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). 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). 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?