Muscle Intelligence How Testosterone Works and Hypogonadism in Males with Dr. Scott Howell #369
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Dec 21, 2023 Dr. Scott Howell, research director and epidemiologist focused on androgen safety and endocrine disruptors. He walks through how testosterone is made and metabolized. The conversation covers who may benefit from replacement therapy, risks of aromatase inhibitors and finasteride, fertility and hematocrit concerns, hair loss strategies, and alarming effects of environmental endocrine disruptors.
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Testis Physiology And Spermatogenesis
- Leydig cells synthesize testosterone and Sertoli cells sequester it to maintain spermatogenesis with intratesticular levels ~100x serum levels.
- Exogenous testosterone cannot cross the blood-testis barrier, so it suppresses intratesticular testosterone and spermatogenesis.
Avoid Aromatase Inhibitors On TRT
- Avoid aromatase inhibitors while on testosterone unless medically necessary because blocking estrogen causes myocardial fibrosis and bone loss.
- Do not use aromatase inhibitors to chase low estradiol symptoms; let aromatization normalize naturally.
Prefer Topical DHT Control If Needed
- Avoid systemic finasteride if possible because blocking DHT systemically affects tissues beyond the scalp.
- Prefer topical/local approaches for hair preservation to limit systemic side effects.