Transdermal Testosterone Cream/Gel
AndroGel is a testosterone gel/cream and is without question the most well known brand on the market. Unimed Pharmaceuticals first released the compound in 2000, and for several years it held a firm grip on transdermal market. However, in 2006, the U.S. FDA approved the manufacturing and use of generic transdermal creams and gels through Watson and several compounding pharmacies soon followed suit. Other than a massive multi-million dollar marketing campaign, there is no difference in AndroGel and these other brands.
The primary reason AndroGel and other transdermal creams and gels have remained so popular is due to the ease of use. Where injectable testosterone must actually be injected, creams and gels can simply be rubbed on the skin like lotion. Unfortunately, transdermal testosterone is often nowhere near as effective as injectable testosterone; in fact, for many men it won’t work at all. There also appears to be many men who while they respond they do so only slightly, and in time they too often end up with little to no response. However, there are those that respond well and indefinitely, but it’s impossible to predict where any man will fall.
Functions & Traits:
AndroGel is a hydroalcoholic transdermal testosterone medication. A synthetic version of the male androgen testosterone, it is a perfect replica of the naturally produced primary male hormone. The human body will not make a distinction between testosterone provided by AndroGel or any other transdermal testosterone cream or gel and naturally produced testosterone.
Like most all transdermal creams and gels, AndroGel carries an absorption rate of approximately 10%. As the absorption rate is rather low, large doses of testosterone will necessarily be administered. When it first hit the market, AndroGel was released under a 1% concentration and could be found in 2.5g and 5g sachets providing 25mg and 50mg of testosterone respectively. The AndroGel brand can now be found in a 1.62% concentration, which allows for less gel to be applied and the same dose received. However, many compounding pharmacies now manufacture testosterone gels and creams in a 10%, 15% and 20% form providing far more efficiency over AndroGel.
When applying transdermal testosterone, testosterone levels will begin to increase approximately 30 minutes after administration. Total serum levels will continue to rise and will reach their peak at approximately 12 hours post administration. Once the 12 hour mark has passed, they will begin to rapidly fall back to baseline, which will necessitate daily administration.
Like all mediations, transdermal testosterone gels and creams like AndroGel do carry possible side effects. The side effects of AndroGel are identical to all other forms of testosterone including injectable testosterone. You will find some physicians who state there are more side effects with injectable testosterone, but there is simply no data to back this up. Further, such a claim does not make any sense; once the testosterone is in the body, regardless of how it got there, it is the same testosterone hormone.
While the side effects of AndroGel are the same as all testosterone forms, there is one side effect of transdermal medications that is unique and based on application, not the hormone itself. Some men will report skin irritation at the applied area. In some cases, changing the applied area will remedy this problem, but for most men who experience this, their skin will not tolerate it regardless of where they apply it. It should be noted, only a small minority of men will have this problem.
The primary side effects of AndroGel will surround its estrogenic nature. As a testosterone hormone, testosterone has the ability to convert to estrogen through the aromatase process. If estrogen levels increase beyond the optimal level, this can encourage gynecomastia (male breast enlargement), water retention and high blood pressure if water retention becomes severe. For this reason, an Aromatase Inhibitor (AI) is often needed. AI’s function by inhibiting the aromatase process, in turn lowering serum estrogen levels; Anastrozole will be the most commonly prescribed AI. Thankfully, elevated estrogen is extremely easy to control as long as an AI is available; however, approximately 25-30% of all men will not experience elevated estrogen and will not need any type of anti-estrogen medication.
Beyond elevated estrogen, the side effects of AndroGel can include those of an androgenic nature. This is due to testosterone’s ability to convert to dihydrotestosterone (DHT) as the hormone is metabolized by the 5-alpha reductase enzyme. However, while this occurs with all testosterone hormones, the rate of DHT conversion does appear to be slightly higher with transdermal testosterone compared to injectable testosterone. This can lead to hair loss, acne and body hair growth. Fortunately, the androgenic side effects of testosterone are highly dependent on genetics and dose. For example, hair loss is impossible unless you are predisposed to male pattern baldness. If you are predisposed, you are going to lose your hair no matter what you do, but the use of AndroGel may speed it up. However, in a TRT setting, doses will be low and it is extremely rare for men to experience any type of androgenic side effect. Androgenic side effects of testosterone are far more common when testosterone is used at performance enhancing level doses. In testosterone therapy, we are merely replacing what we are lacking.
As with all testosterone compounds, the side effects of AndroGel will include natural testosterone suppression. This will also promote testicular atrophy. None of this should be a concern for the low testosterone patient. While natural production of testosterone is being suppressed, a man with low testosterone isn’t producing enough on his own to begin with. Due to the suppression, the testicles will lose some of their fullness; no, they will not shrivel up and disappear, they will merely lose some of their fullness. Many men will, however, experience no loss in fullness by accompanying their testosterone use with hCG, which has numerous benefits in its own right, including keeping the testicles full.
Important note – Transdermal testosterone creams like AndroGel have in no way been linked to prostate or any other type of cancer and cannot promote heart disease. In fact, studies have found that men with optimal testosterone levels are far less likely to develop any of these conditions.
Doses & Administration:
AndroGel is normally prescribed in the 5g-10g per day range. However, if you are using a generic brand, keep in mind the concentration is often greater and the dose will need to be adjusted accordingly. Regardless of the dose, transdermal testosterone creams are best applied to the inner-thighs, upper-arms/shoulders and abdomen. Once applied, you will want to wash your hands thoroughly to ensure others do not come into contact with your medication. It is also highly recommended that you do not engage in sexual activity or any type of skin-to-skin contact until 12 hours have passed after administration in order to avoid transferring gel to your female partner. If sexual activity is to take place during this initial 12 hour window, it’s recommended that you shower first. While this is the best practice, it should be noted that how much actual testosterone is transferred through contact is highly debatable and it may not be as much as once thought, but it is best to fall on the side of caution.