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Thread: SS Radio #171: Hormone Optimization with Mike Wittmer MD

  1. #11
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    Here is where the devil is in the details. The reference ranges from "healthy non-obese man ". It depends on how you define healthy. They simply defined healthy as a man with a BMI less than 30. These men were not screened for symptoms of a deficiency. Healthy was simply defined as a BMI less than 30. These men could've felt terrible and had many symptoms attributable to testosterone deficiency but yet they were still included in the normal range. The problem is that the literature shows us that there is no level of testosterone that denotes a deficiency. There is no number that you can hang your hat on and say every man above that number does not need testosterone and every man below that number does. The reason it is done is because it makes medicine efficient. A provider only has to look at a lab value and make a decision instead of actually taking time to speak with the patient and actually discuss their symptoms. The present normal range is the average of a population of sick poisoned men who are producing less testosterone than ever.

  2. #12
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    Quote Originally Posted by J. Keith Nichols MD View Post
    The present normal range is the average of a population of sick poisoned men who are producing less testosterone than ever.
    I think that's the kicker. It's common knowledge that men's levels have declined over the decades so just because it's "normal" now doesn't mean it's the way it's supposed to be. On my last blood work, normal free test had a range that topped out at 155 pg/ml, which if I'm not mistaken (and I could be) is 15.5 ng/dl. That's the high end. That's terrible. To add to the confusion, ranges will vary depending on the lab. I've seen 1100 as the top of normal and I've seen 850 as the top of normal. If I recall, when I started paying attention years ago, the top was 1190- something. Its like we're intentionally being feminized little by little.

  3. #13
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    Greatly enjoyed the discussion with Dr. Wittmer, although I think the doc was a bit subdued - possibly due to a cold he seemed to be nursing. Question: Rip brought up Bio-identical testosterone treatment, seeming to ridicule it a little, but that is what is offered on the Wittmer Rejuvenation Clinic’s website. Did I understand Dr. Wittmer to say that what that is is just the synthetic, lab produced testosterone that all TRT clinics would be offering?

  4. #14
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    "Bio-identical" is marketing. Mike knows this. He's just the doctor.

  5. #15
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    Gotcha.

  6. #16
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    Quote Originally Posted by J. Keith Nichols MD View Post
    They simply defined healthy as a man with a BMI less than 30. These men were not screened for symptoms of a deficiency. Healthy was simply defined as a BMI less than 30.
    They also screened for comorbidities:
    Of the 1912 men who attended the first Gen 3 examination (2002–2005), 1893 had total testosterone measurements, 962 were 40 yr of age or younger among whom 456 men were free of cancer (self-report of physician diagnosis supported by medical records when available), CVD (occurrence of any of the following: myocardial infarction, sudden death, stroke, congestive heart failure, coronary angioplasty or coronary artery bypass surgery, claudication, or peripheral angioplasty), DM, hypertension, hypercholesterolemia, obesity, and smoking, and constituted the reference sample (Fig. 1).
    Still, you are right: some people can oddly manage to be “healthy” in spite of deficient T. These tail cases currently determine how the entire population is treated.

  7. #17
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    Quote Originally Posted by Shiva Kaul View Post
    They also screened for comorbidities:


    Still, you are right: some people can oddly manage to be “healthy” in spite of deficient T. These tail cases currently determine how the entire population is treated.
    Yes that's why I specifically stated that they weren't screened for a deficiency. The men could've felt terrible even though they passed the screening for the comorbidities. For the most part everyone on this forum would pass the screening for comorbidities. But what you're seeing over and over again is men that don't feel well and are not functioning as well as they know they should be even though they don't have significant comorbidities. So they did exclude the very sick that had a history of cardiovascular disease or myocardial infarction etc. but they didn't exclude those that had all the signs and symptoms of testosterone deficiency. The author of the study has also stated that the study should not be utilized to influence clinical decision making, but that's exactly what has happened.

  8. #18
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    Quote Originally Posted by Shiva Kaul View Post
    The problem is that uncontextualized, arbitrary statistical “reasoning” has taken precedence over basic cost-benefit analysis. The reference range of 264-916 ng/dL is a 95% confidence interval covering the bottom 2.5% to the top 2.5% of the population. Can you imagine prescribing strength training to only the 2.5% weakest people?
    Correction: the range was obtained using quantile regression. But the point about arbitrary cutoffs remains.

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