TRT: Dose Shaming, Fat Shaming, Gatekeeping, Low Androgen Sensitivity – Myth, Stigma, and Misinformation is Toxic and Pernicious – Ryan Root

I.             (Introduction). This is one of the first articles that I have done.  I originally wanted to start with the basics, how to design a TRT protocol, but there is a narrative being promulgated over Reddit and other TRT help forums that may be beneficial to some, but is misleading and pernicious to many. 

II.            The first thing that is important to understand about Reddit and other TRT help forums, is that they are places for people who need help.  These forums are an accrual of people who have problems. When reading a help forum, you are inculcated with horror stories and problems, to the point where you may begin to believe that adverse side effects are much more common than they actually are.  Ninety to ninety five percent of people immediately improve their quality of life upon using a proper protocol of testosterone, and they do not come to Reddit to say, “Everything is great!  Welp, see you later”, they simply live their improved lives.  Therefore, the audience on Reddit and other TRT help forums is not an accurate representation of a real sample set of society.  It is an aggregation of anomalies.  I like Reddit and TRT help forums because they are helpful tools.  If you are experiencing a side effect, it is beneficial to see how others have dealt with similar issues, because these tactics may help you as well.  On the other hand, I have seen Reddit scare people who would benefit from testosterone out of using TRT.  Certainly, caution should be used when considering TRT to make sure you meet criteria and to make sure you understand what you are getting into.  However, alarmists are so concerned with preventing people from using testosterone unnecessarily that they don’t think about the flip side; their overabundance of caution is unnecessarily scaring and preventing people from utilizing testosterone to dramatically improve their quality of life.  Most people who use TRT benefit from it, and, after experiencing the immensely positive results, they tend to get angry because they felt duped.  They feel duped because most of the information they learned, from physicians, from peers, was the wrong information. The most common refrain I hear from people who commence TRT is; “I wish I had started TRT years ago”. 

III.           For those of us who have vast amount of knowledge and experience in the hormone industry; we see two main reasons for the promulgation of myth, abysmal advice, and toxicity: 1. When people believe everyone is the same, and that their own experiences, or what they have seen from a few others, is exactly how everyone else should act, react, and behave, and;  2. When people begin to regurgitate the antiquated notions and dogma from the medical community, which is decades old, biasedly views testosterone as dangerous, refuses to keep up with contemporary knowledge and evidence, and notoriously establishes poor protocols, poor understanding of hormones, and poor results. 

A.            A personality trait, inherent within most people, that causes the dissemination of misleading information, especially on these TRT help forums, is the inability for most people to see outside their own self-centricity.  Most people assume that what worked for them, and a couple of their gym buddies, should work for everyone, without the slightest consideration of differing genetic predispositions.  Many people do not understand that there is a massive disparity in the way each individual reacts to different compounds and different blood levels of hormones.  Consequently, when you have a TRT subreddit, or TRT help forum, that accumulates an audience of people with similar problems, they tend to speak as if their personal experiences are gospel, when in reality, their experiences are atypical of the greater population.

B.            Within the TRT subreddit and other TRT help forums, there exists a subset, or cult, of people who have convinced themselves that testosterone should rarely be used:

1.            only in instances where people have medically low testosterone, below 250ng/dL, according to the low end of the ranges utilized by medical community. 

a)            These ranges are arbitrary, and rooted in nothing real.  These ranges simply stem from an aggregation of data, of the blood levels from people that have taken these blood tests in the past (typically older, sick people). There was never any research performed to prove that 250ng/dL and above is “normal”, and that people should feel optimal at that level.  We see in the field that most people begin to feel suboptimal below 700ng/dL, and below 500ng/dL, people are beginning to live lives of despair. To think of a total testosterone below 400ng/dL as “normal” is ludicrous; no one feels good at that level. 

2.            The cult of people who believe that the use of testosterone should be parochial in nature, or narrowly restricted, have also commenced fat shaming, as well as shaming people’s life choices; stating the common refrain that if they lost weight and made positive life changes, their testosterone levels would dramatically change for the better.  Many believe that testosterone levels lower when people become overweight and unhealthy.  However, in the field, we find that the reciprocal is true: most people are overweight and unhealthy because their testosterone level is low.

a)            Contrary to popular belief, most people notice very little or no change in hormone levels from losing weight and making positive life changes.  Positive life changes will positively affect testosterone, but often it is only a very mild addition to their total testosterone.  From a vast amount of experience, although positive life changes are enough for some people, it is not for many people;  the minimal addition of testosterone from positive life changes is not enough to feel any difference. Again, many people themselves, or they know a guy, who was able to make significant improvements through diet and exercise, and therefore, are unable to see outside their own self-centricity; causing them to incorrectly believe that everyone should be able to replicate that scenario. 

b)            Many believe that overweight people should be able to motivate themselves and lose weight before they commence TRT.  This stems from a fundamental misunderstanding of biochemistry, and what causes motivation.  Dopamine causes motivational salience.  Therefore, motivation is another word for an uptake of dopamine.  In order for humans to produce dopamine, or motivation, we have to receive a reward, or positive results, from an action.  If someone has poor genetics for hormones, or they never learned proper diet and exercise, and they do not notice any appreciable results from diet and/or exercise, they will not produce dopamine, and hence, will not have the motivation to lose weight and improve their aesthetics.  If dieting and exercise does not yield any positive results, human nature will motivate them to stop exercising and eat comfort foods which do elicit the production of dopamine.  This becomes a negative reinforcing cycle.  For an overweight person with low testosterone, the introduction of testosterone, which is itself dopaminergic, and increases metabolism to aid in fat loss, will suddenly allow a person to see results from exercise and diet, eliciting a strong dopamine response, motivating them to continue to exercise and to continue to clean up their diet.  Testosterone creates a positive reinforcing cycle that jumpstarts progress, and motivates people to continue on a dramatic and life changing path. 

