What I can say, without intending to offer specific advice to someone I haven't fully evaluated, is that I have seen MANY cases where a person had multiple symptoms that were typical of hypothyroidism but their labs were all within the posted reference ranges. In a lot of those cases (not all, but enough to make this a common scenario and one worth investigating) when I had the person experiment with thyroid hormone as I described previously, their symptoms all resolved and the thyroid tests all remained within the reference range still. This is the whole point of a reference "RANGE" - not everyone has optimal results at the same damn levels! Therefore, if it seems like a possibility that a mild hormone deficiency ("mild" only because the labs aren't out of range, and lord knows the labs tell us all we need to know...) could explain a person's symptoms we should try supplementing the natural molecules your body actually produces internally FIRST, before we go experimenting with unnatural molecules made in a factory... That's a basic philosophy that I think should resonate with anyone who hears it, but it is the total opposite of the medical education people have received for the past century in America and most of the western world. The symptoms of low thyroid are legion, and there are many classes of medication people may end up taking in an effort to resolve their issues - when those drugs might all be replaced by a single molecule your body just wasn't managing to produce for you in adequate amounts. To make things more confusing to the poorly-educated modern practitioner, people may also have hormonal "receptor resistance", where they have deficiency symptoms even when the level of that hormone is in the upper quartile of its reference range (in the case of testosterone, well above the posted range because the ranges are absurd...). In those cases, the patient will not feel optimally replaced until the hormone level has gone up well above the reference range.

One other thing - if a given person does seem to require what looks like an excessive amount of some hormone in order to resolve their symptoms, it is prudent to find some other way of determining whether the person is being "overdosed" using secondary indicators or outcomes. In the case of thyroid this would mean making sure their resting heart rate is abnormally high, they aren't experiencing palpitations or feelings of heart racing, and you can monitor urine bone collagen fragments to make sure their bones aren't breaking down too fast. If those things check out as normal, you are NOT overdosing the person in a physiologic sense.

I have prescribed Anastrozole for thousands of people over twenty years and have only seen two or three people have any negative effects from the drug itself. Those people all felt some heart racing, anxiety and fear with a disturbing feeling in their chest. Switching to Letrozole was fine for all three of them. I don't think there is any mechanism inherent to an AI drug that would have any effect on the nervous system. All the other problems I've seen with AI's have been due to over-use for the individual, driving estrogen levels down too far. Even men need a certain amount of estrogen and will experience fatigue, depression, brain fog/cognitive suppression, low libido, and even erectile dysfunction (a lot like low T itself). In my experience most practitioners only check one form of estrogen (usually Estradiol) and not both (forgetting Estrone). Someone can have an Estrone level three-fold different from Estradiol or vice versa, so this is managed very poorly by most people. Many practitioners also have some "protocol" for dosing the AI at the same regimen for everyone rather than tailoring it to the individual. If you adjust the medication to keep E1+E2 in the 50-100pg/mL range men do great.

@Jordi Walter Hoock CastroYes, exactly. That drug itself rarely causes any negative effects or side effects. It is the misuse of the drug, failing to tailor dosing to each individual, that leads to problems. It's irresponsible in my opinion to prescribe hormones or drugs that alter a person's hormone levels and NOT monitor those levels. Urologists still prescribe drugs like Finasteride if a man's prostate seems enlarged, without EVER (at least I've never seen a urologist do it) measuring that man's dihydrotestosterone level. Those drugs only do that one thing, lower DHT. It's easy to check it and make sure first! They all just assume a big prostate means high DHT because they don't recognize the epidemic of low testosterone our population now has. Men with enlarged prostates today are far more likely to have high Estrogen levels and low testosterone/DHT.

The drugs ending in "sartan" are in a class called ARB's - angiotensin receptor blockers. They block the action of a molecule that regulates vasoconstriction in the blood vessels and some upstream BP regulation through the kidney/adrenal system. They are some of the safer BP medications that have few side effects or serious problems and tend to show some of the better results in terms of preventing kidney damage and cardiovascular complications associated with hypertension (HTN). The benefits are pretty small and no BP drugs really make a big difference in terms of those outcomes, but the ARB's are one of the better classes of BP drugs to use in general. The most important thing in regard to HTN is to try and figure out WHY each person has it, just like with anything else in medicine. Making the "diagnosis" should be seen as the beginning of investigation, not the end. There are some physiological/metabolic causes that can be easily ruled out with some simple blood tests, and if none of those causes are found it's usually related to one or more of a few upstream general causes: 1 - The crap we eat and drink that's full of chemicals and sugar 2 - Being overweight or obese (see cause #1) 3 - Psychological/emotional stress/distress (this is very common and the hardest issue to fix). 4 - Salt deficiency leading to chronic dehydration. This is something I will make a long form video about because what I have to say runs totally counter to what the medical system has been telling people about salt being dangerous for decades. I tend to suggest that people with HTN, anxiety, muscle tension, headaches, constipation, fatigue, muscle cramps, dry skin, and essentially everyone take 1-2 tsp raw sea salt (unrefined, pink or dirty-looking salt with lots of minerals in it - Himalayan, Celtic, Redmond, Murray River, etc.) once or twice per day in a small amount of water. Drink plain water only when you feel thirsty for it and not intentionally just because you think it's good for you.

