TRT & 24-Hour Urine

[Michael Scally MD]

Re: Where's the beef?

That is quite a list of references (I shortened the list for post brevity.). I see your working PubMed. However, your search is general in nature and does not answer the question of the thread. I looked through the cites and NOT ONE supports the use of 24-hour urine. Care to provide a single citation to support its use?

Gilad S, Chayen R, Tordjman K, Kisch E, Stern N. Assessment of 5 alpha-reductase activity in
hirsute women: comparison of serum androstanediol glucuronide with urinary androsterone and
aetiocholanolone excretion. Clin Endocrinol (Oxf). 1994 Apr;40(4):459-64


Urinary 7-ketosteroids in men
316. Hamilton JB, Bunch LD, Mestler GE. Urinary 17-ketosteroids in castrated vs. noncastrated men.
J Clin Endocrinol Metab. 1959 Dec;19:1680-2
317. Furman RH, Howard RP. Urinary 17-ketosteroid excretion in castrated and intact men. J Clin
Endocrinol Metab. 1959 Nov;19:1510-2
318. Dorfman RI, Hamilton JB. Concerning the metabolism of testosterone to androsterone. J Biol
Chem. 1940;133:753-60
319. Callow, Nancy H. The isolation of two transformation products of testosterone from urine.
Biochem J. 1939; 33: 559-64
320. Dehennin L, Matsumoto AM. Long-term administration of testosterone enanthate to normal men:
alterations of the urinary profile of androgen metabolites potentially useful for detection of
testosterone misuse in sport. J Steroid Biochem Mol Biol. 1993;44 (2):179-89
...

24-hour urine androgen tests in men
Urinary testosterone in men
257. Ooi LS, Panesar NS, Masarei JR. Within- and between-subject variation in, and associations
between, serum concentrations and urinary excretion of testosterone and estradiol in Chinese
men. Clin Chim Acta. 1995 Apr 30;236(1):87-92
258. Borts DJ, Bowers LD. Direct measurement of urinary testosterone and epitestosterone
conjugates using high-performance liquid chromatography/tandem mass spectrometry. J Mass
Spectrom. 2000 Jan;35(1):50-61

. . . .

 

[Michael Scally MD]

Re: Where's the beef?

Urinary testosterone in women
98. Doberne Y, New MI. Urinary androstanediol and testosterone in adults. J Clin Endocrinol Metab.
1976 Jan;42(1):152-4
99. Karila T, Kosunen V, Leinonen A, Tahtela R, Seppala T. High doses of alcohol increase urinary
testosterone-to-epitestosterone ratio in females. J Chromatogr B Biomed Appl. 1996 Dec
6;687(1):109-16


Urinary 7-ketosteroids in men
316. Hamilton JB, Bunch LD, Mestler GE. Urinary 17-ketosteroids in castrated vs. noncastrated men.
J Clin Endocrinol Metab. 1959 Dec;19:1680-2
317. Furman RH, Howard RP. Urinary 17-ketosteroid excretion in castrated and intact men. J Clin
Endocrinol Metab. 1959 Nov;19:1510-2
318. Dorfman RI, Hamilton JB. Concerning the metabolism of testosterone to androsterone. J Biol
Chem. 1940;133:753-60


24-hour urine androgen tests in men
Urinary testosterone in men
257. Ooi LS, Panesar NS, Masarei JR. Within- and between-subject variation in, and associations
between, serum concentrations and urinary excretion of testosterone and estradiol in Chinese
men. Clin Chim Acta. 1995 Apr 30;236(1):87-92
. . . . . .

That is quite a list of references. I see your working PubMed. However, your search is general in nature and does not answer the question of the thread. I looked through the cites and NOT ONE supports the use of 24-hour urine. Care to provide a single citation to support its use?

 

[Michael Scally MD]

have you read these studies? Do they favorably or unfavorably compare results? I looked and found an old study that would suggest the value of serum over urine assays for gonadotropic hormones.

http://jcem.endojournals.org/cgi/content/abstract/52/2/225?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=24+hour+urine&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT (Interrelationship of Plasma and Urinary Gonadotropins: Correlations for 24 Hours, for Sleep/Wake Periods, and for 3 Hours after Luteinizing Hormone-Releasing Hormone Stimulation -- CHIPMAN et al. 52 (2): 225 -- Journal of Clinical Endocrinology & Met)

Thank you. The cites are a nonspecific PubMed search that is not on point.