C.            Additionally, Within the TRT subreddit and other TRT help forums, there has formed a cult of low-dose TRT evangelists. 

1.            These Low Dose evangelists believe that 60-120mg of testosterone cypionate per week is the maximum dose anyone should take, and that blood testosterone levels in the upper “normal” range of 700-900ng/dL is an optimal and maximum level for all humans.  The low dose evangelists go as far as shaming anyone who prefers 200mg or more of testosterone per week, using language that has developed negative connotations such as “cycle”, “steroids” (testosterone is a steroid), or “PED’s” to describe their dosing behavior; even becoming angry, acrimonious, and discriminatory against people who feel better using 200mg of testosterone or more per week. 

a)            Congratulations to those who have dialed themselves in, and found that they feel better on low dose testosterone, but, The fact is, from a vast amount of experience and empirical evidence, in the field, we see most people feel better with perfect health markers on a dose of 200mg or more.  Again, if you happen to react better to a lower dose, and you surround yourself in a community that evangelizes low dosing, it is difficult for humans to see outside their own self-centricity, that there is a bigger world out there with a myriad of possibilities outside what you have experienced.  Carl Sagan and Nassim Taleb, in his book The Black Swan and Antifragile famously quoted: “Absence of evidence is not evidence of absence.”  Just because you and a few others react better to low doses, is not evidence that everyone will. 

b)            There are a myriad of reasons why people subsume myths or false narratives, of which we will delve into later, but one of the reasons people give as to why they adamantly object to doses of 200mg per week, or total blood testosterone levels of over 1200ng/dL, is that they believe it is dangerous and could lead to long term health conditions.  Although there has been evidence of very large doses of testosterone and its derivatives exacerbating adverse health conditions when taken at abusive levels very long term; doses of 200mg, or a little more, per week, or blood testosterone levels of 1500ng/dL, or a little more, have never been correlated to any long-term adverse health concerns.  Naysayers will regurgitate the medical community’s insistence that we don’t know How these hormones will affect people long term.  Bullshit!  People have been administering doses of 200mg, with levels of around 1500ng/dL, beginning in the 1950’s, and there has been no evidence that these moderate doses cause any long-term consequences.  Quite the opposite.  I have personally witnessed thousands upon thousands of people taking doses of 200mg per week, many taking more, for decades with no adverse long-term consequences.  Millions of people have been taking a dose of 200mg or more for the last 70 years; plenty of empirical and anecdotal data exists, yet the medical community refuses to bone up on contemporary knowledge, and acknowledge current empirical data and the superabundance of anecdotal data. 

c)            Invariably, everyone reacts differently to hormone levels, dosing protocols, medications, and blood test ranges.  Total testosterone is just one factor in a myriad of factors that determines how we react to testosterone treatment. As an analogy, scientists conducted a massive research project on the number of genes involved in determining a human being’s height, and found that over 20,000 genetic factors were utilized.  Most physicians only look at Total testosterone and maybe free testosterone to gauge how a person is reacting to testosterone treatment, but that is only two genetic factors, where there are likely thousands of genetic factors that determine each individual’s reaction to testosterone. 

(1)          What about frequency of androgen receptors?  Some people have many more androgen receptors than others.  Someone with a low frequency of androgen receptors would need more testosterone to have the same results as someone with a higher frequency of androgen receptors. 

(2)          What about binding affinity of testosterone to the androgen receptor?  (Explain Androgen receptors). 

(3)          What about potency of the cascade effect after testosterone binds to the androgen receptor?  How much does the cascade effect hypertrophy an individual’s muscle cells; how much does the cascade effect increase dopamine and dopamine receptors; how much does the cascade effect increase red blood cell count?  The potency of testosterone’s cascade effect would differ for each individual. 

These are three more examples of factors that determine the effects of testosterone that no one considers – and there are likely thousands more factors that we don’t even understand or know about.

IV.           Why do people appropriate myths, false narratives, and form cults to deter people from taking testosterone?  There are likely a myriad of reasons why, some of which we already went over, but here are a few reasons that make sense:

A.            To illuminate where the testosterone epistemology and ontology is flawed, where the education and understanding is lacking, I would like to introduce the concept of varying degrees of low androgen sensitivity. Testosterone in the blood has no effect, whether it is 500ng/dL or 2000ng/dL, until it binds to androgen receptors and completes its cascade of effects.  For the reasons stated earlier, sensitivity to testosterone varies with everyone.  900 – 1000ng/dL affects everyone differently.  Someone with low sensitivity to testosterone may need 1500ng/dL, or 1800ng/dL, to have the same effects as 900 – 1000ng/dL would affect a person with normal sensitivity to testosterone.  No one every considers this when discussing testosterone blood levels and dosing protocols. 

