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Comment by gadders | Hacker News Reader

>>The trick the clinics are using now is “diagnosing by symptoms”.

You can't really diagnose by levels, though, unless you knew what that person's previous levels were. Setting an average across a population is not really realistic - you can't say Shaq should work to the same levels as, say, Emo Phillips.

TRT is normally used due to aging, though, so you are unlikely to have your testosterone levels spontaneously recover as you get older. You do tend to need to be on it for life, in the same way that women stay on HRT.

However, if you did need to get off, bodybuilders have "post cycle therapies" to kick start production so it seems to be possible.

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If someone shows up with a testosterone level of 700 you can (and should) explain that low testosterone is not the explanation for whatever they’re suffering from.

The TRT clinics are ignoring levels or even not testing at all. They’ll find an excuse to prescribe to someone even who has clinically high levels because they want the monthly recurring revenue from keeping that customer for life.

> If someone shows up with a testosterone level of 700 you can (and should) explain that low testosterone is not the explanation for whatever they’re suffering from.

I'm not going to say TRT clinics are the best actors here, but to an actual endocrinologist, diagnosing hormone issues isn't so simple as looking at single point-in-time measurement of total testosterone.

Testosterone levels naturally vary even for a given individual - two readings at the same time of day on different days even a short period apart can be dramatically different - and that's not even taking into consideration the fact that total testosterone levels aren't the sole (or even primary) mechanism for diagnosing androgenic endocrine issues.

Have no idea why you're getting down voted for actual literal scientific fact that any doctor would agree with.

Yup that's right. I had multiple low (<200) tests over 3 years, and finally was able to get on it (haven't actually started it yet to be fair).

Now I am worried about the long term effects, but it's been so long that if I am on it for the rest of my life and it does help me, that's good enough.

What if the person complaining had spent all their life at a base level of 1000? Diagnosing off population base levels is a very blunt tool.

I don't disagree that there are some bad actors out there - the bar to getting it under 40 or 50 should be very high. But honestly, I think everyone's levels should be checked before being put on an SSRI for depression.

HRT is also a life-long treatment, no?

>You can't really diagnose by levels, though, unless you knew what that person's previous levels were.

Exactly. Before suggesting it. my doctor had more than a year's worth of data. (I have some blood tests done quarterly; so, he added one for testosterone.) Even then, he sent the results to my urologist.

But also - say over your 55th year your levels were 800, but when you felt your best and most confident at 35, your levels were 1000. What is the correct level for you?

TBD. I was told you start TRT and then check the level in three months. Based on the new level and symptoms, the dosage gets adjusted. That's the difference between doing actually in consultation with a doctor, as opposed to a one-time phone/internet "consult."

> bodybuilders have "post cycle therapies" to kick start production so it seems to be possible.

I mean, bodybuilders essentially have a whole branch of alternative medicine which they have wholesale made up, so, ah, I'd be sceptical.

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