Free-T Levels - Where is the Proof?

Bigger Stronger Leaner Over 35 Lifter
1

I recently had to change doctors because my HRT doctor moved to Denver. My primary care doctor agreed to take on the HRT therapy and then almost immediately claimed my levels were too high and dropped my dosage from 200MG (1cc per week) to 100MG (1/2 cc per week). Prior to this my free T levels were 250-300 and I felt much better. Soon after he dropped my dose I began to put on weight around the waist, decline in energy, sex drive, et cetera. My free T dropped to 150. I want it back to where it was and he stated that if I could find a â??university- study stating that 250-300 was a viable number he would adjust my dosage. I’ve been searching but cannot find anything that will explicitly state a number relative to free T. Everything is so vague.

I have four excellent links regarding T replacement but apparently I am not able to upload so I have added the links to the end of this post. They are very good articles regarding T replacement in men and should be read but again do not give precise numbers relative to total T or free T. I need a double blind study or university study. Is anyone on this forum aware of one? Your help is much appreciated - my thanks in advance.

The articles are all 2008, 2009 articles with excellent reference sections. However, I still have not found that one study that states beyond any doubt that best results are achieved (I believe) at 300 Free T. And when my levels were at 300 I felt great, body fat was low, I had energy, everything was better. The funny thing is my doctor graduated from Harvard Medical School and is about my age so you would think he would be familiar with HRT. I have given him books, articles, et cetera but now he insists on a -university study- before he will do anything higher. I will provide the HTML Links at end of this post to the referenced articles. Iâ??m not sure if you have to sign up with LEF.org to open them.

Btw:
38 years old
Total T was 1000 now 550
Free T was 300 now 150
Diagnosed with low T - 5 years ago - Total T was 200
The theory is Male hypogonadism or possibly testicular damage when I had a vasectomy 12 years ago.

2

Please edit lab ranges into the above. What lab?

You need youthful TT and FT numbers, not age adjusted. There are big differences in FT upper ranges with different labs.

TT=1000 is a good target. Your body seems to eat T. Some guys are like that and need higher amounts. Perhaps your doc is objecting to the dose.

SHBG increases with age and older guys need more T to achieve target FT levels as more of the T is SHBG bound. Some docs do not test TT at all. My dose has progressed 100->125 and now 175 trying to get my FT levels up.

You need a new doc. Can’t help with the specific FT range.

3

[quote]KSman wrote:
Please edit lab ranges into the above. What lab? You need youthful TT and FT numbers, not age adjusted. There are big differences in FT upper ranges with different labs. TT=1000 is a good target. Your body seems to eat T. Some guys are like that and need higher amounts. Perhaps your doc is objecting to the dose. SHBG increases with age and older guys need more T to achieve target FT levels as more of the T is SHBG bound. Some docs do not test TT at all. My dose has progressed 100->125 and now 175 trying to get my FT levels up. You need a new doc. Can’t help with the specific FT range. [/quote]

I agree with you assessment that I need a new doctor but they are so hard to find. What I mean is, I have been diagnosed with LOW T. My original TOTAL T was 159. The previous numbers I supplied was TOTAL T of 1000 and FREE T of 300. This is when I felt BEST. Primary care doctors donâ??t seem to care about how you feel and I cannot afford one of these Anti-Aging doctors that donâ??t accept insurance. It is a double edged sword. You are correct in that my primary care doctor is concerned about me take 1 CC of my require hormone â??testosteroneâ??. He thinks the dose is too high and that I would be susceptible to â??roid rageâ?? which goes to show how uneducated doctors are about male hormones. I am taking 200MG per WEEK, NOT 3000 MG PER WEEK! They will prescribe hormones to women without thought but when it comes to treating male hormones they feel like they are somehow borderline breaking the law. Possibly this is due to the negative press? Iâ??m not sure and I donâ??t care. Basically, if I can find a legitimate research article from a source that he would trust then I could continue back on my treatment of 1CC per week versus ½ a CC per week. This has impacted my life and health. I know it might seem melodramatic but I have been negatively impacted in the following ways: 1) Waistline expanding (known cardiac risk factor), low energy, lower libido, decreased concentration, and decreased drive.

