, September 27, 2022

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A Deep Dive Into TRT with Iron Culture


  •   27 min reads
A Deep Dive Into TRT with Iron Culture

This past week I had the opportunity to record a podcast with Dr. Eric Helms and Omar Isuf of Iron Culture on a large number of the nuances and simple stories that swirl around Testosterone Replacement Therapy.

It is always a blast to talk shop with Eric and Omar and it was my hope that giving away this information could help some individuals potentially make a more informed and active decision when it comes to hormone replacement therapy.

You can check out that full episode below or any podcast app and you can read a fully-referenced article on this topic HERE on Deconstruct Nutrition.

I also put together a 171 reference document for the show which you can search on this page if you want to read more on any of the authors or keywords we mention.

*A brief note on Varicoceles because we get into it.

Below is a table from a systematic review by Cayan et al., 2020 showing the potential effect of varicocele repair on serum testosterone. It looks like again there is nuance in regards to the potential rise in serum testosterone based on if someone is eugonadal or hypogonadal pre-surgery which you can read more about HERE.

From the Open Access paper by Cayan et al., 2020

I wasn't really expecting this topic to be the weaving piece of information that varicoceled its way into the episode and I am sure peeps will want the reference for that 60-80% bodybuilder number. It looks like it is a bit of PubMed telephone ending in an Italian article from 2010.


"While genitourinary complaints have been well studied in cyclists, the negative effects of the cyclist's physical position and the resultant perineal hypoperfusion should be relatively obvious. Certain studies have also reported up to 30% of athletes being diagnosed with varicocele, representing a significantly higher incidence than in the general population, and up to 60–80% of bodybuilders are recorded as being affected. The incidence of varicocele has been shown to increase with the number of hours spent training."

-Radojevic et al., 2015


"High incidence (up to 30%) of varicocele has been reported in a population of athletes and up to 60-80% in the subgroup of body-builders."

-Gulino et al., 2010 (That original article is in Italian)


The number may not be as high as 60-80% and other papers do have it in the 40-50% range. But, regardless of the citation, the risk is significantly and consistently higher than the general population's risk (where the risk is still relatively high and a big deal when it comes to fertility).

“Varicocele is the most common identified cause of male factor infertility. It is found in 15% of the general population, but is present in up to 35% of men presenting with primary infertility and up to 80% of men presenting with secondary infertility.”

-Whelan et al., 2016

It should be noted that these varicocele percentage ballpark numbers of ~40 to 80% are kind of on par with the prevalence of other pelvic floor issues in lifting populations.

See Skaug et al., 2020

REFERENCES for Iron Culture TRT Episode:

Hit CTRL F and Party

1.         Alexander GC, Iyer G, Lucas E, Lin D, Singh S. Cardiovascular Risks of Exogenous Testosterone Use Among Men: A Systematic Review and Meta-Analysis. Am J Med. Mar 2017;130(3):293-305. doi:10.1016/j.amjmed.2016.09.017

2.         Alizade E, Avci A, Tabakci MM, et al. Comparison of Right Ventricle Systolic Function between Long-Term Anabolic-Androgenic Steroid User and Nonuser Bodybuilder Athletes: A Study of Two-Dimensional Speckle Tracking Echocardiography. Echocardiography. Aug 2016;33(8):1178-85. doi:10.1111/echo.13243

3.         Ambrozy T, Rydzik L, Obminski Z, et al. The Effect of High-Intensity Interval Training Periods on Morning Serum Testosterone and Cortisol Levels and Physical Fitness in Men Aged 35-40 Years. J Clin Med. May 15 2021;10(10)doi:10.3390/jcm10102143

4.         Anaissie J, DeLay KJ, Wang W, Hatzichristodoulou G, Hellstrom WJ. Testosterone deficiency in adults and corresponding treatment patterns across the globe. Transl Androl Urol. Apr 2017;6(2):183-191. doi:10.21037/tau.2016.11.16

5.         Andrews MA, Magee CD, Combest TM, Allard RJ, Douglas KM. Physical Effects of Anabolic-androgenic Steroids in Healthy Exercising Adults: A Systematic Review and Meta-analysis. Curr Sports Med Rep. Jul 2018;17(7):232-241. doi:10.1249/JSR.0000000000000500

6.         Araujo AB, Esche GR, Kupelian V, et al. Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab. Nov 2007;92(11):4241-7. doi:10.1210/jc.2007-1245

7.         Aversa A, Bruzziches R, Francomano D, Spera G, Lenzi A. Efficacy and safety of two different testosterone undecanoate formulations in hypogonadal men with metabolic syndrome. J Endocrinol Invest. Dec 2010;33(11):776-83. doi:10.3275/6903

10.1007/BF03350341

8.         Babak J, Behruz F, Mohammadreza Y, Morteza FK. The Effect of Human Chorionic Gonadotropin Therapy on Semen Parameters and Pregnancy Rate after Varicocelectomy. Curr Urol. Feb 2018;11(2):92-96. doi:10.1159/000447200

9.         Baggish AL, Weiner RB, Kanayama G, et al. Cardiovascular Toxicity of Illicit Anabolic-Androgenic Steroid Use. Circulation. May 23 2017;135(21):1991-2002. doi:10.1161/CIRCULATIONAHA.116.026945

10.       Bandari J, Ayyash OM, Emery SL, Wessel CB, Davies BJ. Marketing and Testosterone Treatment in the USA: A Systematic Review. Eur Urol Focus. Oct 2017;3(4-5):395-402. doi:10.1016/j.euf.2017.10.016

11.        Behre HM, Zitzmann M, Anderson RA, et al. Efficacy and Safety of an Injectable Combination Hormonal Contraceptive for Men. J Clin Endocrinol Metab. Dec 2016;101(12):4779-4788. doi:10.1210/jc.2016-2141

12.       Bell L, Ruddock A, Maden-Wilkinson T, Hembrough D, Rogerson D. "Is It Overtraining or Just Work Ethic?": Coaches' Perceptions of Overtraining in High-Performance Strength Sports. Sports (Basel). Jun 7 2021;9(6)doi:10.3390/sports9060085

