pmgamer18
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Quote:
Originally Posted by 1cc
If one was to measure Total testosterone only, then how would one know if a person's T is too high or too low. Some people will have higher Free T with a lower Total T, or vice versa. In the case of having a higher Free T with a lower Total T, increasing Total T beyond that point may increase Free T too much, and/or increase E2 too much. It seems that Free T is the gauge which indicates whether more or less supplementation is required. What are your thoughts on this?
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Free Testosterone will be determined by how much albumin is present to bind to testosterone (weakly bound testosterone), and how much SHBG is present to bind to testosterone (strongly bound testosterone). Albumin production is fairly stable and difficult to change without severe illness present. The albumin concentration is primarily determined by hydration - with dehydration increasing its level. SHBG is modified by multiple hormones: increased by thyroid, estrogens, progesterone; lowered by testosterone, DHT, DHEA, growth hormone, insulin; and is modified up or down by some medications, etc.
Is Free Testosterone a good measure of testosterone activity to determine whether nor not to adjust the testosterone dose? Not really.
First, Free Testosterone not a reliable test.
Secondly, and more importantly, it is also determined by multiple factors. It is more a measure of the sum of these factors than of testosterone activity itself.
For example, if there is too much estrogen, free testosterone can be lower since SHBG will be higher. If there is too little thyroid hormone, free testosterone can be higher. If there is insulin resistance (i.e. too much insulin), free testosterone will be higher. And so on. Thus, what is being measured by free testosterone? Certainly much more than testosterone activity itself. Therefore, it is difficult to say determine what needs to be adjusted to optimize function if free testosterone is used as the primary measure.
If anything, high or low free testosterone indicates there is a good chance that other hormonal imbalances (besides testosterone) are also occurring which need to be assessed and addressed - e.g. hypothyroidism, insulin resistance, high estradiol levels, etc.
Testosterone activity is determined by the sum of free testosterone's activity, weakly bound testosterone's activity (which has partial activity), and SHBG- bound testosterone activity (testosterone has signaling activity to SHBG receptors when bound to SHBG). Thus, Total testosterone comes closest to describing testosterone activity for clinical decision-making purposes for testosterone dosing.
One can also add DHT's activity (as some practitioners do) but one has to be careful since DHT can counteract testosterone's activity when DHT is too high.
How can one decide that the testosterone dose is too high or too low?
Using total testosterone, the TRT decisions become very simple:
1. The goal of TRT is getting the average total testosterone to at least 650 ng/dl (midrange on a reference scale from 300-1000 ng/dl).
2. If any problems remain, then it is due to other neurotransmitter/hormone/cytokine imbalances or excessive testosterone dose (i.e. supraphysiologic total testosterone).
These two constitute a rule of thumb - determined by the individual patient's circumstance - some patients need a lower, some patients need a higher dose of testosterone. However, no matter what the dose, realize that other imbalances in the body's information processing system (i.e. the sum of the nervous system, endocrine system, and immune system activities) may be present and need to be addressed.
Whether the total testosterone level over time is flat (as with pellets and usually alcohol-based gels) or with peaks or valleys (e.g. with testosterone injections, oil-based creams) is determined by the route of administration and the person's half-life for testosterone (and the ester if injections are used). Whether a flat or peak/valley testosterone time-curve is preferred depends on what a person best responds to.
Given how large an overlap there is between the symptoms of testosterone deficiency, thyroid hormone deficiency, cortisol deficiency, insulin resistance/diabetes, etc., it is important to look at the other hormones for a solution if total testosterone is at a good level.
How much estradiol (E2) is made depends a lot on how high total testosterone becomes and how much aromatase activity is present.
HCG use increases the production of aromatase - increasing estradiol production.
High testosterone doses (such as injections given once every two weeks), results in long-lasting supraphysiologic levels of estradiol. A solution in this case is to use smaller and more frequent doses of testosterone (such as by going to a twice a week injection - rather than larger once a week or once every two week injections). The lower peak testosterone levels resulting from more frequent injections reduces the exposure to aromatase, resulting in smaller estradiol levels. At the extreme, testosterone pellets usually have the least problems with estradiol. Of course, using Arimidex can also reduce estradiol.
__________________
Any statement I make on this site is for educational purposes only and is subject to change. It does not constitute medical advice, does not substitute for proper medical evaluation from physician, does not create a doctor/patient relationship or liability. If you would like medical advice, you will have to make an appointment. Thank you.
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Last edited by marianco : Today at 01:48 AM.
