Understanding Testosterone and Myth-Busting with Dr. Abraham Morgentaler

madman

Super Moderator
He mentions Bhasin's latest paper when speaking about TT vs FT!






45:34-58:43 (TT vs FT, estradiol/AI, hematocrit)


In this episode, Dr. Steinberg sits down with world-renowned testosterone therapy pioneer Dr. Abraham Morgentaler. From studying testosterone in lizards at Harvard to becoming a leading academic urologist, Dr. Morgentaler shares his journey and challenges long-standing beliefs surrounding testosterone therapy.They explore the decades-old fear linking testosterone to prostate cancer, why traditional testosterone testing can be misleading, and how modern research is reshaping the way testosterone deficiency is understood and treated.




Key Topics:
  • The truth about testosterone and prostate cancer
  • Total vs. free testosterone
  • Estrogen blockers and hematocrit
  • Who may benefit from testosterone therapy
  • The future of testosterone treatment



Dr. Abraham Morgentaler

* What’s important to understand, though, is that the concept of testosterone therapy, in theory, is designed to replicate youthful levels of testosterone to help people who are deficient in this hormone. The goal isn’t to make them into supermen, and the real question is why do people want to go above normal, if at all?

Much of the concept of treating up, let’s say, to 1,000, let’s say, our normal upper limit,
in the anti-aging community or age management community, there are some people who believe there’s an optimal level of testosterone that may be 1,200 or 1,500, or even, I’ve heard, 1,800, and the basis for that is
WEAK!




* Optimal results often require T values in the upper range of normal (T 600-900 ng/dL)

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* Some groups target T levels 1200-1800 ng/dL

* Supraphysiological/pharmacological rather than restoration of robust youthful levels


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*However some men won't achieve adequate response until total T in upper levels of normal 650-1000 ng/dL

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Dr. Morgentalers stance on hematocrit (52:24-56:14)

* The Endocrine Society, which is normally a very conservative group, gave a number of 54% is where you need to sort of do something about it, and I've used that with good success. So, I don't care if its 51, if its 52, if its 53%, its fine with me. At 54%, mainly for medical/legal reasons, I don't want to go higher. There is NO EVIDENCE, NONE, that shows that having HEMATOCRIT 54 or 55 or 56% is DANGEROUS.








* No evidence of increased risk when elevated hematocrit is due to TTh

* Erythrocytosis suggests a possible cause of VTE and CV events with TTh, however no evidence of any association

* The hematocrit level at which the risk of neuro-occlusive events or cardiovascular events increases is not known

* Implication - 54% is an arbitrary cut-off

* The frequency of neuro-occlusive events in men with hypogonadism enrolled in RCTs of T who developed erythrocytosis has been very low

* Implications - little evidence of actual vascular risks associated with elevated hematocrit

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* 54% is a useful, reasonable upper limit of acceptability

* NO NEED TO INTERVENE unless HCT >54%


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