And you rightly point out that the article you cite states, "The results demonstrate that sleep/wake differences in urinary gonadotropins are qualitatively similar to plasma changes but are quantitatively unreliable as a screening test for the presence of pubertal hypothalamic-pituitary maturation."

I understand the use of urine testing, but for TRT: Where's the beef? (not directed to HeadDoc)

 

[Michael Scally MD]

This was written almost 3 years ago. Dr. Mariano has used urine testing in a while, if ever.

I read the post by Marianco! My take was he thought it theoretically possible, but not of use. Does anyone realize all of the testosterone metabolites (that include all of the estradiol metabolites) needed for a so-called 24-urine test? This is exactly what Marianco said in the post. The metabolism differs from individual to individual, their are significant other influences on metabolites (estradiol), never mind the cost and hassles. I can guarantee there is NO literature in support of this quaky and crazy idea based on the preceding alone.

 

[Michael Scally MD]

Sorry can't type.

Should say .......Dr. Mariano hasn't used urine testing in a while, if ever.

I apologize for using the wrong post, but I got your meaning anyhow (obviously).

 

[Michael Scally MD]

No, but the point is that Scally used his "preference" for serum testing as an excuse to ridicule both a licensed medical practitioner who sometimes uses this procedure and a forum member who simply thought urine testing made sense. Ridicule is the tool of a bully.

Further, he refused to support his "preference" when I explicitly asked. I didn't even ask him to support it with studies, i just wanted to know why he thought the 24 hour urine test in the case of TD application was ill-advised.

He not only refused to explain, but threw the burden of disproving his statements back on the members of this forum. Well, studies have been provided. Will he respond now?

From your post, it is clear you fail to understand proper argument. You want me to prove a negative! It is not question of : "preference." As far as using serum testing, I do not think there is even a minimum argument it is the standard of care. I did review the cites posted and NONE provide support. Once again, you want me to provide the support for something that is nonexistent. Show me/anyone a single citation in support of 24-hour urine testing for TRT?

Quack - Quack - Quack - Quack - Quack

Take this opportunity to show up Dr.Scally.Others have tried and failed. (Although I did make an error for "right way" for "right away." And I admitted my bad.) I will gladly issue a mea culpa once the evidence is provided.

 

[Michael Scally MD]

Bingo! The existence of studies examining this relationship and the mere existence of laboratory tests doesn't automatically provide scientific justification for a given treatment over another.

Bingo! Bingo! Bingo!

Did I say, "Bingo!"

This thread is meant to provoke discussion. All comments are revealing. Thank you.

 

[Millard]

Further, he refused to support his "preference" when I explicitly asked. I didn't even ask him to support it with studies, i just wanted to know why he thought the 24 hour urine test in the case of TD application was ill-advised.

He not only refused to explain, but threw the burden of disproving his statements back on the members of this forum. Well, studies have been provided. Will he respond now?

Dr. Scally has engaged in a scientific argument.

You argument is a logical fallacy asking him to prove a negative. This is called "argument from ignorance".

[ame="http://en.wikipedia.org/wiki/Negative_proof"]Proving a negative - Wikipedia, the free encyclopedia@@AMEPARAM@@/wiki/Fileisambig_gray.svg" class="image"><img alt="Disambiguation icon" src="http://upload.wikimedia.org/wikipedia/commons/thumb/5/5f/Disambig_gray.svg/30px-Disambig_gray.svg.png"@@AMEPARAM@@commons/thumb/5/5f/Disambig_gray.svg/30px-Disambig_gray.svg.png[/ame]

The burden is indeed on you and/or advocates of the 24 hour urine test.

If the listed studies prove the superiority of urine testing over serum testing the you must engage in the scientific argument and explain how any of those studies can support your position.

Dr. Scally has given an excellent example of how to provide scientific documentation (with the use of scientific studies with relevant commentary) to support his medical positions and recommnedations in numerous posts throughout these forums.

Dr. Scally thinks like a researcher and scientifist and wants to inspire critical thinking and science-based dialogue from members and colleagues. He is more than willing to engage anyone interested in the same.

