Supra physiological FT
- Thread starter Seagal
- Start date
Share this page
Nelson Vergel
Founder, ExcelMale.com
So does that mean what he says in his videos is BS?
I really enjoyed the video.
I like how the findings demonstrate Treating symptoms over Thresholds and opinion based Reference Ranges. AUA: "Guidelines do not necessarily establish a standard of care".
The data did not expose adverse reactions to supraphysiologic doses. i.e. Higher BP, the increase in Hct, and need for phlebotomy or the subsequent lower Iron and Ferritin levels after Phlebotomy. They did not control or manage E2 and allowed it to rise naturally. But, did not account for any adverse effects like Higher BP or Gynecomastia, from the higher E2.
I do like TRT following a symptomatic approach based on individual biological tolerance and efficacy. It makes perfect sense. But, what keeps guys from falsely complaining (Lying) about Low T symptoms just to get an ever increasing Higher dosage? -I'm sure that happens now. But, Dr's generally hold to "normal" Ref Ranges, (albeit unreliable and opinion based) they are established limits or guidelines, which surely help to limit liability
I didn't watch all of the video.
Where did the reference ranges for testosterone come from?
What was the sample size of men used to come up with the reference range?
Were these men healthy and asymptomatic?
Is there enough evidence that the use of exogenous testosterone that puts a man well above the reference range like most of Dr Nichol's patients causes any harm?
If so, what harm can be done?
Where did the reference ranges for testosterone come from?
What was the sample size of men used to come up with the reference range?
Were these men healthy and asymptomatic?
Is there enough evidence that the use of exogenous testosterone that puts a man well above the reference range like most of Dr Nichol's patients causes any harm?
If so, what harm can be done?
madman
Super Moderator
Still caught up on those kiddie forums I see!
Much more to the story BRUH!
One sided view as you clearly have no clue either!
Would not even waste my time listening to this BIRD!
The guy still preaching that optimized sky-high trough FT BULLS**T!
The guy still caught up on that Bhasin/Jasuja study!
End all be all right!
Hate to burst your bubbles here but the reference ranges only apply to that specific assay (ED device/procedure).
Look over the study.
In the subset of healthy natty males age 19-39 years mFT 2.5-97.5th percentile 12.0-36.8 ng/dL.
It's those NATTY OUTLIERS that fall in the 97.5% as in the upper limit of the reference range that are hitting a FT 36.8 ng/dL and this is a DAILY SHORT-LIVED PEAK to boot!
Better yet look at where the median 19.0 ng/dL sits!
* In the subset of men, 19 to 39 years, the corresponding 2.5 th, 10th, 25th, 50th, 75th, 90th and 97.5th percentile values for absolute free testosterone were 120, 128, 149, 190, 228, 274, and 368 pg/mL.
In healthy natty males age 19 years or older mFT 2.5-97.5th percentile 6.6-30.9 ng/dL.
Again It's those NATTY OUTLIERS that fall in the 97.5% as in the upper limit of the reference range that are hitting a FT 30.9 ng/dL and this is a DAILY SHORT-LIVED PEAK to boot!
Better yet look at where the median 14.1 ng/dL sits!
* In healthy nonobese men, 19 years or older, the 2.5th, 10th, 25th, 50th, 75th, 90th and 97.5th percentile values for absolute free testosterone were 66, 91, 116, 141, 190, 240, and 309 pg/mL, respectively (Table 3)
LMFAO!
This is the same guy that uses/relies on Labcorp's Equilibrium Ultrafiltration assay which no one should be using at it is more susceptible to technical artifacts that can introduce either overestimation or underestimation of free T.
He already got called out on this!
Equilibrium ultrafiltration is a direct method for measuring FT but compared with the gold standard Equilibrium dialysis it is more susceptible to methodological variability.
He is the one always bashing Quests ED assay because he is caught up on that top-end reference range 15.5 ng/dL.
LMFAO!
Again not all ED devices/procedures are the same.
The gold standard Equilibrium Dialysis is where it's at otherwise you need to use/rely on the calculated go to linear law-of-mass action Vermeulen which will give a good approximation.
