Got Testosterone?

[usmcvet]

Hmmm, well, no reason not to print that out or email to docs as a reason you need to manage high E2 levels. #1 way to lower E2, is to lose weight. What's your BMI and or Bf% these days?

Thank you Will. I am not sure what it is right now but it's too high. It's a never ending struggle for me. I am working on it now.

[WillBrink]

This is one of the more important studies looking at this topic. Why? Vast majority of studies are epi/correlational/observational studies that find an association between T and X disease, pos or neg. Page 1 of any good epi book "correlation does not = causation" and so there's a limited amount of conclusive info from such studies, no matter how compelling they appear. This was a direct intervention study where they actively manipulated the variables (in this case T and estradiol) with meds to raise/lower T and estradiol to see what impact it had on risk factors for CVD. What did they find? Levels of T nor E independently impacted known risk factors, but the ratio of T/E did. That's something that more cutting edge scientists/docs have understood for a while, and why men should never go on an AI unless absolutely needed, which is most cases, they don't need.

Men's heart disease risk linked to high testosterone and low estrogen

Source:

The Endocrine Society

Summary:

Why men have more heart disease than premenopausal women has been unclear, but a new study shows that the sex hormones testosterone and estrogen alter cardiovascular risk factors in a way that raises a man's risk of heart disease.

Why men have more heart disease than premenopausal women has been unclear, but a new study shows that the sex hormones testosterone and estrogen alter cardiovascular risk factors in a way that raises a man's risk of heart disease. Results of the study will be presented Saturday at the Endocrine Society's 97th annual meeting in San Diego.

Men have higher testosterone and lower estrogen levels than premenopausal women. Therefore, doctors have suspected that testosterone may promote cardiovascular disease or that estrogen may protect against it, or both, according to Elaine Yu, MD, MSc, the study's lead investigator and an assistant professor at Harvard Medical School, Boston.

Their study, conducted in 400 healthy men ages 20 to 50, found that higher levels of testosterone led to lower levels of HDL cholesterol, or "good" cholesterol, but estrogen appeared to have no effect on HDL cholesterol. In contrast, the investigators reported that low levels of estrogen led to higher fasting blood glucose (sugar) levels, worsening insulin resistance and more fat in muscle, markers for developing diabetes, which is itself a risk factor for heart disease.

"These observations may help explain why men have a higher risk of cardiovascular disease," Yu said.

Yu and her research team were able to determine whether estrogen or testosterone regulated various cardiovascular risk factors by comparing two groups of men whose hormone levels were temporarily changed with combinations of medications.

At the start of the study, all men received the drug goserelin (Zoladex, AstraZeneca) to suppress their own production of testosterone and estrogen. Then the 198 men in the first group received daily treatment for four months with either a placebo (dummy) gel or one of four doses of testosterone gel (AndroGel, AbbVie), ranging from low to high (1.25 to 10 grams). This treatment set the men's testosterone levels from very low (as in before puberty) to high-normal, Yu said.

The other group, made up of 202 men, received the same treatment as in group 1 but also received anastrozole (Arimidex, AstraZeneca) to block conversion of testosterone to estrogen. Men naturally convert some testosterone to estrogen. Blocking this process resulted in very low levels of estrogen in the second group, according to Yu.

Study participants had their weight measured and had fasting blood tests for markers of heart disease and diabetes. At the start and end of the study, they had a thigh scan with quantitative computed tomography (CT) to measure muscle fat.

The researchers found that neither testosterone nor estrogen regulated changes in LDL, or "bad," cholesterol; blood pressure; and body weight. "It appears that these common risk factors for cardiovascular disease are not regulated by sex hormones," Yu said.

In summary, higher testosterone levels and lower estrogen levels in men worsen cardiovascular risk factors that may help to explain gender differences in heart disease.

Cite:

https://www.sciencedaily.com/release...0308091404.htm

[WillBrink]

We know being obese suppresses T levels, and losing some BF one of most effective ways to increase T levels. One reason we are seeing men with lower T levels is in part due to increased rates of obesity, and automatically putting an obese man on TRT due low T is not always the right approach. The first thing I ask men with low T on the net is what's their BMI, or bodyfat % of they know it, as that's often the answer to their problem and they're looking a magic shot (literally) vs dropping some fat. This review covers that topic well:

Hypogonadism and Male Obesity: Focus on Unresolved

Clin Endocrinol (Oxf). 2018 Apr 23. [

Abstract

Obesity, increasing in prevalence globally, is the clinical condition most strongly associated with lowered testosterone concentrations in men, and presents as one of the strongest predictors of receiving testosterone treatment. While low circulating total testosterone concentrations in modest obesity primarily reflect reduced concentrations of sex hormone binding globulin, more marked obesity can lead to genuine hypothalamic-pituitary-testicular axis (HPT) suppression.

