What is TRT and What is NOT TRT

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I read the book chapter and conclude the opposite. See tables 1 and 2 (ECs and VSMCs) if you don’t want to read the chapter. The toxicity/dose response of testosterone in humans is complex enough and transfer function between rodent studies and humans also fraught with uncertainty for a number of reasons.

But I understand it’s an easy rationalization to make (T is “safe” unlike those “dangerous” other AAS). Thanks for taking the time to comment.

I understand but this is what is so confusing to so many of us. Can we really take a rodent study and translate those results in the humans in every instance? In other words what about the studies where we give humans testosterone and then see what happens. From what I have found there has never been any harm in any of the randomized control trials that have been done. So if it caused harm and cardiac toxicity why haven’t they seen that in human studies? Hasn’t been used for like over half a century? Major institutes like the mayo clinic as well as the DeBakey Institute which is known for its heart transplant etc. have put out papers about testosterone and they all reported to be cardio protective. So much confusion but what I’m trying to find is an actual randomized control trial where testosterone caused a major adverse cardiac event and I can’t find any.

Also, when they talk about giving 500 mg that once again is in the bodybuilding realm and actually has nothing to do with testosterone therapy from all the studies that I have looked at. Can’t you kill yourself by drinking too much water? I’m just trying to find any harm from any study giving men a rational dose of testosterone like for testosterone therapy. The harm caused by excessive doses of anything cannot be applied to men taking a normal dose can it? You seem to be well-versed so can you show me any harm involving the heart or any other body system with a normal dose of testosterone not 500 mg or more? I don’t consider the bodybuilding world and the dosages use their as well as the substances should be discussed in the same conversation with men needing testosterone therapy

“Testosterone at supraphysiological levels increases cardiovascular disease risk,
causes myocardial infarction, stroke, high blood pressure, blood clots, and heart failure” one must read this chapter with extreme caution. Testosterone therapy has never been shown to cause any major adverse cardiac events in any randomized control trials. Supraphysiological is now anything higher than 916 ng/dL. Are we now to believe that 917 ng/dl is going to cause everything bad that has reported in this chapter? Only five years ago the normal range went up to 1197 ng/dL. Is what was healthy then now all the sudden dangerous? Of course it’s not, men are producing less testosterone than ever and that is the real problem and the elephant in the room. Many of the remaining bullet points are also completely false and are not what the actual medical literature states with regard to testosterone therapy. One cannot extrapolate what happens when bodybuilders abuse massive doses of testosterone along with other anabolic substances and apply that to testosterone therapy. Testosterone therapy has not been shown in any randomized controlled trial to have any negative effects on the cardiovascular system but in fact just the opposite… a positive effect. This is the problem whenever books are published people believe everything they read even if it is false. One has to look at the references and understand where the misinformation comes from. Here is what testosterone has actually been shown to to

Surely one of the first papers you’ve ever come across if you are a serious student in this field. Nevertheless, do I think the vast majority of T users will run into problems with 1200 ng/dl TT trough for 10-20 years? There’s plenty that have no long term complications when I discuss this with providers who do have lots of clinical experience.

But get your facts straight.

Adverse events

Older men had 147 adverse and 12 serious adverse events. Twelve serious adverse events occurred in nine older men and included hematocrit greater than 54% (six events), leg edema with shortness of breath (one event), urinary retention (one event), and prostate cancer (two events). There were dose-dependent increases in hemoglobin and hematocrit (dose effect, P < 0.0001; see [Table 6] and [Fig. 3]. One older man receiving the 125-mg dose, three receiving the 300-mg dose, and two receiving the 600-mg dose had hematocrits greater than 54%. Leg edema occurred in eight older men: one receiving 50 mg, four receiving 300 mg, and three receiving 600 mg.

