I have a friend and trainee who is in his early 60s and is clearly dealing with low T problems: trouble sleeping, stiff and sore all of the time, poor recovery from relatively low stress training days and major depressive disorder. He’s also bipolar and is uncertain that his psychiatrist would be on board for prescribing or recommending TRT.
You present a very convincing argument for starting a patient on TRT under circumstances like these and I was hoping that you could recommend some compelling studies/articles to present to his doctor?
Why must his psychiatrist be the one who prescribes the TRT?
From my own experience, the best Dr. to go to would be an endocrinologist. Psychiatrists don't have experience with TRT, and thus don't prescribe it. This is exactly how they should approach it, since doctors shouldn't prescribe treatments they don't know about. Find an endocrinologist with testimonials or reviews online from satisfied patients who receive TRT. Then you know you're dealing with one who's not squeamish about prescribing it.
Just go to a TRT clinic. We know they will prescribe it.
He previously had asked his psychiatrist if TRT would have negative side effects in regards to treating his bipolar disorder and at the time his psychiatrist felt like it would interfere with the process of getting his meds right.
I’ve almost convinced him to try it without consulting his psychiatrist, but he still wants to check with her before proceeding.
I told him I’d ask around and dig up some studies/articles for him to present to the doc.
...
He never had it checked to his recollection. I recommended he get it checked at a t-clinic years ago, as it has been proven to help treat depression. He then mentioned this to his psychiatrist, who said it wasn’t a good idea at the time because they were trying to get his meds right. He was then hard to convince otherwise.
Recently he had to get off a med that had been linked to Alzheimer's and he sunk into a pretty bad depression. He stopped training, got out of town for two months and was almost hospitalized twice. He’s back now and wants to get his life in order.
Seems to me they’re always trying to get his meds right, because he gets depressive, lethargic episodes, at least partly, from having low T. But I’m not a doctor...
Isn't it interesting that the only "med" he may need to get right is testosterone, but the sillyass psychiatrist won't even try it until she gets through playing with his brain.
Yep. I may have talked him into just going to the T clinic now that he’s at the point of “it can’t get worse than this.”
The list of conditions that cause these problems is surprisingly long. Before assuming it’s low testosterone, it would be worth checking it.
Few psychiatrists will manage testosterone replacement therapy, although you might get one to order a test.
The best thing would be to have the GP/urologist/endocrinologist, or whoever is going to manage T replacement, communicate with the psychiatrist.
Low T can cause depression, but would not cause bipolar disorder. If that is your friend’s actual diagnosis (you also mention “major depressive disorder,” which is not diagnosed simultaneously with bipolar), he should not forego psychiatric treatment once starting testosterone, even if it helps with his depression.
And even if the testosterone level is not "low", if TRT improves the patient's symptoms, we have permission to use it anyway, right? Would it be okay to at least try it, given that the reference range is very seldom predictive of symptoms, and that response is usually noted in 48-72 hours, so we'll know pretty quick if it helped? And what exactly is the downside of trying it? More importantly, why has the T level not been checked already? Had he presented with lethargy/tiredness, he would probably have been checked for thyroid hormone levels immediately, if he hasn't been already. But not testosterone. Testosterone is an important hormone, low levels of which cause profound problems, but because Mark McGwire had to talk to the Senate about STEROIDS, we can't even consider it? Is it a bias against the idea that "enhancing masculinity" might be a good thing for some men?
I think part of your friend's problem is that he is perfectly happy with letting other people decide what he should do. Test might help with that too.
Can you explain to me how the chin-up is an assistance movement for the press and bench press? It doesn't mimic the presses, nor does it utilize the same musculature that the presses use to directly transfer force into the barbell.
I have failed to find material within the SS methodology that explains this, and I am dissatisfied with the response to this question outside the methodology: "Have you ever seen a good bench presser with a small back back, bro?!"
Is the chin-up also an assistance movement for the deadlift for those who cannot keep the bar in contact with their legs despite using the correct cues?
Technically, it is an Ancillary exercise, as defined in the blue book in chapter 7. We are sometimes not careful about this term.
Thank you for the correction, Rip. Is it useful for the presses because you need to keep the last tight in each movement, or is the chin-up useful for another reason that I am missing?
ARMS????
Who are you and what have you done to the real Mark Rippetoe?
Did you just go bro on us Rip?! Haha I guess with that comment in mind, a little hypertrophy specific training is included in the program, and maybe for elbow health?
Just trying to increase my knowledge.
It's for the lats, forearms, biceps (largely missing from the main lifts). Basically, yer arms, bro.
Trainers Who Think They’re Physios –Carl Raghavan
Quotes from Iron Mike Webster –Colin Webster
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