HPT axis suppression is likely mediated via pro-inflammatory cytokine and dysregulated leptin signalling and aggravated by associated comorbidities. Whether estradiol-mediated negative hypothalamic-pituitary feedback plays a pathogenic role requires further study. Although the obesity-hypogonadism relationship is bi-directional, the effects of obesity on testosterone concentrations are more substantial than the effects of testosterone on adiposity. In markedly obese men submitted to bariatric surgery, substantial weight loss is very effective in reactivating the HPT axis.

In contrast, lifestyle measures are less effective in reducing weight and generally only associated with modest increases in circulating testosterone. In randomised controlled clinical trials (RCTs), testosterone treatment does not reduce body weight, but modestly reduces fat mass and increases muscle mass. Short-term studies have shown that testosterone treatment in carefully selected obese men may have modest benefits on symptoms of androgen deficiency and body composition even additive to diet alone. However, longer-term, larger RCTs designed for patient-important outcomes and potential risks are required.

Until such trials are available, testosterone treatment cannot be routinely recommended for men with obesity-associated non-classical hypogonadism. Lifestyle measures or where indicated bariatric surgery to achieve weight loss, and optimisation of comorbidities remain first line.

https://www.ncbi.nlm.nih.gov/pubmed/29683196

[jpmuscle]

Test Cyp should be available OTC. Period end of story.


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[WillBrink]

Test Cyp should be available OTC. Period end of story.

In some countries it is.

[Don Robison]

I don't expect health related labs to be out of whack per, but I guarantee your total T (assuming you're in the US using typical esters of T) and free T, will be well above TRT ranges. I'm surprised you found an endo who started you off on that dose. Typical dose (though not what I'd recommend...) might be 300mg every 2 weeks.

Good luck.

Late getting back to this one; had my labs doe about six weeks ago. Two things surprised me, how high my test levels were and that my doc agreed to let me stay o my current dosage since all of my other numbers were right in the center of the normal range. Total test was greater than 1500 and free test was 28.6. Energy levels are outstanding, workouts are better than ever. I'm down from 42 pants to 38s getting ready to move into 36s.

[WillBrink]

Late getting back to this one; had my labs doe about six weeks ago. Two things surprised me, how high my test levels were and that my doc agreed to let me stay o my current dosage since all of my other numbers were right in the center of the normal range. Total test was greater than 1500 and free test was 28.6. Energy levels are outstanding, workouts are better than ever. I'm down from 42 pants to 38s getting ready to move into 36s.

What about E2 levels? How about lipids, LDL/HDL?

[Don Robison]

What about E2 levels? How about lipids, LDL/HDL?

E2 was 31, LDL 80, HDL 50. My cholesterol is likely all over right now because I quit taking cholesterol meds at the beginning of the year and trying to keep it under control with diet and exercise. The test prior to this one cholesterol levels were horrible. Something like 190 LDL, 30 HDL.

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[ABNAK]

I'm a little over a year out from prostate cancer. Still coming back undetectable on the PSA, knock on wood. I had to knock off the T supplementation when I was diagnosed with it (doesn't cause it per se but will feed it). I was on T for 7 1/2 years. Being off of it SUCKS. Libido and "performance", combined with the effects of prostate removal, is shitty. I work out the same amount of cardio and weights, eat the same, but have gained 15 pounds. I don't move anywhere near the weights I used to although I still keep at it religiously. Energy levels suck.

I was cleared by the surgeon (who is also a national-level expert in prostate cancer) to resume T if I wanted. I'm just a little paranoid and gun-shy though. The specter of returning prostate cancer casts a large shadow, trust me. I want to make it 2 years with undetectable PSA before I resume T, so maybe by this time next year I'll be back on it.

Seeing the above posts my HDL level is 75, which is likely due to exercise so I guess I'm still seeing some benefit to working out although I don't necessarily feel like it.

[WillBrink]

I'm a little over a year out from prostate cancer. Still coming back undetectable on the PSA, knock on wood. I had to knock off the T supplementation when I was diagnosed with it (doesn't cause it per se but will feed it). I was on T for 7 1/2 years. Being off of it SUCKS. Libido and "performance", combined with the effects of prostate removal, is shitty. I work out the same amount of cardio and weights, eat the same, but have gained 15 pounds. I don't move anywhere near the weights I used to although I still keep at it religiously. Energy levels suck.

I was cleared by the surgeon (who is also a national-level expert in prostate cancer) to resume T if I wanted. I'm just a little paranoid and gun-shy though. The specter of returning prostate cancer casts a large shadow, trust me. I want to make it 2 years with undetectable PSA before I resume T, so maybe by this time next year I'll be back on it.

Seeing the above posts my HDL level is 75, which is likely due to exercise so I guess I'm still seeing some benefit to working out although I don't necessarily feel like it.

Good reading here:

Two experts examine the pros and cons of this controversial practice

https://www.harvardprostateknowledge...rostate-cancer