Dr. Peter Attia on PEDs

A business guy/entertainer and an MD I used to really enjoy reading. The latter does not understand how FT works in the human body and still thinks reducing SHBG someone "frees up more T". Hint...it does not.

Can people no longer read? Well I know @Type-IIx can read.

Entertainment value usually inversely proportional to educational value unless you are seriously demented and enjoy the details. When did Peter decide to join the TRT/TOT youtube bromance? 3+ hr video. Wow.

Derek, please share your grades in your three quarters/semesters of college organic chemistry? Curious. All of these guys (I withhold this comment on Peter although he has said some dumb stuff lately) are only as smart as the latest "guru" they are being advised by. See for example the Banny Dossa effect.
 
I find Dr. Peter Attia to be thoughtful with his analysis. He tends to be skeptical and digs into the research studies to understand what they are really revealing versus taking high points out of context. I also like that he readily admits when he is wrong or new scientific studies reveals something that contradicts his previous understanding. He is also very skeptical of the US insurance driven healthcare system which reactively waits for a person to get problems before doing anything, versus being proactive in detecting and preventing issues early on. He is one of a few people I follow for age related treatments.
 
I find Dr. Peter Attia to be thoughtful with his analysis. He tends to be skeptical and digs into the research studies to understand what they are really revealing versus taking high points out of context. I also like that he readily admits when he is wrong or new scientific studies reveals something that contradicts his previous understanding. He is also very skeptical of the US insurance driven healthcare system which reactively waits for a person to get problems before doing anything, versus being proactive in detecting and preventing issues early on. He is one of a few people I follow for age related treatments.
Thanks for sharing the link.
 
The latter does not understand how FT works in the human body and still thinks reducing SHBG someone "frees up more T". Hint...it does not.
For you details people...





Dose sets fT (your body eliminates fT not TT). fT + SHBG then set your TT on a very rapidly attained chemical equilibrium between fT and SHBG. Reaction of fT + SHBG —> TT much faster than apparent elimination rate of fT with injectable testosterone ester.



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Also exacerbating the issue is the accurate measurement of fT vs calculated or direct RIA methods. Historically only TT gets measured. If measuring your fT accurately, oxandrolone use (with a fixed dose of exogenous Test) will not increase your fT unless it changes your fundamental elimination rate of fT (sometimes correlated but not caused by SHBG). What oxandrolone will do is drop liver production of SHBG and hence drop TT (for a given level of fT).

For a fixed dose of exogenous T, at steady state your fT is fixed. Adding oxandrolone drops SHBG. Fixed fT (based on dose via law of mass action) + lowered SHBG ====> lowered TT.

Hence, absolute fT does not increase but %fT (fT/TT) does increase on oxandrolone.

My point, you gotta really dig into this if you want to understand it correctly. Attia and Andrew are not immune even with MDs / PhDs. Youtube is the great functional IQ dropper.




Most stuck in this TT+SHBG ---> fT paradigm

Move on to the fT+SHBG ----> TT paradigm

#fT_is_the_independent_variable
 
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A business guy/entertainer and an MD I used to really enjoy reading. The latter does not understand how FT works in the human body and still thinks reducing SHBG someone "frees up more T". Hint...it does not.

Can people no longer read? Well I know @Type-IIx can read.

Entertainment value usually inversely proportional to educational value unless you are seriously demented and enjoy the details. When did Peter decide to join the TRT/TOT youtube bromance? 3+ hr video. Wow.

Derek, please share your grades in your three quarters/semesters of college organic chemistry? Curious. All of these guys (I withhold this comment on Peter although he has said some dumb stuff lately) are only as smart as the latest "guru" they are being advised by. See for example the Banny Dossa effect.
I like Peter, smart man and highly productive. Derek's channel gets click, he's a pop. culture icon, or at least a bodybuilding subculture icon, at this point. Naturally, most would strike at the opportunity to be a guest of his. Thankfully, it looks like Peter provided an annotated summary with links to the time-point in the video by topic. I might, perhaps, check out sections of this, but like any YouTube video, I suspend judgment about its quality and secretly doubt I'll be learning anything here. But many might!
 
bodybuilding subculture icon,
Lol. I think this is my suppressed and subconscious wish. Sounds very rewarding and hopefully everybody reading/watching at home will be flexing/pumping/posing/doing muscle checks in their tighty whities or thongs.
 
