trt the definitive guide to testosterone replacement therapy

Testosterone Replacement Therapy Is On The Rise!

Low testosterone in men over 50 is not a new thing really. Research shows that testosterone levels in men generally drops about 1%-2% per year after the age of 35. However, more and more men that are around 30 or even younger have been experiencing low t symptoms at a much higher rate. This has men running to their doctors and clinics seeking testosterone replacement therapy, better known as TRT. Low T is not just for older men anymore, could you be affected? Quite possibly! We will be going over in depth what testosterone is, the symptoms and having low testosterone and what you can do about it.

testosterone in men on the decline

Testosterone or TRT therapy drugs are being prescribed 5x more than in the past based on current studies. Testosterone levels are on the decline across men of all ages in the United States which has caused more men than ever to seek out advice from their doctors.

My TRT Experience

myfitclient adamI have been on TRT for roughly a year now. My first test levels came back just slightly over 300 and a few months later my total testosterone was at 187 and I was feeling many of the symptoms. My doctor first started me on Androgel but it wasn’t helping at all. I later learned that testosterone gels are not a very effective treatment option. My doctor then placed me on injections which I do each week at home. Now my low testosterone symptoms are actually getting better.

I’m writing this guide to help others who are suffering from symptoms of low testosterone and don’t know much about it and what to expect. If I can answer any questions please feel free to drop a comment down below.

What Is Testosterone?

Simply put, testosterone is the main male hormone. It is what helps to develop those manly muscles and your deeper voice. Women also have testosterone, in small amounts that is. In women, testosterone can help with bone density and strength. If women have too much of it though, it can lead to some nasty side effects. Want your lady to have a beard or get male pattern baldness? Probably not I’m guessing.

Testosterone is produced mainly in the testicles, which makes sense right? Men have testicles and both words start with test… ha ha. Anyways, once testosterone is produced in your body, your brain and pituitary gland help send it along throughout your body to handle all of its important jobs.

Why Is Testosterone Important?

testosterone replacement therapy low testosterone symptomsTestosterone is important for many reasons, it is involved in many bodily functions. When you’re growing up as a young boy it’s important for the deepening of your voice, the growth of your male parts, body composition and even your height. As you get older testosterone impacts your sex drive, erections, energy levels, mental function, red blood cell counts and much more. In addition to these things, testosterone can also impact your mood. Having low testosterone is no joke, especially in your 20’s, 30’s and 40’s. You don’t expect to be dealing with these types of issues when you’re practically still young or middle-aged.

As I stated before, women also have testosterone. It plays a role in their bone density, mood and sex drive or libido. On the other hand, when women have too much it can cause problems. As stated earlier, male pattern baldness, enlarged female parts, facial hair growth and a deeper voice.

Low Testosterone Symptoms

Think you might have low t? It’s possible if you have any of these symptoms listed here. Probably a good idea to get your levels checked as well which we will talk about in the next section.

  • Decreased Sex Drive (Low Libido) – No or little interest in sex?
  • Decreased Energy – Are you have to take a lot of naps?
  • Brain Fog – Having trouble with think clearly or memory issues?
  • Erection Issues – Missing those morning erections or problems elsewhere?
  • Difficulty Losing Weight – On a diet and not seeing results?
  • Trouble Gaining Muscle – Hitting the gym consistently and not seeing any results?
  • Enlarged Breasts – Are you getting the dreaded man boobs and not really overweight? Maybe your chest or nipples are sensitive?
  • Weight Gain – Holding a lot of water or seeing unexplained weight gain?
  • Mood Changes – Are you up and down with your mood often? Overly sensitive?

These are just some of the most common symptoms you may see with low testosterone levels if you’re a man. Some of these can be natural as you age and become expected in some cases in older men. Still worth discussing with your doctor and getting your levels checked.

NOTE: It’s important to note here that TRT is not necessarily a cure. Typically low testosterone is caused by some underlying factor such as estrogen being too high, issues with the pituitary gland, tumors and more. Some doctors will take the time to find the underlying cause instead of just jumping straight to TRT.

