What is TRT and What is NOT TRT

[Charliebizz]

I agree that is strange. I knew Crisler through DATbTrue. I communicated frequently by email, and through postings at Professional Muscle. Had no idea about his business as a doctor and assumed he was well known in the field. He was very interested in our experiences with peptides. Honestly I would have been shocked as you were. I knew many of the guys on his board from other boards but very rarely participated in Crisler's board as I was not interested in TRT at the time. I was still doing more of the blast and cruise type doses and only interested in being BIG.

I loved the group of guys in his forum. Learned a lot. But honestly dr crisler never seemed truly interested in my case. Always felt like I was bothering him with my questions. As a patient. Online he was much more personable. I hate to talk about a man that passed away. But I really wasn’t impressed at all as a patient.

 

[BigTex]

I loved the group of guys in his forum. Learned a lot. But honestly dr crisler never seemed truly interested in my case. Always felt like I was bothering him with my questions. As a patient. Online he was much more personable. I hate to talk about a man that passed away. But I really wasn’t impressed at all as a patient.

This is very strange. Especially when he listened to everything on the internet. I never dealt with him in person and was never a patient.

 

[tareload]

You guys are gonna get this thread shutdown Haha.

This is all poor little readalot has now that I have been banned at TNation again.

Come on @RobRoy where is your substantive response on my statistical power analysis and other comments? You want a formal list to discuss on your next entertainment hour?

 

[JmarkH]

This is all poor little readalot has now that I have been banned at TNation again.

Please tell me the thread that got you banned so I can go read it.

 

[SteveCleves]

@readalot

From t-nation:

This user is suspended.
Reason: Would not listen to staff feedback


Id love to know the feedback....

 

[Charliebizz]

@readalot

From t-nation:

This user is suspended.
Reason: Would not listen to staff feedback


Id love to know the feedback....

I just don’t understand why these guys hate @readalot. so much. Even if he was wrong he brings so much to the table as far as debate And gives you the platform to prove yourselves right. honestly @readalot is what keeps me coming back on the forums. Im In a pretty good place now and do not really need to be on the boards searching for answers. But he keeps me coming back just for the debate and the comedy lol.

 

[tareload]

@readalot

From t-nation:

This user is suspended.
Reason: Would not listen to staff feedback


Id love to know the feedback....

First time I was temp suspended Colucci did not want to change the word "safe" to "safer" in the Pharma section description. I chatted with owner of BioTest Tim Patterson and to his immense credit he changed the word. If you want some entertainment go see the three threads I argue with Colucci about this. Talk about an OCD pest. I don't think I would have been as patient in his shoes.

Hence my legacy over there...I got a word changed.

Over the years I linked to ExcelMale stuff over there which is a no no. They claim the policy stems from spammers of the past. Clearly EM is not spam. You don't see Mods here complaining when I link to something over there that I think is valuable. I was using both sites as a sort of database to house stuff I thought valuable/helpful. Quite a group over here that I am grateful for.

What finally got me banned was for a 2nd or 3rd time trying to correct their "member coach" over there on some of the errors he makes. I think the first one was claiming he tested at ~30 ng/dl TT and I asked where his LH test was before he goes on TRT. Where was the retest? He got miffed. I did not want newbie thinking this was sound approach.

So yesterday he claimed he was correcting his testosterone through medicine and diet. Diet? I was curious how someone adjusts their TT/FT levels once on exogenous Test.

Long story short, do not challenge the "pwnisher". He is protected Haha.

Shortly after the message came the ban. I don't think some people take kindly to scientific debate or losing face. I get it but getting to the facts is messy sometimes.

Oh well it was a good run. I hope I helped some people.

More Trouble Than I Am Worth: Chaos Is The Plan (T3hPwnisher Log)

Wow…glad the pituitary showed all clear. That is crazy.

forums.t-nation.com

More Trouble Than I Am Worth: Chaos Is The Plan (T3hPwnisher Log)

Testosterone being fixed through combo of medicine and diet. The second the key of the 1-2 punch

forums.t-nation.com

Admin deleted latest "offending" post. Since some were interested, those are the facts. Serial EM linker here. Guilty as charged LMAO!

I think I will stay here. I am told I would not fit in at UGBB or Professional Muscle. This is a smart group at ExcelMale.