There has to be a way to equalize the support for HRT in men as with women. I know there has to be a doctor in my area that specializes in this and also takes my insurance Iâ??ve just yet to find them. Most of them wonâ??t take me as a patient â?? I know this sounds unbelievable but it is true! They state to me that that is out of their â??comfort zoneâ?? or they donâ??t feel â??comfortableâ?? with my treatment plan despite all the evidence that it works for men just as well as it works for women. Imagine, if family practice doctors would open their mind to this treatment for men they could help so many people that suffer from all the side effects of having low T. They label it as â??Syndrome Xâ?? â?? but within 6 months of treatment my body began to repair. I had high triglycerides - now in range. I had high cholesterol - now in range. I had high blood pressure â?? now in range (115 over 70). I was overweight â?? now Iâ??m about right (205 lbs and 5â??11 from 240). The ONLY thing I changed in my regime was the addition of the hormone â?? â??testosteroneâ??.

However, my, yours, anyone on this forum testimonial are not enough. I need some studies, I know Universities have to be looking at this and published something I just cannot find it because I donâ??t know where to look or how to look.

Or, am I just going about this entirely wrong? How does everyone else do it? Do you just have a doctor that happens to agree with you and does not require â??researchâ?? to back up how you feel?

Would it be appropriate for me to post my City information on this forum and ask for referrals? Private referrals?

I do agree that I need a new doctor but how do you find doctors that take insurance plans and support HRT?

Based on the forum rules and regulations, would it be considered inappropriate to ask people to send me information for doctors?

I just donâ??t want to do anything that would be considered unethical or inappropriate and offend anyone that participates in this valuable forum.

Comments, suggestions welcome. Thank you in advance. Thank you for taking the time to read my plea for help.

4

I don’t think that you will find anything in print supporting above range T levels. Some docs go there based on symptom relief. Insurance companies may be getting the the way as well, not wanting to spend money on things that exceed normal.

Your FT was probably 30 pg/ml and reported to you as 300 pg/dl.

As SHBG increases with age and this increases SHBG bound T, TT numbers can be increase relative to bio-T simply because of increased SHBG T, which is inert.

TT=1000 is a nice number, but some docs will not even test TT and dose to achieve a high normal youthful [not age adjusted] FT number.

Many docs dose 200mg/week if the patient is a high metabolizer. We have seen a few guy like that in this forum.

My dose was 100, 125 and now 175; TT>1500, FT>49 [pg/ml] and DHT=161ng/dl. We decided to ignore TT and go after higher youthful FT numbers. Some labs have much higher DHT and FT numbers, so its hard to see that a particular lab’s upper range should be a limit. And yes, I do feel better, stronger and more active.

You can find things like this:
http://deposit.ddb.de/cgi-bin/dokserv?idn=969518463&dok_var=d1&dok_ext=pdf&filen
But it is not really going to sell anything.

5

I’m going to play the devil’s advocate.

To my knowledge, there are no large, long term, well designed studies that could answer the basic questions you have. No one knows what is the optimal level of free testosterone in aging men, or what is the optimal level of E2. No one even knows what are the long term effects of TRT, for that matter. Most of what we think we know comes primarily from two sources: folk wisdom from steroid using body builders; and small, short term medical studies that have not found any harm from TRT.

Full-on TRT is so far the province of anti-aging doctors, who deal only in cash and lots of it. Anti-aging doctors make claims for which there is no good evidence, at least by the standards of mainstream medicine. Mainstream conservative doctors are reluctant to get involved because the data to support anti-aging practices just isn’t there.

Also, consider that a man has about 1 in 6 chances of having prostate cancer in his lifetime. That rises to 1 in 3 if a first degree male relative has it. If that man is diagnosed with prostate CA while receiving TRT do you think he might blame it on the TRT and sue the prescribing doctor? What data will doctors use to defend themselves?

HRT in women is well studied over a long period of time, and yet there is still some uncertainty about its long term health consequences. HRT in men is, by comparison, a big black hole.

We may feel better with high testosterone blood levels but that is not our doctor’s only consideration.

Don’t forget that testosterone is a Schedule III Controlled Substance. Doctors don’t want to run afoul of the Feds.

Right now you have a legitimate, well trained doctor willing to write a reasonable dose of testosterone for you. As you have found, finding a replacement doctor is difficult.

