TRT in men in their Nineties

[Bremster]

It has been a while since I posted anything, I turned 93 in January, my Urologist has been suggesting that I lower my dosage of Testosterone. Without getting into specifics numbers, my testosterone levels were about 1500 total. I should add that all of other blood markers were within acceptable range, all, no exceptions. Any way I still tried and succeeded in getting it down in 1000 range, I have noticed a drop off in sexual performance and desire, also some joint pain occasionally, so I bumped up my testosterone to about 250 mg per week and I am back. So, my rhetorical question is, maybe you when you get as old as I am, you need a little more testosterone than younger men?

 

[Guided_by_Voices]

Keep on keeping on! You're a role model. As to your question, I remember seeing that the body actually conserves T as we get older, however there are some people who just do better at higher levels so maybe you're one of them regardless of age. It may also be that if something else is in decline, such as growth hormone, that the T is partially compensating for that. Just guesses.

 

[Vince]

That's awesome, you're 93 is still looking good. I agree with you. Most younger men seem to do worse on higher levels. Older men seem to do better at higher levels like me. I'm in your camp. I need high-levels to feel my best.

 

[Cataceous]

Older men do get more "bang for the buck" from testosterone because the metabolic clearance rate declines with age. That is, free testosterone will typically go higher at the same dose as we age. There is no evidence that high levels of testosterone are healthier or to be preferred in any way, with the possible exception of gains in body composition. But the latter typically come at the expense of overall health when the testosterone dose is excessive.

It is quite common for a reduction in the dose of testosterone to lead to symptoms until the body becomes used to the lower levels. This process can take weeks to months. Far too many men misinterpret these transient symptoms as permanent and resume taking excessive amounts of testosterone. More specifically, healthy young men typically produce testosterone at a rate equivalent to using 60-70 mg of testosterone cypionate per week. In this we see that taking much over 100 mg per week is gratuitous unless specifically intended for bodybuilding.

Older men do tend to have elevated SHBG, so it is important to monitor free testosterone rather than total. Free testosterone can be measured accurately with equilibrium dialysis. Otherwise it should be estimated with the Vermeulen calculation, which requires measuring total testosterone, SHBG and albumin levels.

 

[madman]

It has been a while since I posted anything, I turned 93 in January, my Urologist has been suggesting that I lower my dosage of Testosterone. Without getting into specifics numbers, my testosterone levels were about 1500 total. I should add that all of other blood markers were within acceptable range, all, no exceptions. Any way I still tried and succeeded in getting it down in 1000 range, I have noticed a drop off in sexual performance and desire, also some joint pain occasionally, so I bumped up my testosterone to about 250 mg per week and I am back. So, my rhetorical question is, maybe you when you get as old as I am, you need a little more testosterone than younger men?

It has been a while since I posted anything, I turned 93 in January, my Urologist has been suggesting that I lower my dosage of Testosterone. Without getting into specifics numbers, my testosterone levels were about 1500 total. I should add that all of other blood markers were within acceptable range, all, no exceptions.


Big mistake getting caught up on TT, free testosterone is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

You stated that you are hitting a TT 1500 ng/dL which does not paint the full picture here without knowing how many days post-injection blood work was done.

Big difference between peak vs trough!

Big difference between one hitting a trough TT 1500 ng/dL and high/absurdly high FT injecting daily vs twice-weekly vs once weekly!

If one is hitting a whopping trough TT 1500 ng/dL and more importantly high trough FT 7 days post-injection then their peak TT and more importantly FT will be absurdly high!

Top it off that if one is hitting a healthy let alone high steady-state/trough FT it would be a given that the majority would have elevated hematocrit unless they were anemic or had lower-end hematocrit pre-TTh.

Big questions here are what is your injection frequency and how many days post-injection were your labs done?

Even then we always want to test at the true trough (lowest point) before your next injection.

Top it off that what is critical here is not just where your trough TT sits but more importantly your trough free testosterone.

You need to know where your trough TT and more importantly trough FT sits on said protocol (dose of T/injection frequency).

Most men on TTh are injecting 100-200 mg T/week whether once weekly or split into more frequent injections as in twice-weekly (every 3.5 days), M/W/F, EOD or daily.

The majority of men can easily hit a healthy let alone high trough FT injection 100-150 mg T/week especially when split into more frequent injections.

Yes some men may need the higher-end dose 200 mg T/week but it is far from common as in rare!

250 mg/week is a whopping dose of T!

If you truly feel great overall minus any sides and overall blood markers remain healthy than I see no issue here.

Do what you feel is best for you!




