Testosterone Therapy options

[sliphill]

I thought I would see an increase in libido, but I have not. I went on T for that reason.

Here is a book reference that might, or might not, be helpful:

http://www.amazon.com/Improving-Male-Se ... Dan+Purser

Here's a quote from it:

"In men low testosterone is the most common influencer of low libido but there’s a lot more involved in this problem than just low testosterone levels. "

Would you say 350 ng/dl is low for a 59 yo man?

[rlm1818]

Would you say 350 ng/dl is low for a 59 yo man?

If you're asking me, I have no medical training whatsoever. So, not sure what my opinion is worth.

According to the book above, "the widely accepted medical limits espoused by knowledgeable urologists and endocrinologists" is:

"MILD HYPOGONADISM is: TOTAL TESTOSTERONE of < 400 ng/ dL
SEVERE HYPOGONADISM is: TOTAL TESTOSTERONE OF < 288 ng/ dl"

The doctor in the book above has his own higher limits, but stresses the importance of also considering symptoms:

MODERATE HYPOGONADISM is: TOTAL TESTOSTERONE of 361-600 ng/dl (MUST have symptoms too)
MILD HYPOGONADISM is: TOTAL TESTOSTERONE OF 601-799 ng/ dl (MUST have symptoms too)

I was 353 3 years ago, with was (barely) within the reference range of the lab used, which was 348-1197 at the time. Both the urologist then treating me for ED and my PCP both declared me 'normal'.

However, from what I've read, how you feel, and how your body actually reacts, depends on 'free testosterone'. Most of the T you have is bound to various proteins and other substances, and not really available for anything useful. Every time I've had my T levels measured, they've also measured 'free testosterone'. For me that's usually also at the low end of the reference ranges. So, I think free T is possibly more useful as a measure. Taking exogenous T has raised both my free T and total T levels.

But, you also need to consider other things, such as LH and estradiol (E2 or estrogen). T converts (aromatizes) into E2. Too much E2 and you'll feel like crap. Many docs think that too much E2 is a key risk for heart attack, stroke and other things, and some docs think the risk of TRT is primarily that you drive E2 too high. Other docs think TRT alone is just risky. You can, of course, and probably should, measure estadiol too along with T levels. There is also medication that can control your E2 levels.

LH is also a consideration. Pituitary produces LH witch stimulates testicles to produce T. If your LH is high (mine has been sky high with lower T) that's a signal your body thinks your T is too low too, and is trying to get you to produce more. But, low LH (or abnormally normal LH in the presence of low T) and low T doesn't necessarily mean your body thinks your T is ok. It could mean your pituitary is damaged. The book above claims more cases of low T are due to damaged pituitary than to damaged testicles. If your pituitary is damaged, the treatment choices should not start with TRT. You should try clomid, which tries to stimulate the pituitary to produce LH. If that doesn't work (ie LH doesn't rise), then take HCG (which is 70% LH) and see if your testicles start producing more T. Only if that fails, or if your LH is high to begin with, should you even try TRT.

There is also an issue with measuring T levels if you take exogenous T (ie TRT) using gels, creams or any transdermal delivery medium. There is a lab (zrtlab.com) where they claim that venous blood levels of T do not reflect the rate of T uptake in the body of T when you absorb transdermally. They claim venous blood levels will way understate the amount of T your body absorbs in that case, and many men are overdosing T with products like androgel. In many of these cases E2 is going too high too. They have alternative technology for measuring T. However, if you take exogenous T as injections or pellets zrt will tell you venous blood measurements are fine. So, if you take androgel and your T level is, say 550, zrt says alternative measures (saliva or blood spot) may well say your T levels are far above normal.

Sorry, no simple answer to your question from me, but for me if you're 350, not doing TRT, and you feel like crap, its too low IMHO. But measure LH, E2, DHEA, thyroid, cortisol, micronutrient levels, etc etc too as these all affect how you feel and also how your body reacts to and produces T and free T. If you do transdermal TRT be careful what and how you measure, and what conclusions you draw.

Edit:

Oh, one other thing I've read in non-medical places, by guys that experiment with T for performance reasons, is that to 'feel good" you want your E2 levels low normal and your T levels high normal. You don't want E2 too low though (below normal), as apparently you'll really feel awful. They suggest a ratio of 40 to 1, total T to E2. Eg 800 to 20, or 1000 to 25. I can't vouch for this one way or other really, as I'm not at that ratio at this point.

[sliphill]

rim1818. I am on Testosterone cyp. Last measured my levels were up over 1000 ng/dl. I feel pretty good. I just don't have too good of libido. I had my e2 checked 2 times. Both times it was 15. I believe I went over board with arimidex. Now I only take 1.4mg a week of it. IDK, maybe I should just continue with the therapy. Aint hurting me none. One thing I have noticed is I am a lot hairier.