<p><span style="color: #000000;">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.</span><span style="color: #333333;"><br /> <br /></span><span style="color: #201f1e;">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 <a href="https://peterattiamd.com/members/private-podcast-feed/">private RSS feed</a> or on our website at the <a href="https://peterattiamd.com/ama28/">AMA #28 show notes page</a>. If you are not a subscriber, you can learn more about the subscriber benefits <a href="https://peterattiamd.com/subscribe/">here</a>.</span><span style="color: #333333;"><br /> <br /></span><span style="color: #201f1e;">We discuss:</span><span style="color: #333333;"><br /></span></p> <ul> <li><span style="color: #000000;">A primer on the hormone testosterone and how it influences gene expression [3:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">How the body naturally regulates testosterone levels [11:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">The defining threshold for "low testosterone," how low T impacts men, and why free testosterone is the most important metric [16:15];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">When it makes sense to treat low testosterone [26:00];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">The structural and metabolic benefits of testosterone replacement therapy [29:15];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Body composition changes with TRT [45:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Changes in bone mineral density with TRT [48:15];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">The metabolic impact of TRT: glucose, insulin, triglycerides, and more [52:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">A study investigating testosterone replacement therapy for prevention or reversal of type 2 diabetes [59:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #333333;">The impact of TRT on metabolic parameters and body composition—A study comparing results from continuous vs. interrupted treatment [1:07:15]</span></li> <li><span style="color: #000000;">The controversy over TRT and cardiovascular disease [1:21:45];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Two flawed studies that shaped perceptions of risks associated with TRT [1:44:15];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">The controversy over TRT and prostate cancer [1:56:45];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Other potential risks with testosterone replacement therapy [2:02:15]; a</span><span style="color: #201f1e;">nd</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #201f1e;">More</span></li> </ul> <div>Learn more: <a href="https://peterattiamd.com/">https://peterattiamd.com/</a><br /> Show notes page for this episode: <a href="https://peterattiamd.com/ama28/">https://peterattiamd.com/ama28/</a> <br /> Subscribe to receive exclusive subscriber-only content: <a href="https://peterattiamd.com/subscribe/">https://peterattiamd.com/subscribe/</a><br /> Sign up to receive Peter's email newsletter: <a href="https://peterattiamd.com/newsletter/">https://peterattiamd.com/newsletter/</a><br /> Connect with Peter on Facebook | Twitter | Instagram.</div>
Actionable Insights
1. Improve Sleep, Reduce Stress
If you have low testosterone combined with inappropriately low LH and FSH, prioritize improving sleep and reducing stress (hypercortisolemia), as these are common causes for this central issue.
2. Identify Low T Cause
When considering treatment for low testosterone, differentiate between testicular causes (high LH/FSH, low T) and central causes (low LH/FSH, low T), because treatment strategies are highly dependent on this distinction.
3. Focus on Free Testosterone
When assessing testosterone levels, pay special attention to ‘free testosterone’ numbers from lab tests, as symptoms tend to track more closely with this biologically active form compared to total or bioavailable testosterone.
4. Learn About Hormones
Get smart on the topic of testosterone and hormone replacement therapy (HRT) for both men and women, as there is a lot of misinformation out there.
5. Consult Healthcare Professionals
Do not disregard or delay in obtaining professional medical advice for any medical condition you have, and always seek the assistance of your healthcare professionals for such conditions.
6. Understand Exogenous T Risks
Be aware that if a person takes exogenous testosterone for long enough, their body will likely lose the ability to make its own testosterone, becoming a permanent issue.
7. Anticipate Male Testosterone Decline
Understand that males will experience a decline in testosterone levels, akin to female menopause, and be prepared to consider if any intervention should be done about it.
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