Sorry I won't be able to keep up with you at TNation anymore @RobRoy. I did enjoy our interactions under your handles "yeti308" and "carma" and I think one more I can't remember. It was sometimes painful but at least others get to see the debate. Thanks for the feedback @Charliebizz. It is the only reason I do it. I have nothing to gain from all this but an excuse to learn and read myself and apply what I was trained to do.

 

[tareload]

I just don’t understand why these guys hate @readalot. so much. Even if he was wrong he brings so much to the table as far as debate And gives you the platform to prove yourselves right. honestly @readalot is what keeps me coming back on the forums. Im In a pretty good place now and do not really need to be on the boards searching for answers. But he keeps me coming back just for the debate and the comedy lol.

I am gladly you are doing better. I have really tried to make some of this dry technical stuff somewhat engaging. I appreciate the feedback. My comedy is sort of a mess. I continue to appreciate the Moderator leeway here.

 

[BigTex]

First time I was temp suspended Colucci did not want to change the word "safe" to "safer" in the Pharma section description. I chatted with owner of BioTest Tim Patterson and to his immense credit he changed the word.

Hence my legacy over there...I got a word changed.

Over the years I linked to ExcelMale stuff over there which is a no no. They claim the policy stems from spammers of the past. Clearly EM is not spam. You don't see Mods here complaining when I link to something over there that I think is valuable. I was using both sites as a sort of database to house stuff I thought valuable/helpful. Quite a group over here that I am grateful for.

What finally got me banned was for a 2nd or 3rd time trying to correct their "member coach" over there on some of the errors he makes. I think the first one was claiming he tested at 6 ng/dl TT and I asked where his LH test was before he goes on TRT. He got miffed. I did not want newbie thinking this was sound approach.

So yesterday he claimed he was correcting his testosterone through medicine and diet. Diet? I was curious how someone adjusts their TT/FT levels once on exogenous Test.

Long story short, do not challenge the "pwnisher". He is protected Haha.

View attachment 34441

Shortly after the message came the ban. I don't think some people take kindly to scientific debate or losing face. I get it but getting to the facts is messy sometimes.

Oh well it was a good run. I hope I helped some people.

More Trouble Than I Am Worth: Chaos Is The Plan (T3hPwnisher Log)

Wow…glad the pituitary showed all clear. That is crazy.

forums.t-nation.com

More Trouble Than I Am Worth: Chaos Is The Plan (T3hPwnisher Log)

Testosterone being fixed through combo of medicine and diet. The second the key of the 1-2 punch

forums.t-nation.com

Admin deleted latest "offending" post. Since some were interested, those are the facts. Serial EM linker here. Guilty as charged LMAO!

I think I will stay here. I am told I would not fit in at UGBB or Professional Muscle. This is a smart group at ExcelMale.

Sorry I won't be able to keep up with you at TNation anymore @RobRoy. I did enjoy our interactions under your handles "yeti308" and "carma" and I think one more I can't remember. It is painful but at least others get to see the debate. Thanks for the feedback @Charliebizz. It is the only reason I do it. I have nothing to gain from all this but excuse to learn and read myself and apply what I was trained to do.

Sounds like a very immature moderator got his feelings hurt and responded by suspending you. I am wondering when T-Nation is going to run its course. It has been around since about 2000. Surprised it made it this long. Most of these boards unless they are very unique, are short lived.

OK, I just watched the CHEEEEEZY "metabolic" workout he posted of himself. Exactly what I thought. Especially with all the "DUDE" stuff thrown in. Mid 20s and uses the young audience to pat him on the back about being "unstoppable." What is he trying to accomplish? Loose weight? He looks very soft. Or aspirations of being a cross-fit warrior. @readalot, I can promise you these people take up space in my gym. I see girls doing stuff like this. The fact that he is by himself and set up a video camera to film himself working out shows he has a HUGE need for approval on T-Nation. More of the YouTube generation looking for hits. Then he write he has no idea what he is going to do tomorrow....then calls it chaos. Chaos is right. Tell "punisher" the head band is very 70's. My wife just saw the video and said for all the fasting this guy is doing he is still puffy. Might try eating a good meal before doing the 4am workouts. Now I see why I don't look at T-Nation.

I have been a member of Pro Muscle since maybe 2005 and have not posted in 15 years or more. It has gone the same direction. Full of young kids who believe if they just do more drugs they will be Mr. Olympia in a year.

 

[tareload]

My wife just saw the video and said for all the fasting this guy is doing he is still puffy

I'd love to see the two of you training at the gym in your prime or even now. Must be quite the sight!

