Should I consider T replacement?

[flyingfool]

I just turned 56 years old. Maybe 10 lbs overweight. 176lbs and 5’-7”.

I take 50 mcg thyroid T4

I swim 1 mile three days a week.

Recent blood labs from yesterday

Total T=489
Free T=12.44
SHBG=22.9
Estradiol=20

Are these decent or poor numbers for a man my age?

Symptoms:
Do not wake up with erection.

Erections work but are maybe 75% of what they used to be when younger

Get aroused and get errction. But lose it fairly quickly and takes fair amount of stimulation to get erection back.

I have used tadalafil 10mg once a day with some positive effect. But still not a solid erection like when I was in my 30’s or even 40’s.

Libido and interest are OK. Not anywhere like it used to be. But still more libido than my wife has so I am afraid if I get higher T levels all I will do is frustrate the crap out of my self! Being horny and no where to go with my desire.

Stamina for physical work seems to be waning in last couple years

I get muscle tone but not really muscle gain. But swimming is not resistance workout. And I HATE weight lifting. I just don’t enjoy it at all.

Cholesterol slightly high 216 HDL low at 36 LDL high 144. No amount of exercise has ANY effect what so ever on HDL. Increasing workouts does NOTHING and has actually decreased HDL rather than increase. Triglycerides high 178. NOT on a statin. Want to remain off statin if at all possible.

Was wondering if I started a cream on scrotum, if that would shut down all natural production. Is there any small dose that would be additive or is any drop of Testosterone applied totally shut down all production?

Will T cream on scrotum eventually desensitize and lose ability to absorb T?

Am I just getting older and this is just the way it is? Or am I low and should I consider T replacement?

 

[Systemlord]

Free T=12.44

What testing methodology was used for this Free T result?

What are the reference ranges?

Or am I low and should I consider T replacement?

If it were only that simple. AR gene CAG repeats long/short determines how sensitive you are to T. A longer CAG repeat means you need more T to feel normal.

Men below 550 ng/dL are 30% greater risk of full-blown heart attack and death by any cause.

Studies show loss of libido and vigor happen below 500 ng/dL. Desirable, healthy T levels are much higher than what doctors consider normal.

Am I just getting older and this is just the way it is?

I'm going to answer your question with a question, are you going to accept it or are you going to ensure a higher quality of life till the end?

 

[Systemlord]

I take 50 mcg thyroid T4

Maybe your thyroid is not optimized. Some people with thyroid problems have conversion disorders. The T4 doesn't convert well enough to fT3.

Therefore a combination of T3 and T4 are needed.

What are your TSH and fT3 levels?

 

[flyingfool]

I convert T4 to T3 very well. While only being 14% of the range of FT4 I am 45% of the range of FT3.

I don’t have any typical hypo thyroid symptoms. I may ask the Dr for a bump in my dosage to 75mcg. But with my TSH (which is a junk test to adjust dosage with) at the doctors beloved 1.0. The Dr may not go along with a increase. My argument is a very slow but consistent decrease in FT4 levels over the last couple years.

Perhaps increase in thyroid could potentially lower cholesterol levels. But if I also change diet and exercise and lose weight, it may be hard to tell what was the cause of the lowered cholesterol. IF it even lowers.

 

[flyingfool]

What testing methodology was used for this Free T result?

What are the reference ranges?


If it were only that simple. AR gene CAG repeats long/short determines how sensitive you are to T. A longer CAG repeat means you need more T to feel normal.

Men below 550 ng/dL are 30% greater risk of full-blown heart attack and death by any cause.

Studies show loss of libido and vigor happen below 500 ng/dL. Desirable, healthy T levels are much higher than what doctors consider normal.


I'm going to answer your question with a question, are you going to accept it or are you going to ensure a higher quality of life till the end?

I am not sure. That is why I am asking the question.

 

[flyingfool]

What testing methodology was used for this Free T result?

What are the reference ranges?


If it were only that simple. AR gene CAG repeats long/short determines how sensitive you are to T. A longer CAG repeat means you need more T to feel normal.

Men below 550 ng/dL are 30% greater risk of full-blown heart attack and death by any cause.

Studies show loss of libido and vigor happen below 500 ng/dL. Desirable, healthy T levels are much higher than what doctors consider normal.