13.       Bellamy LM, Joanisse S, Grubb A, et al. The acute satellite cell response and skeletal muscle hypertrophy following resistance training. PLoS One. 2014;9(10):e109739. doi:10.1371/journal.pone.0109739

14.       Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. May 1 2018;103(5):1715-1744. doi:10.1210/jc.2018-00229

15.       Bhasin S, Hatfield DL, Hoffman JR, et al. Anabolic-Androgenic Steroid Use in Sports, Health, and Society. Med Sci Sports Exerc. Aug 1 2021;53(8):1778-1794. doi:10.1249/MSS.0000000000002670

16.       Bhasin S, Storer TW, Berman N, et al. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. The New England journal of medicine. Jul 4 1996;335(1):1-7. doi:10.1056/NEJM199607043350101

17.       Bhasin S, Travison TG, Storer TW, et al. Effect of testosterone supplementation with and without a dual 5alpha-reductase inhibitor on fat-free mass in men with suppressed testosterone production: a randomized controlled trial. JAMA. Mar 7 2012;307(9):931-9. doi:10.1001/jama.2012.227

18.       Bhasin S, Woodhouse L, Casaburi R, et al. Testosterone dose-response relationships in healthy young men. Am J Physiol Endocrinol Metab. Dec 2001;281(6):E1172-81.

19.       Bonde JP, Te Velde E. Male factor infertility: Declining sperm counts - the never-ending story. Nat Rev Urol. Nov 2017;14(11):645-646. doi:10.1038/nrurol.2017.153

20.      Bonnecaze AK, O'Connor T, Aloi JA. Characteristics and Attitudes of Men Using Anabolic Androgenic Steroids (AAS): A Survey of 2385 Men. Am J Mens Health. Nov-Dec 2020;14(6):1557988320966536. doi:10.1177/1557988320966536

21.       Brambilla DJ, O'Donnell AB, Matsumoto AM, McKinlay JB. Intraindividual variation in levels of serum testosterone and other reproductive and adrenal hormones in men. Clinical endocrinology. Dec 2007;67(6):853-62. doi:10.1111/j.1365-2265.2007.02976.x

22.       Cadegiani FA, da Silva PHL, Abrao TCP, Kater CE. Diagnosis of Overtraining Syndrome: Results of the Endocrine and Metabolic Responses on Overtraining Syndrome Study: EROS-DIAGNOSIS. J Sports Med (Hindawi Publ Corp). 2020;2020:3937819. doi:10.1155/2020/3937819

23.       Cadegiani FA, Kater CE. Hormonal aspects of overtraining syndrome: a systematic review. BMC Sports Sci Med Rehabil. 2017;9:14. doi:10.1186/s13102-017-0079-8

24.       Cadegiani FA, Kater CE. Hypothalamic-Pituitary-Adrenal (HPA) Axis Functioning in Overtraining Syndrome: Findings from Endocrine and Metabolic Responses on Overtraining Syndrome (EROS)-EROS-HPA Axis. Sports medicine - open. Dec 8 2017;3(1):45. doi:10.1186/s40798-017-0113-0

25.       Cadegiani FA, Kater CE. Body composition, metabolism, sleep, psychological and eating patterns of overtraining syndrome: Results of the EROS study (EROS-PROFILE). J Sports Sci. Aug 2018;36(16):1902-1910. doi:10.1080/02640414.2018.1424498

26.       Cadegiani FA, Kater CE. Basal Hormones and Biochemical Markers as Predictors of Overtraining Syndrome in Male Athletes: The EROS-BASAL Study. Journal of athletic training. Aug 2019;54(8):906-914. doi:10.4085/1062-6050-148-18

27.       Camacho EM, Huhtaniemi IT, O'Neill TW, et al. Age-associated changes in hypothalamic-pituitary-testicular function in middle-aged and older men are modified by weight change and lifestyle factors: longitudinal results from the European Male Ageing Study. European journal of endocrinology / European Federation of Endocrine Societies. Mar 2013;168(3):445-55. doi:10.1530/EJE-12-0890

28.      Cangemi R, Friedmann AJ, Holloszy JO, Fontana L. Long-term effects of calorie restriction on serum sex-hormone concentrations in men. Aging Cell. Apr 2010;9(2):236-42. doi:10.1111/j.1474-9726.2010.00553.x

29.       Cayan S, Akbay E, Saylam B, Kadioglu A. Effect of Varicocele and Its Treatment on Testosterone in Hypogonadal Men with Varicocele: Review of the Literature. Balkan Med J. Apr 10 2020;37(3):121-124. doi:10.4274/balkanmedj.galenos.2020.2020.1.85

30.      Chahla EJ, Hayek ME, Morley JE. Testosterone replacement therapy and cardiovascular risk factors modification. The aging male : the official journal of the International Society for the Study of the Aging Male. Jun 2011;14(2):83-90. doi:10.3109/13685538.2010.541538

31.       Chao J, Rubinow KB, Kratz M, Amory JK, Matsumoto AM, Page ST. Short-Term Estrogen Withdrawal Increases Adiposity in Healthy Men. J Clin Endocrinol Metab. Oct 2016;101(10):3724-3731. doi:10.1210/jc.2016-1482

32.       Chasland LC, Yeap BB, Maiorana AJ, et al. Testosterone and exercise: effects on fitness, body composition, and strength in middle-to-older aged men with low-normal serum testosterone levels. American journal of physiology Heart and circulatory physiology. May 1 2021;320(5):H1985-H1998. doi:10.1152/ajpheart.00010.2021

33.       Claudino JG, T JG, de Sa Souza H, et al. Which parameters to use for sleep quality monitoring in team sport athletes? A systematic review and meta-analysis. BMJ Open Sport Exerc Med. 2019;5(1):e000475. doi:10.1136/bmjsem-2018-000475

34.       Cohen J, Collins R, Darkes J, Gwartney D. A league of their own: demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the United States. J Int Soc Sports Nutr. Oct 11 2007;4:12. doi:10.1186/1550-2783-4-12

35.       Corona G, Isidori AM, Aversa A, Burnett AL, Maggi M. Endocrinologic Control of Men's Sexual Desire and Arousal/Erection. The journal of sexual medicine. Mar 2016;13(3):317-37. doi:10.1016/j.jsxm.2016.01.007