 

[HeadDoc]

are we all having fun? When I have the time to devote to researching answers, I find this fun--and rewarding.

 

[Millard]

are we all having fun? When I have the time to devote to researching answers, I find this fun--and rewarding.

Yes, I have a great appeciation of everyone who has a grasp of the scientific literature in relevant fields. The critical thinking and lit reviews facilitate increased knowledge for everyone!

The answers aren't simple.

I encourage everyone to spend at least a fair amount of time researching the scientific basis for the treatments they undergo.

It is easier to idolize cult figures that have become popular in a given field and follow them blindly. Often these figures exploit their following and rely on their own status (self-perceived or otherwise) to justify their protocols while moving away from or abandoning scientific justification.

Instead, the best experts in a field will serve as a guide to enable you to grasp the scientific rationale of a given protocol.

Anyone who tells you they are right because of who they are is someone to be avoided.

Those who empower you to learn and understand are the true experts.

 

[cvictorg]

Dr Jonathan Wright is the leading advocate of 24 hour urine testing - here are his reasons

http://ahha.org/BHRT-Article.htm

The most comprehensive and accurate way to monitor hormone metabolites is with a 24-hour urine test. Many of the people I work with are surprised that I don't recommend blood testing to measure hormone levels. But there are a few factors that explain why blood testing isn't the best choice.

When your body produces hormones internally, they're secreted in "pulses," (bursts and pauses) and when you use BHRT, you supplement with the hormones once or twice a day. So they're not continuously circulating throughout your body at steady levels, which makes obtaining an accurate measurement from a blood sample extremely difficult: Blood levels of any hormone can be quite variable depending on the time of day the sample is drawn. Urine testing, on the other hand, determines the entire amount produced-or supplemented-in a 24-hour period.

Except with testosterone, blood tests also don't distinguish between the "free" and "bound" forms of hormones. And, according to researchers, the "bound" forms are inactive. So nearly all of the estrogens and progesterone measured in blood are the inactive "bound" form. The "free" forms-the active forms -are actually not measured at all. But urine testing measures the sum of free and "conjugated" hormonal steroids. (Conjugated steroids are ones that have combined with other simple molecules.) The "free" form of any hormone is the most active form, but the "conjugated" form can be active, too, so it's beneficial to know how much of these types of hormones are in your body, as opposed to a measurement that includes forms that research has found to be inactive.

One other quirk of blood testing is that estriol-one of the most important protective estrogens-is practically unmeasurable in blood samples by most labs, while in urine estriol is found in greater quantities than nearly any other single estrogen. While they aren't absolutely certain why, experts think this may occur because even though considerable estriol is secreted every day, it's "cleared" from the blood very rapidly.

And on top of these drawbacks, blood testing just isn't presently available for many of the steroid metabolites that are important for ensuring BHRT safety. In addition to estriol, at present blood tests for 2-methoxyestradiol (a "good" estrogen), 4-hydroxyestrone (considered the "worst" estrogen), androstanediol (a "good" testosterone), and others are not available.

 

[ProfBush]

Dr. Scally has engaged in a scientific argument.

You argument is a logical fallacy asking him to prove a negative. This is called "argument from ignorance".

Argument from ignorance - Wikipedia, the free encyclopedia

The burden is indeed on you and/or advocates of the 24 hour urine test.

If the listed studies prove the superiority of urine testing over serum testing the you must engage in the scientific argument and explain how any of those studies can support your position.

Dr. Scally has given an excellent example of how to provide scientific documentation (with the use of scientific studies with relevant commentary) to support his medical positions and recommnedations in numerous posts throughout these forums.

Dr. Scally thinks like a researcher and scientifist and wants to inspire critical thinking and science-based dialogue from members and colleagues. He is more than willing to engage anyone interested in the same.

I wasn't asking him to "prove" anything. I was simply asking him to share his reasons for his opinion about urine testing.

I also asked that he refrain from name-calling and ridiculing our forum members. Apparently the latter was too much to ask.

Any idiot can type: Quack - Quack - Quack - Quack - Quack

 

[Michael Scally MD]

You sure love to refer to him as a doctor, even though he isn't one anymore? His license got revoked for what i imagine to be rather unscrupulous activities.

