T Nation

Androgel is Useless


I am currently seeing my family MD for HRT. I went to see him initially 8 months ago jecause I was not feeling well, not sick, just not feeling well. I described my symptoms and was diagnosed with Metabolic Syndrome ( middle aged fat man syndrome) and Hypogonadism-primary. I was a poster boy for the symptomology of both the syndromes. I am 46 years old, 6�??3�?? and 266lbs. My labs were classic for both syndromes. My T-levels were 150 on my first visit and I was Rx�??ed Androgel. 7.5 grams qd.

On my second visit, 3 months later all my labs improved due to my diet, but my T-levels were at 120. I was still letting him know I was not feeling any better. On third visit, three months later, all my labs were normal except my T-levels were at 96. I told him I felt no better if not worse. I tried to talk to him about injections but he was not very receptive to the idea. I pay for the Androgel out of pocket at $235 a refill. I presented him with some literature and dosing modalities, and cost of injections to me.

And he basically told me the appointment was over There is a moderate sized medical community where I live and I feel awkward asking another MD to Rx me injectable steroids, plus the added expense and wait to see another MD. I�??m tired of feeling bad and just want to feel a little like the old me when I played football and power lifted. I think he was treating my low T-levels the same as he would treat a man 65 or 70 years old. Has anyone else had this problem with their MD, if so what did you do.


Some do not absorb well. Those who are hypothyroid are famous for that. Low thyroid can mean low energy and weight gain.

Some absorb good in the start, then the skin changes from the effects of the T (gets better) and that for some means the end of absorption.

TDs also lead to more T-->E aromatization than injections. For some the E increases, the increased E suppresses the HPTA and the natural T production fails. If the TD was absorbed well, then the HPTA would be completely shut down.

You doctor is a jerk, a steroid phobic republican or misinformed. I don't know what is worse. He was not going to do anything right. You may need to go out of town.

Ask the local pharmacies what doctors are prescribing testosterone ethanate or cypionate. Explain that you have T levels down through the floor and are seeking a doctor who will deal with your situation. You could show them your lab results!

Many guys struggle to get proper care. It is sad. Some get the testosterone and can't get their doctors to prescribe arimidex/anastrozole to control E2 levels. Many of those are driven to underground supplies. You need to get your E2 levels checked. Do not test for total estrogen. The LabCorp serum E2 (0-53) works well. You may be very high. You will feel best with E2 in the low twenties.

Test for total T, free T, TSH, free T3, free T4, PSA.

If all of that is working right, you may not want to have shrinking testes.

Do you know anyone who has a Sam's Club business membership? You can get a sub card under theirs. The primary card holder will never see what you purchase. 10ml 200mg/ml test cypionate Watsons costs $42.50, 10,000iu HCG APP costs $16.25, 50iu insulin syringes are $12.42 per 100 at Sam's or Walmart.

You can inject T cyp with an insulin syringe into the vastus lateralis. Injecting every week or every two weeks is completely wrong, even though that is mainstream practice. That creates T spikes that lead to E spikes and increased SHBG that reduces your %FT. I inject 28mg EOD. My HCG is 250iu SC EOD.

Elevated E is a main feature of metabolic disorder, the E reduces LH and that means less T. I think that all men in that state would profit from arimidex. Metabolic disorder is also pre-diabetes. Your CBC will cover that. Some might test for fasting insulin.

You can get your own lab work done via LEF.org, for about 1/2 of what the doctors and clinics will bill for. The 'male panel' will do the TT, FT, E2. Add thyroid labs to that.

A trial dose of hCG is 1mg/week. At $9/mg that gets costly. There are non-drug sources of anastrozole that many turn to, even if they have a prescription. With your weight, you might want to scale up the 1mg/wk by your weight against a 160lb reference. Depending on your E2 lab results, you may need more again. I would not exceed 2mg/wk.

Do not get onto injected T without the anastrozole. That would make your E2 worse! If you get lab work and have a cooperative doctor, you could take some anastrozole for relief before you get on T. You should still push to get onto the AI (aromatase inhibitor) from the very start and front load with 1mg/day for 2 or three days then start you dosing after that. The non-drug anastrozole comes in a liquid, 1mg/ml (60 ml $50.00), which allows for good dosing options other that breaking up a tiny expensive pill.

Get the script for arimidex, and take the prescribed amount with the liquid. Do not tell the doctor about what you are doing. Follow his changes based on blood work. Then you can make changes later based on the lab work yourself. You doctor will not understand dosing changes of .4mg/wk as he thinks your are using pills. Your doctor does not want to know about this.

With the elevated E2 that you probably have, you might have some female fat deposition patterns and perhaps some degree of gynecomastia. If any signs of gyno, all the more info to present to a doctor in support of the AI. TRT without AI would then make things real bad.

You need to learn all about this stuff, because chances are your doctor will not explain things.

Go to that other doc and get good copies of ALL OF your lab results. Always obtain good copies and never loose them. Have them in hand when you see another doctor. Have an androgel prescription label to document what you have been taking.

