re: Testosterone-replacement therapy does not increase cardiac events in men

quote:

---

I asked my doctor at my last annual checkup if I should have mine tested since I'm mid 40s. He said if I don't have any symptoms then there's no need. That makes sense and I don't feel like I'm low but I was almost hoping that I was so I could get some extra gains.

---

uhhh you should still have it tested for nothing more than to monitor it.

might not have symptoms of high cholesterol either, but you should still test and monitor.

as far as extra gains...not getting into supra levels with trt. frankly imo shouldnt get above top of age group, atleast not for more than 3-4 months at a year so doubtful you would be looking at much in terms of gains.

some of the posters here disagree with me though and feel that no reason to own a corvette with a honda civic motor and believe you should keep levels at the top of the natural range in the 1000-1200ng/dl range.

thats prolly fine, at least until your mid 50s, but i do think you start putting extra stress on the system by doing that. I spend a lot of time and money on my health so not worth it for me personally.

i kind of feel the same way about those that add low dose nandrolone(deca) and anavar(well until recently with the ban) in that yea...prolly safe if having blood work but both compounds 100% can speed up calcification of the arteries and need to be careful with that.

its one thing to stay on low dose nandrolone 16 weeks once every 2 years or 6 weeks of low dose anavar a year but those are not things you should stay on....i feel the same way about test levels above the top of your age group.

Would appreciate your thoughts 777, especially based on your comments a couple post above about guys over 50.

I just turned 61, 6'1", 210lbs. Until around 2012, was 240+/-. Changed diet and began exercising. Got to 190 and kept it below 200 until lockdown.

Put on the pounds during Covid and now even with bumping up cardio, I can't seem to lose it. Lift 3 days, try to get 10K steps in at least 5 days. Added 20 minutes of stairmaster after lifting most days. Don't track calories, but I did for so long I'm pretty good at knowing where I am, which is around 2000-2400. Aim for 150g protein daily.

Had labs done and everything looks good. Cholesterol 178 (LDL 106) Test is 663, free is 8.0, DHEA is 84. I take 10mg boron, 1mg Finasteride, 2.5 Tadalafil, ZMA, fiber.

NP wants to start me on 80mg Test 2x/week to get me over 1000. I would say I have some symptoms - libido isn't what it used to be but still there, fatigue comes quicker, focus can be difficult occasionally, sleep pretty well but could be better. But is that just normal aging?

Should I give it try? Do you think it would help me shed lbs while maintaining muscle mass? If I start, can I ever stop?

Or am I just lazy and looking for a quick fix - you don't have to answer that, I know.

quote:

---

can i ask how you feel about the study from Cal on the use of Subq vs IM? LINK that is the power point on it. dont have the actual study, maybe you can find.



they found
14% greater Total t in subq vs IM
41% lower avg hematocrit subq vs IM
26.5% lower estrodiol
no rise in PSA


i think this is the study LINK

---

I'll take a look at this stuff. One of the guys I worked with at the VA had a friend that was going subq with his patients, with good results. Really small injections, daily or EOD. Patients liked it.

quote:

---

My biggest qualm with TRT is that a lot of patients come see me and when I saw I am going to check their levels they get mad at me. They expect me to put them on it willy nilly.

I tell them I am not starting it if their levels are normal and then if they are normal, I usually never see them again for anything.

---

The key is not the normal range, but what's normal for them. There are some papers out there that found patients reporting all of the classic symptoms of hypogonadism while over 400ng/dl.

This drives patients crazy. Most of them don't understand the math involved, they just hear you say "your levels are normal" and then refuse medication while they do not feel normal. I'm sure some of them are there to game things a bit and get swole at the gym, but many are suffering.

This paper for example describes the normal range being 264 to 916, but 264 is the 2.5th percentile. If someone comes in with 300ng/dl and has all the hallmarks, it's a very small chance they are actually normal. Normal for the population is not normal for each person.

One of the worst areas for this is in thyroid care. Normal TSH levels are roughly 1.5 to 4.5, and doctors / providers will stop levo or lio if a patient is at 4.3 for example and say "it's normal", while 95% of the population is around 2.5 and lower. Tails of the distribution get really far out there. (for those that don't know, thyroid is on a negative feedback and more thyroid means lower TSH so if you need supplementation of levels, your TSH is high and you want to drive it lower)

I had to deal with this stuff with a Physician's Assistant once. She was very nice, but she was never trained on the math involved. She was just told to follow the normal range. Once I explained this to her she just sent me direct to the Endocrinologist and thankfully she understood these things a bit more.

But again, this stuff drives patients absolutely crazy.

quote:

---

Where are you located?

---

New Orleans/Metairie. I do test plus hcg. So far so good except the price. My total t was 311, 335, and 430 before going on. Feel much better. Urologist said I was normal, which pissed me off as I felt like absolute dog shite.

Pardon my hate on the medical doctors, but when I say I’m exhausted and all you take into account is a lab value that is at the extreme low range of “normal” maybe the patient isn’t lying.