For you details people...





Dose sets fT (your body eliminates fT not TT). fT + SHBG then set your TT on a very rapidly attained chemical equilibrium between fT and SHBG. Reaction of fT + SHBG —> TT much faster than apparent elimination rate of fT with injectable testosterone ester.



View attachment 267561View attachment 267561


Also exacerbating the issue is the accurate measurement of fT vs calculated or direct RIA methods. Historically only TT gets measured. If measuring your fT accurately, oxandrolone use (with a fixed dose of exogenous Test) will not increase your fT unless it changes your fundamental elimination rate of fT (sometimes correlated but not caused by SHBG). What oxandrolone will do is drop liver production of SHBG and hence drop TT (for a given level of fT).

For a fixed dose of exogenous T, at steady state your fT is fixed. Adding oxandrolone drops SHBG. Fixed fT (based on dose via law of mass action) + lowered SHBG ====> lowered TT.

Hence, absolute fT does not increase but %fT (fT/TT) does increase on oxandrolone.

My point, you gotta really dig into this if you want to understand it correctly. Attia and Andrew are not immune even with MDs / PhDs. Youtube is the great functional IQ dropper.




Most stuck in this TT+SHBG ---> fT paradigm

Move on to the fT+SHBG ----> TT paradigm

#fT_is_the_independent_variable

I always ask first: what's the practical upshot (i.e., application)? Remember, this is a bodybuilding (i.e., definitionally AAS-abusing) readership.

Frankly, I am of the view that bloodwork for TT & fT, SHBG, & DHT while using supraphysiologic AAS is practically pointless and should be foregone. With testosterone in the mix, the testosterone assay will just be maximally saturated. With synthetic AAS, TT & fT should decline, albeit stanozolol is strange here (probably why it was undetectable for so long, it does not alter basic hormonal parameters). All AAS dose-dependently lower SHBG. You can inhibit 5α-reductase at low dosages of testosterone to reduce DHT, but blasting testosterone means you basically do not care about short-term increases to it; and that's not a big deal practically.

FAI is a simple proxy for bioavailable T that considers SHBG, I've found it to be useful, and simple to boot, for those embarking on "TRT+." It reflects gonadal status very well in my experience.

I know that the Vermeulen equation breaks down with supra-physiologic dosing, but can be used to approximate free T concentration (AFTC), are you saying that's been absolutely outright superseded by a new method that can be readily applied?

At the end of the day, you just titrate dose to objective parameters (in bodybuilders, muscle size & strength, and secondarily, decreased fat mass). This increases absolute free androgen.

How does our not having a perfectly precise quantity for fT practically affect our decisionmaking for bodybuilding applications?
 
With testosterone in the mix, the testosterone assay will just be maximally saturated.
Preface: My links above were originally written for the ~100 to 300 mg/week Test ester (exogenous) crowd ("TRT"/TOT/legal androgen user/abuser) who decide to throw in a little oxandrolone or stanozolol to "free up some more T" after hearing about this approach on the internet or their provider.

You are referring to IA (ECLIA) for TT when you use the term "saturated" for supraphysiolgic doses of Test in the mix?

Yes absolutely. You would always use a reputable lab and go with LCMS assay. No upper limit and no interference. You have to look at each ECLIA machine/kit to understand potential interence (e.g., nandrolone). Black box for almost everyone.


Now the rest of your comments I am trying to clarify since some of them don't seem to follow from what I posted above. But this is the forum environment and we know it is easy to speak past each other on the forum.

I know that the Vermeulen equation breaks down with supra-physiologic dosing, but can be used to approximate free T concentration (AFTC), are you saying that's been absolutely outright superseded by a new method that can be readily applied?

Does it? I have used it with data corresponding up to to 300 mg/week Test ester and up to 50 ng/dl FT and it seems to do pretty well. This brings up the accuracy of LCMS plus equilibrium dialysis (ED) methods to accurate measure FT. Right now there is no harmonized approach for FT measurement like has been done with TT (CDC Host program).

Nevertheless, assuming Quest and Labcorp measure something like FT (I have good agreement between these two labs on roughly the same sample), the Vermeulen calculator (cFTV) does a remarkable job in comparison to ED. It s typically 10 to 20% higher than the ED measured value and I've checked this on a bunch of samples along with all the literature work. The Tru-T model claims it incorporates all the in vitro binding isotherm data for SHBG but in practice in fails miserably compared to cFTV when they are compared across the practical range of SHBG.

