Testosterone & Testosterone Replacement Therapy (TRT)

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madman

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Beyond Testosterone Book by Nelson Vergel
Stellar interview with one of the top experts in the field!

We need an english version LOL!

Painstaking relying on the subtitles!

Professor Michael Zitzmann one of the most knowledgeable men when it comes to the androgen receptor/polymorphism of the AR/CAG repeat length (long/short).

Been at this for decades!


*CAG repeats, I would say, were discovered in the 90s and in fact that was one of my research areas the androgen receptors and also still when I started here at the university in Munster in 2001, the first research over many years was always about the androgen receptor. In fact, this field was also founded by me with a few people, of course, that we discovered it. That has a clinical significance, not every man is the same and not the testosterone level, you can't lump them all together









Deep dive into the topic of testosterone and testosterone replacement therapy with Prof. Michael Zitzmann, endocrinologist, andrologist and senior physician at the University Hospital Münster.


Chapters


00:00:00 Intro
00:00:45 What do you need testosterone for?
00:03:00 Regulation of testosterone levels
00:05:45 Symptoms of a testosterone deficiency
00:07:30 Causes

00:08:30 Martial arts & concussions to the head
00:10:00 Mental/psychological effects of testosterone
00:11:30 How common is a testosterone deficiency
00:14:00 Are testosterone levels continuing to decrease?
00:15:00 Decline in testosterone in old age: “Andropause”
00:17:00 Diagnostics: Blood values

00:19:00 Free testosterone & SHBG
00:22:00 Normal values

00:25:00 Androgen receptor: CAG repeats
00:29:00 The effect of being overweight
00:32:30 Nutrition
00:34:45 Underweight & diets
00:36:30 Fat content in the diet
00:38:15 Sleep, stress & cortisol
00:40:30 Testosterone replacement therapy vs doping with anabolic steroids
00:43:00 Application: Injections, patches, gels
00:44:15 Advantages of replacement therapy
00:46:00 Risks: Risk of heart attack

00:47:00 Thrombosis & pulmonary embolism
00:49:15 Blood pressure, blood lipid levels & diabetes
00:52:15 Prostate cancer
00:56:00 Infertility

00:59:00 Outro




00:25:00 Androgen receptor: CAG repeats

* the androgen receptor has a gene that is located on the x chromosomes we get in men, so they were all supplied by our mother and there are areas that are different for each person called CAG repeats.
The longer this area is in the gene, the larger the gap in the receptor where the testosterone can bind, so to speak. You can imagine this lock. It may also be a bit hard or worn out in some people where testosterone doesn't work as well in those where it fits exactly, you can't change it, it's genetically predetermined for us and if the body is healthy it regulates it on its own. If you now have a bad receptor, you also produce more testosterone, but of course someone can then slip into a testosterone deficiency if their receptor is not okay

* the receptor density by the way, is very difficult to measure, CAG repeats, I would say, were discovered in the 90s and in fact that was one of my research areas the androgen receptors and also still when I started here at the university in Munster in 2001, the first research over many years was always about the androgen receptor. In fact, this field was also founded by me with a few people, of course, that we discovered it. That has a clinical significance, not every man is the same and not the testosterone level, you can't lump them all together

* we don't always measure the CAG repeats, that's a genetic test, it's terribly expensive , cost around €300 and only has to be determined once in a lifetime because that doesn't change, but we don't do it routinely for every patient









Again

Yes there is such a thing as AR DDS (distribution, density, sensitivity/polymorphisms).

When it comes to sensitivity of the AR, polymorphism of the AR/CAG repeat length (long/short) tread lightly when you speak on such especially those pushing that everyone and their brother needing to run these very high/absurdly high trough FT levels 30-60 ng/dL in order to experience the beneficial effects of T!

Yes we are talking TROUGH f**king levels here!





What is that Abe?

Oh yeah, those so-called gurus (hint hint) claiming that everyone and their brother that they treat need to be running trough TT 1200-1800 ng/dL (or higher LOL) with sky-high FT to experience relief/improvement of low-T symptoms due to testosterone resistance let alone being cursed with that polymorphism of the AR/gene CAG repeat lengths >24.

Teflon testosterone-resistant BRUH, stricken with that longer CAG repeat length BRUH!

* Based on a total sample of 57,826 males occupying 78 countries, the overall average number of AR CAG repeats was found to be 21.40. National averages ranged from 17.00 to 23.16.

*The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical TD [93]


LMFAO!




*Some groups target T levels 1200-1800 ng/dL

*Supraphysiological/pharmacological rather than restoration of robust youthful levels

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* Based on a total sample of 57,826 males occupying 78 countries, the overall average number of AR CAG repeats was found to be 21.40. National averages ranged from 17.00 to 23.16.





*The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical TD [93]


*
In humans, the AR gene comes in many forms, called alleles. The best-studied alleles are those involving a CAG repeat sequence that encodes a polyglutamine tract near the amino end of the androgen receptor. This CAG repeat has different lengths for different people. In humans, the number of AR CAG repeats ranges from as few as 9 to as many as 36, but population averages are typically between 17 and 24 (Chamberlain et al., 1994; Hsiao et al., 1999; Irvine et al., 2000; La Spada et al., 1991). Individuals with higher numbers of AR CAG repeats will normally have diminished testosterone action on cellular functioning, effectively making males with high AR CAG repeats less masculine regarding most sexually dimorphic traits when compared to males with fewer AR CAG repeats (Loehlin et al., 2004; Simanainen et al., 2011)

*
Based on a total sample of 57,826 males occupying 78 countries, the overall average number of AR CAG repeats was found to be 21.40. National averages ranged from 17.00 to 23.16. Five countries had averages in the 17.00s; they were Swaziland (17.00), Zambia (17.00), Sierra Leone (17.30), Nigeria (17.58), and Senegal (17.90). Five countries had averages of 23.00 or higher; they were Lithuania (23.00), Mongolia (23.00), Ireland (23.07), Thailand (23.10), and Romania (23.16).


















AR CAG repeat lengths (short/long)

*The number of cytosine–adenine–guanine triplet (CAG) repeats in androgen receptors differ in men and influences the androgen receptor activity [88,89,90,91] (Figure 1). Hence testosterone sensitivity may vary in different individuals.

*The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical TD [93]

*In general, it is currently speculated that variable phenotypes of androgen insensitivity exist, mainly owing to mutated androgen receptors. More subtle modulation of androgen effects is related to the CAG repeat polymorphism in exon 1 of the androgen receptor gene: transcription of androgen-dependent target genes are attenuated with the increasing length of triplets.

*As a clinical entity, the CAG repeat polymorphism can relate to variations of androgenicity in men in various tissues and psychological traits: The longer the CAG repeat polymorphism, the less prominent is the androgen effect when individuals with similar testosterone concentrations are compared.

*A strictly defined threshold to TD is likely to be replaced by a continuum spanned by genetics as well as symptom specificity. In addition, the effects of externally applied testosterone can be markedly influenced by the CAG repeats and respective pharmacogenetic implications are likely to influence indications as well as modalities of testosterone treatment of hypogonadal men. Investigation of CAG repeat polymorphism in exon 1 of the androgen receptor gene may be useful in testosterone treatment regimens adjustment





Highly cited paper here!

Eye opener for many!


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