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  1. #51
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    • starting strength seminar june 2022
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    I think this video is a perfect example of whatís going on and what Iíve experienced. Itís 15 minutes long, but if anybody takes the time to watch it, I think itíll be eye opening. Does this mother fucker care about you or is he more interested in cutting your dick and installing the ďGold StandardĒ for erectile dysfunction? You be the judge:

    How to CURE ED! [5 KEY Pillars] in 2021 - YouTube

  2. #52
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    This thread is great. I'd bet there are quite a few people who truly want a legit TRT prescription from a legit doctor like Dr Nichols but are forced to take another path because they can't find s doctor who hasn't got his "knowledge" from outdated information. The old "200mg every two weeks" (I've even heard as infrequently as once a month) is still very much alive in the medical community, if you can get them to prescribe at all.

  3. #53
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    Different labs have different normal ranges but LabCorp for instance the normal range for total testosterone is 264 to 916 ng/dL And the free testosterone ranges from 5 to 21 ng/dL but sometimes in some labs that is reported in picograms per milliliter. I always report total and free in nanograms per deciliter and if the free is reported in picograms per milliliter I will convert to nanograms per deciliter. For example, Quest labs normal range for total testosterone is 250 to 1100 ng/dL, and then they report the free as 35 to 155 pg/mL. If I have a patient that comes back from Quest with a free testosterone of 155 pg/ml, for instance, I will convert to nanograms per deciliter so it’s 15.5 ng/dL. Different labs have different normals, but I always like to report the total and free testosterone in the same units of measure. But to answer your question I like to see the total testosterone at a level where the free testosterone is definitely over 30 ng/dL and preferably closer to 50 ng/dL so the total testosterone is usually somewhere between 1000 and 2000 ng/dL. I hope this answers your question. I would recommend you get your next lab work either at Quest or LabCorp and make sure they use the ultrafiltration dialysis method to get a accurate free level.

  4. #54
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    Buddy, I never would’ve believed it when I first went into Medicine, but what I’ve come to learn over the years is that medicine is just a business and that too many providers use patients as income generators instead of treating patients as they would themselves or their family members. Medicine is really about informed decision making. A good provider will always discuss with you multiple alternatives for treatment. A really good provider will actually offer you options that they may not even do them selves. You’re going to see how this works in the real world on the next podcast with Rip, where we will be discussing the diagnosis of prostate cancer, as well as its treatment and the utilization of testosterone in men that have it or have had it. I look forward to seeing you soon.

  5. #55
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    Quote Originally Posted by J. Keith Nichols MD View Post
    ...but sometimes in some labs that is reported in picograms per milliliter. I always report total and free in nanograms per deciliter and if the free is reported in picograms per milliliter I will convert to nanograms per deciliter. For example, Quest labs normal range for total testosterone is 250 to 1100 ng/dL, and then they report the free as 35 to 155 pg/mL.
    Thank you for noting this. I thought my free levels were red-lining, until I noticed the disparity in units: pg/mL vs. ng/dL. Correcting units dropped me an order of magnitude: pg = 10^-3 ng , mL = 10^-2 dL, so pg/mL = (1/10) ng/dL

    Labs from the Parkview System in NE Indiana show these ranges for Normal. Perhaps they use Quest.




    Quote Originally Posted by J. Keith Nichols MD View Post
    ... I like to see the total testosterone at a level where the free testosterone is definitely over 30 ng/dL and preferably closer to 50 ng/dL so the total testosterone is usually somewhere between 1000 and 2000 ng/dL. I hope this answers your question. I would recommend you get your next lab work either at Quest or LabCorp and make sure they use the ultrafiltration dialysis method to get a accurate free level.
    I thought I was at 65 ng/dL, when I am really at 6.5 ng/dL. Bummer.

    Total is 630 ng/dL, which an endocrinologist said I should be grateful for. "Most of his clients are around . . . zero." His attitude was "why are you here?". How do I not pay for such service without incurring legal fees?

  6. #56
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    Quote Originally Posted by VNV View Post
    Thank you for noting this. I thought my free levels were red-lining, until I noticed the disparity in units: pg/mL vs. ng/dL. Correcting units dropped me an order of magnitude: pg = 10^-3 ng , mL = 10^-2 dL, so pg/mL = (1/10) ng/dL

    Labs from the Parkview System in NE Indiana show these ranges for Normal. Perhaps they use Quest.






    I thought I was at 65 ng/dL, when I am really at 6.5 ng/dL. Bummer.