Treatment was discontinued because of serious adverse events in three subjects receiving 600 mg and in three receiving 300 mg. In the 600-mg group, treatment was discontinued in one man because of hematocrit above 54%, in one because of hematuria and urinary retention, and in another man because of leg edema. In December 2002, one additional subject receiving the 600-mg dose stopped treatment after DSMB discontinued this study arm in older men because of a high frequency of serious adverse events. Three men receiving the 300-mg dose were discontinued from the study: one because of hematocrit above 54%, one because of hematocrit above 54% and leg edema, and one because of hematocrit above 54% and PSA above 4 μg/ml ([Fig. 3]. Two older men were found to have prostate cancer; one man receiving the 300-mg dose underwent biopsy because of a PSA level greater than 4 μg/ml, and a second man receiving the 50-mg dose underwent biopsy because of prostate irregularity that was palpated on digital rectal examination on the last recovery day.

There were 55 adverse events, but no serious adverse events, in young men ([12]. The frequency of total and serious adverse events and prostate events by testosterone dose was not statistically different between young and older men, although the total number of adverse events was numerically greater in older men than young men. The older men had significantly greater increments in hemoglobin and hematocrit than young men after adjusting for testosterone levels (age effect, P = 0.0001; [Table 6] and [Fig. 3].

The best trade-off between anabolic effects and adverse effects was achieved with the 125-mg dose. These data suggest that in efficacy trials for aging-associated sarcopenia, serum testosterone levels should be raised into high end of the normal male range to maximize anabolic effects; the long-term safety of such an approach has not been tested. Also, lower testosterone levels might be sufficient for efficacy trials in men with sexual dysfunction. These data should not be interpreted to justify the 125-mg dose as the replacement dose in clinical practice. Because older men have lower plasma testosterone clearance than young men, it is likely that older men would need lower doses of testosterone than younger men to achieve the desired serum testosterone levels.

Administration of 300- and 600-mg testosterone doses was associated with a high frequency of serious adverse events in older men. An increase in hematocrit was the most frequent dose-limiting adverse event in older men. Testosterone stimulates erythropoietin production and erythropoietic stem cell replication ([63]–[67]. The reasons for greater hematocrit increment in older men are unknown. High hematocrit levels are associated with increased plasma viscosity and risk of stroke and hypertension. Leg edema developed in some older men receiving 300- or 600-mg doses. Testosterone administration to castrated male rats causes transient salt and water retention ([57]. In older men with preexisting heart disease, high testosterone doses may induce edema. Androgen administration induces myocardial hypertrophy ([68]; we do not know whether androgen-induced myocardial hypertrophy is beneficial or deleterious.

Two older men were diagnosed with prostate cancer (Gleason grade 4 in one man in whom information was available). There is concern that testosterone administration may induce subclinical prostate cancers to grow ([69]. More intensive PSA monitoring during testosterone administration might lead to the detection of a greater number of prostate cancers.

Discussion

Because supraphysiological doses of testosterone (300 and 600 mg) were associated with a high frequency of adverse events, it is unlikely that these doses can be used in long-term human trials. However, these data provide compelling rationale for the development of selective androgen receptor modulators with anabolic properties that are free of dose-limiting adverse effects of testosterone ([70]. The Institute of Medicine committee on assessing the need for clinical trial of testosterone replacement therapy recommended studies of testosterone replacement in older men with low testosterone levels and symptoms attributable to androgen deficiency, such as sexual dysfunction, sarcopenia, or depression ([71]. Our study was designed to compare the androgen responsiveness of healthy, young and older men, and was not an efficacy trial. The study did not have adequate power to demonstrate improvements in clinical outcomes or risks of testosterone supplementation. We do not know whether testosterone-induced gains in muscle mass and strength translate into improved physical function or quality of life, or whether these gains in muscle mass and strength obtained in the controlled setting of a clinical research center can be replicated in a community setting. Thus, no claims about the efficacy or long-term risks of testosterone replacement in older men can be based on these results. However, these data provide evidence that some age-related changes in body composition and muscle strength are reversible, and that remarkable alterations in muscle mass and strength and fat mass are achievable in older men with androgen administration.

