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Summary of Transcript:
In this podcast episode, Peter and Bob discuss testosterone and testosterone replacement therapy (TRT) in men. They begin by explaining what testosterone is, how it works, and how it is transported in the blood. They also discuss the importance of knowing the levels of free testosterone, which is the portion of testosterone not bound to carrier proteins, and bioavailable testosterone, which includes the fraction of testosterone bound to albumin. The hosts also explain the role of another hormone called dihydrotestosterone (DHT), which is converted from testosterone using an enzyme called 5-alpha reductase. Later in the podcast, they discuss the epidemiology of testosterone deficiency, the benefits and risks of TRT, and the controversies surrounding TRT’s impact on cardiovascular disease and prostate cancer.
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Summary of Description:
In this podcast episode, Peter and Bob discuss all aspects of testosterone, including what happens with low levels, the potential benefits and risks of testosterone replacement therapy (TRT), and the controversy surrounding its impact on cardiovascular disease and prostate cancer. They delve into the science behind testosterone, its natural regulation in the body, and the existing literature showing TRT’s potential structural, functional, and metabolic benefits. They also talk about potential risks, such as its impact on cardiovascular disease and prostate cancer, and explore other risks associated with the therapy.
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Testosterone: Understanding Low Levels and Replacement Therapy
Testosterone is a hormone produced mainly in the testicles of men’s and women’s ovaries. It is responsible for various bodily functions, including muscle mass, bone density, sperm production, and body hair.
In a recent episode of the Peter Attia Drive podcast, Peter and Bob discussed testosterone. They’re here to share their insights into the hormone and testosterone replacement therapy’s potential benefits and risks (TRT).
What Happens When Testosterone Levels Are Low?
Low testosterone can cause several harmful effects on men, including low libido, erectile dysfunction, and fatigue. The defining threshold for “low testosterone” is 300 ng/dL, but free testosterone is essential. It is the amount of testosterone available to support your body’s needs, separated from what is inactive or bound to proteins.
How the Body Naturally Regulates Testosterone Levels
The human body naturally produces testosterone in the testicles and ovaries using a complex detection and feedback system. When the body detects low levels of testosterone, the hypothalamus in the brain signals the pituitary gland to release more of the luteinizing hormone. This hormone, in turn, signals the testicles to produce testosterone.
The Physiology of Testosterone
Testosterone affects the body’s gene expression in critical areas, including bone density, red blood cell production, and muscle mass. It is an important hormone that regulates mood, body fat distribution, and sexual function.
The Potential Benefits of Testosterone Replacement Therapy (TRT)
Testosterone replacement therapy has vast potential structural, functional, and metabolic benefits. One of the most significant benefits is increased muscle mass and enhanced strength. It aids in creating lean body mass and improves bone density, mood, and cognitive function. It supports healthy erythropoiesis (red blood cell production), enhances endurance and oxygen transport, and stimulates growth hormone secretion.
Body Composition Changes With TRT
Testosterone promotes muscle protein synthesis, reducing body fat and increasing muscle mass. Testosterone levels significantly contribute to the strength of your bones and the amount of fat your body carries. Testosterone levels usually cause changes in body composition, with lower levels leading to increased body fat.
Changes in Bone Mineral Density With TRT
Research shows that testosterone replacement therapy correlates with decreased bone loss and increased bone mineral density, particularly in the lumbar spine and hips.
The Metabolic Impact of TRT
TRT can tremendously impact metabolic health, including blood glucose, insulin, and triglyceride levels. TRT has been shown to lower HbA1c, glucose, and insulin resistance levels, making it a potentially helpful therapy for those with type 2 diabetes.
Controversial Effects on Cardiovascular Disease and Prostate Cancer
There is a great deal of controversy surrounding the relationship between TRT and cardiovascular disease. The debate exists because some studies show a link between TRT and increased heart attacks or cardiovascular events in men with a prior history of heart disease. TRT comes with some potential risks.
Similarly, there is a controversial link between TRT and prostate cancer. According to existing literature, TRT does not lead to prostate cancer. However, increasing your testosterone level could increase cancer growth rates if you have undiagnosed prostate cancer.
Conclusion
Testosterone plays a crucial role in the body. While TRT has the potential for significant benefits, it is essential to consider the potential risks. Low testosterone levels can cause multiple harmful effects on men. If a patient’s testosterone levels are low, it is best to consult a doctor if TRT is necessary. Testosterone replacement therapy is a promising tool for helping men maintain optimal testosterone levels and improve overall health.
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Source Description
In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to testosterone: what happens when testosterone levels are low and the potential benefits and risks of testosterone replacement therapy (TRT). They explain the physiology of testosterone, how it works, and how its level changes throughout a person’s life. They have a detailed discussion about existing literature, which reveals vast potential structural, functional, and metabolic benefits of testosterone replacement therapy. They also closely examine the potential risks of this therapy, focusing on the controversial effects of cardiovascular disease and prostate cancer.
In this sneak peek, we discuss the following:
00:00 – Intro
00:10 – A primer on the hormone testosterone and how it influences gene expression
09:00 – How the body naturally regulates testosterone levels
In the entire episode, we also discuss the following:
-The defining threshold for “low testosterone,” how low T impacts men, and why free testosterone is the most critical metric;
-When it makes sense to treat low testosterone;
-The structural and metabolic benefits of testosterone replacement therapy;
-Body composition changes with TRT;
-Changes in bone mineral density with TRT;
-The metabolic impact of TRT: glucose, insulin, triglycerides, and more;
-A study investigating testosterone replacement therapy for the prevention or reversal of type 2 diabetes;
-The impact of TRT on metabolic parameters and body composition—A study comparing results from continuous vs. interrupted treatment;
-The controversy over TRT and cardiovascular disease;
-Two flawed studies that shaped perceptions of risks associated with TRT;
-The controversy over TRT and prostate cancer;
-Other potential risks with testosterone replacement therapy; and
-More
Show notes page: https://peterattiamd.com/ama28/
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About:
The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 30 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more.
Peter is a physician focusing on the applied science of longevity. His practice extensively deals with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease) while improving healthspan (quality of life).
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