Over the past few years, testosterone replacement therapy has gained a lot of popularity partly because of media and marketing, but partly because it can produce real results and life-changing results for guys who have testosterone deficiency. So, let’s look at the big picture first. After age around 35, men’s testosterone levels naturally decrease by about 1% every year, and that means that when you’re in your 60s, you might have 25 to 35% less testosterone.
For some guys, this leads to a lot of problems, it leads to feelings of low energy, no sexual drive, even depression or inability to build muscle and lose fat. These are things that are real symptoms of testosterone deficiency in men. But our bodies naturally decrease in testosterone. What also happens is when we put on the whole layer of our modern stressors, meaning we’re living in stressful environments, we’re not sleeping enough, and there’s also a lot of estrogens in our environment from plastics and things that are in our water supply. Men’s testosterone levels are being bombarded.
There’s a lot of guys turning to TRT as an option to feel better, and when some guys take it, they feel substantially better. What is testosterone replacement therapy? Well, quite frankly, it is administering external testosterone in a variety of different forms.
Under normal circumstances, our brain communicates with our testicles to produce testosterone levels, and normal men’s testosterone levels are anywhere from 280, which is on the baseline of the low range nanograms per deciliter, up to around 1000. When we’re teenagers, we’re on the higher end of the range, slowly decreasing over time. There are a lot of reasons why your testosterone could be in the low range.
It’s taking external testosterone through either injection, pill, cream, or an implantable pellet that actually gives your body testosterone. What happens is that testosterone binds to the androgen receptors on your cells and does all the things that normal testosterone would do. As a result, your body stops producing its own testosterone for the most part. When we take it externally, it provides a feedback loop in the body, and the body stops making testosterone.
There’s not too much of a difference between an anabolic steroid that a bodybuilder may use and the stuff you would get in testosterone therapy. In fact, a lot of bodybuilders use the exact same thing that you might get – injectable testosterone. Bodybuilders used the same drug, but it’s the dose that changes the difference. Normal testosterone replacement therapy dose may be anywhere from 75 mg up to 150 mg on the very high end per week if we’re talking an injectable form.
A bodybuilder will take 5 to 10 times that amount, so need to know just to kind of clear that thing up. It’s really a question for your doctor and getting some real lab work. You should know where do you fall on the total testosterone picture. You can do with a simple blood test. You’d also know what your free testosterone is because a lot of guys don’t realize your total testosterone levels don’t give the whole picture. There’s something called sex hormone-binding globulin (SHBG) that binds up your testosterone and keeps it from acting on these nuclear testosterone receptors.
Free level, which is basically how much is bioactive, can be low in guys. You could have high total fine total testosterone, but a low level of free and TRT still could be indicated for you. That is why your doctor needs to really work with you on what’s your blood work and what are your symptoms and does it fit the picture.
It’s kind of like the Wild Wild West right now on testosterone levels that people are prescribing on. Some doctors are prescribing testosterone replacement therapy for guys at a range around 500. Others think that’s absolutely crazy, and you need to wait until you’re around 200-300 range.
It’s very dependent on your relationship with your doctor, what they think is medically safe based on your history. Go to your doctor if you’re interested in looking at going down this route and getting supervision for your particular circumstance.
We can’t just say: “Oh, you have testosterone levels of 400, it’s good for you to do TRT therapy” because there are other alternatives. There are some ways you can potentially increase your testosterone naturally that does not require going on TRT, which shuts down your internal production of it in the long-term. If you want TRT, it’s something that you’re sticking for. It’s not like you do it for a little bit, and you necessarily come off.
Let’s talk about the benefits.
Well, when you have more testosterone, and you’ve been deficient, you’re going to experience an overall greater sense of well-being in energy. A lot of guys who feel like they’re just lethargic and exhausted all the time and feeling kind of depressed, when they start TRT, they feel better, they feel youthful, they feel the vigor because testosterone acts on our brains too. What we also know is that testosterone deficiency is a risk factor for Alzheimer’s and cognitive decline, so you don’t want low testosterone levels. You don’t necessarily want super high levels either.
You might find that your muscle mass increases a little bit, you might find that it’s easier to recover from your workouts, and you lose fat a little bit better. But do know this: just taking testosterone replacement therapy without changing your diet, and your exercise is not going to turn you into Arnold Schwarzenegger. You need to have the whole plan in place, but it can augment your results on those things.
The most common form of TRT would either be a gel or injections. You can rub the gel on your skin, so it can deliver the testosterone transdermally. Other guys use injections, which we would say is honestly a better option because you can be a little more standardized with your dose. There are other methods too for guys who don’t want to have to get injected once a week or a month, depending on your doctor’s schedule. You might do something like a pellet where they can actually implant a little pellet into your hip that releases testosterone.
There are even some oral forms that are available. But with a lot of these oral forms of testosterone and derivatives of testosterone, you have to worry about the effect on your liver because that can be a little hard on your liver.
Let’s talk about medical risks.
Because as good as testosterone sounds like, wouldn’t we all want more vigor, muscle building, fat loss, a better sense of confidence and energy? There are legitimate risks because testosterone does certain things to the body. The first main thing we see with most people who start TRT is they do have a thickening of their blood. Testosterone causes your blood to be thicker, it causes your body to produce more red blood cells. It’s not causative, but it increases your risk for certain heart problems. You have thick blood pumping through those arteries and it increases your risk for potential things like strokes and blood clots.
Some people who are on TRT need to have this aspect managed to get regular blood work, and some people even take baby aspirin to thin the blood a little bit to make sure it doesn’t get too thick. Another risk that can happen is for some guys, especially with family histories of male pattern baldness, testosterone can convert to dihydrotestosterone. This can cause balding on the scalp in some particular areas. So some guys find that they lose their hair when they take testosterone.
That’s not something that necessarily comes back unless you do another different kind of therapy with stem cells or things to get your hair back. That’s why you see a lot of bald professional bodybuilders who abuse this for years. Also important to you consider that testosterone can increase the oil production of the glittering glands on your skin. So you can find that you have acne for the first time in 20-30 years if you start testosterone therapy.
Another thing worth considering is testosterone doesn’t just state testosterone. It converts to things like DHT and estrogen, so some guys find that they have growth of breast tissue under the nipples when taking testosterone. Things that can happen, and doctors often prescribe different adjunct medications with TRT to block some of these estrogen effects.
TRT is a big decision. If you’re going to go down this route, you’re going to be managing a lot of different variables. It’s just going to make things a lot more complicated. You should also understand that it does decrease your own natural testosterone production. If you do it long enough, it can be you can get kick-started again, but your levels can really really decrease. If you come off the testosterone, you are going to have lower levels.
If you are looking for some alternatives, there are certain things you can do in terms of vitamins, herbs, and minerals that may be able to increase your free testosterone levels. For example, stinging nettle is an herb that has some research showing that it increases free testosterone levels.
What can we do to naturally increase free testosterone levels? We can sleep more because cortisol in testosterone has a seesaw relationship. The cortisol goes up, and testosterone goes down. Along with spooning with sleep and reducing stress, we take some of these natural precursors that tend to support testosterone levels like vitamin D, DHEA, magnesium, etc. A good probiotic is also a really good idea as well and some creatine monohydrate. These things are research-proven to help support natural testosterone levels.
So, what is our overall take on this? TRT can absolutely be life-changing for you if it’s medically indicated. But before you start TRT, you should work with your doctor, see if it’s right for you.