Low T and Missed Reps

[Steven Kalin]

Just make sure we don't confuse true gynecomastia which is glandular enlargement with pseudogynecomastia which is an increase in body fat. Testosterone therapy will actually decrease and improve pseudo gynecomastia without the use of an aromatase inhibitor.

Dammit. I feel like I’m kind of at the mercy of the Canadian healthcare system up here. Not a lot of options. I’ll have to maybe learn more about this than I feel I have the mental capacity for.

[dalan]

Dammit. I feel like I’m kind of at the mercy of the Canadian healthcare system up here. Not a lot of options. I’ll have to maybe learn more about this than I feel I have the mental capacity for.

I never had it looked at bit I'm pretty sure I had gynecomastia during puberty, which can happen from what I understand. It was a hard, decent size lump under one nipple. I don't know if was regular gynecomastia as we're speaking about or the fatty kind Dr Nichols mentioned but it eventually went away on its own and has never returned despite my continuous use of testosterone for over the last 15 years. I've never used any kind of AI or any other ancillary drug. That's just my experience.

[Yonason Herschlag]

Well, my T level came in at 639 today, so I think I can predict how my appointment with my GP is going to go tomorrow. I wonder if Dr. Nichols has a recommendation for a hormone optimization doc in the Southern California area…

In 20015 my testosterone was at the bottom of the normal range. Somehow I convinced my GP that the Endo recommended Clomephene (and he's been renewing the prescription ever since). With 50mg Clom nearly every day, my testosterone hovers at or just above the top end of the normal range. The good thing about Clom is it tricks the pituitary into producing and releasing more LH, which directs the testes to produce more testosterone. The shriveled up testes become bigger and more vibrant. Keep in mind, that the male body produces estrodial by converting some of the testosterone to estrodial. After several months on Clom, I saw that my Estrodial numbers had climbed significantly. To be clear, it's not simply the testosterone levels that need to be high, but rather the free-testosterone levels. So prevent my body from converting my treasured T to E, I took what's called an anti-aromatose med, Letrozole 2.5mg to be exact. Unfortuneately no endo was willing to guide me on this, so I simply forged a prescription, and started taking the Letrozole. However, the next time I tested, my E was so low, that it didn't even register at all. So I kept reducing the dosage until I found that 1.25mg to 2.5mg per MONTH was sufficient to keep my E in check where it needs to be. Be aware, that proper amounts of E are essential for many bodily functions, and for a short time I had mine dangerously low.
I'm 58 years old, working out about six hours per week, only lifting heavy once or twice a week. Recently I deadlifted 220kg, squated 160kg X3, and benched 110kgX2. Like most guys my age I've been through all sorts of physical injuries, the most recent being hit by a bus in 2017, which has helped me become a bit nuttier that I was previously.
Don't be like me doing this on my own; get the meds from a qualified doctor. I'm a do-it-myself guy to an extreme; I've been giving myself haircuts for thirty years. I built my own home. I just did my own plumbing job and was splattered in ten year aged shit. Don't be like me.

[Mark Rippetoe]

If only there was a source for information on this topic. Maybe an internet podcast, where a knowledgeable person talks to an expert in the field -- maybe even multiple experts. Something to think about...

[Jovan Dragisic]

the most recent being hit by a bus in 2017, which has helped me become a bit nuttier that I was previously.

I like you.

[J. Keith Nichols MD]

In 20015 my testosterone was at the bottom of the normal range. Somehow I convinced my GP that the Endo recommended Clomephene (and he's been renewing the prescription ever since). With 50mg Clom nearly every day, my testosterone hovers at or just above the top end of the normal range. The good thing about Clom is it tricks the pituitary into producing and releasing more LH, which directs the testes to produce more testosterone. The shriveled up testes become bigger and more vibrant. Keep in mind, that the male body produces estrodial by converting some of the testosterone to estrodial. After several months on Clom, I saw that my Estrodial numbers had climbed significantly. To be clear, it's not simply the testosterone levels that need to be high, but rather the free-testosterone levels. So prevent my body from converting my treasured T to E, I took what's called an anti-aromatose med, Letrozole 2.5mg to be exact. Unfortuneately no endo was willing to guide me on this, so I simply forged a prescription, and started taking the Letrozole. However, the next time I tested, my E was so low, that it didn't even register at all. So I kept reducing the dosage until I found that 1.25mg to 2.5mg per MONTH was sufficient to keep my E in check where it needs to be. Be aware, that proper amounts of E are essential for many bodily functions, and for a short time I had mine dangerously low.
I'm 58 years old, working out about six hours per week, only lifting heavy once or twice a week. Recently I deadlifted 220kg, squated 160kg X3, and benched 110kgX2. Like most guys my age I've been through all sorts of physical injuries, the most recent being hit by a bus in 2017, which has helped me become a bit nuttier that I was previously.
Don't be like me doing this on my own; get the meds from a qualified doctor. I'm a do-it-myself guy to an extreme; I've been giving myself haircuts for thirty years. I built my own home. I just did my own plumbing job and was splattered in ten year aged shit. Don't be like me.

