Hormones

Testosterone Replacement Therapy: Beyond Natural

In our last post, we discussed ways in which you could naturally raise your testosterone through a combination of diet, exercise, and abstaining from products that could contain phytoestrogens, those nasty endocrine disruptors.

However, there are many men whose test levels are far too low to benefit from the natural methods discussed, and will need an exogenous (outside the body) form of testosterone therapy. 

In today’s post, we’ll examine some of the options currently available to men in the United States, their pros and cons, and discuss the risks associated with being on TRT (Testosterone Replacement Therapy). Hopefully, by the end of this post you’ll have a better idea of what therapy best suits you.

On one hand, you have a guy in his mid 20s who's over- stressed to the point that he begins producing less testosterone. He gets on therapy for a year, then gets off, and is fine.

On the other hand, you can have someone who, since birth, has exhibited below- normal levels, with early development of gynecomastia (male breast tissue), and may need a combination of a higher test dose and some type of estrogen blocker.

So how low is too low for natural methods? When does TRT become the only option? According to the guideline set by The Endocrine Society, someone whose levels are below 300 ng/dL should consider TRT. However, there are cases where someone will be above 300 but still have symptoms of testosterone deficiency.

A testosterone level not below 300 ng/dL will most often leave physicians encouraging natural methods first (change in diet, exercise, sleep habits, etc.) for a period of 6-8 months before re-evaluating the patient. If in that time there is no improvement in mood, libido, or other symptoms associated with low testosterone, then they will be put on some form of therapy.

If you’re confused by all this and don’t know where to begin, I’ve attached a guide you can follow at the end of this post, along with a brief explanation of the various TRT treatments, their pros/cons, and price.

Everyone is different, so it's difficult to say where your “sweet spot” testosterone number may lie, as different people will experience results at various levels. Specifically, when dealing with younger men whose levels are in the range of hypogonadism (testosterone deficiency), a combination of factors will need to be examined to determine how successful the therapy is.

Examples could be how much better a person on TRT feels emotionally, whether not his mood has improved, or if he has noticed an increase in libido. The amount of testosterone required for this may be less than, say, more physical improvements like bone density and muscular development.

Types of Testosterone Replacement Therapy

A dozen or so are implanted into the body.

PELLETS

Small crystalline testosterone pellets slightly larger a grain of rice are implanted in the body where they slowly dissolve, releasing a specific amount of testosterone over a period of 3-6 months depending on what the doctor recommends. Normally you’ll be given 10 to 12 pellets in order to last the entire duration of the therapy.  

PROS

Many of the options currently available require you to religiously apply every day at a specific time, such as injections, patches, or topical creams. Pellets, on the other hand, are already inside your body, requiring no maintenance on your part. You get to “set it and forget it”.  

CONS

You’ll be required to undergo a small procedure where a physician will make small incisions into the skin to implant the dozen or so pellets. There’s also the risk of the body rejecting the pellets, resulting in “extrusion” or pushing them out of the body, similar to someone who receives a body piercing only for the body push it back out. Also, if the dosage needs to be adjusted, that’s going to require cutting back into the site to add or remove pellets, ouch.

SIDE EFFECTS

Most commonly associated with this therapy:

  • Nausea
  • Ankle Swelling
  • Rejection by body (extrusion)

PRICE

For a set of 10 pellets, the non-insurance price is $930 or $93 per pellet. Given that a doctor might prescribe a dozen, the grand total could run you over $1000.  

Applied on the body daily.

GELS

Gels are more of a topical approach to applying testosterone. Brands like AndroGel will have you apply it to your shoulders, while other brands like Axiron have you apply under the arm like a deodorant stick. Dosage level is around 5-10g and you’re going to be applying this every day at the exact same time to maintain consistency.

PROS

Compared to pellets or injections, topical testosterone doesn’t involve any needles or surgical implanting by a skilled physician. You’re applying it yourself as you would deodorant or lotion depending on the brand you use. You’re also not running the risk of liver damage like you would with other methods.

CONS

One notorious issue with topical gels is the risk of exposing others to the hormones. Once administered, doctors advise to avoid coming in contact with anyone for the next 4 hours. Someone who does this first thing in the morning wouldn’t be able to hug his children before school or share the same bed with his wife if done at night.

SIDE EFFECTS

Most commonly associated with this therapy:

  • Headaches
  • Dry skin
  • Muscle pain/weakness
  • Decrease in libido

It may increase your risk for prostate cancer, depending on your risk your doctor may have you use a different therapy.

PRICE

The cost tends to be $225 for 150 grams of the AndroGel brand if paying out of pocket. The price can vary depending on which pharmacy you visit and how much they have available in stock.

PATCHES

Patches are more or less what they sound like, you place it on your thigh, abdomen, or upper arm at night before bed. You’re going to leave it on for 24 hours, then replace with a new one on a different part of the body. You’ll want to wait at least 7 days before placing the patch on the same part of the body. Once it’s on, you’ll need to wait 3 hours before getting it wet. (shower, swimming, etc)

PROS

Compared to gels, there’s no “4-hour no-contact” rule. ANDRODERM’s brand claims you can even have sex with it on, as the testosterone is contained directly under the patch while it’s on.

CONS

People have reported breaking out in rashes in and around the area of the patch. If your skin tends to be on the sensitive side like mine is, this might be a problem whenever you use different lotions or soaps. Another problem is if it does get wet, you can receive higher amounts of testosterone, resulting in inconsistent dosages throughout the day.  

SIDE EFFECTS

Most commonly associated with this therapy:

  • Rashes on/near patch site
  • Gum or mouth irritation

PRICE

For a 2-month (60 day) supply of the patches or “films”, the non-insurance price $544.

testosterone injections

INJECTIONS

Last but not least you have injections of testosterone or “intramuscular shots”. These are one of the more familiar and preferred methods of testosterone therapy by endocrinologists, as they can more easily control the dosage and administer the injections themselves. The dosage ranges from 75-100mg injections of testosterone enanthate or cypionate on a weekly basis or 150-200mg every 2 weeks.

PROS

Very easy to control dosage, you get a consistent amount of testosterone and avoid accidentally receiving too much (wet patches) or too little (gels/pellets). Injections are also generally seen as superior to the above-mentioned treatments; you’re absorbing more testosterone than any other method, but the biggest selling point in my opinion is that it can be up to 10 times cheaper than other methods!

CONS

If you’re afraid of needles then this is not for you. That’s because you’ll be receiving these shots every 1-2 weeks for 3-6 months, possibly more depending on your body’s hormone production or lack thereof.

SIDE EFFECTS

Most commonly associated with this therapy:

  • numbness/tingly feeling; or
  • pain or swelling where the medicine was injected

PRICE

For a one month supply of "Depo-testosterone shots”, the non-insurance price is $200.

WHICH ONE IS RIGHT FOR YOU?

testosterone replacement therapy

Each treatment comes with its own set of pros and cons, as well as drastic differences in price. The determining factor should be which will be most comfortable for you.

Keep in mind that for some men Testosterone Replacement Therapy can last anywhere from 3-6 months to decades. Some men who no longer produce optimal levels of testosterone will need to be on this indefinitely, something that should be seriously considered before beginning your therapy.

In the end however, the majority of men who I’ve spoken to over the years have come to regard TRT as a blessing more than a curse, citing improved mood, better fitness, and increased libido. 

While it still falls short of being the “fountain of youth” as many like to call it, it can be a dramatic upgrade from the life of low energy, decreased libido, and depressed moods that men with low testosterone must endure.

If you'd like to check your own hormone levels, click the link below to get started.

Until next time,

Dimitri

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