I have been on therapeutic testosterone for 2 decades, guided by some of the world’s best clinical physicians in the hormone optimization space.
Of those 20 years, I spent the first 18.5 years on intramuscular injections as they were the gold standard of testosterone optimization therapy (TOT).
As I have previously stated in The TOT Bible, no other method of administering testosterone (patches, pellets, capsules, buccal, topical creams, etc.) came close.
They were either ineffective at optimizing testosterone levels, came with too many unwanted side effects, and/or were extremely inconvenient to fit into one’s lifestyle.
My personal protocol for mimicking endogenous production of testosterone was every other day (EOD) injections of testosterone cypionate and propionate.
At 150 mg of injectable testosterone per week, my serum testosterone levels would fluctuate between 720-1450 ng/dL over a period of 7 days.
As much as I loved the protocol and got comfortable with injections, it wasn’t perfect.
Although I never had any major side effects with injectables, I always wondered if there was a less invasive way to administer testosterone
Compounded Testosterone Cream On Your Balls?!
Dr. Keith Nichols introduced me to the concept of trans-scrotal testosterone cream in July 2018.
As he’s one of the world’s top optimization physicians with decades of using testosterone on himself and his patients, I was eager to learn more.
His idea was based on the extremely high permeability of the skin at the base of the scrotum (i.e. your "sack").
This makes it THE most efficient area for transdermal absorption of testosterone.
In fact, the bioavailability of testosterone via the scrotal skin is 8 TIMES HIGHER than anywhere else on the body.
I was initially skeptical of this as creams were never my top choice and they have historically been ineffective.
The concentrations of testosterone were typically too low, and it was difficult to control the delivery of the dosage.
Not to mention poor absorption of testosterone via skin due to sweat glands, poor food choices and other factors.
I’ve always believed that creams could not bring one’s testosterone levels into the optimal range, but I was willing to be proven wrong.
My Personal Experience In Using Trans-Scrotal Testosterone Cream Instead Of Intramuscular Injections
Having used the trans-scrotal cream for close to 1.5 years now, it is now my #1 recommendation for people who are seeking to optimize their testosterone levels.
For one, it’s certainly less invasive as you don’t have to spend the rest of your life injecting yourself, thereby lessening scar tissue formation.
Anybody looking for a faster and completely pain-free experience with TOT should consider it.
The cream also offers a slightly better increase in dihydrotestosterone (DHT) levels, thereby enhancing erectile strength and overall sexual functioning.
As DHT is crucial to a man’s libido, it makes sense that the trans-scrotal scream has an edge over intramuscular injections.
The increase in DHT and potentially PSA is transient at best (and why it's critically important you work with a doctor who is an expert at using transdermal delivery systems in their practice).
Aside from these primary differentiators, the creams and injections provide very similar results under the guidance of a progressive-minded and experiential-based physician.
You will end up getting the same physiological benefits with either method - muscle mass gain, cognitive enhancement, greater energy levels, endurance, and so on.
Either way of administering therapeutic testosterone can help you optimize your testosterone and estrogen levels when used properly.
The only real downside with the trans-scrotal scream is the possibility of wiping it off on someone else by accident.
You will have to avoid certain activities for up to 90 minutes for maximal absorption of testosterone to take place (sex, working out, any activity involving water, etc.).
But this is an extremely minor inconvenience compared to the benefits you will get from using trans-scrotal cream.
How To Properly Use Trans-Scrotal Testosterone Cream
You will want to use 200 mg/g (200 mg testosterone per gram of cream) Versa base or HRT base compounded cream.
It is extremely important to avoid using an alcohol-free cream as alcohol is harmful for scrotal skin health.
You must apply it to the base of a clean, dry and shaven scrotum (too much hair on your testes will minimize testosterone absorption).
The dosage will vary - based on your biochemically individual response and your doctor’s recommendation - but a standard dose is 1-4 “clicks” of the cream per application (~100 mg of testosterone).
Patients are typically instructed to apply the cream first thing in the morning, and again in the evening.
For myself, I have found that applying the cream once in the morning (3-4 "clicks") is sufficient to feel optimal.
If I want to enhance my sexual performance during a weekend gateway, I’ll apply a second dose at night after stepping out of the shower.
As for which compounding pharmacy to get this cream from, as long as it is 200mg/g and either versa base or HRT base, I don't think you'll notice that much of a difference.
NOTE: I have personally used Tailor Made Compounding, Empower Pharmacy and Med Quest formulations, and they all have worked amazingly well.
Final Thoughts On Trans-Scrotal Cream As A Form Of Testosterone Optimization Therapy
As with all delivery methods of TOT, trans-scrotal compounded testosterone cream has to be used correctly and consistently.
You MUST work with a TOT-prescribing physician who has an experiential-based practice of optimizing men (and themselves - they should practice what they preach!).
You are responsible for using ancillary medications alongside TOT for maintaining fertility (ex. Clomiphene, hMG, hCG) if you wish to have children in the future.
The use of aromatase inhibitors should rarely if ever be used.
IF and WHEN there is a clinical need for them (i.e. for men with increased aromatase activity, often times obese men with high levels of body fat and inflammation), doctors should use the lowest dose possible and titrate off as soon as symptoms are resolved.
Your testosterone cream dosage may also need to be adjusted over time due to biochemical individuality.
As I've stated many times before, everyone’s path towards full health optimization will be unique.
The end goal should be fully optimized, with a balance between testosterone and estrogen (no side effects or symptoms) and a state of happiness.
No form of TOT will work if you are not living a fully optimized lifestyle.
Where Can I Learn More About Testosterone Optimization Therapy?
The Testosterone Optimization Therapy Bible is my magnum opus on anything and everything related to the subject of therapeutic testosterone.
If you want a more high-level look on full health optimization, check out my latest book Living A Fully Optimized Life.
For a list of doctors I’ve personally worked with and endorse, here you go!
And if none of these doctors are within your physical or financial reach, make sure you sign up with MensHealthcare.com.