This is one of my soapbox issues, so I'll try to generate a video soon with a thorough discussion of the subject.

Correct, "atrophy" is the right word. When you aren't using certain cells/tissues it isn't worth maintaining their full function in terms of energy and resources from your body, so those cells/tissues shrink - but they are not "damaged". From a quick internet search: "Duck testicles undergo extreme seasonal variation, fluctuating in size by up to 1,000-fold depending on the time of year. During the non-breeding season, they regress to a nearly invisible state, but swell into prominent, active organs at the peak of the mating season to accommodate a massive increase in sperm production." I thought I recalled learning years ago (took an ornithology course for my biology degree, in 1992 maybe) that a male duck's nuts change size about 300-fold, and this AI report says 1000-fold - but either way it's a massive change in size with no "damage" involved and full fertility retained. If you stop working out your muscles will atrophy too, with no damage or scar tissue or anything. Start working out again and they grow back, even faster than before because of the "muscle memory" concept. That isn't unique to muscles, it's the same with almost all tissues in your body - that's what it means to be "alive" instead of dead. There is a huge amount of ignorant fear-driven mythology about TRT in the medical field and now all over the internet, which is really disastrous considering how many men need TRT now to have a reasonable quality of life and to live past 60. I encourage everyone to ask all the questions you can and find answers that make the most sense and are the most supported by available science. Also, be prepared to change your understanding when new/better information becomes available. Don't ever believe in your own beliefs too strongly.

If it's possible for an animal testicle to change size 300-fold or more due to hormonal changes (that's what regulates "mating seasons" internally, it isn't the moon and the stars doing that), then it likely extrapolates to other animals. If you can find any actual study that shows loss of function long term I'd love to see it. The Chinese have done more than one study looking at using TRT for contraception in men (go to Pubmed and search "testosterone contraception Chinese" and you'll find multiple articles). They had more than 1000 men enrolled, used testosterone undecanoate I think at only 500mg every 12 weeks or something, and even that small amount turned off sperm production completely for around 95% of men. They continued for 5-7 years depending on the study you read and those men all got their sperm production back (may have reported just 98-99% of men resuming sperm production actually - and I expect those 2% were probably going to lose it anyway because it's such a small percentage you can't logically attribute that to the TRT). Show me anything that says otherwise if you can find it.

Thank you for that video - it feels a lot like chemical-company funded propaganda. That industry is trying to convince people that their chemicals don't contribute to the horrible downward trend in our health since they cranked up the chemical revolution. Your bathroom scales may have a 5-10% variance, but medical equipment has stringent standards and no matter what type of test you run it would have to be compared to some standard and have a very small variance. The different lab processes still report the same units (ng/dL for Total T in the U.S., but other countries tend to use nmol/L). A nanogram and a milliliter should be the exact same at every lab. The reference range for LabCorp (16-25 age range at least) when I started prescribing around 2005 was 347-1197ng/dL. Jump 20 years later to 2025 and their range for that age group is now around 175-750 (I think it's 174-740, but didn't feel like checking). That the same lab using the same data (Generation III Framingham cohort data) over those 20 years. The average level for young men in that age range has fallen from around 750 to around 400. None of his discussion addresses how dramatic that is. It's true testosterone wasn't accurately and broadly measured until around 1975, so we have no data prior to that. I haven't asserted that the decline began in the 1950's as if it were a fact, I suggest that is the likely decade we would have seen the decline based on how the chemical industry really boomed leading up to WWII and since then. The Massachusetts Male Aging Study began in 1983 I believe and demonstrates this consistent trend into the 2010's and may still be going. The other reason I suspect this began in the 1950's is that you will now commonly see men around age 80 having total testosterone levels in the 800-900ng/dL range while men age 16-25 are running levels half that. LabCorp posted age-bracketed reference ranges they intend to start using this year; for males age 16-17 it's 145-749, staying pretty similar into the 30's, gradually declining into the 60-70 range, but then for 80-90yo men it jumps to the 800-900 range at the upper limit.