoms once my TT dipped below 15nmol. I wish you the best of luck in your conquest to figure out what the problem is.


#11

Hello,

Wow, 9/10mnol is low! I think my lowest reading was 13.9mnol and my highest 18mnol, so still very low for my age. You say you are on Testo Gel, do you take a sachet a day and have you noticed any real improvements? I think with gels it’s very much to do with the individual patient and how well they absorb the stuff. I was on the gel for four weeks and did not see any improvement at all. I got bad headaches and it pushed blood pressure up as well, which obviously is very dangerous and not good! Have you had any sides at all?

I have been told that the cause of my symptoms is idiopathic; that is, they do not seem able to locate precisely what is causing my symptoms, so helpful! Prolactin has been elevated, so hopefully my endo can do MRI or CT scan and see whether a smal prolactinoma might be to blame. I do not want to have to take TRT, with all the associated risks, unless it is absolutely necessary.

What are your blood levels now that you are on Testo Gel? I would be aiming for 21-25mnol, but the other important issue of course is keeping your oestrogen within a healthy range. Too much or too little can cause similar problems to low testosterone ironically.

I guess, what I am asking you is: if you were me, with levels hovering around 15mnol-17mnol, would you go flat out on a three month trial of the gel, sachet a day, risk the potential side effects and then stop if your symptoms did not improve?

I just want to feel like a normal,healthy young guy and am willing to accept risks if my quality of life improves.

Joe.


#12

I started at half a satchet per day, and that got me up to 14nmol, I am now on a full satchet and the dose will likely be increased until I reach desired testosterone levels. Gels are an individual thing, people with a lot of body fat will likely find that a large portion of the gel is converted to excess E2. People prone to MPB and prostate enlargement may also need to be careful as gels can push DHT concentrations into supraphysiological ranges (which is awesome for libido but not so great for balding and prostate health if one is genetically presdisposed to such issues). High blood pressure can be caused by excess estrogen levels as water retention can push up blood pressure and High blood pressure can cause headaches. I cannot give you medical advice on what to do as I am 16, and I would feel really bad if I told you to do something as drastic as take hormones and shut down your HPTA and it resulted in consequences, I am very knowledgeable about medicine in general however I am not a doctor. If one sachet of testogel didn’t work for you, two sachets could be attempted, however I worry about the concerns you had over blood pressure and headaches from one sachet, how is your blood pressure when not on testogel? Another issue with testogel is, giving that your levels are (on average) around 15nmol, you will likely be looking at a private script (Do they do private scripts in the UK), and testogel is considerably more expensive than injections.


#13

Hey,

I am currently on a sachet a day, or will be once I begin taking it again. Headaches were bad and blood pressure did rise, but perhaps that was just an initial reaction to the gel? When you first began on the treatment, did you notice any side effects? I am based in the UK, so I imagine the reference ranges for oestrogen are different than in Australia? What is an optimally healthy level of oestrogen? My understanding is that too much or too little can cause problems like Gyno, bloating and water retention.

Due to see the endo in a couple of weeks, so hoping he will check my thyroid and other hormones thoroughly, as it may be that my sub-optimal t levels are down to some other medical condition, which, once corrected, will negate the need for lifelong TRT. So on the gel you have noticed some symptom improvement? I have read that guys with borderline low TSH, like myself, can sometimes have difficulties absorbing the gel. Is it worth asking my doctor to consider polytherapy with a low dose of Levothyroxine?

Yes, Testogel is on a private script. If it works and improves my overall quality of life then I would definitely be keen to take it for life. However, because of the serious side effects, I want to be absolutely sure that it is indeed what I need!

Welcome your thoughts.


