Got Testosterone?

[Dave Williams]

+1 Will.....I emphasized to my Doc that I FEEL great around 1000 and I want it there all the time.

[WillBrink]

Will, that's good to see this study got published.

Agreed! It's an important finding to be sure.

[WillBrink]

A new study showing benefits of T in dieting men who often suffer low T and the symptoms of low T (eg, low mood, ED, etc), in this study, greatly improved via TRT.

Symptomatic response to testosterone treatment in dieting obese men with low testosterone levels in a randomized, placebo-controlled clinical trial

International Journal of Obesity (28 December 2016) | doi:10.1038/ijo.2016.242

Abstract

Background:

Obese men commonly have reductions in circulating testosterone and report symptoms consistent with androgen deficiency. We hypothesized that testosterone treatment improves constitutional and sexual symptoms over and above the effects of weight loss alone.

Methods:

We conducted a pre-specified analysis of a randomized double-blind, placebo-controlled trial at a tertiary referral center. About 100 obese men (body mass index (BMI)greater than or equal to30 kg m−2) with a repeated total testosterone level less than or equal to12 nmol l−1 and a median age of 53 years (interquartile range 47–60) receiving 10 weeks of a very-low-energy diet (VLED) followed by 46 weeks of weight maintenance were randomly assigned at baseline to 56 weeks of intramuscular testosterone undecanoate (n=49, cases) or matching placebo (n=51, controls). Pre-specified outcomes were the between-group differences in Aging Male Symptoms scale (AMS) and international index of erectile function (IIEF-5) questionnaires.

Results:

Eighty-two men completed the study. At study end, cases showed significant symptomatic improvement in AMS score, compared with controls, and improvement was more marked in men with more severe baseline symptoms (mean adjusted difference (MAD) per unit of change in AMS score −0.34 (95% confidence interval (CI) −0.65, −0.02), P=0.04). This corresponds to improvements of 11% and 20% from baseline scores of 40 and 60, respectively, with higher scores denoting more severe symptoms. Men with erectile dysfunction (IIEF-5less than or equal to20) had improved erectile function with testosterone treatment. Cases and controls lost the same weight after VLED (testosterone −12.0 kg; placebo −13.5 kg, P=0.40) and maintained this at study end (testosterone −11.4 kg; placebo −10.9 kg, P=0.80). The improvement in AMS following VLED was not different between the groups (−0.05 (95% CI −0.28, 0.17), P=0.65).

Conclusions:

In otherwise healthy obese men with mild to moderate symptoms and modest reductions in testosterone levels, testosterone treatment improved androgen deficiency symptoms over and above the improvement associated with weight loss alone, and more severely symptomatic men achieved a greater benefit.

http://www.nature.com/ijo/journal/v4..._id=IJO-201703

[WillBrink]

This new study applies mostly to vets, but PTSD caused by exposure to stressors not unique to soldiers:

Dual-hormone stress reactivity predicts downstream war-zone stress-evoked PTSD

Highlights

•We tested the singular and interactive effects of cortisol (CR) and testosterone (TR) reactivity as moderators of PTSD emergence in theater.
•Blunted cortisol and testosterone stress reactivity at pre-deployment prospectively predicted PTSD symptom emergence in the war-zone.
•This hormonal reactivity profile appears to confer increased risk for PTSD by potentiating the pathogenic effects of war-zone stressors.
•Findings underscore the utility of assessing both HPA and HPG stress reactivity and may inform early detection of at risk soldiers for PTSD.

Abstract

Background

The crucial role of the hypothalamic-pituitary-adrenal axis (HPA) in stress-related homeostasis suggests dysregulated HPA involvement in the pathogenesis of post-traumatic stress disorder (PTSD), yet most studies examining linkages between HPA axis measures and PTSD have yielded null findings. One untested explanation for this inconsistency is a failure to account for simultaneous adrenal and gonadal influence. Here we tested the singular and interactive effects of cortisol (CR) and testosterone (TR) reactivity as moderators of war-zone stress evoked PTSD emergence in the war-zone.

Methods

U.S. soldiers (N = 120) scheduled for deployment to Iraq completed pre-deployment measures of CR and TR stress reactivity to a CO2 inhalation challenge. Once deployed, monthly assessments of exposure to traumatic war-zone stressors and PTSD symptoms were collected via a web-based assessment system.
Results

Cortisol hypo-reactivity potentiated the pathogenic impact of war-zone stressors only in soldiers for whom the CO2 challenge did not elevate testosterone, suggesting that the dual hormone stress reactivity profile of blunted cortisol and testosterone may confer increased risk for PTSD emergence by potentiating the pathogenic effects of war-zone stressors.
Conclusions

Findings underscore the utility of assessing both HPA and HPG stress reactivity when assessing PTSD vulnerability and may help inform efforts for enhanced soldier screening and inoculation to war-zone stressors.

http://www.psyneuen-journal.com/arti...676-X/fulltext

[Flankenstein]

Will - Let's talk aromatase inhibitors, relating to TRT. Effectiveness, safety, side effects, etc. Most of the time I see people recommend Arimidex (Anastrozole) and I wanted to learn more. So, after a bit of research, I thought I'd shoot a doctor friend an email and get his thoughts on Letrozole VS Anastrozole. One of the primary concerns with using Letro as an AI is erectile dysfunction, which I mentioned in my correspondence to him, and his reply was...

