Androgel Failure, Injections -- Questions and Ideas

[Guest guest]

Many of us have experienced the gradual failure of Androgel to

maintain serum levels of testosterone after years of use. I am now

experiencing that problem after having used Androgel successfully for

over 5 years. In the last two years my T levels have declined from

around 800 ng/dl on 6 pumps (7.5 GM) Androgel daily, to around 250

ng/dl on 8 pumps (10 GM daily). My doctor has now prescribed 12

pumps (15 GM) but I am doubtful that's going to give any better

results. Even on 12 pumps I feel lousy, so I'm sure my T is still

low.

Now the obvious answer would be to go to injections. However I have

a history of endocarditis (bacterial infection of the heart valves)

which was caused by a gangrenous gallbladder. My endocarditis was

not caused by the injections; but a history of endocarditis makes

intramuscular injections a bit risky, since any infection could

spread the the heart and be fatal.

I did do injections for about 10 years (before my endocarditis

episode) and we are considering going back to them, but due to the

risk in my case I might want to try other approaches first.

Questions:

1. Has anyone on Androgel who has found their levels declining been

able to get the levels back up by changing the site of

application? For example, I am now doing belly and

shoulders. Would it help to apply the Androgel to my thighs instead?

2. Has anyone whose Androgel failed gotten good results from

anything other than i.m. testosterone, eg. patches, buccal (Straint)

or even HCG alone? (HCG injections would not pose as much risk for

me as they are not intramuscular.)

If it makes any difference, my hypogonadism is tertiary: my

hypothalamus doesn't put out GnRH, hence no LH/FSH, hence no

Testosterone. Without treatment my T levels are below 100 ng/dl.

3. Has anyone doing testosterone injections had an infection from

them? I noticed that Groh mentioned he developed cellulitis. I

did injections for 10 years without any problem, but it's a little

more risky for me now. (It's not risky for most guys, just possibly

those of us who have had endocarditis.)

Finally, I thought I'd share a theory I have about why Androgel may

stop working. I know some guys have mentioned skin thickening -- and

that could be one cause. But I have not noticed a change in skin

quality, so that led me to some other ideas. I should mention that I

have a degree in Biochemistry and even published a paper or two on

drug metabolism (before my own health fell apart), so I'm on somewhat

familiar ground.

What I think might be happening is this: Skin cells contain the

various enzymes that metabolism and break down testosterone:

aromatase, 5-alpha-reductase and others down the line that convert T

to estrogen or DHT and then to inactive compounds. Furthermore it

appears that these enzymes may be inducible. That is to say

exposure to T may increase the activity of the enzymes that break it

down. Now when you put Androgel on your skin you are exposing the

skin cells to concentrated levels of T that are possibly thousands of

times higher than normal. It may be that in time this induces the

skin cells to have an exaggerated ability to break down

testosterone. Thus the testosterone in the Androgel is destroyed by

the action of the skin cells before it can penetrate to the

bloodstream.

Nice theory perhaps, but it doesn't necessarily solve the

problem. Maybe one could apply Androgel with some kind of topical

aromatase inhibitor and 5-alpha-reductase inhibitor in high

concentrations, but I'm not sure that's practical. So that brings

me back to the idea of changing application sites. Or the

alternative of injections.

Any comments would be appreciated.

Thanks,