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Very familiar with all the dose response relationship studies. And yes once you are a student of the literature you’ll understand how when they report adverse events that they are not actually dangerous events. There’s a huge difference. Fluid retention or edema can occur initially in many men on testosterone. It is usually self limited and easily treated but those in the field would not call it a serious adverse event. A rise in PSA is expected in men with low testosterone levels who start testosterone. So a rise in PSA is not a serious adverse event and we all know that testosterone does not cause prostate cancer or does not cause it to grow rapidly if my man has prostate cancer and takes testosterone. Please refer to the above mentioned guidelines as they discuss all of your points. The hematocrit above 54% has never been shown to cause harm… Ever… in men on testosterone. The 54% was chosen arbitrarily and not because it’s ever caused harm when someone’s hematocrit is higher than 54%. In fact that’s the normal hematocrit for men that are not on testosterone or for men that don’t live at high altitude. The normal hematocrit for certain areas of countries where they have a large population at high altitude ranges from 45 to 61% and they are not at an increased risk of cardiac events nor do they have to manage their hematocrit. Where actually none of the “serious adverse events” that the study reports were actually serious adverse events such as major adverse cardiac events such as heart attacks strokes or blood clots. Calling these side effects serious adverse events is the equivalent of falling off your bicycle and scraping your knee and calling it serious trauma. Now this is just one study of many studies that one must know. If you’ll read the guidelines they will tell you straight out that testosterone has never been shown to cause major adverse cardiac events in any study. Your fear mongering with regard testosterone levels is really unparalleled on forums. The normal range went up to 1593 ng/dL in 2006 in some labs. I think you fear men having good levels which would be 1000 to 2000 and now hundreds of clinics have literally thousands of patient years with men who have optimal levels and no adverse events occurring. If they did you would read about it every day in the paper. Your fear and what you’re trying to present constantly has not been proven in the medical literature and 80 years of testosterone use. It’s OK that you don’t want a man to have a man’s level of testosterone but just say that or at least provide evidence that it has ever caused harm. It’s been used since 1937 and if you think that it would cause harm we definitely would’ve seen it by now. Men have been abusing it as well for decades and yet there’s not an epidemic of heart attacks strokes blood clots in men on testosterone. You can extrapolate the bodybuilding world to me and I’ll testosterone. And there is no harm with testosterone levels being 1,500 ng/dl Long term. When you have a man that has had those levels for 10 years and when every parameter of health that you can measure improves what would be the harm? There is no harm only benefit. The problem and the harm is from men who don’t have optimal levels of testosterone. The normal range for testosterone is the average of a population of men that are producing less testosterone than ever due to the environmental toxins they are exposed to. These endocrine disrupting chemicals are getting front page news every day now. Just look at what’s happened in the last week in Europe with regard to their changes in acceptable levels of chemicals. It’s obvious spend your time in books and abstract surfing but have no clinical experience and no clinical acumen.

can you provide me with a link? Genuinely curious

They’ve been doing the same thing in Aus, i’ve had reference ranges cut off at 550ng/dl for me


