compounded testosterone cream doseage question

I have a question about the doseage of the compounded testosterone cream that some women are using. For instance if you tell me you are taking a 1/2 gram of cream and that should equal 5mg. of testosterone now I understand that your topical dose is 5mg. How do you measure the dose? Why not have a measuring device? My next question is what % of the dose is absorbed systemically. Over what period of time is it absorbed. When you have had your blood level checked- what was the relationship to when you applied the testostorone and when you had the level checked? Time of day is supposed to be another variable in blood level, what time of day do you have your level drawn?
Does your pharmacist have any pharmokinetic data available. Mine did not. I have an inquiring mind.

That is a difficult question to answer. The reason is, everyone's skin is different in its permeability to the molecules in the cream, so everyone will absorb the testosterone at a different rate from the exact same amount of cream that is the same concentration. In addition, the dosages are only approximate because of the way they're computed... we assume the cream (ie the base, for all intents and purposes) has a density of 1 gram per cc, when it may or may not. (That's the density of water -- if your cream floats in water, it is less dense.)

I don't measure my cream other than by eyeballing how big a 'blob' I squeeze out of the container. I've gotten very good at that over the four years I've used it. I find that it's really easy to use fairly close to the same amount every time, and I don't feel any different if it's a little off. I figure, don't sweat the small stuff.

Besides, really what matters is how you feel, bottom line. Numbers are just numbers. I understand how frustrating it can be to look for a way to quantify things and try to calculate how much your ideal dose should be, but in the real world, it just doesn't work that way -- at ALL. First off, everyone feels best at a different level, and that level also depends on how much estrogen is present relative to the testosterone level (possibly progesterone, too, but we don't know that for sure).

Also, there are way too many variables that affect how a given mass of testosterone will get in through the skin and make it to the bloodstream, and then transport to, and bind onto, the cells that need it. And, to make things more complicated, layer onto that the fact that, as we get closer to having the level that we need (ie some receptors saturated), the efficiency with which we use whatever testosterone we absorb starts to drop off. There is simply NO WAY to quantify the exact amount one should use based on hormone levels.

When you're at a relatively steady state in terms of using the testosterone regularly and maintaining fairly constant levels, it really isn't important what time of day any testing is done. Frankly, imho, the only time testing is really useful is before you start supplementing with testosterone, to make sure your levels are really too low to begin with; and then, maybe occasionally, to make sure your levels aren't off-the-charts high from over-supplementing, and in that case, precise results aren't too important. All that's needed is a ballpark. The only thing I'd advise if one is getting their levels checked is not to have the testing done within, say, about 12 hours of applying testosterone. That isn't a problem for most of us, who don't even use it close to daily.

I have seen very limited pharmacokinetic data on the transdermal absorption of testosterone, but don't have any on hand at the moment. Obviously P&G has done some testing in the course of preparing their Intrinsa patches for the approval process. There are more data for creams and gels in men. But, again, I really don't think it matters, since everyone is different in how we absorb transdermals.

I don't mean to be so discouraging, but unfortunately, I think you're looking to make an exact science out of something that just isn't going to cooperate. HRT just plain doesn't work that way.

s,
-Linda

Surferbabe, I find this all very interesting. Is your answer from the point of view of a user relating your own personal experience or from a scientific background? Would you subjectively feel any different on different doses of testosterone? If you "know" what the dose was as opposed to not knowing or receiving a placebo? Do levels matter? There is plenty of research out there that suggests hormone levels do matter. Which hormone or combination of seems to be up for question depending on what is being studied.

I find it very interesting (I have followed these boards for some time now) that few women report the dose of testosterone they are on. They do report the %. Does this matter. I don't know. I would like to know what doctors out there are prescribing and how they monitor it. From reading these boards I am seeing a wide range of practices in the real world.

I am feeling that the advice and recommendations sometimes offered here sound more like astrology than science. I would like to see more evidence based science. I think women are often guinea pigs in these matters. There may be some individual differences in absorbtion and metabolism but I bet most women will fall inside certain parameters in a bell curve. There is data available for men. We women deserve no less. I personally am uncomfortable that the most frequent answer to my questions are no one really knows. Proctor Gamble probably does have statistics on the pharmokinectics of their product. It most likely would not apply to a topical cream made up at your local compounding pharmacy. Their patch would have a patented reservoir which would act as a time release mechanism.

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Originally Posted by Pearle I find it very interesting (I have followed these boards for some time now) that few women report the dose of testosterone they are on. They do report the %.

IMHO I don't think that really matters. If someone asks me what my doseage is, than I usually will answer. I often don't reply with my doseage of bi est or progesterone either. If someone asks me "what hrt are you using". I will usually reply "bi est, progesterone and testosterone". If someone asks me what my doseage is, I will reply with that information. Granted, sometimes I may misread a post and not reply with all the information requested, but I don't think it's that big of a deal that some posts do not contain the doseage of testosterone that a person is using We are, afterall; women supporting women, we are not medical professionals nor are we scientists.

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Originally Posted by Pearle Surferbabe, I find this all very interesting. Is your answer from the point of view of a user relating your own personal experience or from a scientific background?

The answer to that is ... both, but what counts here is, as (((Kim))) said, the "women supporting women" nature of this site. There are medical websites out there; while some of us are educated in these topics beyond just personal experience, that's outside the scope of Hystersisters and just a *bonus* if our knowledge happens to be relevant to someone else's concerns.

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Originally Posted by Pearle Would you subjectively feel any different on different doses of testosterone? If you "know" what the dose was as opposed to not knowing or receiving a placebo? Do levels matter?

