You don’t think he should try daily dosing to troubleshoot his protocol and are concerned about his E2 levels to be 25-35.
Right. Okie dokie then. Face-palm.
Will you debate me on a live YouTube webcast oh lord of the forum? Or do I need to start a new thread for that?
I’m going to make the same comment that Greta, the climate activist said to the interviewer about meeting with President Trump, “I don’t see what good it would do, I don’t know why I would do that”.
You’re making a claim that you are disagreeing with the demonstratable methods in which I believe make for good TRT. I am making a claim that your methods could not be further from the truth. People are reading these comments and wondering who is correct.
What is the best way to go about determining who is correct? A live debate where people can ask us questions would be a good idea. The only problem is that the 35%+ body fat and poor overall health would be an immediate detriment and would eliminate virtually all credibility.
You could do it audio only if you really wanted to.
You see, I’m confident enough to do something like this with my eyes closed. Are you? Or do you just give bad advice anonymously but won’t back up your claims in the real world?
I go by feel, not numbers. I know what numbers guys generally feel best at based on the majority and use it as a starting point, and adjust from there. You keep saying his testosterone is ‘high’ and it should be lowered. What would you have said ten years ago when those levels were normal?
I absolutely go with how people feel. If they don’t feel well I know exactly what they need to change most of the time. It’s almost always the same three variables 90% of the time. Most of the time they wind up answering their own questions simply with the questions I asked them in regards to how they have been feeling.
Debate me through audio only and back up your claims. I’ll be on video as usual.
I think this topic was discussed already several times, so I keep it short.
T measurement is not absolut, its always relative and depending on the method! Its NOT like a meter is a meter and has and will always be a meter. This is NOT how this works.
Please read the relevant publications, i referenced them previously. If you have any problems understanding the content, please dont hesitate to ask. And i dont mean to the a smart ass here, but this is just scientific fact and I would love to be able to help you understand.
Btw. I have a lab result from the early 2000s - so about 15 years ago - in which the upper range is below 1000 ng/dl.
I was coming in to say it literally says that on my lab results every time I get them back
I’m not saying every person included in calculating the “normal” range is perfectly healthy or that the range is perfect, but they aren’t using obese, old or known to be in terrible health people like is commonly stated.
And yet nowadays for one reason and another many non-obese and clinically healthy men have suboptimal testosterone levels like me for example
I agree… but the statement that they are obese/old simply isn’t true.
My current quest upper limit is 1100. Do you know why quest differs from others? Is what they are using an acceptable reference range?
He’s posted a bunch on this but honestly it’s over my head. There seemed to have been some sort of “adjustment” to more normalize the values between different labs that tweaked the ranges & results.
That’s not to say suddenly the ranges actually represent lower/higher levels as much as it is the way the amount of T is measured was shifted so the normal ranges had to shift with it.
It’s like saying something used to be 3" but now it’s 4". If you want a foot to be the same as it was then you have to change it by the same amount to account for the change in how far an “inch” now is.
That’s the only way I’ve been able explain it/understand it. Tried watching some videos on how the tests are actually performed but they were pretty dense.
I have a lab from 2006 with upper range at 1592.
Let’s assume it is due to a change in measurement methods. However, why would the levels keep falling each year? Someone sent me labs last week that showed upper limit in the 700’s for crissakes. Will we continue to have our annual checkup with our docs who will tell us how much we need to lower our dose to get down into the new ‘normal’?
I’ll self medicate before I do that.
My opinion is it’s probably some of both… some from population levels actually going down and pushing down the normal ranges, some from the measurement adjustment that Johan has posted some studies about. Obviously I have nothing to prove that. How much is which? Who knows.
I’ll take whatever amount and get to whatever levels I need to feel good, I think we all agree on that
There are a few options why, on average, testosterone levels are declining. Put aside measurement techniques and ranges. And frankly forget about the top level of the range and whether its 1000 or 1200 or 1500. You cant manage a population to the highest possible number. And its hard to draw comparisons to things outside of hormones…like money, where having more money can be put to use to make more money and it can have multiplier effects and be put to good use for either greater economic output or charity or whatever. I cant really do anything with extra T over 1000 other than get bigger. And unless you are malnourished, getting bigger has a negative correlation to a healthy life.