Part of the reason I am posting on here is to explore cFTV accuracy with higher measured FT levels. It kicks ass IMO and experience. Tru-T sucks.


How does our not having a perfectly precise quantity for fT practically affect our decisionmaking for bodybuilding applications?

Again I am not understanding how this question follows from my prior comments. Regardless, to your point it absolutely does not. Take as much AAS as your estimated survival timeline supports. Just don't be shocked when your estimate and plan for AAS sides fails. I have had a scare and it sucked.

In short, I am just a slightly ASD BB enthusiast so I like to explore the numbers. This is the place for numbers you don't find on Elsevier.

Perhaps another thread on finer points of FT would be cool. I gotta bunch of comparisons if there is interest.

Thanks for weighing in @Type-IIx. I enjoy chatting with you even when you are on Tren or missing your workouts.

Reflecting on our earlier exchange I can understand your initial bristling of my TT dose response work. I am hopeful as we continue the dialog we will develop a better understanding. My goal is to educate myself and the reader in the process if I can. I will throw up some more examples taken with data from this site to show both the practical and entertainment utility of the dose response tool.
 
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I like Peter, smart man and highly productive. Derek's channel gets click, he's a pop. culture icon, or at least a bodybuilding subculture icon, at this point. Naturally, most would strike at the opportunity to be a guest of his. Thankfully, it looks like Peter provided an annotated summary with links to the time-point in the video by topic. I might, perhaps, check out sections of this, but like any YouTube video, I suspend judgment about its quality and secretly doubt I'll be learning anything here. But many might!
Yeah, it’s great that he provides annotated transcripts of his videos. Easier and quicker to read through the details than try to follow a 3 hour video.
 
Preface: My links above were originally written for the ~100 to 300 mg/week Test ester (exogenous) crowd ("TRT"/TOT/legal androgen user/abuser) who decide to throw in a little oxandrolone or stanozolol to "free up some more T" after hearing about this approach on the internet or their provider.
OK, very good. I think the scope of this, then, is for a very narrow audience here. Maybe, not really anybody besides yourself and a couple other ExcelMale guys that check in here intermittently.
You are referring to IA (ECLIA) for TT when you use the term "saturated" for supraphysiolgic doses of Test in the mix?
Yeah, just practically, this is what is most often used. I just think that it's better to not even waste the money on measuring the aforementioned hormonal parameters (TT, etc., above) for anyone blasting or running a cycle.
Yes absolutely. You would always use a reputable lab and go with LCMS assay. No upper limit and no interference. You have to look at each ECLIA machine/kit to understand potential interence (e.g., nandrolone). Black box for almost everyone.
Sure, usually you can refer to cross-reactivity data. It's just that this becomes so cumbersome in practice.

As much as I love data, I try not to get bogged down by it also!
Now the rest of your comments I am trying to clarify since some of them don't seem to follow from what I posted above. But this is the forum environment and we know it is easy to speak past each other on the forum.



Does it? I have used it with data corresponding up to to 300 mg/week Test ester and up to 50 ng/dl FT and it seems to do pretty well. This brings up the accuracy of LCMS plus equilibrium dialysis (ED) methods to accurate measure FT. Right now there is no harmonized approach for FT measurement like has been done with TT (CDC Host program).
@PeterBond will tell you that, definitely, it does. I haven't compared cFTV vs. equilibrium dialysis measurement of fT to have an opinion. I think that practically, calculated fT works well for those embarking on "TRT+" and after dose adjustments on TRT – instances where I believe it to be useful for more readers here.
Nevertheless, assuming Quest and Labcorp measure something like FT (I have good agreement between these two labs on roughly the same sample), the Vermeulen calculator (cFTV) does a remarkable job in comparison to ED. It s typically 10 to 20% higher than the ED measured value and I've checked this on a bunch of samples along with all the literature work. The Tru-T model claims it incorporates all the in vitro binding isotherm data for SHBG but in practice in fails miserably compared to cFTV when they are compared across the practical range of SHBG.
10 - 20% is kind of a lot; and if it varies within that range, we can't consistently add any multiplier. You see, I think that with 20% variability, we're already wasting energy talking about quantification, it's so imprecise that it defeats our very purpose.
Part of the reason I am posting on here is to explore cFTV accuracy with higher measured FT levels. It kicks ass IMO and experience. Tru-T sucks.
Oh, I definitely want this project of yours, then, to succeed. I think, though, that Peter Bond might be able, if he reads this, to discuss this with you better than I can.
Again I am not understanding how this question follows from my prior comments. Regardless, to your point it absolutely does not. Take as much AAS as your estimated survival timeline supports. Just don't be shocked when your estimate and plan for AAS sides fails. I have had a scare and it sucked.
I suppose that the reason we are seeming to be talking past one another at points is that I approach every problem with the question: "How can this be applied to achieve a bodybuilding outcome (bulking, cutting, recomp)?" Everything that I do is to that end; it's my basic objective.