What Causes Low Testosterone?

There are many possible causes for your low testosterone. Some you’re born with or develop over time and some are due to injury, illness or something like your pituitary gland not working properly. 

It also could be due to aging, testosterone in men declines naturally as we age. It can impact some men sooner than others though.

  • High Body Fat
  • Natural Decrease Due To Aging
  • Certain Medications Such as Prescription Pain Medications
  • Undescended Testicles
  • Too Much Iron In Your Blood
  • Injury To The Testicles
  • Some Cancer Treatments Like Chemo/Radiation
  • Pituitary Gland Issues
  • Inflammatory Issues Like Tuberculosis, Sarcoidosis, etc.
  • HIV/AIDS

How To Check Testosterone Levels

Ok, so you think you might have low T but how do you find out for sure? One option and the most common would be to talk to your doctor and get a blood test done. You can visit your normal family care doctor for this type of test. Another option would be an endocrinologist or anti-aging and wellness clinics. There are also some home testing options that you can explore as well if you want more privacy or don’t have insurance. Testosterone test that you can take at home or by visiting a lab yourself through one of these services can be preferred by some just due to privacy alone. Cost wise though, if you have insurance then going through your doctor is going to be your best option.

Related  5 Ways to Increase Testosterone Naturally

In addition to testing testosterone blood levels, I would also suggest checking estradiol levels once you’ve been on TRT. TRT can cause a rise in estrogen shown through the E2 or estradiol levels. If these get too high or too low it can create additional problems. Discuss testing this with your doctor or order the test online yourself.

Testing Options

Based on the results of your lab test and your specific scenario your doctor may recommend diet changes or write you a prescription for testosterone. We will talk about the different T prescriptions later. The bottom end of the scale is typically around 300 ng/dl and the high end being around 1000. If your levels are below 300 then some changes are in order, either with your diet or you need to address the low T through a prescription.

Most doctors will write a prescription when patients are below 300 but some may not. If you’re having trouble with your primary care doctor, you may try seeking the advice of a male hormone specialist or even an anti-aging or wellness clinic.

Other Lab Tests You May Need

These tests can be completed by your doctor or using one of the options listed above.

  • SHBG – Sex Hormone Binding Globulin
  • E2 or Estradiol – Sensitive or Ultra Sensitive is Recommended
  • Basic Blood Work Including Hematocrit, Red Blood Cell Count and others.
  • Thyroid PSH Test – This ensures proper thyroid function that could be causing low testosterone issues.

How Can Testosterone Be Increased Naturally?

I mentioned diet changes in the previous section because there are some things in our diet that can have an impact on male hormone production. You can actually increase and decrease your bodies natural testosterone production through diet. Listed below you will find foods that boost testosterone naturally and some foods that can do the opposite as well.

If you’d like to read more about foods that can boost your testosterone and foods that can kill your testosterone levels then check out the following two articles we’ve posted previously.

5 Ways to Increase Testosterone Naturally

5 Foods That Kill Testosterone

Boost Testosterone Naturally

  • Get More Zinc – Take a Daily Men’s Vitamin
  • Add More Magnesium
  • Get Proper Sleep (7-8 hours generally)
  • Workout – If you’re not already workout out, now is a good time to start
  • Get More Vitamin D – Get out in the sun more or take a Vitamin D3 Supplement
  • Boron – Supplementing with 3-10mg of Boron daily has been shown to increase testosterone levels

Avoid These to Protect Your T Levels

  • Soy Products
  • Alcohol
  • Processed Foods – Say no to fast food and microwave meals

Testosterone Replacement Therapy Options

testosterone injection cost side effectsSo you’ve found out that you have low T, so what are your options for TRT? As I said before, your doctor may write you a prescription and if diet wasn’t your problem then that’s probably the route you’re going to go.