Those of us on legal TRT are on thin ice. It would take just one good published study finding harm from TRT and many of us would be cut off. There was turmoil in the female HRT literature a few years ago and that is a much more mature field. We are pretty vulnerable.

If you are one TRT, get your PSA checked at least yearly and get a digital rectal exam with it. It is best if the same doctor does your DRE over time. Besides prostate CA, some rectal CAs can be felt and the stool will be checked for occult blood which could indicate a bowel CA further upstream. I’m speaking from experience here.

6

TRT:
Lowers LDL cholesterol
Improves endothelial function
Improves elasticity of the blood vessels which:
Lowers blood pressure which reduces congestive heart failure
Resolves mood problems that otherwise have SSRIs thrown at them
Fixed many cases of low libido and ED
Resolves social withdrawal and apathy
Improves energy, alertness and activity
Increases muscle
Reduces fat
Lower weight reduces loads on aging joints
Improves thyroid levels in some cases
Restores skin tone where skin has become thin and inelastic
Finger nails grow faster, thicker and stronger
Improves prostate condition when E2 is managed
Increases morning and nocturnal erections improving health of the penis
Resolves some anemia cases
When the testes are kept functional with hCG, pregnenolone production is supported which:
Resolves brain fog and improved memory [pregnenolone]
Improved pregnenolone levels support DHEA levels and adrenal function
Strengthens the heart muscles which opposes congestive heart failure
Improves strength and connective tissue thus:
Improving balance and reducing falls and fractures.
Extends ability for independent living and self sufficiency
-The one year life expectancy for males who fall and fracture hip bones at the hip is very poor. Almost 30% will die in the first year. While males have a lower level of hip fractures than women, one year mortality for males is much higher than for females. The death rates are also 2.5 times higher than control groups of males who do not suffer hop fractures. Low testosterone weakens muscles and bone and probably is the major factor in fractures. Low T also interferes with post-op healing and recovery of activity.

Untreated low testosterone levels are associated
With issues listed above
Shorter life span and poor QOL

Doctors see this all of the time.

7

I am not arguing that the above claims are false, only that the evidence for much of them is weak. What is needed are large (say N>10,000), long term (>20 years) well designed studies, probably involving multiple research universities. These studies will look at outcomes in a large population of men over a generation of time. Until then, TRT as advocated here is not going to become standard practice taught in medical schools and residencies.

That is actually the argument I used to get it from my endocrinologist. I told him I was willing to risk the unknown and I didn’t have time to wait for those non-existent long term outcome studies to bear fruit.

I suggest that what is needed is political action. Baby-boomer men should organize and agitate in the public square (metaphorically speaking) for TRT. Make it a cause like the breast cancer gals have. Money has to flow to make TRT research happen. The kind of money needed is controlled by politicians.

Look at this problem not from the point of view of a patient or doctor. Think like a politician. What do they respond to?

How do you think TRT will fare in an environment of government controlled medicine? Do you think they will do a cost-benefit analysis? What are are costs of putting tens of millions of men on TRT? And if those men live longer, what is the cost of that? Questions worth asking. Think like a politician, or a bureaucrat.

8

Men on TRT would probably have lower life time medical costs.

9

Lower lifetime costs? Maybe, but that would have to be demonstrated. The counter-argument, totally utilitarian, is that older people use more “medical resources”, to use the lingo. Utilitarian thinking by politicians and bureaucrats is going to dominate future medical decision making. The sanctity and even privacy (electronic medical records, anyone?) of the doctor-patient relationship is slipping away.

Another factor working against TRT is the bad PR that has accrued against “steroids”. Three hundred pound, five foot eight men with no body fat are walking advertisements against TRT. Everyone can see that for what it is. Look what has happened to bodybuilding over the years.

No female HRT drugs are Federal Controlled Substances, to my knowledge. My own urologist, who does not prescribe my TRT, has questioned my motives for TRT, noting that I am lean and strong. Of course, I was that way before I started TRT but that is quickly forgotten. My point is that baby-boomer men who agitate for TRT research are going to be painted as selfish narcissists who are trying to hold onto their fading youth. We will be competing for research dollars against AIDS activists, childhood vaccine advocates, breast cancer researchers - you name it.

Expect opposition. TRT for men will go against the prevailing public narative for aging men. And what is the utility of an aging man?

