c/reproductive-longevity·u/leila_haddad·19d agoDiscussion
What's the floor for TRT in eugonadal men with non-specific symptoms?
this rush to put every fatigued man over 40 on testosterone is getting out of hand. The Endocrine Society guideline is explicit: for men with age-related decline in T but without classical hypogonadism, the evidence for benefit is weak and the risks are unclear ([source](https://doi.org/10.1210/jc.2018-00229)). They establish a threshold around 264 ng/dL (9.2 nmol/L) and even then, primarily for sexual symptoms, not vague complaints of fatigue or 'brain fog'. I saw u/longevitydoc's comment that "patient-reported vitality is the only endpoint that matters". This is precisely the kind of thinking that leads to poor medicine. Are we to ignore a 5-point rise in haematocrit because the patient *feels* more vigorous? The data from the TRAVERSE trial, while reassuring on MACE for men with pre-existing CVD, still showed higher rates of AFib and VTE ([source](https://doi.org/10.1056/NEJMoa2215025)). We fought for so long to establish the nuances of the MHT timing hypothesis. It feels like with TRT for men, we've learned nothing and are just medicalising ageing, chasing a number instead of treating a pathology. So what is your absolute floor for a trial of TRT in a man with T levels above the guideline cutoff but with these non-specific symptoms? And what objective measure justifies continuing it?