36.       Corona G, Isidori AM, Buvat J, et al. Testosterone supplementation and sexual function: a meta-analysis study. The journal of sexual medicine. Jun 2014;11(6):1577-92. doi:10.1111/jsm.12536

37.       Corona G, Rastrelli G, Di Pasquale G, Sforza A, Mannucci E, Maggi M. Testosterone and Cardiovascular Risk: Meta-Analysis of Interventional Studies. The journal of sexual medicine. Jun 2018;15(6):820-838. doi:10.1016/j.jsxm.2018.04.641

38.      Corona G, Rastrelli G, Monami M, et al. Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis. European journal of endocrinology / European Federation of Endocrine Societies. Jun 2013;168(6):829-43. doi:10.1530/EJE-12-0955

39.       Costanzo PR, Pacenza NA, Aszpis SM, et al. Clinical and Etiological Aspects of Gynecomastia in Adult Males: A Multicenter Study. Biomed Res Int. 2018;2018:8364824. doi:10.1155/2018/8364824

40.      Crabbe P, Bogaert V, De Bacquer D, Goemaere S, Zmierczak H, Kaufman JM. Part of the interindividual variation in serum testosterone levels in healthy men reflects differences in androgen sensitivity and feedback set point: contribution of the androgen receptor polyglutamine tract polymorphism. J Clin Endocrinol Metab. Sep 2007;92(9):3604-10. doi:10.1210/jc.2007-0117

41.       Crosnoe LE, Grober E, Ohl D, Kim ED. Exogenous testosterone: a preventable cause of male infertility. Transl Androl Urol. Jun 2013;2(2):106-13. doi:10.3978/j.issn.2223-4683.2013.06.01

42.       Dahlgren A, Kecklund G, Theorell T, Akerstedt T. Day-to-day variation in saliva cortisol--relation with sleep, stress and self-rated health. Biol Psychol. Oct 2009;82(2):149-55. doi:10.1016/j.biopsycho.2009.07.001

43.       De Naeyer H, Bogaert V, De Spaey A, et al. Genetic variations in the androgen receptor are associated with steroid concentrations and anthropometrics but not with muscle mass in healthy young men. PLoS One. 2014;9(1):e86235. doi:10.1371/journal.pone.0086235

44.       Dias JP, Melvin D, Simonsick EM, et al. Effects of aromatase inhibition vs. testosterone in older men with low testosterone: randomized-controlled trial. Andrology. Jan 2016;4(1):33-40. doi:10.1111/andr.12126

45.       Dobrosielski DA, Nichols D, Ford J, Watts A, Wilder JN, Douglass-Burton T. Estimating the Prevalence of Sleep-Disordered Breathing Among Collegiate Football Players. Respir Care. Sep 2016;61(9):1144-50. doi:10.4187/respcare.04520

46.       Egner IM, Bruusgaard JC, Eftestol E, Gundersen K. A cellular memory mechanism aids overload hypertrophy in muscle long after an episodic exposure to anabolic steroids. J Physiol. Dec 15 2013;591(24):6221-30. doi:10.1113/jphysiol.2013.264457

47.       Elagizi A, Kohler TS, Lavie CJ. Testosterone and Cardiovascular Health. Mayo Clinic proceedings. Jan 2018;93(1):83-100. doi:10.1016/j.mayocp.2017.11.006

48.      Emmelot-Vonk MH, Verhaar HJ, Nakhai-Pour HR, Grobbee DE, van der Schouw YT. Effect of testosterone supplementation on sexual functioning in aging men: a 6-month randomized controlled trial. Int J Impot Res. Mar-Apr 2009;21(2):129-38. doi:10.1038/ijir.2009.5

49.       Englund DA, Peck BD, Murach KA, et al. Resident muscle stem cells are not required for testosterone-induced skeletal muscle hypertrophy. Am J Physiol Cell Physiol. Oct 1 2019;317(4):C719-C724. doi:10.1152/ajpcell.00260.2019

50.       Falqueto H, Junior JLR, Silverio MNO, Farias JCH, Schoenfeld BJ, Manfredi LH. Can conditions of skeletal muscle loss be improved by combining exercise with anabolic-androgenic steroids? A systematic review and meta-analysis of testosterone-based interventions. Rev Endocr Metab Disord. Jun 2021;22(2):161-178. doi:10.1007/s11154-021-09634-4

51.       Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts male aging study. J Clin Endocrinol Metab. Feb 2002;87(2):589-98. doi:10.1210/jcem.87.2.8201

52.       Finkelstein JS, Lee H, Burnett-Bowie SA, et al. Gonadal steroids and body composition, strength, and sexual function in men. The New England journal of medicine. Sep 12 2013;369(11):1011-22. doi:10.1056/NEJMoa1206168

53.       Finkelstein JS, Lee H, Burnett-Bowie SA, et al. Gonadal steroids and body composition, strength, and sexual function in men. The New England journal of medicine. Sep 12 2013;369(11):1011-22. doi:10.1056/NEJMoa1206168

54.       Finkelstein JS, Lee H, Burnett-Bowie SM, et al. Dose-Response Relationships Between Gonadal Steroids and Bone, Body Composition, and Sexual Function in Aging Men. J Clin Endocrinol Metab. Aug 1 2020;105(8)doi:10.1210/clinem/dgaa318

55.       Finkelstein JS, Yu EW, Burnett-Bowie SA. Gonadal steroids and body composition, strength, and sexual function in men. The New England journal of medicine. Dec 19 2013;369(25):2457. doi:10.1056/NEJMc1313169

56.       Francomano D, Lenzi A, Aversa A. Effects of five-year treatment with testosterone undecanoate on metabolic and hormonal parameters in ageing men with metabolic syndrome. Int J Endocrinol. 2014;2014:527470. doi:10.1155/2014/527470

57.       Fujioka M, Shinohara Y, Baba S, Irie M, Inoue K. Acute suppression of endogenous testosterone levels by exogenous testosterone in normal men. Life Sci. Aug 24 1987;41(8):945-9. doi:10.1016/0024-3205(87)90681-3

58.       Funder JW. The multiple actions of testosterone in men: nature knows best. Asian J Androl. Mar-Apr 2014;16(2):266-7. doi:10.4103/1008-682X.122367

