What is TRT and What is NOT TRT

[GreenMachineX]

View attachment 21660
I have to chuckle every time I read this. I'm seeing peak daily TT of 700 ng/dL on 4.4 mg/day, with SHBG ~30 nMol/L. Castration? I think not.

I think I'm doing pretty well going on 4 weeks of 4-5mg test cyp daily. I'll test in a couple more weeks to verify. But his suggestions are insane.

 

[Willyt]

@readalot can you walk me through in layman's terms what I am looking at on those graphs?

 

[tareload]

@readalot can you walk me through in layman's terms what I am looking at on those graphs?

95% confidence estimate of what guys will hit on mean TT level (over the course of the week) vs weekly test ester dosage (corrected for injection frequency and hence peak/trough ratios, details, details).

Green shaded region is generous physiologic range (300-1200 ng/dl).

 

[tareload]

D.H. not a big fan of the fT construct . Also the concept of GAINZ doesn't seem to be covered anywhere in this review.

Frontiers | The Illusory Case for Treatment of an Invented Disease

www.frontiersin.org

Doctors, especially endocrinologists, should be vigilant in recognizing that testosterone is highly susceptible to wishful thinking and marketing fueled by confected, internet-driven patient fantasies. They should take care to distinguish between pathological hypogonadism and functional disorders leading to reduced blood testosterone, a functional pathophysiological state, not a disease. Ageing co-morbidities including the pseudo-hypogonadism of obesity and functional impacts on the HPT axis from numerous systemic diseases causing mild lowering of blood testosterone, should not be confused with genuine organic hypogonadism. Care is needed when considering marketing-friendly, disease-mongering guidelines that promote excessive testosterone prescribing that contribute to the epidemic of excessive testosterone prescribing of recent decades. When termed “hypogonadism” (or any of its neologistic synonyms) under the expanded disease-mongering definition, these ageing-comorbidities are a fiction in search of a definition. Finally, there is no basis for population or individual patient screening (“case finding”) by measuring blood testosterone without a genuine clinical suspicion of underlying male reproductive pathology based on the clinical presentation including examination of testes. When measurement of blood testosterone is justified by the clinical presentation including physical examination, it should be accompanied by blood LH, FSH and SHBG to clarify interpretation and assays should be performed multiple times. Pathologists should be encouraged to switch to more accurate LCMS-based measurements of testosterone and stop reporting the misleading imaginary fractions of testosterone (“free”, “bioavailable”), a numerical artifice signifying nothing for clinical guidance (41).

 

[DS3]

D.H. not a big fan of the fT construct . Also the concept of GAINZ doesn't seem to be covered anywhere in this review.

Frontiers | The Illusory Case for Treatment of an Invented Disease

www.frontiersin.org

Doctors, especially endocrinologists, should be vigilant in recognizing that testosterone is highly susceptible to wishful thinking and marketing fueled by confected, internet-driven patient fantasies. They should take care to distinguish between pathological hypogonadism and functional disorders leading to reduced blood testosterone, a functional pathophysiological state, not a disease. Ageing co-morbidities including the pseudo-hypogonadism of obesity and functional impacts on the HPT axis from numerous systemic diseases causing mild lowering of blood testosterone, should not be confused with genuine organic hypogonadism. Care is needed when considering marketing-friendly, disease-mongering guidelines that promote excessive testosterone prescribing that contribute to the epidemic of excessive testosterone prescribing of recent decades. When termed “hypogonadism” (or any of its neologistic synonyms) under the expanded disease-mongering definition, these ageing-comorbidities are a fiction in search of a definition. Finally, there is no basis for population or individual patient screening (“case finding”) by measuring blood testosterone without a genuine clinical suspicion of underlying male reproductive pathology based on the clinical presentation including examination of testes. When measurement of blood testosterone is justified by the clinical presentation including physical examination, it should be accompanied by blood LH, FSH and SHBG to clarify interpretation and assays should be performed multiple times. Pathologists should be encouraged to switch to more accurate LCMS-based measurements of testosterone and stop reporting the misleading imaginary fractions of testosterone (“free”, “bioavailable”), a numerical artifice signifying nothing for clinical guidance (41).

