Testogel- first time user

I saw my Urologist and he is very happy with my trough results of 18nmol/L, he said peak results ma be high but they do drop off drastically through out the day. He has no concerns with the results, but did suggest another set of results should be taken.

He is also writing to my doctor with full instructions on Nebido Injections, correct dosing / timing of dosing's etc 

I am of much better frame of mind after this consultation, a £100 fee which I do not grudge for private consultation.

P.S.

this reply from Besins also arrived today;

.

Dear Mr -----------

I am writing in response to your recent request for information regarding our product Testogel. You enquired about the availability of the 50 mg sachets and when blood testosterone levels should be monitored.

Sachet availability

I can confirm that we are continuing to experience difficulty in the supply of Testogel 50 mg gel in a sachet formulation.

Unfortunately, we do not have an expected return date and the supply issue is likely to continue for the foreseeable future. If you have any further queries relating to the availability of Testogel or possible replacements, please contact your doctor or your pharmacist.

As you may appreciate they are best placed to provide you with accurate advice for your individual needs.

Blood monitoring

The Summary of Product Characteristics (SPC) is a more detailed document than the Patient Information Leaflet (PIL), and is primarily written for healthcare professionals.

The SPC for Testogel1 states in section 4.2 "Posology and method of administration":

"Steady state plasma testosterone concentrations are reached approximately on the 2nd day of treatment by Testogel. In order to adjust the testosterone dose, serum testosterone concentrations must be measured in the morning before application from the 3rd day on after starting treatment (one week seems reasonable)"

I would advise that you discuss this further with your doctor or pharmacist. As you will appreciate, they are best placed to provide you with advice relating to your personal medical condition. Your doctor will also have details of your medical history.

......

Finally, I am sorry to hear that you have experienced unsatisfactory blood test results while taking Testogel. I have passed details of this on to our Drug Safety Department who may contact you under separate cover to obtain further details about your case.

Details of the issue you have reported have also been passed to our Product Complaints Department, who may contact you under separate cover for further information.

I hope you find this information useful. Please do not hesitate to contact me if you require any further information.

Yours sincerely

Medical Information Officer

on behalf of Besins Healthcare (UK) Ltd

Reference:

I had exactly the same letter and they have now contacted me asking for more details of dates and symptoms.

If you don't hear, I suggest anyone with the same problem should email: PHARMACOVIGILANCE@besins-healthcare.com because something is very wrong with this product.

It would be great if it worked.

Hi All,

Just wanted to join this thread as concerned that I am not getting the correct dosage.

On Testogel for approx 3 months, first script was a box of sachets but since then I have been on the pump at 2 1/2 pumps daily (was told this is equivalent to 1 sachet).

T level pre therapy was 6 however just had a test last week and it is down to 4.99 despite the Tgel, My GP says she does not know the correct dose and has written to endocrinology at the hospital so stuck in limbo.

Any advice? 

Thanks

Al

I fear this is going to be a big can of worms for Besin healthcare.

They seem to think the pump gives a higher absorption rate than the sachets and there is no evidence to support this.

They told me there has been no head to head comparison between the two products.

Time and again, people are getting low readings after following their advice on dosage.

I researched and wrote this a couple of weeks ago.

Anyone with low test readings should contact them, so they eventually get the message

Email in previous posting last week.

Thanks

I have to agree with you, I don’t have a reading from while I was on the sachets to compare as I only used 1 box however I do feel that the pump does not have the same effect.

Surely on 2 1/2 pumps I should be above 4.99

I have emailed Besins for a response, will post back when I get a reply.

Al

Everyone's different. I'm confused how you can use 2.5 pumps as it's a measured dose. Do you throw some away?

Besins advise 2 pumps as an equivalent to 1 sachet but 2 pumps equals 40.5mg of T, so 2.5 equals approx 50mgs but -  the absorption through your skin at an average of 5% means you only get 2.5mgs into the blood stream. And on the sachets you absorb about 10% on average which gives you 5mgs of T into the blood stream. So, basically you'd need about 5 pumps on those calculations.

Thanks, 

I find you can depress about 1/2 way for a half pump, not precise I know but aiming for the 50mgs.

The absorption rate could be the game changer here, why do Besins recommend 2 pumps = 1 sachet when the absorption rate is half and the dosage lower, makes little sense to me.

I feel Besins need to clarify the math here.

Al

I have been using Testogel Sachets for 5 years following bilateral orchidectomies for Semionoma. I too had to switch to the new preparation using the pump applications and as we all know the new dosage delivery is rather confusing. I was using 1 sachet = 50mg daily. I was advised by my clinician to use the higher dose i.e. 3 pumps rather than the lower Besins recommendation of 2 pumps, which is deemed to be equivalent to the 50mg sachet version.

After 8 weeks on the pump version, using 3 pumps, I had my Testosterone (peak) levels measured and they revealed that the level had dropped from 19 to 9.5 (lowest acceptable on this scale is 7). So although I am within "normal limits", it is quite a drop, especially when my dose has essentially been increased. I have been advised not to pay so much attention to the Testosterone level, but more to my mood and physical state of being. I have been further advised to either stay on my current dose or increase to 4 pumps daily and check my levels again in August.

I must admit that my previous Testosterone trends, whilst using the sachets were quite erratic. so my next measure could possibly increase without increasing the dose.

What do you guys think or suggest?

I think there's a pattern emerging here, that the majority of people are getting a drop in T levels with this new pump. Personally, I was on 1.5 sachets a day and felt great. My T Levels were perfect according to the recommended levels for my age, 13.8 but when I went on the pump, I knew the levels were dropping fast and felt so ill and exhausted within a week, I had to go back on the sachets, hoping I can still get them regularly. Within a few days I started to recover. The doctor told me I should try again and have my levels measured on the pump, but I don't want to feel like that again and am loath to try it again.

I've tried explaining the maths to Besins and my GP but it's like banging your head on a brick wall. The pharmacist was the only one who seemed to understand the calculations.

Besin healthcare are going by a study back in 2011 which states the pump has a higher absorption rate than another 'unnamed' gel which concluded something like 80% of men had T levels in the normal range on the recommended dosage.

I wish they would re-evaluate and compare with their own sachets.It's rediculous. 

If you feel OK with the levels as they are now, then stick with it. But you may find your levels start getting lower - I don't know.

Good Luck and let us know how you get on.

Thank you very much. I will do :-)