Quote:
Originally Posted by 1cc
If one was to measure Total testosterone only, then how would one know if a person's T is too high or too low. Some people will have higher Free T with a lower Total T, or vice versa. In the case of having a higher Free T with a lower Total T, increasing Total T beyond that point may increase Free T too much, and/or increase E2 too much. It seems that Free T is the gauge which indicates whether more or less supplementation is required. What are your thoughts on this?
------------------------------------------------------------
Free Testosterone will be determined by how much albumin is present to bind to testosterone (weakly bound testosterone), and how much SHBG is present to bind to testosterone (strongly bound testosterone). Albumin production is fairly stable and difficult to change without severe illness present. The albumin concentration is primarily determined by hydration - with dehydration increasing its level. SHBG is modified by multiple hormones: increased by thyroid, estrogens, progesterone; lowered by testosterone, DHT, DHEA, growth hormone, insulin; and is modified up or down by some medications, etc.
Is Free Testosterone a good measure of testosterone activity to determine whether nor not to adjust the testosterone dose? Not really.
First, Free Testosterone not a reliable test.
Secondly, and more importantly, it is also determined by multiple factors. It is more a measure of the sum of these factors than of testosterone activity itself.
For example, if there is too much estrogen, free testosterone can be lower since SHBG will be higher. If there is too little thyroid hormone, free testosterone can be higher. If there is insulin resistance (i.e. too much insulin), free testosterone will be higher. And so on. Thus, what is being measured by free testosterone? Certainly much more than testosterone activity itself. Therefore, it is difficult to say determine what needs to be adjusted to optimize function if free testosterone is used as the primary measure.
If anything, high or low free testosterone indicates there is a good chance that other hormonal imbalances (besides testosterone) are also occurring which need to be assessed and addressed - e.g. hypothyroidism, insulin resistance, high estradiol levels, etc.
Testosterone activity is determined by the sum of free testosterone's activity, weakly bound testosterone's activity (which has partial activity), and SHBG- bound testosterone activity (testosterone has signaling activity to SHBG receptors when bound to SHBG). Thus, Total testosterone comes closest to describing testosterone activity for clinical decision-making purposes for testosterone dosing.
One can also add DHT's activity (as some practitioners do) but one has to be careful since DHT can counteract testosterone's activity when DHT is too high.
How can one decide that the testosterone dose is too high or too low?
Using total testosterone, the TRT decisions become very simple:
1. The goal of TRT is getting the average total testosterone to at least 650 ng/dl (midrange on a reference scale from 300-1000 ng/dl).
2. If any problems remain, then it is due to other neurotransmitter/hormone/cytokine imbalances or excessive testosterone dose (i.e. supraphysiologic total testosterone).
These two constitute a rule of thumb - determined by the individual patient's circumstance - some patients need a lower, some patients need a higher dose of testosterone. However, no matter what the dose, realize that other imbalances in the body's information processing system (i.e. the sum of the nervous system, endocrine system, and immune system activities) may be present and need to be addressed.
Whether the total testosterone level over time is flat (as with pellets and usually alcohol-based gels) or with peaks or valleys (e.g. with testosterone injections, oil-based creams) is determined by the route of administration and the person's half-life for testosterone (and the ester if injections are used). Whether a flat or peak/valley testosterone time-curve is preferred depends on what a person best responds to.
Given how large an overlap there is between the symptoms of testosterone deficiency, thyroid hormone deficiency, cortisol deficiency, insulin resistance/diabetes, etc., it is important to look at the other hormones for a solution if total testosterone is at a good level.
How much estradiol (E2) is made depends a lot on how high total testosterone becomes and how much aromatase activity is present.
HCG use increases the production of aromatase - increasing estradiol production.
High testosterone doses (such as injections given once every two weeks), results in long-lasting supraphysiologic levels of estradiol. A solution in this case is to use smaller and more frequent doses of testosterone (such as by going to a twice a week injection - rather than larger once a week or once every two week injections). The lower peak testosterone levels resulting from more frequent injections reduces the exposure to aromatase, resulting in smaller estradiol levels. At the extreme, testosterone pellets usually have the least problems with estradiol. Of course, using Arimidex can also reduce estradiol.
__________________
Any statement I make on this site is for educational purposes only and is subject to change. It does not constitute medical advice, does not substitute for proper medical evaluation from physician, does not create a doctor/patient relationship or liability. If you would like medical advice, you will have to make an appointment. Thank you.
--------------------------------------------------------------------------------
Last edited by marianco : Today at 01:48 AM.