  • Injections – Testosterone injections are very common and most effective. Many times these are also the lowest cost option as well. These injections can be done in the doctor’s office or at home depending on your doctor. T injections are done in the hip/butt, deltoid or thigh. Personally, I do my TRT injections in my thigh because it tends to be easier for me.
  • Topical Gels – The gel or lotion form of testosterone tends to be fairly common but you only absorb around 10% so T gels are not very effective most of the time. They can also be costly without insurance.
  • Pellets – Not many doctors do this but they can implant multiple pellets, usually into your butt which will break down over time releasing testosterone into your body.
  • Pills – In March the FDA gave approval for Jatenzo, a testosterone replacement pill. Jatenzo is suggested for men with certain types of hypogonadism. Read more about Jatenzo.
  • Thyroid Treatment – In some cases, you could have a thyroid issue that is causing your low testosterone. If you do, you may not need TRT at all.

SHBG and Testosterone

SHBG, also know as sex hormone binding globulin is a protein that attaches with testosterone in your body. If you have high amounts of SHBG in your body, it could be that your body is producing adequate testosterone, but too much is getting attached to the SHBG proteins. This can cause your total testosterone to appear normal or within range, but your available testosterone will be low or out of range.
This can be verified by doing a Total T test along with a Free or Available T test as well. If you have normal total T but low free T, the symptoms of low testosterone, in general, may be impacting you. You should discuss this with your doctor.

What If My Doctor Will Not Prescribe TRT?

This is fairly common it seems, especially with primary care doctors. Either your doctor says your levels are normal even though you have many symptoms of low testosterone. Or you do have low levels but they are not educated on hormone replacement.

At this point, I would suggest finding a good endocrinologist, or look up compounding pharmacies in your area and ask them for a referral to a doctor that prescribes testosterone.

I have seen many people have better luck with younger doctors, as they have received more recent training and tend to be open to TRT more so than older doctors.

As a last resort, you can look at TRT, anti-aging or wellness clinics. These tend to be expensive as they do everything in house including the prescriptions. Many of these may not take insurance so it will be left up to you to fight with the insurance company to cover any treatment or medications.

Common Testosterone Dosage

Your next question may be what is the typical dosage for TRT? I’m going to give you some answers based on my own personal journey with testosterone replacement therapy and based on the research I’ve done personally.

NOTE: More importantly than just treating a number, you and your doctor should be more concerned with treating the symptoms, underlying issues and any side effects that come up during treatment. Simply getting you above 300 is usually not going to make you feel better. The needed T level in each man’s body varies in order to help them feel normal and balanced. If your doctor is simply giving you testosterone and not following up on the symptoms, side effects and monitoring your other blood work… find another doctor who knows what they’re doing.

  • TRT Injection Dosage – Typically are starting dose could be 50mg per week, done 2 times per week, weekly, bi-weekly or monthly. If your doctor will allow it, do the injections 2 times per week or weekly to avoid peaks and valleys. Many patients on TRT work up to around 100mg to 150mg per week. No bodybuilder testosterone dosages here, you would need 500mg or more per week to catch up with them.
  • TRT Topical Gel Dosage – This will be highly dependent on the type of gel but from my experience, you would be prescribed 1 to 4 pumps per day.
  • TRT Pellets – I don’t have any personal experience with testosterone pellets but based on my research they will implant multiple pellets which will last for around 6 months.
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More About Testosterone Injection Dosage:

  • Every 3-4 days or 2 times per week at least is preferred to keep levels balanced at all times. *Preferred Dosage Schedule*
  • 1 time per week is what some doctors will tell you. While this is better than every two weeks it’s still not preferred due to peaks and valleys.
  • Once every two weeks, you’re going to experience peaks and valleys for sure. The half-life of most medications for TRT is around 8 days. By the time you reach your next injection, your levels will be pretty low and you will feel like garbage.
  • One per month some doctors will prescribe. This is a sign that your doctor is not very experienced with TRT and you should educate them or find a new doctor.

What Are The Common TRT Medicines?

The common medicines that you’re going to see on your TRT journey are the following.

