Testosterone: A mans guide

[ppwc1985]

For all the new guys this book was recommended by kel here in forums. If you want to know and understand get it and study it. I understood some but there is so much info on this site sometimes it's hard to take it all in. I started the book and it makes things so easy to understand. It's worth the few bucks. My TRT is important so I wanted to know why and how, I think I have a better understanding now. Thanks KEL.

[energizer bunny]

I agree with the above, this book is excellent and will help you understand TRT.

[Beethoven]

I'm glad this thread came up. I'm really wanting to learn more about this and was considering the book. Thanks for the review.

[ppwc1985]

I'm glad this thread came up. I'm really wanting to learn more about this and was considering the book. Thanks for the review.

NP, makes it pretty simple. Starts out kinda slow but keep with it and you can learn a lot.

[kelkel]

For all the new guys this book was recommended by kel here in forums. If you want to know and understand get it and study it. I understood some but there is so much info on this site sometimes it's hard to take it all in. I started the book and it makes things so easy to understand. It's worth the few bucks. My TRT is important so I wanted to know why and how, I think I have a better understanding now. Thanks KEL.

You are welcome. It's a great book and I'm fortunate to consider Nelson a friend. Another good one is Testosterone for Life by Abraham Morgantaler.

[ppwc1985]

I may just pick that one up too.

[Rrexy]

Thanks for the info.
I just downloaded Testosterone: "A Mans Guide" onto my iPad.

Looking forward to reading!

[sparverius]

It's worth reading if you're on TRT.

[Metalject]

Here's a good read from Nelson about high estradiol and how many may be over treating with anastrozole and taking their estradiol too low for their own good. This will definitely fly in the face of what's often preached on most TRT message boards.

High Estradiol Boosts Libido in Men on Testosterone Therapy

[almostgone]

....... It's a great book and I'm fortunate to consider Nelson a friend. Another good one is Testosterone for Life by Abraham Morgantaler.

Both of them are en route now. Looking forward to it!

[2Sox]

Here's a good read from Nelson about high estradiol and how many may be over treating with anastrozole and taking their estradiol too low for their own good. This will definitely fly in the face of what's often preached on most TRT message boards.

High Estradiol Boosts Libido in Men on Testosterone Therapy

It "looks like" a good study but one ought to approach it with a great deal of skepticism - particularly in light of the anecdotal reports of the men who are undergoing TRT and who experience low or no libido with both too low and too high estrogen levels AND in light of this quote from the same article:

Although their study highlights the importance of estrogen in men on TST, the authors explained, limitations include a lack of a control group and absence of score comparisons before and after start of TST. They also noted that a larger sample size might have unmasked a confounding relationship between testosterone and libido.

This quote bears out exactly what men on TRT experience; very low E2 levels and very high E2 levels wreak havoc on a man's libido:

The study, which was published in the New England Journal of Medicine (2013;369:1011-1022), showed that libido declines dramatically in conjunction with decreased levels of serum estrogen.

Although this seems to be an "abstract" of the actual research, what is conspicuously absent are any mention of ranges and any definition of what is "low" or "decreased".

Another quote - which would elicit a "Duh" from those of us on TRT:
“Aromatase inhibitors to reduce estrogen should be used judiciously to treat symptoms, such as gynecomastia and breast tenderness, and not for the sole purpose of reducing a high estrogen laboratory value,” Dr. Ramasamy cautioned.

I wonder if any of the researchers are on TRT. Walk a mile in my shoes, as the saying goes.

I respect Nelson Vergel a great deal but I wonder what his true opinion of this study is.

I'd highly doubt that this article would have anybody abandoning their AI's

[Beethoven]

I downloaded the book and have been reading. Excellent thus far. Right on 2Sox.

[Low Testosterone]

It "looks like" a good study but one ought to approach it with a great deal of skepticism - particularly in light of the anecdotal reports of the men who are undergoing TRT and who experience low or no libido with both too low and too high estrogen levels AND in light of this quote from the same article:

Although their study highlights the importance of estrogen in men on TST, the authors explained, limitations include a lack of a control group and absence of score comparisons before and after start of TST. They also noted that a larger sample size might have unmasked a confounding relationship between testosterone and libido.

This quote bears out exactly what men on TRT experience; very low E2 levels and very high E2 levels wreak havoc on a man's libido:

The study, which was published in the New England Journal of Medicine (2013;369:1011-1022), showed that libido declines dramatically in conjunction with decreased levels of serum estrogen.

