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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Low libido and a visit to the Endocrinologist
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<blockquote data-quote="madman" data-source="post: 143911" data-attributes="member: 13851"><p>Your TT is definitely sub-par but your FT is low due to your high SHBG and although TT is important.....FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive benefits.</p><p></p><p>Most men need FT 2-3% of TT or in the 20-30 ng/dL range and yes some can do well slightly lower.</p><p></p><p></p><p>Your endo is an idiot.....who tests FAI (free androgen index)?</p><p></p><p></p><p></p><p><strong><span style="color: rgb(184, 49, 47)">Table 3.</span></strong></p><p><span style="color: rgb(0, 0, 0)"><strong>The Relative Merits and Demerits of Various Methods of Measuring Free and Bioavailable Testosterone Levels</strong></span></p><p></p><p></p><p><strong><span style="color: rgb(184, 49, 47)">Free androgen index </span></strong></p><p>•<strong> <span style="color: rgb(184, 49, 47)">Represents the ratio of total testosterone/SHBG </span>• Has been shown to correlate with free testosterone measurements • Simple to obtain </strong></p><p></p><p>• <strong><span style="color: rgb(184, 49, 47)">Overly simplistic</span> and <span style="color: rgb(184, 49, 47)">inaccurate measure of free testosterone concentrations </span>• <span style="color: rgb(184, 49, 47)">Poor indicator of gonadal status </span>• Dependent on accurate measurements of total testosterone and SHBG • <span style="color: rgb(184, 49, 47)">Most experts do not favor its use </span></strong></p><p></p><p></p><p>[ATTACH=full]7167[/ATTACH]</p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p><strong>Technical remark</strong></p><p></p><p>• <strong>Testosterone concentrations exhibit <span style="color: rgb(184, 49, 47)">significant diurnal and day-to-day variations</span> and may be <span style="color: rgb(184, 49, 47)">suppressed by food intake or glucose.</span></strong> <strong>Therefore, clinicians should measure <span style="color: rgb(184, 49, 47)">total testosterone concentrations</span> on <span style="color: rgb(184, 49, 47)">two separate mornings</span> when the patient is <span style="color: rgb(184, 49, 47)">fasting.</span> Clinicians should use an<span style="color: rgb(184, 49, 47)"> accurate and reliable method</span>, optimally, an <span style="color: rgb(184, 49, 47)">assay that has been certified</span> by an <span style="color: rgb(184, 49, 47)">accuracy-based standardization or quality control program </span>[e.g., Centers for Disease Control and Prevention (CDC) Hormone Standardization Program for Testosterone]. </strong></p><p></p><p></p><p>• <strong>In men who have conditions that <span style="color: rgb(184, 49, 47)">alter sex hormone–binding globulin (SHBG) (Table 2)</span>, or whose initial <span style="color: rgb(184, 49, 47)">total testosterone concentrations </span>are at or near the <span style="color: rgb(184, 49, 47)">lower limit of the normal range (Fig. 1)</span></strong>, <strong>clinicians should determine f<span style="color: rgb(184, 49, 47)">ree testosterone concentrations</span> either directly from <span style="color: rgb(184, 49, 47)">equilibrium dialysis assays</span> or by <span style="color: rgb(184, 49, 47)">calculations that use total testosterone, SHBG, and albumin concentrations. </span>Clinicians should <span style="color: rgb(184, 49, 47)">not use direct analog-based free testosterone immunoassays, </span>as they are <span style="color: rgb(184, 49, 47)">inaccurate. </span></strong></p><p></p><p></p><p>• <strong>Clinicians should not test men for testosterone deficiency who have or are recovering from an <span style="color: rgb(184, 49, 47)">acute illness </span><span style="color: rgb(0, 0, 0)">or are engaged in </span><span style="color: rgb(184, 49, 47)">short-term use of medications (e.g., opioids) </span>that <span style="color: rgb(184, 49, 47)">suppress testosterone concentrations. </span></strong></p><p></p><p></p><p></p><p></p><p></p><p>I will make this point below</p><p></p><p>- THIS NEEDS TO BE STRESSED:</p><p><span style="color: rgb(184, 49, 47)"><strong>*</strong></span><strong>Clinicians should <span style="color: rgb(184, 49, 47)">not use direct analog-based free testosterone immunoassays, </span>as they are <span style="color: rgb(184, 49, 47)">inaccurate. </span></strong></p><p></p><p>- FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive benefits.....<span style="color: rgb(184, 49, 47)"><strong>why everyone is still using the </strong></span><span style="color: rgb(0, 0, 0)"><strong>direct analog-based free testosterone immunoassays </strong></span><span style="color: rgb(184, 49, 47)"><strong>is beyond me.</strong></span></p></blockquote><p></p>
