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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Is this primary or secondary hypogonadism?
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<blockquote data-quote="FunkOdyssey" data-source="post: 227985" data-attributes="member: 44064"><p>Thank you for your reply readalot. I've been reading alot here and on t-nation and find your posts very informative and well-researched. You are probably saving some lives by highlighting the risks of high hematocrit.</p><p></p><p>I don't think a diagnostic algorithm that depends on a certain threshold of total testosterone before considering free testosterone is useful in scenarios where SHBG is out-of-range high. It makes more sense to jump directly to free testosterone in that case. I have observed that my free testosterone, which you well know correlates better with hypogonadal symptoms than total testosterone, is actually lower than many men whose total testosterone is below 300 ng/dL.</p><p></p><p>So what value of free testosterone threshold should be used to define hypogonadism? I found a useful table in Nelson's book:</p><p></p><p>[ATTACH=full]23565[/ATTACH]</p><p></p><p>It seems I would be considered hypogonadal based on the thresholds of multiple medical associations above. I don't know how exactly Quest established their reference range, but I would assume they have included old and obese men. In my opinon, the most useful reference range for both total and free testosterone is based on a cohort of healthy, non-obese men ages 19-40 from the Framingham Heart Study: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146796/" target="_blank">Reference Ranges for Testosterone in Men Generated Using Liquid Chromatography Tandem Mass Spectrometry in a Community-Based Sample of Healthy Nonobese Young Men in the Framingham Heart Study and Applied to Three Geographically Distinct Cohorts</a></p><p></p><p>[ATTACH=full]23566[/ATTACH]</p><p></p><p>These are the sort of men I want to compare myself with, and my free T values are below their 2.5th percentile and would be flagged as out-of-range low.</p><p></p><p>The calculated values you provided are interesting but I don't know how relevant they are when I have actual measurements via "gold-standard" equilibrium dialysis already.</p><p></p><p>Beyond the T values, I also respond yes to 9 out of 10 items on the ADAM survey and have long-standing borderline anemia of the normochromic, normocytic variety which supports the diagnosis.</p></blockquote><p></p>
[QUOTE="FunkOdyssey, post: 227985, member: 44064"] Thank you for your reply readalot. I've been reading alot here and on t-nation and find your posts very informative and well-researched. You are probably saving some lives by highlighting the risks of high hematocrit. I don't think a diagnostic algorithm that depends on a certain threshold of total testosterone before considering free testosterone is useful in scenarios where SHBG is out-of-range high. It makes more sense to jump directly to free testosterone in that case. I have observed that my free testosterone, which you well know correlates better with hypogonadal symptoms than total testosterone, is actually lower than many men whose total testosterone is below 300 ng/dL. So what value of free testosterone threshold should be used to define hypogonadism? I found a useful table in Nelson's book: [ATTACH type="full"]23565[/ATTACH] It seems I would be considered hypogonadal based on the thresholds of multiple medical associations above. I don't know how exactly Quest established their reference range, but I would assume they have included old and obese men. In my opinon, the most useful reference range for both total and free testosterone is based on a cohort of healthy, non-obese men ages 19-40 from the Framingham Heart Study: [URL='https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146796/']Reference Ranges for Testosterone in Men Generated Using Liquid Chromatography Tandem Mass Spectrometry in a Community-Based Sample of Healthy Nonobese Young Men in the Framingham Heart Study and Applied to Three Geographically Distinct Cohorts[/URL] [ATTACH type="full"]23566[/ATTACH] These are the sort of men I want to compare myself with, and my free T values are below their 2.5th percentile and would be flagged as out-of-range low. The calculated values you provided are interesting but I don't know how relevant they are when I have actual measurements via "gold-standard" equilibrium dialysis already. Beyond the T values, I also respond yes to 9 out of 10 items on the ADAM survey and have long-standing borderline anemia of the normochromic, normocytic variety which supports the diagnosis. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Is this primary or secondary hypogonadism?
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