Testosterone: The "Metabolic Messenger" Rehabilitation

#16

No disrespect, since we are all self experimenters, but I still don’t believe we should normalize a serum T of 1400 with an unknown free T level. The honest answer is, it isn’t normal. The Men’s Health article doesn’t even have an author listed. If 100-200mg/week was the standard dose needed in men then why does Xyosted come in dosages of 50, 75, 100mg? The reason is that for Xyosted to gain FDA approval they had to perform dose finding studies and they settled on 50, 75, and 100mg because that put 93% of men between 300-1000ng/dl. The highest “normal range” I could find was 1200ng/dl with most using the 1000ng/dl threshold. You are another 20-40% above this. I can pull the population serum T papers later, but I’d be surprised if outliers in those papers even reached 1400ng/dl.

I don’t doubt you feel good. High T feels great. Honestly, though in regards to longevity we have no data to support that dose. Also no data to support safety. The TRAVERSE study supplemented to ~25% of your level. Even in the studies that show benefits to “high” testosterone they are looking at upper tertile or quartile which still renders a serum T <1000ng/dl. If we have data on levels >1200ng/dl, I’d be interested to see it?

In regards to your comment on steroid abuse, yes pro bodybuilders (think Olympia level) use massive doses. But a standard 1st cycle of steroids for a new user is often ~400mg T per week. Your dose is not as far from steroid user doses as you think. This dose has been shown to add muscle even in the absence of strength training. 8g of anabolics is not common in your average gym steroid user. I also agree with Luke, if I was injecting 200mg/week I’d definitely be splitting it up.

From a clinical perspective, I’ve never seen a serum T of 1400 outside of exogenous hormones. I’ve seen a handful of men ~1100 and have never needed much over 100mg to achieve therapeutic levels. Consistent with the Xyosted dose studies.

Ultimately, do as you please and I’m glad you feel well but forum readers shouldn’t get the impression that 1400 is normal or even the correct target when it comes to testosterone replacement therapy.

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#17

Yes that’s the article…

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#18

I understand… and each person is different. Measured caution is good. I have been tweaking my health for about 10 years… since I hit 58 years old.

For example, my response to rapamycin seems to be a super responder… in fat burning… strength, knocking down senescent cells and inflammation… skin quality, building immune resistance to allergies and such. There are those that seem to get no benefits, and many that say no to rapamycin at any dose. Same with HGH no dose. Understandable. I have found testosterone, rapamycin and HGH synergistic. A lot different from solo rapamycin, solo testosterone or solo HGH. That’s my qualitative physical feeling.

I do monitor my health more than most on this site with full blood panels every 4 months and body scans DEXA, Coronary Calcium Scans… as often as insurance permits… and do private pay Glycan and Methylation test every 6 month. Working with my physician to maximize all aspects… including D and B12 levels. Which are high normal.

So yeah, one size diet, workout or supplements doesn’t fit all. Or it would be easy. Chronological age can also have a lot to do with your plan. I’d be doing half my doses or less, if I were under 40 for rapamycin, TRT, HGH and other supplents.

Many do fine with testosterone at 600 or 900 ng/dL. Great. Or rapamycin at 2 mg weekly… or 12 mg…I believe is too high.

With my physician, I think I do fine a bit higher on testosterone. Not really a lot of good research on TRT. But, the attitude on supplemental testosterone for aging health has pivoted 360 from bad… to beneficial.

I have had several doctor’s my age in their earlier 60’s that would not support any anti-aging protocols at all… aging is normal accept it. They are looking their advanced age and seek retirement. I am catching my second wind.

Fortunately, you get the benefit of what is being learned now… through us. I took the leap on TRT and Rapamycin as an early adopter when these were :100: negative. I like my choices.

As Blagosklonny said… from Seth Godin… If you wait until you are ready … its almost certainly too late." A little higher dose is a safe bet for me.

I don’t have the luxury of youthful years that you have… to wait and see. And, monitoring and health/biological testing tell me… stay the course. But, my course shouldn’t be yours. Almost everyone in the field says this… Kaeberlein Attia, etc.

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#19

I agree but I’ll also say the truth is that we don’t really know if 1400 ng/dL from injectable testosterone is harmful or not. You could make the case for some other hormones that a slightly higher than normal level could be ideal.

With the limited data we have now, I’d say 800-900 is a good target until we know more. We don’t really know if the normal range on injectable testosterone should be the same as the range for people who are not on TRT.

That being said, we also don’t know that 1400 extends lifespan either so your point is valid. The question is where the cut off is.

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#20

We identified 7,790 males aged 18 or older with mortality data. Of those, 7,715 had testosterone <1000 and 75 men had testosterone > 1000. Among all patients in our cohort, 643 died of all causes, and 199 died of MACE. In the multivariable logistic regression adjusted for potentially confounding variables, we found testosterone >1000 was associated with all-cause mortality (OR 2.59, 95% CI 1.29-5.20, p=0.007).

https://academic.oup.com/jsm/article/21/Supplement_1/qdae001.281/7600971

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#21

Thanks for sharing

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#22

Well going for quality living and longevity.

Let’s see how it is working at 80… I am no hurry. Hahaha :laughing:

#23

…but also no idea what these people were taking. Huge doses of testosterone, growth hormone, synthetic anabolic steroids, stimulants, etc?

