Reply With QuoteUse and abuse are two different things. Myself nor Mark are going to condone abuse. We are talking about the responsible use of testosterone for health as well as to resolve symptoms of a deficiency.Originally Posted by randomuser
TMPHBITEU
You're posting on the wrong board.
Member
Use and abuse are two different things. Myself nor Mark are going to condone abuse. We are talking about the responsible use of testosterone for health as well as to resolve symptoms of a deficiency.
Member
My understanding is that as discussed on your show that replacement doses appear to have little to no risk. The benefits which appear to be vast obviously outweigh these minor risks at those doses. However, it appears that the risk is dose dependent and there is a tipping point where the risk outweighs the added benefit of higher doses. I'm not sure what those risks are as we can't discuss them with the "pro" test crowd and the "con" crowd keeps stating BS so...we appear to be no closer to understanding that inflection point since risk can't be factually explored. This inquiry seems to not have moved forward at all.
TMPHBITEU
If you want to take a bunch of steroids, go ahead. Learn about them the old-fashioned way, like everybody else did. But we're not going to help you.
Member
We are looking at testosterone as a cure, you are looking at it as a performance enhancer. Taking more testosterone does not make resistance training healthier.
It is like you are nude on a regular beach, instead of a nude beach. Different mindset, different places.
Member
Thank you Rip and Dr. Nichols. This is exactly what I was trying to figure out...where does use end and abuse begin?
Member
Rip and Dr. Nichols, I listened to your episode and I think every episode that Rip has done in the last two years regarding testosterone. I was tested spring of last year after I complained to my Dr. about low energy, libido, and poor concentration. my total was at 649 with free at 8.1, both the GP and the endocrinologist refused to treat me as I was "within the reference range". I sucked it up and drove on, but a year later the symptoms were even worse, up to and including crying at the endings of the Cars movies that I'd watch with my little boy. Again I went and complained to the Dr. and was tested 417 and 7.2 respectively, went to another endocrinologist and was tested again three weeks later 352 and 5.6. The endocrinologist tells me to lift for two weeks and get tested again, numbers go back up a bit, I don't have the results handy mid 500s for the serum, but I don't remember the free. All along he refuses to prescribe me and wants me to keep lifting and to test again in January. I'm 39, 5' 10" and weigh about 190.
I've been incredibly disheartened as every single one of these Drs repeats the lines about prostate cancer, blood clots, and all that, all while my marriage is going to rot, and when I complain to my wife about it she just says something to the line of "that's why you should listen to your Dr and not some podcast. I know that with proper testosterone levels I would feel so much better and my marriage would be better (even better if she would get some hormonal therapy as well as she's perimenopausal but refuses to acknowledge it).
What advice is there for someone who doesn't have the time to shop around for a Dr. who will actually treat me as a person and not a data point on a reference range and doesn't have the disposable income to pay out of pocket for treatment not covered by insurance? The worst-case scenario is that I continue to suck it up and drive on until our boy starts kindergarten next year and I'm no longer paying for preschool which is basically college tuition at this point.
TMPHBITEU
Call Dr. Nichols.
Member
Could be worse mate, you could be in Australia.
"Hypogonadism remains significantly undertreated in Australia,7 but concerns about testosterone overuse may be overshadowing the underdiagnosis and undertreatment of androgen deficiency."
That's the gp council of australia being more concerned about the overuse of a medication then treating the condition.
If I want TRT I have to go to a shady gym and ask randoms for it and hope it's actually test.
On topic, I see a lot of "systematic reviews" that claim that there's no actual benefit to taking TRT. I haven't bothered to track them down and read them, but I assume they're using something silly like a weekly 50mg dose for their studies and recording no changes?
Member
Even though your total appears adequate it's your free that matters and your free testosterone is not very good at all. The level doesn't matter anyway because everyone has a different androgen receptor sensitivity and the fact that you're having symptoms should dictate care not a level. Unfortunately your doctors are not educated on the real risk and benefits of testosterone therapy. This is exactly why mark and I did the last video. It was to help dispel some of these myths and tell you where they originated from and why they are incorrect. It sounds like the first person you need to convince of the seriousness of how you feel is your wife. Maybe take her out to a nice dinner and while there try to have a very open and honest discussion and let her know just how bad you feel and that you would be a much better husband and father if you could receive treatment. Let her know that if she was on the other foot you would do everything on demand to assist her with improving her health and feeling better. Maybe you can convince her to just sit down and listen to Mark's videos on the subject of testosterone therapy. I have already posted the initial rough draft of the myth concerning testosterone therapy and it causing heart attacks, strokes, or blood clots. I will now provide with you what Mark and I talked about regarding the issues surrounding prostate cancer. Maybe you can get your wife to read both of the forum topics
Testosterone and Prostate Cancer:
THE HISTORY OF DR. HUGGINS, DR. MORGENTALER, AND THE SATURATION MODEL
The belief for over seven decades has been that high testosterone causes prostate cancer or increases a man's risk of developing prostate cancer, that low testosterone is protective against prostate cancer and that if you raised testosterone you would cause an existing prostate cancer to grow rapidly…The “equivalent of pouring gasoline on a fire”.
Now where did this androgen hypothesis originate? It came from a paper written in 1941 by two urologists Drs Huggins and Hodges. Dr. Huggins was a very well-known urologist who in fact went on to win the Nobel Peace Prize in 1966 for his work with hormones and cancer.