[QUOTE="madman, post: 143911, member: 13851"] Your TT is definitely sub-par but your FT is low due to your high SHBG and although TT is important.....FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive benefits. Most men need FT 2-3% of TT or in the 20-30 ng/dL range and yes some can do well slightly lower. Your endo is an idiot.....who tests FAI (free androgen index)? [B][COLOR=rgb(184, 49, 47)]Table 3.[/COLOR][/B] [COLOR=rgb(0, 0, 0)][B]The Relative Merits and Demerits of Various Methods of Measuring Free and Bioavailable Testosterone Levels[/B][/COLOR] [B][COLOR=rgb(184, 49, 47)]Free androgen index [/COLOR][/B] •[B] [COLOR=rgb(184, 49, 47)]Represents the ratio of total testosterone/SHBG [/COLOR]• Has been shown to correlate with free testosterone measurements • Simple to obtain [/B] • [B][COLOR=rgb(184, 49, 47)]Overly simplistic[/COLOR] and [COLOR=rgb(184, 49, 47)]inaccurate measure of free testosterone concentrations [/COLOR]• [COLOR=rgb(184, 49, 47)]Poor indicator of gonadal status [/COLOR]• Dependent on accurate measurements of total testosterone and SHBG • [COLOR=rgb(184, 49, 47)]Most experts do not favor its use [/COLOR][/B] [ATTACH=full]7167[/ATTACH] [B]Technical remark[/B] • [B]Testosterone concentrations exhibit [COLOR=rgb(184, 49, 47)]significant diurnal and day-to-day variations[/COLOR] and may be [COLOR=rgb(184, 49, 47)]suppressed by food intake or glucose.[/COLOR][/B] [B]Therefore, clinicians should measure [COLOR=rgb(184, 49, 47)]total testosterone concentrations[/COLOR] on [COLOR=rgb(184, 49, 47)]two separate mornings[/COLOR] when the patient is [COLOR=rgb(184, 49, 47)]fasting.[/COLOR] Clinicians should use an[COLOR=rgb(184, 49, 47)] accurate and reliable method[/COLOR], optimally, an [COLOR=rgb(184, 49, 47)]assay that has been certified[/COLOR] by an [COLOR=rgb(184, 49, 47)]accuracy-based standardization or quality control program [/COLOR][e.g., Centers for Disease Control and Prevention (CDC) Hormone Standardization Program for Testosterone]. [/B] • [B]In men who have conditions that [COLOR=rgb(184, 49, 47)]alter sex hormone–binding globulin (SHBG) (Table 2)[/COLOR], or whose initial [COLOR=rgb(184, 49, 47)]total testosterone concentrations [/COLOR]are at or near the [COLOR=rgb(184, 49, 47)]lower limit of the normal range (Fig. 1)[/COLOR][/B], [B]clinicians should determine f[COLOR=rgb(184, 49, 47)]ree testosterone concentrations[/COLOR] either directly from [COLOR=rgb(184, 49, 47)]equilibrium dialysis assays[/COLOR] or by [COLOR=rgb(184, 49, 47)]calculations that use total testosterone, SHBG, and albumin concentrations. [/COLOR]Clinicians should [COLOR=rgb(184, 49, 47)]not use direct analog-based free testosterone immunoassays, [/COLOR]as they are [COLOR=rgb(184, 49, 47)]inaccurate. [/COLOR][/B] • [B]Clinicians should not test men for testosterone deficiency who have or are recovering from an [COLOR=rgb(184, 49, 47)]acute illness [/COLOR][COLOR=rgb(0, 0, 0)]or are engaged in [/COLOR][COLOR=rgb(184, 49, 47)]short-term use of medications (e.g., opioids) [/COLOR]that [COLOR=rgb(184, 49, 47)]suppress testosterone concentrations. [/COLOR][/B] I will make this point below - THIS NEEDS TO BE STRESSED: [COLOR=rgb(184, 49, 47)][B]*[/B][/COLOR][B]Clinicians should [COLOR=rgb(184, 49, 47)]not use direct analog-based free testosterone immunoassays, [/COLOR]as they are [COLOR=rgb(184, 49, 47)]inaccurate. [/COLOR][/B] - FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive benefits.....[COLOR=rgb(184, 49, 47)][B]why everyone is still using the [/B][/COLOR][COLOR=rgb(0, 0, 0)][B]direct analog-based free testosterone immunoassays [/B][/COLOR][COLOR=rgb(184, 49, 47)][B]is beyond me.[/B][/COLOR] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Low libido and a visit to the Endocrinologist
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