Tell the doc that TD test has been useless, your lab results will substantiate that, and ask to be put on 100mg test cyp per week, 250iu HCG EOD [I can supply research material to support that], and arimidex to get E2 under control with a target level in the lower 20's - the E2 levels of a young lean male. You need all three items to get optimal results. Without the AI, I would expect quite poor results.

If you take 100mg test cyp per week, you are under control of how you do that. Injecting EOD or twice a week will be better for you. You do not need to inject into the gluts with 1.5" needles!

Cut and paste this into a file for future reference.

I will work with your via PMs through the doctor things and details of getting started.

PM me and tell me where you are located and I will try to help you located a TRT or age management doctor.


That is AWESOME stuff - Thanks KSman.


Androgel gave me lot's of estrogen (converted from T), and that prescribing doctor wouldn't prescribe an aromatas inhibitor.

Switched doctors, switched to T-cyp injections plus hcg plus arimidex (all now by prescription), and I'm feeling GREAT!


KSMan knows more about this than jusr about any doctor you'll meet. Most are whores for pharmaceutical companies.


Your post screams at me that you haven't accepted a very important fact.

Your health and well being are YOUR responsibility.

You have solid lab work showing that the Androgel isn't helping. You tried reasoning with him and he told you to go away. You should do that.

You can fret over feeling awkward or you can take responsibility for your own health and find someone who is going to help you.

I would call every doctor in town and ask their age. In my experience, younger doctors are more open to suggestions from their patients. Also ask if they are currently treating patients with TRT.

Don't forget that your doctor works for you. It's your life and your well being and you're the one paying the bills. He either helps you or you fire him.


Seems like things are falling in to place, thanks to ksman, I have found and made an appointment with a MD that specializes in THT. This MD has just started a satellite anti-aging clinic in my town. He only sees patients on Wednesdays, so I see him tomorrow and will see how it goes. Then I have an appointment with a local urologist on Friday to see if he can treat me with THT the way I think I need to be treated.

I want to thank ksman for the information and the links to, hopefully, better health. You are right Happydog48, one has to take control of one�??s own health. I�??ll let ya�??ll know how it goes.


KSMan makes the doctors I've been to look like plain fucking morons...why I started a thread to honor him. He has helped so many here, he should be T-Man of the year. Seriously.


Well, I went to the Anti-aging clinic last Wednesday and met with the Anti-aging doctor. The Doctor was very pleasant and had 50 years of experience as an Urologist. The only problem was he was 83 years old and retired from practice 20 years ago. He only see�??s patients one day a week from 10 am �?? 2pm. We talked about my problem for 5 minutes and his grandkids for 45 minutes. He did see my labs and agreed my T was very low and felt I could use a �??boost�?? in my T levels but he was more interested in starting me on HGH and continue using my Androgel. I told him I was concerned about the cost of HGH compared to T injections. He said the cost has come down in the last few years but didn�??t know the exact cost.

This visit caught me completely off guard because I was prepared to discuss TRT not HGH therapy.
On Friday I went to see a local Urologist and discuss my problem. He was very through in his exam and with my lab work. My T was 286 using 7.5 grams of Androgel every day. He said this was within normal range and did not see any need for any treat other than Androgel. He said as long as I could have and maintain an erection I was fine. I questioned him about my other symptoms and he said those were usually related to a mild case of depression. And I should consider an anti-depressant. I told him no thank you and the visit was over.

I called the aging anti-aging doctor�??s office and made an appointment with him next week, again.
I can�??t believe this is turning out to be so difficult.
KSMAN this endeavor turned out just like you said it would. So I�??m hoping you can give me some insight on HGH therapy in conjunction with Androgel or HGH therapy only. Do you think the old Doc may be the one to see or avoid.
Look forward to hearing some opinions or suggestions


Welcome to hell.

From the doctor's point of view: You are obviously interested in becoming a steroid 'gear head'. All guys who want TRT just want to look like Arnold and steroids don't improve and never have improved anyone life. I will give you this absurdly low dose Androgel or 100 mg of Cyp every two weeks, just to make a little money for myself. Now, write me a check --- payment is due on my chalet!!

I'm beginning to hate all doctors and feel like Diogenees.


RN Dave,
I hate most doctors, but there are a few out there who will get the job done. Finding one is sometimes like finding the Wizard of OZ. While a few T nation folks have been fortunate to find a urologist or non AMM (age management doc) to treat their low T completely, I think that is very rare. Obviously, just going to an "anti-aging" doc is no guarantee, either. Here are some tips, from my experience.

My HRT doc goes by guidelines set by the Cenagenics Organization, one of the two largest AMM training organizations in the country. The other is A4M. If you go to a doctor trained by either of these organizations, they are more likely to treat you with injectable T, an A.I., HCG, and HGH if indicated. They may be assholes, greedy, and the epitome of seemingly every doctor Headhunter has gone to, but if they give you what you need, who cares?

