Clinical Testosterone

by Austin Baraki

Testosterone is a steroid hormone that exerts a wide number of important androgenic and anabolic effects in the human body. It is a fundamental component of male physiology, although smaller amounts are produced in females as well. Adequate levels are crucial for optimal health, and there have been growing concerns about hypogonadism (commonly known as “Low T”) being a highly prevalent and under-diagnosed condition with the potential to dramatically reduce quality of life among males.

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This article, frankly, is a mishmosh of facts, pop/broscience, and myths. While it can usefully stimulate some thinking and avenues to pursue, you should look elsewhere for a proper understanding of this topic.

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Originally Posted by Ehrgeiz

This article, frankly, is a mishmosh of facts, pop/broscience, and myths. While it can usefully stimulate some thinking and avenues to pursue, you should look elsewhere for a proper understanding of this topic.

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Perhaps you might enlighten us with some specific criticisms and supporting evidence?

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Originally Posted by Ehrgeiz

This article, frankly, is a mishmosh of facts, pop/broscience, and myths. While it can usefully stimulate some thinking and avenues to pursue, you should look elsewhere for a proper understanding of this topic.

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Yes. Please be specific when you dismiss a well-written piece, or risk being perceived as a sophist fool.

Quote:

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Originally Posted by Ehrgeiz

This article, frankly, is a mishmosh of facts, pop/broscience, and myths. While it can usefully stimulate some thinking and avenues to pursue, you should look elsewhere for a proper understanding of this topic.

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http://homokananen.sarjakuvablogit.c.../escalated.jpg

Thanks for the interesting article.

One thing that caught my interest, at the end of the article you state that "there are several well-established lifestyle measures that improve testosterone levels naturally [...][e.g.] Reducing use of [...] marijuana.

I occasionally read about the "T-lowering" effects of Marijuana before, but always categorized that under Reefer Madness bullshit. Now, after reading your article, I browsed the internet for medical articles and studies about this topic. The results I found are mixed. Leaving aside the usual not very meaningful studies with in vitro cells from rats or the like, there are studies that claim to have found a reduction in testosterone or it's precursors and other that claim there is no such reduction. Unfortunately most of them are available to the layperson only as abstract.

Question, do you have some pointers to studies that undoubtedly can establish proof that there indeed is a negative impact on the production of testosterone or it's precursors through marijuana use? What studies would you consider the strongest evidence?

Of course I'm only interested in this topic because of a close friend's chronic use.

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Originally Posted by wwg

Thanks for the interesting article.

One thing that caught my interest, at the end of the article you state that "there are several well-established lifestyle measures that improve testosterone levels naturally [...][e.g.] Reducing use of [...] marijuana.

I occasionally read about the "T-lowering" effects of Marijuana before, but always categorized that under Reefer Madness bullshit. Now, after reading your article, I browsed the internet for medical articles and studies about this topic. The results I found are mixed. Leaving aside the usual not very meaningful studies with in vitro cells from rats or the like, there are studies that claim to have found a reduction in testosterone or it's precursors and other that claim there is no such reduction. Unfortunately most of them are available to the layperson only as abstract.

Question, do you have some pointers to studies that undoubtedly can establish proof that there indeed is a negative impact on the production of testosterone or it's precursors through marijuana use? What studies would you consider the strongest evidence?

Of course I'm only interested in this topic because of a close friend's chronic use.

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Good question. I agree that the evidence is mixed on the topic, with a number of studies of rather poor quality (small sample sizes, etc.) - so perhaps including that in the "well-established" list alongside alcohol and opiate use was too bold. But although we like our skepticism around here, I would not automatically dismiss rat studies just because they were performed in rats, as that's where the majority of translational research begins.

The recommendation in the article was therefore to "reduce" (rather than "eliminate") marijuana use, because it is very plausible that heavy, chronic use (pun intended) could contribute to decreased testicular synthesis of testosterone. Whether this then results in symptomatic hypogonadism remains unclear, but if your "close friend" had symptomatic hypogonadism and was a very heavy marijuana user, I would probably still recommend that they try reducing their use and working on the remaining lifestyle interventions as well.

I unfortunately don't have time to dig up all the citations for you, but a reasonably good primer on the topic (with a number of citations) can be found here.

Dr. Baraki,

Have you any experience with "exercise-induced" hypogonadism?

I believe that I am recovery challenged in that I am a piss poor sleeper: wake up for no reason (that I can discern) multiple times, wake up 2 hours before alarm and then can't fall back asleep, wake up feeling like crap, can't get out of bed, etc. I am 99.7% sure that I do not have sleep apnea. I'm a middle aged male (39) that has been doing SS and intermediate programs for the last 3 years with decent results.