I am sure the personal attacks prove your point!!! What is the purpose of the post? If it makes you feel better, my license was revoked. I am still in the appeal process. I am a Doctor of Medicine. Why don't you run back to your hideout? I can't blame you for your statement except it is borne out of ignorance.

How does this prove up the quackery of 24-hour urine testing? And point to a post where I mislead posters or provide quackery as the urine testing.

 

[Michael Scally MD]

I wasn't asking him to "prove" anything. I was simply asking him to share his reasons for his opinion about urine testing.

I also asked that he refrain from name-calling and ridiculing our forum members. Apparently the latter was too much to ask.

Any idiot can type: Quack - Quack - Quack - Quack - Quack

You were asking me to provide support (prove) for a "preference" as shown below. Moreover, the thread was about urine testing. Even knowing this you challenge the well accepted use of serum testing even though I did not raise the subject. Your reference to the citations is added evidence you want me to "prove" something!

That you are unable and incapable of argument is your use of personal attacks. I did not use a personal attack, but used a metaphor for anyone advocating the use of 24-hour urine testing for TRT as a quack. As far as idiots, what was it you typed?

We are still left with the fact there is NO literature support for 24-hour urine testing in TRT. If your doctor uses this and you accept it, I will repeat as I said elsewhere, it is an obedience and loyalty test for a cult-like practice.

No, but the point is that Scally used his "preference" for serum testing as an excuse to ridicule both a licensed medical practitioner who sometimes uses this procedure and a forum member who simply thought urine testing made sense. Ridicule is the tool of a bully.

Further, he refused to support his "preference" when I explicitly asked. I didn't even ask him to support it with studies, i just wanted to know why he thought the 24 hour urine test in the case of TD application was ill-advised.

He not only refused to explain, but threw the burden of disproving his statements back on the members of this forum. Well, studies have been provided. Will he respond now?

 

[Michael Scally MD]

Dr Jonathan Wright is the leading advocate of 24 hour urine testing - here are his reasons

http://ahha.org/BHRT-Article.htm

The most comprehensive and accurate way to monitor hormone metabolites is with a 24-hour urine test. Many of the people I work with are surprised that I don't recommend blood testing to measure hormone levels. But there are a few factors that explain why blood testing isn't the best choice.

When your body produces hormones internally, they're secreted in "pulses," (bursts and pauses) and when you use BHRT, you supplement with the hormones once or twice a day. So they're not continuously circulating throughout your body at steady levels, which makes obtaining an accurate measurement from a blood sample extremely difficult: Blood levels of any hormone can be quite variable depending on the time of day the sample is drawn. Urine testing, on the other hand, determines the entire amount produced-or supplemented-in a 24-hour period.

Except with testosterone, blood tests also don't distinguish between the "free" and "bound" forms of hormones. And, according to researchers, the "bound" forms are inactive. So nearly all of the estrogens and progesterone measured in blood are the inactive "bound" form. The "free" forms-the active forms -are actually not measured at all. But urine testing measures the sum of free and "conjugated" hormonal steroids. (Conjugated steroids are ones that have combined with other simple molecules.) The "free" form of any hormone is the most active form, but the "conjugated" form can be active, too, so it's beneficial to know how much of these types of hormones are in your body, as opposed to a measurement that includes forms that research has found to be inactive.

One other quirk of blood testing is that estriol-one of the most important protective estrogens-is practically unmeasurable in blood samples by most labs, while in urine estriol is found in greater quantities than nearly any other single estrogen. While they aren't absolutely certain why, experts think this may occur because even though considerable estriol is secreted every day, it's "cleared" from the blood very rapidly.

And on top of these drawbacks, blood testing just isn't presently available for many of the steroid metabolites that are important for ensuring BHRT safety. In addition to estriol, at present blood tests for 2-methoxyestradiol (a "good" estrogen), 4-hydroxyestrone (considered the "worst" estrogen), androstanediol (a "good" testosterone), and others are not available.

I read the link. I wish you had included your analysis of the link. The linked article says nothing about using 24-hour urine testing for TRT or cites for the use of urine testing in TRT. Further, the article, while poor, does point out the importance of T metabolites. This shows the virtual impossibility of 24-hour urine testing as a tool. {AS a small note, does anyone really believe this testing is valid? T is bound to albumin, which does not pass through the kidney. Protein in the urine indicates a BAD disease. The use of 24-hour urine test for TRT is by snake oil salesman.]