    Total is 630 ng/dL, which an endocrinologist said I should be grateful for. "Most of his clients are around . . . zero." His attitude was "why are you here?". How do I not pay for such service without incurring legal fees?
    This is in no way to make light of your situation but an effort to point out the under treatment of men...I have 60 and 70 y/o women with a free T of 6 ng/dl or more in my practice. When you are confined to the normal range which is not a healthy range your health suffers.
    Keith

  7. #57
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    So many doctors feel that if you can go to work then come home and sit on the couch effectively, your levels are fine. They really, really don't get it.

  8. #58
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    Dr. Nichols, I am in total agreement with all you've said, not that you care what I think, but a question if I may. Have you found that high estrogen levels increase water retention, or for some other reason, cause an increase in blood pressure at some point? If so, is this self correcting or is it not even an issue? You may feel like such questions should be handled at a consultation and if so, I completely understand.

  9. #59
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    Quote Originally Posted by dalan View Post
    Dr. Nichols, I am in total agreement with all you've said, not that you care what I think, but a question if I may. Have you found that high estrogen levels increase water retention, or for some other reason, cause an increase in blood pressure at some point? If so, is this self correcting or is it not even an issue? You may feel like such questions should be handled at a consultation and if so, I completely understand.
    Dalan,
    I was waiting for this topic to come up and I’m glad you asked it. The water retention that some men get when they first start testosterone has nothing to do with estradiol and everything to do with testosterone itself. Testosterone increases sodium absorption, which can lead to fluid retention. It is usually self-limited and resolves on its own. It can be mitigated by getting adequate exercise, drinking plenty of fluids, and avoiding all sodium intake. This initial fluid retention can cause a transient elevation in blood pressure, but once again this is self-limited and resolves with time. Testosterone has been shown to be cardioprotective and it lessens blood pressure over time -- it doesn’t lead to hypertension.

    The problem is that most clinics don't want to educate their patients on what to expect with regard to the side effects that may occur when one goes from a relatively low testosterone level to an optimal level in a short period of time. The body has to acclimate. This is a topic for a podcast but let me go ahead and touch on it now. When you produce testosterone on your own, or you take it exogenously, it goes down three separate pathways. Testosterone exerts effects as itself directly on muscle tissue, and that’s why bodybuilders want to abuse it. All of the other beneficial effects of testosterone are mediated by the other two pathways, and that is via it’s conversion to DHT or estradiol in the target tissues. So all of the wonderful things that you know about testosterone are for the most part due to its conversion into estradiol. When men block estradiol they are blocking the beneficial effects of testosterone at the tissue level. I would be willing to bet that the men at my clinic as a whole probably have the most optimal levels of any clinic in the country, and I can say that none of those men has estrogen symptoms or needs an aromatase inhibitor.

    With all the men that I have treated who are members of Starting Strength Gyms, there has to be some men that are reading this forum and can give their own testimonials. As Ray Gillenwater has so correctly stated, with increasing androgen levels DHT and estradiol reach a saturation point. Once the five alpha reductase enzyme as well as the aromatase enzyme is fully saturated with androgen it can no longer produce DHT or estradiol. So DHT and Estradiol will reach a point where they can increase no further, but you can continue to raise androgen levels to the tens of thousands. So to specifically answer your question, estradiol does not cause water retention and neither testosterone nor estradiol causes hypertension, but in fact lowers blood pressure with time. When one first starts testosterone there can be a transient increase in blood pressure and water retention which will resolve.

    As I teach all of my men there are three myths with regard to testosterone replacement therapy. The first myth is that you need to block estradiol. The second is that it causes or worsens prostate cancer. The third is that you have to donate blood while on testosterone replacement therapy. You can but you don’t have to. The secondary erythrocytosis one gets while on testosterone is a beneficial effect and is what increases endurance and what improves healing capacity. This secondary erythrocytosis has never shown any harm in any randomized controlled trial to date, and there have been thousands done. From an observational standpoint, testosterone is presently abused by millions of men worldwide who aren’t under the supervision of a provider, nor do they get blood work, and yet there is no increase in heart attacks, strokes, or blood clots in these men. Yes, most all of them have a secondary erythrocytosis. There is a lot of misinformation out there, and that’s the real problem.

    Keith
    Last edited by Ray Gillenwater; 12-03-2021 at 10:16 AM.

  10. #60
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    Wow, thank you for the detailed response, Doctor. Very valuable and interesting information. You also touched on another question I had which was concerning RBC, or more precisely the related hematocrit levels but I'll save that for another time.

    Thank you greatly for your time and sharing your knowledge. It is appreciated.

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