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Topics - oldolylifter

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Testosterone, Hormones and General Men's Health / Starting too high?
« on: August 04, 2018, 02:18:53 pm »
I have read quite a bit from guys starting their TRT with too high of a dose.  I understand how everyone reacts differently and the need for managing E2, Hct, etc. over the long term. 

Back in the day, when pretty much all competitive weightlifters used anabolic steroids, we would start testosterone at 200mg.  No sense putting a needle in your ass (they were 20g, 1.5in needles) for anything less than a full cc.  Usually, we'd start test about a third of the way in to the cycle when natural test would be dropping.  From there, we'd ramp up to 400-800mg per week for most of the guys I knew.  I knew of a few who used more. 

No one, ever, complained of symptoms related to the high dose of test, quite the opposite, actually.  Granted, towards the end of the cycle, when estrogen was elevating, the grind of heavy training was taking a toll, etc., we'd start to not feel well.  But, that was after being on for 8-12 weeks, certainly not towards the beginning and we were stacking multiple substances. 

So what gives with some of the relatively minor adjustments to lower doses changing outcomes so much?  Are some just that sensitive?  I'm not doubting what I have read, just never saw this back then, and many took a once a week injection.  If we went to multiple weekly dosing, it was because we were using too many cc to put in one dose.  No one ever felt anything but great with this method. 

Any explanation for this?

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Testerosterone Therapy Safe Despite Prostate Cancer History

Jody A. Charnow, Editor

May 20, 2018
 
The following article is part of conference coverage from the 2018 American Urological Association meeting in San Francisco. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2018.

SAN FRANCISCO—Testosterone replacement therapy (TRT) for men with a history of prostate cancer (PCa) does not increase recurrence rates following radical treatment or progression rate after placement on active surveillance, investigators reported at the American Urological Association 2018 annual meeting.

In a study examining the outcomes of 190 men with PCa (mean age 68 years) who received TRT after diagnosis and/or treatment for PCa over the previous 5 years, Abraham Morgentaler, MD, Director of Men's Health Boston and Associate Clinical Professor of Urology at Harvard Medical School in Boston, and colleagues found that biochemical recurrence rates after radical prostatectomy (RP) and radiation therapy, and the progression rate while on active surveillance (AS), were consistent with published rates from other studies.

After a mean follow-up of 47 months, the recurrence rates were 11.6% among the 86 men who underwent RP and 4.1% among the 49 men who had either external beam radiation therapy or brachytherapy. None of the 5 men treated with RP followed by salvage radiation had recurrence. The progression rate among the 47 men on AS was 10.6%.

“This is the largest series to date investigating the safety of testosterone therapy in men with prostate cancer,” Dr Morgentaler told Renal & Urology News. “Recurrence rates following prostate cancer treatment with surgery or radiation were low for men treated with testosterone, and were quite similar to expected recurrence rates based on numerous published studies. This was also true for men on active surveillance.”

He added: “For decades, physicians have feared offering testosterone therapy to men with prostate cancer because we were taught that raising testosterone would be like ‘pouring gasoline on a fire.' From this study, and smaller studies before it, we know this concept can no longer be correct.”

Dr Morgentaler stated that TRT can make an enormous difference in the lives of men who are testosterone-deficient. “I've had quite a few men tell me they wouldn't mind continuing with testosterone therapy even if it were certain to shorten their lives,” he related.
Eric A. Klein, MD, Chair of the Cleveland Clinic's Glickman Urological & Kidney Institute, who was not involved in the study, said the investigation by Dr Morgentaler's team “adds to the existing data that T replacement in men with early stage low-grade prostate cancer or those treated for cancer is safe and does not appear to increase the risk of progression.”

Dr Klein cautioned, however, that testosterone replacement should only be considered for men who have symptoms related to documented low testosterone levels.

Visit Renal and Urology News' conference section for continuous coverage from AUA 2018.

In a separate study presented at the conference, Unwanaobong Nseyo, MD, and colleagues at the University of California, San Diego, looked at outcomes among 123 men who were on AS for PCa—61 on TRT and a matched group of 62 patients not on TRT. The groups had similar proportions of men with a positive family history of PCa (15.7% vs 16.7%).
 
Overall, 11 men experienced progression on repeat biopsy during AS (5 in the TRT group and 6 in the non-TRT group). All 5 patients who progressed in the TRT arm and only 1 who progressed in the non-TRT arm underwent definitive treatment due to pathologic progression.

Men in the TRT group were diagnosed at lower PSA values than those in the non-TRT group (3.1 vs 5.3 ng/mL).
Dr Nseyo's group concluded that their data suggest that aggressive screening or treatment is not indicated for men undergoing TRT, but TRT might alter patient choice of definitive treatment during AS.

References

Morgentaler A, Magauran D, Neel D, et al. Recurrence rates following testosterone therapy in a large clinical cohort of men with prostate cancer. Data presented in poster format at the American Urological Association 2018 annual meeting in San Francisco, May 18–21. MP17-03.

Nseyo U, Unterberg S, Hsieh M. Testosterone supplementation does not increase the risk of prostate cancer progression but might alter patient choice for definitive treatment during active surveillance. Data presented in poster format at the American Urological Association 2018 annual meeting in San Francisco, May 18–21. MP17-09.

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http://www.mayoclinicproceedings.org/article/S0025-6196(14)00925-2/fulltext

Authored by Abraham Morgantaler MD, et al

Conclusion
In the absence of large, prospective, placebo-controlled studies of several years’ duration, it is impossible to provide any definitive comment on the absolute safety or risk of T therapy with regard to CV outcomes. However, review of the literature clearly reveals a strong relationship between higher serum T concentrations, endogenous or via T therapy, as beneficial for reduction of CV disease and CV risk factors. Public health may be harmed not only by inadequate appreciation of an actual risk but also by the failure to offer beneficial treatment for a medical condition because of false claims of risk concerns. On the basis of the current state of evidence, placing restrictions on the appropriate use of T therapy for T-deficient men is likely to result in compromise of public health and a substantially increased future financial burden on the US health care system.

In summary, we find no scientific basis for the suggestion that T therapy increases CV risk. In fact, as of this date, we are unaware of any compelling evidence that T therapy is associated with increased CV risk. On the contrary, the weight of evidence accumulated by researchers around the world over several decades clearly indicates that higher levels of T are associated with amelioration of CV risk factors and reduced risk of mortality.

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Testosterone, Hormones and General Men's Health / E2 TESTING
« on: March 22, 2018, 04:50:10 am »
I’m a little over four years into TRT, and doing well. I have always had the immunoassay estradiol test and results are usually 20-24. I’ve been aware of the LC/MS/MS ultrasensitive test.

Recently, in part due to what I have read here, I asked for both and received these results:

immunoassay: 21        < OR = 39 pg/mL
LC/MS/MS: 23             < OR = 29 pg/mL

I understand that with the immunoassay, if the result is <15 it will not register, but since mine is not, given the above results, why would I want one test over the other or why would I insist on the ultrasensitive test?

Thanks for any insight.

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