Testosterone and Cardiovascular Disease

Pharma / TRT Testosterone Replacement
61

Gentleman, before I drop out of this forum because I am tired of these kind of discussions let me make these comments.

What I am saying here is not my personal opinion, I am trying to make published work understandable and accessible to you. This is all peer reviewed work from the best scientists in the world in their respective field. Being it the study from Gagliano-Juca & Basaria, 2019 that discusses the knowledge about a cardiovascular risk on TRT or the study by Travis et al, 2017 which explains the new reference system. These guys are experts in their field who devote their lifes to extend knowledge and to share this knowledge in an unbiased way with the scientific community.
I thought that I could contribute to this forum by providing my knowledge of 20 years in research (about 12 of which I used LC-MS as a technology) and by my experience of having published many articles in peer reviewed jounals myself. I know how science works and I know how to read and interpret scientific articles. Again, my idea was not to share my interpretation of these studies but merely to translate and explain the outcome and the experiments to ‘non scientific experts’.

Respectfully, I strongly disagree. Primary scientific articles never express the opinion of a single person, all co authors actually have to sign a form from the publishrs where one needs to state that everybody fully agrees with the data and the conclusions drawn. Travis et al 2017 has been written by absolute top experts in the field associated with the endocrine society and PATH. Unfortunately your statement is a reflection of the tone of many members here that think that they know things better than the professional scientists. It shows a general disrespect for the scientific community.

Thats true, sensitivity and specificity are not related to the discussion around the reference ranges. The method parameter that matters is accuracy. MS is not quantitative per se. What you get in LC-MS is a peakarea and you need a calibrant to translate the peak area into a concentration eg ng/dl. When the calibrant changes the result changes. Thats what happend in the 2 ref range studies. I am saying this with almost 20 years experience as an analytical biochemist. I used LC-MS during my PhD and postdoc studies and I am now heading a department which mostly uses MS to characterize biologic samples.

Whether a decline of T on a population level is taking place or not is obsolete for the discussion about the differences in old vs new reference range. That is simply because of one fact; for both ref ranges, the old one from Bhasin 2011 and the new one from Travis 2017 samples were analyzed from the same time period.

  • Bhasin used sample from the Framingham study collected between 1998 and 2005.

  • Travis used samples from 4 cohorts
    –Framingham study collected between 1998 and 2005 (exactly the same samples as in the Bhasin study, this serves as the link between the Bhasin and the Travis study in terms of LC-MS readout)
    –EMAS collected samples from 2003 to 2005
    –MrOS samples were collected between 2002 and 2004
    –SIBOS samples were collected between 2002 and 2003

Its not the case, that the old ref range based on Bhasin collected samples in 2000 and the new ref range by Travis collected 15 years later eg in 2015. The samples both studies used were collected exactly in the same time period and froozen for further analysis. The only difference between the studies is that Bhasin used ‘lean’ men and Travis used ‘non obsese’ men and that Bhasin used the newly calibrated method. The impact on the reference range has been discussed before.

Thats an interesting approach. If I read an article in spanish I might be able to understand a bit but it wont make sense to me. But my conclusion would be rather that I have to improve my spanish skills than questioning the validity of the article.

Once you finalized your education you will have learned that in a scientific discussion one reads and discusses every available data before drawing a conclusion. The studies that you linked are very valuable, but its not the only data available on this subject.
On a population levels this topic is extremely import and I too think that there is something going on. However, science is about being unbiased.
One study that you linked shows a decline in TT, the second also but does not show any decline in freeT and Nyante et al, 2012 concluded that there is no evidence for a decline in US men whatsoever. You will also find the last one, as I think you are a clever guy.

I wish you guys all the best for your future endevours.

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62

If you go because of this than go.

Understand this is a public forum. Views are presented. People read your posts. You’ve made your point and we read it. It is great to hear your view and facts you present. Am sure you have enlightened some with facts and knowledge.

You don’t have to keep arguing your point with the same person because that leads to frustration and you wanting to leave. Most of us are smart and get it. Just because we don’t comment that we agree with you doesn’t mean that we don’t.