59.       Gagliano-Juca T, Li Z, Pencina KM, et al. Oral glucose load and mixed meal feeding lowers testosterone levels in healthy eugonadal men. Endocrine. Jan 2019;63(1):149-156. doi:10.1007/s12020-018-1741-y

60.      Gencer B, Bonomi M, Adorni MP, Sirtori CR, Mach F, Ruscica M. Cardiovascular risk and testosterone - from subclinical atherosclerosis to lipoprotein function to heart failure. Rev Endocr Metab Disord. Jun 2021;22(2):257-274. doi:10.1007/s11154-021-09628-2

61.       Giorgi A, Weatherby RP, Murphy PW. Muscular strength, body composition and health responses to the use of testosterone enanthate: a double blind study. Journal of science and medicine in sport / Sports Medicine Australia. Dec 1999;2(4):341-55. doi:10.1016/s1440-2440(99)80007-3

62.       Goldman AL, Bhasin S, Wu FCW, Krishna M, Matsumoto AM, Jasuja R. A Reappraisal of Testosterone's Binding in Circulation: Physiological and Clinical Implications. Endocr Rev. Jun 29 2017;doi:10.1210/er.2017-00025

63.       Grandou C, Wallace L, Impellizzeri FM, Allen NG, Coutts AJ. Overtraining in Resistance Exercise: An Exploratory Systematic Review and Methodological Appraisal of the Literature. Sports medicine. Apr 2020;50(4):815-828. doi:10.1007/s40279-019-01242-2

64.       Grossmann M, Matsumoto AM. A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management. J Clin Endocrinol Metab. Mar 1 2017;102(3):1067-1075. doi:10.1210/jc.2016-3580

65.       Hackney AC. Hypogonadism in Exercising Males: Dysfunction or Adaptive-Regulatory Adjustment? Front Endocrinol (Lausanne). 2020;11:11. doi:10.3389/fendo.2020.00011

66.       Halappanavar A, Pakhetra R. Prevalence of hypogonadism in young obese males. Clin Med (Lond). Mar 2020;20(Suppl 2):s108. doi:10.7861/clinmed.20-2-s108

67.       Hamilton EJ, Gianatti E, Strauss BJ, et al. Increase in visceral and subcutaneous abdominal fat in men with prostate cancer treated with androgen deprivation therapy. Clinical endocrinology. Mar 2011;74(3):377-83. doi:10.1111/j.1365-2265.2010.03942.x

68.      Hammes SR, Levin ER. Impact of estrogens in males and androgens in females. The Journal of clinical investigation. May 1 2019;129(5):1818-1826. doi:10.1172/JCI125755

69.       Handelsman DJ, Yeap B, Flicker L, Martin S, Wittert GA, Ly LP. Age-specific population centiles for androgen status in men. European journal of endocrinology / European Federation of Endocrine Societies. Dec 2015;173(6):809-17. doi:10.1530/EJE-15-0380

70.       Hartgens F, Kuipers H. Effects of androgenic-anabolic steroids in athletes. Sports medicine. 2004;34(8):513-54. doi:10.2165/00007256-200434080-00003

71.       Hartgens F, Van Marken Lichtenbelt WD, Ebbing S, Vollaard N, Rietjens G, Kuipers H. Body composition and anthropometry in bodybuilders: regional changes due to nandrolone decanoate administration. Int J Sports Med. Apr 2001;22(3):235-41. doi:10.1055/s-2001-18679

72.       Haun CT, Vann CG, Mobley CB, et al. Pre-training Skeletal Muscle Fiber Size and Predominant Fiber Type Best Predict Hypertrophic Responses to 6 Weeks of Resistance Training in Previously Trained Young Men. Frontiers in physiology. 2019;10:297. doi:10.3389/fphys.2019.00297

73.       Hildreth KL, Barry DW, Moreau KL, et al. Effects of testosterone and progressive resistance exercise in healthy, highly functioning older men with low-normal testosterone levels. J Clin Endocrinol Metab. May 2013;98(5):1891-900. doi:10.1210/jc.2012-3695

10.1210/jc.2013-2227

74.       Hooper DR, Kraemer WJ, Saenz C, et al. The presence of symptoms of testosterone deficiency in the exercise-hypogonadal male condition and the role of nutrition. European journal of applied physiology. Jul 2017;117(7):1349-1357. doi:10.1007/s00421-017-3623-z

75.       Howard EE, Margolis LM, Berryman CE, et al. Testosterone supplementation upregulates androgen receptor expression and translational capacity during severe energy deficit. Am J Physiol Endocrinol Metab. Oct 1 2020;319(4):E678-E688. doi:10.1152/ajpendo.00157.2020

76.       Hu TY, Chen YC, Lin P, et al. Testosterone-Associated Dietary Pattern Predicts Low Testosterone Levels and Hypogonadism. Nutrients. Nov 16 2018;10(11)doi:10.3390/nu10111786

77.       Ip EJ, Barnett MJ, Tenerowicz MJ, Perry PJ. The Anabolic 500 survey: characteristics of male users versus nonusers of anabolic-androgenic steroids for strength training. Pharmacotherapy. Aug 2011;31(8):757-66. doi:10.1592/phco.31.8.757

78.       Irwig MS, Fleseriu M, Jonklaas J, et al. Off-Label Use and Misuse of Testosterone, Growth Hormone, Thyroid Hormone, and Adrenal Supplements: Risks and Costs of a Growing Problem. Endocr Pract. Mar 2020;26(3):340-353. doi:10.4158/PS-2019-0540

79.       Jockenhovel F, Minnemann T, Schubert M, et al. Comparison of long-acting testosterone undecanoate formulation versus testosterone enanthate on sexual function and mood in hypogonadal men. European journal of endocrinology / European Federation of Endocrine Societies. May 2009;160(5):815-9. doi:10.1530/EJE-08-0830

80.      Johannsson G, Gibney J, Wolthers T, Leung KC, Ho KK. Independent and combined effects of testosterone and growth hormone on extracellular water in hypopituitary men. J Clin Endocrinol Metab. Jul 2005;90(7):3989-94. doi:10.1210/jc.2005-0553

