What is testosterone replacement therapy (TRT)? What are the symptoms of low testosterone? Do I have “low t.” How do I find a doctor to put me on testosterone replacement therapy? What are the downsides or side effects of TRT? Is TRT dangerous? How do I know if I have low testosterone? (Also, check out our TRT podcast, where we answer questions that were posted in the comments. Chances are that any question you have has already been answered in the podcast)
[This is not medical advice. Always seek the advice and assistance of a qualified healthcare provider.]
Quick summary for the attention-deprived: A proper TRT dose should be approximately 125 mg of testosterone injected weekly, although 100 mg every 5 days is ideal. Blood levels on a proper TRT dose should put the patient on the high side of the normal range of natural testosterone levels. People have used TRT doses as high as 200 mg a week (supra-physiological levels) for several decades without experiencing any negative side effects. Your hair won’t fall out unless you’re genetically predisposed to hair loss. Yes, your body will stop producing its own testosterone. That’s why you shouldn’t use testosterone replacement therapy unless your natural levels are low and need replaced - get it?
Although we supposedly live in an era where God is dead and science lives, most remain ignorant about the single most important hormone in the body. If Aristotle were around, he would call this hormone the sine qua non of masculinity. Without this drug, you are not a man. Indeed, women who want to “become” men inject this drug.
We are talking, of course, about testosterone.
Let’s get one thing out of the way. Testosterone boosters do not work. If testosterone boosters worked then the very people peddling them would not be on TRT. Test boosters are a scam that many (including myself) have fallen for. Consider it a rite of passage.
TRT is for big boys who can make big boy decisions – not for little kids looking to take a pill that will have magical effects.
Although I have been preaching the benefits of testosterone for almost 20 years, only recently has this hormone penetrated popular consciousness. You now see commercials warning men of low T.
There is one problem. One huge problem.
Chances are that you doctor does not know anything about testosterone. If you have any interest in getting on TRT, you have to educate yourself to avoid these common mistakes:
- Inadequate doses of testosterone are prescribed – usually 100 mg every two weeks.
- Injections are spaced too far apart. Idiot doctors often tell patients to inject every 2 weeks. This shows a gross incompetence and ignorance of a basic principle of pharmacology – namely half-life and peak blood levels.
- Large needles are given to patents. These needles create massive amounts of scar tissue in the muscle fibers.
What does “testosterone level” even mean?
Testosterone level refers to a scientific measurement. After blood is drawn from your arm, your blood is sent to a lab where it’s spun around in a machine until the testosterone floating around is measurable.
Check out Blood Work and TRT to learn how to get your testosterone level measured.
Although the scales vary, testosterone levels are generally in a range of around 225 to 1100 - that’s nano grams of testosterone per deciliters of blood. The scale varies and as you see the range is wide.
(Aside: A lot of people try needing out and talk about the difference between free and total testosterone. Total testosterone is all of the testosterone in your body and free testosterone is the test available for your body to use. But. I’ve yet to learn of a person who had low total testosterone and also had high free testosterone, or a man or has had high total testosterone but low free testosterone.)
Now think about that scale for a minute and see if you can identify two fundamental problems.
What’s the problem with the scale used to evaluate low testosterone levels in men?
One, the scale isn’t age adjusted. Hence you could be 30 years old with testosterone levels of 300. That’s normal – for a 70 year old man. But isn’t a 30 year old with the levels of a 70 year old man running on empty?
Two, the scale is based on percentiles. Let’s say 225 ng/dl is the bottom 10th percentile and 1100 mg/dl is the top 10th percentile. At the 11th percentile, you’re normal. But that’s still significantly lower than what is nevertheless physiologically normal and attainable in 89% of other men. So aren’t you low even if you’re within range? Who wants to be a bottom of the barrel man?
Many doctors will refuse to prescribe their patients testosterone if they fall within range, i.e., if you’re 25 and have the test levels of an octogenarian, you’re perfectly healthy! Really!
How do I find out if I have low testosterone?
Get blood work done. Ask your doctor to get your labs done. You can also get labs done yourself. See, Blood Work and TRT.
Your total cost should be $52 or so. Your lab work will give you your free and total testosterone levels, your estrogen levels, and some other stuff that I’m not going to get into.
Who is on TRT?
Vitor Belfort, Randy Couture, Joe Rogan, Dan Henderson, Frank Mir, and Chael Sonnen are admitted TRT users. Even the guy who sells Bulletproof Coffee and other overpriced nonsense is on TRT. (Typical supplement salesperson: He sells one thing but gets his results from something altogether different.)
Pretty much every Hollywood actor and in fact any man who makes his living using his body is on TRT, although they can’t admit it because Midwestern sheep would be appalled to learn that people who get paid millions of dollars based on how they look and perform actually use drugs to improve their looks and performance.
Basically, everyone over 35 or 40 who is not a chump is on TRT. (Obviously everyone is overstating things. But past a certain age a man needs to keep an eye on his test levels. They do start declining and eventually tip you into “low T” territory.)