So the change is either from environmental influences, genetic selection, or a combination of both(ding ding). Lets say we fix environmental influences and remove all pollutants, EDC’s, etc… There is still some component in society that is self selecting for a lower T level overall. We can philosophize all day on why…as population increases we need less aggression and assertiveness and more cooperation? etc blah blah… It really doesnt matter in the long run. T levels will never be a major focus of the medical community. And not because the entire medical community is useless because of this misguided ‘woke’ idea that the establishment is always fundamentally wrong. On the whole, the goal of the medical community will always be focused on the most pressing issues…like starting with someone in the emergency room who’s about to die from trauma and then working their way back through the line. This is the only way it works for the masses. This does not preclude you or I from pursuing our health privately from the standpoint of ‘optimized health’. But, this will never work for the masses. Testosterone is a luxury item for the body. The average Dr. will never look at some low average number and say ‘OMG, we need some T stat!’ A total T level of 300-400 is 30-40 times the Testosterone level of a woman. It doesnt make anyone here less of a man for having a slightly below average level of T. So, for a thread titled ‘Having second thoughts about TRT’…yes, everybody should have second thoughts before they start. Just look at the banter on the threads…a select group of people have literally the same answer no matter what…‘Damn you have the T levels of a 90 year old, did you know neanderthals had T levels over 2000? get lit on T!’ While others are overly cautious and push their protocols as gospel. The truth is way more complicated than that. There should be a long list to cross off before jumping on T for life. Become as educated as possible and be as honest as possible with yourself about why you are here.
rant over.
Where I do absolutely agree is that just because somebody is within the reference range, doesnt mean that his symptoms are
I do absolutely agree that a borderline low free T in combination with symptoms or androgen deficiency can and should be experimentally treated by TRT.
The reference values are after all just statistics and its impossible to accurately separate T deficient from non-deficient men. Its a guiding principle, not a black or white decision.
Many men below 300 are absolutely fine and have no symptoms at all, whereas some men with 450 might already experience symptoms. One study showed that about 50% of men with a free T of 5ng/dl (which is really low) are free of any symptoms. One just has to accept that men coming to this forum and seeking for help are rather the outliers than the majority.
Where i do strongly disagree - and this is my main point that I want to make - is, that somebody (whoever this might be) is intentionally lowering the lower reference level just to deny access to TRT or to ‘fake’ the health or sickness of todays men.
Regarding the reference range used by Quest:
The ref range is based on the Massachusatts Male Ageing study (Mohr et al., 2005).
They used an immuno assay type of assay which resulted in a reference range of 250 to 913 ng/dl. Why Quest uses an upper limit 1100 ng/dl I dont know.
The new reference range by Travison used exactly the same population (among others) and basically arrived at the same ref range.
http://www.imperialendo.co.uk/mohr.pdf
The upper range isnt that important as there are no negative health consequences to be expected between 900 and 1500 ng/dl.
From the quest homepage regarding the lower limit:
Question 8. What is the lower limit of the total testosterone adult male reference range?
There is no universally accepted lower limit. Studies have used different methods, different populations, different times of the day for specimen collection, and different statistical methods. The Quest Diagnostics assays have a reportable lower limit of 250 ng/dL which is consistent with that reported by other laboratories. This is based on the 2.5th percentile of a distribution of results, the approach used to define most reference ranges. In a study by Mohr et al. (2005), the 2.5th percentile for men in their 40s was 251 ng/dL virtually identical to what is commonly reported by laboratories.
Thats also the difference between the Quest and the LabCorp ref range. LabCorp used the ref range based on Bhasin with a lower limit of around 350. This value was artificially ‘high’ because Bhasin used a LC-MS method with a different calibrant that now the CDC recommends.
Quest uses and has always used the ref range based on Mohr which is more in agreement with the LC-MS results of Travison, altough they used different methods. But that the reason LabCorp changed their (lower) ref range and Quest did not.
IT gets interesting if T can start to be embraced by the mental health community. Connect the dots of the drastic increase in suicides by middle aged men to lower testosterone levels…Then there is a basis for intervention and we can broaden the population of those eligible for T covered under insurance.
My mother thinks I should get SSRI instead of TRT… I tried not to quarrel with her, it was really tough
Yea, but many also seem to report an increased level of anxiety and even a feeling of ‘down’ when starting TRT. I think this is because TRT may just aggrevate the already existing problems.
I am just not sure if TRT hasnt become just a major business. Look at all the TRT clinics especially in the US. One could argue that its an increased awareness of the problems of low T (and thats good), but one could also argue that ‘making money’ is a big driver of all of those low T centers. Just look at the density of advertisments everywhere. Low T is just everywhere, if you are a middle aged men in the US its basically impossible to ignore it and to dismiss the urge of ‘i need to get tested for low T’. And after all prescriptions of T kind of exploded in the last decade.
Again, I am not against TRT, not at all. But having second thoughts about TRT is actually a very valuable thing have.
Do you have any reference?
No reference, Im just saying that if the medical community could establish a causal relationship between suboptimal T and suicide…then mental health professionals could have T as a treatment. Thus, broadening the availability under traditional health coverage plans. It would heighten the necessity beyond…‘i dont feel good and i want to feel better’
What should dictate the upper range of the lab test is the maximal amount of TT an adult male without disease can produce. For me, that would be the natural threshold I do not want to cross.
It’s still possible that supraphysiological TT can mask certain mental health problems. For example, my brother used to be depressive but felt good on dianabol (not exactly TT I know). Increasing TT dosage when not feeling good might be effective in a similar way, but I don’t know if it is viable on the long term. I should be able to feel good at 800-1000ng/dl, and I know for a fact that I can feel good with even less than that.