I'm going to answer your question with a question, are you going to accept it or are you going to ensure a higher quality of life till the end?

 

[flyingfool]

Said above “Men below 550 ng/dL are 30% greater risk of full-blown heart attack and death by any cause.”

THAT is very concerning. Can you point me to a few credible references that reaches that conclusion. I have also read stuff that says men who do replacement die sooner. So how do I really know the truth?

 

[Systemlord]

Said above “Men below 550 ng/dL are 30% greater risk of full-blown heart attack and death by any cause.”

THAT is very concerning. Can you point me to a few credible references that reaches that conclusion. I have also read stuff that says men who do replacement die sooner. So how do I really know the truth?

The link to these papers is at the bottom of the link below.

Defining "Healthy" Testosterone

Multiple peer-reviewed papers state that "testosterone deficiencies" are more prevalent and "desirable testosterone" levels in men are actually much higher than what is currently being considered as "normal" in doctors' practices across the country. Case in point: A cross-sectional study of Swedish men ages 69 to 80 years showed the risk for premature death from any cause and the risk for suffering a major cardiovascular event were inversely correlated with the total serum testosterone concentration (i.e., the higher the testosterone levels, the lower the risk of death).

Specifically with regards to cardiovascular events, men in the highest quartile of testosterone (at or higher than 550 ng/dL) had a lower risk of cardiovascular events compared with men with lower testosterone.

More importantly, details from this study show that it did not matter if a man's total testosterone was very low (below 340 ng/dL ) or moderately low (up to 549 ng/dL ) – all men with T levels below 549 ng/dL had a similar increased risk for suffering a cardiovascular event. Only when total testosterone exceeded 550 ng/dL did cardiovascular risk drop.

This is truly alarming, as cardiovascular disease is the No. 1 killer of men in the United States and even more – this study was published in the Journal of the American College of Cardiology. These researchers documented a 30 percentreduction in cardiovascular events as well as a decrease in cerebrovascular disease incidence. Men with the highest total testosterone had a 24 percent reduced risk of transient ischemic attack or full-blown stroke. Clearly, based on this study, the only target for "healthy testosterone" is to maintain total testosterone at or above 550 ng/dL.

As a health care practitioner, please note the following:

According to LabCorp, the "healthy reference range" for total testosterone is 348–1,197 ng/dL. So, the lower part of this range completely ignores recent science that shows total testosterone levels need to be maintained above 550 ng/dL.

Subjectively, this broad range is ridiculous. As any 45-year-old man who has suffered with low normal testosterone knows,there is a world of difference in how a man feels and performs (both mentally and physically) when testosterone is "low normal" versus higher up the healthy "normal" reference range.

Giving Testosterone Levels a Boost | Dynamic Chiropractic

www.dynamicchiropractic.com

 

[Cataceous]

Said above “Men below 550 ng/dL are 30% greater risk of full-blown heart attack and death by any cause.”

THAT is very concerning. Can you point me to a few credible references that reaches that conclusion. I have also read stuff that says men who do replacement die sooner. So how do I really know the truth?

The unmentioned caveat is that correlation does not prove causality. In this context one must also consider free testosterone and SHBG. Free testosterone is considerably more important than total testosterone when it comes to the effects of testosterone. Lower SHBG artificially reduces total testosterone without affecting free testosterone. Therefore this study could be reflecting a risk linked to lower SHBG. Lower SHBG is correlated with metabolic syndrome, for one.

For a more balanced take, read here:

Testosterone, DHT and Estradiol and Mortality in Older Men

Testosterone Is Associated With Reduced All-Cause Mortality and Higher Dihydrotestosterone With Reduced Ischemic Heart Disease Mortality, While Estradiol Levels Do Not Predict Mortality- In older men, having total T levels in the middle two quartiles at baseline predicted reduced incidence...

www.excelmale.com

Our results challenge the concept that lower T is associated with increased mortality in a linear fashion. Instead, an optimal range of circulating total T corresponding to a range of 9.8 to 15.8 nmol/L (282–455 ng/dL) exists for older men, which predicts survival independent of other risk factors.​

What's interesting is that their graph shows mortality bottoming out when free testosterone is 200 pMol/L, which is 5.8 ng/dL. In comparison, your Vermeulen free testosterone is 12.4 ng/dL. In my opinion this value is into the healthy normal range. I would avoid TRT—but if you want to find out if higher testosterone would be beneficial then run a trial with a testosterone nasal gel such as Natesto. This has the advantage of causing less overall disruption to your hormones than conventional TRT.