81.       Jue JS, Ramasamy R. Re: Association Between Direct-to-consumer Advertising and Testosterone Testing and Initiation in the United States, 2009-2013. Eur Urol. Nov 2017;72(5):853. doi:10.1016/j.eururo.2017.08.032

82.      Kanayama G, Pope HG, Jr. History and epidemiology of anabolic androgens in athletes and non-athletes. Mol Cell Endocrinol. Mar 15 2018;464:4-13. doi:10.1016/j.mce.2017.02.039

83.      Kelly DM, Jones TH. Testosterone and obesity. Obes Rev. Jul 2015;16(7):581-606. doi:10.1111/obr.12282

84.      Kelsey TW, Li LQ, Mitchell RT, Whelan A, Anderson RA, Wallace WH. A validated age-related normative model for male total testosterone shows increasing variance but no decline after age 40 years. PLoS One. 2014;9(10):e109346. doi:10.1371/journal.pone.0109346

85.       Khodamoradi K, Khosravizadeh Z, Parmar M, Kuchakulla M, Ramasamy R, Arora H. Exogenous testosterone replacement therapy versus raising endogenous testosterone levels: current and future prospects. F S Rev. Jan 2021;2(1):32-42. doi:10.1016/j.xfnr.2020.11.001

86.      Kim JH, Hollowed C, Irwin-Weyant M, et al. Sleep-Disordered Breathing and Cardiovascular Correlates in College Football Players. The American journal of cardiology. Oct 15 2017;120(8):1410-1415. doi:10.1016/j.amjcard.2017.07.030

87.       Kraemer WJ, Ratamess NA, Hymer WC, Nindl BC, Fragala MS. Growth Hormone(s), Testosterone, Insulin-Like Growth Factors, and Cortisol: Roles and Integration for Cellular Development and Growth With Exercise. Front Endocrinol (Lausanne). 2020;11:33. doi:10.3389/fendo.2020.00033

88.      Kravitz RL. Direct-to-Consumer Advertising of Androgen Replacement Therapy. JAMA. Mar 21 2017;317(11):1124-1125. doi:10.1001/jama.2017.1364

89.      Kreher JB. Diagnosis and prevention of overtraining syndrome: an opinion on education strategies. Open Access J Sports Med. 2016;7:115-22. doi:10.2147/OAJSM.S91657

90.      Kuipers H, Wijnen JA, Hartgens F, Willems SM. Influence of anabolic steroids on body composition, blood pressure, lipid profile and liver functions in body builders. Int J Sports Med. Aug 1991;12(4):413-8. doi:10.1055/s-2007-1024704

91.       Kvorning T, Andersen M, Brixen K, Madsen K. Suppression of endogenous testosterone production attenuates the response to strength training: a randomized, placebo-controlled, and blinded intervention study. Am J Physiol Endocrinol Metab. Dec 2006;291(6):E1325-32. doi:10.1152/ajpendo.00143.2006

92.       Kvorning T, Andersen M, Brixen K, Schjerling P, Suetta C, Madsen K. Suppression of testosterone does not blunt mRNA expression of myoD, myogenin, IGF, myostatin or androgen receptor post strength training in humans. J Physiol. Jan 15 2007;578(Pt 2):579-93. doi:10.1113/jphysiol.2006.122671

93.       Kvorning T, Kadi F, Schjerling P, et al. The activity of satellite cells and myonuclei following 8 weeks of strength training in young men with suppressed testosterone levels. Acta Physiol (Oxf). Mar 2015;213(3):676-87. doi:10.1111/apha.12404

94.       Laurent MR, Hammond GL, Blokland M, et al. Sex hormone-binding globulin regulation of androgen bioactivity in vivo: validation of the free hormone hypothesis. Sci Rep. Oct 17 2016;6:35539. doi:10.1038/srep35539

95.       Layton JB, Kim Y, Alexander GC, Emery SL. Association Between Direct-to-Consumer Advertising and Testosterone Testing and Initiation in the United States, 2009-2013. JAMA. Mar 21 2017;317(11):1159-1166. doi:10.1001/jama.2016.21041

96.       Lee JA, Ramasamy R. Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men. Transl Androl Urol. Jul 2018;7(Suppl 3):S348-S352. doi:10.21037/tau.2018.04.11

97.       Levine H, Jorgensen N, Martino-Andrade A, et al. Temporal trends in sperm count: a systematic review and meta-regression analysis. Hum Reprod Update. Nov 1 2017;23(6):646-659. doi:10.1093/humupd/dmx022

98.      Li F, Yue H, Yamaguchi K, et al. Effect of surgical repair on testosterone production in infertile men with varicocele: a meta-analysis. Int J Urol. Feb 2012;19(2):149-54. doi:10.1111/j.1442-2042.2011.02890.x

99.       Lippi G, Franchini M, Banfi G. Biochemistry and physiology of anabolic androgenic steroids doping. Mini Rev Med Chem. May 2011;11(5):362-73. doi:10.2174/138955711795445952

100.    Loves S, Ruinemans-Koerts J, de Boer H. Letrozole once a week normalizes serum testosterone in obesity-related male hypogonadism. European journal of endocrinology / European Federation of Endocrine Societies. May 2008;158(5):741-7. doi:10.1530/EJE-07-0663

101.     MacDonald AA, Herbison GP, Showell M, Farquhar CM. The impact of body mass index on semen parameters and reproductive hormones in human males: a systematic review with meta-analysis. Hum Reprod Update. May-Jun 2010;16(3):293-311. doi:10.1093/humupd/dmp047

102.     Maestu J, Eliakim A, Jurimae J, Valter I, Jurimae T. Anabolic and catabolic hormones and energy balance of the male bodybuilders during the preparation for the competition. J Strength Cond Res. Apr 2010;24(4):1074-81. doi:10.1519/JSC.0b013e3181cb6fd3

103.     Maganty A, Shoag JE, Ramasamy R. Testosterone threshold - does one size fit all? The aging male : the official journal of the International Society for the Study of the Aging Male. Mar 2015;18(1):1-4. doi:10.3109/13685538.2015.1004047