There are some smaller organizations and coalescing of groups going on right now in AMM because the AMA has still not sanctioned any of them and they are all vying for credibility. You may see different names, like AMMG. Docs who are not aligned with any organization are either not going to give you anything unless your T is below 260, and even then undertreat, neglect the E2 issue, and so forth.

Then there are a few docs with poor credentials who will give you damn near anything if you write them the check they want-I can understand how in these circumstances these money whores may be preferable to the other options. The problem with many of the highest trained docs, particularly the Cenagenics ones, is that they paid $14,000 for their training (yes, $14,000 for a ten day seminar in Vegas) and they are trained to "close" their patients for a $3000 per year "deal" or more.

Some will negotiate for a six month clause. Very few of these will work for a pay by visit fee, or work with insurance.
It's not quite hell, more like purgatory mixed with Iraq. Good luck, it'll all be worth it when you get treated right. Doc


If you rely on doctors for your well being, you're sunk. So the first thing you have to do is seriously educate yourself. The internet makes this surprisingly easy. Here's a page I put together with some sources to get you started... and this really should only be a start:


Next, do the easy things to help yourself. This means eating right, taking the right supplements and losing the fat. Fat cells produce estradiol and the more fat you have, the more of a problem this is.

Understand that controlling estradiol is just as important as controlling testosterone. Very few doctors understand this, so it is especially critical that you do. I was depressed for 15 years and it completely went away as soon as I improved my testosterone to estradiol ratio and it came back for a couple of weeks once when I had an interruption in my AI supply and my T went down and my E went up. Your mileage may vary, but it my case, my experiences have proven to me that my depression was 100% due to estrogen dominance. Raising your T won't help if your E goes up with it.

You already know that this isn't going to be easy, so face that fact and take the bull by the horns and do what you have to do.

I'm 56 and I went from 380 lbs and a poster boy for ED who hadn't had morning wood in 15 years to 185 lbs of lean, mean, hardon machine. My morning erections now are so intense they wake me up so I know personally that you can have it all if you dedicate yourself to doing what it takes to getting what you want. And I did it all without help from doctors. You can too.



That was one of the best posts I've ever read. I wish I had read it 3 years ago.


Read his post one more time. It is the T to E RATIO that is important, and which your doctor doesn't understand. Raising Test WILL NOT HELP us older gents because we will very shortly turn that Test into Estrogen. You will feel good for a couple of weeks, then BAM! You need an AI.

Your doctor (perhaps most) will not, repeat, will not give you an AI. Without it, you are screwing yourself.


Happydog, do you still take trib, maca, ZMA, fish oil, CLA and multivitamin (presumably in addition to TRT)? Thanks for your post and your links.


I don't bother with trib and maca anymore but I do recommend them for people in the herbal stage of things. I found the Bulgarian trib much more effective that the run of the mill stuff. You can get the maca in bulk off eBay - the caps are way too expensive to take at decent levels.


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Hey Guys
Good news! I went to a new urologist today. I knew about him from work but thought he was a little up tight because he was in with the urologist that thought a T-level of 296 after 6 months of androgel 7.5 grams everyday was acceptable. I called to check on my labs and the young urologist spoke to me and explained my labs to me and commented on my labs and low T. LH,PSA and FSH. PSA was normal and LH and FSH were extremely suppressed, R/T Androgel usage. He told me to come in today and see him and we would talk about T injections.

During the visit I explained what been going on and the great difficulty I�??ve had finding some one to listen to me, and the problems I�??ve been having getting a doctor to talk to me about T injections. He said injections would be no problem and stop using the Androgel because I have a severe case of hypogonadism and Androgel will not do me any good because my T- levels are still sub-therapeutic .

He gave me an injection of 400mgs of test. cyp. with 1 cc of B12. I discussed weekly injections and he said come back in 3 weeks and he will draw labs and if everything looks good he will give me an Rx and I can inject at home. I mentioned dosages and he said he will base that on my labs, most likey around 200 to 250mgs a week. But we�??ll see in three weeks.

I can finally see the light at the end of the tunnel and hope it lights the way to feeling better and getting back on track with my health.
Thanks to ksman, happydog48 and mr power clean for your great posts, replies, and PM�??s. I will keep posting and let you all know how its going.


Congratulations, good times and better health are ahead. Hope you have a wife or girlfriend to help you out when the big bang comes.
But make sure and read the full threads about high E etc as KSman warned. Doc


That's good Dave. Be sure to access to an aromatase inhibitor. You probably will make some estrogen with all that T.

Hope it works out for you!


Thanks for the link. I found an MD in the Swales MD finder. I have an appointment for next friday. And in my discussion with his secretary, she claims he is down to earth and the patients like him. I just hope I do. At 55, I shouldn't have a problem convincing them it's not about getting big, but beings I lift, they automatically think otherwise.

Even if the appointment goes south, I printed out a list of about 50 MDs from NJ that are enrolled in the anti-aging group.

Thanks again.