People have different views and can present different facts that they think are relevant.

Btw I generally believe staying within range is the way to go especially as we age. Are our older bodies (organs aging etc) capable to handle high free t??

Anyway my range am in is good - why? Just 30 minutes ago wife said you are banging me too hard
I had to slow down. Kids sleeping. My bed is too noisy. Lol

Funny think Is
after she said that- a minute later she says harder.

63

Hardartery was directing the “lacked eloquence” comment at enackers quote of the researcher he is in contact with, not you. You might want to go reread that post.

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64

That’s how I read it as well.

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65

Agreed. There was a time when I ran numbers over >1500 because I was convinced that was what it required for me to feel good. Being in that mindset, I would have refused to consider the clear facts presented by @johann77

Now I run numbers within range and I feel even better, more stable and healthier. My personal belief for my own testosterone levels is that if I am in range or at the top of the range, yet I still don’t feel good? I need to look elsewhere in my health to optimize my hormones. But what do I know, I’m not an MD or someone who is buddies with a hormone expert.

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66

I was in fact praising @johann77 in the comment, and his cogent argument. I am not a professional scientist, almost no one on here is. It does not mean that we do not value the information, or fail to understand it. There is a marked distrust of the medical community here (me included), which sometimes spills over onto the scientific community. I do not believe in conspiracies, but I also do not consider scientists or studies to be infallible. I do think they are trying to be honest though, and we gain greatly by reading these peer reviewed and published studies.

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67

For those discussing labs and their moving scales
My PC doc is through a major US health corporation with its own labs. The ranges they’re using are:

Total (280-1100 ng/dL) ( Mine: 226)
SHBG (11-80 nmol/L) ( 20 )
T Free (47 - 244 pg/ml) ( 51 )
% Free (1.6 - 2.9) ( 2.3 )
Bioavail ( 131 - 682 ng/dL) (138)

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68

You are taking this to heart. I disagree with what you are saying. What’s wrong with that?

I will finish reading your post later and respond; until then I want you to understand where I’m coming from.

I hate to sound like i don’t appreciate your opinion and insight. You have a good eye, but we disagree on certain points. Ifs probably because I have a totally different way of looking at HRT. My way of looking at trt is that men and hormones are under fire. This saved my life. I was border line going to kill myself until i realized all I needed was test and thyroid hormones. Now I see all those nonsense of labs lowering and cbs news saying T kills men and its unhealthy. They reference studies yet these studies are debunked. Thousands of men are neglected TRT and instead given ssri, cialis, statins, anxiety meds and etc. when all they need was to raise their hormones.

I also see men being told they need to lower their dose because their levels are too high. I recall recently men who were having a 1k plus dose and their doctors telling them to lower the dose. Because new labs are lower. Yet 2 years ago this guy found those dose to resolve all symptoms and his doctor wouldn’t of said a thing.This is happening to the majority of men in trt. Yes majority until they research and find a good doc.

This is why I am so critical of any studies that lower our lab ranges. It’s not fair to us men and to me there is something fishy going on.

End of day we disagree, but we also agree on many points like “men should be able to take a dose that keeps them healthy”.

The other aspect of this entire story is that I tried to understand what you were saying. Before opening my mouth and using my biased opinion I read the study, i looked at other studies and questioned your comment on the assays.

The next day I spoke to Scott and my doc. Both are trt doctors and one has spent decades studying androgens. He’s a research specialist meaning all he does is read studies and extrapolate truth from false hood. He takes studies and makes his own studies.
He never uses one study he looks for a trend.

He made a good point about the testing accuracy. How does a test go from 1200 to 900. We’d be all screwed if this was truth.

Finally and almost done. I see men who are on trt and will be effected by this. Why not think “how the he’ll can I believe this shit. This is effecting me and they used one study to change our lab ranges. Due to this men will have to take less and are being effected by the majority of doctors who use lab ranges as their guiding factor to Therapeutical dosages of T”.