104.     Malkin CJ, Pugh PJ, Morris PD, Asif S, Jones TH, Channer KS. Low serum testosterone and increased mortality in men with coronary heart disease. Heart. Nov 2010;96(22):1821-5. doi:10.1136/hrt.2010.195412

105.     Mann U, Shiff B, Patel P. Reasons for worldwide decline in male fertility. Curr Opin Urol. May 2020;30(3):296-301. doi:10.1097/MOU.0000000000000745

106.     Matsumoto T, Tanizawa K, Tachikawa R, et al. Associations of obstructive sleep apnea with truncal skeletal muscle mass and density. Sci Rep. Apr 25 2018;8(1):6550. doi:10.1038/s41598-018-24750-z

107.     McCormack JP, Holmes DT. Your results may vary: the imprecision of medical measurements. BMJ. Feb 20 2020;368:m149. doi:10.1136/bmj.m149

108.    McCullough D, Webb R, Enright KJ, et al. How the love of muscle can break a heart: Impact of anabolic androgenic steroids on skeletal muscle hypertrophy, metabolic and cardiovascular health. Rev Endocr Metab Disord. Jun 2021;22(2):389-405. doi:10.1007/s11154-020-09616-y

109.     Melhem AJ, Jr., Araujo AC, Figueiredo FNS, Figueiredo DLA. Acute Myocardial Infarction in a Young Bodybuilder: A Case Report and Review of the Literature. Am J Case Rep. Aug 27 2020;21:e924796. doi:10.12659/AJCR.924796

110.     Melmed S, Polonsky KS, P. Reed Larsen, Kronenberg HM. Williams Textbook of Endocrinology 13th Edition. Elsevier; 2016.

111.      Mitchell L, Slater G, Hackett D, Johnson N, O'Connor H. Physiological implications of preparing for a natural male bodybuilding competition. European journal of sport science. Mar 1 2018:1-11. doi:10.1080/17461391.2018.1444095

112.     Montisci M, El Mazloum R, Cecchetto G, et al. Anabolic androgenic steroids abuse and cardiac death in athletes: morphological and toxicological findings in four fatal cases. Forensic Sci Int. Apr 10 2012;217(1-3):e13-8. doi:10.1016/j.forsciint.2011.10.032

113.     Moran LJ, Brinkworth GD, Martin S, et al. Long-Term Effects of a Randomised Controlled Trial Comparing High Protein or High Carbohydrate Weight Loss Diets on Testosterone, SHBG, Erectile and Urinary Function in Overweight and Obese Men. PLoS One. 2016;11(9):e0161297. doi:10.1371/journal.pone.0161297

114.     Morton RW, Sato K, Gallaugher MPB, et al. Muscle Androgen Receptor Content but Not Systemic Hormones Is Associated With Resistance Training-Induced Skeletal Muscle Hypertrophy in Healthy, Young Men. Frontiers in physiology. 2018;9:1373. doi:10.3389/fphys.2018.01373

115.      Nimrod A, Ryan KJ. Aromatization of androgens by human abdominal and breast fat tissue. J Clin Endocrinol Metab. Mar 1975;40(3):367-72. doi:10.1210/jcem-40-3-367

116.     Page ST, Amory JK, Bowman FD, et al. Exogenous testosterone (T) alone or with finasteride increases physical performance, grip strength, and lean body mass in older men with low serum T. J Clin Endocrinol Metab. Mar 2005;90(3):1502-10. doi:10.1210/jc.2004-1933

117.      Paoli A, Cenci L, Pompei P, et al. Effects of Two Months of Very Low Carbohydrate Ketogenic Diet on Body Composition, Muscle Strength, Muscle Area, and Blood Parameters in Competitive Natural Body Builders. Nutrients. Jan 26 2021;13(2)doi:10.3390/nu13020374

118.     Pardue A, Trexler ET, Sprod LK. Case Study: Unfavorable But Transient Physiological Changes During Contest Preparation in a Drug-Free Male Bodybuilder. Int J Sport Nutr Exerc Metab. Dec 2017;27(6):550-559. doi:10.1123/ijsnem.2017-0064

119.     Patel AS, Leong JY, Ramos L, Ramasamy R. Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility. World J Mens Health. Jan 2019;37(1):45-54. doi:10.5534/wjmh.180036

120.     Pereira E, Moyses SJ, Ignacio SA, et al. Anabolic steroids among resistance training practitioners. PLoS One. 2019;14(10):e0223384. doi:10.1371/journal.pone.0223384

121.     Permpongkosol S, Khupulsup K, Leelaphiwat S, Pavavattananusorn S, Thongpradit S, Petchthong T. Effects of 8-Year Treatment of Long-Acting Testosterone Undecanoate on Metabolic Parameters, Urinary Symptoms, Bone Mineral Density, and Sexual Function in Men With Late-Onset Hypogonadism. The journal of sexual medicine. Aug 2016;13(8):1199-211. doi:10.1016/j.jsxm.2016.06.003

122.     Perry JC, Schuetz TM, Memon MD, Faiz S, Cancarevic I. Anabolic Steroids and Cardiovascular Outcomes: The Controversy. Cureus. Jul 22 2020;12(7):e9333. doi:10.7759/cureus.9333

123.     Punjani N, Bernie H, Salter C, Flores J, Benfante N, Mulhall JP. The Utilization and Impact of Aromatase Inhibitor Therapy in Men With Elevated Estradiol Levels on Testosterone Therapy. Sex Med. Aug 2021;9(4):100378. doi:10.1016/j.esxm.2021.100378

124.     Rajkanna J, Tariq S, Oyibo SO. Successful fertility treatment with gonadotrophin therapy for male hypogonadotrophic hypogonadism. Endocrinol Diabetes Metab Case Rep. 2016;2016:150124. doi:10.1530/EDM-15-0124

125.     Ramasamy R, Armstrong JM, Lipshultz LI. Preserving fertility in the hypogonadal patient: an update. Asian J Androl. Mar-Apr 2015;17(2):197-200. doi:10.4103/1008-682X.142772

126.     Ramasamy R, Lipshultz LI. Words of wisdom. Re: Gonadal steroids and body composition, strength, and sexual function in men. Eur Urol. Apr 2014;65(4):843-4. doi:10.1016/j.eururo.2013.12.029