Whenever I need to push a little harder I just ask myself what would Mr. and Mrs. BIG Tex do?

I am really not comfortable gaining any more muscle at my age and with previous heart scare. Perhaps I just need to get uncomfortable again. It is like that cartoon with the devil and angel on your shoulders. I am glad you are here @BigTex.

 

[BigTex]

Thanks for the kind words @readalot. I remember going to Buenos Aires in my prime. My sponsor sent me with two huge duffle bags of his lifting gear to give an potential distributor. I would do a reduced weight exhibition training of each lift at different gyms. I did 600lbs-12 times on the squat with just a belt and knee wraps. I pulled 700 for a single in the deadlift in the gym at the University of Buenos Aires. These guys were not use to seeing anything like that. I swear the weights south of the equator are lighter.

My wife still does 14-45lb plates on the leg press 10 times.

Don't worry about t-nation. You are better off over here and out of that. We are very lucky here that we have adults who post. And many brilliant minds. Now if we can just get RobRoy to join us more frequently. I do want to hear what he has to say.

 

[tareload]

Don't worry about t-nation

Not worried about it. Thanks a bunch.

I am not making another handle and the Pharma/TRT posts are hidden from public view. Hope some of that stuff stays around and informs those curious and patient enough to read through.

 

[tareload]

Wow, I am really moving up in the world. I give of my valuable time as a way to say thank you to @Nelson Vergel for all of his altruism over the years. And of course to help the guys who don't know any better and listen to above podcast and think it is more than what it actually is....dangerous entertainment that instills a false sense of confidence in some.

Here you go for those that can appreciate this sort of thing:


View attachment 34267

Post-hoc Power Calculator

Calculator to determine the post-hoc power of an existing study.

clincalc.com

View attachment 34266





View attachment 34268
View attachment 34269

View attachment 34270


Nice hand waving with the COVID angle. I guess by magic the placebo arm somehow did not have an opportunity to be exposed to COVID.

My opinion, the discussion is not a credible scientific discussion of the trial. It is entertainment. Never use a physician who appends the words "Woke" and "TRT" IMHO.

Too bad as I agree on many on the points around diet, training, stoicism, etc. Unfortunately @RobRoy reminds me of one of my project partners in undergrad. I refused to let him assist on the project and sent him off while I did the work. We all got an "A" of course.

Remember, these types of people are now out there in the workforce. We used to joke at graduation and ask what state they will be working in so to steer clear of that state for reasons particular to our undergraduate major.



Funny you won't get the above analysis on Jay's podcasts. Leave it to the people who understand this stuff and do related jobs for a living.

Yes, I am running post hoc power analysis on two statistically significant findings from the TRAVERSE study. What does this tell you @RobRoy? Maybe phone a friend?

https://www.tandfonline.com/doi/abs/10.1198/000313001300339897

What does the significant result on the arrythmia component of TRAVERSE trial tell you? See above article to understand why the comments you made about power are absurd.

Sincerely,
Dude with 30 ng/dl FT level as I write this. Ok, maybe a little higher haha. I am woke out of my mind!

Tick tock...where did you go @RobRoy? No rebuttal / response to above? Wednesday will be here before you know it.


A couple more along with above for next show....you need to consider a retraction.

- correct yourself for saying that staying in physiologic range is microdosing. It ain't.

- some of those " old sick" guys during COVID you made fun of did not fare too well on even the mild TRT intervention wrt arrythmia/afib. So your answer...give them more T. What do we know about autonomic activity and serum Test levels?


Hint: embarrassment of riches here for you. Read it.

Nandrolone for Mood | Feeling much Better..

Also, I haven't read the mouse study, but it occurs to me that in the early days of Low Carb, there was an attempt to show that (I think) olive oil was toxic using FMD as a measure. However I believe Volek subsequently showed that it was a short-term affect which disappeared after several weeks...

www.excelmale.com

Please stop this nonsense. Find a better group of people to podcast with that will hold you intellectually accountable. The paychology of a group is dangerous especially when you are in deep water.

 

[RobRoy]

Tick tock...where did you go @RobRoy? No rebuttal / response to above? Wednesday will be here before you know it.


A couple more along with above for next show....you need to consider a retraction.

- correct yourself for saying that staying in physiologic range is microdosing. It ain't.