He is still clearly out to lunch when it comes to testing the most critical fraction free testosterone let alone the reference ranges.
Hitting the nail on the head!
* An expert panel of the Endocrine Society (9) reviewed the various methods for determining free testosterone (4,5,9,21-32) and concluded that each method has some inherent limitations but that the equilibrium dialysis method is the reference standard against which all other methods should be compared (33). However, substantial heterogeneity in the procedures used by various laboratories for performing the equilibrium dialysis assay has contributed to variability in the reported free testosterone values
* Because of the wide variation in the equilibrium dialysis procedures, the reference ranges are not generalizable across laboratories
* These reference ranges, generated in a reference sample of healthy men, should not be applied to other assays in other laboratories without appropriate cross-calibration of assays. Differences in study populations, time of sample collection, and testosterone assays can contribute to the differences in reference ranges. The adoption of a standardized procedure for measuring free testosterone and cross-calibration of the testosterone assays against an accuracy-based benchmark such as the CDC's HoST program will facilitate the application of these reference ranges across laboratories
* The accuracy and precision of the total testosterone assay also affect the precision and accuracy of the measured free testosterone concentration. Most commercial laboratories do not report the buffer composition and other dialysis conditions which renders it difficult to evaluate their methods; the procedures for equilibrium dialysis have varied even in published reports from academic research laboratories (2,24,32-37). Because of the wide variation in the equilibrium dialysis procedures, the reference ranges are not generalizable across laboratories
My reply:
Even then Quest''s ED assay is not the same as the ED assay used in the Jasuja/Bhasin paper that I posted back in 2022 before it was released.
The reference ranges given in that paper only apply to that specific assay (ED device/procedure).
The reference ranges in that paper are not set in stone!
As of now there is no standardized ED procedure/assay or harmonized reference range for free testosterone!
Also need to understand that when it comes to the confusion of the currently used/relied upon ED methods between laboratories for testing free testosterone everyone needs to keep in mind that not all ED devices/procedures are the same.
Dr. Shalender Bhasin
* Equilibrium Dialysis is the reference method which I recommend highly, the problem is that the Equilibrium Dialysis method has not been harmonized across laboratories and the reference ranges vary across laboratories so there's a great need for standardizing the procedure and generating population-based harmonized reference ranges and we have done this and published a standardized procedure for Equilibrium Dialysis and published the reference ranges in this paper that you can look up
* In healthy nonobese men, 19 years or older, the 2.5th, 10th, 25th, 50th, 75th, 90th and 97.5th percentile values for absolute free testosterone were 66, 91, 116, 141, 190, 240, and 309 pg/mL, respectively (Table 3). To convert standard units (pg/mL) to SI units (pmol/L), please divide the concentrations in pg/mL by 0.2885. In the subset of men, 19 to 39 years, the corresponding 2.5 th, 10th, 25th, 50th, 75th, 90th and 97.5th percentile values for absolute free testosterone were 120, 128, 149, 190, 228, 274, and 368 pg/mL. By convention, the 2.5th percentile of the reference sample defines the lower limit of the reference range and the 97.5th percentile value defines the upper limit (46,47). By this convention, the normal range in the reference sample of men 19 to 39 years is 120 to 368 pg/mL (415 to 1274 pmol/L) and, in all men, the range is 66 to 309 pg/mL [229 to 1072 pmol/L], respectively
* These reference ranges, generated in a reference sample of healthy men, should not be applied to other assays in other laboratories without appropriate cross-calibration of assays. Differences in study populations, time of sample collection, and testosterone assays can contribute to the differences in reference ranges. The adoption of a standardized procedure for measuring free testosterone and cross-calibration of the testosterone assays against an accuracy-based benchmark such as the CDC's HoST program will facilitate the application of these reference ranges across laboratories
Throw this into the F**KING mix too!
* In this study, we present the largest dataset of mFT levels to date, providing male reference ranges spanning a wide age range, using a gold standard quantification method and accepted CLSI methodologies for generating reference ranges.