Tisk tisk. How dare men want to improve their body composition.

 

[tareload]

Tisk tisk. How dare men want to improve their body composition.

Not sure about you but FFMI has to be in there with %BF for me. I am still waiting for androgens to be prescribed for body dysmorphia. The cat is out of the bag now.

List of 9 Body Dysmorphic Disorder Medications Compared

Compare risks and benefits of common medications used for Body Dysmorphic Disorder. Find the most popular drugs, view ratings and user reviews.

www.drugs.com

Pharmacological Treatment of Body Dysmorphic Disorder

Body dysmorphic disorder is a challenging disorder that manifests as erroneously perceived flaws in one’s physical appearance and repetitive behaviors in response to appearance concerns. This disorder is also frequently comorbid with other psychiatric ...

www.ncbi.nlm.nih.gov

Where's the AAS and regimen to reduce risk? Why would my thinking be erroneous?

When does body dysmorphia get a revision in the DSM? There is recent precedent (see below). Should be termed FFMI / BF dysphoria so that we stay consistent.

The DSM-5 and the Politics of Diagnosing Transpeople - PubMed

In the DSM-5, there has been a change in the diagnosis for transpeople of all ages from Gender Identity Disorder (GID) to Gender Dysphoria (GD), in part to better indicate the distress that transpeople may experience when their gender identity feels incongruent. The Workgroup for Sexual and...

pubmed.ncbi.nlm.nih.gov

Gender dysphoria - Symptoms and causes

www.mayoclinic.org

 

[DS3]

Not sure about you but FFMI has to be in there with %BF for me. I am still waiting for androgens to be prescribed for body dysmorphia. The cat is out of the bag now.

List of 9 Body Dysmorphic Disorder Medications Compared

Compare risks and benefits of common medications used for Body Dysmorphic Disorder. Find the most popular drugs, view ratings and user reviews.

www.drugs.com

Pharmacological Treatment of Body Dysmorphic Disorder

Body dysmorphic disorder is a challenging disorder that manifests as erroneously perceived flaws in one’s physical appearance and repetitive behaviors in response to appearance concerns. This disorder is also frequently comorbid with other psychiatric ...

www.ncbi.nlm.nih.gov

Where's the AAS and regimen to reduce risk? Why would my thinking be erroneous?

When does body dysmorphia get a revision in the DSM? There is recent precedent (see below). Should be termed FFMI / BF dysphoria so that we stay consistent.

The DSM-5 and the Politics of Diagnosing Transpeople - PubMed

In the DSM-5, there has been a change in the diagnosis for transpeople of all ages from Gender Identity Disorder (GID) to Gender Dysphoria (GD), in part to better indicate the distress that transpeople may experience when their gender identity feels incongruent. The Workgroup for Sexual and...

pubmed.ncbi.nlm.nih.gov

Gender dysphoria - Symptoms and causes

www.mayoclinic.org

The main issue that you are hitting on is clinically diagnosable body distortion (dysmorphia). Men on TRT who train hard, eat religiously, and take their TT to upper end physiological or even slightly supraphyiological levels in order to obtain body composition changes should not be chastised. Lethargy and obesity should be chastised.

Men who eat poorly, train mediocre, and take excessive androgens/anabolics to obtain muscle hypertrophy with little work should be discouraged from their abuse or AAS.

The line between body dysmorphia and fitness goals is not well defined. However, we should be highly cautious in describing men and women as dysmorphic when exhibiting behaviors that improve quality of life, body composition, and health.

 

[tareload]

The main issue that you are hitting on is clinically diagnosable body distortion (dysmorphia). Men on TRT who train hard, eat religiously, and take their TT to upper end physiological or even slightly supraphyiological levels in order to obtain body composition changes should not be chastised. Lethargy and obesity should be chastised.

Men who eat poorly, train mediocre, and take excessive androgens/anabolics to obtain muscle hypertrophy with little work should be discouraged from their abuse or AAS.

The line between body dysmorphia and fitness goals is not well defined. However, we should be highly cautious in describing men and women as dysmorphic when exhibiting behaviors that improve quality of life, body composition, and health.