Your objective is different, in that seems to be use a deductive methodology in the spirit of rationalism to derive generalizable formulae for problems that you are interested in, that can be applied, and yield f(x) = y.

I arrive at this based on your posts (that have been outstanding contributions to that end), and your own characterization of your motivations here:
In short, I am just a slightly ASD BB enthusiast so I like to explore the numbers. This is the place for numbers you don't find on Elsevier.

Perhaps another thread on finer points of FT would be cool. I gotta bunch of comparisons if there is interest.

Thanks for weighing in @Type-IIx. I enjoy chatting with you even when you are on Tren or missing your workouts.

Reflecting on our earlier exchange I can understand your initial bristling of my TT dose response work. I am hopeful as we continue the dialog we will develop a better understanding. My goal is to educate myself and the reader in the process if I can. I will throw up some more examples taken with data from this site to show both the practical and entertainment utility of the dose response tool.
I think that you should absolutely continue your work here, because it serves you and some readers. I will not sling barbs or try to have you bristle at criticism. Admittedly, my first posts on your TT dose/response thread were a bit of trial-by-fire or the gauntlet, but it's all in good faith and hopefully constructive!
 
just think that it's better to not even waste the money on these hormonal parameters (TT, fT whether calculated or by equilibrium dialysis) for anyone blasting or running a cycle.

If you are using IA for TT while on the gas then absolutely a waste.

10 - 20% is kind of a lot; and if it varies within that range, we can't consistently add any multiplier. You see, I think that with 20% variability, we're already wasting energy talking about quantification, it's so
if curious you can see the links and plots I just put up on the dose response thread. The bias is consistent and typically 10 to 20% so actually workable with a multiplier. I show that approach as well in those links.


@PeterBond will tell you that, definitely, it does

Would love to compare notes. Thanks for tagging him. He may have a lot more ED data for the BB crowd. The rub is that there is still at least two camps in the ED wars and their data sets are inconsistent. Then the model builders always highlight the data set that fits their model. With 1 DOF you can make cFTV fit any of the data so in my mind that is a superior tool from AIC standpoint.

because it serves you and some readers. I will not sling barbs or try to have you bristle at criticism. Admittedly, my first posts on your TT dose/response thread were a bit of trial-by-fire or the gauntlet, but it's all in good faith and hopefully constructive!

Hey, fire away. My job any time I go to a new forum is to find the smartest dude and try to get him to blast my work. That is the only way to get better and we will call it the UG peer review by fire. There are no PIs to send this stuff too. Perhaps I should have tapped Peter earlier if he is planning to publish something on this.

Sure, usually you can refer to cross-reactivity data. It's just that this becomes so cumbersome in practice.

Yes I have done that for nandrolone with TT by IA. 5% to 180% interference is quite the range. Run LCMS if you want a usable number.
 
I suppose that the reason we are seeming to be talking past one another at points is that I approach every problem with the question: "How can this be applied to achieve a bodybuilding outcome (bulking, cutting, recomp)?" Everything that I do is to that end; it's my basic objective.

Your objective is different, in that seems to be use a deductive methodology in the spirit of rationalism to derive generalizable formulae for problems that you are interested in, that can be applied, and yield f(x) = y.

I arrive at this based on your posts (that have been outstanding contributions to that end), and your own characterization of your motivations
Understood and thank you for taking the time to capture that so we can further our understanding of each other.

If I used your approach I would be bigger and veiny-er but probably not. Just my heart is the only muscle that seems to really excel at gainz. AFIb was a pain. So you are absolutely right I am trying to build some decent models and you are focused on genius level analysis for getting big or die trying. What a great forum.

I appreciate your comments.
 
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