It’s understandable from your previous post that you’re sickly and not in great health. I can only assume that you’re probably jealous of those that have their health and have optimal levels of testosterone which help them maintain that health. You have not learned to question and understand everything that you read you just simply take it at face value. You see it in a book therefore it must be true and nothing could be further from the truth. Understanding the medical literature and also understanding the bias of some that write articles helps when it comes to clinical management. You lack any clinical knowledge nor do you have the ability to speak with hundreds of other clinicians. When you talk with these many physicians and the benefits that testosterone therapy provides their patients especially when the testosterone is an optimal range. Every parameter of health improves. You have a bias against optimal levels of testosterone and you keep promoting your fear mongering that is not based on anything bad that has happened in over 80 years of using testosterone. Some of the leading urologists in the country are now using very supraphysiologic levels of testosterone in the treatment of prostate cancer and guess what? Nothing thing bad is happening. They are in fact starting to question where the fear came from. It certainly didn’t come from any study showing any harm as once again testosterone has never shown any major adverse cardiac event in any randomized control trial. You have a dialogue that you keep trying to push on people as it appears you have nothing else to do. Your fear mongering is just that and it’s not based on any medical reality or facts. Please provide any studies that support this fear of yours in men on testosterone. I would love to pull up some of your other post as well about the fallacy of endocrine disrupting chemicals. Would you like to rethink those statements now? Still think that endocrine disrupting chemicals are not harming men and their testosterone levels? Want to make fun of it now? You have no idea what optimization really is. You have no clinical experience in what optimization really is. Problem is you are not very healthy and I think you have a problem with others that are or want to be. You spend all your time on forums and I think it’s more to impress yourself than it is others. It’s just that most can’t discern that half of what you write is ridiculous.

You should also be careful regarding libel. Your identity can be easily obtained… Just be careful what you write about individuals or clinics. You would not be the first to be sued by an individual or clinic for libel from a forum or other social media platform. I can post you some examples if you would like



Tareload,
I believe Danny , Rouzier, Howell, and many others could get together and have a field day with you what do you think? Would you like to go there? You start posting specific names of people you have already committed defamation and libel. You might wanna be looking at some of your old post and erasing some of them along with the newer ones. Once you have suggested that an individual, or a physician, or a clinic, has caused harm or is causing harm you best be able to prove it beyond a reasonable doubt. If you cannot then you have committed defamation and libel. In a lawsuit like this the onerous is on you to prove that what you said is 100% true. The people you are writing about don’t have to prove that it is false. You have to prove that what you are saying is totally true. If you are insinuating that a very specific person or clinic or anything else is causing harm and you do not have 100% proof that it is true then you have committed defamation and libel. You may wanna do a little Internet searching on your on concerning this topic. You may be shocked at what you read and what is going on with regard to lawsuits and settlements. You should be really careful when it comes to attacking very specific people or making claims against very specific people by name.

I don’t think you understand how hard these are to prove in court. You have to show actual malice and intent, you have to show tangible injury BASED PURELY on the offending comments, and you have to be able to prove they are false to begin with. Do you want to go there? Lol

Edit: on the flip side, I’m not sure if you’re aware how many ppl leave that HOT FB group and complain about “Danny or Gil told me to let e2 go to whatever high level and I had heart palpitations or high BP or whatever” to their new FB group. That is EASILY provable harm and malpractice (since their recommendations aren’t based on accepted current science/treatment). They might want to be careful, esp since both are not actual doctors. Just saying.

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Oh my now that is where you are wrong. I have very specific knowledge of a 2 million dollar lawsuit that was ultimately settled. It is very easy to file one of these lawsuits. People think they are protected by the Internet and they’re not. If you make a false claim against a business for instance, or a clinic for instance, or a doctor for instance, or even a nurse practitioner etc. and it is not true they can and some will take action. A simple Google review and you will see that there are now plenty of attorney offices that now specialize in these types of lawsuits. It is very easy let me tell you how it was easily done. First an attorney will subpoena the website for the persons Internet address. Once that is obtained they will then subpoena the Internet provider for the persons information. Once that is obtained they will then go after that person. The initial lawsuit is called a John Doe or Jane Doe lawsuit as you don’t know who you are suing initially until you find the above mentioned information. It’s very easy to prove because the person that makes the false claims has to prove that they are absolutely true and the person who files a lawsuit does not have to prove anything. You may want to Google these things. You should probably do a little research before you post on forums because all you have to do is Google a John Doe or Jane doe lawsuit. Also Google how many cases there have been concerning Internet defamation. So you asked me if I want to go there? Yes I want to go there because you don’t know anything that you are talking about. The person filling the lawsuit does not have to prove anything. The person making the false statements has to prove they are true. Yes if you say that Danny’s business for instance is harming people And by you saying that he says it has affected his business or may affect his business then you have to prove he is actually harming people. He doesn’t have to prove that he’s never harmed a person
Do you always post responses before you fact check anything? With regard to the estradiol if you look at the newest recommendations above by the leading urologist in the country it is very specific in there with regard to not blocking estradiol and only using aromatizable androgens. If you want to really get into specifics there’s not a single guideline that states one should measure and control estradiol in men on testosterone. There’s not a European guideline or an American guideline or any other guideline so the ones that are doing it or actually not following guidelines . So like it or not what Danny is saying is actually true.
Also, it goes without saying that if you make derogatory comments and somebody sues you for Internet defamation or libel you realize your defense is not free. You’ll end up spending tens of thousands of dollars on attorneys fees.

