The News Herald (Willoughby, OH)

Tips for applying testostero­ne gel

- Keith Roach Contact Dr. Roach at ToYourGood­Health@med. cornell.edu.

DEAR DR. ROACH » I am an 84-yearold male. I recently switched from testostero­ne patches to AndroGel. My testostero­ne levels have gone up considerab­ly, and I have seen some improvemen­t in my erectile dysfunctio­n. I suspect just a little more testostero­ne might get me a usable erection.

My physician said to rub the gel into my shoulder. She could not explain how it gets through the skin. Am I literally rubbing it in? Would more pressure push it through the skin better?

Is the gel absorbed? Are some areas more absorbent than others? Where is the best place to apply the gel? Is the skin already saturated if I apply the gel to dry skin following a bath? — Anon.

DEAR READER » The ability to absorb drugs across the skin has made administra­tion of some drugs much easier, especially those like testostero­ne, which are not absorbed when taken by mouth. However, there are some factors to keep in mind.

First, the testostero­ne is absorbed through the skin over time — you don’t need to massage it in. The alcohol in the gel allows the skin to absorb it better. Skin absorbs better when moist, so applying after a bath may help your body absorb the full dose your doctor is giving you. Applying a moisturize­r the skin an hour after the gel also helps absorption. However, the medicine is still being absorbed even four hours later, so a shower or bath will wash it off. The shoulder is a better place than the abdomen, so always use it there, but you can change sides.

Some of my colleagues who prescribe these drugs more than I do have written that some patient just have not been able to get enough testostero­ne with the gel, and must use injection.

DEAR DR. ROACH » I take all of my meds at once in the morning, including an over-50 vitamin as well as a vitamin D supplement. My other medication­s are Cymbalta and an occasional OTC antihistam­ine during the spring. I read that the effectiven­ess of many medication­s can be diminished when they are taken at the same time as vitamins. Is this true? If so, which medication­s are affected this way? Are certain vitamins more likely to have this effect? — F.F.

DEAR READER » There are only a few instances when taking over-the-counter vitamins and minerals can interfere in a clinically relevant way with the absorption of prescripti­on medication­s; however, one to be concerned with is calcium. Calcium can reduce absorption of antibiotic­s, thyroid medication and other drugs. Calcium is in some vitamins but not others, so you need to check.

Your pharmacist is a most valuable resource when it comes to medication interactio­ns. That’s why it’s important to get all your prescripti­ons filled at the same pharmacy. It’s also worthwhile to check in with your pharmacist, especially if you are getting medication­s from multiple doctors or if you are taking over-the-counter medication­s or supplement­s. New computer systems have built-in logic to look for drug interactio­ns, but they are no substitute for knowledge and experience.

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