To me this single study has huge implications for men for years to come. We went from a Max range of 1330 to 1500 down to 1200/1300 and now 900 to 1100. It’s not like they changed our test accuracy 3 times. What’s next 700? Are we going to say the accuracy is not 20% greater and the value NG/DL isn’t worth the paper it was written upon?

There is a trend that is going on which does not help men. It’s as though there is a war that’s going on against TRT. Studies are being released that day trt is harmful. Causes strokes. Heart attacks. Makes you angry. Men don’t really need test. Etc

So I wonder how anyone can so easily take a study and simply believe the answer for why. This is happening. The attacks on men taking trt is getting worse.

We both know every study has ifs faults and around 95+% of studies are bullshit.

This is where I am coming from. I am not trying to be rude or make you feel unwelcome.

We should seriously consider each other’s sides and not just shoot one or the other down. I always do my research when someone presents a conflicting POV. I did it for you and I don’t think that was done for me.

I’m not leaving and you shouldn’t either.

If anything we produced some great information and people have studies they’ve probably never heard of or seen.

We are doing a good thing here and I hope you stick around man. Who knows maybe one day I’ll agree with 90% of what you say and we can agree to disagree on the rest.

Cool?

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69

What about the guys who tried it. They sat at 1k never felt good. Got tk 1200 and felt great by adjusting the dose form 170 to 190. What about them?

Some people do need 1500 or 2k due to a 100 SHBG like some of the men here.

Others need more because of EDCs that compete with the androgen receptors.

My docs actually talking to labs and soon will be able to test for specific EDCs to see if that is a problem with a patient.

If you go to the endocrin societies website they specifically stated that EDCs are real and causing issues: The problem Is that they have not integrated this into how they treat men clinically.

There is so much more to trt than just a level. Today we have so many more toxins which are harming men. There are also so many men who have symptoms yet their levels are great.

One size does not fit all. I’m glad you feel great on a low level dose. Good for you.

70

I will review your previous posts again just to make sure I haven’t missed any good points and wasn’t being biased with my understanding .

So give me a bit and let me do some research on the assays and dig into this a bit further before doing so.

If you are correct I will concede and will shake your hand and hats of to yah.

Sound good?

71

EDCs

They have this on their site yet they Do not treat with this in mind.

For example “why are twenty somethings snowing hypogonadil symptoms” or “why isn’t the T working and only a larger dose works”.

Dig into it. Read up on Anthony jay he’s an EDC expert. His career is based on this and he discusses how it effects our androgen receptors and why men need more.

He has a great book as well.

Check it out. You can understand what’s happening today.

72

I guess I’m more referring to people with Free T at 1.5-2x the top end of the range. I’m high shbg (60-75 historically) so I can relate. You’re right, total T isn’t the best indicator. But some people are blowing free T out of the water (at trough, no idea where it sits at peak) with the idea that they’re still doing “hormone replacement.” I personally can’t sit with good conscience doing that long term.

73

If they have found a dose that resolves symtoms, yet continue increasing that dose for more gains ifs not longer hormone therapy.

We should be careful to judge simply because someone is taking 200 or 250mg or has a 30 free t. I’ve helped guys who had 20 free t , didn’t feel well for months. Increased that to 30 and finally symptoms resolved. Others 30-35 and very rarely over 35.

I agree. I just don’t like it when someone calls someone out and says they are abusing T based upon levels alone.

Very ignorant.

74

I can
 I just don’t associate it as HRT though, more like an enhanced cruise. Long term effects from slightly elevated TT/FT probably pale in comparison towards heavy AAS abuse, and some get away with using grams of gear for decades on end. It’s all up to genetic predisposition and lifestyle somewhat

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75

Yup I agree . T is like a little kitten compared to the anabolics bb use today.

76

I’m just gonna pour gas on an old fire and drop this little gem I just found right here

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77

Poor Johann arguing the finer points of specificity vs sensitivity on here.

The concern with these videos (actual video is great) is the difference between what the speaker has in his head for TT on TRT (let us be generous and spot everyone 600 to 1000 ng/dl peak) vs what today’s “TRT” enthusiast has in his (1200 to 1500+ ng/dl trough).

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78

I hate western medicine. So sick of it.