Im still wondering if someone would benefit from T to lose weight, and get in better shape. Maybe say someone with less than 20th a to lose. Chicken or egg thing. I just had zero in the tank, as in I’d get down on my bench for a bench press and want to take a nap - which I did a time or two.

I thought the same but he's already on 2.5mg daily of tadalafil. Maybe upping it to 5mg and see if that makes a difference.

quote:

---

can i ask how you feel about the study from Cal on the use of Subq vs IM? LINK that is the power point on it. dont have the actual study, maybe you can find.



they found
14% greater Total t in subq vs IM
41% lower avg hematocrit subq vs IM
26.5% lower estrodiol
no rise in PSA


i think this is the study LINK

---

Hope this helps. That study made me ask more questions than got answered.

I was not able to get the full text of the publication, that is important because I saw some errors in the PowerPoint and the abstract is a bit different than the PowerPoint slides.

All but one of the authors is an MD, which is a red flag to me, and the guy that isn't an MD seems to be a med student with a master's degree. This does not bode well for the rigor of the study.

Baseline
SUBQ group is much smaller.
On the PowerPoint slides they say the SUBQ group had higher baseline T but their table shows the opposite. It's about 65ng/dl lower with a SD about half of the IM group, so it's a much more homogenous group. Also about 5 years younger - so younger with lower T - could be meaningful.

PSA and HCT very similar, which is expected. E2 a bit higher in IM, which is also expected and follows higher baseline T, although age difference suggests it would go that way as well but that is a minor point due to minor difference in age.

No mention of how they, or if they, randomized in some way but looking at baseline numbers, this is going to be a problem for the statistical analysis.

Results
They give some tables and it appears they conducted multiple regression analyses. There are some problems here. Some predictors are related with one another. This affects the results and basically renders it useless. When you have TRT modality as an independent variable and you gave TRT, knowing T levels go up, you're really just finding a typical increase in T according to the value, which you know will be statistically significant, but attaining significance means nothing because you know the T will go up. So, you look for how much of a difference the modality makes, but that is blurred by the relationship between modality and the other variables, which are related because they interact with one another numerically. You have to look at the formulas involved and it becomes a bit clearer, but the result is that their statistical analysis leaves a lot to be desired.

It appears things like this were caught in the review process, where the abstract says no statistically significant effect of modality upon resulting T levels, which is not reported in the PowerPoint, so reviewers probably directed them toward a different analysis. To be honest, since the groups were not properly randomized and vary on baseline values, this sample needs to be stratified or something like propensity scoring needs to be done. This really leaves the only meaningful comparisons between pre and post by group.

Raw Data
SUBQ group starts lower and ends higher on T. That is interesting. So, why is that? Could be the peak and valley effect v more stable disposition and distribution via subcutaneous.

IM group has a much bigger jump in HCT, but they don't give peak T or a longitudinal graph of T values to help parse that out. This is statistically significant but it doesn't hold a lot of practical significance for the regular guy, IMO. Both groups seem to be at safe levels.

E2 is most interesting because the IM group post therapy T is about 1.7x pre therapy, and E2 is about 1.5x the pre therapy value. So those are fairly close and we usually see these values roughly parallel each other. In the SUBQ group, the T value jump is 2.2x and E2 jump is 1.3x, and that is very different. This is the main finding, or point of interest, IMO.
Let's look at the ratios:
IM Group
Pre therapy E:T 0.097
Post therapy E:T 0.087
SUBQ Group
Pre therapy E:T 0.101
Post therapy E:T 0.060

I did't find a direct comparison in another paper, meaning same dosing. But in a paper that had different dosing of SUBQ at 50 and 100, the E2 levels were in proportion to dosing, and much closer in ratio, so this doesn't seem to be a dosing effect, or at least this is not in alignment with the other paper.

I did not find other papers that indicated there should be such a difference in the ratio, except one, but it had the ratio for IM lower than the ratio for SUBQ. Makes me want to see the full text of this paper even more.

I don't know what to think about the difference in baseline to post therapy values. Other review papers from people doing T research for a long time did not indicate why E2 would behave differently as seen here. I suspect there are / is some difference between groups that led to this, or maybe there is an error somewhere. These trends just don't match up with other stuff I've seen in the literature.

Looks like E2 levels are fine but I'd really like to understand why there is that differential response.

The younger but lower T cohort suggests higher body fat, meaning more aromatase activity and higher levels of SHBG. Maybe that had an effect, but you would expect higher E2, unless there's something I'm not thinking about. At baseline the E2 values were lower in that cohort, which goes with lower baseline T. They are also younger, which goes with lower E2, but not that much age difference and most comparisons for age involve guys at 25 v guys at 50 or something like that. When you're dealing with kinetics and different body compartments, things get complicated, but again this doesn't really line up with other papers I saw.

Maybe this is an artifact and isn't something to dwell on, but I found it interesting. Need another study on this. I don't trust MD's that much when it comes to doing research. Some early papers on this auto injector have interesting data but I didn't find one with baseline like this one, to make some comparisons of response.

No increase in PSA. This is not surprising. Consistent with other findings.

Overall
This new method is promising for convenience but is a lot more expensive. It would be good to see a very thorough exploration of all the parameters involved and a better study design.