Any way I still tried and succeeded in getting it down in 1000 range, I have noticed a drop off in sexual performance and desire, also some joint pain occasionally, so I bumped up my testosterone to about 250 mg per week and I am back. So, my rhetorical question is, maybe you when you get as old as I am, you need a little more testosterone than younger men?

In order to truly state such you would have needed to be running a TT 1000 ng/dL for 12 weeks before jumping to any conclusions here as when one is tweaking a protocol (increasing/decreasing dose of T or manipulating injection frequency) it will take 4-6 weeks for blood levels to stabilize due to the PKs (TC/TE) and it is common for one to experience ups/downs along the way especially lower libido as the body is trying to adjust to the lower T levels during the transition (next 4-6 weeks) and even than once blood levels have stabilized (4-6 weeks) it will still take a few more months for the body to adapt to its new set-point and this is the critical time period when one needs to gauge how they truly feel regarding improvement of low T symptoms and overall well-being.

Every protocol whether starting TTh or tweaking (dose of T/injection frequency) needs to be given a full 12 weeks before claiming whether it was truly as success or failure!

IMany still lack the understanding of how exogenous esterified T works and end up tweaking their protocols every 6 weeks because they do not feel good.

Most are left in a constant state of confusion chasing their tales endlessly!

 

[madman]

Older men do get more "bang for the buck" from testosterone because the metabolic clearance rate declines with age. That is, free testosterone will typically go higher at the same dose as we age. There is no evidence that high levels of testosterone are healthier or to be preferred in any way, with the possible exception of gains in body composition. But the latter typically come at the expense of overall health when the testosterone dose is excessive.

It is quite common for a reduction in the dose of testosterone to lead to symptoms until the body becomes used to the lower levels. This process can take weeks to months. Far too many man misinterpret these transient symptoms as permanent and resume taking excessive amounts of testosterone. More specifically, healthy young men typically produce testosterone at a rate equivalent to using 60-70 mg of testosterone cypionate per week. In this we see that taking much over 100 mg per week is gratuitous unless specifically intended for bodybuilding.

Older men do tend to have elevated SHBG, so it is important to monitor free testosterone rather than total. Free testosterone can be measured accurately with equilibrium dialysis. Otherwise it should be estimated with the Vermeulen calculation, which requires measuring total testosterone, SHBG and albumin levels.

$$$

 

[Guided_by_Voices]

Another factor here is that being dialed in is sufficiently rare that changing anything, especially in pursuit of a theoretical but unknown "improvement" seems very risky. It assumes you can always get back to where you were before and although that is likely true from a numbers perspective, it is not necessarily true from a outcome perspective.

 

[Willyt]

My friend, you are playing with house money at 93 years old. Do whatever makes you happy at this point. The fact that you have any libido is a minor miracle.

And I hope you are not trolling us because I want to believe...

 

[Seagal]

I should add that all of other blood markers were within acceptable range, all, no exceptions.

That's great!
What @Cataceous wrote makes sense, it's reasonable.
My gut says, if it's working smoothly, don't try to fix it. On the other hand, blood markers don't show the full picture. ... Then again, you are 93 yrs.
For how long have you been on TRT?

 

[Bremster]

I am guessing, but I think it has been about 25 to 30 years.

 

[Dr.V.P.C.]

I have 3 patients on 80´s ( one is my daddy ) on TRT ( 2 on transdermal scrotal cream and 1 on nebido )
IMO the level in blood is not the main target since it fluctuates a lot ( even more in transdermal ) and also always there is an androgen receptor sensivity individuality .
So the improve of the symptoms of low test , blood work , organs image exams ( cardio, prostate, liver, etc) , will always dictate the dosage and type of administration.

 

[Bremster]

I truly appreciate all the comments, I could have been more forthcoming with details. I had been injecting 3 times per week for a total of 200 mg. As mad man suggested older people may get “more bang for the buck”.

 

[Vince]

Keep It Up: The Power of Precision Medicine to Conquer Low T and Revitalize Your Life! Hardcover October 8, 2013 by Florence Comite - I read this book a couple of years ago and thought it was really good. I read the kindle version. She talks about men feeling their best, when having their testosterone levels, at the levels they were, when they were young. She believes young men should have their levels tested, so when they get older they know what to shoot for.

Most older men had higher levels when they were young. Of course, most young men having to start out on TRT had low levels when they were young. That's why I believe they're so big of a difference in the levels. We need to help us feel good.

 

[excelnelg]

Living to 93 sounds like my worst nightmare. So glad it's working for you.