Men's Health Forum: This is a discussion on Creams versus gels? within the Anabolic Steroids forums, part of the extensive steroid information at MESO-Rx; I must say that using 50-60 mgs of cream has knocked me on my butt in terms of side effects! ...
I must say that using 50-60 mgs of cream has knocked me on my butt in terms of side effects! My face has been red half the day, I have a headache, and I feel quite flushed. I will lower the dose and get tested, but assuming that I can't get my testosterone levels to a middle range without having excessive estrogen and/or DHT, what is the objection to adding very small amounts of arimidex or propecia to get those latter hormones back into line?
I must say that using 50-60 mgs of cream has knocked me on my butt in terms of side effects! My face has been red half the day, I have a headache, and I feel quite flushed. I will lower the dose and get tested, but assuming that I can't get my testosterone levels to a middle range without having excessive estrogen and/or DHT, what is the objection to adding very small amounts of arimidex or propecia to get those latter hormones back into line?
First of all DHT levels will be higher on creams and DHT is an E2 antagonist. With creams your E2 should be lower unless you are overweight.
DIM or IC3 are good choices with 50-75mg of zinc per day for keeping E2 under control. If that does not work, low dose Arimidex in the amount of .25 mg every 3 or 4 days would do the trick but it is so powerful that you do run the risk of your E2 going to low, and you will feel bad and it will shred your cholesterol profile. You need E2 in balance.
I would not touch propecia with a ten foot pool, some guys have permanent libido dysfunction and ED from it.
You don't want to jump ahead here unless the sides are so severe that you cannot tolerate them. They should clear up in a few days of lowering your dose
I must say that using 50-60 mgs of cream has knocked me on my butt in terms of side effects! My face has been red half the day, I have a headache, and I feel quite flushed.
Give your body a few days to adjust (after applying it correctly), and the estrogen/DHT should correct itself and your symptoms should go away.
Quote:
Originally Posted by drp90210
I will lower the dose and get tested, but assuming that I can't get my testosterone levels to a middle range without having excessive estrogen and/or DHT, what is the objection to adding very small amounts of arimidex or propecia to get those latter hormones back into line?
I'm not a proponent of using drugs/supplements to control estrogen and DHT, unless it's absolutely necessary and all other methods of TRT that may correct the problem, have been tried. The reason is because it is extremely difficult to do, results are usually not optimal, and it is a lot easier to let the body do this naturally. If for whatever reason the T Cream does not do the job for you, then there are a number of other options you can try which may do so.
1 cc -- I was wondering -- applying testosterone cream to a thin-skinned area (like the inner bicep area) theoretically reduces DHT conversion (due to less skin), but wouldn't it also have the effect of speeding up the delivery of testosterone? I seem to recall various doctors saying that after one hour, the skin acts as a slow-release reservoir for the testosterone, which should be slowly released throughout the day. If the skin is thinner, wouldnt this also mean that the delivery reservoir is smaller, and therefore might give a testosterone peak in the AM and low levels by the evening?
1 cc -- I was wondering -- applying testosterone cream to a thin-skinned area (like the inner bicep area) theoretically reduces DHT conversion (due to less skin), but wouldn't it also have the effect of speeding up the delivery of testosterone? I seem to recall various doctors saying that after one hour, the skin acts as a slow-release reservoir for the testosterone, which should be slowly released throughout the day. If the skin is thinner, wouldnt this also mean that the delivery reservoir is smaller, and therefore might give a testosterone peak in the AM and low levels by the evening?
All of the pharmacists I have spoken to have said that T Cream should be applied once a day to the thin skin of the inner forearm, inner bicep, or inner thigh areas. Dr. Philip Miller author of the excellent book, "The Life Extension Revolution", has his patients apply their T Cream to the inner forearm area. I would trust these people's experience with regards to this.
An easy thing that you can do is to apply T Cream in the morning as usual to the inner bicep area, and then do labs in the morning about 3 hours after applying the T Cream and then later at about 6pm in the afternoon again do Total T and Free T labs. This will show you weather you are going too low or not.
