What is TRT and What is NOT TRT

So when I add trestolone to my routine will that still count as trt? :joy:

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Thanks for sharing this paper. Taking it at face value besides the great nice observations from @blshaw

Analysis sample

To enhance comparability of age distributions across study waves and to allow for analyses of T concentrations by subjects’ birth cohorts, data were restricted to observations obtained on men of age 45–79 yr born between 1916 and 1945, inclusive. This yielded potential samples of 1399, 975, and 579 observations at T1, T2, and T3, respectively. Of these, we excluded all observations on the seven men who had T1 serum total T less than 100 ng/dl (3.5 nmol/liter), and two outlying observations with total T more than 1200 ng/dl (41.6 nmol/liter). One hundred twenty-six observations were excluded because they were taken on subjects who, before the relevant study wave, had a diagnosis of prostate cancer, for which treatment via hormone suppression therapy could not be ruled out. An additional 44 observations were excluded because subjects lacked complete health data. This yielded samples of 1374, 906, and 489 observations at T1, T2, and T3, respectively, totaling 2769 observations taken on 1532 men.

Notice the max range of the y-axis:

I was trying to be generous with setting upper bound at 1200 ng/dL up above. Pretty consistent range across studies.

but guys! I thought average test levels 40 years ago was 1800ng/dl, “cuz they keep messing with the normal range”, those legit dudes on utube told me?

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Hey @highpull, I appreciate the feedback and compliment. I also appreciate and understand your philosophy towards therapy. Rather than Testosterone Restoration Therapy, the approach you summarize would have to be described as Symptom Resolution Therapy (SRT) or Feeling-Function Restoration Therapy (FRT) or “Super Man Mode” or “Mild Continuous Cycle - MCC”. Restoration is not resetting something to a much higher level than it was originally. So FRT I can buy. I am glad that men have this option and are free to choose once they have given informed consent. My mission here was to define TRT so that guys can educate themselves and decide if they want TRT or SRT/FRT. I can understand your POV on numbers but this becomes a slippery slope as numbers do matter and if they don’t why measure stuff? We both know the associated penalty functions and delicate homeostasis of the human body so that’s why standardized ranges are developed as there’s usually risk/reward involved in violating them.

Even within the standard range, what’s normal for one dude may be a no-no for another (hence the distribution). I think that’s why the endocrinologists are typically very conservative as they know they don’t know very much (no one does).

Once we accurately define TRT, then we can attack what’s going on with guys now days and discuss this in depth (EDCs, obesity, screen time, …).

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Thank you, will be good data in the future.

https://onlinelibrary.wiley.com/doi/10.1111/cen.14068

https://onlinelibrary.wiley.com/doi/full/10.1111/cen.13840

The only group of humans walking around above 1200 ng/dL except for those taking exogenous testosterone.

The testosterone levels in the genetic males with 5ARD2 and AIS are shown in Table 2.7, 24-34 These values are from individuals with a range of phenotypes and varying degrees of virilization. Most of these males showed virilization with apparent male external genitalia. However, some do show a more female phenotype, with testosterone in the normal male range.26 The mean/medians for males with 5ARD2 ranged from 13.4 to 31.2 nmol/L (386‐899 ng/dL), and the absolute range of individual values was 3.6‐47.2 nmol/L (104‐1360 ng/dL). Males with AIS had mean/medians ranging from 11.9 to 55.7 nmol/L (343‐1605 ng/dL), and the overall absolute range was 4.8‐68.3 nmol/L (138‐1968 ng/dL) (Table [3](https://onlinelibrary.wiley.com/doi/full/10.1111/cen.13840#cen13840-tbl-0003)).7, 28, 30-34 Testosterone levels were similar in males with partial AIS (PAIS) and complete AIS (CAIS). Some of the reports included pubertal males for both 5ARD2 and AIS, and their ranges overlapped with the postpubertal males.

Genetic males with CAIS have a blind vagina, no cervix or uterus, and undescended testes which are usually located in the abdomen.28, 34, 40, 41 They have normal foetal male testosterone levels in utero, but ambiguous genitalia, as the impaired androgen receptors do not activate appropriate cellular responses and tissue action. At puberty, testosterone levels increase into the normal adult male range, but there is no tissue response to testosterone and no masculinization. However, the pubertal increase in testosterone causes an increase in estradiol, by aromatization of the testosterone, leading to feminization, with breast development and a near‐normal female phenotype. The testes usually remain in the abdomen. Because males with CAIS lack ovaries, they often present for primary amenorrhea with anovulation and lack of menses. Men with PAIS show a range of phenotypes with progressive masculinization depending on the degree of androgen insensitivity.40 As children, males with 5ARD2 and PAIS may be raised either as girls or boys, depending upon whether female or male phenotype predominates, and depending upon parental, social, religious and ethnocultural considerations.

8-24 hrs for intramuscular / subq studies testing every few hours. Let me know if you want more info or how to calculate from the paper I shared above.

Steroid immunoassay for E2 first came out in 1969 which required chromatography first to separate the analyze. Assays for other hormones shortly followed.