Exactly. I’ve been slandered and libeled, didn’t hurt me a bit, did not cost me a dime. No damages, no settlement.

I don’t think so. They are not holding themselves out to be someone they are not. There is no formal professional relationship, it’s not “practice”. For all we know, those are not even their real names.

If someone willingly decides to take to the internet for health care advice, from unknown strangers, at no monetary expense, I guess you get what you pay for. Seems like you’d have to take some responsibility for your own actions.

However, I could be wrong, I’m not an attorney…

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You would be wrong because I’ve seen it personally. It is happening all the time now because people and businesses are fighting back from these Internet trolls. Just Google it you’ll see for yourself. Nonetheless you see that I specifically stated Danny’s business not what Danny does on forums. You can’t hurt Danny by complaining about what he does with regard to testosterone because he doesn’t have a practice or a clinic nor would he suffer any harm to his reputation or business. He does have a legitimate business though and if someone were to attack him with regard to that business then he would have a recourse if the claims were not true . So the point I’m trying to make is that if you attack a business with false claims they do have a recourse and they do not have to prove that you damaged them to sue you you have to prove that what you said was true. When you research this a little further you’ll see that people are not as protected as they think they are and they should be careful about what they say. It’s OK to disagree but it’s not OK to suggest someone or some clinic is causing harm unless you have specific knowledge that harm was caused. I saw that $2 million lawsuit firsthand and it wasn’t pretty for the person they got sued. Also, their attorney fees were not pretty. It was a colleague that decided he was going to fight back against an Internet troll and all they did was write a false review . A review I guess they wish they could take back now. It’s no different on these forums as I or no one else can get on here and attack another clinic or suggest another clinic is causing harm because that clinic can fight back. This is to stop competitors from doing it to their competition . It’s happened with other businesses where they hired people to write bad reviews or to say false things on forums and it came back to bite them in the ass. Point being everyone should just be careful what they say when it comes to anything specific about someone else unless the statement is completely true. When you Google Internet defamation you will see that the best defense against it is the truth. So just make sure what you say about someone, their business, their family etc. is 100% true before you put it in writing. If I were to say don’t go to clinic XYZ because what they do hurts people and could potentially kill them then that business would be able to sue me and make me prove that what they do is dangerous And could kill people. I would have to give specific examples of people being harmed or killed

Lol, yeah you can file anything. Winning is another thing entirely.

I dunno about this … Danny and Gil both give consults and advice that amounts to medical treatment (even if they say they aren’t). Like the finance bros on IG saying “this isn’t financial advice, but BUY DOGE COIN!!!” Sure it’s not advice lol. But, I could be wrong, I am also not an attorney, just dated a law student for 3 years.

These ppl charge for their advice that isn’T really advice. I heard $250 per consult, but can’t and won’t verify it.

Anyway, use the AI if you need to, don’t if you don’t. I’m still amazed at what ppl choose to get all fired up about.

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Yes, they could. Whether they would win or not is a different beast. Can i prove what they advised caused harm? If yes, then that lawsuit looks pretty dead.

I did not know that.

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