There is an interesting study that might provide some information, but unfortunately it didn't even have an abstract at pubmed. If anyone can get a hold of the full study or even the abstract, that would be great. This is the info:
"Progesterone skin cream and measurements of absorption." by Dr. Gambrell
There is an interesting study that might provide some information, but unfortunately it didn't even have an abstract at pubmed. If anyone can get a hold of the full study or even the abstract, that would be great. This is the info:
"Progesterone skin cream and measurements of absorption." by Dr. Gambrell
Quote:
Progesterone skin cream and measurements of absorption
[Editorials]
Gambrell, , R. Don Jr. MD
Reproductive Endocrinology,
Augusta, GA, USA
During the clinical trials of the first transdermal estradiol (E2) in the early 1980s, I asked Alza Pharmaceuticals if they could develop a progesterone patch. They responded that some preliminary information would be available within a few weeks. However, after no response for several months, they informed me that it would take a body surface area the size of two football fields to get enough progesterone on a patch to provide luteal phase levels. When you think about it, transdermal patches 0.1 mg provide up to 100 pg of E2; however, to achieve a luteal level of 15 ng/mL of progesterone, a 3.0 mg patch would be needed, 30 times the size of the original estrogen patches. The transdermal E2 systems have been improved over the years with advancing technology so that much smaller patches deliver the same amount of E2. As technology advances, someday a patch or system will be developed to drive progesterone through the skin. The combination estrogen-progesterone patches available now all use synthetic progestogens such as norethindrone acetate 1 or norelgestromin, 2 which is in the new contraceptive patch.
A decade or more ago, my patients started bringing in the various “progesterone” creams from the health food stores to replace their oral progestogens. These health food stores were promoting skin creams with extracts of the Mexican wild yam under different brand names, including Progest, Born Again Wild Yam Cream, and Progesterone–HP, as a source of progesterone supplementation. However, there are no studies to even suggest that any progestational effect can be obtained by applying extracts of Mexican wild yam cream to the skin. Even when progesterone 15 mg twice a day was added to these creams, serum levels of progesterone only increased to 1.8 ng/mL, far below desired luteal levels. 3 The use of these creams has come about because the Mexican yam root contains a plant steroid, diosgenin, from which some of the progestogens, norethynodrel and norethindrone, were synthesized in the laboratory for the original oral contraceptives. It is unlikely that the human skin can absorb and convert diosgenin to a biologically active progestogen.
In the mid 1990s, a pharmacist sent me a progesterone gel, with the daily dose prepared in a syringe for my clinical trial. Two surgically menopausal female volunteers who were not using HRT used this progesterone gel daily for 10 days, and serum progesterone was drawn thrice weekly during use. Progesterone level remained less than 1ng/mL in both women. It has been suggested that salivary progesterone may be a useful index for estimating luteal function. 4 During the luteal phase of the cycle, salivary progesterone correlated well with plasma progesterone but was found to be about 1% of that in plasma. This correlation held true during conception cycles and increased proportionately during the evolution of the corpus luteum of pregnancy. During four cycles of luteal insufficiency, progesterones were lower than normal in saliva as well as in plasma.
A progesterone cream containing 16, 32, or 64 mg of progesterone during the second 14 days of a 28-day cycle, administered along with continuous transdermal E2 in postmenopausal women, raised serum progesterone to 1.2 nmol/L. 5 These levels were insufficient to induce any changes in the endometrium, although one patient had bleeding for 2 days after the third cycle of sequential E2-progesterone skin cream.
In this issue of Menopause, Wren et al report a study of the effects of transdermal progesterone on vasomotor symptoms, moods, sexual response, cardiovascular lipid levels, and bone mineral density metabolic markers. 6 In a double-blind trial of 80 postmenopausal women, half received a transdermal cream containing 32 mg of progesterone, and the other half received a placebo cream in a 12-week trial. All participants were postmenopausal women having hot flashes with follicle stimulating hormone levels in excess of 30 IU/L. Transdermal progesterone cream resulted in an elevation of circulatory progesterone levels from a median of 0.11 ng/mL to a median level of 0.31 ng/mL after 12 weeks. This was a significant increase, but far below that expected to induce biological changes in the endometrium. There was no change in blood lipid levels nor was there any apparent influence on bone metabolic markers. They were also unable to detect any changes in clinical parameters, such as vasomotor symptoms, moods, sexual enjoyment, or quality of life. In previous research, using a continuous transdermal E2 patch with 14-day sequential cream containing 16, 32, or 64 mg of progesterone, serum levels of progesterone increased from a range of 0.1 to 1.1 nmol/L to a range of 0.6 to 3.2 nmol/L in the third cycle. 6 However, salivary progesterone levels were increased up to 1,000 times that found in plasma. Although the present study is a negative study, it is important because it shows that the minimal increase in plasma progesterone correlates with symptoms, lipids, and bone markers. Their previous study also showed minimal increase of progesterone in plasma, which also correlated with failure of secretory changes in the estrogen-stimulated endometrium.
