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Dr. Andrew Rynne

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How is testosterone replacement therapy done?

Answered by
Dr. Elona Xhardo


Practicing since :2008

Answered : 686 Questions

Posted on Tue, 3 Apr 2018 in General Health
Question: I have a question about testosterone replacement therapy.
MD - urologist, has prescribed androgel 5 mg /day for low testosterone. I have taken that for 8 weeks. Pre-treatment free testosterone was 180 pmols/l. Now it is 90 pmols/l. MD says wait at least three months before reassessing. no other health issues. I am unclear why the level has dropped instead of gone up. Thank you.
Answered by Dr. Elona Xhardo 2 hours later
Brief Answer:
I suggest to repeat the testosteron test.

Detailed Answer:
I have gone through your question.

The normal range of testosterone levels in healthy adult males is between 280 to 1,100 nanograms per deciliter (ng/dL).

Testosterone replacement therapy (TRT) should be given based on symptoms instead of blood values.

You should know that blood values of testosterone vary by the minute and the day.
The only way to get a reasonably accurate reading would be to collect urine over a 24-hour period and have the lab use it to measure testosterone and its metabolites.
Alternately, you could donate at least three blood samples from different times during the day. The lab would then pool the samples together and test that sample.

Testosterone gels provide a much more natural androgen rhythm and there's probably some argument to be made that mimicking the body's natural rhythms is the way to go.

Normaly,within a couple of weeks,after you start the TRT,your total and free T level will increase.

In your circumstances i will recommend to repeat the Testosteron test in another lab.

I have a question for you:-Are you sure that you have used the gel as you have been told by the doctor ?
For better results,You should only apply gels to freshly showered skin. You should refrain from swimming or working up a sweat for at least an hour and do not put on the genitals.

You should only apply gels to freshly showered skin. You should refrain from swimming or working up a sweat for at least an hour.

If you repeat the Testosteron test and you have the same result than i can deduct that The testosteron replacement therapy is not effective,the gel don't penetrate the skin and maybe you should choice another way to take this hormone.

I suggest to talk with your treating doctor about the right dosis and the right way to take the TRT.

Hope this information is helpful.
Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Elona Xhardo 3 hours later
Thank you for the informative answer. I was unaware that lab values could vary so much. I will have the pre-dose level retested.

The diagnosis was made based on symptoms of fatigue and weight gain. I have applied gel carefully and follow the instructions in the packaging. During the third week of treatment i noticed a marked increase in mood and energy but it only lasted two days.
Could it be that initially my own testosterone production was added to the gel, but subsequently my own production has ceased? Thank you for your time. Also in addition to the follow up predose lab work, is there any value in a post-dose measurement? Thank you.
Answered by Dr. Elona Xhardo 9 hours later
Brief Answer:
Yes,TRT can affect the post-dose measurement.

Detailed Answer:
Hi again XXXXXXX

After age 30, most men begin to experience a gradual decline in testosterone.
A decrease in sex drive,low energy and weigh gain; sometimes accompanies the drop in testosterone, leading many men to mistakenly believe that these symptoms are simply due to "age".

The best treatment for "low T" depends on its cause.
Sometimes testosterone replacement therapy is needed; other times, weight loss is the best medicine.(if you are overweight or obese,weight loss will be helpful for your problem).

The TRT has a lot of benefits.
It's impossible to predict, because every man is different. Many men report improvement in energy level, sex drive and muscle mass.
Men also often report an improvement in mood from testosterone replacement. Whether these effects are barely noticeable, or a major boost, is highly individualized.

You had some of these benefits but it is strange why these positive effects disappear after two days.
It is possible that the TRT in the form of Gel is not effective for you because the level of free T do not increased,after a couple of weeks under this therapy.
Your own testosteron production is low and this is not consequence of the gel-testosteron therapy.

About the second question i can say : It is True that androgen therapy may affect the result of T level test.
Because hormone levels are highest in the morning, you may need to take this test between 7 a.m. and 10 a.m.

A follow-up testing or treatment plans should be discussed during an appointment with your treating doctor.

Hope i have answered to all your question.
Thanks for using HCM.
Wish you all the best.

Above answer was peer-reviewed by : Dr. Kampana

The User accepted the expert's answer

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