  • Injections – Testosterone Cypionate or Enanthate. These have a half-life of around 8-10 days based on research. This is why twice a week or weekly injections are suggested. If your injections are more than 1 week apart then your T levels are going to drop big time before your next injection.
  • Topical Gels – Androgel, Testim and Fortesta are some of the more common ones. I was prescribed Androgel for about 6 months but these do not absorb well so results may vary. I did not see good results for my low T symptoms while using it.

Beware of Gels – The testosterone gels are a real pain. You need to shower before applying and then let it dry. Throughout the day you need to be careful who you come into contact with as the testosterone can rub off and cause unwanted effects on other people.

What’s The Cost Of TRT?

We have a complete write up on the cost of TRT but we’ll give you a basic run down here.

  • Injections – This is probably going to be your cheapest option with or without insurance. Could be as cheap as $15 per month
  • Gels – Can be quite expensive (around $600 in some cases) without insurance. If you have insurance and it’s covered then your copay will likely cover the cost.
  • Pellets – No real data from experience here. However some report over $1,000 but it’s not clear if that was after insurance or not.

A quick note about anti-aging and wellness clinics. These clinics typically won’t take insurance at all so your cost can vary. Many of these can be $200-$500 per month for treatment.

How Long Do I Need To Be On TRT?

In general, you will be on TRT for the remainder of your life. Your body will lower the amount of testosterone that it produces naturally, so when you stop taking it your levels will plummet. 
In some cases, your doctor may be able to identify the root cause of your low testosterone and by resolving that issue you could stop taking it.

What Are The Side Effects Of Testosterone Replacement Therapy?

Are there side effects to TRT? It’s quite possible you could see some side effects from taking testosterone. However, these side effects are typically only seen at higher dosages and on a low TRT dose, you may not see any at all. Your doctor may prescribe other medicines to help combat these side effects like an aromatase inhibitor.

TRT Side Effects

  • Increased Estrogen also know as E2 or Estradiol – Can be managed with proper dosage schedule(more often), a lower dosage or in worst case an aromatase inhibitor
  • Hematocrit or Red Blood Cell Count Increases – Possible to manage with blood donation but research is not clear that this works in all cases. [1]
  • Acne
  • Enlarged Breasts – Also known as Gynecomastia or Gyno for short
  • Breathing Issues – Could make sleep apnea worse
  • Enlarged Prostate
  • Oily Skin
  • Dull Pain in Testicles
  • Increased Risk for Stroke and Cardiovascular Disease (Mixed Data from Research)

Life After Starting TRT

Once you’ve started on TRT you need to understand that for many men this is a life long commitment. You will likely take some form of hormone replacement like testosterone for many years. Unless you were lucky enough to have a doctor who could find the underlying cause of your low T.

You will start to feel the difference usually after about 5-6 weeks of consistent treatment. Energy levels and libido will begin to improve during this time. If not then you may need to discuss with your doctor changing the dosage.

While you’re on TRT you should take advantage of the anabolic effects and start hitting the gym. Not just because the muscle gains will come easier than they did before you were on TRT but because it’s another tool you can use to make you feel more energized and manly. Plus for general health working out is a great idea!

Check out these recent articles before starting your journey in the gym

#1 Best Workout Routine for Men

Top 5 Best Muscle Building Diet Tips

Take this knowledge combined with your increased testosterone levels and go build some rock hard muscle.

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About

Hi, I’m Adam!

I started my fitness journey in 2015 and haven’t looked back. I was about 30 pounds overweight, fat, lazy and not motivated. Via a series of unfortunate life events and feeling like I was lacking structure in my life, I decided to join my local gym. I dove head first into researching workouts, what worked and what didn’t along with supplements and anything else fitness related. I’ve never felt better!

Along my journey I also found out that I have low testosterone, that of an 80 year old man. 

With all of the fitness and and TRT research I’ve done, I figured it would be a great idea to start a blog and share that knowledge. Don’t hesistate to leave feedback or reach out with any question you may have via my Contact Me page.