The Testosterone Spectrum: From Biosynthesis To Re[placement & Misuse (Hypogonadism Management – A Guideline Review)

madman · 2026-02-13T11:39:27-0600

KEY POINTS

madman · 2026-02-13T11:51:00-0600

Late-onset hypogonadism

Clinical Diagnosis and Evaluation

Physical examination

Laboratory Diagnostics

* In clinical conditions that may interfere with SHBG levels evaluation of T should be considered to better estimate actual androgen levels particularly when TT levels are between 8.0-12.0 nmol/L

* No validated thresholds for fT are available, however, data from the EMAS indicated that fT levels < 220 pmol/L (6.4 ng/dL)

Other investigations

Thread 'Re-evaluating the role of Free Testosterone and SHBG'

Sep 2, 2025

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.

Thread 'Dr. Shalender Bhasin: Optimizing the Diagnosis and Treatment of Hypogonadism 2025'

Oct 7, 2025

Nelson's house u heard it here first!

Dr. Shalender Bhasin!

* over the past 4 decades he has become a global leader in the biology of androgens, sarcopenia and aging related functional decline, his research has shaped clinical guidelines, its informed public health policy particularly around testosterone therapy, anabolic interventions and then the development of function promoting therapies

Pay attention to 25:40-34:36 of the presentation where he explains the importance of measuring free testosterone using a standardized Equilibrium Dialysis method!

Explains the...

madman · 2026-02-13T11:57:31-0600

Screening?

madman · 2026-02-13T12:02:37-0600

MANAGEMENT

When?

Why?

Meta-analysis

Cardiovascular Safety of Testosterone- Replacement

Thread 'Upcoming FDA Expert Panel on Testosterone Replacement Therapy for Men'

Dec 1, 2025

@Nelson Vergel

We need you here!

FDA Expert Panel on Testosterone Replacement Therapy for Men

www.fda.gov

Location: FDA White Oak Campus, 10903 New Hampshire Ave., Building 31, Great Room, Silver Spring, MD 20993-0002. There will be limited seating for the public.

Registration: Registration is only required for in-person listen-in attendance. Space is limited. Please plan to arrive at least 30 minutes prior to the start time to be checked in.

How to Virtually Attend: This FDA Expert Panel will be live...

madman · 2026-02-13T12:06:08-0600

Mood and cognition

Body composition and metabolic profile

Bone Health

Lifestyle modifications

madman · 2026-02-13T12:21:12-0600

To be continued......

madman · 2026-02-13T12:58:58-0600

Medical preparations

Oral formulation:

Parental formulations

Transdermal preparations

Transmucosal formulations

Subdermal depots

Thread 'Hypogonadism 101'

May 12, 2023

Hypogonadism 101

madman · 2026-02-13T13:11:10-0600

Anti-oestrogens

Gonadotropins

Hypogonadism and fertility issues

Thread 'Testosterone & Fertility: Novel Techniques in Monitoring & Treating Hypogonadal Fertile Men: SERMs, hCG, rFSH, Aromatase Inhibitors'

Oct 18, 2025

Nelson's Excel kicking facts here!

Dr. Bernie dropping gems!

Something everyone needs to keep in mind here!

* There are very few large RCTs comparing theses strategies in the fertility-seeking hypogonadal male!

Limitations/Future Directions

Key Takeaways

madman · 2026-02-13T13:13:07-0600

Thread 'Testosterone Therapy and Erythrocytosis - the most common dose-limiting effect of testosterone therapy'

Apr 21, 2024

Testosterone Therapy and Erythrocytosis • The Blood Project

Introduction Androgens play a crucial role in the development and maintenance of: Male reproductive and sexual functions Body composition Erythropoiesis

www.thebloodproject.com

Introduction

Androgens play a crucial role in the development and maintenance of:

Male reproductive and sexual functions

Body composition

Erythropoiesis

Muscle and bone health

Cognitive function
Testosterone falls progressively with age and a significant percentage of men over the age of 60 years have serum testosterone levels that are below the lower limits of young...

madman · 2026-02-13T13:16:50-0600

VTE

EXTRA-CAUTION?!