Well said. And as you have stated before, sometimes very hard to maintain upper end or slightly supra and not go higher. Dosage creep if you will.

But then we wouldn't tell a TGM you can only go slightly supra of the TT range for biological women. The clinical implications and side effects of androgen therapy for TGMs is trickling out. Are these sides tolerable /acceptable for gender dysporphia but not for muscle/body composition dysphoria?

 

[FunkOdyssey]

D.H. not a big fan of the fT construct . Also the concept of GAINZ doesn't seem to be covered anywhere in this review.

Frontiers | The Illusory Case for Treatment of an Invented Disease

www.frontiersin.org

Pathologists should be encouraged to switch to more accurate LCMS-based measurements of testosterone and stop reporting the misleading imaginary fractions of testosterone (“free”, “bioavailable”), a numerical artifice signifying nothing for clinical guidance (41).

This author's use of charged, emotive language really stands out while reading the paper and raises questions of bias. He makes a number of claims that are worth further examination. Most glaring I think, his criticism of free testosterone as a useless construct is supported by cherry-picked evidence. An unbiased discussion of the topic would have included papers like these:

Int J Impot Res

. 2019 Mar;31(2):132-138.
doi: 10.1038/s41443-018-0090-y. Epub 2018 Oct 22.

Free testosterone correlated with erectile dysfunction severity among young men with normal total testosterone​

Yan-Ping Huang 1, Wei Liu 1, Sheng-Fu Chen 2, Yi-Dong Liu 1, Bin Chen 1, Chun-Hua Deng 3, Mu-Jun Lu 4

• PMID: 30349000
• DOI: 10.1038/s41443-018-0090-y

Abstract​

Erectile dysfunction (ED) due to androgen deficiency is rare in the young population. We retrospectively evaluated in this study men aged 18-40 years presenting with ED from 2015 to 2017. The International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Grade Scores (EHGS) were used to assess erectile function. Total testosterone (TT), sex hormone-binding globulin (SHBG), lipid profile, and glycometabolic indicators were tested in fasting blood sample. TT and SHBG were detected by electrochemiluminescence immunoassay, and free (FT) and bio-available testosterone (BT) were calculated from a validated formula. Linear regression was used to analyze the data. In total, 140 cases (30.56 ± 4.81 years) with a mean TT levels of 6.15 ± 2.17 ng/ml were enrolled. Decreased levels of FT were associated with lower IIEF-5 scores(β = 0.176, P = 0.048) and EHGS (β = 0.198, P = 0.026) after adjustment for age, body mass index (BMI), smoking, comorbidities, high-sensitive C-reactive protein (hsCRP), uric acid, fructosamine, and quantitative insulin sensitivity check index (QUICKI). TT was only associated with EHGS in the crude model (β = 0.177, P = 0.037) and some single factor adjustment models, whereas BT and SHBG were not related with erectile function in any model. Low FT level, even in the presence of normal TT, is associated with ED severity in young men. FT levels should be screened in ED patient even with normal total testosterone.

J Clin Endocrinol Metab

. 2016 Jul;101(7):2647-57.
doi: 10.1210/jc.2015-4106. Epub 2016 Feb 24.

Low Free Testosterone Is Associated with Hypogonadal Signs and Symptoms in Men with Normal Total Testosterone​

Leen Antonio 1, Frederick C W Wu 1, Terence W O'Neill 1, Stephen R Pye 1, Tomas B Ahern 1, Michaël R Laurent 1, Ilpo T Huhtaniemi 1, Michael E J Lean 1, Brian G Keevil 1, Giulia Rastrelli 1, Gianni Forti 1, György Bartfai 1, Felipe F Casanueva 1, Krzysztof Kula 1, Margus Punab 1, Aleksander Giwercman 1, Frank Claessens 1, Brigitte Decallonne 1, Dirk Vanderschueren 1, European Male Ageing Study Study Group