Lee has been one of the leading advocates for natural progesterone cream for menopausal symptoms. 7 He also recommends progesterone skin cream for premenstrual syndrome and endometriosis. Lee maintains that saliva is the only way to measure bioavailable progesterone for dosing purposes. He stated that serum and plasma are watery and contain water-soluble (hydrophilic) substances such as water-soluble vitamins, carbohydrates and proteins. Serum and plasma do not contain fat-soluble (lipophilic) substances. Sex hormones such as progesterone, estrogen, and testosterone are fat-soluble steroids similar to cholesterol. Lee points out that, when cholesterol is measured, it is cholesterol bound to protein (high-density lipoprotein or low-density lipoprotein cholesterol) which makes it water-soluble. Ovarian progesterone is largely protein-bound and, therefore, is not readily bioavailable to receptors in target tissues. Lee states that only 2% to 5% of serum progesterone is “free” or nonprotein bound. This is the progesterone available to target tissues and to saliva.
Transdermal progesterone is highly lipophilic, which is absorbed though the skin into the fat layer. This progesterone is taken up gradually by red blood cell membranes and is readily available to all target tissues and saliva. It is completely bioavailable and readily measured by saliva testing. According to Lee, only a small fraction of progesterone is carried by the watery serum, so this is not a good way to measure transdermal progesterone absorption. Lee states that the goal of progesterone supplementation is to restore normal physiologic levels that are bioavailable, which is about 0.3 to 0.5 ng/mL in saliva. In Lee's experience, the topical dose required to achieve a saliva level of progesterone of 0.5 ng/mL transdermally is 12 to 15 mg per day. Creams containing 900 to 1000 mg per 2-oz container would provide 12 to 15 mg a day for approximately 72 days.
Perusal of the Internet indicates that virtually all of the health food store progesterone creams have from 480 to 1,020 mg of progesterone added per ounce with varying other ingredients, such as wild yam, red clover, aloe vera, vitamin E, evening primrose oil, black cohosh, dong quai, and even ginseng. These are marketed under many catchy brand names, including Progesterone Cream, Hormonil Progesterone Cream, Women to Women Body Cream, Phytoprolief progesterone cream. Progesta-Eze, Young Again Natural Progesterone Cream, Wild Yam and Natural Progesterone Cream, and Progest, just to name a few. Many of these Web sites have various quotations from Lee.
In a study from England, Progest cream with 200 mg of progesterone added per ounce (teaspoon per day dose) was compared with oral micronized progesterone 300 mg daily and placebo cream in a 10-day crossover trial. 8 Serum progesterone increased from a mean of 0.7 to a mean of 2.9 nmol/L with Progest cream; however, the mean increase from oral micronized progesterone was 9.5 nmol/L. There were similar increases with both the Progest cream and the oral micronized progesterone in serum 17-hydroxyprogesterone. Urinary pregnanediol-3-glucoronide increased with Progest and the oral micronized progesterone; however, the increase with oral micronized progesterone was far greater. The researchers concluded that these minor increases of serum progesterone to 3 nmol/L would not protect the endometrium from stimulation by estrogen and would not conserve bone. Another study of applying a quarter-teaspoon of cream daily containing 20 mg of progesterone, or placebo, for a year found that 83 % of those applying the progesterone cream had improvement of vasomotor systems, compared with 19 % of those using the placebo cream (P < 0.001). 9 However, after 12 months there was no gain in bone density. Neither serum nor salivary levels of progesterone were measured.
