T Nation

Need Pre-TRT Advice

If cortisol is low when you start TRT, you will not get the benefits that TRT is supposed to do. Your cortisol levels will decrease from your starting point, hence TRT makes your situation worse. It is inevitable because steroids are guaranteed to suppress both the HPTA AND the Glucocorticoid production (cortisol). One needs to treat the root cause of low cortisol levels prior to initiating TRT.

Here’s the reply from @johann77 the last time you stated that.

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@wolf359 I didn’t write the amounts because he said I will get instructions. 2x week and will haves test, hcg and aromatase inhibitor.I can post it later

You enjoy being his lackey, huh? Follow the INSTRUCTIONS on the saliva kit.
IT HAS ZERO TO DO WITH HYDRATION. Fill the tube half way. If the patient fails to do this, it is user error. It states it can take up to 30 minutes or more depending on the the patient’s saliva flow. So, stop backing people’s comments that you know NOTHING ABOUT.

The test itself is extremely accurate, the gold standard for saliva testing bio-available hormones.

“Saliva testing has been used in scientific testing for decades and has been shown to be highly accurate. It is the most reliable way to measure free, bioavailable hormone activity — those hormones actually doing their job at the cell level. Standard blood and urine tests do not measure bioavailable hormone levels. Numerous scientific studies have shown a strong correlation between the levels of steroid hormones in the blood stream and the bio-available levels of steroid hormones in saliva. Peter T. Ellison, Ph.D. of the Department of Human Evolutionary Biology, at Harvard University, Cambridge, MA, has used this method of hormone testing in cross-cultural comparisons of hormone levels among women living in industrialized vs. non-industrialized countries. (Human Reproduction vol.8 no.12 pp.2248-2258, 1993; Human Reproduction Vol.17, No.12 pp. 3251–3253, 2002.) His research in the field is the subject of his 2001 publication, On Fertile Ground: A Natural History of Human Reproduction (Harvard University Press). In addition, saliva hormone testing more accurately reflects tissue uptake and response of hormones delivered through the skin in creams, gels, or patches than blood or urine tests.”

Collection instructions videos.

The issue has NOTHING to do with a patient not filling the tube, I’m not sure where you’re getting this? We aren’t backing anyone’s comments, but you sure don’t seem very interested in responding to someone that actually knows enough to debate you on this… instead you just get pissed off when me and @dextermorgan bring it up. @johann77 has been very good at helping put some facts / studies behind (or against) things that are commonly said here. If he’s wrong then prove it. I’m sure he would be happy to have learned something as much as the rest of us.

Is anyone even saying the test at the lab itself is inaccurate? From what I understand, the lab can accurately determine how much cortisol is in the vial of spit. The problem is the amount of cortisol actually being deposited into the tube will vary based on how quickly someone is producing saliva. i.e. tons of saliva means you can fill the tube more quickly, which means a lower concentration of cortisol. Slow saliva production takes longer to fill which means more cortisol ends up in the same sample, resulting in a higher reading from the lab.

Quoting a lab that’s trying to sell something as your proof is not exactly confidence inspiring. It really isn’t.

Again, I just want to know who is right and what the facts are. Both of you guys know more than I do about this, but when he questions what you’re saying (and provides studies to back up what he’s saying) and you just ignore it, what are we supposed to think? If someone told me I was wrong and I had proof I was right, I’d be sharing it. Why aren’t you doing the same?

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@ncsugrad2002
Extremely well said

@TRT_Phoenix I would hate for someone to do a test that may be worthless and start treating themselves based on inaccurate results so I’m sorry if I hurt your feelings but this forum is for folks to find the knowledge that makes them better. No one is keeping score or cares who is more knowledgeable. They just want to feel good again. When @johann77 first came here I wasn’t a big fan but he’s definitely schooled me on shit I thought was legit but turned out it wasn’t. I would feel horrible if I gave someone information that led to them feeling worse because I didn’t know any better and I’m sure I have. I’ve been on the receiving end myself. I followed a member’s info like it was gospel when I first found this forum and that led to me having one of the worst years of my life. If I can keep someone from having to go through that then I definitely will.

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Maybe the graph below helps you to understand the problem of both, salivary and serum morning cortisol for the detection of adrenal insufficiency.

The two populations (black AI ruled out; blue AI confirmed) simply can’t be separated by means of a static test such as the morning cortisol test (also not for other time points as the discriminative power is even lower). At t=0 (morning test before ACTH administration) about half of the population of subjects with AI ruled out overlaps with half of the population with confirmed AI. This problem is completely independently of the question whether cortisol can be accurately quantified or not.
Only at t=90 after ACTH the populations are sufficiently separated increasing sensitivity and specificity of the test.