127.     Ravanos K, Petousis S, Margioula-Siarkou C, et al. Declining Sperm Counts... or Rather Not? A Mini Review. Obstet Gynecol Surv. Oct 2018;73(10):595-605. doi:10.1097/OGX.0000000000000599

128.     Rice TB, Dunn RE, Lincoln AE, et al. Sleep-disordered breathing in the National Football League. Sleep. Jun 2010;33(6):819-24. doi:10.1093/sleep/33.6.819

129.     Rizk PJ, Kohn TP, Pastuszak AW, Khera M. Testosterone therapy improves erectile function and libido in hypogonadal men. Curr Opin Urol. Nov 2017;27(6):511-515. doi:10.1097/MOU.0000000000000442

130.     Rodriguez-Tolra J, Torremade Barreda J, del Rio L, di Gregorio S, Franco Miranda E. Effects of testosterone treatment on body composition in males with testosterone deficiency syndrome. The aging male : the official journal of the International Society for the Study of the Aging Male. Dec 2013;16(4):184-90. doi:10.3109/13685538.2013.839648

131.     Rogerson S, Weatherby RP, Deakin GB, et al. The effect of short-term use of testosterone enanthate on muscular strength and power in healthy young men. J Strength Cond Res. May 2007;21(2):354-61. doi:10.1519/R-18385.1

132.     Rosca AE, Vladareanu AM, Mititelu A, et al. Effects of Exogenous Androgens on Platelet Activity and Their Thrombogenic Potential in Supraphysiological Administration: A Literature Review. J Clin Med. Jan 4 2021;10(1)doi:10.3390/jcm10010147

133.     Rossow LM, Fukuda DH, Fahs CA, Loenneke JP, Stout JR. Natural bodybuilding competition preparation and recovery: a 12-month case study. Int J Sports Physiol Perform. Sep 2013;8(5):582-92.

134.     Rubinow KB. Estrogens and Body Weight Regulation in Men. Advances in experimental medicine and biology. 2017;1043:285-313. doi:10.1007/978-3-319-70178-3_14

135.     Rynders CA, Schmidt SL, Bergouignan A, Horton TJ, Bessesen DH. Effects of short-term sex steroid suppression on dietary fat storage patterns in healthy males. Physiol Rep. Jan 2018;6(2)doi:10.14814/phy2.13533

136.     Samavat J, Cantini G, Lotti F, et al. Massive Weight Loss Obtained by Bariatric Surgery Affects Semen Quality in Morbid Male Obesity: a Preliminary Prospective Double-Armed Study. Obes Surg. Jan 2018;28(1):69-76. doi:10.1007/s11695-017-2802-7

137.     Sansone A, Romanelli F, Sansone M, Lenzi A, Di Luigi L. Gynecomastia and hormones. Endocrine. Jan 2017;55(1):37-44. doi:10.1007/s12020-016-0975-9

138.     Sartorius G, Spasevska S, Idan A, et al. Serum testosterone, dihydrotestosterone and estradiol concentrations in older men self-reporting very good health: the healthy man study. Clinical endocrinology. Nov 2012;77(5):755-63. doi:10.1111/j.1365-2265.2012.04432.x

139.     Schneider G, Kirschner MA, Berkowitz R, Ertel NH. Increased estrogen production in obese men. J Clin Endocrinol Metab. Apr 1979;48(4):633-8. doi:10.1210/jcem-48-4-633

140.     Schoenfeld BJ, Alto A, Grgic J, et al. Alterations in Body Composition, Resting Metabolic Rate, Muscular Strength, and Eating Behavior in Response to Natural Bodybuilding Competition Preparation: A Case Study. J Strength Cond Res. Nov 2020;34(11):3124-3138. doi:10.1519/JSC.0000000000003816

141.     Schulte DM, Hahn M, Oberhauser F, et al. Caloric restriction increases serum testosterone concentrations in obese male subjects by two distinct mechanisms. Horm Metab Res. Apr 2014;46(4):283-6. doi:10.1055/s-0033-1358678

142.     Shawish MI, Bagheri B, Musini VM, Adams SP, Wright JM. Effect of atorvastatin on testosterone levels. Cochrane Database Syst Rev. Jan 22 2021;1:CD013211. doi:10.1002/14651858.CD013211.pub2

143.     Sinha-Hikim I, Artaza J, Woodhouse L, et al. Testosterone-induced increase in muscle size in healthy young men is associated with muscle fiber hypertrophy. Am J Physiol Endocrinol Metab. Jul 2002;283(1):E154-64. doi:10.1152/ajpendo.00502.2001

144.     Sinha-Hikim I, Cornford M, Gaytan H, Lee ML, Bhasin S. Effects of testosterone supplementation on skeletal muscle fiber hypertrophy and satellite cells in community-dwelling older men. J Clin Endocrinol Metab. Aug 2006;91(8):3024-33. doi:10.1210/jc.2006-0357

145.     Sinha-Hikim I, Roth SM, Lee MI, Bhasin S. Testosterone-induced muscle hypertrophy is associated with an increase in satellite cell number in healthy, young men. Am J Physiol Endocrinol Metab. Jul 2003;285(1):E197-205. doi:10.1152/ajpendo.00370.2002

146.     Skinner JW, Otzel DM, Bowser A, et al. Muscular responses to testosterone replacement vary by administration route: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. Jun 2018;9(3):465-481. doi:10.1002/jcsm.12291

147.     Snijders T, Aussieker T, Holwerda A, Parise G, van Loon LJC, Verdijk LB. The concept of skeletal muscle memory: Evidence from animal and human studies. Acta Physiol (Oxf). Jul 2020;229(3):e13465. doi:10.1111/apha.13465

148.     Steele I, Pope H, Ip EJ, Barnett MJ, Kanayama G. Is competitive body-building pathological? Survey of 984 male strength trainers. BMJ Open Sport Exerc Med. 2020;6(1):e000708. doi:10.1136/bmjsem-2019-000708

149.     Svartberg J, Agledahl I, Figenschau Y, Sildnes T, Waterloo K, Jorde R. Testosterone treatment in elderly men with subnormal testosterone levels improves body composition and BMD in the hip. Int J Impot Res. Jul-Aug 2008;20(4):378-87. doi:10.1038/ijir.2008.19

