I’m a 63-year old male. 6’2", 180lbs. Resistance train 4 days a week. Not obese.
Anyway, my nurse wrote the following Testosterone Cream prescription.( I’ve never done TRT before).
Testosterone Cream 200mg/ml. Apply 1ml twice a day.
My nurse confirmed I would be applying 200mg, scrotal, twice a day for a total of 400mg daily.
I’,m new to this, but this seems like a massive dose to start out on. Am I wrong? Thanks.
https://onlinelibrary.wiley.com/doi/full/10.1111/andr.12357
Is it nuts? Depends on your goal. Applied to the scrotum you will likely be running much higher than true TRT replacement levels. Absorption via scrotum is pretty high.
You could ask the Nurse where he/she/it expects your TT peak/trough on this regimen to see if your expectations align with your providers expertise.
You sure it wasn’t like apply one click of cream maybe?
Thanks. The nurse made it clear I would be applying 200mg twice a day. 400mg total. All I want is replacement levels. I’m not taking this dosage.
Well done for thinking on your own. The amount of bad instruction out there is incredible.
If you are going for TRT and not “TRT” then 25 to 50 mg of T in cream twice per day to scrotum should be a decent start. Get bloodwork after a few weeks and confirm your own peak/trough at 2 and 10 hr post application.
Great job looking out for you.
Oddly enough, I found this nurse on the World Link Medical website, Dr. Neal Rouzier’s group. The nurse claims to be accredited through WLM for BHRT, and says she’s been through all of Dr. Rouzier’s courses. I sent an email to Dr. Rouzier today to get his thoughts on this prescription. I’ll report back if I get a response.
This is a lot for a 20% cream, but maybe it’s a 10%? Do you know what it is?
I thought 200mg/ml was 20%? No?
I got a reply from Dr. Rouzier. I said I was concerned about the massive dose, considering this was my first prescription for TRT. Here’s his snarky reply-
“Jim: If you are concerned, then don’t use testosterone.”
In case anyone is interested, I asked the nurse about the dosage. Here is her rationale:
"Everyone absorbs the cream differently. A starting dose for someone with a total testosterone of 260 when optimal is 1500 to 2000 with symptoms similar to yours is 200mg/ml applying 1ml twice per day. I have some men doing 3 ml twice a day which is 1200 mg a day. Each person is individual and so is their absorption and how their body uses the testosterone.
If you feel more comfortable starting at a smaller dose, that is not a problem. You can apply 1/2 ml twice a day which is a total of 200 mg a day."
By the way, I measured 260 for Total T at 2:00PM in the afternoon. Still low, I know. But, she had indicated it didn’t matter what time. Weird.
The same applies when being started on injections. Some guys get 200mg/wk, some 160mg/wk, and some are started at 100mg/wk. some guys are not able to deal with high dose so they champion low dose therapy when starting. Others champion high dose, like me. So do what you feel is better or follow doctors orders. Testosterone is not going to kill you just because you started high. Titration is part of the therapy. You either start high to quickly climb to healthy or supra levels and you titrate down for longevity. Or you can work your way up to it, like some men prefer. The beauty is your nurse gave you the freedom to do so. Either way, you’re being managed. I agree with those who applaud your ability to not go through this blindly. So you can stick with the protocol and suddenly find yourself feeling great or not so great. Or you can change the dose and feel great or not so great. Its that simple.
Thanks. That makes total sense.
Do you think it matters what time you draw labs? The nurse didn’t care when I had the blood draw. It just seems that if the prescription is based on numbers, I may have gotten a different prescription had I had an 8:00AM draw, or even at 5:00PM.
Since you’re dosing daily. Mornings before your dose will give a good indication
Here’s more info if you’d like:
In this paradigm they aren’t putting you back at replacement levels so not much care about peak/trough with your baseline. There seems to be this gulf between in network care where you are lucky to walk out with any T script and cash pay Docs that will put you in pharma land or “TRT” as I’ve been calling it lately. Nice to have options and it pays to understand the risk/reward based on what you want.
Correct.
This is not odd. It’s completely expected to me.
Makes sense. Thanks for the data point.
The phrasing is difficult to parse but my estimation is the protocol would put you above 2000 ng/dL at peak and 1500 ng/dL trough.
Here’s 50 mg of test applied either once per day or 25 mg applied twice per day:
Here’s a rough estimate of 200 mg Test applied either once daily or 100 mg Test applied twice daily:
Of course based on your absorption there’s some uncertainty here. Taking a guy from 260 ng/dl up to 2000 ng/dL not my idea of a good starting place. But hey that’s just me.
Are you opposed to injections? I see less guys with issues with injections, than with cream. That is just my observation.
The diagnostic approach to hypogonadism is illustrated in Figure 1 . Normal values for testosterone levels vary among different sources (2, 11, 12). The most common cutoff transitioning from normal to low ranges from 280 ng/dL to 320 ng/dL; the guidelines recommend using 300 ng/dL as the cutoff (11). Serum testosterone levels exhibit ultradian and circadian variation, providing physiologic sources of biologic variability. Ultradian fluctuations (rhythmic fluctuations of less than a 24-hour period but more than 1 hour) are more pronounced in older men, while circadian variation in testosterone is blunted, but still present, in older men (12). Therefore, except in older men, a morning (7 to 11 AM) serum total testosterone should be checked initially, if testing is necessary. There is some evidence that a glucose load can significantly decrease testosterone levels for a short time, so conducting this test in the fasting state may result in improved accuracy (13). If initial test results are low, repeat measurements are recommended in 2 to 3 weeks, since repeat levels may be within the normal range in up to 30% of cases. Additionally, at this point it is prudent to consider outside influences on sex hormone production and address these issues first if appropriate. Such issues include use of corticosteroids or opiates, malnutrition, acute illness, alcoholism, and cirrhosis (5, 11, 12). If the testosterone levels are equivocal, consider checking a free or bioavailable testosterone level. It is important to note that there is an age-associated increase of sex hormone binding globulin levels by about 1.2% per year, so the decrease of free testosterone is larger than that of total serum testosterone in older patients.
Not really.
Thanks for all the help, especially this graph.
I would ask about them, if you don’t feel as well as you think you should. It just seems like guys struggle more with cream, and although it isn’t giving yourself a shot, it is almost more of a PITA, if you have to do it twice a day.
Yeah, but there’s also plenty of guys who switch to cream for the same reason. I think some providers only use “bioidentical hormones”, so, injectables are out. I have to research bioidentical hormones vs synthetic.
Dr. Rouzier, et al, feel that low T levels should be raised to “youthful/optimal levels”, apparently between 1,500-2,000. They say this range is where the protective benefits lie. Rouzier will break out the studies to prove it. I have no problem with these levels, but just not right out of the gate. My morning total T levels are ~580, but drop to 260 by 2PM. My free T at 2PM measured “3.0”. Amazing I can still function as well as I do. I must have good androgen receptors, I guess.