By the way, do you have the same moniker on PeakTestosterone? Unfortunately the owner(s) of that site seem to have lost interest in keeping it going.

 

[molonlabedoc]

but if you want to find out if higher testosterone would be beneficial then run a trial with a testosterone nasal gel such as Natesto.

I have never heard of this! How interesting.

 

[Systemlord]

I have also read stuff that says men who do replacement die sooner.

You are likely referring to the poorly done study that came out of the VA in 2013 that made headlines across the world. The study was compiled of women and men NOT on T therapy and has long since been discredited.

All of the credible high quality studies on men NOT receiving T therapy who are T deficient have poorer health outcomes.

Mayo Clinic ->

Testosterone therapy is associated with reduced obesity, fat mass, and waist circumference (LOE Ib) and also improves glycemic control (LOE IIa). Mortality was reduced with T therapy in 2 retrospective studies. Several RCTs in men with coronary artery disease or heart failure reported improved function in men who received T compared with placebo. The largest meta-analysis to date revealed no increase in CV risks in men who received T and reduced CV risk among those with metabolic disease. In summary, there is no convincing evidence of increased CV risks with T therapy. On the contrary, there appears to be a strong beneficial relationship between normal T and CV health that has not yet been widely appreciated.

https://www.mayoclinicproceedings.org/pb/assets/raw/Health%20Advance/journals/jmcp/jmcp_ft90_1_2.pdf

 

[flyingfool]

The unmentioned caveat is that correlation does not prove causality. In this context one must also consider free testosterone and SHBG. Free testosterone is considerably more important than total testosterone when it comes to the effects of testosterone. Lower SHBG artificially reduces total testosterone without affecting free testosterone. Therefore this study could be reflecting a risk linked to lower SHBG. Lower SHBG is correlated with metabolic syndrome, for one.

For a more balanced take, read here:

Testosterone, DHT and Estradiol and Mortality in Older Men

Testosterone Is Associated With Reduced All-Cause Mortality and Higher Dihydrotestosterone With Reduced Ischemic Heart Disease Mortality, While Estradiol Levels Do Not Predict Mortality- In older men, having total T levels in the middle two quartiles at baseline predicted reduced incidence...

www.excelmale.com

Our results challenge the concept that lower T is associated with increased mortality in a linear fashion. Instead, an optimal range of circulating total T corresponding to a range of 9.8 to 15.8 nmol/L (282–455 ng/dL) exists for older men, which predicts survival independent of other risk factors.​

What's interesting is that their graph shows mortality bottoming out when free testosterone is 200 pMol/L, which is 5.8 ng/dL. In comparison, your Vermeulen free testosterone is 12.4 ng/dL. In my opinion this value is into the healthy normal range. I would avoid TRT—but if you want to find out if higher testosterone would be beneficial then run a trial with a testosterone nasal gel such as Natesto. This has the advantage of causing less overall disruption to your hormones than conventional TRT.

By the way, do you have the same moniker on PeakTestosterone? Unfortunately the owner(s) of that site seem to have lost interest in keeping it going.

Yes I am the same person as from Peak T site. I also recognize your alias/moniker.

 

[flyingfool]

I started taking tadalafil. Is -0mg a day too much?

How long will it take to notice any difference to know if it is working?

What if I don’t notice any better erection quality? What would that suggest?

 

[Systemlord]

I started taking tadalafil. Is -0mg a day too much?

This dosage isn't expected to show any results, lol!

What if I don’t notice any better erection quality?

Then you increase the dosage until you notice a difference or get side effects. If you don't notice any positive results increasing the dosage, then you're erectile problems have nothing to do with the structure of your penis and something else is causing the ED.

 

[Deleted member 43589]

I just turned 56 years old. Maybe 10 lbs overweight. 176lbs and 5’-7”.

I take 50 mcg thyroid T4

I swim 1 mile three days a week.

Recent blood labs from yesterday

Total T=489
Free T=12.44
SHBG=22.9
Estradiol=20

Are these decent or poor numbers for a man my age?

