Your Question: I have a patient using 4 pumps of Androgel 1.62 daily. What dose per gram would equal that in compounded form? 80mg from androgel seems like a lot.
Larry’s Response: The Androgel 1.62 is Testosterone USP 1.62%, which is 16.2 mg in each 1 mililiter (ml). The pump device delivers approximately 1.25 ml in each activation. Four pumps would be 5 ml of gel (a teaspoonful of gel is a lot to spread around), delivering 81 mg. That is certainly a lot of testosterone. The company mentions two pumps as a staring dose, 40.5 mg. Still, a fairly good dose of testosterone.
Why so much?
It is probably closely related to the delivery vehicle, a gel of water and alcohol. It delivers testosterone, a fat soluble hormone, to the skin and the gel evaporates leaving dried testosterone powder distributed over the skin – usually a fairly large area. Dried testosterone that isn’t brushed away on the clothing can be absorbed. There is still a good chance that the powder can be passed to other people or just lost in transit.
Compounded transdermal preparations are made in a base that dissolves the testosterone in the lipid portion. This preparation is more easily absorbed and there’s less opportunity for dry testosterone to remain on the skin to be brushed off.
Compounded creams can be made in any strength and doses can be adjusted by the user. For example, a 5% cream would deliver 50mg in each 1 ml. The person can apply 0.1 ml (5mg) or even more than 1 ml if needed. There are clinical advantages to a compounded transdermal testosterone. There is evidence that more of the testosterone is absorbed and not brushed off. The doses can be customized for the user. There is significantly less preparation used each time, as low as 0.1 ml.
Using 5 ml would never be necessary because we can make a stronger cream.
For example, a 10% transdermal preparation would deliver 100 mg in each 1 ml. A 10 mg dose is 0.1 ml and a 100mg dose would be a full 1.0 ml. In the case you’ve mentioned, a patient could apply 0.81 ml of a 10% transdermal testosterone cream to deliver 81 mg, but that may be too much. Only the patient and the doctor together will be able to determine the correct dose. We dispense our transdermal testosterone in a syringe-like delivery device, which allows a user to customize their dose.
There is not a one-to-one conversion from Androgel to a compounded preparation.
The best way to prescribe a compounded transdermal testosterone preparation is by the number of mgs to be applied, the instructions, the number of doses to be delivered, and the number of refills. The compounding pharmacist will dispense the preparation that will deliver the correct amount of testosterone with each use.
I hope this answers your basic question. Anything else? Just ask.