Ain't Done Yet

Low T?

Sunday, August 11, 2013

        What is low T? That is in fact a loaded question. First off in this era of fast marketing and government “oversight” in medications what are your expectations? Well you would expect in this day and age that a blood test would be both evidence and definitive. Anti doping began almost 100 years ago (1928). Doping has been a subject in Olympic competition off and on since. The IOC (international Olympic Committee) administered in the Olympics since 1960 that standards would be hard and fast. You would expect that the tests will tell the story and there would be research that will define where someone is gaining an advantage. Also we would also expect to know what is normal. Here is the WADA  (World Anti Doping Agency) explanation on not specifying a number: “Normative reference ranges are dependent on the laboratory and assay providing the analyses, thus it is not possible for WADA or USADA to outline definitive reference ranges.”  So the lab with no set methodology defines the “normal”. Which is actually the case for most lab data. You never get a researched healthy range all you may see is “normal” ranges. Try this next time, ask your doctor what the normal range means? Next ask him/her what is an optimal number for good health? Do that for say Vitamin D. and when the doc finally gives up that 100 is a toxic level ask what are the symptoms of toxic D levels. This is why you don’t see many people actually get stripped of credentials, and a large amount of lesser suspensions. The evidence is in question right from the git go.

            As you might have guessed, these seemingly foundational conditions are in great dispute. Here are some realities. Not even the society of Endocrinologists can agree on a testing standard. That they can not even agree as to the testing protocol. I found this out when while applying for a therapeutic use exemption for testosterone This is what I got in writing from USADA.

1.Low-normal refers to a T value within the age-appropriate reference range, but toward the lower end of the range. This measurement in itself is not sufficient justification for diagnosis of androgen deficiency and granting a TUE. at least two baseline T measurements (i.e. measurements of T without any T therapy).  If the athlete has been on T therapy, it should be discontinued for 1-2 months and then two baseline T measurements should be taken in the morning on two separate visits). There should be at least one measurement of calculated free T using a validated formula or a free T by equilibrium dialysis. Measurements of free T by direct analog immunoassay are not an accurate measurement of free T and should not be used. LH and FSH levels are required to assess whether the diagnosis is primary or secondary hypogonadism and prolactin is needed if secondary hypogonadism is present.

2. WADA clearly states that TUE should only be approved for androgen deficiency that has an organic etiology, thus this is the standard USADA evaluates all TUE applications for testosterone in accordance with the International Standard for TUEs. TUE will not be approved for androgen deficiency due to functional disorder.

3.   It is extremely unlikely that a Therapeutic Use Exemption will be approved for "functional" hypogonadism (a diagnosis of hypogonadism based on low testosterone (T) levels but without a defined etiology).

4. The etiology of androgen deficiency may be organic, in which there is a pathological physical change in the structure of an organ or within the hypothalamic-pituitary-testicular axis. Androgen deficiency may be functional in which there is no observable pathological change in the structure of an organ or within the hypothalamic-pituitary-testicular axis.

5. It is extremely unlikely that a TUE will be granted for adult idiopathic hypogonadotropic hypogonadism.

6. It is extremely unlikely that a Therapeutic Use Exemption will be approved for "functional" hypogonadism (a diagnosis of hypogonadism based on low testosterone (T) levels but without a defined etiology).

7. As noted on the TUE application physician worksheet instructions, it is extremely unlikely that a TUE will be granted for adult idiopathic hypogonadotropic hypogonadism.

8. Normative reference ranges are dependent on the laboratory and assay providing the analyses, thus it is not possible for WADA or USADA to outline definitive reference ranges.

9. In a community-based, multiethnic cohort of middle-aged to older men, day-to-day variations in serum testosterone concentrations were found to be sufficiently large that single testosterone measurements were inadequate to characterize an individual’s levels, and at least two testosterone measurements were needed to diagnose androgen deficiency with greater confidence (Brambilla DJ, O’Donnell AB, Matsumoto AM, McKinlay JB 2007 Intraindividual variation in levels of serum testosterone and other reproductive and adrenal hormones in men. Clin Endocrinol (Oxf) 67:853-862)

10. WADA and USADA are unable to provide advice to support a medical diagnosis. The TUE Committee need enough medical information, clinic notes and laboratory testing notes to make the same diagnosis, and arrive at the same treatment plan as the athlete’s physician without ever seeing the patient.  The TUEC evaluate against the criteria set forth in the World Anti-Doping Agency (WADA) International Standard for Therapeutic Use Exemptions (ISTUE 2011). A TUE will be granted only in strict accordance with the criteria as stated in the ISTUE.