How do I get on TRT?
See a doctor who knows what he is doing. This eliminates 90% of physicians.
Even endocrinologists are pretty silly. A good friend of mine kept getting tested for brain tumors and shit. I laughed, told him he needed test, and his endo took weeks to get him on the right stuff.
If you’re going to go the prescription route (your only option if you live in the United States), go to an anti-aging clinic.
Doctors at anti-aging clinics actually know what they are doing. The downside is that anti-aging clinics charge a yearly fee that is formidable for some (usually around $500 or so a year).
You pay the fee, get a consultation and lab work done, and then get proper testosterone treatment.
If you have cash, just avoid the hassle of dealing with doctors. Go to an anti-aging clinic and pay out of pocket.
If you’re short on cash, go nag your doctor. Or if you live in a civilized country where testosterone is sold over the count, be your own doctor.
Is TRT life changing?
Yes, just like the world is measured in BCE or BC, your life will be measured in Pre-TRT and Post-TRT. If you have already or ultimately get on TRT because of my writings, you should send me a major token of gratitude. I’m not even joking.
How much does it cost?
Costco is selling 10 ml vials of testosterone cypionate for around $75.
A vial of test cyp is going to have 200 mg of testosterone per ml/cc of product. At normal TRT doses, that’s 20 injections. (It’ll actually be closer to 18 or 19, as you lose a little bit of test that gets stuck in the syringe after each injection.)
A doctor’s visit is usually covered by insurance. Anti-aging clinics charge a membership fee ($400 or so per year).
Needles and other supplies are dirt cheap.
All in, TRT is going to cost $50-100 or so a month. It’ll cost more if you go to an anti-aging clinic and pay out of pocket. It will cost less if you go to a doctor and are covered by insurance.
What’s the best way to administer TRT? How much testosterone, how often, and what needles?
Blood levels of testosterone spike after a day or so and level off until declining after 7 days. To prevent highs-and-lows, it’s best to take an injection every 5-7 days. Many doctors will tell you otherwise.
When your doctor says something stupid, push back. Say, “When are peak levels of testosterone obtained? When do those values decline? My research suggests that after 7 days, testosterone levels fall off of a cliff. What does your research show.”
Smaller needles lead to less scar tissue buildup. A 25 gauge (refers to needle thickness; a larger gauge is a thinner needle and a smaller gauge is a thicker needle) needle works just fine. If injecting into the delt, a 5/8″ needle is long enough. If going into the glute, a longer needle is required. But not a thicker needle.
Will my balls shrink?
Testicular volume will generally decrease by around 25%. There are substances you can take to prevent this (HCG), but in truth you will find that the “ball shrink question” is a young man’s stupid question.
Past a certain point, gravity is going to take its toll on your scrotum. Those big balls that I was once so proud of started hanging down in an unaesthetic manner. They started getting in the way of riding a spin bike and they just flopped around during sex.
Smaller balls are more manageable.
Will I go bald?
From a TRT dose, you shouldn’t lose more hair than you’re already losing. (Even if you have a magnificent mane, you’re going to lose 50-100 hairs a day.)
Is TRT cheating?
Whose rules are you following? If you want to be a slave, follow society’s rules. Go home and drink some brewskis and watch the game while father time takes a dump all over your head.
Is TRT steroids?
No, the difference between TRT and anabolic steroids, to borrow from Mark Twain, is the difference between the lightning bug and the lightning.
Even if I say yes, why care? Are you one of those people who gets wrapped up with labels. “Oh, I can’t do steroids. The media says that’s immoral and dangerous.” If so, kindly find another site to read; this isn’t the place for you.
Isn’t TRT just fake masculinity?
That question doesn’t make much sense. Are diabetics who inject insulin taking fake glucose disposal agents? If it works, there’s nothing fake about it.
Can’t I just raise my testosterone levels naturally?
Sure. Take that Vitamin D and eat those almonds and pop zinc tablets and do those heavy squats. Maybe it will work. Good luck.
Won’t I have to be on TRT for life?
Yes and no. Yes, that’s why you shouldn’t go on TRT unless you need to. A blood test costs $52. Don’t cheap out on your health.
No, you can go off of test, run some HCG and HMG, and your body’s crappy natural levels of testosterone will return to the low levels that they were.
Does TRT make me sterile?
Many men have made the mistake of believing the hype. Those men are called fathers.
Even in the rare occasion with exogenous testosterone makes you sterile, there’s a simple solution. Go off, take some HCG or HMG, and have babies.
I’ll be happy to answer theoretical questions. However, remember these important points:
- This is not medical advice. Seek out a qualified healthcare practitioner to get medical advice.
- Specific questions about your situation will not be answered by me. Answering such questions would be illegal and unethical.
Take care. And remember, if you went on TRT because of me, email me and I’ll tell you where to send the check.
Learn more: Blood Work and TRT: What is my Testosterone Level?