Given that poor sleep is both a cause and a symptom of a hormonal imbalance, where would one start with trying to address a suite of symptoms would otherwise point toward low testosterone? For example, for the last year, I've felt chronically fatigued (feel like passing out between hours of 2-4, take 2 hour naps on weekends), have ED, libido tanking, lack motivation, irritable and low mood (not depressed, but no joy).

I've had some blood work done:
first
second

My testosterone is considered "normal", but on the low end. I have not had SHBG or cortisol tested, but my suspicion is that my SHBG is high and my cortisol is whacked. I think my adrenals are jacked up due to poor recovery and stress from lifting and that is affecting my HPA axis and therefore my hormonal milieu.

Any thoughts or recommendations (e.g., would one of those 4 sample cortisol saliva tests be worthwhile)? I realize that I am not a special snowflake so surely there are others who feel this way and are not willing to chalk it up to "getting older"? I'm not even looking to go on testosterone. I am very interested in exploring a "restart" option like Clomid given my age and situation. I have a consultation scheduled with one of the more well known HRT tele-medicine practices.

Thank you for your time.

I enjoyed the article, I have some questions.
1. If a regimen of testosterone is begun, does it act solely as a supplement to the hormones a body produces, or does it replace the body's production?
2. If a regimen of Rx testosterone is discontinued, will the body then produce testosterone as effectively as it did prior to the Rx?
3. In short, what is the evidence regarding the impact of Rx testosterone on the long term functioning of a body's endocrine system?
4. If there is an effect, is there any correlation between the extent of the effect and the age of the patient?

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Originally Posted by BryanW

Dr. Baraki,

Have you any experience with "exercise-induced" hypogonadism?

I believe that I am recovery challenged in that I am a piss poor sleeper: wake up for no reason (that I can discern) multiple times, wake up 2 hours before alarm and then can't fall back asleep, wake up feeling like crap, can't get out of bed, etc. I am 99.7% sure that I do not have sleep apnea. I'm a middle aged male (39) that has been doing SS and intermediate programs for the last 3 years with decent results.

Given that poor sleep is both a cause and a symptom of a hormonal imbalance, where would one start with trying to address a suite of symptoms would otherwise point toward low testosterone? For example, for the last year, I've felt chronically fatigued (feel like passing out between hours of 2-4, take 2 hour naps on weekends), have ED, libido tanking, lack motivation, irritable and low mood (not depressed, but no joy).

I've had some blood work done:
first
second

My testosterone is considered "normal", but on the low end. I have not had SHBG or cortisol tested, but my suspicion is that my SHBG is high and my cortisol is whacked. I think my adrenals are jacked up due to poor recovery and stress from lifting and that is affecting my HPA axis and therefore my hormonal milieu.

Any thoughts or recommendations (e.g., would one of those 4 sample cortisol saliva tests be worthwhile)? I realize that I am not a special snowflake so surely there are others who feel this way and are not willing to chalk it up to "getting older"? I'm not even looking to go on testosterone. I am very interested in exploring a "restart" option like Clomid given my age and situation. I have a consultation scheduled with one of the more well known HRT tele-medicine practices.

Thank you for your time.

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Sorry, Bryan. This is a bit too complicated of a question to delve into in this forum. With that said, I would be interested to hear how your consultation goes.

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Originally Posted by agingbones

I enjoyed the article, I have some questions.
1. If a regimen of testosterone is begun, does it act solely as a supplement to the hormones a body produces, or does it replace the body's production?
2. If a regimen of Rx testosterone is discontinued, will the body then produce testosterone as effectively as it did prior to the Rx?
3. In short, what is the evidence regarding the impact of Rx testosterone on the long term functioning of a body's endocrine system?
4. If there is an effect, is there any correlation between the extent of the effect and the age of the patient?

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1. As discussed in the article, serum levels are regulated by multi-level feedback mechanisms. Exogenous testosterone can interfere with these mechanisms and, over the long term, result in decreased natural production. The alternative, of course, is to not get treated (or stop treatment), and continue to deal with symptomatic hypogonadism.

2. If/once treatment is discontinued, the body will not immediately begin producing at optimal levels due to the chronic feedback effects; however, there are a number of "restart" protocols that have been used to re-start endogenous production. Unfortunately, they have not been adequately studied. TRT is usually used long-term without significant adverse effects in most individuals; however, it has also been used as a temporary bridge to help patients deal with the underlying cause of their hypogonadism (e.g, in obese individuals to improve energy levels, facilitating exercise to increase muscle mass and lose bodyfat, which can itself reverse hypogonadism) and can later be discontinued once this cause is addressed. Not all physicians are willing to offer this, however.

3/4. These are not specific enough questions.