10

[quote]Turtello wrote:
I am not arguing that the above claims are false, only that the evidence for much of them is weak. What is needed are large (say N>10,000), long term (>20 years) well designed studies, probably involving multiple research universities.

[/quote]

I think your qualifications are unrealistically stringent, especially the part about “multiple research universities” which adds nothing to the reliability and validity of the research. But, what about the longitudinal study referenced in the following WebMD article? Low Testosterone, Early Death?

n=~12,000
4 years with a later follow-up

11

Multi-center study only because an undertaking of this magnitude almost requires it. Big longitudinal studies that answer big basic questions usually are collaborative, if only to get the numbers up. That’s all I meant. As far as I know, nothing like this has been done.

The study you cite is reassuring but it says nothing about the effects of raising testosterone levels in aging men. We need TRT outcome studies with big numbers over many years.

12

You are right about exogenous supplementation, but I am not waiting for the type of study you are suggesting when testosterone is something I’ve been on my whole life. When my T levels were much higher, I never had an outbreak of allegedly T-related diseases. Stupidity yes, diseases no.

13

Turt, you are spinning your wheels on this. Find something more rewarding to be so concerned about.

14

KSman, please address my arguments. I’m just the messenger.

My purpose has been to point out some realities in the medical world. It is not just incompetent or poorly trained doctors. There are good reasons why nearly every post-menopausal woman is on some form of HRT while we aging men are not.

If we want to change that we will have to more fully understand the problem.

15

We can talk to death about docs who do not understand these things. T is schedule III because of the abuse potential. Female hormones do not have abuse potential. But women still need to get a script, the exception is progesterone cream. You can’t argue male-female parity and make the abuse go away. The real problem was docs prescribing cycles for athletes and BB’s. Docs are now afraid of female HRT after the WHI showed more heart attacks. They do not understand that the problem was progestins and fake estrogens. Most docs will not do bio-identical female HRT because the drug reps do not tell them how to prescribe. Women still are getting progestins in their OBC.

You can’t solve this from the top down. Educate one doctor at a time. Support compounding pharmacists.

16

[quote]KSman wrote:
T is schedule III because of the abuse potential. [/quote]

Bingo, just like what you are doing. In my opinion, you are not on TRT you are on TET (E = Enhancement). There is no evidence that taking your levels to the top of the range (and over) is beneficial. It is guys like you that will ruin it for everyone that really needs TRT. JMHO.

17

Uh,
not free T range… But I think it is the harvard study clearly shows that 600-900 had almost no cardio vascular deaths, compared vastly increase risk in the lower groupings…

But then what middle aged man would care about heart attacks or stroke?

18

[quote]asdf wrote:
KSman wrote:
T is schedule III because of the abuse potential.

Bingo, just like what you are doing. In my opinion, you are not on TRT you are on TET (E = Enhancement). There is no evidence that taking your levels to the top of the range (and over) is beneficial. It is guys like you that will ruin it for everyone that really needs TRT. JMHO.[/quote]

I agree with your premise. My dose had not changed and my TT and FT levels were dropping, more T, same thing. And I was having hypogonadism symptoms. There is also a whole unknown concerning how ones T receptors respond. T receptors may decline. If I feel better, stronger, more agile, more active and alert, those are the expected benefits of TRT. So the results are justified, even if the process is suspect. There are still some testing labs that have quite high FT levels, greater than Quest and Labcorp. One can argue that those are valid targets. We are all letting the statistical results from testing labs determine our hormone replacement goals. The goals are youthful levels, not age adjusted. The testing labs may not be collecting much TT, FT data from young healthy males.

There is a lot of talk about personalized medicine. Some do need different levels of an agent. The current system cuts off the top 2.5 or 5% of the bell curve then implicitly removes these higher levels from the playing field. The danger in this is that most guys would want to be in the top of the discarded high range. One can argue that that would be wrong, but how is that different from saying that all guys using labcorp can be TT=827?

