This update brought to you by the letters D and T and by the number 208

Those of you who -- inexplicably -- read my posts may remember a thread last month where I reported the failure of my plans to regain my pre-ADT baseline levels of Testosterone without exogenous supplementation. (see Still Hung Like a Hamster: and Update ) I decided to supplement and, after a struggle to find an affordable source, I finally managed to score some 10% T cream on 1/26 which I have been applying as directed every morning since. I just got back the results of blood work after 25 days of the treatment. I'm not sure what to think of the results.

Here are my previous seven total T levels, approx every three months, starting in April 2016 when my T recovery peaked then started to decline: 273, 206, 188, 199, 126, 185, 172. My lab suggests a "normal" range of 175-781 ng/dL and the midpoint of that range is 478. My pre-ADT baseline was around 700. During those 20 months I tried clomiphene and hCG to stimilate my natural production with disappointing results.

I had blood drawn earlier this week and the number is... drumroll... 208 ... rimshot, kazoo fanfare dribbles off...

So, OK, that's kinda disappointing. I was hoping for twice that.

But it's only been four weeks. Maybe I should be patient and see where I am in another three months. Does transdermal T supplementation take a while to reach a stable level? Or should I talk about boosting the dose? Whaddja think?

I am also thinking about boosting my daily vitamin D3 supplementation. I take sort of a lot (15,000 IU daily) but my tested levels (Vitamin D 25 Hydroxy) have been dropping: 39, 30, 29, 56, 54, 49, 49, 46. The normal range is 30-100, mid-range is 65. The jump from 29 to 56 was a response to increasing my daily D3 from 10,000 to 15,000 IU but it's been dropping off since. Maybe I'll try 20,000 IU and see what that does.

There have been a few studies that look at the relationship between Vitamin D levels and testosterone. They have a fairly high correlation but they both also correlate with obesity. Some researchers "control" for obesity and find that it explains most of the correlation but I'm not sure how much sense that makes. It's not at clear to me that weight is a free variable. It seems equally valid to consider the three to constitute a syndrome -- Low Vitamin D, Low T, and Low self-control in the lunch line seem to go along together.

Classical reference in title.

I think 208 is disappointing, but are you getting free testosterone levels checked as well? How about estradiol and DHT? Assuming that free T is low too, I have a couple of hypotheses:

(1) The T is getting in, but your body is over-controlling it. I think this is what is happening with your other supplemented steroid, Vitamin D, as well: even though you are supplementing high amounts, very little free vitamin D is showing up in your serum. Serum steroids levels are mediated by specific binding proteins. For T, there is a protein called "sex hormone binding globulin (SHBG)" that complexes "excess" and delivers it for metabolic waste removal as estrogen or DHT. So, it may be that you are overproducing SHBG - you can tell by measuring free T, and estrogen and DHT. If free T is low but estrogen or DHT is high, it's a good bet that this is going on.

Aromasin (exemestane) is a drug that prevents T from being metabolized to estrogen, and it reduces SHBG levels, so it boosts T on two fronts. It is too good at its job -- men actually want some estrogen - it contributes to proper sexual funcion, good skin, etc. But you can try it for a limited time to see if your free T increases. (Tamoxifen has the opposite effect - it increases SHBG and reduces serum T)

(2) The T isn't getting in. Some guys don't get adequate absorption transdermally. We all have different skin characteristics. if this is your dysfunction:
• you can try a higher dose - say, 20% T
• you can try a different base - like an alcohol gel
• you can give up on transdermal, and use shots or subcutaneous pellets instead

There should be good absorption through underarm skin (even with hair). The best absorption is through the scrotum - but your appliances may be in the way. The reason they tell you to avoid scrotal application is because a lot gets converted to DHT, which can cause balding and bad skin. It can also be made into a sub-bucal troche to be held under the tongue or between the gums and the cheeks. I don't know why they don't make a testosterone rectal suppository - I reckon that would be the best absorption rate.

Paxton,

I am fairly hairy. Before my ADT the word furry might have applied. Currently I am smearing the goo on my upper chest between my collar bone and shoulder joint. For the first few days I also tried my inner thigh near the knee. I have noticed that the goop tends to clump onto any fine hair in the application area. So maybe that's the reason.

It appears that the T is being converted to DHT as fast as you rub it on. The solution is simple - block the enzyme (5-α-reductase) that converts T to DHT by taking Proscar or Avodart. The high DHT will only make your hair fall out and give you acne.

Fortunately, conversion to estrogen (the other main metabolic pathway) doesn't seem to be a problem. And you don't have elevated SHBG that might otherwise reduce your free T.

from my endocrinologist: "Get all your testing done first thing in the morning at the lab. That's when your hormones are at their highest. If not that, test every time at the same time of day for most uniform results."