In this paper they looked at men with metastatic prostate cancer. Back then there was not a PSA test so they looked at something called prostate acid phosphatase as a serum marker for metastatic prostate cancer. In this study Dr. Huggins reported that when men were castrated either surgically or chemically the acid phosphatase levels went down. He also gave testosterone injections to men and he reported that in every man that got testosterone injections the acid phosphatase levels went up. Now this was an important paper at the time because it was the first paper that identified a cancer to be hormonally sensitive. This paper established three things: 1. That prostate acid phosphatase could be used as a serum marker for metastatic prostate cancer. 2. Castration was effective for metastatic prostate cancer. 3. Testosterone injections given to men with metastatic prostate cancer was dangerous.
Now when you take a closer look at the paper you see that testosterone injections were only given to three men. Results were given for only two of those men and one of those men had been surgically castrated so he was no longer hormonally intact and what we would call "androgen deprived “. So the general conclusion that "cancer of the prostate is activated by testosterone injections” was based on one hormonally intact patient who received testosterone injections for only 18 days who's acid phosphatase levels went up and down and were essentially uninterpretable.
So decades of depriving men of testosterone was based on the over interpretation of the results of one single man in one study
Now you may wonder how that can happen but the problem was that in the 1940s and 50s there weren't many physicians with experience using testosterone so no one had an adequate knowledge to question the results so it became dogma… that testosterone was dangerous for prostate cancer
It wasn’t until the 1990s that a Harvard urologist by the name of Abraham Morgentaler began to question the validity of the Androgen hypothesis. In 1988 he began treating men with sexual dysfunction and low testosterone levels with testosterone . At that time there wasn't any Cialis or Viagra so treatment options were limited. What he noticed was that not only did they improve sexually but they also improved both physically and mentally. Now at this time his treatment defied standard medical practice because in the 1980s testosterone therapy was limited to three groups of men
1. Men who had congenital or genetic disorders like Klinefelter's
2. Pituitary disorders 3. And those with absent testes.
He became concerned because some of his colleagues warned him that he could potentially be causing harm based on the work of Dr. Huggins.
So in 1992 he began performing biopsies prior to initiating testosterone therapy in symptomatic testosterone deficient men who had normal PSA's and digital rectal exams in an effort to rule out an existing prostate cancer. What he found was 11 out of the first 77 men that he biopsied had prostate cancer. Now remember low testosterone was supposed to be protective against prostate cancer and what he found was that approximately 14% of men with low testosterone levels had prostate cancer. Now this percentage was almost the same as the percentage of men that have prostate cancer with increased risk factors such as an elevated PSA or a positive digital rectal exam.
So low testosterone was found not to be protective and these findings were published in the Journal of the American medical Association in 1996.
So now that he knew that low testosterone was not protective , what about high testosterone being harmful?
In 2004 Dr. Morgentaler published the paper “risks of testosterone replacement therapy and recommendations for monitoring” in the New England Journal of medicine. For that paper he performed a review of the World literature between 1985 to 2004 looking for any worrisome relationship between testosterone and prostate cancer or testosterone therapy and prostate cancer.
He was unable to find a single article that testosterone increased a man's risk of getting prostate cancer or that testosterone therapy caused prostate cancer progression.
He also made the observation that with a 10 fold increase in testosterone prescriptions after the release of Androgel in 2001 there was not an epidemic of prostate cancer. We know that 50% of men more than 50 years old have micro foci of prostate cancer in their prostates. If Increasing levels of androgens cause cancer to grow more rapidly then we should see more cancer growth in these men but we don't. The observation has also been right in front of us for decades that younger men with high testosterone levels don't get prostate cancer but instead it is a disease of aging when testosterone levels decline.
So in 2007 Dr. Morgentaler developed the saturation model to make sense of two opposite observations that the data reported. Castration decreases testosterone and the PSA goes down. If you increase testosterone levels out of the castrate range the PSA also increases. But the data also shows that for most of the range of testosterone levels including supraphysiologic levels there's no change in PSA level or prostate size.
This is because androgens have a limited ability to stimulate prostate tissue. In order for androgens to exert an effect on prostate tissue they must first bind to the androgen receptor. Once the androgen receptors are fully saturated with androgen any increase in androgen will simply be excess. This saturation of the androgen receptors occurs at a very low level which is around 250 ng/dL. Above this level androgens have no further effect on benign or cancerous prostate tissue growth.
Think of the prostate like a house plant. If you deprive the plant of water it will shrink. If you give it water at this point it will grow. Giving it any additional water past this point will have no effect on growth. You could give it a constant water supply and it will never grow into a tree. Once it's thirst has been quenched giving it any additional water will have no effect on growth and the same goes for testosterone and the prostate.
So what does the modern data show us?
1. In hypogonadal men testosterone therapy does not increase the risk of developing prostate cancer even in high-risk individuals. It may in fact have a protective role against high-grade cancer and Studies have shown that higher levels of testosterone can suppress prostate cancer growth. There is an inverted U with regard to prostate cancer cell proliferation and testosterone levels. At low Testosterone levels there is suppression of prostate cancer cell proliferation, between castrate levels and the saturation level (hypogonadal) there is growth, and with high levels of testosterone there is once again suppression of prostate cancer cell proliferation. The unfortunate reality is that about 1 in 6 men have prostate cancer and if you are in a clinic and you're seeing at least 60 patients then you are most likely treating at least 10 men with active prostate cancer. So all of these clinics are in effect treating men on active surveillance with prostate cancer without any detrimental effects.
2. Testosterone therapy does not increase the risk of progression in men on active surveillance
3. Testosterone therapy does not increase the risk of biochemical recurrence after treatment of prostate cancer by radiation therapy or radical prostatectomy. Some studies have shown decreased recurrence rates in men on testosterone therapy.
Multiple studies have revealed that low testosterone is associated with
1. Higher grades of cancer
2. A more advanced stage of cancer at surgery
3. A increased rate of recurrence after surgery
4. Decreased survival
It is not high testosterone levels that are associated with poor prognostic factors but it appears to be low testosterone levels.
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