Testosterone Therapy (TTh) - How To Treat - Abraham Morgentaler

[madman]

Have every lecture!

Link to some of them.

Excel is littered with AM!

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[madman]

 

[madman]

 

[madman]

 

[madman]

 

[madman]

 

[madman]

 

[madman]

*Optimal results often require T values in the upper range of normal (T 600-900 ng/dL)

 

[madman]

 

[madman]

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!

LMFAO!


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

*Supraphysiological/pharmacological rather than restoration of robust youthful levels

Clinical implications of AR polymorphism in sexual health

www.excelmale.com

* 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.

Variations in CAG Repeats of Men’s Androgen Receptor Gene

As the mediator of androgen actions, the androgen receptor (AR) plays a central role in establishing both physical and behavioral sex differences. The AR gene contains a CAG repeat polymorphism that is related to the strength of androgen actions on target tissues and that is correlated with...

www.excelmale.com

*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).

 

[madman]

 

[madman]

 

[madman]

 

[madman]

Had been treating men for DECADES!

Pay close attention @6:34-7:02

This sums it up

*So we start at 0.5 and if that's not good enough we go to 0.6 (120 mg) and 0.7 (140 mg) and occasionally but NOT VERY OFTEN we go above that

What is that Abe?

Those so-called gurus (hint hint) claim that's BABY DOSES of T and would have everyone and their brother that they treat believing that they need 200 mg T/week to achieve HEALTHY let alone HIGH trough FT levels 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!

LMFAO!

Clinical implications of AR polymorphism in sexual health

www.excelmale.com

Testosterone Formulations (4:48-7:02)

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Dose T/week

The starting dose is about 100 mg/week.

If they're going to be giving it to themselves or coming into the office every week we start with 100 mg but you can move up.

Rarely do we go lower but some people will.

100 mg is 0.5 CC each CC is 200 mg per CC or per mL.

So we start at 0.5 and if that's not good enough we go to 0.6 (120 mg) and 0.7 (140 mg) and occasionally but not very often we go above that

 

[madman]

Tell me it aint so!

LMFAO!

So-called men's health/HRT forums loaded with those blast n cruizerzzz or gootube loaded with some of those so-called TTh gurus.


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

*Supraphysiological/pharmacological rather than restoration of robust youthful levels




Baby doses BRUH baby doses!

*So we start at 0.5 and if that's not good enough we go to 0.6 (120 mg) and 0.7 (140 mg) and occasionally but NOT VERY OFTEN we go above that

 

[madman]

Insights on Testosterone, Libido, Premature Ejaculation, Painful Sex, and Men’s and Women’s Sexual Dysfunction

https://podcasts.apple.com/ca/podcast/ep-16-medical-and-lifestyle-approaches-to-intimacy/id1683559994?i=1000626092413 Summary In this episode of The Luke Coutinho Show, I had an opportunity to engage in a riveting dialogue with the acclaimed Urologist, Dr. Mohit Khera, an authoritative...

www.excelmale.com

 

[FunkOdyssey]

Have every lecture!

Link to some of them.

Excel is littered with AM!

Hey @madman , you've watched all of his lectures I'm sure. How much emphasis does Morgantaler place on restoring every hormone / neurosteroid affected by TRT to normal levels ("backfilling" etc)? Does he address this topic anywhere? Or does it seem like a non-issue from his perspective?

 

[Mountain Man]

I have been a patient at his clinic in Boston since 2016. He recently sold his practice but is still affiliated with them. This is the exact protocol that I started on in 2016. I was started at .05 and was allowed to bump it up as I felt necessary. The theory that the clinic uses, which is Morgentaler’s, is to start your dose at 100 and keep it simple. It was explained to me that this is to ensure that if anything goes wrong or needs to be adjusted, you know what needs adjusting. The shotgun approach where a person starts on an AI and possibly other medication‘s makes it difficult to figure out what is working and what’s not.

While he was not my personal doctor while he while he was there, all the PAs that work there consulted with him on a regular basis. He was the doctor that did my prostate biopsy, as well as the follow up and I did get an appointment with him when my PA was out sick. Very knowledgeable, very patient, and answered a ton of questions that I asked him. He’s a year or two younger than I am, and spoke about the benefits that I was getting as being because of my age. He felt that older man in particular do very well on this regimen. He also explained to me that he believes that TRT is heart protective as well as prostate protective.

It also seems that after you’re doing well for a while with their protocols, they give you the wiggle room to bump up or bump down. I went up to 160 once a week when I had hip replacement to see if it would help recovery. They supported that. Eventually, I brought it back down to 140 because there was no real benefit to that higher dose and I felt no different. Right now my dose is 135–140 once per week. The clinic seems to discourage people from going up to 200. I asked my PA about it out of curiosity, and he said that if someone’s doing that, then it’s not really TRT, but using it as a steroid like substance.