* In the current study, we used a state-of-the-art direct ED method to reassess FT in sets of representative serum samples. This method takes advantage of the ability of a highly sensitive and accurate measurement of T by liquid chromatography–tandem mass spectrometry (LC-MS/MS) to reliably measure the low FT concentration directly in the dialysate after ED.
* The established reference ranges are in line with previous reports of mFT (22,33,34) and may potentially be used as a reference data set for other methods. However, before these data can be more broadly implemented in clinical laboratories and clinical care,harmonization/standardization and cross-validation of existing mFT methods are required. Harmonization/standardization initiatives are crucial to move forward, given the increasing interest in mFT. Indeed, more clinical and commercial laboratories have been developing in-house mFT methods with improved throughput and shorter dialysis times (23,35,36). However, without the existence of a reference measurement system and reference measurement procedures, the performance of existing routine methods in terms of calibration and sample related effects cannot be assessed, nor can the calibration of the assays be traceable to a common reference point. This may result in large differences between methods.
Wonder why he left out the most recent study LMFAO!
My reply:
Healthy natty males age 18-29 years mFT 2.5-97.5th percentile 6.39-25.3 ng/dL.
It's those natty outliers that fall in the 97.5% that are hitting a FT 25.3 ng/dL and this is a daily short-lived peak to boot!
Better yet look at where the median 11.71 ng/dL sits!
*We established mFT reference ranges for healthy men aged 18 to 69 years
We present 95% mFT age-stratified reference ranges
Age category (years) | Median mFT (ng/dl) | 95% mFT reference range (ng/dl) |
18-29 (n=140) 30-39 (n=252) | 12.0 9.8 | 6.7-25.3 4.9-18.5 |
40-49 (n=207) | 8.1 | 4.3.14.2 |
50-59 (n=146) | 7.1 | 3.8-12.8 |
60-69 (n=126) | 6.4 | 3.4-11.7 |
70-79 (n=125) | 5.6 | 2.7-8.7 |
*The gold-standard for the determination of FT levels is considered to be directly measured free testosterone (mFT) using equilibrium dialysis followed by mass spectrometry (ED LC-MS/MS). However, no widely accepted reference ranges are available for this clinical parameter. We established mFT reference ranges for healthy men aged 18 to 69 years
*Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies
* mFT levels were measured in 867 men using ED LC-MS/MS as previously reported (1).
Reference: 1. Fiers T, Wu F, Moghetti P, Vanderschueren D, Lapauw B, Kaufman JM. Reassessing Free-Testosterone Calculation by Liquid Chromatography–Tandem Mass Spectrometry Direct Equilibrium Dialysis. J Clin Endocrinol Metab. 2018;103(6). doi:10.1210/jc.2017-02360
In the current study, we used a state-of-the-art direct ED method to reassess FT in sets of representative serum samples. This method takes advantage of the ability of a highly sensitive and accurate measurement of T by liquid chromatography–tandem mass spectrometry (LC-MS/MS) to reliably measure the low FT concentration directly in the dialysate after ED. This more straightforward method avoids potential sources of inaccuracy in indirect ED, such as those resulting from tracer impurities or from measures to limit their impact (e.g., sample dilution). We then used the measured FT results to re-evaluate some characteristics of two more established and a more recently proposed calculations for estimation of FT.
No one should be using/elying on the known to be inaccurate direct immunoassay!
Speakers: Jessica Colon-Franco, Ph.D., Cleveland Clinic; Leslie Farris, Ph.D., Cleveland Clinic
Accurate assessment of free testosterone (FT) is essential in evaluating androgen status, particularly in cases where total testosterone may be misleading due to altered binding protein levels. This workshop will describe a practical and state-of-the-art LC-MS/MS method for directly...
Speakers: Jessica Colon-Franco, Ph.D., Cleveland Clinic; Leslie Farris, Ph.D., Cleveland Clinic
Accurate assessment of free testosterone (FT) is essential in evaluating androgen status, particularly in cases where total testosterone may be misleading due to altered binding protein levels. This workshop will describe a practical and state-of-the-art LC-MS/MS method for directly...