150.     Tajar A, Huhtaniemi IT, O'Neill TW, et al. Characteristics of androgen deficiency in late-onset hypogonadism: results from the European Male Aging Study (EMAS). J Clin Endocrinol Metab. May 2012;97(5):1508-16. doi:10.1210/jc.2011-2513

151.      Thirumalai A, Rubinow KB, Cooper LA, et al. Dose-response effects of sex hormone concentrations on body composition and adipokines in medically castrated healthy men administered graded doses of testosterone gel. Clinical endocrinology. Jul 2017;87(1):59-67. doi:10.1111/cen.13342

152.     Torrisi M, Pennisi G, Russo I, et al. Sudden Cardiac Death in Anabolic-Androgenic Steroid Users: A Literature Review. Medicina. Nov 4 2020;56(11)doi:10.3390/medicina56110587

153.     Traish AM. Testosterone and weight loss: the evidence. Curr Opin Endocrinol Diabetes Obes. Oct 2014;21(5):313-22. doi:10.1097/MED.0000000000000086

154.     Travison TG, Araujo AB, Kupelian V, O'Donnell AB, McKinlay JB. The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. J Clin Endocrinol Metab. Feb 2007;92(2):549-55. doi:10.1210/jc.2006-1859

155.     Travison TG, Araujo AB, O'Donnell AB, Kupelian V, McKinlay JB. A population-level decline in serum testosterone levels in American men. J Clin Endocrinol Metab. Jan 2007;92(1):196-202. doi:10.1210/jc.2006-1375

156.     Travison TG, Vesper HW, Orwoll E, et al. Harmonized Reference Ranges for Circulating Testosterone Levels in Men of Four Cohort Studies in the United States and Europe. J Clin Endocrinol Metab. Apr 1 2017;102(4):1161-1173. doi:10.1210/jc.2016-2935

157.     Tremellen K, McPhee N, Pearce K, Benson S, Schedlowski M, Engler H. Endotoxin-initiated inflammation reduces testosterone production in men of reproductive age. Am J Physiol Endocrinol Metab. Mar 1 2018;314(3):E206-E213. doi:10.1152/ajpendo.00279.2017

158.     Trexler ET, Hirsch KR, Campbell BI, Smith-Ryan AE. Physiological Changes Following Competition in Male and Female Physique Athletes: A Pilot Study. Int J Sport Nutr Exerc Metab. Apr 19 2017:1-25. doi:10.1123/ijsnem.2017-0038

159.     van Amsterdam J, Opperhuizen A, Hartgens F. Adverse health effects of anabolic-androgenic steroids. Regul Toxicol Pharmacol. Jun 2010;57(1):117-23. doi:10.1016/j.yrtph.2010.02.001

160.     van der Spoel E, Roelfsema F, van Heemst D. Relationships Between 24-hour LH and Testosterone Concentrations and With Other Pituitary Hormones in Healthy Older Men. J Endocr Soc. Sep 1 2021;5(9):bvab075. doi:10.1210/jendso/bvab075

161.     Varanoske AN, Margolis LM, Pasiakos SM. Effects of Testosterone on Serum Concentrations, Fat-free Mass, and Physical Performance by Population: A Meta-analysis. J Endocr Soc. Sep 1 2020;4(9):bvaa090. doi:10.1210/jendso/bvaa090

162.     Vidic V, Ilic V, Toskic L, Jankovic N, Ugarkovic D. Effects of calorie restricted low carbohydrate high fat ketogenic vs. non-ketogenic diet on strength, body-composition, hormonal and lipid profile in trained middle-aged men. Clinical nutrition. Apr 2021;40(4):1495-1502. doi:10.1016/j.clnu.2021.02.028

163.     Vieira TM, Rossi Junior WC, Da Re Guerra F, Damiao B, Marques PP, Esteves A. Effect of testosterone cypionate and stanozolol on the heart of young trained mice: A morphometric study. Steroids. May 2019;145:19-22. doi:10.1016/j.steroids.2019.02.011

164.     Watts EL, Appleby PN, Albanes D, et al. Circulating sex hormones in relation to anthropometric, sociodemographic and behavioural factors in an international dataset of 12,300 men. PLoS One. 2017;12(12):e0187741. doi:10.1371/journal.pone.0187741

165.     Westerman ME, Charchenko CM, Ziegelmann MJ, Bailey GC, Nippoldt TB, Trost L. Heavy Testosterone Use Among Bodybuilders: An Uncommon Cohort of Illicit Substance Users. Mayo Clinic proceedings. Feb 2016;91(2):175-82. doi:10.1016/j.mayocp.2015.10.027

166.     Winters SJ. SHBG and total testosterone levels in men with adult onset hypogonadism: what are we overlooking? Clin Diabetes Endocrinol. 2020;6:17. doi:10.1186/s40842-020-00106-3

167.     Yafi FA, Jenkins L, Albersen M, et al. Erectile dysfunction. Nat Rev Dis Primers. Feb 4 2016;2:16003. doi:10.1038/nrdp.2016.3

168.     Yokomizo A, Shiota M, Kashiwagi E, et al. Statins reduce the androgen sensitivity and cell proliferation by decreasing the androgen receptor protein in prostate cancer cells. Prostate. Feb 15 2011;71(3):298-304. doi:10.1002/pros.21243

169.     Yu JG, Bonnerud P, Eriksson A, Stal PS, Tegner Y, Malm C. Effects of long term supplementation of anabolic androgen steroids on human skeletal muscle. PLoS One. 2014;9(9):e105330. doi:10.1371/journal.pone.0105330

170.     Zhou CK, Advani S, Chaloux M, et al. Trends and Patterns of Testosterone Therapy among U.S. Male Medicare Beneficiaries, 1999 to 2014. J Urol. Jun 2020;203(6):1184-1190. doi:10.1097/JU.0000000000000744

171.      Zoob Carter BN, Boardley ID, van de Ven K. The Impact of the COVID-19 Pandemic on Male Strength Athletes Who Use Non-prescribed Anabolic-Androgenic Steroids. Front Psychiatry. 2021;12:636706. doi:10.3389/fpsyt.2021.636706

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