• PMID: 26909800
• DOI: 10.1210/jc.2015-4106

Abstract​

Context: During aging, total testosterone (TT) declines and SHBG increases, resulting in a greater decrease in calculated free T (cFT). Currently, guidelines suggest using TT to diagnose androgen deficiency and to reserve cFT only for men with borderline TT.
Objective: Our objective was to investigate if either low cFT or low TT is more strongly associated with androgen-related clinical endpoints.
Methods: A total of 3334 community-dwelling men, aged 40-79 years, were included in this study. Differences in clinical variables between the referent group of men with both normal TT (≥10.5 nmol/liter) and normal cFT (≥220 pmol/liter) with those who had normal TT/low cFT, low TT/normal cFT, and low TT/low cFT were assessed by regression models adjusted for age, center, body mass index, and comorbidities.
Results: A total of 2641 men had normal TT (18.4 ± 5.5 [mean ± SD] nmol/liter)/normal cFT (326 ± 74 pmol/liter), 277 men had normal TT (14.2 ± 3.7)/low cFT (194 ± 23), 96 men had low TT (9.6 ± 0.7)/normal cFT (247 ± 20), and 320 men had low TT (7.8 ± 2.5)/low cFT (160 ± 55). Men with normal TT/low cFT were older and in poorer health. They had higher SHBG and LH and reported more sexual and physical symptoms, whereas hemoglobin and bone ultrasound parameters were lower compared to the referent group. Men with low TT/normal cFT were younger and more obese. They had lower SHBG, but LH was normal, whereas features of androgen deficiency were lacking.
Conclusions: Low cFT, even in the presence of normal TT, is associated with androgen deficiency-related symptoms. Normal cFT, despite low TT, is not associated with cognate symptoms; therefore, cFT levels should be assessed in men with suspected hypogonadal symptoms.

 

[DS3]

Well said. And as you have stated before, sometimes very hard to maintain upper end or slightly supra and not go higher. Dosage creep if you will.

But then we wouldn't tell a TGM you can only go slightly supra of the TT range for biological women.

Escalating zero point is alive and well.

 

[tareload]

This author's use of charged, emotive language really stands out while reading the paper and raises questions of bias. He makes a number of claims that are worth further examination. Most glaring I think, his criticism of free testosterone as a useless construct is supported by cherry-picked evidence. An unbiased discussion of the topic would have included papers like these:

You beat @Cataceous to the punch. Well done!! Really nice having you on here. Thanks!

I personally am looking forward to what comes from the CDC Host program for fT. Genuinely interested @Funkodyssey

 

[tareload]

Escalating zero point

Thirty Second Theories: Herzberg’s Motivator-Hygiene Theory

Two issues are addressed in dealing with employee motivation: (1) Prevent job dissatisfaction (2) Encourage Growth Theory Designer: Frederick Herzberg Theory Summary: There are two factors that …

wingedspur01.wordpress.com

Decent summary for those interested.

 

[FunkOdyssey]

You beat @Cataceous to the punch. Well done!! Really nice having you on here. Thanks!

I personally am looking forward to what comes from the CDC Host program for fT. Genuinely interested @Funkodyssey

Thank you. I've been impressed by the level of discourse and quality people around here. I think this is my new favorite forum.

I'm cautiously optimistic that the CDC HoSt program will be a good thing for everyone. It may create some short-term chaos for the TOT crowd until they find the new equivalent of 25-30 ng/dL but then things should settle down.

 

[tareload]

TOT crowd until they find the new equivalent of 25-30 ng/dL

25-30 ng/dl is for babies. Most of our guys are feeling there best at 30-50 ng/dl !

But 80-150 may be a little much.

Props to disciplined_TRT over at other forum. I know you would appreciate this:

What is TRT and What is NOT TRT

Haha. I was thinking about how I’d try to explain to someone how absurd 16 SD’s is. And you can’t really because those numbers are ridiculous, but I think I’d go with… “Ok, let’s say we have 10 billion people on the planet. Now imagine there’s 10 billion times those 10 billion people. Really...

forums.t-nation.com

====

I was thinking about how I’d try to explain to someone how absurd 16 SD’s is. And you can’t really because those numbers are ridiculous, but I think I’d go with…