This gives us an OPTIMIZATION WINDOW of 11.8-15.9 ng/dL
* over 20 years of the Millennium's clinical observation of patients we have identified that patients within this upper-mid quartile range demonstrate better energy, enhanced cognitive performance, improved metabolic stability and better androgen receptor activation compared to those clustered in the lower half of the reference range this slide reinforces the central theme of this presentation that normal spans a wide statistical range but OPTIMAL PHYSIO:OGY often resides within a NARROWER FUNCTIONALLY DEFINED BANDWIDTH which we believe based upon patient outcomes is BETWEEN the SECOND and THIRD QUARTILES
* When free testosterone is optimized into the upper functional quartile of the reference range, often ~12–22+ ng/dL, patients consistently report improvements in cognition, motivation, emotional resilience, and metabolic stability. These subjective gains are frequently accompanied by objective changes, including improved IGF-1 signaling, enhanced mitochondrial efficiency, and favorable shifts in body composition and hematologic parameters.
Seagal
Well-Known Member
That was only one part of his lecture, where he explains why some men need need higher levels.
The whole lecture
Nice to see you moved on from Tru-T and have joined Team cFTV. Well done!
Re: Tru -T Vs. Team cFTV
What's funny (peculiar) is; even on this site, much of the data (even posted by Nelson Vergel) continues to support and reference TT #'s as the Gold standard or at least the standard for reference.
So, as long as there continues to be credible data supported by TT #'s AND FT #'s widely circulating, there is going to be confusion and debate among patients and peers. Which is unfortunate. Everyone on here wants to better understand TRT.
Most unfortunate is the judgement and perceived hierarchy sometimes handed down from those who share the FT is King opinion! I'm not debating either way. Cause either camp is validated by "Studies" and "data" and neither has been exalted as absolute.
Our Political landscape and Social Media is bad enough. I gotta wonder; does every aspect of our lives need to turn into an "Us or Them" mentality? As responsible adults now, do we need to continue the petty Middle school/High school peer pressure tactics? The sarcastic judgmental comments towards those who might not see things the same way? (especially on this ever evolving subject)
Everyone with Low T is on the same Team.
oraldate, I'm Not aiming this at you personally or at your above comment. I'm new on here and have noticed some very biased view points and conjecture at times, resulting in demeaning sarcasm.
My apologies to all, if my remarks seem out of line or course. I just call 'em like I see 'em
madman
Super Moderator
Just to be very clear here I never joined any team LOL!
I fly in my own lane here as in solo!
Got my fingers deep in the game as in far reaching.
Excel is a different animal here!
If it does not suite your fancy then move on.
I'm not here to play games.
As I already told you bad move getting caught up TT.
FT is the critical fraction!
Any top expert truly in the know would tell you this.
The legendary Dr. Bhasin, the man who would be considered the father of testosterone Dr. Morgentaler and the master blaster Dr. Khera would be considered three of the top heavyweights when it comes to (research/clinical experience as in DECADES) in the field of hormone replacement therapy!
Throw in Traish, Zitzmann, Anawalt and Corona too.
These guys are powerhouses especially when it comes to research/clinical experience (decades)!
Free testosterone is the primary driver of both benefits and side effects once someone is on exogenous T.
Those truly in the know use TT as a safety ceiling and FT as the actual therapeutic target.
All that should really matter here is the dose one needs to achieve a healthy trough FT which will result in relief/improvement of low-T symptoms and overall well-being.
Unfortunately many are overmedicated on T especially from the get-go!
Yes symptom relief is what truly matters but when it comes to what FT level is needed one needs to keep in mind the overall goal would be to use the least amount in order to feel well while at the same time minimizing sides and keep blood markers healthy long-term.
The goal here would be to target the lowest effective dose that relieves symptoms and restores physiologic--->high-normal Free T trough levels (15-30 ng/dL).
Critical to pay attention to ones injection frequency/trough FT as there is going to be a big diffrerence between one hitting a high-end/high trough FT injecting daily vs twice-weekly vs once weekly
There is also going to be a big difference in what FT level is achieved running a high-end/high TT in a man with low vs normal vs high SHBG!
