Okay, thx Samson. Another great post.
This is interesting. The study cited I have seen before, but now they are actually looking for details behind it:
Here is the key statement give in my mind and the issue seems to be with just the topicals, although I think they need to see if there is an issue indeed:
"In contrast to what we see with endogenously produced hormones, when testosterone, or any other steroid hormone, is applied topically as a cream, gel, or spray, levels in capillary blood (finger) are remarkably higher, by 10-20 fold, than venous blood levels. Moreover, salivary hormones are often >100% of venous serum levels, which ordinarily are only 2-3%. This remarkable increase in capillary blood and salivary testosterone is NOT seen when it, or other hormones, are delivered orally, or as im-injections or sc-pellet implants. With these delivery systems capillary blood and venous serum levels are about the same."
"Of further relevance to the NEJM study, we find that men using the higher pharmacological topical testosterone gel have capillary blood levels of estradiol that usually exceed 100 pg/ml, which is very high for males. While physiological levels of estrogens are beneficial to the male cardiovascular system, higher levels can be harmful (
. Unfortunately, estrogens were not monitored in the NEJM study so it is not possible to know if levels, even in venous serum, were higher than physiological range. It is very possible that some of the cardiovascular events observed in the older high risk men participating in the NEJM study were precipitated by excess estrogens derived from excess testosterone."