“Ok, let’s say we have 10 billion people on the planet. Now imagine there’s 10 billion times those 10 billion people. Really think about it; it’s not 10, 100 or even 1000 times those 10 billion people, it’s 10 billion times those 10 billion people. Right? Ok…now take 10 billion times that population, so that you have 10 billion times 10 billion times those 10 billion people. Now do that again and again and again, so that you end up with a population of 10 billion times 10 billion times 10 billion times 10 billion times 10 billion times the current population of 10 billion people we have. Ok? Now out of that population, there is statistically one guy with Free T at 80ng/dL”
===

What is TRT and What is NOT TRT

Danny gets a little introspective here at 2:45: Was that an eye roll? fT of 80-150 ng/dl (LMFAO) and he starts to get a little concerned. Good job Danny, great to know you start to worry about limits of human physiology at some point. You even mentioned to go do some bloodwork...

forums.t-nation.com

 

[Deleted member 43589]

The main issue that you are hitting on is clinically diagnosable body distortion (dysmorphia). Men on TRT who train hard, eat religiously, and take their TT to upper end physiological or even slightly supraphyiological levels in order to obtain body composition changes should not be chastised. Lethargy and obesity should be chastised.

Men who eat poorly, train mediocre, and take excessive androgens/anabolics to obtain muscle hypertrophy with little work should be discouraged from their abuse or AAS.

The line between body dysmorphia and fitness goals is not well defined. However, we should be highly cautious in describing men and women as dysmorphic when exhibiting behaviors that improve quality of life, body composition, and health.

I 100% agree with you. I have read a few things about dysmorphia and personally can't see that this not a positive trait that leads to success. Coaching athletes for most or my life, some at a pretty high level, I have notice one trait most all of them have and that is obsessive compulsive which psychologists consider a treatable psychological disorder.. Most high level successful athletes are very obsessive compulsive. In fact, most successful people are too.. While psychologists see this as a disorder, athletes see this as a positive train which leads to success. It enables you to dedicate yourself to your goal and keep the mind in a type of tunnel vision. If your goal is to be Mr. Olympia, you are going to have to train harder than anyone else, eater better than anyone else and find the perfect combination of drugs to maximize your growth. You sleep, breathe and eat for the day you go on stage. Your whole life revolves around it and is consumed. Successful athletes often times have no life outside of their sport and many times have no relationships outside of the sport. I actually see this idea of dysmorphia is a way to keep psychologists in business, kind of inventing issues.

 

[tareload]

What is TRT and What is NOT TRT

24 min 46 sec chock full of convincing data from the latest review of scientific literature. Where is the “entertainment, not medical advice” disclaimer. If the rule #3 is to use MinEffDose and physiologic dosing works to relieve symptoms (individual basis), why are supra levels necessary?

forums.t-nation.com

 

[tareload]

https://onlinelibrary.wiley.com/doi/abs/10.1002/pros.2990100106

Body surface area - Wikipedia

en.wikipedia.org

 

[tareload]

What is TRT and What is NOT TRT

Exhaustive labs, history, protocols…? Edit: found your thread. Did you try anything that was offered up in that thread?

forums.t-nation.com

Other video highlights...

Danny and Grant ponder whether the T used to make Test Ester is really T and bioidentical. Reference ranges, burden of proof, ....

 

[tareload]

Since it is Christmas time and there is no better time to ridicule haughty "experts" who don't understand what the heck they are talking about...

https://www.center4menshealth.com/PDFs/Myth_2.pdf

So if you get bored this Holiday season take a look at above and marvel at what's wrong with this picture. Then convince yourself we need to invest more in math and science education to save our society.

What is the author missing in his analysis? How would you like this person guiding your medical care?

HINT:

Starting TRT Over Soon

Sorry for the error above @Gibbon (I input 300 mg/week every 7 days instead of the 300 mg you were doing every 28 days approx.) Very likely you were up close to 3000 ng/dl at peak and now the 755 ng/dl 10 days after injection makes sense. Sorry for confusion previous graph caused. Graph as...

forums.t-nation.com

 

[tareload]

C4MH: Pricing

www.center4menshealth.com

$85 every 14 days for an injection. Hmmm.

Beware that cut rate T. LoL.

https://www.center4menshealth.com/PDFs/Cut-Rate-T.pdf