Hmmm...interesting. You take a medication to raise testosterone and the estradiol goes up. Well, that's exactly how testosterone works. When you raise testosterone levels -- either naturally or with a medication -- you will also raise levels of its active metabolites, which are estradiol and DHT. That's how testosterone exerts its beneficial effects through it's ACTIVE metabolites. I find it strange that someone wants to have really great testosterone levels but wants to maintain their estradiol levels in a range for a man with low testosterone. You mentioned that you want to keep your estradiol in a "range where it needs to be ". What exactly is that range? Is it the range for a man with low testosterone or the range for a man with optimal testosterone levels? When you look at all the studies done with testosterone in men which showed improvement what you will see is that in none of those studies did they block or control estradiol. And none of the guidelines in any country do they recommend controlling or blocking estradiol. In fact, in the newest guidelines put out by some of the worlds leading urologist they specifically state "do not block estradiol and do not use androgens that do not aromatize ". They say that because they at least understand that many of the beneficial effects from testosterone come from the aromatization into estradiol, and when you block the estradiol you block the beneficial effects at the tissue level. If you will take the time to listen to the podcast you will understand that what you're measuring in your serum is not reflective of what's occurring at the tissue level. What you are measuring in the serum is what is produced peripherally, not what is produced at the tissue level.

Well, my free testosterone lab test just came back at 49. Way below avg even for a 70 yo guy. Going to have to make an appointment with an endocrinologist soon.

That's not a healthy free testosterone at all. That is 49 pg/mL which equates to 4.9 ng/dL and your total testosterone is 639 ng/dL. I'll give you a reference point: whenever I'm treating a female they typically have a free testosterone in the range of 3 to 6 ng/dL. Some are even higher than that depending on their individual needs. So you have the free testosterone level presently of a female that is getting treatment in my practice, and that includes my 75-yea- old females as well.

[VNV]

That's not a healthy free testosterone at all. That is 49 pg/mL which equates to 4.9 ng/dL and your total testosterone is 639 ng/dL. I'll give you a reference point: whenever I'm treating a female they typically have a free testosterone in the range of 3 to 6 ng/dL. Some are even higher than that depending on their individual needs. So you have the free testosterone level presently of a female that is getting treatment in my practice, and that includes my 75-yea- old females as well.

Me too Chess guy (64.9 pg/ml here). And I’m 53, so you’re doing much better than I.

[topcraig]

I'm 64 years old and I finally decided to do something about my shitty attitude and my waning ability to satisfy my 41-year-old wife. My bloodwork said my total testosterone was 430, and free testosterone was 73. After describing my symptoms of bad sleep, no energy, brain fog, inability to recover from training, and waning libido, the Nurse Practioner I spoke with asked me if I had been lifting weights or doing intermittent fasting. I said I have been doing both. He said both can have an effect on your testosterone levels. He also asked me what time of day I had my blood drawn. Apparently lifting, intermittent fasting, and getting blood drawn earlier in the day can skew your numbers to the high side. The morning I had my blood drawn I woke up with "Blue-Steel" for the first time in months. Anyway, I'm starting TRT. I'm going to use the cream first, and if it doesn't get me back in the game, I'll start injections after three months. My wife is looking forward to my "therapy" as much as I am.

[J. Keith Nichols MD]

I'm 64 years old and I finally decided to do something about my shitty attitude and my waning ability to satisfy my 41-year-old wife. My bloodwork said my total testosterone was 430, and free testosterone was 73. After describing my symptoms of bad sleep, no energy, brain fog, inability to recover from training, and waning libido, the Nurse Practioner I spoke with asked me if I had been lifting weights or doing intermittent fasting. I said I have been doing both. He said both can have an effect on your testosterone levels. He also asked me what time of day I had my blood drawn. Apparently lifting, intermittent fasting, and getting blood drawn earlier in the day can skew your numbers to the high side. The morning I had my blood drawn I woke up with "Blue-Steel" for the first time in months. Anyway, I'm starting TRT. I'm going to use the cream first, and if it doesn't get me back in the game, I'll start injections after three months. My wife is looking forward to my "therapy" as much as I am.

Hopefully you've had a chance to listen to some of the podcast and it's great that you're getting treatment but make sure you get adequate treatment. The main reason a lot of men don't do as well as they should is because they don't get enough testosterone when they undergo testosterone therapy. I can show you dozens of studies where testosterone was given to men and didn't work.The Common denominator in every single one of those studies was that their testosterone was only raised a little bit. Quite honestly you have to have levels that are for the most part supraphysiologic to really exert a good response. A lot of doctors will not treat outside of the normal range but that's where all the benefits occur.

[topcraig]

Thanks, Dr. Nichols. I had a discussion with the Nurse Practioner about the first three months of using the cream and during this period how my natural testosterone production will be decreasing. I told him I was ok with going through the first three months to see if the cream is going to raise my levels. He said if my next blood work-up and my own experience indicate the dose is too low, we would switch to subQ injections and adjust the dose accordingly. By the way, I've watched all of the TRT-related podcasts and they were a big help and a great motivator.