#180 - AMA #28: All things testosterone and testosterone replacement therapy
whatshot 9 snips
Oct 18, 2021
In this engaging AMA session, Peter and Bob dive into testosterone's critical role in health and well-being. They discuss what constitutes low testosterone and its impact, particularly on men. Testosterone replacement therapy (TRT) is examined for its potential benefits and risks, especially regarding cardiovascular health and prostate cancer. The conversation sheds light on body composition changes and the importance of free testosterone as a key metric. Whether you're curious about hormone health or considering treatment, this discussion is insightful and thought-provoking.
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insights INSIGHT
Testosterone Physiology
Testosterone, a steroid hormone from cholesterol, binds to androgen receptors, influencing gene expression.
Free testosterone, unbound to carrier proteins (SHBG, albumin), is the biologically active portion.
insights INSIGHT
Testosterone Regulation
The body regulates testosterone via a feedback loop involving the hypothalamus, pituitary gland, and testes.
In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to testosterone: what happens when testosterone levels are low, and the potential benefits and risks of testosterone replacement therapy (TRT). They explain the physiology of testosterone, how it works, and how its level changes over the course of a person's life. They have a detailed discussion about existing literature, which reveals vast potential structural, functional, and metabolic benefits of testosterone replacement therapy. They also take a very close look at potential risks of this therapy, with a focus on the controversial effects on cardiovascular disease and prostate cancer. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #28 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:
A primer on the hormone testosterone and how it influences gene expression [3:30];
How the body naturally regulates testosterone levels [11:30];
The defining threshold for "low testosterone," how low T impacts men, and why free testosterone is the most important metric [16:15];
When it makes sense to treat low testosterone [26:00];
The structural and metabolic benefits of testosterone replacement therapy [29:15];
Body composition changes with TRT [45:30];
Changes in bone mineral density with TRT [48:15];
The metabolic impact of TRT: glucose, insulin, triglycerides, and more [52:30];
A study investigating testosterone replacement therapy for prevention or reversal of type 2 diabetes [59:30];
The impact of TRT on metabolic parameters and body composition—A study comparing results from continuous vs. interrupted treatment [1:07:15]
The controversy over TRT and cardiovascular disease [1:21:45];
Two flawed studies that shaped perceptions of risks associated with TRT [1:44:15];
The controversy over TRT and prostate cancer [1:56:45];
Other potential risks with testosterone replacement therapy [2:02:15]; and
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