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To treat or not to treat low T, that is the question: Low Testosterone and TRT for Men

Updated: Jun 20, 2023


A man lifting weights in the gym
There are many benefits to testosterone replacement therapy (TRT)

I am sitting here reading the summary and recommendations from well-respected clinical database providers often use during research or for patient diagnosis and treatment.


Essentially it reads: for hypogonadal men with symptoms of low libido, decreased morning erections, loss of body hair, low bone mineral density (like we all know this number), gynecomastia (AKA: man boobs/moobs), and small-sized testes, with subnormal serum testosterone measured two to three times from 8 am to 10 am, testosterone replacement therapy (TRT) is recommended.


The clinical article further suggests that TRT should not be prescribed for vague symptoms such as fatigue with only one testosterone serum measurement. Why do we need to take testosterone levels in the morning? Why twice? Why thrice?


Let's take a break and look at another article (referenced below) of just some benefits of testosterone replacement therapy:

  1. Sexual function - TRT was associated with a moderate improvement in sexual function with sexual activity, libido, and erectile function. Sounds great to me!

  2. Physical function - TRT improved walking distance when all 788 men studies were included. Sounds great, right?!

  3. Vitality - (Yes, I know, it's the name of my company, but it says Vitality in the article. I'm not making this shit up!) TRT improved vitality (measured as energy) with better mood and lower severity of depressive symptoms.

  4. Cognitive function - TRT improved executive function when all trials were included together. I want to be a tad smarter.

  5. Anemia - TRT is known for its stimulatory effect on erythropoiesis. 126 men were anemic for known and unknown reasons, and hemoglobin increased by 1 g/dL or more in all of them on TRT. Do you know why people train at high altitudes? To increase their red blood cell count and efficiency for improved performance. This is exactly what TRT does, too. I'd love to run up a mountain like a sherpa.

  6. Bone density - Essentially, volumetric bone density significantly increased after 12 months of testosterone replacement therapy. This doesn't sound like a bad thing. I wonder if I would sink to the bottom of the pool.

OK, take a minute...stop the bus. You're telling me that items 1-6 improved? All of them?! All of them?!


Back to the point above:


The last time I looked around, men/humans were awake, working, moving, and doing things after 8 am. I want to know my levels at 2 pm when I'm feeling tired, run-down, and about to conk out after lunch. That is a more accurate reflection of my T/low T levels.


OK, time to get to the point: current guidelines essentially make treating men for low T impossible. If your testosterone levels are 200-800 ng/dL, you don't need TRT. Are you serious? This isn't age-adjusted. This is a HUGE range. This is BS. Yes, BS. Mama ain't proud I said it.


An article by Finkelstein et al., 2013 (which is actually used as a reference in the same article saying the BS above) showed that androgen deficiency accounted for decreased lean mass, muscle size, and strength with a decline in sexual function. The article's conclusion states that clinicians should change their approach to the evaluation and management of hypogonadism in men.


Well, that's what we are doing at Vitali-T Men's Health & Testosterone Clinic. We are assessing men using a scientific approach that makes sense; we use the guidelines for safety, the full laboratory panel for a full health picture, and your symptoms (yes, fatigue counts) combined to assess and treat you. We don't need 2 or 3 separate random testosterone readings. What's the difference of 50-100 ng/dL anyway? Will you feel better at 200 vs. 250 ng/dL? Answer: Probably not!


Update: The New England Journal of Medicine published findings of a multi-center, randomized, double-blind, placebo-controlled trial illustrating no increased cardiovascular risk to men on TRT.


*Fill out the contact form, and we'll investigate if you have low testosterone and might benefit from TRT therapy.


References

  • Snyder, P. (2020). Approach to older men with low testosterone.

  • Snyder, P. (2022). Testosterone Treatment of male hypogonadism.

  • Finkelstein, J.S. (2013). Gonadal steroids and body composition, strength, and sexual function in men.

*retrieved from UpToDate, 2023






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