Hot topic: Testosterone Replacement Therapy (TRT)
Intro to Testosterone Replacement Therapy (TRT)
Testosterone replacement therapy (TRT) has exploded in popularity the last several years, and for good reason. It's one of the most popular topics I get asked about as a fitness coach and fit dude who uses it himself.
Optimizing hormone levels is a game-changer for both your physical and mental health. It's well known that testosterone levels decline as you age, but more and more men of all ages are having their testosterone levels checked and coming back low.
What is Testosterone Replacement Therapy (TRT)?
It's long-term medication therapy for guys with low testosterone levels. It involves once or twice weekly intramuscular injections of RX testosterone. Yes, there are gels, pellets and pills - but the injectable version is the most widely available and optimal administration method.
Signs & Symptoms of Low T
- Reduced muscle mass and strength
- Increased body fat, especially in the abdominal area
- Low energy levels and fatigue
- Decreased libido and sexual dysfunction
- Difficulties with concentration and memory
- Mood disturbances, such as irritability or depression
- Insomnia or other sleep disturbances
- Reduced bone density, increasing fracture risk
Getting Started with TRT
Step one in the process is blood work. Set up an appointment with your primary care doctor and ask to have your hormone levels checked (specifically total & free testosterone, estrogen). Different labs may have slightly varying reference ranges, but the generally accepted "normal" range for total testosterone levels in males is 300-1000 (ng/dL).
If your total testosterone levels are outside of, or on the low end of the reference range, you'll likely benefit from this therapy. Many primary care doctors are still hesitant to prescribe testosterone to patients, even when their levels are low or "not optimal" for their age. Advocate for yourself. Explain to your doctor the ways you believe this is negatively affecting you and your overall health.
You may get lucky with a doctor that is willing to prescribe and manage your TRT protocol - this is best case scenario. It will often be covered by insurance and is convenient to have one doctor managing all of your care.
What Are The Other Options?
Even if your doctor says "no", you have options. You'll want to search for a local or online "mens clinic" or "TRT clinic" - find a place with good reviews and set up an appointment. I'd also consider talking with your friends to see if any of them have a specific recommendation.
$$ - How Much Does it Cost?
Again, best case scenario is your PCP prescribing you the testosterone - it'll cost a lot less and should be covered (at least in part) by insurance. At the specialty clinics you can expect to pay anywhere from $150-$400/month - which generally includes office visits, the prescription and blood work every few months.
How Does Testosterone Replacement Therapy Work?
Once you have a provider on board to manage your TRT, they'll likely prescribe you Testosterone Cypionate (200mg/ml). Most providers will start at a dose of 100-150mg/week, administered via intramuscular injection. They will require you to get repeat blood work every 3-6 months, and will adjust your dose accordingly.
Some clinics will require you to come into the office for weekly injections, others may prescribe it to administer yourself. The injections can be done in any major muscle group - glutes, quads & shoulders being the most common sites to use.
Are You On TRT For Life?
In most cases, yes - that's the idea. Once you start introducing exogenous testosterone into your body, it shuts down your natural production. This idea might sound intimidating, but once you have been on it a while, it just becomes part of your routine and you won't think much about it - especially as you experience the benefits it provides.
This doesn't mean that you absolutely CANNOT come off the medication. There are other pharmaceuticals that can be used to kick start your natural testosterone production if you were to come off. Even without these, your body will start producing testosterone again after a period of time.
The Awesome Benefits of TRT
Okay, so once you have confirmed with blood work that your levels are low and found a doctor to manage your TRT protocol - you'll probably be wondering what sort of benefits you can expect to experience:
- Increased muscle mass, strength & endurance
- Improved ability to reduce body fat
- Increased sexual performance and bone density
- Improved mood and reduced symptoms of depression and anxiety
- Boost in energy levels and improved overall vitality
- Enhanced cognitive functions such as memory and concentration
Healthy testosterone levels are vital for your body to function optimally - both physically and mentally.
Are There Any Side Effects?
TRT is widely considered to be safe for most guys; however, as with any medication - there are potential side effects. The most common include acne, worsening sleep apnea, changes in blood lipid & RBC levels, reduction in sperm count & fertility and mood changes - these are generally manageable and outweighed by the substantial benefits.
If you do experience negative side effects, they are often able to be mitigated by having your dose adjusted, additional medications and lifestyle changes. The doctor prescribing your protocol will help you navigate these scenarios if they arise.
Tips For Consistent Blood Work
Consistency with blood work is often overlooked - even by the doctors. Be sure that each time you get blood work completed, your previous injection time is consistent. (If you have blood drawn 72 hours after your previous injection - be sure to do the same every time going forward). This will ensure an accurate trend of your levels over time.
Self-Managed TRT
Let me start off by saying that I do not encourage or condone using testosterone outside of being managed by a reputable doctor or healthcare provider. However, I know that there are a growing number of guys that are doing this, so it felt necessary to offer some guidance.
If this applies to you, be smart about it. DO YOUR RESEARCH! 150-200mg/week - split between twice weekly injections is all you need. Order blood work every 3-6 months (Hormone Panel with Estradiol Ultrasensitive, Testosterone LC/MS-MS and Lipid )
It's also a good idea to donate blood every several months to avoid high red blood cell & hematocrit levels. If you are relatively lean, you may opt for using 29g 1/2" needles for IM injections.
This is for educational purposes ONLY. Again, I do not encourage or condone undergoing testosterone replacement therapy outside of the supervision of a reputable doctor/healthcare provider. I'm just a guy who gets asked about this often and recognizes the need for information to guide proper management for whom it applies.
Additional Resources To Educate Yourself
The Complete Guide to TRT for Men
AUA Testosterone Deficiency Guideline
Endocrine Society Clinical Practice Guidelines on Testosterone Therapy
Concluding Thoughts on TRT
Stable, optimized hormone levels will provide a significant boost in your physical and mental performance if your levels are low. Even if you're not experiencing any of the signs & symptoms of low T - I'd encourage you to have your hormone levels checked at least once per year (in addition to standard health marker blood work).
I know this was a lot of information packed into one email, so thanks for reading through. I hope you found it insightful! If you have questions, are interested in fitness coaching or want to suggest a topic for future emails - contact info is down below.