Listen closely (7:20-15:17) as Traish lays it out here!
07:32 - Testosterone measurement and its limitations
Gets even better @ 15:18-26:37 if you want to get into AR DDS (distribution, density, sensitivity of the AR,/polymorphism of the AR/CAG repeat length (long/short)!
That young lady from Belgium behind the ground breaking study he mentions is Dr. Leen Antonio (thread posted below)!
14:10 - Individual testosterone levels and how they respond differently to different levels of testosterone
19:12 - Testosterone levels and their interpretation, with criticism of the 300 ng/dL cutoff point
World renowned Abdulmaged M. Traish!
Great interview!
As usual free testosterone is where it's at!
Nelson we need to inform Dr.Traish or better yet all of the uros, endos and GPs about discounted labs LMFAO!
Listen closely 7:20-15:17
* it's easy to measure Total Testosterone, it's not easy to measure Free Testosterone
* it's so easy to measure Total Testosterone, it's really COMPLEX to measure Free Testosterone
*it's the Free Testosterone that matters not the...
Great interview!
As usual free testosterone is where it's at!
Nelson we need to inform Dr.Traish or better yet all of the uros, endos and GPs about discounted labs LMFAO!
Testosterone, Free (Equilibrium Dialysis) and Total, MS | Discounted Labs
Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.
Listen closely 7:20-15:17
* it's easy to measure Total Testosterone, it's not easy to measure Free Testosterone
* it's so easy to measure Total Testosterone, it's really COMPLEX to measure Free Testosterone
*it's the Free Testosterone that matters not the...
Dr. Leen Antonio
The case for free testosterone
Leen Antonio
Leen Antonio
We do it big here at Nelson's stomping ground!
Dr. Leen Antonio (UZ Leuven)!
She has collaborated with the heavyweights in the field Dr. Bhasin and Dr. Jasuja (Brigham and Women's Hospital)), Dr. Fiers and team (UZ Ghent) on research related to free testosterone.
Dr. Leen Antonio (UZ Leuven)!
She has collaborated with the heavyweights in the field Dr. Bhasin and Dr. Jasuja (Brigham and Women's Hospital)), Dr. Fiers and team (UZ Ghent) on research related to free testosterone.
My only point was the obvious superiority of Vermeulen over Tru-T (at least to date) in estimating FT from TT and SHBG (in comparison to measured ED FT values). No offense at all sir.
Just to be very clear here I never joined any team LOL!
I fly in my own lane here as in solo!
Got my fingers deep in the game as in far reaching.
Excel is a different animal here!
If it does not suite your fancy then move on.
I'm not here to play games.
As I already told you bad move getting caught up TT.
FT is the critical fraction!
Any top expert truly in the know would tell you this.
The legendary Dr. Bhasin, the man who would be considered the father of testosterone Dr. Morgentaler and the master blaster Dr. Khera would be considered three of the top heavyweights when it comes to (research/clinical experience as in DECADES) in the field of hormone replacement therapy!
Throw in Traish, Zitzmann, Anawalt and Corona too.
These guys are powerhouses especially when it comes to research/clinical experience (decades)!
Free testosterone is the primary driver of both benefits and side effects once someone is on exogenous T.
Those truly in the know use TT as a safety ceiling and FT as the actual therapeutic target.
All that should really matter here is the dose one needs to achieve a healthy trough FT which will result in relief/improvement of low-T symptoms and overall well-being.
Unfortunately many are overmedicated on T especially from the get-go!
Yes symptom relief is what truly matters but when it comes to what FT level is needed one needs to keep in mind the overall goal would be to use the least amount in order to feel well while at the same time minimizing sides and keep blood markers healthy long-term.
The goal here would be to target the lowest effective dose that relieves symptoms and restores physiologic--->high-normal Free T trough levels (15-30 ng/dL).
Critical to pay attention to ones injection frequency/trough FT as there is going to be a big diffrerence between one hitting a high-end/high trough FT injecting daily vs twice-weekly vs once weekly
There is also going to be a big difference in what FT level is achieved running a high-end/high TT in a man with low vs normal vs high SHBG!