- some of those " old sick" guys during COVID you made fun of did not fare too well on even the mild TRT intervention wrt arrythmia/afib. So your answer...give them more T. What do we know about autonomic activity and serum Test levels?


Hint: embarrassment of riches here for you. Read it.

Nandrolone for Mood | Feeling much Better..

Also, I haven't read the mouse study, but it occurs to me that in the early days of Low Carb, there was an attempt to show that (I think) olive oil was toxic using FMD as a measure. However I believe Volek subsequently showed that it was a short-term affect which disappeared after several weeks...

www.excelmale.com

Please stop this nonsense. Find a better group of people to podcast with that will hold you intellectually accountable. The paychology of a group is dangerous especially when you are in deep water.

So read a lot and Joseph Hernshaw maybe you should step away from your woke TRT movement and listen to what even the co-author had to say about the traverse study. The problem with you Joseph and read a lot is that you suffer from extreme confirmational bias. You cannot see the forest for the trees. Your writings will be used for some upcoming videos.


The Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy Response in Hypogonadal Men (TRAVERSE) trial was designed to determine the effects of testosterone-replacement therapy on the incidence of major adverse cardiac events among middle-aged and older men with hypogonadism and either preexisting or a high risk of cardio- vascular disease.





It enrolled 5,204 men, 45 to 80 years of age, with a mean treatment duration of 21.7 +-14.1 months





Inclusion criteria included meeting the study definition of clinical hypogonadism which was 2 serum testosterone levels less than 300 ng/dL collected between 5 AM and 11 AM


And, the presence of at least one sign or symptom that may be related to low testosterone such as:


Decreased libido, decreased morning erections, decreased energy or fatigue, depressed mood, loss of body hair or reduced shaving, or hot flashes





Participants also had to have pre-existing cardiovascular disease or at least three cardiovascular risk factors.





Pre-existing cardiovascular disease would be a diagnosis of coronary artery disease, cerebrovascular disease, or peripheral artery disease.





Cardiovascular risk factors included hypertension, dyslipidemia, current smoker, stage three kidney disease, diabetes, elevated CRP, or high coronary artery calcium score





Some baseline characteristics : average age was 63 , the average BMI was 35, and the median testosterone level was 227 ng/dL (188-258)





The patients were randomly assigned to either receive transdermal testosterone gel 1.62 % (40.5 mg)or placebo


The dose was adjusted to maintain testosterone levels between 350 and 750 ng/dL. The mean daily dose was 65 +-22mg. At 12 months the median increase in testosterone levels from baseline was 148 ng/dL (34-312)





The primary cardiovascular endpoint was a composite of cardiovascular mortality, nonfatal myocardial infarction or nonfatal stroke. The secondary cardiovascular endpoint was a composite of the primary endpoint plus coronary revascularization





The primary endpoint occurred in 182 patients (7.0%) in the testosterone group and 190 patients (7.3%) in the placebo group . Rates of the secondary endpoint and each of the components of the primary endpoint were similar between the groups.





The conclusion was that in men with hypogonadism and pre-existing or a high risk of cardiovascular disease testosterone replacement therapy was non-inferior to placebo with respect to the incidence of major adverse cardiac events





61% of patients in both groups dropped out ??? What does that tell us?


It tells us that if you only raise testosterone levels a little bit then the patients will notice minimal benefit and will discontinue treatment no different than discontinuing placebo. A little bit of testosterone is not much better than getting nothing at all and this is reflected in the identical dropout rate between the treatment group and the placebo group.





So here is what a couple of endocrinologist are saying about the study in the national media:


"It's important to emphasize that this is a study of men with bona fide testosterone deficiency and symptoms. It doesn't give carte blanche to prescribe to men with normal testosterone concentrations. It doesn't tell us about the safety of that"


“It is essential that the findings be interpreted appropriately and not applied to patient populations beyond middle-aged and older men with documented hypogonadism and established cardiovascular disease or high cardiovascular risk. “They don’t apply to athletes taking super-high doses or to people who don’t have low testosterone levels”





So are we to believe that we can give testosterone to very sick men and not have any major adverse cardiac events but yet we can give it to a relatively healthy man and somehow it will cause harm? Are we also to believe that we have to wait until someone develops cardiovascular disease or significant risk factors for cardiovascular disease along with hypogonadism until we are able to treat? Why do we not prevent cardiovascular disease and risk factors for cardiovascular disease before it occurs? Testosterone therapy has been shown in multiple studies to prevent these risk factors before they develop into actual cardiovascular disease.


