At the 10-Day Mark

I've been on AndroGel for the past ten days — this is now my eleventh day. The results have been gratifying. I am thinking more clearly and I definitely feel more ebullient. And my libido (sex drive) is noticeably stronger. I actually am able to get an erection and masturbate successfully, which hasn't been the case for months.

I also have found that my voice, not at all times but sometimes, seems deeper than before starting AndroGel.

Just prior to my starting the AndroGel therapy ten days ago, my primary care physician, Dr. Moore, did a second blood test for testosterone, and my T level had risen to 364.3 ng/dL from its previous 269.0. So he wrote, on the printed results he mailed to me, "no therapy needed." I went to see him yesterday to ask whether he wanted me to stop using the AndroGel.

He told me he thought he had said not to even start the AndroGel therapy until the second blood test had confirmed the low T level of the first. I told him I truly had no recollection of his saying that, and that I am so pleased with the results of the therapy thus far that I would like to continue it.

He said, "Maybe you are just an individual who needs to have a testosterone level of 450-500." As I interpret it, that is a suggestion that the nominal "low T" threshold for most men of my age (65), seemingly 181 ng/dL, does not apply in my case, and that I need a significantly higher T level in order to function properly.

I  readily agreed, saying that either that is so or I am merely experiencing a placebo effect. "Placebo" is the term experts use to describe the ability of many patients unconsciously to manufacture a positive result even when given a medication that actually does nothing at all. I said to him, "What do we have against a placebo effect, anyway?" Dr. Moore smiled, saying, "That would be an expensive placebo" — given the $92 cost I paid for a one-month supply of AndroGel. He then urged me to be sure to look into using the discount card he had earlier handed me. I now intend to do exactly that.

I then asked to have another blood test, and he said he preferred to wait until I've been on the AndroGel for about a month before testing again. And so that is exactly what will happen. I next asked whether I will be able to refill the AndroGel prescription when I run out at the end of one month, and he readily gave me a second prescription to be filled at that time.

The lesson here is that, barring a placebo effect, AndroGel seems to work very fast to reduce the symptoms of low T levels. And, further, that men with those symptoms need not necessarily have to have measured T levels which are below some nominal age-related threshold to be able to benefit from AndroGel or some similar T-replacement therapy.

I need to add to the above that my pre-AndroGel blood test showed a fairly high level of sex hormone-binding globulin (SHBG): 70.9 nmols/L, with a normal range of 13.0 - 71.0. My "TEST/SHBG index" was 17.8, compared with a normal range of 14.8 - 94.8.

SHBG is a substance the body puts into the blood stream. It binds to testosterone and keeps testosterone from being "free" to enter the cells of the body to do its magic stuff. If SHBG is "too high," then not enough of the testosterone that the body makes is "free testosterone" and therefore able to be used effectively by the cells of the body.

I do not really know how to interpret the fact that my TEST/SHBG index is at the very low end of the supposedly normal range in my latest blood test, but possibly my SHBG level, which is at the extreme high end of the supposedly normal range, contributes to my need for an external testosterone boost in order to avoid experiencing the dire symptoms of low T levels.

However, I should add that my previous blood test, in which my T level was 259.0 and was definitely considered too low by my doctor, showed an SHBG level of 70.9 ... just as my latest test shows. The change from a T level of 259.0 to one of 364.3 had nothing to do with any measured change in SHBG level. (The TEST/SHBG index of the previous test was 12.7 and was considered "LOW," in that an index value of 14.8 is given as the bottom of the normal range.)

So on two consecutive blood tests, eleven days apart, my testosterone level measured too low on the first test and not too low on the second. My SHBG level consistently measured at the very high end of normal, giving the same number both times. My TEST/SHBG index went from "LOW" to not-low-but-still-near-the-low-end-of-the-normal-range.

Incidentally, back on April 2, 2009, my blood test showed:

• TESTOSTERONE: 469.0 ng/dl
• SHBG: 41.5 nmols/L
• TEST/SHBG index: 39.2

So, over that extended period of time, my T level and my TEST/SHBG index have gone down as my SHBG has gone up. That's exactly what the graph above shows to be the usual case for an aging male such as myself.

I conclude that for many of us aging guys, including me, short-term changes in T level are not necessarily due to SHBG changes, but long-term T level drops can be related to rising levels of sex hormone-binding globulin.

How Long a Wait?

It is not terribly clear how long it will take for AndroGel (left) to work to get my T levels up. I managed to find information at www.AndroGel.com that suggests that 16 weeks was the time frame used in clinical trials. Will I need to wait that long to expect improvement?

Dr. Moore, the primary care physician who prescribed AndroGel for me, wants to see me again in 6-8 wks. for a follow-up with further blood work and possible dosage adjustment. Will I need to wait that long to expect improvement?

At this Drugs.com page about AndroGel it says:

The dose can be adjusted between a minimum of 20.25 mg of testosterone (1 pump actuation or a single 20.25 mg packet) and a maximum of 81 mg of testosterone (4 pump actuations or two 40.5 mg packets). To ensure proper dosing, the dose should be titrated based on the pre-dose morning serum testosterone concentration from a single blood draw at approximately 14 days and 28 days after starting treatment or following dose adjustment. In addition, serum testosterone concentration should be assessed periodically thereafter.

That suggests I can expect results in as soon as 14 days.

Another part of the same web page talks about "Serum Total Testosterone Concentrations on Day 7," so maybe my good results will come even sooner than 14 days.

On the other hand, many of the mostly positive reviews at User Reviews for AndroGel ...