Listen closely (7:20-15:17) as Traish lays it out here!
07:32 - Testosterone measurement and its limitations
Gets even better @ 15:18-26:37 if you want to get into AR DDS (distribution, density, sensitivity of the AR,/polymorphism of the AR/CAG repeat length (long/short)!
That young lady from Belgium behind the ground breaking study he mentions is Dr. Leen Antonio (thread posted below)!
14:10 - Individual testosterone levels and how they respond differently to different levels of testosterone
19:12 - Testosterone levels and their interpretation, with criticism of the 300 ng/dL cutoff point
World renowned Abdulmaged M. Traish!
Great interview!
As usual free testosterone is where it's at!
Nelson we need to inform Dr.Traish or better yet all of the uros, endos and GPs about discounted labs LMFAO!
Testosterone, Free (Equilibrium Dialysis) and Total, MS | Discounted Labs
Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.
Listen closely 7:20-15:17
* it's easy to measure Total Testosterone, it's not easy to measure Free Testosterone
* it's so easy to measure Total Testosterone, it's really COMPLEX to measure Free Testosterone
*it's the Free Testosterone that matters not the...
Dr. Leen Antonio
The case for free testosterone
Leen Antonio
We do it big here at Nelson's stomping ground!
Dr. Leen Antonio (UZ Leuven)!
She has collaborated with the heavyweights in the field Dr. Bhasin and Dr. Jasuja (Brigham and Women's Hospital)), Dr. Fiers and team (UZ Ghent) on research related to free testosterone.
Thx Forty2!
Watched the 1st one and absolutely LOVE his simplistic SYMPTOM BASED approach! As opposed to simply treating by #'s and incomplete data.
Sure, "IF" we had credible hard and fast #'s to work from, and with, across the board, it would be awesome. But, we are individual genetical beings with inherent gene flaws and mutations, etc... No cookie cutter TRT approach is ever going to be adequate or fit into a box.
Like he mentioned, Testosterone is not a patentable money maker for Big pharma. Therefore IMHO, the money needed to do extensive TRT research is simply not there. As it is with many other PROFITABLE pharmaceuticals.
With all health related Research, (Studies, Trials) I always like to 1st consider WHO funded the Research? -as, they can often times have an influence on the results! (Also, the size and length of the trial, segment of population studied, etc..) Too many times, folks cherry pick the findings, (especially on SM, Ytube, etc...) and create false narratives and erroneous absolutes regarding the outcomes...
Looking fwd to watching the 2nd Vid!
madman
Super Moderator
Yawn.
What all those little people from that more T is better mentality camp you know that ones pushing that so called optimal bulls**t.
What those so called top clinicians/providers the same guys that only treat a minuscule slice of the TRT pie.
LMFAO!
They would all get trampled on by the higher ups!
Any of the top experts in the field would blow holes through some of the s**t these guys spew!
I can name off numerous top experts in the field that have been treating 1000s of men over decades (20-30 yrs) with VAST clinical experience and YEARS of RESEARCH in the field.
Throw my doctor in there too who has 20+ years under his belt and would be considered one of the top uros in Canada specializing in testosterone therapy.
They would eat this up quick.
Abe hitting the nail on the head here!
Come again?
* in the anti-aging community or age management community there are some people who believe the there's an optimal level of testosterone that may be 1200 or 1500 or even I've heard 1800 and the basis for that is WEAK!
Abe putting the nail in the coffin!
Abraham Morgentaler
* what's important to understand though is that the concept of testosterone therapy in theory is designed to replicate youthful levels of testosterone to help people who are deficient in this hormone, the goal isn't to make them into supermen and the real question is why do people want to go above normal if at all, much of the concept of treating up lets say a 1000 let's say our normal upper limit, in the anti-aging community or age management community there are some people who believe the there's an optimal level of testosterone that may be 1200 or 1500 or even I've heard 1800 and the basis for that is WEAK!
You know the man who would be considered the father of modern T-therapy and has made huge contributions in the field of testosterone therapy and men's health let alone has treated 1000s of men over decades as in 30+ yrs.
The man that lectures all over the world.
