See below
It is, as it results in non-physiological levels for a vast majority of men.
Since you're so fond of anecdotes, take a spin through the
Excel Male forums and look for posts describing symptoms that are clearly linked to excessive doing, such as elevated hematocrit. This will be easy since there are several a week, on average. Next look for instances where the dose is objectively too low and the poster was given no option to increase it. Consider the ratio of these two types of posts and what is says about the way TRT should be approached.
This update to the Endocrine Society’s 2010 testosterone guideline, prepared by an expert panel, describes the diagnosis, screening, treatment, and monitor
academic.oup.com
Testosterone testing and prescriptions have nearly tripled in recent years; however, it is clear from clinical practice that there are many men using testosterone without a clear indication. AUA identified a need to produce an evidence-based document that informs clinicians on the proper...
www.auanet.org
To assess the relative effects of individual testosterone products among hypogonadal men. Systematic review and network meta-analysis. We searched MEDLINE, Embase, Cochrane CENTRAL, and grey literature (25 May 2017) for randomised-controlled trials ...
pmc.ncbi.nlm.nih.gov
AbstractIntroduction. Sustained treatment with elevated levels of exogenous testosterone (T) has been linked to various adverse events, particularly concer
academic.oup.com
Introduction: Testosterone replacement therapy (TRT) is a generally accepted method treating for aging-related late-onset hypogonadism (LOH). However, the ef...
www.frontiersin.org
Testosterone replacement therapy (TRT) is commonly used to treat men with hypogonadism in order to replace the physiological levels of testosterone, although the cardiovascular safety and metabolic advantages of this treatment are still controversial. This article is a systematic review of the...
www.cureus.com
Testosterone replacement therapy produces clinically meaningful improvements in sexual function, mood, muscle mass, bone density, and quality of life in hypo...
www.droracle.ai
1.) sure, I’ve seen plenty of posters that I think were on on too high of a dose and have myself suggested lowering them. In those cases it’s normally when the poster is on 150 or more per week and are having obvious issues. Still, that does nothing to negate the fact that hundreds of thousands(possibly over a million) men are on doses between 100-125 per week and are doing great. It also doesn’t negate the fact that benefits are often greater at these doses and the safety of them is well-established by numerous studies as well as the experience of the aforementioned men and their doctors. Sure some guys will have problems at those doses. It also true that some guys will require doses higher than that for maximum benefits. But we don’t base general guidelines on outliers. You never see me going “sure you’re doing alright at 100 mg/week but you should absolutely try 200 because that’s the only way to be certain you aren’t better there”. Yet you constantly do that in reverse with guys doing great on doses that are clearly effective and which seem to be completely safe for them(and that is further supported by the studies).
As for your links… I clicked the first two an they were just links to panels getting together to establish guidelines. That’s not a study, that’s a group of humans coming up with an approach. You wouldn’t see a group of doctors coming up with guidelines on anti-depressants and call it a study on anti-depressants. Also, they don’t say anything about doses, they talk about hitting certain blood levels. And to make it worse they only focus on total testosterone levels, a possible signal that their approach is flawed right out of the gate.
From the link:
Evidence
This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies.
Consensus Process
One group meeting, several conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees and members and the cosponsoring organization were invited to review and comment on preliminary drafts of the guideline.
One of the studies you posted found this:
From a cohort of 537 men diagnosed with hypogonadism, we included 184 patients who underwent testosterone replacement therapy (TRT). Among these patients, 135 (73.4%) were treated to achieve physiological testosterone levels, with a median level of 468.0 ng/dL (interquartile range, IQR = 308.0-644.5), while 49 patients (26.6%) were treated to attain supraphysiologic testosterone levels, with a median level of 1552 ng/dL (IQR = 1279-1700). Before initiating TRT, there was no significant difference in testosterone levels between the two groups (p = 0.11). Moreover, no significant differences were found between the groups in terms of a history of diabetes mellitus (DM; p = 0.422) or prostate cancer (p = 0.29). However, significant differences were observed in the history of hypertension (HTN; p = 0.003) and hyperlipidemia (HLD; p = 0.006), with more patients in the physiologic testosterone group having a diagnosis of HTN and HLD prior to treatment.
Regarding adverse events, there were more cases of polycythemia in the supraphysiologic testosterone group compared to the physiologic testosterone group (p < 0.001; 35.4% vs. 7.0%). Interestingly, there was no significant difference in the rate of other adverse events after TRT between the two groups, including venous thromboembolism (VTE; p = 0.285), major adverse cardiovascular events (MACE; p = 0.768), deep vein thrombosis (DVT; p > 0.999), myocardial infarction (MI; p = 0.562), and stroke (p > 0.999).
So even by more than tripling the number for total t in the supraphysiological group, the only adverse event that saw an increase in was polycythemia. All other adverse events occurred at the same rates among the groups. And the Traverse trial seems to provide a signal that shows as long as hematocrit is kept at or below 54 then there it is perfectly safe.
And yes, if someone starts getting up close to 55 on hematocrit I’ll be the first to tell them they need to make adjustments.
You seem fixated on this approach that anything above what is produced normally is almost certainly bad. You’re taking an unnatural phenomenon and trying to bind it to natural parameters. However, the evidence and experiences of millions of men across the globe doesn’t support your argument. For the 4,728th time, the sweet spot for the majority of men seems to be in the 100-125 range. That is where maximum benefits are seen without significantly increasing risks.