#14

When I first began treatment (which was quite recently) the only side effects I noticed was that I started to notice when a cute girl walked past me (which I would not have noticed prior) and a slight increase in my libido, however my TT and FT levels are still nowhere near optimal so only time will tell as to whether I receive the full benefits of TRT, however it has been promising so far. I did not notice any problems with HPB or headaches. You are right, too much oestrogen can cause problems like high blood pressure, excess water retention, gynecomastia, brain fog, erectile dysfunction etc. However low oestrogen can cause a different profile of side effects such as joint pain (joint and bone pain from tanked E2 can be severe, at least in my case it was), reduced bone density, low libido and whatnot. I cannot specify as to what “normal” oestrogen levels are as all reference ranges tend to differ with their cut-off points, and what may show up as “normal” on the reference range, may not be normal for you. My oestradiol never rose above 14pg/ml after being put on 1mg of anastrozole per day for nearly two years. Another problem with aromatase inhibitors, especially when combined with testosterone (or any anabolic steroid), is that it can mess with your lipid profile, specifically in suppressing levels of HDL cholesterol. While I was on anastrozole, my HDL hovered around 39-43 and my LDL at around 130 and my total cholesterol around 200 (not great, I know). High levels of LDL cholesterol and low levels of HDL cholesterol cause an increase in the process of atherosclerosis, which is the plaque formation in arteries that increases the risk of heart attacks and stroke. I am not advising you to take or stay away from an aromatase inhibitor, I am merely stating what I know. You say you have borderline LOW tsh, wouldn’t this mean you either have healthy thyroid levels or are borderline hyperthyroid? I think you mean elevated TSH, if this is the case, speak to your doctor about it. I am not particularly knowledgeable about thyroid hormones however I believe the two thyroid medications are Levothyroxine and cytomel (Liothyronine). If you have hypothyroidism, this could be contributing to your symptoms of low T (so please get it checked because hypothyroidism sounds like a nightmare based on what I have read). You need to know if your T3 or T4 is low, as levothyroxine will most likely not help if T3 is low but T4 is normal (cytomel is T3). I am unable to answer as to whether it is worth asking a doctor for levothyroxine as I do not feel comfortable giving medical advice to people (sorry). If anything, I have put in here is wrong feel free to correct me as I am always open to learning new things or being corrected. You are right about people with thyroid issues sometimes have issues absorbing gels. If you have any more questions, feel free to ask.


#15

Hello,

Thank you for your detailed reply! How long were you using the gel before you noticed libido improvements? Also, excuse the directness, but did you have any form of ED prior to or whilst on the treatment? ED is a problem that has plagued me for a long time. I am getting a penile doppler ultrasound done next year to check blood flow and blood vessel damage, as I have been told that low testosterone levels alone rarely cause ED? Has the TRT improved both your frequency and firmness of erections? I hope you will pardon my bluntness here, but it’s important to speak to guys who have gone through some of what I have.

As you are in Australia, I do not know how oestrogen levels are measured, but my reading was well into the 100s? Might it be that in the UK we use different methods of measuring? I will ask my GP to check the levels again and I do have abdominal bloating and mild Gynaecomastia, which, apparently is “normal” :stuck_out_tongue: Since being on TRT, have you gained any muscle mass or bulk? I am quite slim, especially arms and shoulders, so was hoping that with the help of protein and weight training the TRT might enable me to develop more muscle tone.

As regards the use of aromatase inhibitors, I have mentioned these to my TRT doctor, but he tells me sometimes lowering or suppressing oestrogen can produce some negative symptoms. What level could gels realistically get me to do you think? As I said before SHBG is always at the higher end of normal, so might be worth looking into?

Will speak to GP/ endo about more thorough thyroid testing, as it might be that combining a form of thyroid replacement with the gel produces stronger results, as so far I have gained nothing aside from higher blood pressure and headaches!

Joe.


#16

Can u ask for a prescription for Viagra? If you take that and you get hard and stay hard you know your penis is working. I did that and felt at least it works and great psychologically.
I believe if T levels are low and e2 levels are not right it will cause ED. It can’t be a coincidence that when I inject testosterone the next night I get erections and can have sex with a good erection.


#17

Also you mentioned high blood pressure. That’s could be a problem for erection too.


#18

Hey Charlie 12,

Thank you for your message. I have tried Levitra dispersible tablets and the difference in erection duration and strength they produced was not remotely superior to the erections I get naturally. As stated above, I am getting a doppler ultrasound done in the new year, as it could be that I have venous leakage or another blood flow or blood vessel disorder which is contributing to ED.

