Ep. 136 - All About Testosterone & TRT (Yeah We Go There)
Sep 13, 2021
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Dr. Ben House, expert in testosterone replacement therapy, discusses the risks and considerations of TRT, the relationship between obesity and testosterone levels, factors contributing to low testosterone, the prevalence of low testosterone, marketing pitfalls of TRT, the Joe Rogan Experience and TRT, and the risks of testosterone replacement therapy.
Research shows that a high percentage of men (80-85%) who go on TRT eventually stop within a year, suggesting unrealistic expectations and dissatisfaction with the treatment.
There are various factors that should be explored before considering TRT, including underlying causes of low testosterone (such as varicoceles, drug use, or low energy availability) and potential alternatives to hormone replacement therapy.
Thorough examination and comprehensive diagnosis of an individual's specific situation are crucial before starting TRT, with a focus on addressing potential underlying causes and considering psychotherapeutic and lifestyle interventions.
TRT should be seen as a long-term commitment, requiring informed consent, research, and consultation with qualified healthcare professionals to understand the potential risks and benefits and promote a holistic approach to hormone balance.
Deep dives
Testosterone Replacement Therapy (TRT) and its Misconceptions
TRT, commonly known as testosterone replacement therapy, has gained popularity due to heavy marketing and financial interests. However, research shows that a high percentage (80-85%) of men who go on TRT eventually stop within a year. There are various factors contributing to this outcome. One possible reason is the unrealistic expectations, as TRT is often seen as a panacea for all issues related to low testosterone. Moreover, the side effects and inconvenience of lifelong administration of testosterone injections may lead people to discontinue TRT. Additionally, the underlying causes of low testosterone, such as varicoceles (enlarged veins in the testicles), drug use, or low energy availability, should be explored before resorting to TRT. It is crucial to have a comprehensive understanding of TRT, including potential side effects and long-term implications, before making an informed decision about hormone replacement therapy.
Exploring the Link Between Obesity and Testosterone Levels
The rise in testosterone prescriptions and the prevalence of low testosterone levels are observed in middle-aged males (35-45 years old), which is unexpected. Obesity has been identified as a contributing factor to low testosterone, with the obesity rate reaching 36%. Additionally, endurance athletes often experience a decrease in testosterone levels due to the intense physical activity. However, it is worth noting that athletes in this case don't exhibit symptomatology, which raises questions about the long-term implications of a reduction in testosterone levels. Other factors like varicoceles (enlarged veins in the testicles), micronutrient deficiencies, and low energy availability also influence testosterone levels. Understanding these factors and assessing individual circumstances are crucial before considering TRT as a solution.
The Importance of Proper Diagnosis and Individual Context
The decision to start TRT should not be taken lightly, and it requires a thorough examination of the individual's specific situation. Simply having low testosterone levels is not sufficient reason to immediately resort to TRT. Other potential causes, such as varicoceles, hormone imbalances, traumatic brain injuries, micronutrient deficiencies, and energy availability, should be evaluated and addressed. Additionally, psychotherapeutic and lifestyle interventions may be necessary for those experiencing psychological issues or seeking body composition changes. A comprehensive diagnosis and context-based approach are essential to make informed decisions regarding hormone replacement therapy.
The Need for Informed Consent and Responsible TRT Usage
TRT should be seen as a long-term commitment and not a quick fix solution. However, many people undergoing TRT may not be fully aware of the lifelong commitment and potential side effects associated with it. Informed consent, research, and consulting with qualified healthcare professionals are crucial before starting TRT. It is essential to differentiate between legitimate medical reasons for TRT, such as hypogonadism, and non-medical motivations driven by aesthetics or performance enhancement. Responsible usage entails addressing the underlying root causes, seeking evidence-based treatments, and understanding the potential risks and benefits, ultimately promoting a holistic approach to hormone balance and overall well-being.
The role of testosterone in overtraining
The podcast episode explores the role of testosterone in overtraining. While a low testosterone level (around 400 nanograms per deciliter) may indicate possible overtraining, it is not the only value used to determine overtraining. Symptoms and motivation to train are also important factors. The sex hormone-binding globulin (SHBG) is discussed in relation to testosterone binding in the blood. Free testosterone is thought to be bioavailable to cells, and SHBG levels can impact testosterone availability. The importance of considering diagnostic criteria and evaluating energy availability and training volume is highlighted.
Considering factors beyond testosterone levels
The podcast emphasizes the need to consider various factors beyond testosterone levels when evaluating hormonal health. It mentions the impact of weight loss, dieting, and energy availability on testosterone levels. Additionally, it discusses the potential effects of concussions, endurance training, and obesity on testosterone. The importance of taking a comprehensive approach and evaluating the whole picture is stressed, rather than relying solely on testosterone levels.
Making informed decisions about testosterone replacement therapy (TRT)
The podcast provides insights into testosterone replacement therapy (TRT). It cautions against solely relying on TRT as a first-line solution, emphasizing the importance of exploring other factors that may contribute to low testosterone. The potential risks and side effects of TRT, such as elevated hematocrit levels and cardiovascular concerns, are discussed. The need for individualized risk assessments, consulting knowledgeable healthcare professionals, and considering lifestyle changes alongside TRT is highlighted.
Testosterone. The obsession of the lifting world. Previously on Iron Culture, we’ve had Roundtables on PEDs (taking supraphysiological levels of testosterone, synthetic testosterone, and other performance-enhancing drugs), and we’ve had experts on to discuss the history of PEDs, their long term effects, and how they are tested for in sport. But today, we have Dr. Ben House back on the podcast to talk specifically about testosterone replacement therapy (TRT) in a clinical setting…and well, the *wink wink nudge nudge* common practice of not so clinical usage of TRT. It’s hard to get good information on this topic, some claim TRT is just as innocuous as taking creatine, and the number of men who hop on TRT in middle and old age has skyrocketed in recent times. But do you know what also has skyrocketed? The number of men who stop taking TRT within a year of starting. Some studies suggest 8-9 out of 10 men will cease TRT, despite claims it’s a fountain of youth without side effects. But why? Join us today for a deep dive on this topic to learn what really seems to be going on.
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