In a short-term absorption study of Progest progesterone cream, transdermal E2 0.05 mg was applied continuously. 10 Progesterone cream was then applied for 14 days at a dose of 30 mg/day. After two weeks, this dose was doubled to twice daily (60mg/day). Serum progesterone concentrations ranged from 1.0 to 3.3 ng/mL. The mean serum progesterone level after 2 weeks with the 30-mg/day dose was 1.6 mg/mL; the following 2 weeks, with the 60-mg/day dose, mean serum progesterone levels were 2.3 ng/mL. Serum progesterone levels were sustained at approximately 1ng/mL for at least 8 h after application. These were significant increases in serum concentrations of progesterone from a mean at baseline of 0.17 ng/mL to a mean of 2.3 ng/mL by day 29 of the study (P < 0.0001). This is another study that demonstrates that progesterone cream is well absorbed through the skin, but only at low levels of 1 to 2 ng/mL. No clinical parameters were evaluated nor saliva progesterone levels obtained.
All of the studies demonstrate that progesterone in cream form can be absorbed through the skin. Although some studies demonstrate symptom relief, serum levels of progesterone remain low. None of these studies reveal any improvement of other parameters, such as bone mineral density, endometrial protections, or cardiovascular lipid and lipoprotein markers.
Systemic absorption of progesterone from Progest cream in postmenopausal women.(Research Letters). A. Cooper, C. Spencer, M.I. Whitehead, D. Ross, G.J.R. Barnard and W.P. Collins.
Progest (Professional and Technical Services, Portland, Oregon, USA) is a natural progesterone cream used to reverse postmenopausal [osteoporosis.sup.1]. We have patients who substitute Progest for the progestogen component of combined hormone replacement therapy (HRT). However, when we measured plasma progesterone the values were below 3 nmol/L which indicates little, if any, systemic absorption (unpublished observations). Therefore, we have carried out a randomised, double-blind, placebo-controlled, cross-over study to assess absorption, metabolism, and urinary excretion of progesterone in postmenopausal women.
With approval of local research ethics committees, we recruited 20 postmenopausal women aged between 37 and 70 years who had undergone hysterectomy and bilateral salpingo-oophorectomy. None had taken HRT for at least 3 months, smoked more than ten cigarettes each day, or had any skin disease. We purchased Progest and, as a placebo, Boots emollient cream. Both were transferred to identical, lidded, plastic containers which were marked A for placebo and B for Progest. The study lasted 33 days and patients were randomly allocated to treatment in blocks of four. For the first 10 days they applied either cream A or B: there was then a 4-day no-treatment washout. For the next 10 days (days 15-24) the other cream was applied and this was followed by a further 4-day no-treatment washout. All patients then took oral natural progesterone (Uterogestan, Laboratoires Besins-Iscoveso, Paris, France) 100 mg in the morning and 200 mg at night for 5 days. We asked patients to apply one teaspoon morning and night which was 2-4 times the manufacturer's recommended dose. All patients collected a sample from the first morning urine into prelabelled bottles. These were stored in a domestic freezer before transfer to hospital in ice-filled flasks and storage at -20[Degree]C until analysed for pregnanediol-3[Alpha]-glucuronide (P3G). Venepuncture was performed pretreatment and at the end of each treatment phase (days 10, 24, and 33) 4-6 h after the cream had been administered or the 100 mg natural progesterone tablet had been ingested. The plasma was separated and stored at -20[Degree]C until analysed for progesterone and 17-hydroxyprogesterone (17-OHP). All samples were analysed in batches at the end of the study with appropriate samples for quality control. Urinary P3G was measured by direct time-resolved [fluoroimmunoassay.sup.2]. Plasma progesterone and 17-OHP were extracted with diethyl ether, reconstituted in buffer, and measured by time-resolved fluoroimmunoassays (Delfia, Milton Keynes, UK). The code for randomisation was broke n after all samples had been analysed.
All 20 patients completed the study. One patient forgot to take the Uterogestan tablets on the 2nd, 3rd, and 4th days of scheduled administration and her results for P3G for these 3 days were omitted. Although Progest significantly increased urinary P3G and plasma progesterone and 17-OHP values compared with placebo (table), the median plasma progesterone after 10 days of administration of 2-4 times the amount of Progest recommended by the manufacturer was only 2-9 nmol/L. This is much below the day 21 plasma progesterone of at least 30-35 nmol/L which is observed in fertile women. We observed a median progesterone value with Uterogestan in this study of 9-5 nmol/L; this is similar to the values (8-10 nmol/L) previously reported by our group 4-6 h after ingestion of 100 mg of [Uterogestan.sup.3]. In this previous study, plasma progesterone values surged to 35 nmol/L within 3 h of administration of Uterogestan 200 mg at night, and we suspect that this surge is largely responsible for the secretory transformat ion of the endometrium observed in oestrogen-exposed postmenopausal [women.sup.4].