If a person keeps androgen stimulation on the higher end with testosterone supplementation only, keeps lipids and blood pressure and inflammation low, gets lots of exercise and takes potential anti-aging compounds, can they have their cake and eat it too?

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#24

I am in the camp that over 1000 isn’t something I would bet on being good for longevity. I do know a surgeon that runs 1200-1300. But, for the individual, they may not care. A bit dangerous to think about on a population basis for sure.

It seems unlikely that a natural 600 is at all the same as a supplemented 600. The supplemented does not vary in the same pattern as natural - a natural 600 is peak of the day where a supplemented 600 is not. This matters for everything of course - effect and longevity.

Hopefully, someone out there is collecting data but I doubt it. Would be nice to see longevity data after 20 years with different doses and schedules. Maybe the once a weekers will do better as they are cycling up and down.

I’m naturally 500 with high fsh and lh at 55yo. I may start some because YOLO and it looks like I am going to fall soon anyway. I am a bit curious how someone who is 62 and on T lifting and doesn’t injure themselves - I am still learning to hold back as I am nursing 2 areas currently - shoulder and back.

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#25

I don’t know what bodybuilders check for, but aren’t you supposed to measure hematocrit as well? Perhaps cardiac MRI periodically to check for heart enlargement or is that just with growth hormone? No idea.

When you need a lot of substantive counter-measures of other factors you might have just discovered an anti-longevity drug at a specific dose. A longevity drug tend to affect a lot of factors in a net general beneficial way. They are general purpose medicines in some sense. The effects might also occur in things you can’t measure. If many negative effects that come online generalize equally to non-measurable negative effects at an increasing dose is the problem. If that generalization is the case it might not be enough to control what you can measure. So maybe then it’s important drugs at a specific dosage don’t have multiple negative effects that have to be controlled in the first place? This doesn’t mean such a drug on a large enough dose doesn’t have a place for treating specific conditions with net benefit on risk vs. reward.

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#26

Yes, one has to monitor hematocrit for sure, and ideally IMO do an echocardiogram once/year. Angiotensin receptor blockers can help to block or even reverse left ventricular hypertrophy, as can SGLT2 inhibitors (although SGLT2i drugs also increase hematocrit, so have to be careful there). I reversed my LVH in the presence of higher-range testosterone levels per recent echocardiogram (was mild LVH 2 years ago).

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#27

You’re probably right but I think other healthy longevity habits would easily offset a long term slightly elevated testosterone.

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#28

In my anecdotal experience, my dose of testosterone has had no impact on my own personal hematocrit. Raising/lowering the does does nothing for some reason. When I first started it, I didn’t really get much of a large increase but over time, it kept going up. Jardiance further elevated it a little bit.

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#29

David wrote: I am a bit curious how someone who is 62 and on T lifting and doesn’t injure themselves - I am still learning to hold back as I am nursing 2 areas currently - shoulder and back."

How about almost 68? Past 6-years on T and never injured once.

Weights have gone up significantly too. Chest Flys 30 in a set at 190 pounds - 3 sets. Lat pull downs 30 in a set at 175 pounds - 3 sets . 2 sets of 20 pull ups. And, such. Workout nonstop 1 hour and 15 minutes, every other day. All machines… but more or equal to the mid-20 year old medical students working💪out.

Never even think about injuries tbh.

#30

RapAdmin,
Thanks for this detailed and important post on testosterone. I prescribe a lot of replacement testosterone dosing for my Long Covid and ME/CFS patients, male and female, based on free testo levels. Your AI derived breakdown is hugely informative and I will share with patients if interested.

Can you share what your prompts are to generate this format when you ask AI to review a paper and which AI tool you are using.
Thanks.

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#31

See this prompt discussion thread here: Using AI for Health and Longevity and Research - Your Favorite Prompts

I use Google Gemini Pro. I’ll post the most recent prompt I’m using here, but its always changing, suggestions for improvements are always welcome: See here: Using AI for Health and Longevity and Research - Your Favorite Prompts - #87 by RapAdmin

#32

Interesting - so you used a an angiotensin receptor blocker and felt that it reversed your LVH alone? Am I following that correctly? Or were there a bunch of changes that you feel contributed to this?

#33

I was also taking empagliflozin for most of that time (recently stopped in order to get hematocrit under control). I just started an ARB about 6 months ago (first irbesartan and now telmisartan 80mg QD). So the LVH reversed despite high testosterone (which I wasn’t even taking at baseline) significantly increased weight training and minimal cardio, all of which would have been expected to exacerbate LVH.

It looks like the combo of SGLT2I and ARB is an amazing 1-2 punch for LVH, but the hematocrit elevation from SGLT2I and testosterone should be taken very seriously. See my post in the SGLT2 thread on a new study.

#34

So… I should take telmisartan with my eventual TRT? I’ve more or less decided to hop on it, for quality of life reasons if nothing else.

#35

I can’t tell you what you should do because that’s between you and your medical provider, but it’s a combination that seems to work well for a lot of people. Telmisartan helps control blood pressure, reduces risk of LVH, has other potential positive metabolic and health benefits, and even has a small effect on lowering hematocrit, all with a relatively low risk of side effects. My PCP had no problems prescribing it for me.