Would be considered one of the top heavyweights when it comes to (research/clinical experience) in the field of hormone replacement therapy.
Everyone of the top experts in the fiel would tell you that the majority of men will do well on 100-150 mg T/week which would easily allow one to hit a healthy/high trough FT 15-30 ng/dL and more importantly relieve/improve every f**king symptom of low-T.
The majority of low-T symptoms will be relieved/improved hitting a healthy trough FT as in 15-30 ng/dL or the upper 1/3rd.
Plain and simple!
Of course there will always be those outliers who would need the higher-end dose 200 mg T/week but they are far and few as in rare!
Anyone truly in the know would tell you this.
Hope you understand that some do cater to their patients but it in no way means high doses across the board are needed not a chance!
Those wanna be so called gurus pushing that sky-high trough FT 40-60 ng/dL are out to lunch.
What on dialies, EOD, M/W/F, twice-weekly, once weekly protocols where do you want to go with this cause I will stomp it out quick.
Based on what testing method the known to be inaccurate direct IA, cFTV, Equilibrium Ultrafiltration or the gold standard Equilibrium Dialysis?
Do you even understand FT let alone the testing methods?
Most of these so called experts are clueless when it comes to testing FT!
As of now (largest dataset) the top-end is 25.3 ng/dL using a standardized state of the art ED assay and it would not even make a s*t lick a difference if it was 30 or 40 or 50!
Why because those OUTLIERS you know the men hitting that top-end FT would fall in the 97.5th percentile.
Better yet this is a short-lived daily peak to boot!
Not 24 hrs post-injection on dailies, 48 hrs post-injection EOD, 84 hrs post-injection twice-weekly, 72 hrs post-injection M/W/F and sure as hell not 7 days post-injection.
LMFAO!
As of now there is no standardized ED assay (device/procedure) or a harmonized reference range for FT as this is still in the works.
Even then once it happens I would put money on it that the top-end as in 97.5th percentile will be 25-30 ng/dL.
No one told you that one of those so called experts from the OPs post is the same guy that uses/relies on Labcorp's Equilibrium Ultrafiltration assay which no one should be using at it is more susceptible to technical artifacts that can introduce either overestimation or underestimation of free T.
He already got called out on this!
Again Equilibrium ultrafiltration is a direct method for measuring FT but compared with the gold standard Equilibrium dialysis it is more susceptible to methodological variability.
Need to get on that ED if you want to know where FT truly sits especially in cases of altered SHBG.
These so called experts from that more T is better mentality camp claiming everyone and their brother needs to be injecting 200 mg T/week let alone hitting a sky-high trough FT 40-60 LMFAO!
Show me a natty with low SHBG or even normal SHBG that is running around with an absurdly high TT/FT and we are talking a daily short-lived peak here sure as hell not trough!
Such does not exist.
The only men on exogenous T that would ever need to set foot well over 1000 ng/dL in order to hit a high trough FT would be men with high/very high SHBG.
These clowns from that more T is better mentality camp are pushing absurdly high TT (1500-2000 ng/dL) and more importantly FT levels (40-60 ng/dL) and this is TROUGH we are talking about here.
LMFAO!
Give your head a shake!
Again.
T is a threshold hormone!
Main point here being start low and go slow titrate the dose if need be until the threshold is crossed (bloodwork + symptoms).
Symptoms improved while at the same time minimizing/avoiding sides, keeping blood markers healthy and maintaining long-term health is key here.
Crossing the threshold turns the lights on but cranking the dimmer switch past that doesn't make them shine brighter. It's a ceiling effect, not a linear dose-response.
The majority of symptoms will be improved once you achieve a healthy FT which for most would be aiming for a healthy/high-end trough 15-30 ng/dL with F**KING EASE!
Yes some will choose to run higher levels but the main benefit you are going to get here when driving up your FT sky-high is better gains in muscle/enhanced strength and recovery.
No denying high FT levels 24/7 steady-state are optimal when it comes to packing on muscle/increasing strength that is why men abuse T/AAS!
