Testosterone Deficiency

[gmack]

I was only recently diagnosed with low T and took my first treatment of Testim gel 50mg today. Because of the unscheduled nature of my job (on call 24 hours; can leave with no warning and be out in the field for a day or two) I'm certain to have trouble trying to dose at or near the same time every day. Is this a problem, and would injections be a better choice for me? What are the dangers of missing a dose?

[rockofage]

I'm not a doctor, but I have been on Testosterone treatment for ~6 years now. I work for an agency in the federal government, and for the past five years I am frequently either in the field with the military in Iraq, Colombia, or other areas, or on the road somewhere else on short notice. I used to be a cop on call 24hrs so I know where you are coming from.

I use the patch (androderm), and I don't always get a chance to dose at the same time, usually because I am out for over 24hrs for some reason. My mental trigger to remove the old and apply a new patch is taking a shower in the morning, and quite often in the field, there is no shower, and/or I don't have a dose with me where I am located.

I am a big fan of the patch (androderm). With the patch, if I forgot to apply a new one the next day, I find I am alright (no loss of energy, lethargy, libido) for ~ another 24hour period as long as I don't remove the old patch. This appears to be because the patch is time released, and in order to administer the correct daily dose through the membrane, each patch has to contain ~5-6 times the daily dose. The 5mg patch actually contains 24.3mg of testosterone (designed to release 5mg/day), and the 2mg patch actually contains 12.2mg of testosterone (designed to release 2mg/day). So if I miss a dose, there is still about 4-5 times the daily dose under the membrane. It is not recommended by the manufacturer, and may not work for everyone, but I can go another day without any negative effect (loss of energy, lethargy). However I do notice it (slightly lower energy) on the third day of a missed dose (I got caught in a nasty piece of work in Najaf Iraq for well over three days from my shaving kit once). It appears that when the level under the membrane drops to 2-3 times the daily delivered dose (14.3 after two consecutive days on the same 5mg/day patch), there is not enough left to deliver the 5mg dose/day through the membrane (however you are probably still getting a smaller dose).

I do not personally recommend the injection. However Smokescreen has had good luck with T injections, but he also injects a smaller dose more often and supplements with either androgel or androderm to keep his level constant at the end of the moth.

I had big mood swings with monthly injections. For the first 10 days I felt like I was 18 again (aggressive, excess energy & libido), for the second 10 days I was "normal" & felt good, for the third 10 days I was lethargic w/ little libido.

I also did the gel (androgel) for a short period and got shorter duration (daily) mood swings. As I understand with androgel, the entire dose is absorbed very quickly. I felt great in the AM right after I applied the dose, good (normal) in the afternoon, but had no energy or libido left after dinner. I went back to the patch and am perfectly satisfied.

With the patch, I get a good constant dose (zero mood swings with the patch), and I have found (even though it is not advertised) if I miss a dose, I am good to go for another 24hrs. I also now keep two patches in a sealed envelope, in a small notebook I always carry on my person (even in the field). It is not an imposition, and theoretically If I got stuck in the boonies again, I could stretch it for ~9 days (If I am in the boonies, unplanned, for over nine days, I have other problems to deal with).

Both the androderm and androgel literature say, if you miss a dose, just pick it up again at the same time the next day (but don't double dose).

Hope this helps.

[gmack]

Thanks for your reply. From what you say, I think I might be better off with the patch. You didn't mention physical exertion or sweating being a problem so I assume it works well under those conditions. Pretty sure you may have sweated in Najaf. My son passed through there in the spring of '03 with the 101st and reported it being pretty interesting.

[rockofage]

Profuse sweating can be a problem depending on the location you wear your patch. On a day-to-day basis I rotate my patches through four locations; right & left triceps, and abdomen below the waistband above the right and left leg. I move them through the four stations clockwise, so each location has three days without a patch. There are quite a few other areas you can apply them, but these are the least invasive and most comfortable for me. The literature recommends you don't apply a patch to the same area on two consecutive days, and when you first start using them you can get some tenderness or a slight burning sensation that you only notice after a patch is removed. It hasn't really bothered me to leave the same patch on for two consecutive days, but I follow the literature when I can.

Setting up an application and rotational routine, helps you remember to apply a new patch (and gives your skin some rest too). It sounds crazy, but you will get used to wearing them, and won't really notice them after awhile. If I don't lay out a new unopened patch to be applied after I dry off from the shower, when I am really tired (like up for 24+hrs) I sometimes forget to remove the old one (unless I catch it in the shower) and apply a new.

If I know I am going to be doing extreme physical labor resulting in profuse sweating, I will wear the patch under the waistband, which usually ensures it stays put. If I am sweating like a banshee, they will tend to come off my triceps. In those instances, I will just slip it under my waistband and continue on my way, no bother really. If you shave the area you apply them, they will tend to adhere better under profuse sweating, but I can get by in a pinch without shaving (I tried it for awhile, but found it wasn't really necessary).

I travel a great deal internationally, and a word of advice is to pack your patches in a sturdy 1 quart freezer bag, and carefully remove and reapply the pharmacy sticker from one of the patch boxes to the outside of the freezer bag. I have never had a problem, anywhere in the world using this method. However I have gotten hassled carrying them loose in my shaving kit (luckily I had cut the prescription sticker off and had it in another compartment of my shaving kit. Two reasons for this; primarily this is a controlled substance that is abused by some athletes worldwide and some countries monitor it very closely, secondly the patch does have a small amount of gel under the membrane and, if you are flying through a TSA approved international airport, all gells and liquids under 3oz have to be in a clear 1qt plastic bag. I have never gotten hastled about the gel/liquid thing, and it is usually because it is recognized as a controlled substance. Additionally, don't check your meds, carry them on. Since 9-11 airlines have had to tighten the belt, and have either hired a lot of contract (i.e. low bid) baggage handlers, or have made do with less help. I read an article that said six of ten bags don't get where they need to be, on time, on flights that have a connection. I don't know if that is accurate, but every time I connect through certain airports, my bags don't arrive at my destination on time with me. I don't even check a bag anymore unless I am going for over three weeks, and/or am carrying weapons. Take a quick photo of the outside and what is on the inside with your digital camera or cell phone. Most savvy international travelers will also shrink wrap their bags to deter sticky fingers at third world airports. TSA doesn't like it, but they don't prohibit it. Don't check it, unless you don't mind loosing it. It won't kill you to not have your dose on time, but if you are like me, without the right dose, I get lethargic, slightly depressed, have a low libido, and can be real cranky. You'll survive, but if it is business you won't have the edge, and if it is pleasure you also won't have the edge.

The patch (androderm) works best for me, for a number of reasons, the most important is that it it the best delivery system to give me a consistent dose of Testosterone to keep my levels "normal", and I have never had the mood swings on the patch. Give it a test drive and see for yourself though. I had to try the gel to learn it wasn't for me.

[motivatedvet]

Hi rock and gmack....I am about to be back in a similar situation to you guys (or at least I think I am). Part of my question is are you allowed to serve in the military (specifically in an SF unit) if you have low testosterone? I'm already in the process of heading back in and I posted on the site with the subject "Recently diagnosed - unique situation".

If one or both of you could take a look at my post I would be extremely appreciative. It is such a tough situation and it would be great to speak with someone that has a similar job. Hope to hear from you guys....