T Nation

The Obsession with Numbers


#1

I think this is worth discussing. It seems from posts about TRT on the internet that many men are fixated, if not obsessed, with T and E2 numbers. It seems that a great many men believe that their T values MUST be in the range of 800 to 1000. In some cases of TRT, it seems they believe that magic will happen if they go from let's say, a mid-normal value of 600 or so, to 800 to 1000, when likely little regarding well-being and health will change so long as men are consistently above 500, I believe.

Although I have regularly tested in the range of 700 to 900 for the past thirteen years with gels or testosterone cypionate, I have had occasions in which I have tested in the range of 500 to 600. At the times I tested at these lower, though mid-normal levels, I did not notice any difference in my well being.

Same goes for estradiol, I believe, an obsession with numbers.

I ask, why not focus on well being, regardless of numbers, so long as the value for T is mid to high normal?

There have even been countless men on this forum, who, even with very good numbers for T, either tampered or were planning on tampering with dosing, even in cases in which the T value was 700 to 800, as if magic was going to happen when they finally got tested at 1000 or so.

I believe there is an obsession with E2 as well, which I've expressed before. I've never used an AI in thirteen years and even when my E2 tested in the high 40's with high normal T, I did not have any related symptoms.

I also believe, that although many doctors, including endocrinologists and urologists, have no idea what they're doing with TRT, that many men, it seems from their posts at least, are pains in the asses and hypochondriacal with their doctors. I've seen a number of men on here with ordinary dosing and normal T values screw with doctors orders for no good reason. A doc is doing a decent job, monitoring lab values, etc., and then some men come on here angling at a way to tamper with their doc's work or are looking for a new one, all with some golden aim of CONSTANTLY testing at 900 to 1200 or whatever whimsical number these men will have them walking around all day with blue balls and a stiff one, an ability to put up 80 work ours per week and daily two-hour gym sessions--in short, it will turn them supermen.


#2

Did “magic” happen for you above 500? What did happen? Maybe magic isn’t happening for them at 500, 600, 700 - and so they’re just trying to get the same magic you got?

One study found that, among men who came in for pellet implantations whenever they were feeling hypogonadal…“at the time of return of androgen deficiency symptoms the blood total and free testosterone concentrations were highly reproducible within individuals (F = 0.8, P = 0.49 and F = 1.4, 0.24, respectively) but varied markedly between men (F = 167 and F = 138, both P < 0.001), indicating that each person had a consistent testosterone threshold for androgen deficiency symptoms that differed markedly between individuals.”


#3

[quote]Ambitious wrote:
Did “magic” happen for you above 500? What did happen? Maybe magic isn’t happening for them at 500, 600, 700 - and so they’re just trying to get the same magic you got?[/quote]

Maybe that is the problem. People expecting TRT to make “magic” happen. That isn’t what TRT does.


#4

[quote]Ambitious wrote:
Did “magic” happen for you above 500? What did happen? Maybe magic isn’t happening for them at 500, 600, 700 - and so they’re just trying to get the same magic you got?

One study found that, among men who came in for pellet implantations whenever they were feeling hypogonadal…“at the time of return of androgen deficiency symptoms the blood total and free testosterone concentrations were highly reproducible within individuals (F = 0.8, P = 0.49 and F = 1.4, 0.24, respectively) but varied markedly between men (F = 167 and F = 138, both P < 0.001), indicating that each person had a consistent testosterone threshold for androgen deficiency symptoms that differed markedly between individuals.”

http://www.ncbi.nlm.nih.gov/pubmed/15292310[/quote]

Magic did not happen for me. Normal functioning and well-being did.


#5

So you are different and we now have to question what works well and yields improved quality of life for others?


#6

[quote]KSman wrote:
So you are different and we now have to question what works well and yields improved quality of life for others?[/quote]

Nope. I was not saying people should not be treated according to symptoms, regardless of numbers. I was addressing obsession with numbers, which is not the same as focusing on well-being.


#7

I’m in agreement with BrickHead. However most people are not going to be satisfied unless they actually experiment and play around with it. I was obsessed with the numbers, I wanted to know if I would actually feel different if my numbers were closer to what everyone said the optimum numbers should be.

What I found out was,

  1. I don’t feel any different with my total testosterone at 700 vs 1200.
  2. My E2… I feel much better with it closer to 50 than I do with it between 20 and 30.
    If you are going to experiment, pay attention to how you feel. No point in having your testosterone all jacked up if it doesn’t make a difference on how you feel. Same with E2, no reason to try to get to that magic E=22 by using an AI if it doesn’t make you feel any different. I think low E2 will make you feel much worse than having it slightly high.

#8

[quote]Dymitryy wrote:

I don’t feel any different with my total testosterone at 700 vs 1200.
[/quote]

I think many guys who obsess about numbers want higher T than their body can sustain because they think it will make it easier to be muscular and lean and like a porn star in bed. This isn’t necessarily the case, but that is the psychology. Then because few guys can sustain health for long with such elevated T levels, when they start having side effects from it they spend a lot of time futilely adjusting everything else (such as E2 with AIs) but the more sustainable solution, namely lowering the T dose, is psychologically very hard for them to do.