You mention Viagra, how much do you take and what is your age if you do not mind me asking? Problem is, I struggle with swallowing tablets, so in response to your question, I cannot say either way whether Viagra works for me or not. In any event, rather than just relying on drugs for my erections, I want to ascertain what is causing me to experience these difficulties at such a young age! Hopefully, if we can correct whatever abnormalities there are, I can go without medications as really at 24 I should have good erections naturally.

Joe.


#19

GymI think you are handling your situation well.

Viagra I use 30 mg and it does the trick. And I certainly do not want to use any medication either. I just started trt injections so I hope it solves the problem. My issue is I can get erections but have decreased sensation on my penis and so I lose my erection quickly without constant tactical stimulation.

With Viagra I would say I acheive 80-90 percent of my normal size erection. Though I can pound away with it, it just does not feel the same with the medication. But it’s worth it because my manhood is in practice if you know what I mean.

I am 41. I have a thread on here if you want to see.

I had a testicular ultra sound but how does a penile one work? Well I can Google that .


#20

I noticed a slight improvement in libido around week 2. I have had ED for the better part of a year now, which seems to have improved a bit on the gel. TRT has improved the frequency of morning erections for me, as I used to NEVER get them when my levels were around 9-10nmol. I still do not experience spontaneous erections like I used to, however I believe this will come with higher testosterone/DHT levels. Have you tried Viagra, Levitra or Cialis, it will not cause sexual arousal however if the problem to your erectile dysfunction is related to trouble with blood flow to the penis then one of those medications may help (this is not medical advice, I am not a doctor, if you think one of these meds may be of help talk to your doc). Erectile dysfunction meds will not help with libido, they will just help with the process of getting an erection. I have personally tried Cialis and I can testify that it greatly helped me in the process of getting an erection as I am obviously a sixteen year old in a ninety seven year old’s body. Low testosterone levels can cause ED when levels are low, if you look at clinical trials involving androgel such as this one https://academic.oup.com/jcem/article/89/5/2085/2844212 you can see that the frequency of erections, sexual desire and sexual activity in men on androgel (testogel) increased dramatically. You will notice that around month 36 of the trial testosterone levels fall well below optimal, this is due to oestrogen levels climbing too high. If your oestrogen is 100pg/ml then that is way too high, if it is WELL into the 100’s such as above 150pmol then your estrogen is high (not medical advice, just an observation). I don’t know about gynecomastia being normal for twenty-four-year-old men, however I know it is common amongst males going through puberty (I myself had mild gyno when I was around 10-11 and going through puberty). Once again, if you look at clinical trials on TRT, an increase in lean body mass is noted, however this takes time and will not occur overnight or be anywhere near the calibre compared to a steroid cycle implemented by a bodybuilder. However, if you were hypogonadal previously and your testosterone levels are raised into normal range, you should find it easier to progress in the gym GIVEN that your training and NUTRITION is good (diet is very important when it comes to gaining mass). I am on the stockier side and I am quite a bit shorter than you are, and I believe it is too soon for me to be seeing differences in body composition, I will report back to you on week twelve of TRT and tell you if I have noticed a difference. The suppression of oestrogen on aromatase inhibitors is dose dependant, however your doctor is right in saying that lowering oestrogen too much can cause negative symptoms, however having oestrogen too high can also be negative, it is all about balance, you want ideal oestrogen levels just as you want ideal testosterone levels. People with high SHBG tend to have lower free testosterone, even if you get your levels to 21-25nmol, I would focus on increasing free testosterone as one can have a normal TT but a low FT and still feel like shit, on the flip side some people can have a low normal TT but a high FT and not suffer from symptoms of low T. I cannot specify as to what level of testosterone or oestrogen gels could get you to as everyone is unique and will experience different results from the same medication. Also try not to transfer the gels to any sexual partners or relatives, I wear a pair of gloves when I apply the gel and throw away the gloves afterwards.