Symptoms:
Do not wake up with erection.

Erections work but are maybe 75% of what they used to be when younger

Get aroused and get errction. But lose it fairly quickly and takes fair amount of stimulation to get erection back.

I have used tadalafil 10mg once a day with some positive effect. But still not a solid erection like when I was in my 30’s or even 40’s.

Libido and interest are OK. Not anywhere like it used to be. But still more libido than my wife has so I am afraid if I get higher T levels all I will do is frustrate the crap out of my self! Being horny and no where to go with my desire.

Stamina for physical work seems to be waning in last couple years

I get muscle tone but not really muscle gain. But swimming is not resistance workout. And I HATE weight lifting. I just don’t enjoy it at all.

Cholesterol slightly high 216 HDL low at 36 LDL high 144. No amount of exercise has ANY effect what so ever on HDL. Increasing workouts does NOTHING and has actually decreased HDL rather than increase. Triglycerides high 178. NOT on a statin. Want to remain off statin if at all possible.

Was wondering if I started a cream on scrotum, if that would shut down all natural production. Is there any small dose that would be additive or is any drop of Testosterone applied totally shut down all production?

Will T cream on scrotum eventually desensitize and lose ability to absorb T?

Am I just getting older and this is just the way it is? Or am I low and should I consider T replacement?

Your metabolics are a mess, you need to get that under control. This can lead to cardiovascular disease. Might consider doing some type of highintensity interval training (HIIT) exercise, this can easily be done swimming too. Why? Take a look at the graph below from a study done comparing aerobic exercise with high intensity training, especially in your age group. The key to the response by resistance training, is combining periods of brief high intensity, where the heart rate goes 85%+ of your max (140+) followed by a resting period where the heart rate returns below 100bpm. 15 seconds of fast swimming followed by 1-2 minutes of very slow swimming can easily change some of your metabolics. You can get by with doing this every other day (3/d/wk) for 15 minutes.

Testosterone boost......A 2012 study compared HIIT with steady-state endurance exercises and found that HIIT actually increased testosterone levels while running continuously for 45 minutes did not.

HIIT produces increases in muscle power and free testosterone in male masters athletes - PubMed

High-intensity interval training (HIIT) improves peak power output (PPO) in sedentary aging men but has not been examined in masters endurance athletes. Therefore, we investigated whether a six-week program of low-volume HIIT would (i) improve PPO in masters athletes and (ii) whether any change...

pubmed.ncbi.nlm.nih.gov

Testosterone and Cortisol Responses to HIIT and Continuous Aerobic Exercise in Active Young Men

It is well known that physical exercise modifies plasma levels of testosterone and cortisol. However, the effect of high-intensity interval training (HIIT) on the plasma hormone levels is controversial. The aim of the study was to compare the effects of HIIT exercise or submaximal continuous...

www.mdpi.com

 

[flyingfool]

The tadalafil was supposed to be 10 mg.

I interval my swim. 100 yards 4 laps. My HR is nearly 90% of max. Followed by 60 second break. And repeat. 20 times. 2,000 yards which is over a mile in about 50 minutes.

 

[Deleted member 43589]

So you are good on the exercise. Have you tried any changes in your diet?

As far as testosterone replacement, metabolic syndrome is one of the side effects of not having enough testosterone in males. Might be you need to talk to a qualified doctor about this.

 

[flyingfool]

Well my blood pressure has also been rising. And my cholesterol has always been pretty high my whole life. And exercise does absolutely nothing for it.

 

[Deleted member 43589]

At your age you really need to get all of that in check. But I am sure you are already aware, high blood pressure and metabolic syndrome are setting yourself up for cardiac problems. You seem to have done a lot of things that woudl clean all of this up and its not working. Might be time for a doctor to check your hormone levels and perhaps prescribe TRT..

 

[flyingfool]

I think the starting post for this thread I posted my testosterone levels. They are not really low enough to justify T replacement.

My dr I will be starting on BP med’s and a statin. I do need to lose about 9 lbs. and will be adjusting diet. My wife needs to as well. We need to commit and change over the house pantry.

I absolutely hate weight lifting. So that will be the absolute last thing I will try.

I wanted to do this without meds but my genetics prevent that I guess.