 

[madman]

Hey @madman , you've watched all of his lectures I'm sure. How much emphasis does Morgantaler place on restoring every hormone / neurosteroid affected by TRT to normal levels ("backfilling" etc)? Does he address this topic anywhere? Or does it seem like a non-issue from his perspective?

Was big on T-only protocols (sensible doses) or T + hCG in those men interested in minimizing/preventing testicular atrophy and maintaining fertility.

Not too fond of AIs or 5ARis due to the importance of testosterone metabolites estradiol and DHT.

*Natural testosterone is viewed as the best androgen for substitution in hypogonadal men. The reason behind the selection is that testosterone can be converted to DHT and E2, thus developing the full spectrum of testosterone activities in long-term substitution

Estradiol and DHT are needed in healthy amounts to experience the full spectrum of testosterone's beneficial effects on mood, energy, libido, erectile function, cardiovascular health, brain, bones, tendons, immune system, body composition, and recovery.

Thyroid would be another area he would address as dysfunction can negate the overall effectiveness of a TRT protocol.

Pretty much sums it up!

 

[madman]

Has treated thousands of men over the decades!

Rarely used a f**KING AI to boot!

Again not too fond of AIs or 5ARis due to the importance of testosterone metabolites estradiol and DHT.

Commonly prescribed T doses are 100-140 mg/week.


*restoration of robust youthful levels

*So we start at 0.5 and if that's not good enough we go to 0.6 (120 mg) and 0.7 (140 mg) and occasionally but NOT VERY OFTEN we go above that

*Optimal results often require T values in the upper range of normal (T 600-900 ng/dL)

@6:34-7:02


*So we start at 0.5 and if that's not good enough we go to 0.6 (120 mg) and 0.7 (140 mg) and occasionally but NOT VERY OFTEN we go above that Dose T/week




The starting dose is about 100 mg/week.

If they're going to be giving it to themselves or coming into the office every week we start with 100 mg but you can move up.

Rarely do we go lower but some people will.

100 mg is 0.5 CC each CC is 200 mg per CC or per mL.

So we start at 0.5 and if that's not good enough we go to 0.6 (120 mg) and 0.7 (140 mg) and occasionally but not very often we go above that.

A Primary Care Approach to the Evaluation and Treatment of Male Hypogonadism

www.excelmale.com

2024 and still singing the same old tune!


*However some men won't achieve adequate response until total T in upper levels of normal 650-1000 ng/dL

Controlling the polycythemia effect associated with TRT

Shane M. Kelleher, *InfiniT Men’s Health Clinic, Burleson, TX76028, USA Abstract The goal of this study was to determine how to minimize the secondary polycythemia effect observed in patients on testosterone replacement therapy (TRT). Patient hemoglobin, estradiol (E2), and total...

www.excelmale.com

*The goal of this study was to minimize the polycythemia effect associated with TRT while maximizing the benefits of treatment.

*In this study, patients’ TT levels stabilized between 605–1051 ng/dL. The majority of patients were still experiencing symptoms of testicular hypofunction when their TT level was<605

*Additionally, the side effects started to outweigh the benefits of treatment when TT levels were >1051. The side effects observed at higher TT levels included acne, aggression, erectile dysfunction, difficulty losing weight, elevated E2 levels, hair loss, and increased body hair. Hair loss with TRT did not occur with appropriate dosing and management unless the patients had a family history of hair loss. In these cases, hair loss tended to accelerate, following their family history of male pattern baldness. Similarly, patients were more likely to experience acne if they had a personal history of acne or naturally oily skin

*Regardless, maintaining relatively consistent and appropriate TT and E2 levels minimized all side effects and helped patients achieve the best results on treatment. Therefore, the data collected in this study suggest that the ideal range for a patient’s total testosterone level, drawn after four consecutive weeks of injections and exactly seven days after the previous injection, is 605–1051 ng/dL. Note that this is a much narrower range than the currently suggested ranges, including 348–1197 ng/dL [1]


*Based on the data collected from sixty total patients who reached stabilization on TRT (30 previously on TRT and 30 never on TRT), the average TC weekly dosage at stabilization for those previously on TRT was 147 mg, and the average weekly TC dosage at stabilization for those never on TRT was 149.3 mg. Therefore, it is recommended to start patients with 140–150 mg TC injections weekly (ideally every seven days) for the first four weeks of treatment (accounting for the thirty-day elimination time). Testosterone levels should then be remeasured at the half-life (seven days post-injection) for accuracy. We recommend that dosing adjustments be made in 10–20 mg increments, and only after four consecutive injections of the same TC dose. TT levels stabilized at 780.1 ng/dL on average (range: 605–1020 ng/dL) for those previously on TRT and 794.53 ng/dL on average (range: 641–1051 ng/dL)for those never on TRT. The range of 605–1051 ng/dL was then used to create a testosterone treatment flowchart, and when tested for accuracy held true. Based on these results, the recommended target range for a total testosterone level is 605–1051 ng/dL.