#9

[quote]seekonk wrote:

[quote]Dymitryy wrote:

I don’t feel any different with my total testosterone at 700 vs 1200.
[/quote]

I think many guys who obsess about numbers want higher T than their body can sustain because they think it will make it easier to be muscular and lean and like a porn star in bed. This isn’t necessarily the case, but that is the psychology. Then because few guys can sustain health for long with such elevated T levels, when they start having side effects from it they spend a lot of time futilely adjusting everything else (such as E2 with AIs) but the more sustainable solution, namely lowering the T dose, is psychologically very hard for them to do.
[/quote]

Yup. This is the point I was getting at. There was even a guy on here who said he was feeling very good with a value of 800 and change and normal estradiol who wanted to fidget with his dosing amount and/or frequency so that he could get to 1000 and his estradiol lower. Again, the guy said he felt good. One can only assume this is a pain in the ass to doctors, even good ones, and also unnecessary.

I recall there was on another forum a guy with a natural value of 640 (not a TRT patient) who wanted to get on TRT because his buddies on TRT with values of 800 to 1000 were putting up a huge amount of work hours with no signs of burnout. A man with 640 with vague markers of well-being (e.g., fatigue, drowsiness, lack of motivation) will certainly not be prescribed T and not be diagnosed as hypogonadal. But again, some believe that insignificant increases in the normal range will have them performing in work, sports, and the gym at higher levels.

Likely, to feel or perform differently, one will have to go from a mid to high normal value to a supra-normal value, say 1300 or above. In thirteen years, the only time I felt and performed differently was when my value got up to 1500 and change from two packs of Androgel. Over the course of about two months, I got bad, painful acne on my lower back, felt bloated, and my emotions were all over the damn place.

I felt damn awesome in the gym though, and it felt as if when I was done with my workout, I wanted to work out even more! I scheduled a doctor’s appointment and lo and behold my T and HCT were abnormally high. A similar incident happened with my friend when his level got to 1300. He just suspected something was off, and it was. He felt awesome with his cycling regimen, but otherwise he felt lousy.

I never said symptoms should not be treated, regardless of numbers. If some guy does not feel like his old, normal self with values in the 400s and 500s, then by all means, he should tell this to the doc and possibly have his dose adjusted.


#10

There is no way to know who the out liers are in advance. So you aim for the known targets. How you make changes from there and evaluate is probably messy. How to you suggest this be done?


#11

[quote]KSman wrote:
There is no way to know who the out liers are in advance. So you aim for the known targets. How you make changes from there and evaluate is probably messy. How to you suggest this be done?[/quote]

I am not a doctor, but from my knowledge of a patient, being in the care of a doctor for thirteen years, and some reading, I plausibly assume that a doctor starts out with a standard dose of T, say five grams of gel per day or 100 mg of T cyp, takes labs a month later, and adjusts from there, depending on numbers AND feelings of well being and sexual function.


#12

[quote]KSman wrote:
There is no way to know who the out liers are in advance. So you aim for the known targets. How you make changes from there and evaluate is probably messy. How to you suggest this be done?[/quote]

I have no issue with all he information you provide here. You’ve helped people and have a good grasp on it for someone who is not a doc and are an intelligent and generous guy. None of what I say is aimed for opposition to anything you’ve ever written here, from what I’ve read.


#13

True, some guys do focus on the numbers (particularly the TT), especially in the beginning of the protocol. I was guilty of this as I thought having high T will make me feel great. It made lot of things better but I feel no different with a high dose than I do with a moderate dose. I have went from 140mg to 105mg to 84mg and now my final dose is only 70mg per week. 125iu HCG EoD. Sex drive between 140mg and 70mg is the same, mental function the same, energy levels the same. Then why did I go down? I hated the acne. I miss the gym gains on 140mg but I’d rather have clear, healthy looking skin. From now I may run short bursts (6 weeks) of high T for some gains.

I do not agree with your stance on E2, however. Perhaps you feel good now with E2 in 50s but long term exposure to high estrogens and and high DHT from TRT is a recipe for prostate nightmare. Maybe not now but perhaps down the road. My prostate flares up immediately if I let my E2 get to mid 30s and above and calms down as soon as I get to mid 20s.


#14

[quote]Igs wrote:
True, some guys do focus on the numbers (particularly the TT), especially in the beginning of the protocol. I was guilty of this as I thought having high T will make me feel great. It made lot of things better but I feel no different with a high dose than I do with a moderate dose. I have went from 140mg to 105mg to 84mg and now my final dose is only 70mg per week. 125iu HCG EoD. Sex drive between 140mg and 70mg is the same, mental function the same, energy levels the same. Then why did I go down? I hated the acne. I miss the gym gains on 140mg but I’d rather have clear, healthy looking skin. From now I may run short bursts (6 weeks) of high T for some gains.