... talk about the good effects taking weeks or months to fully arrive, often after one or more dosage adjustments by the doctor.

So I guess I will just have to wait and see how long it takes for me to turn back into Conan the Barbarian ....

AndroGel to the Rescue?

Yesterday I visited my primary care physician, Dr. Parry Moore, who prescribed AndroGel 1.62% testosterone gel.

AndroGel 1.62%

AndroGel comes in a pump-style dispenser (see above). Each press of the pump squirts a dab of the gel onto your waiting fingers. You then spread the dab onto the opposite upper arm/shoulder, in an unexposed area that a t-shirt would cover (see illustration at left).

The alcohol base of the gel evaporates immediately, leaving just the dried gel on your skin. You spread a second dab onto the other shoulder, using your other hand. Then you wash the remaining gel off your hands.

Dr. Moore also took another blood sample that is intended to confirm my low T level from the previous test, and will establish my baseline for prostate-specific antigen (PSA). PSA can be read as a tipoff for prostate cancer. Using a testosterone replacement product like AndroGel can change one's PSA reading, so Dr. Moore wants to keep tabs on my PSA count.

Dr. Moore was at first reluctant to begin AndroGel for me because he feels a single low T-level measurement can just be a temporary anomaly. I pressed him to go ahead and prescribe AndroGel right away for me, citing the list of symptoms I have been experiencing (see below).

Dr. Moore gave me a promotional packet of information from the maker of AndroGel, Abbott Laboratories. In the packet is a list of symptoms that may or may not go along with any given man's low T levels:

• fatigue or decreased energy (I have that)
• reduced sex drive or libido (yes)
• sexual dysfunction — weak or fewer erections (yes)
• depressed mood (somewhat)
• increased body fat (don't believe so)
• reduced muscle mass/strength (maybe)
• decreased bone strength (don't know)
• loss of body hair — less frequent shaving (not really)
• hot flashes/sweats (no)

Any of these symptoms can of course have other causes. Yet they can be used by a physician, along with a low T level in the blood serum and a man's general medical history, to determine a possible need for T replacement therapy.

Type II diabetes and chronic obstructive pulmonary disease, both of which I have, can also be associated with or bring on low T, according to Abbott Laboratories.

The male body — i.e., the testicles — can lose ability to make sufficient T naturally. Or low T can happen when the brain, through the hypothalamus and pituitary gland, stops ordering up as much T production as before from the testes.

I asked Dr. Moore how many of his male patients have low T, and he responded that about 20 percent of those over 50 do.

AndroGel is expensive, by the way. A one-month supply cost me $92. The packet Dr. Moore gave me contains a card that when activated may lower my costs to $10 per month.

Welcome to My "Low-T Me" Blog

Suffering is painful, and I've been suffering.

I went to the doctor last week complaining of mental confusion and feeling as if my head is fogged in. He used the term "cognitive impairment." He suggested trying a number of things, and he also said he wanted to do some blood tests. I blurted out, "Can you include a test for testosterone?" He said that it might reveal an interesting result: low testosterone making my brain soggy ...

The testosterone level in my blood turned out to be 259.0, given in nanograms per deciliter, I believe. The normal range for males over 50 (I'm 65) is 181-758. (For men 20 to 49 years of age it's higher: 262-1593 ng/dL.)

The middle of that range is 469.5, which is roughly where I was 3 1/2 years ago. Here are the numbers I have in my records:

• 1-7-2005     535.0
• 2-7-2006     490.0
• 4-2-2009     469.0
• 4-6-2010     402.0
• 10-23-2012   259.0

Testosterone is a hormone produced by the male testes (testicles). It starts getting churned out at the arrival of puberty, when a boy starts to become a man. (I am paraphrasing a lot of this from Wikipedia's article on Testosterone.) It causes facial hair, pubic hair, pubic hair, and other body hair to start to grow, as do the penis, testicles, scrotum, etc. The boy begins to experience penile erections and gains the capacity for ejaculation.

Throughout his adult life, the human male continues to secrete testosterone in large, but varying, amounts. (Women also secrete testosterone in smaller amounts.) Most significantly, T (as I'll call it for short) is associated with a man's ability to be aroused sexually and carry out the procreative act.

Various life situations can cause a man's T secretion to go up or down.

Apparently, T (or a chemical derivative of T made within the male body) is essential to a man's proper cognitive function and his general sense of well-being. I have seemingly lost both of those things in some degree, as I have lost my erectile capacity and my sex drive. These symptoms have come to a crisis stage, I feel, though I have been experiencing them in lesser degree for two or three years.

My list of symptoms includes:

1. Erectile dysfunction
2. Loss of libido (sex drive)
3. Mental confusion
4. Indecisiveness
5. Poor memory
6. Loss of interest in usual activities and pursuits
7. Lower sense of well-being
8. Fatigue

Put another way, there's less pep in my step, sexually and otherwise.

Plus, all my attitudes have become platitudes.

My symptoms are worse in the afternoon and evening than in the morning. Apparently, T levels are higher in the A.M. than in the P.M. for most men, so the 259.0 ng/dL T level I got in an early morning blood test surely drops as nighttime approaches.

There seems to be a difference of opinion: some experts say it's normal for aging men to have lower testosterone. Others say it's not. But one way or the other, the drop from 469 to 259, which is over a 43 percent drop between age 61 and age 65, seems like I've gone over a cliff.

Tomorrow, I see the doctor about this. I expect he will start me on testosterone replacement therapy, giving me some kind of T supplement — a pill, a gel, a cream, a patch, whatever.

Next week I hope to be back to my usual self:

Just kidding ... or maybe not!