11. As a courtesy, we are providing the name of a resource which may be discussed with your physician. Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline. This can be found on the Endocrine Society’s website.

 

            So now for the third time in 3 years I am coming off of supplementation to fulfill the required testing for a TUE. This process was twice initiated by me in attempts to try alternatives to naturally raise my androgynous (natural)production of T. This is a horrible experience on so many levels, and as far as training 3 months outright going backwards so the effect is 6 months of no training. This hole I climb into is getting harder and harder to climb out of.

            One might expect that I feel the USADA or WADA is the enemy, they are not and are merely functioning within strict guidelines. Guidelines that were meant for professional athletes/Olympians that are typically 20-35 years old for the most part. The testing of age group athletes yes some in their 80’s is clearly new ground. Testosterone levels have not been studied for longevity or performance for that matter. Even the Endocrinologists can’t agree. The issue has not really gained much popularity until a major pharmaceutical company developed a product to “correct” th evils of low T. Namely bedroom crap rather than the real issues. Do I have an absolute right to compete? Maybe, maybe not.  Does the Americans with disabilities act apply? But the WTC celebrates those with disabilities? At least obvious physical ones.

 

 

            If you are wondering why am I doing this? Let me bring you up to speed. About 4 years ago after being diagnosed hypothyroid I requested additional tests based on my research, that test showed a level of 107. That is about what a 30 year old woman packs around. I weighed #340 at the time. Long story short I hired a consultant for nutrition and also had him write a training plan for me concerning cycling. He changed my diet, got rid of wheat . 9 months later I did my first triathlon, a sprint tri-it at Fairview Oregon (Blue Lake), a month later I did my first Olympic triathlon . That October I went to the big island on the second Sunday and watched the 2009 WTC world Championship. At that time I decided that I too was going to participate in the big race. In 2010 WTC announced that all Kona qualifiers would be tested for performance enhancing drugs. Now testing of 80 year olds is in play. This testing has opened up the proverbial can of worms.

            At this point in my life supplementing T is a requirement for my health. Low T is serious business, dramatic increase in heart issues and other very serious degenerative conditions are the risks. I believe that some men who died of heart attacks or pulmonary issues had low T in the mix. The reason is that T is quite simply, a major Anabolic hormone. Anabolic is growth/repair. When rebuild/growth occurs faster than we destroy then we grow, such as a teenager. When repair is slower than degeneration we “age”.  So when your liver degenerates and does not have all the pre-cursors to build back up it declines in function. That decline in function in itself can directly cause issues. Or it may drive other organs past their limit and accelerate the degenerative process. Having low T is a lot more than bedroom performance, in fact that has never been an issue for me at all. But bedroom performance sells and if you are supplementing for that you are supplementing for the wrong reasons, and you will do more harm than good.

            Now the reason for low T is a very complicated one. From what I have experienced there are numerous factors that affect your level of testosterone. Check out this vicious circle- excessive fat will elevate estrogen levels, which promote fat gain.  Fat gain and added estrogen conversion reduces drive to be active. Then take all the emotional frustration, treat with alcohol, which further depresses T, and there you go. You can see it if you look for this vicious circle. I have not even tried to explain the intricate dance that all our hormones play with each other. It is very complicated to a point that even endocrinologist will argue about almost every aspect of hormone interaction. New information continues to this day and enzymes are being discovered as little as a few years ago. Let alone explain their interaction.

            Bottom line if you are looking for hard and fast rock solid science, hormones are not the place to find it. You are a study of one, you do need to make your own decisions. The less you leave up to the pop culture of medicine the better.

 

Here are some links to some light reading

The endocrine society home page

Clinical Practice Guidelines-Androgens-in-Men

USADA testosterone-guidelines

WTC suspends Kona Qualifyer

history of anti-doping

 

 

 

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