The P3G values confirm that the systemic absorption of progesterone from Progest is small. The median value after 10 days of treatment was only 4-2 [micro]mol/L which is lower than the mean value observed during the luteal phase of the ovulatory cycle (12.5 [micro]mol/L and on day 21 (22.7 [micro]mol/L in our laboratory. The very high P3G values observed with Uterogestan are supraphysiological and reflect the route of administration. The low plasma progesterone and urinary P3G values observed here reflect the mass of progesterone which is administered. Each 2 oz (57 g) pot of Progest cream contains 200 mg of progesterone which is equivalent to about 4 days of peak production by the corpus luteum. An increment of plasma progesterone of 3 nmol/L will not protect the endometrium from stimulation by oestrogen and will not conserve bone. Thus, Progest should not be substituted for the progestogen in conventional oestrogen/progestogen HRT.
We thank N Colville, K Moms, and F Rees from the Menopause Clinics at Kings College Hospital and the Amarant Trust for their help with patient management and sample collection. We also thank M Rees, Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Infirmary, Oxford for providing information on the content of progesterone in a jar of Progest.
(1.) Lee JR. Osteoporosis reversal: the role of progesterone. International Clinical Nutr Rev 1990; 10: 384-89.
(2.) Kesner JS, Knecht EA, Krieg EF Jr, et al. Validations of time-resolved fluoroimmunoassays for urinary esterone-3-glucuronide and pregnanediol-3-glucuronide. Steroids 1994; 59: 205-11.
(3.) Padwick ML, Endacott J, Matson C, Whitehead MI. Absorption and metabolism of oral progesterone when administered twice daily. Fertil Steril 1986; 46: 402-07.
(4.) Lane G, Siddle NC, Ryder TA, et al. Dose-dependent effects of oral progesterone on the oestrogenised post menopausal endometrium. BMJ 1983; 287: 1241-44.
Menopause Clinics, King's College Hospital, London SE5 8RX, UK (M I Whitehead); Amarant Trust, Churchill Clinic, London; Endocrine Unit, Department of Chemical Pathology, Southampton University Hospital Trust, Southampton; and Academic Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, London
Treatment P3G (nmol/L) P (nmol/L)
Median Range Median
None (baseline) 0.7
Placebo (10 days) 1.1 0.3-2.8 0.8
Progest (10 days) 4.2 [1.6-13.1.sup.#] 2.9
Uterogestan (5 days) 291.0 [124.0-1004.0.sup.ss] 9.5
17-DHP (nmol/L)
Range Median Range
None (baseline) 0-02-1.7 0.4 0.1-1.4
Placebo (10 days) 0.3-1.8 0.4 0.2-0.9
Progest (10 days) [0.7-15.00.sup.+] 1.1 [0.3-6.4.sup.*]
Uterogestan (5 days) [1.8-21.9.sup.ss] 1.2 [0.7-2.6.sup.ss]
(*.)p<0.05, +p<0.005, #p<0.0001. Progest versus placebo: p<0.0001, Utrogestan versus placebo. All analyses Student's t test. P=progesterone.
P3G concentrations In daily samples of early morning urine during treatment and concentrations of plasma progesterone and 17-OHP on last day of treatment
Just wanted to report that my negative symptoms have been elminated by substantially increasing the amount of compunded testosterone cream I apply. For me, Androgel was absorbed about 3 times more efficiently than the compunded cream. I'm now using 15% test cream applying 1 1/2 grams a day, or about 22 grams of test. This makes my labs about the same as using 6 pumps of Androgel, or 7.5 grams. So the cream is clearly not absorbnog as well, but of course is significantly less expensive. With a teeny amount of progesterone cream, my DHT levels are in check and I'm feeling fairly good.
Re: Creams versus gels? 
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