B.            As I stated earlier, the medical community believes testosterone and its derivatives may be dangerous, and should only be used in the most parochial of circumstances; specifically, not because they have knowledge of the subject, but because they notoriously have a lack of knowledge and are ignorant regarding the subject.    Many people tend to believe that if you maintain a level of over 1200ng/dL, you may experience long term health consequences.  However, there is no evidence of this in the seventy years people have been taking far ranging doses of testosterone.  There isn’t a specific range that will universally cause a problem.  If testosterone is going to cause an adverse health condition in an individual, it will manifest itself through drastically increased creatinine or c reactive protein, drastically increased hematocrit and hemoglobin, high blood pressure or drastically increased heart rate. If someone has a blood testosterone level of 1200ng/dL, but their hematocrit, blood pressure, and heart rate is elevated, and they try to maintain that level for a decade or more despite the manifested health concerns and elevated health markers – then they may develop  long term health consequences.

If a person with low sensitivity to testosterone, has a Total testosterone level of 1500, or 1800, but the rest of their health markers are adequate and not problematic, then a wealth of empirical and anecdotal dating indicates there will be no long term health consequences.  Remember, the fact that there is any amount of testosterone in the blood does not mean anything, positive or negative, until it binds to androgen receptors.

C.            When humans form a belief, especially when that belief comes from someone we consider to be respected, highly credentialed, such as from the believability of a physician; it notoriously becomes difficult, if not impossible, for people to change their minds (There are evolutionary mechanisms and reasons for this, for which I will make a video later, because it is fascinating).  Cognitive dissonance will not allow most people to change their mind even when presented facts contrary to their belief, say from a guy who has studied solely in this specific field for over twenty years, who has more experience than almost any physician or anyone in the entire country. 

D.            Dr. Yuval Noah Harari wrote a fascinating and popular book entitled “Sapiens”, which defined that a major reason for human progress was due to our ability to unite under fictions, or beliefs.  Humans are the only animals that will unite in massive populations under beliefs, such as: governments, monetary systems, human rights, sports fans, and capitalism.  Frequently, we see people unite under beliefs diurnally to form cults, sects, factions, groups, and movements for wide variety of shared ideologies.  Uniting under beliefs is responsible for the massive amount of progress made in human history.  Unfortunately, it is also responsible for insidious and toxic beliefs such as: racism, scientology, and the misinformation regarding testosterone and its derivatives.  When you have a large trusted institution, such as the medical community, that has inculcated itself with misinformation, that misinformation promulgates and it takes a very long time to shift the paradigm into a more progressive understanding – again, such as with the medical community and the misinformation regarding testosterone and its derivatives. What has developed is sects, or factions, consisting of people with a more progressive understanding from contemporary knowledge and research, and those that still conform to the antiquated notions and dogma from the old paradigm.

E.            Finally, it is inherent within human nature to desire to keep that which benefits us a secret.  This tendency is driven by evolutionary mechanisms.  In the cave man days, keeping food sources, or good hunting grounds, a secret would ensure your own survival.  When people can gain an edge, they typically like to protect that edge, and prevent others from attaining it.  This is why some people do not want others to use testosterone and gain the same edge on life that they have.  Additionally, I have noticed a sense of jealousy, especially coming from low dose evangelists. People who use 200mg, or a little more, tend to look and feel better than those who use a lower dose.  Some people who are prone to side effects from 200mg of testosterone, and simply cannot use that much (this is where derivatives with lower side effect profiles could come into play to help further reduce symptoms of hypogonadism without the side effect profile).  For those prone to side effects, one way to make yourself feel better about taking low doses, when others praise the effects of higher doses, is to demonize those taking 200mg or a little more, and make it sound like they are deviants by using stigmatized language to describe their behavior such as “cycling”, “steroids”, or other vituperative. 

V.            What you learn when you start to become adept at understanding hormones, is that we cannot put everyone in a box, and decide that everyone needs to be in a certain range, or on a certain dose, or on a certain protocol.  There is a massive disparity between the way each individual reacts to different compounds, different blood levels, different doses, and different treatment protocols.

There are many complexities that we cannot measure, and because we can’t measure most of the complexities, THE NUMBERS DON”T MEAN MUCH!  It is not about putting everyone in a box by maintaining everyone at the same blood level range or the same dose, or same treatment protocol.  Anyone who does this, is not good at TRT/HRT.  Unfortunately, using predetermined protocols for everyone are how most physicians, and the greater medical community, treat hormones deficiency.  Everyone is vastly different and are better optimized at different ranges and different doses.  Again, I reiterate this because it is important;  it is not about putting everyone in a box, and using cookie cutter solutions for everyone, It is about developing a methodology to figure out what yields the best results for each individual.  How do we do that?  I will delve into that in future videos and articles.

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