Post in thread 'Functional Hypogonadism Uncovered: The Truth About Modern Testosterone Therapy and Men’s Health'

Wednesday at 10:07 PM

GANGSTARR

* Aside from TRAVERSE, meta-analyses have now concluded that TTh, in doses restoring physiological levels, is not associated with elevated cardiovascular risk.

* One safety consideration that does remain is erythrocytosis. As noted, testosterone often raises hematocrit. In T4DM, for example, about 20% of men on testosterone developed hematocrit >54%, versus 1% on placebo [16]. Similar results were observed in the HEAT-registry [19]. While an increased red cell mass can be beneficial up to a point (alleviating anemia), excessive erythrocytosis...

Thread 'Hormonal Therapy and Thrombosis Risk With Testosterone'

Apr 5, 2025

Hormonal Therapy and Thrombosis Risk With Testosterone

A video from Damon Houghton (as part of Scripps Health), posted on Mar 28, 2025.

www.vumedi.com

madman · 2026-02-13T13:20:56-0600

Cardiovascular Disease

Large Cohort Study

Cardiac Failure

Thread 'Upcoming FDA Expert Panel on Testosterone Replacement Therapy for Men'

Dec 1, 2025

@Nelson Vergel

We need you here!

FDA Expert Panel on Testosterone Replacement Therapy for Men

www.fda.gov

Location: FDA White Oak Campus, 10903 New Hampshire Ave., Building 31, Great Room, Silver Spring, MD 20993-0002. There will be limited seating for the public.

Registration: Registration is only required for in-person listen-in attendance. Space is limited. Please plan to arrive at least 30 minutes prior to the start time to be checked in.

How to Virtually Attend: This FDA Expert Panel will be live...

madman · 2026-02-13T13:25:12-0600

Prostate cancer (PCa)

PCa survivors

LUTS/BPH

Thread 'Upcoming FDA Expert Panel on Testosterone Replacement Therapy for Men'

Dec 1, 2025

@Nelson Vergel

We need you here!

FDA Expert Panel on Testosterone Replacement Therapy for Men

www.fda.gov

Location: FDA White Oak Campus, 10903 New Hampshire Ave., Building 31, Great Room, Silver Spring, MD 20993-0002. There will be limited seating for the public.

Registration: Registration is only required for in-person listen-in attendance. Space is limited. Please plan to arrive at least 30 minutes prior to the start time to be checked in.

How to Virtually Attend: This FDA Expert Panel will be live...

madman · 2026-02-13T13:28:12-0600

Obstructive Sleep Apnea (OSA)

Thread 'The Link Between TRT and Obstructive Sleep Apnea: A Risk Factor Analysis'

Apr 11, 2025

* Our findings suggest that the presence of OSA risk factors may alter the effect of TRT on OSA incidence, where TRT is associated with lower incidence in people without risk factors and higher incidence in people with risk factors.

INCIDENCE OF OBSTRUCTIVE SLEEP APNEA IN PATIENTS TAKING TESTOSTERONE REPLACEMENT THERAPY STRATIFIED BY OSA RISK FACTORS
Kathleen Li*, Rochester, NY; Thomas Chen, New York, NY; Parth Joshi,David Peters, Mineola, NY

INTRODUCTION AND OBJECTIVE

The relationship between hypogonadism, testosterone replacement therapy (TRT), and...

Thread 'Diagnosis and Management of Obstructive Sleep Apnea'

Oct 8, 2022

Diagnosis and Management of Obstructive Sleep Apnea A Review (2020)
Daniel J. Gottlieb, MD, MPH; Naresh M. Punjabi, MD, PhD

IMPORTANCE Obstructive sleep apnea (OSA) affects 17% of women and 34% of men in the US and has a similar prevalence in other countries. This review provides an update on the diagnosis and treatment of OSA.

OBSERVATIONS The most common presenting symptom of OSA is excessive sleepiness, although this symptom is reported by as few as 15% to 50% of people with OSA in the general population. OSA is associated with a 2- to 3-fold...