The only conclusion which can be drawn from a morning salivary cortisol test is to rule AI out at a certain level (= high negative predictive value).

https://ec.bioscientifica.com/view/journals/ec/7/4/EC-18-0085.xml

This statement is unfortunately also incorrect as evidenced by no decrease in DHEA S levels upon TRT start in >99% of men.

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You are all in denial. It is a fact that exogenous AAS/ Testosterone use causes inhibition of both the HPTA and Adrenal (cortisol/DHEA-S) production.

I am having a good laugh at your claim of >99% of men on TRT don’t have a decrease in DHEA-S. It is guaranteed to decrease both cortisol and DHEA-S. The only question is the degree of the decreases for each. Again, MOST men that initiate TRT do so without first addressing other underlying health factors that start them off at a disadvantage and susceptible to poor adrenal status.

How exactly TRT reduces cortisol production? In most men cortisol rises on TRT.
For DHEA I agree…

Then please provide the evidence.

Cortisol synthesis and release is actually increased under TRT.

Circulating serum levels of DHEA and DHEAS are almost exclusively synthesized in the adrenals. There is no evidence that both hormones are reduced upon administration of exogeneous T.

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Vonko, the cortisol decreases; it is a fact.

Johann, you are wrong; Cortisol decreases on TRT.
However, ACTH does increase in response to the decreased cortisol levels.

"…the effect of testosterone in young men is to inhibit rather than augment the cortisol response to CRH stimulation. …recent data suggesting that testosterone suppresses stimulated cortisol secretion through its metabolite 3 β- androstanediol, which acts through ER β in the PVN, but not through ER alpha or the androgen receptor. The surprising finding in our study of increased ACTH during testosterone replacement, however, localizes the suppressive effects on cortisol to the periphery. A possible explanation for reduced stimulated cortisol in the face of increased ACTH is decreased adrenal sensitivity.In conclusion, we have shown that testosterone regulates CRH-stimulated HPA axis activity in men. Similar to findings in animal studies, CRH-stimulated cortisol was decreased during testosterone-replaced compared with hypogonadal conditions. The concomitant increase in ACTH suggests that the decrease in stimulated cortisol levels by testosterone or its metabolites is mediated at the level of the adrenal gland.

https://www.nature.com/articles/1300742

I am trying very hard to help this forum/community. Now, please stop arguing this issue with me. You are impeding the health of others that need to understand the impact of TRT on their adrenal status. Thank you.

It seems more like you can’t prove the things you’re saying to me. I am 100% sure you’re trying to help, but saying something is so doesn’t make it so. Post studies, research, something to prove your positions.

Ditto.

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The study (Rubiniw et al, 2005) you are referencing used a CRH stimulation test to measure the responsiveness of the adrenals after 2 to 3 weeks of leuprolide shutdown of the HPTA +/- T substitution treatment in 10 young men.
The results demonstrated that, neither basal levels of cortisol nor urinary free cortisol levels differed between the groups.
Upon CRH stimulation cortisol levels were indeed reduced by about 10% in the T treatment group. The difference reached statistical significance, however given the very small sample size (total of 10 men, 5 in the placebo group and 5 in the T group) and the standard errors i would be very cautions in the interpretation of this finding.

While the study appears to be in agreement with rodent studies it is in disagreement with 2 more recent human studies and 1 study in rhesus monkeys.

Muniyappa et al, 2010 found no difference between 35 men assigned to two groups (T treated and non treated) in cortisol concentrations, diurnal rythm or any other related markers after 26 weeks of treatment. Noteworthy, the study was conducted in elderly men which would be significantly more susceptible to downregulation of the adrenals ‘productivity’ if there was any.

Knight et al 2017 studied the cortisol response to a social stressful situation in 120 men assigned to a T treatment group and a non T group. They found about 10% higher cortisol level post stress in the T group compared to the placebo group (Figure below).


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@TRT_Phoenix - how about posting in the TRT Credentials thread so those you are trying to help have a little background about the person giving advice?

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OP what protocol were you prescribed? If youre going to start, its best if you dont start off with a bad protocol

This @TRT_Phoenix guy is exhausting

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Based on what? All Ive seen points the opposite. Mine seems to be still the same…

@wolf359
Anastozole .5mg 2x week. A little concerned if this is right with low e2. Input is appreciated.
Test/Cyp 100mg 2x week
HCG 250 iu 2x week

The general concensus here is don’t use the ai at all and only use hcg when trying to be fertile.

Is that 100mgX2 weekly for 200mg total, you gotta start somewhere, and that’s as good a place as any. Perhaps a bit on the higher side. If you wanted to be more conservative 75mgx2/week would be ok, but if it’d been me I’d probably just do the 200mg, but that’s just how I roll.

Not a doc, not medical advice, etc & so forth…