Although this seems to be an "abstract" of the actual research, what is conspicuously absent are any mention of ranges and any definition of what is "low" or "decreased".

Another quote - which would elicit a "Duh" from those of us on TRT:
“Aromatase inhibitors to reduce estrogen should be used judiciously to treat symptoms, such as gynecomastia and breast tenderness, and not for the sole purpose of reducing a high estrogen laboratory value,” Dr. Ramasamy cautioned.

I wonder if any of the researchers are on TRT. Walk a mile in my shoes, as the saying goes.

I respect Nelson Vergel a great deal but I wonder what his true opinion of this study is.

I'd highly doubt that this article would have anybody abandoning their AI's

I can tell you without question Nelson believes more men than not are over treating their estradiol and many who are taking anastrozole or other anti-estrogens should NOT be taking them. This is from speaking to him directly first hand, in person, not on a msg board or email.

[2Sox]

I can tell you without question Nelson believes more men than not are over treating their estradiol and many who are taking anastrozole or other anti-estrogens should NOT be taking them. This is from speaking to him directly first hand, in person, not on a msg board or email.

I've made my own mistakes in this field and I tend to agree with you and Nelson about over treating. The danger, I believe, is for men who have dialed in and are doing well on their AI protocol (as their blood work indicates) - to begin having doubts about the usefulness of AI's and start playing around. "If it ain't broke, don't fix it."

[Beethoven]

In reading the, he really goes out of his way to use the 500-1000 scale for total t, yet I got the impression he was on more than 100 mg a week. In older men with a higher SHBG might need more test. Interesting.

[Low Testosterone]

I've made my own mistakes in this field and I tend to agree with you and Nelson about over treating. The danger, I believe, is for men who have dialed in and are doing well on their AI protocol (as their blood work indicates) - to begin having doubts about the usefulness of AI's and start playing around. "If it ain't broke, don't fix it."

One thing you may find, as it is quite common, many men who need an AI often find that in time they need less and less. This is a very hard thing to mentally get around...like you said, if it ain't broke don't fix it...it was working so it should still work. But the body changes, a lot of men seem to aromatize less and less as time goes by. Of course this doesn't always hold true, but again it is common.

Now the unfortunate truth, most men do NOT give TRT the chance it needs. Androgel released a study a while back that reported the majority of men stay on TRT for 6 months. After 6 months they stop for one of two reasons:

1. They don't notice the improvements
2. They feel great and feel that they don't need it any more.

In 12-18 months after discontinuing, many of these same men start therapy again...and once again stay on treatment for 6 months. As I'm sure you know, some of the benefits of TRT can take more than a year to fully reach, and most never give it that long.

Why this is all important - if you look at all the men on TRT, you will see most need an AI, after all, most on TRT are in the first 6 month phase or their second go around of TRT but in the first 6 month stage of that go around. Therefore, the majority of men on TRT are using significant amounts of AI, they have never regulated thereby flawing data a bit. Anyway, I feel I'm rambling so I'll let it go.

[2Sox]

One thing you may find, as it is quite common, many men who need an AI often find that in time they need less and less. This is a very hard thing to mentally get around...like you said, if it ain't broke don't fix it...it was working so it should still work. But the body changes, a lot of men seem to aromatize less and less as time goes by. Of course this doesn't always hold true, but again it is common.

Now the unfortunate truth, most men do NOT give TRT the chance it needs. Androgel released a study a while back that reported the majority of men stay on TRT for 6 months. After 6 months they stop for one of two reasons:

1. They don't notice the improvements
2. They feel great and feel that they don't need it any more.

In 12-18 months after discontinuing, many of these same men start therapy again...and once again stay on treatment for 6 months. As I'm sure you know, some of the benefits of TRT can take more than a year to fully reach, and most never give it that long.

Why this is all important - if you look at all the men on TRT, you will see most need an AI, after all, most on TRT are in the first 6 month phase or their second go around of TRT but in the first 6 month stage of that go around. Therefore, the majority of men on TRT are using significant amounts of AI, they have never regulated thereby flawing data a bit. Anyway, I feel I'm rambling so I'll let it go.

No, this is a very good point. It makes a lot of sense! Are you saying that statistics show that MOST men use an AI because the numbers include men who have resumed therapy again (which is a rather large number) - so the numbers are really not accurate?

[Low Testosterone]

No, this is a very good point. It makes a lot of sense! Are you saying that statistics show that MOST men use an AI because the numbers include men who have resumed therapy again (which is a rather large number) - so the numbers are really not accurate?

