What are reasonable criteria for TRT?

[Ruper]

A recent thread, which I replied in, had me thinking about ‘normal’ variations in T levels. Rather than sidetrack that thread, I thought I’d start a new one. So I’m going to try to succinctly go though my thought process and ask a lot questions along the way. (I’m hoping the questions give more of an idea of my thoughts than an expectation of getting answers to all of them.)

A number people are most likely reading this forum and wondering if they should start TRT (or even get their T levels checked). I wonder what people’s opinions are of the process by which someone decides whether to start TRT? For many it is very obvious because either their levels are very low, or symptoms are bad. ED and libido and obvious symptoms (although I had the latter for years without going to the doc or even thinking about low T). But what about people in-between? I mean many symptoms could just be short-term stress, or other factors (although some doctors seem to like to use this even when T levels are really low and the symptoms have been going on for years).

Some questions that come to mind;

Is one blood test showing low T enough? How many tests over what sort of time period did you wave before starting TRT? What do you now think is reasonable?

Can a someone’s T levels increase enough (say from 200-300 to 400+) over a period of time to justify them not going on TRT? 400 may be low, but if someone’s symptoms are not too bad should they still seriously consider TRT (or always consider it).

Is TRT so beneficial for long term health and/or quality of life, that someone with levels 350-450 and 30-40 years old start TRT independent of symptoms?

How much below ‘normal’ do doctors with good knowledge of TRT consider administering TRT? Is that totally dependent on the symptoms?

Looking at these data:

http://www.natural-hrt.com/andropause04.html

which are considered the ‘normal’ levels, should everyone below 1 standard deviation get TRT, or be considered for TRT? What about ½ a sd from the mean or median? What is someone is close to the mean and suffering low test symptoms? 1 sd below would be ~15% of the 'normal' population. Or should it be the lowest 10% or 30%? If we look at the population distribution is there a jump from normal to low, or is it normally distributed? I don't know, but I'm not sure looking at the tables and saying 'I'm X sd from the mean, I'd better get TRT' is the best way to go.

In fact, looking at the tables, is there a statistically significant variation with age? The drop in median values from 25-55 on that last table is only 1/2 of the standard deviation. If each age class is truly normally distributed, I'd guess there was a statistically significant decrease. The first study looks more conclusive, but one might be able to argue that there is no decrease with age until about 65 year old.

I’m not a statistician, and I haven’t read the whole trail of articles and sited references. Unfortunately I know enough to know that statistics can be grossly mis-represented. While I presume from the combined knowledge of people here that the age drop is real, the definition of ‘low T’, however is not so obvious. As I eluded to earlier, I guess there is more of a continuum than a sharp definition, so the question remains;

What in you opinion are reasonable criteria for someone to seriously consider TRT, especially if thier T levels are low-normal?

[Brennon]

Originally Posted by Ruper

What in you opinion are reasonable criteria for someone to seriously consider TRT, especially if thier T levels are low-normal?

If T levels are low-normal, reasonable criteria would be asking the individual if he would like to undergo TRT, imo.

[Legenden1999]

Ruper,

Good post!
I would like to see this anwsered as well.

JH

[Albert]

Ruper to are right, but sadly the stats quoted on http://www.natural-hrt.com/andropause04.html are from the Wellman clinic.

I cannot find this at The Wellman Clinics new site or any data to back them up and I had a problem trying to get a doctor to use them.

When a Doctor like Swale has this way of thinking and doctors mine will not look at it, I find it very frustating and annoying. Then I get told I need anti-depressants and blood pressure pills, I wonder why.

Thanks for a top post.

Later,
Albert.

[Legenden1999]

bump, still would like to see some more anwsers on this one...

[pmgamer18]

I was on TRT for a long time before I found this link it is the first thing I ever found yrs. ago about this. I still feel today this is a dam good read. This link got my Dr. to test my E2.
http://www.lef.org/protocols/prtcls-...prtcl-130.html
22 yrs. ago I was so dam sick I could not work I had bad fatigue so bad it was hard to get out of bed. I was told I have low Iron the CFS and after the testing and treatment not working I was told I have Major Depression I was on sick leave and had to go a long with this and go on AD meds. I was on them for 5 dam yrs. and never felt better. I got a bad bladder infection from using a new AD med that slowed down my voiding. So I was sent to a Uro he told me he feels I am not suffering from Depression but Low T. He tested me and my Total T was 120. He took me off all meds I had to go into re-hab to get off them and then tested me again. I was still very low 125 so I was put on T Pills this was over 17 yrs. ago. Two months later the T shots were started and I started getting much better and was back to work. I feel like I lost 5 yrs. of my life on AD drugs walking around in a fog. The link about helped me and my Dr. who after seeing many Endo's was learning how to treat me. Everything you need is to me in this link.