When we restrict care to only those with low testosterone levels then we are ignoring the medical literature that supports the fact that each man has his own so-called "normal level" below which he becomes symptomatic. This is based on genetic factors such as the length of the CAG repeat on the androgen receptor. We should focus more on symptoms and not numbers. If a man has symptoms suggestive of low testosterone then he should be given the opportunity to undergo a trial of testosterone replacement therapy. Now this is in the setting of this individual having already corrected all other potential causes of symptoms such as obesity or being overweight, inadequate sleep, stress, poor diet and nutrition, and lack of exercise.





Here are a couple of findings or better yet observations that are already causing some confusion and misinformation:





A higher incidence of atrial fibrillation (3.5% with testosterone vs. 2.4% with placebo), acute kidney injury (2.3% vs. 1.5%, respectively) and pulmonary embolism (0.9% vs. 0.5%, respectively) was OBSERVED in the testosterone group???





Primary endpoint(s) are typically efficacy measures that address the main research question and for which the trial was adequately powered . Secondary endpoints are additional events of interest but which the study is not specifically powered to assess. Tertiary endpoints typically capture outcomes that occur less frequently or which may be useful for exploring novel hypotheses. Tertiary endpoints can be interesting, thought-provoking, and hypothesis generating but cannot be utilized to establish causation. The traverse trial did not find that testosterone increased the incidence of atrial fibrillation, acute kidney injury, or pulmonary embolism. It was an observation only.





Dr. Abraham Morgentaler had the following to say:


“Those were TERTIARY endpoints.


Need to be REALLY careful


drawing conclusions. Difficult to


know if groups were similar at


baseline. Prior data re AF showed


T therapy reduced risk. Studies


have also previously shown no


increase in PE. Renal injury- never


heard this before.”





The co-author of the traverse study along with one of his colleagues had this to say :





“Bhasin said that the team plans to investigate those cases further to look for possible risk factors, including whether COVID-19 played a role in these outcomes because the trial took place during the pandemic and some participants in both study groups contracted the virus.





Regarding acute kidney injury, Anawalt said: "I don't know that I believe that...It's probably a statistical abnormality. It barely made...significance."





It is always a good idea to understand the prior literature on a topic in order to understand whether the conclusions of a new study make sense. So with regard to atrial fibrillation, acute kidney injury, and pulmonary embolism what does the previous literature show with testosterone therapy. Multiple studies revealed a reduction in atrial fibrillation as well as arrhythmias with testosterone therapy. Testosterone therapy has not been shown in any randomized controlled trial to increase the risk of venous thromboembolism and in fact multiple studies as well as systematic reviews and meta-analysis have not shown any association between testosterone use and VTE. Long-term testosterone therapy has also been shown to improve renal function and delay progression of chronic kidney disease.





When the weight of the previous literature favors the opposite result it raises the possibility that there was something about this particular study that confounded the results





This study was done during the pandemic and participants did develop Covid during the course of treatment. What do we know about Covid and the incidence of atrial fibrillation, pulmonary embolism, and acute kidney injury?


Covid infection significantly increases acute kidney injury, arterial and venous thromboembolic events, as well as cardiac arrhythmias and new onset atrial fibrillation.

So we cannot ignore 85 years of testosterone being utilize to treat men with hypogonadism and other disorders such as Klinefelter's syndrome. When testosterone was first used there were no labs for several decades (in high doses), and yet it did not cause an increase in atrial fibrillation, acute kidney injury, or pulmonary embolism. We cannot throw away decades of previous studies that also show no increase in these events. The traverse study was not powered for these events. Testosterone has been used and abused by literally hundreds of thousands of men over the last couple of decades and yet there has been no epidemic of arrhythmias, pulmonary embolism, or acute kidney injury.

 

[tareload]

So read a lot and Joseph Hernshaw maybe you should step away from your woke TRT movement and listen to what even the co-author had to say about the traverse study. The problem with you Joseph and read a lot is that you suffer from extreme confirmational bias. You cannot see the forest for the trees. Your writings will be used for some upcoming videos.


The Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy Response in Hypogonadal Men (TRAVERSE) trial was designed to determine the effects of testosterone-replacement therapy on the incidence of major adverse cardiac events among middle-aged and older men with hypogonadism and either preexisting or a high risk of cardio- vascular disease.