Correct, the majority of men on TRT are those in their first 6 months of TRT ever or those who have come back after a layoff of a year or more and are now once again in the first 6 months. So this obviously skews a lot of info greatly.

[2Sox]

Correct, the majority of men on TRT are those in their first 6 months of TRT ever or those who have come back after a layoff of a year or more and are now once again in the first 6 months. So this obviously skews a lot of info greatly.

My own experience has been that I felt great when I began TRT but then the feeling started to fade. I realized I needed anAI. I took it for awhile. I found I needed less. Then I recently started DIM, Ziinc, Copper with no AI and I'm doing okay. (We'll see.) So I might just be the poster boy for what you describe.

[kelkel]

One thing you may find, as it is quite common, many men who need an AI often find that in time they need less and less. This is a very hard thing to mentally get around...like you said, if it ain't broke don't fix it...it was working so it should still work. But the body changes, a lot of men seem to aromatize less and less as time goes by. Of course this doesn't always hold true, but again it is common.

Now the unfortunate truth, most men do NOT give TRT the chance it needs. Androgel released a study a while back that reported the majority of men stay on TRT for 6 months. After 6 months they stop for one of two reasons:

1. They don't notice the improvements Poor protocol and / or doctor patient relationship
2. They feel great and feel that they don't need it any more. Simply uninformed.

In 12-18 months after discontinuing, many of these same men start therapy again...and once again stay on treatment for 6 months. As I'm sure you know, some of the benefits of TRT can take more than a year to fully reach, and most never give it that long.

Why this is all important - if you look at all the men on TRT, you will see most need an AI, after all, most on TRT are in the first 6 month phase or their second go around of TRT but in the first 6 month stage of that go around. Therefore, the majority of men on TRT are using significant amounts of AI, they have never regulated thereby flawing data a bit. Anyway, I feel I'm rambling so I'll let it go.

It does seem like everyone tries to over-do it initially, then has to pull back.

Great stuff LT!

[Low Testosterone]

My own experience has been that I felt great when I began TRT but then the feeling started to fade. I realized I needed anAI. I took it for awhile. I found I needed less. Then I recently started DIM, Ziinc, Copper with no AI and I'm doing okay. (We'll see.) So I might just be the poster boy for what you describe.

One thing I've noticed is that it's very common for men to get used to feeling better. Some men feel fantastic pretty quick when they start TRT. I'd consider anything in the first 6-8wks to be very quick and maybe even somewhat attributed to placebo...not all of it but some. But in time, as men slowly get better they slowly become accustomed to it. This frustrates them, they don't have this "AWESOME" feeling anymore, which isn't a real feeling anyway. Think about it, when you were let's say 23yrs old, at the peak of your natural testosterone levels, did you feel awesome? No, you just felt normal, everything functioned like it was supposed to.

Here's a good example of what I mean - when you get laser eye surgery, the idea is to have 20/20 vision, but you do not expect to be able to see through walls after your laser eye surgery. TRT on the other hand, many men (if they're honest) expect to be able to run through walls or even knock them down by breathing on them. The expectations for many on TRT simply aren't reality.

Here are some interesting stats published by the European Society of Endocrinology in 2011:
(note - all stats are assuming all things are perfect - patient is dialed in from day one, has no genetic abnormalities and assumes all men are the same - obviously this is impossible to recreate in real life but it's the best gauge we have)

Libido: Increase should appear in 3wks, max increase 6wks
Erection & Ejaculation: Improvements should occur in 26wks, max in 26wks
Quality of life: Noticeable in 3-8wks, max 78wks
Depression: Possible improvements 3-6wks, max benefit 30wks
Body composition: 12-16wks, max benefit 52wks
Bone mineral density: Improvements 26wks, max benefit 156wks
Glycemic control: 12wks, max benefit 52wks
Inflammation: 3wks, max benefit 12wks.

[Low Testosterone]

It does seem like everyone tries to over-do it initially, then has to pull back.

Great stuff LT!

Actually, I attribute #1 more to lack of patience. Most men expect way too much way too soon. Our staff receives emails and phone calls daily from men who have been on TRT for 2-4 months and they do not understand why they are not sitting on top of the world. The most common complaint "I'm not seeing the gains I want in the gym" or "I thought I'd be able to orgasm a few times a day" or "I don't feel euphoric." All three comments are daily, the first and last most common but the orgasm one is close.

[kelkel]

You need to hand them a top ten list on the way out the door......