A lot of patients are always comparing the use of testosterone cream, the dosages more specifically, to the dosages of the testosterone injections. Because when I mentioned I'm using this cream trans-crotally twice a day for twice 150 milligrams, some people tend to measure this all up and they say, well, you're using more than a gram in a week. So how can these dosages be compared? and I did see that post and I actually got a little chuckle out of it because people don't understand that in pharmacokinetics we have essentially four major steps first you have absorption which is taking the medication into your body.
And this occurs in various different ways, which we'll get into. Then you have distribution, which is a systemic bloodstream flow. Assuming this is a systemic medication and not a localized one.
Then you have metabolism, which generally happens in the liver, but this is where the medication is either broken down into a non-active form, or if it is a pro-drug or a pro-hormone, it is then... metabolized into its active form. And then finally, you have your excretion, which often happens via the kidneys. All of these pharmacokinetic steps are essentially the key to pharmacology and understanding how medication works in the body and essentially how all nutrients work in the body.
So any compound you're going to absorb and metabolize is going to have to go through a process. And the rate of absorption and speed of metabolism and efficacy of the drug are going to really come down. to the initial form of administration.
So as we know, when you use an oral medication, it is extremely rapid. It does go through the GI tract and it goes through what we call the first liver pass. And that first liver pass, which is part of your GI tract, is not just the metabolism that happens after distribution in the bloodstream.
It is the initial digestive process. When this occurs, the liver will generally nullify most hormones. Most hormones do not survive a first liver pass. And because of this, if we know that the anabolic hormones like steroids that are orally bioavailable are C17 alpha-alkylated for the very reason that the liver is not going to be able to break down the efficacy of the hormone.
However, trying to break it down and failing is what's causing the liver hepatotoxicity, which is the strain or elevation of liver enzymes. So if we know that an oral application... tends to break down much faster and to a greater degree than an injection, we know that we have to take a much larger dose of a medication orally in order to equal what would be administered in an IM injection or an intravenous.
So if you look at vitamin C specifically, a nice hefty dose of vitamin C per day would be 5,000 milligrams, right, or five grams. And if it's taken orally in one gram tablets. you're going to essentially split that into five different doses throughout the day to make sure that the medication is absorbed properly.
And if you wanted to take an ascorbic acid or vitamin C injection per se, and really achieve the same level of benefits, you're only going to need about 500 milligrams via the injectable route. So if you look at the PL or oral administration to the IM administration ratio, and it will vary by drug, but if you want to give it a rule of thumb on average, you're looking at about a 10 to 1 ratio. between IM to oral. So someone taking 5,000 milligrams orally will take 500 in an injection.
So we do know that injectables, specifically IVs, are very fast acting, right? There's a reason that the only ways we administer glucose to patients who are hypoglycemic is either oral, sublingual, or IV, because we need it quick. We need the glucose quick. And if you were to apply, let's say, a transdermal cream, it would never hit on time.
So when you're looking at transdermals, they're very, very slow to absorb. They have to go through various different layers of tissues, epithelial tissue, connective tissue, and then finally get absorbed into the bloodstream for circulation. The amount of medication that actually gets absorbed in that process is significantly lower, and it's going to vary patient to patient, skin types, age. We do know that older patients tend to absorb far less medication, but they also tend to excrete far slower than a younger patient due to... degradation of their organs and there's a risk there of over medicating an older person.
person with incorrect doses. We know that children have underdeveloped organs and their rate of absorption and excretion is going to be very different as well. So it's very, very ignorant of someone, and it isn't their fault, they're not educated on the subject.
It's very ignorant to assume that just because 100 milligrams of testosterone per say per week is a dose that you're familiar with, that every form of administration for every single patient should be in that realm. The testosterone cream comes in what's known as a 10% or a 20% compounded concentration, 10% being 100 milligrams per ml and 20 being 200 per ml. If you were to use 4-Clix, which is an ml, you're looking at about 200 milligrams on the 20% cream, and you'd be lucky to absorb 10% of that, if at all. So to say someone is taking 200 milligrams per week of Cipionate and they should take 200 milligrams of cream is just absolutely completely wrong. The cream is going to be more on a daily basis of what you would expect to see on a weekly basis in most people.
So, yeah, very different form of administering medication, not apples to apples.