It enrolled 5,204 men, 45 to 80 years of age, with a mean treatment duration of 21.7 +-14.1 months





Inclusion criteria included meeting the study definition of clinical hypogonadism which was 2 serum testosterone levels less than 300 ng/dL collected between 5 AM and 11 AM


And, the presence of at least one sign or symptom that may be related to low testosterone such as:


Decreased libido, decreased morning erections, decreased energy or fatigue, depressed mood, loss of body hair or reduced shaving, or hot flashes





Participants also had to have pre-existing cardiovascular disease or at least three cardiovascular risk factors.





Pre-existing cardiovascular disease would be a diagnosis of coronary artery disease, cerebrovascular disease, or peripheral artery disease.





Cardiovascular risk factors included hypertension, dyslipidemia, current smoker, stage three kidney disease, diabetes, elevated CRP, or high coronary artery calcium score





Some baseline characteristics : average age was 63 , the average BMI was 35, and the median testosterone level was 227 ng/dL (188-258)





The patients were randomly assigned to either receive transdermal testosterone gel 1.62 % (40.5 mg)or placebo


The dose was adjusted to maintain testosterone levels between 350 and 750 ng/dL. The mean daily dose was 65 +-22mg. At 12 months the median increase in testosterone levels from baseline was 148 ng/dL (34-312)





The primary cardiovascular endpoint was a composite of cardiovascular mortality, nonfatal myocardial infarction or nonfatal stroke. The secondary cardiovascular endpoint was a composite of the primary endpoint plus coronary revascularization





The primary endpoint occurred in 182 patients (7.0%) in the testosterone group and 190 patients (7.3%) in the placebo group . Rates of the secondary endpoint and each of the components of the primary endpoint were similar between the groups.





The conclusion was that in men with hypogonadism and pre-existing or a high risk of cardiovascular disease testosterone replacement therapy was non-inferior to placebo with respect to the incidence of major adverse cardiac events





61% of patients in both groups dropped out ??? What does that tell us?


It tells us that if you only raise testosterone levels a little bit then the patients will notice minimal benefit and will discontinue treatment no different than discontinuing placebo. A little bit of testosterone is not much better than getting nothing at all and this is reflected in the identical dropout rate between the treatment group and the placebo group.





So here is what a couple of endocrinologist are saying about the study in the national media:


"It's important to emphasize that this is a study of men with bona fide testosterone deficiency and symptoms. It doesn't give carte blanche to prescribe to men with normal testosterone concentrations. It doesn't tell us about the safety of that"


“It is essential that the findings be interpreted appropriately and not applied to patient populations beyond middle-aged and older men with documented hypogonadism and established cardiovascular disease or high cardiovascular risk. “They don’t apply to athletes taking super-high doses or to people who don’t have low testosterone levels”





So are we to believe that we can give testosterone to very sick men and not have any major adverse cardiac events but yet we can give it to a relatively healthy man and somehow it will cause harm? Are we also to believe that we have to wait until someone develops cardiovascular disease or significant risk factors for cardiovascular disease along with hypogonadism until we are able to treat? Why do we not prevent cardiovascular disease and risk factors for cardiovascular disease before it occurs? Testosterone therapy has been shown in multiple studies to prevent these risk factors before they develop into actual cardiovascular disease.


When we restrict care to only those with low testosterone levels then we are ignoring the medical literature that supports the fact that each man has his own so-called "normal level" below which he becomes symptomatic. This is based on genetic factors such as the length of the CAG repeat on the androgen receptor. We should focus more on symptoms and not numbers. If a man has symptoms suggestive of low testosterone then he should be given the opportunity to undergo a trial of testosterone replacement therapy. Now this is in the setting of this individual having already corrected all other potential causes of symptoms such as obesity or being overweight, inadequate sleep, stress, poor diet and nutrition, and lack of exercise.





Here are a couple of findings or better yet observations that are already causing some confusion and misinformation:





A higher incidence of atrial fibrillation (3.5% with testosterone vs. 2.4% with placebo), acute kidney injury (2.3% vs. 1.5%, respectively) and pulmonary embolism (0.9% vs. 0.5%, respectively) was OBSERVED in the testosterone group???





Primary endpoint(s) are typically efficacy measures that address the main research question and for which the trial was adequately powered . Secondary endpoints are additional events of interest but which the study is not specifically powered to assess. Tertiary endpoints typically capture outcomes that occur less frequently or which may be useful for exploring novel hypotheses. Tertiary endpoints can be interesting, thought-provoking, and hypothesis generating but cannot be utilized to establish causation. The traverse trial did not find that testosterone increased the incidence of atrial fibrillation, acute kidney injury, or pulmonary embolism. It was an observation only.