There can be no argument that the response of an old guy to a given youthful level of T will not be like that of a young man who has that as his natural level. Older guys need more T to get the job done, some more so than others. And we know that TT=827 in a young healthy guy will be accompanied by a much higher FT or bio=T than an old guy with the same TT=827. From this point of view, all older guys will need higher TT levels, TT levels that are above youthful TT ranges. More and more TT becomes SHBG bound T as we age. SHBG-T is functionally inert and of no HRT benefit. I reject the notion that TT above range in old guys is a problem. I accept that FT above youthful ranges in old guys is open to debate and criticism.

Please explain how my case ruins things for others? Triggering regulatory clampdown?

My doc may be reducing my dose when we review my labs.

19

[quote]KSman wrote:
asdf wrote:
KSman wrote:
T is schedule III because of the abuse potential.

Bingo, just like what you are doing. In my opinion, you are not on TRT you are on TET (E = Enhancement). There is no evidence that taking your levels to the top of the range (and over) is beneficial. It is guys like you that will ruin it for everyone that really needs TRT. JMHO.

I agree with your premise. My dose had not changed and my TT and FT levels were dropping, more T, same thing. And I was having hypogonadism symptoms. There is also a whole unknown concerning how ones T receptors respond. T receptors may decline. If I feel better, stronger, more agile, more active and alert, those are the expected benefits of TRT. So the results are justified, even if the process is suspect. There are still some testing labs that have quite high FT levels, greater than Quest and Labcorp. One can argue that those are valid targets. We are all letting the statistical results from testing labs determine our hormone replacement goals. The goals are youthful levels, not age adjusted. The testing labs may not be collecting much TT, FT data from young healthy males.

There is a lot of talk about personalized medicine. Some do need different levels of an agent. The current system cuts off the top 2.5 or 5% of the bell curve then implicitly removes these higher levels from the playing field. The danger in this is that most guys would want to be in the top of the discarded high range. One can argue that that would be wrong, but how is that different from saying that all guys using labcorp can be TT=827?

There can be no argument that the response of an old guy to a given youthful level of T will not be like that of a young man who has that as his natural level. Older guys need more T to get the job done, some more so than others. And we know that TT=827 in a young healthy guy will be accompanied by a much higher FT or bio=T than an old guy with the same TT=827. From this point of view, all older guys will need higher TT levels, TT levels that are above youthful TT ranges. More and more TT becomes SHBG bound T as we age. SHBG-T is functionally inert and of no HRT benefit. I reject the notion that TT above range in old guys is a problem. I accept that FT above youthful ranges in old guys is open to debate and criticism.

Please explain how my case ruins things for others? Triggering regulatory clampdown?

My doc may be reducing my dose when we review my labs.[/quote]

Before I answer this last thread, i just want you to know that I have nothing against you and I realize you go out of your way to help a lot of guys here. I am just sharing my opinion and debating the issue. With that said:

You are slanting your whole argument in defense of your high TT/FT numbers, although there is nothing to support your argument. I agree low levels are unhealthy and need to be addressed, when to start? - who knows. Can you show me the evidence that high levels (>1000) are beneficial? If there isn’t any evidence, it is like saying that hitting up some heroin or cocain is good for you because it makes you feel good.
One thing I have noticed is that guys who take their levels high always seem to develop problems with their thyroid and addrenals and have to start taking meds for them too. Then there is high HCRT and PSA and blood pressure and lowering of HDL, just to name some of the issues that are associated with overly high T levels.
One last point, where have you seen youthful levels >800 in any modern (last 25 years) study?

20

I know what I hear from my doc who does this for a living, reads research and attends the usual anti-aging conferences. You know that I read and research too.

There are papers that document the fact that SHBG-T increases with age and state that higher TT levels are needed for older guys, and as they age, to maintain effective Bio-T levels and results.

If there are problems with BP, PSA or whatever, that then needs to be dealt with routinely just as this is sometimes needed for guys on more typical doses.

There is nothing wrong with my feeling better on a higher dose of T than you. There is nothing wrong with feeling better on the same does of T as you. There is nothing wrong with wanting to feel better. There is nothing wrong with my 60YO strong arming an heavy extended ladder into a tree and cutting branches 20 feet off of the ground with a chain saw if I want to.

If you or anyone else is doing well on lower doses of T or lower TT/FT levels, good for them. If they later have TT and FT levels dropping and start to get hypo symptoms again, it is really your job or anyone else’s to tell them and their docs that they cannot address the dropping TT and FT levels and hypo symptoms with more T?