Well, now I'm speaking strictly from personal experience. Yes, levels matter, FOR ME. I happen to feel best on a slightly higher testosterone level than the average premenopausal woman. I knew this intuitively from the fact that I had always had very oily skin and hair until I became perimenopausal. However, the reason I've decreased my usage of testosterone over time is because I did discover that I was getting oilier and also more irritable; at that point I had my levels checked and they came back high. Thus, I had my own confirmation that oilier skin and irritability = higher testosterone level than I needed. Since I dropped way down in my usage, my skin has returned to its normal condition and I feel like myself.

I doubt that (for me) the placebo effect has anything to do with it; I'm too much of a scientist to get tricked by that. I am one who wants confirmation, evidence, data... it's just that we have to accept at this point in time that most of the data are qualitative rather than quantitative. That's why we keep saying here that it's important to take time to learn to understand what your body is trying to tell you.

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Originally Posted by Pearle Proctor Gamble probably does have statistics on the pharmokinectics of their product. It most likely would not apply to a topical cream made up at your local compounding pharmacy. Their patch would have a patented reservoir which would act as a time release mechanism.

Actually, no... there's no patented reservoir. P&G developed the Intrinsa patch as a joint venture with Noven, using the Vivelle dot's dot matrix adhesive technology. Its delivery characteristics would be analogous to that of the "dot" except for allowances for the difference in molecular size and affinity between estrogen and testosterone.

I'm sorry you feel like we're astrologers here; I assure you we're not -- or at least I'm not -- although I do find such things entertaining.

s,
-Linda

Okay, I went and got my jar of testosterone cream. It says: apply 1.25 gm at bedtime. It is 1% compounded testosterone cream. I used that much when I started taking it and found that after awhile my clitoris became larger so I backed off to using about half that 2-3 times a week. That much seems to have the desired effect. I don't obsess that much over the dosage, just how I feel. I feel I am more in balance all the time.

It is not a perfect science and we are, in fact, guinea pigs. For the most part we have to take control over our medical care, with the help of our dr's, do our own research and record our symptoms. I dont like it either BUT it is the way it is. Also, Suzanne Somers' book states that the amt of hormones you need changes frequently according to your lifestyle.

Hi Pearle,

I don't have kinetics data for compounded creams, but I found an article that gives these numbers for a gel. If that would help? I tried to find a free reprint of the article, but couldn't. Your local hospital might own the journal though because there are a fair number of hospitals that do. Or you might be able to get a copy through your library. Here's the citation and abstract.

Mazer NA, et al. Transdermal testosterone for women: a new physiological approach for androgen therapy. Obstetrical & Gynecological Survey. 2003 Jul;58(7):489-500. [abstract]

Hi Pearle,

At the moment I use Androgel - 1% - it comes in 5mg packets. To get a smaller dose I use a syringe to suck up the gel and I then measure out a dose from the syringe. At the moment I'm down to .5mg every three days and I think it will go lower based on side effects. I have yet to confirm my level with a blood test due to a lab error (hoping to get one this Friday!) Androgel is technically for men, though I don't think it actually matters except that the amount I'm using is getting small enough that it would be easier to use a cream that came in smaller doses (or even in a bottle so I wouldn't have to futz around with the packet). If you are concerned about how much you are getting you might try getting Androgel and using my method since at least you can measure it exactly.

I do know what you mean about the absence of hard data and it doesn't help that a lot of doctors don't seem to know much about it. My endocronologist doesn't even do reproductive hormones, my OBGYN was willing to give them to me but told me flat out she doesn't do HRT beyond estrogen very often. I finally got a psychiatrist to give me a reference for a nurse practitioner in my area who is supposed to be quite good at HRT, including OTC supplements. I'm seeing her Friday and am hopeful she will be knowledgeable.

The problem is, how do you find people who specialize in HRT and for whom it is the mainstay of their business rather than just a very small part? In reality I don't think it is reasonable for most OBGYNs to specialize this way - their business covers all the areas of fertility and childbearing so I really don't expect them to have a detailed understanding of all aspects of hormone regulation. Not to mention how it impacts not just the health of the reproductive tract, but the health of the entire person including the mind. This is an area in which there doesn't seem to be much specialization, however I would think it could be a lucrative market for someone willing to do that (given that half or more of the population will be in this boat eventually). Possibly I'm mistaken, but I have been unable to even find a society or organization of practicing doctors treating patients who require HRT.

(((staje))) the closest we have at this point is the IACPRX - an internation association of compounding pharmacists. Their website is at www.iacprx.org and has a lot of great information, as well as a pharmacy locator. Where I'm going with this is that the best avenue we have for finding a DR who understands prescribing compounded testosterone for women is to ask the local compounding pharmacist which DRs prescribe it through them. Usually they're more than happy to refer us.

s,
-Linda

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Originally Posted by surferbabe (((staje))) the closest we have at this point is the IACPRX - an internation association of compounding pharmacists. Their website is at www.iacprx.org and has a lot of great information, as well as a pharmacy locator. Where I'm going with this is that the best avenue we have for finding a DR who understands prescribing compounded testosterone for women is to ask the local compounding pharmacist which DRs prescribe it through them. Usually they're more than happy to refer us.

Hi Linda - I did in fact follow this route as well - it is a great resource! However It is not the same as a group of physicians who form a learned society to share information and research - and that is very strange. For example, I have a fairly uncommon stomach problem called Idopathic Gastroparesis and there is actually an association of physicians who work on this disorder and have annual conferences etc. The same is true Endometriosis, in fact I think there are several professional associations with annual meetings, publications, etc.. I would guess that there are way fewer people with these disorders than women who need or are considering HRT.