We are back to square one. In frustration, others are unable to argue and now resort to personal attacks. I give the majority of Meso readers the credit to read the message. The others who try and scream by using personal attacks will either grow up and change or wither away and die.

 

[BBC3]

I think it was Dr. Scally's attempts to treat AAS users post proloned steroid use as an effort to correct their hormonal issues now associated same, that got him in trouble. I certainly have more respect for him at this time as he demonstrates such a mild and controlled response to a sensative issue. After all, it was a pack of ignorant dogs, like yourself, who were looking for a witch to burn, that caused the problem anyway.

SO WHY IN THE FUCK ARE YOU HERE, AT A WEBSITE THAT THRIVES ON CHALLENING THE "NORM"??? GET THE FUCK OUT OF HERE PIECE OF SHIT..............

You sure love to refer to him as a doctor, even though he isn't one anymore? His license got revoked for what i imagine to be rather unscrupulous activities.


Can't you get in trouble for continuing to pose as a doctor and offering to "Help" people after revocation?

 

[BBC3]

"Banned substances".. get a hold of yourself. I think the question was whether or not he used current mainstream acceptable protocol in conjunction with the diagnoses and condition. IF WE LIVED WITH CURRENT PRACTICE WITH NO PUSH FOR CHANGE, NO ONE WOULD BE HERE AND BEING TREATED WITH HRT....

You attack is unwelcomed and unfair considering, the lowest of blows delivered completely out of context and will only further confuse and muddy the water in a VERY IMPORTANT situation. You owe an apology.....

If you were sorry enough to give me a negative rating over that then this just goes to prove that none of my negative ratings hold any water.....

ITS A FREE COUNTRY YOU GET OUT.

It's so fun being childish. He had to break 'medical law' in order to treat people with steroid induced hypogonadism?

I'm pretty sure theres doctors treating people for that condition everyday without offering them banned substances.


Besides, Scallys infamy is hinged upon his personal attacks on various people....so i dont know why hes going down that path of argument.

Scally promotes the use of anabolic steorids, at his medical license's peril.

 

[Michael Scally MD]

Thank you for the supportive posts. I am acutely aware of the use of personal attacks as a method to take an argument off-topic. For a short moment, it has had success. Be Forewarned: Any and all posts whether positive or negative that are off-topic will be deleted. The personal attacks will not take the thread's point elsewhere. I will not accept minions to steer important information from Meso readers.

Again, what is the support for 24-hour urines testing in TRT? Thus far, no one has provided a single article in support of this procedure. Where is the beef?

Absence all literature, provide some scientific reasoning for this practice. This will prove impossible for reasons stated in this thread, but try.

If someone is using these practices (and the quote in the initial post sent me is from a current website forum), what basis is their use? If this type of testing is used, what other unsupported practices is this physician exposing his/her patients?

 

[Michael Scally MD]

Again, what is the support for 24-hour urines testing in TRT? Thus far, no one has provided a single article in support of this procedure. Where is the beef?

Absence all literature, provide some scientific reasoning for this practice. This will prove impossible for reasons stated in this thread, but try.

If someone is using these practices (and the quote in the initial post sent me is from a current website forum), what basis is their use? If this type of testing is used, what other unsupported practices is this physician exposing his/her patients?

By the absence of any literature support, not a single citation even remotely in support, and no reasonable scientific explanation, it can be concluded this practice is far below the standard of care, a total waste of time and money, and draws into question the practice of anyone recommending these tests. Is this an isolated practice or one of many? From my sources sending me copies of the practice, it is not an isolated instance.

 

[Michael Scally MD]

Thank you for the supportive posts. I am acutely aware of the use of personal attacks as a method to take an argument off-topic. For a short moment, it has had success. Be Forewarned: Any and all posts whether positive or negative that are off-topic will be deleted. The personal attacks will not take the thread's point elsewhere. I will not accept minions to steer important information from Meso readers.

This thread will not be pushed off-topic by personal attacks (or supportive personal posts). All were forewarned. If you are unable to argue or contribute constructively, move on.