I do not agree with your stance on E2, however. Perhaps you feel good now with E2 in 50s but long term exposure to high estrogens and and high DHT from TRT is a recipe for prostate nightmare. Maybe not now but perhaps down the road. My prostate flares up immediately if I let my E2 get to mid 30s and above and calms down as soon as I get to mid 20s. [/quote]

What is your T value with 140 mg?


#15

We also have a degree of “drug seeking” behavior with some guys. They are really trying to get as much T as possible.

Then there are types who keep jacking with everything and never feel right and never get balanced. They are their own worst enemy.

Doctors are familiar with these behaviors. But we get idiot docs starting guys by prescribing 200mg T per week …

There will never be perfect approach.


#16

When some do not feel right mentally near E2=22pg/ml, but some feel better with higher E2 levels that would cripple most other guys; there is clearly a different in the brain circuits that are inhibited or exaggerated by estrogens. When most males go through puberty, increased T levels alter [pruning] brain function and connectivity. When most guys become estrogen dominant, areas of the brain do not work right and mental/mood/confusion problems surface. A few seem to be the opposite. I could speculate, but that would not lead to any benefit.


#17

I agree.

There’s a select few people, on this forum, who aren’t licensed professionals and who’ve never gone to medical school who are worshiped on this forum and whose posts are taken literally as gospel. That said, I think that a lot of people who have sexual frustrations or low energy, or anything of that nature, can have their issues resolved by Occam’s razor, where the simplest and most obvious solution is usually the correct one.

All this iodine frenzy is ridiculous, and I’ve talked to a few endocrinologists who think it’s exceedingly more ridiculous to take inordinate amounts of iodine to compensate for previous deficiencies. Additionally, a range is a range. These doctors aren’t trying to get you - they lose nothing by giving or not giving you a prescription. And like the OP said, numbers that may be okay and functional for one individual may not be for an other. Again, if you’ve actually studied these hormones, you’ll know that most are pulsatile, meaning there quantities are wave-like in nature because there precursors are secreted at different times of the day. This is why advocating for an individual to continue taking an AI till they reach exactly or even close to 22 pg/mL is fallacious in nature.

I feel like a lot of people on this forum don’t have thyroid problems and may actually have subclinical low testosterone or some type of ED caused by porn addiction. Those are the two most obvious causes.


#18

Abars: E2 is not pulsatile in TRT when T levels are steady. Aromatase is not part of an endocrine system with a control system. It all about enzymes and available T.

Many have found that dealing with their iodine deficiency really turned around their lives. Who do you speak for? If you don’t like IR, promote your own methods.

The problem is that those who have gone to medical school are deeply ignorant about hormones. And I have only had one report of a doctor asking about iodized salt use. Don’t be playing the doctor is right card.

Porn lowers T levels?

I don’t think that you follow enough of the threads here to be authoritative about case profiles.
See what others think of their doctors: https://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/stupid_things_that_docs_do_and_say


#19

This will always be situation-specific, and I had a lot of very odd blood markers, including a very high RdW (to a degree that they thought I might have some type of autoimmune disorder or blood cancer) years ago.

In general though, my endo at the time* gave me a talk about blood markers where he encouraged me to follow my symptoms as it related to my blood markers given how odd my markers were compared to the normal. The thrust of the conversation was “Look, these ‘normal ranges’ and ‘optimal ranges’ are based on general populations of people and don’t correspond to some special cases. Given your history and the way you’ve expressed symptoms as it relates to your various markers that stand out as deficient or optimal, you should probably start trying to be comfortable with the fact that your blood markers probably never will fall into these ‘ideal’ situations because those ranges don’t necessarily apply to everyone and probably not to you. That doesn’t mean you’re necessarily worse off or in danger, because your body seems to have adapted to those levels in a way that doesn’t seem to affect your quality of life or general health. And when it does, we can do something about that.”

I felt like it was a very thoughtful way to approach a discipline that’s less well-understood than most, and that seems reasonable given the consequences of doing overly invasive types of treatment protocols. I also liked that, unlike many of the people who come to post on these boards about trying to hit some specific level of hormone output/reserve, the emphasis was on maintaining a healthy body instead of hitting some blood marker range that may not even correspond to good health for the individual in question.

*(I feel like he was able to say this because he is highly respected in the general endocrinolgy profession, has an ensconced position at a prestigious hospital, etc so felt free to say whatever, as opposed to a private practice endo who might have more to lose)


#20

Yes, symptoms should rule and labs should support, but with many doctors, we know that the reverse is true. If all doctors were properly skilled and capable of critical thinking and diagnostic skills, there would not be any need for this forum. But here we are, taking care of the diagnostic wreckage. [got carried away with that, sounded good]

Thinking out loud:
If we all had baseline lab results from a point in life where we were young and felt great, we would have a basis for doing things better. But that does not cover guys who have always had lower T levels and were never fully virilized. So you aim for what works most of the time and then see what happens.