Direct RIAs which allowed for widespread adoption and ease of use without chromatography weren’t commercially available until late 1970s…

https://cebp.aacrjournals.org/content/16/9/1713

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My mission is to have a name for you to call it (besides TRT) when this thread is done. I’ll keep you posted. I’ll throw out trestolone rejuvenation therapy for now so maybe it will be known as TRT with a Bill Clinton wink.

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I’d have to find it again, but I’ve read some old studies indicative that SOME men can produce as much as 15mg/day. 100mg/wk appears to restore my TT/FT to physiologic realms (albeit the upper level of physiology)

I’ve posted around 3-5 studies indicating a generational decline in TT/FT to be present. Lab assay variation may be partially at play, though I’d highly doubt assay variation can account for say… a 30-50% swing in androgen status.

Was recently looking at a study comparing bodybuilders (steroid vs steroid free, looking at cardiac geometry, sperm count etc). The steroid free bodybuilders had an average TT of something like 800-900ng/dl, I’d hypothesise lifestyle plays a factor here.

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I think we may be parsing words, but I have agreed with you and often said we’re practicing functional medicine. As for “restoration” vs “replacement” I suppose I’m thinking that when something is replaced it involves something different, like an old car with a new one. Restoration is not different, just better (hopefully). I have a neighbor who just finished “restoring” a '66 Corvette and while it may not look at it on the surface, it is very much at a higher level than originally when it came out of the factory over 50 years ago.

Anyway, function works for me. But, I’m still going to say TRT. It’s like when a stranger would ask if I lifted weights (meaning bench press) and I’d end up trying to explain the Olympic lifts, the snatch and the clean & jerk, to him for 30 minutes. You and I can have the discussion, because you know what your talking about. The guys that ask what I do get, “testosterone replacement therapy, TRT, you’ll gain muscle, lose fat, have more energy and increase libido and sexual function. Any questions?”

Obviously, another excellent point which I think about a lot. I tell patients, there is such a thing as too much of a good thing. I often wonder where that number is and if it is different for everyone (I think so). It’s like using AAS as PEDs back in the day. I found there was a point of diminishing returns (more is not better) and passing that point yields zero return and going further makes you worse. I explain this to patients and they seem to get it, more is not better, so they don’t pressure me to push the envelope. Though, I suppose some here think I do.

You’ll love this then. I know some guys who did but now don’t. They start low and titrate upward to effect. I don’t ever see myself there.

Yes, SOME as in almost none (>99%tile) when you examine the stats. The 15 mg/day would compare well with 1000-1200 ng/dL cutoff in the above posts.

Thank you for sharing the data point. :+1:

Useful to understand the difference between replenishing T levels back to the high end of normal 20 yr physiology vs going higher than this to simulate/restore youthful function with supra dosing.

Man you’re patients are lucky to have you. Very knowledgeable, patient, and open minded provider. Do you do telemedicine :slight_smile: :wink: ?

This back and forth has spurred a thought and better way to remove the ambiguity here between the words replacement vs restoration. TRT should be Testosterone Replenishment Therapy and running higher could be termed *pseudo-Function/Feeling Replacement therapy (*pFRT). The latter may not be addressing root cause but it it’s potentially addressing symptoms and providing improved patient well-being (at least short term). Long term impact of pFRT we don’t know, but I don’t mean to be a purist as we really don’t understand long term impact of all the persistent chemicals that have been released into food/environment/drinking water. So guys can and should be able to choose their path (TRT vs *pFRT) once they’ve given informed consent.

I salute you. Sounds so simple but so important. Some of us (me) have to learn the hard way.

Thanks so much for your time @highpull.

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What did it say about cardiac geometry?

This was in relation to abuse as opposed to therapeutic use. Prolonged use (within this study) induced cardiac enlargement associated with transient, subclinical deteriorations within cardiac function.

Abstinence from use (following abuse) largely reversed cardiac alterations regarding both structure and function.

That being said, alterations on a cellular level (as seen within rodent models and/or in-vitro models) are potentially permenant, and the abuse present within this study pertained to merely (I think) around 150-200 weeks of cumulative use.

@trtwuzup

You can’t really compare 1000mg to 100mg though. It should been noted circulating androgen concentrations were diminished in former abusers, as were testicular volumes. From what I recall effects on fertility were largely reversible.

This isn’t accurate. Restoration in vehicle language, means returning it to its original condition. It’s a very specific meaning. Outfitting a 1966 Corvette with modern brakes, a modern engine, modern suspension, wheels and tires, is not restoration.

I think the same applies to TRT. The goal shouldn’t be to replace, or restore to what our levels were before, unless that’s all you want. For me, I want to feel optimal. If I’m going to go through a lifetime of injections, why not have all of my symptoms gone?

Just like that 1966 Corvette. Why settle for the shitty technology of 54 years ago, when we can have better?

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“Testosterone resto-mod”. Or TRM for short. I think we’re on to something here boys.

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After finding out I had hypogonadism/was put on testosterone replacement my faulty logic came to the conclusion “after practically a lifetime of pain I deserve a little extra boost” :laughing:

I keep my TT between 5-900ng/dl.

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Whatever, we’re parsing words. I’m not going to argue with him, or you, and he sells his “restored” cars for a lot of profit. I guess the buyers are OK with upgraded brakes.

You’re missing my point. I’m simply saying that Testosterone “Replacement” Therapy, and “Restoring” lost testosterone, are inaccurate.