"I see the concerns reading the ED from the letrozole, however, I am more concerned with the increase in side effects including ischemic heart disease, Heart attack, and acute blood clots in the lungs, legs, and eyes that come at a much higher rate with arimidex than it does with letrozole."

Anyhow, let's start there. Hopefully we can all learn something.

Letro on TRT is a terrible (terrible!) idea. My doc persuaded me to go on 1.25mg 2x/mo. Against my better judgement, I agreed. E2 way too low and 2x/mo dosing is idiotic.

Adex is the way to go. Labs will dictate dose.

[johnstone]

Letro on TRT is a terrible (terrible!) idea. My doc persuaded me to go on 1.25mg 2x/mo. Against my better judgement, I agreed. E2 way too low and 2x/mo dosing is idiotic.

Adex is the way to go. Labs will dictate dose.

Adex and letrozole are both non suicidal AI. So they work in the same manner. The only problem was the dosage. Letrozole is a little bit stronger than adex, but 1.25mg of adex would have had the same outcome. Depending on the dosing of the testosterone 2 × per month dosing may be fine. If the patient is only taking 2 shots of test per month the dosing should be fine.

Most trt patients have an e2 spike after injection, and only require an AI around injections. Dosing AI daily or every other day for trt dosages will usually result in e2 levels being far to low.

The best AI for most trt patients is actually aromasin. Its a suicidal aromatase inhibitor, and its much easier on the body than letro or adex. Most men shouldn't even require an AI with trt dosages, if they're not overweight.

[WillBrink]

Adex and letrozole are both non suicidal AI. So they work in the same manner. The only problem was the dosage. Letrozole is a little bit stronger than adex, but 1.25mg of adex would have had the same outcome. Depending on the dosing of the testosterone 2 × per month dosing may be fine. If the patient is only taking 2 shots of test per month the dosing should be fine.

Most trt patients have an e2 spike after injection, and only require an AI around injections. Dosing AI daily or every other day for trt dosages will usually result in e2 levels being far to low.

The best AI for most trt patients is actually aromasin. Its a suicidal aromatase inhibitor, and its much easier on the body than letro or adex. Most men shouldn't even require an AI with trt dosages, if they're not overweight.

A common though terrible dosing schedule. Improved dose schedule often see E2 issues fixed, and no AI needed at all.

[johnstone]

A common though terrible dosing schedule. Improved dose schedule often see E2 issues fixed, and no AI needed at all.

Twice a month dosing is horrible, and I would rather not be on trt than have my shots scheduled that way. A lot of doctors dont know any better. If you need AI on trt dosages you're more than likely at an unhealthy bodyfat levels. I split my 200mg dose twice a week, but even at once a week I dont need an AI.

[WillBrink]

Twice a month dosing is horrible, and I would rather not be on trt than have my shots scheduled that way. A lot of doctors dont know any better. If you need AI on trt dosages you're more than likely at an unhealthy bodyfat levels. I split my 200mg dose twice a week, but even at once a week I dont need an AI.

Exactly, so when we see elevated E2, instead of jumping on an AI, best to look at dosing schedule, body fat levels, etc. first. Yes, vast majority of med practitioners are unaware, most don't even bother to test for E2 at all, but that's another topic. This thread will get anyone squared away with the essential basics, if they can find a doc willing to work with them.

[johnstone]

Exactly, so when we see elevated E2, instead of jumping on an AI, best to look at dosing schedule, body fat levels, etc. first. Yes, vast majority of med practitioners are unaware, most don't even bother to test for E2 at all, but that's another topic. This thread will get anyone squared away with the essential basics, if they can find a doc willing to work with them.

Most doctors dont even really know about AI, or testing e2 is important. I got lucky and found a PA that is pretty well versed in trt, and will read any literature I bring him.

This is a great thread that can help people greatly. I haven't read through the whole thing, but do you cover hcg anywhere in the thread? I choose to only use it for a few months per year, rather than year round. I just wanted to read anything you might have posted about it.

I was also wondering if you know of anybody using aveed (testosterone Undecanoate). The dosing schedule is real nice, after the loading phase injections can be spaced 8-10 weeks apart. Theres not much info on aveed, Nebeido the UK version is easier to find info on.