Recently, there was some confusion with one of my patients, and they were using their new topical cream simultaneously with their injections.

They told me they felt great, and when I looked at their labs, they were perfect. A Testosterone around 800 and a DHT of about 90. normal T to DHT ratio.

This was an accident due to patient confusion, but I thought about it, and it actually solves the problem/drawback of each modality of T.

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Testosterone injections in FTMs come with one major drawback, and that's a low DHT percentage. Normal DHT percent is about 10-12% in cisgender males. In FTM patients on shots, it tends to be about 3-4%. DHT is the "brock lesnar" testosterone variant, which is heavily involved in beard growth and facial masculinization. So injections come with this drawback of having a poor DHT ratio.

My transdermal cream is designed to boost that DHT ratio, as besides testosterone, the cream also contains DMSO which helps with penetration/absorption. The normal DHT on my cream is 10-15%. However, the cream has one major problem. The testosterone in the cream is not conjugated like the Testosterone (Cypionate) in the shots. So instead of a 1 week half life, it has a 4 hour half life on average. This means if the patient doses twice per day, and right after dosing, they are 800ng/dl, 4 hours later its 400, 4 hours later 200, and 4 hours later 100 (if the kinetics were perfectly linear, which they are not, but for the sake of explanation we'll go with it). Basically, cream causes a big spike and then a crash, even when dosed twice per day.

Shot Pros: Long half life, can be dosed weekly

Shot Cons: Low DHT ratio due to 5 alpha reductase mostly living in the liver, skin and testicles.

Cream Pros: High DHT ratio due to skin absorption and conversion

Cream Cons: 4 hour half life, spiky and crashy levels throughout the day.

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But....these two can be combined to solve this problem and get the benefits of both.

Someone can use a low shot dose, like 0.2ml or 0.3ml of 200mg/ml T-cyp, and then also apply a daily cream twice per day to boost the DHT. This cream could be a much lower percent than my typical "transitioning cream" but this would allow for constant basal levels under which the cream cannot crash, but also allow for DHT conversion in the skin.

Basically, I think this would be a superior modality for transgender men, giving both DHT results but stable mood/levels, effectively producing a testosterone level more akin to that made from a Cis man's testicles.

And that's my fun idea of the day.