Every other symptom energy, mood, libido, erectile function let alone overall health (cardiovascular, brain, bone, tendons, immune system, lipids, and body composition) can easily be improved by achieving a healthy FT.
As I have hammered home numerous times on the forum over the years I would put much more weight behind sleep, diet, exercise, thyroid/adrenals and stress (physical/mental) when it comes to energy, mood, libido, erectile function and overall health than supposedly needing a high/absurdly high FT.
This is a given!
The father of MODERN TESTOSTERONE THERAPY!
* Abraham Morgentaler is widely regarded as the father of modern testosterone therapy, thanks to his pioneering research and clinical work since the 1990s, where he treated thousands of men for low testosterone (low-T) and debunked outdated fears about risks like prostate cancer and heart issues. He founded Men's Health Boston, co-created the Androgen Society to advance the science, and authored key books and guidelines that revolutionized men's health care. These days, he's stepped back from direct patient treatment to focus on research, education, and spreading the "Morgentaler method"—a safe, evidence-based approach to testosterone replacement that's transforming how doctors worldwide address low-T.
Listen closely Dr/ Khera hitting the nail on the head here!
T is a threshold hormone!
Set-points BRUH!
31:15- 35:34
* The risks of chasing supraphysiological levels
Ok, watched this 2nd one.
I really like his straight fwd approach and simplistic overview. I Love the fact that he’s not over freaking over complicating the issue or the remedy. Surely, every situation or patient is not a totally simple process. But, getting in there and mitigating symptoms is what TRT is SUPPOSED to be about and it seems as though his objective is exactly that.
So, I'm giving him the benefit of the doubt and thinking outside the Box.
No doubt, many will object to >2000ng/dl and the E2 management that goes along with it. But Why? Because we’ve all been subjected to opinion based protocols (no matter how in the know they are) that completely pale in comparison. Opinion based protocols or Guidelines (set forth by AUA and many others) that in many cases do not fully mitigate the Low T symptoms. Each of us are hammered, or influenced into believing whomever we choose to believe and trust our wellbeing with. –it’s really that simple. Just like the phony Jab, some felt compelled to get it (and all the subsequent Boosters!) and some felt compelled to not get it.
Remember when Margarine was "supposed to be" so much healthier than Butter!?!? (The list goes on and on)
FWIW, I’ve never been close to 2000ng/dl. But, I can say without ANY hesitation for me personally, a trough near 1000 is MUCH closer to “Blue Sky, above the clouds” than 700’s. Hands down, without ANY question and that’s not even close to Supraphysiologic levels.
Everything’s a tradeoff. Low T certainly has its own Bad sides. So does it make TRT WRONG, if we replace many “Bad Sides” (from Low T) with some other manageable sides (from TRT) while achieving the desired effects of TRT?? (remember when those in the know said TRT caused Prostate cancer?? or when they said it caused Cardiovascular disease?)
Is it possible that “Hormone Optimization” may be different for different men with different objectives? Not every man, does Construction, is athletic or Loves to push the edge of the envelope in the gym. Some are just as driven, but in the Corporate world and are also having their asses handed to them by low energy levels, pathetic recovery abilities and a general loss of zeal for life and of course, some men with Low T are not in either camp. But, still suffer...
So, I gotta ask; is it fair (or proper) to place all 3 groups on the same protocol? Especially if that 500-700ng/dl trough protocol clearly falls short of the objective? or optimal?
Is it fair or proper to put every man in a box? Based on inaccurate Ref Ranges and assumptions? (i.e. The Fallacy of Clinical Laboratory Reference Ranges)
Maybe he’s on to something here. I'm not sold on 2000-3500ng/dl yet. BUT, I'm def not sold on econo dosing that does not fully mitigate Low T symptoms. Been there, done that and assumed all the pharma risk, without the reward and that's a pretty Bad trade off. -about the dumbest trade off next to gambling on a untested, under-developed Vaccine
Last edited:
FunkOdyssey
Seeker of Wisdom
ExcelMale Newsletter Signup
Similar threads
- Locked
Sponsors
Share this page
Online statistics
- Members online
- 5
- Guests online
- 730
- Total visitors
- 735
