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.