Dr. Abraham Morgentaler had the following to say:


“Those were TERTIARY endpoints.


Need to be REALLY careful


drawing conclusions. Difficult to


know if groups were similar at


baseline. Prior data re AF showed


T therapy reduced risk. Studies


have also previously shown no


increase in PE. Renal injury- never


heard this before.”





The co-author of the traverse study along with one of his colleagues had this to say :





“Bhasin said that the team plans to investigate those cases further to look for possible risk factors, including whether COVID-19 played a role in these outcomes because the trial took place during the pandemic and some participants in both study groups contracted the virus.





Regarding acute kidney injury, Anawalt said: "I don't know that I believe that...It's probably a statistical abnormality. It barely made...significance."





It is always a good idea to understand the prior literature on a topic in order to understand whether the conclusions of a new study make sense. So with regard to atrial fibrillation, acute kidney injury, and pulmonary embolism what does the previous literature show with testosterone therapy. Multiple studies revealed a reduction in atrial fibrillation as well as arrhythmias with testosterone therapy. Testosterone therapy has not been shown in any randomized controlled trial to increase the risk of venous thromboembolism and in fact multiple studies as well as systematic reviews and meta-analysis have not shown any association between testosterone use and VTE. Long-term testosterone therapy has also been shown to improve renal function and delay progression of chronic kidney disease.





When the weight of the previous literature favors the opposite result it raises the possibility that there was something about this particular study that confounded the results





This study was done during the pandemic and participants did develop Covid during the course of treatment. What do we know about Covid and the incidence of atrial fibrillation, pulmonary embolism, and acute kidney injury?


Covid infection significantly increases acute kidney injury, arterial and venous thromboembolic events, as well as cardiac arrhythmias and new onset atrial fibrillation.

So we cannot ignore 85 years of testosterone being utilize to treat men with hypogonadism and other disorders such as Klinefelter's syndrome. When testosterone was first used there were no labs for several decades (in high doses), and yet it did not cause an increase in atrial fibrillation, acute kidney injury, or pulmonary embolism. We cannot throw away decades of previous studies that also show no increase in these events. The traverse study was not powered for these events. Testosterone has been used and abused by literally hundreds of thousands of men over the last couple of decades and yet there has been no epidemic of arrhythmias, pulmonary embolism, or acute kidney injury.

So your response is to read me what you read on the last podcast. No comment on my extensive comments above. Ok. Be well.

You like Danny seem to be beholden to some SME/authority to tell you what to conclude.

Your tertiary endpoint comment is misleading. I already cracked that nut for you on the power confusion.

Have a great day.

PS...you are really throwing the Joseph Hearnshaw dude under the bus. I am not him and not affiliated with him in any way. One time you implied you were going to sue me on TNation. Be careful he doesn't do that to you.

 

[Charliebizz]

Getting the popcorn ready !!!

 

[RobRoy]

So your response is to read me what you read on the last podcast. No comment on my extensive comments above. Ok. Be well.

You like Danny seem to be beholden to some SME/authority to tell you what to conclude.

Your tertiary endpoint comment is misleading. I already cracked that nut for you on the power confusion.

Have a great day.

Tell it to Bhasin the Co author of the study

 

[tareload]

Tell it to Bhasin the Co author of the study

And let me repeat this so hope it sinks in....

PS...you are really throwing the Joseph Hearnshaw dude under the bus. I am not him and not affiliated with him in any way. One time you implied you were going to sue me on TNation. Be careful he doesn't do that to you.

When brought out to the deep water RobRoy you seem to need your statistics floaties. Why comment on the study if you aren't qualified? Leave it to Bhasin then.

 

[RobRoy]

Getting the popcorn ready !!!

No need it's a waste of time discussing anything with Joseph Hernshaw and read a lot. No more wasted of time on here. If read a lot and Joseph Hearnshaw want to convince you that testosterone is dangerous then I'll leave you to listen to that. No need to try to prove otherwise. Abraham Morgenthaler and Bhasin among others including Mohit Kera disagree with Joseph Hearnshaw read a lot.

 

[RobRoy]

Like I said tell it Abraham Morgenthaler, Mohair Kera, and Bhasin among others ... And yet you think yourself smarter than those men.