Testosterone replacement therapy is a life-changing decision that can benefit a person greatly. However, if the therapy is poorly managed, it can cause a variety of problems. Proper TRT requires careful consideration and planning. Of course, many will still fail to do this, despite being warned of the risks. I wanted to try and put together some of the most common reasons men fail to fully benefit from TRT and distilled it to 7 key issues, or as I like to call them, “The 7 Deadly sins of Bad TRT Use”.
One of the biggest problems we’re trying to resolve is the issue men have getting access to pharmacy grade forms of Testosterone Replacement Therapy. Proof of low testosterone (Testosterone, Free & Total values below 500 ng/dl) via blood test results are often needed for a primary care physician or endocrinologist to sign off on a prescription.
For those already experiencing symptoms (mood swings, low energy, low libido, etc.), other treatments may first be sought by their physicians, leading to further frustration. In some cases, men claiming to suffer from these symptoms are disregarded or even seen in the same light as the “pill-popping doc-shopper” who goes from clinic to clinic claiming they’re always suffering from back pain and need those Oxycodones. Listen to enough of these stories and it’s no wonder patients turn to the black market out of desperation.
Right off the bat, you gotta keep it legal. I’m not here to judge, but in addition to serving serious time (it's still considered a schedule III drug), you have no idea the quality of product you’re receiving. Search around and you’ll find horror stories of people injecting what they thought to be Testosterone-Ethanate, only to find out it was oil or unknown fillers and binders.
Bottom line is to play it safe and legal for the sake of your health—after all your goal here is to improve your health, not jeopardize it with “mystery oil” from the sketchy website with the pre-2000s design template.
OK, so you got a blood test, brought your results to a physician who greenlit you to get on TRT, awesome! But hold on, don’t just jump on the first thing they give you; explore your options.
There’s a variety of TRT options that are at your disposal, some more expensive and invasive, but HIGHLY more effective (injections vs. creams/patches). Getting the best bang for your buck should be your priority, even if it’s the shots in the butt.
For a more detailed analysis of your TRT options, check out my previous article “Testosterone Replacement Therapy: Beyond Natural” where I not only discuss the options available, but provide links to the current out of pocket costs for each. Keep in mind some insurances will only cover certain options, gels and creams being some notorious examples.
Unfortunately, topical treatments lack the effectiveness of other options and can get in the way of your daily routine. For example, applying the gel/cream requires you to avoid touching anyone for 4 hours after applying it.
This can be difficult to control if you’re receiving injections from a physician. One size-fits-all dosages aren’t realistic, and each person is going to require different dosages. Often times, you’ll be given a set dosage every two weeks, which can lead to wild swings in your hormone levels. One big complaint is patients are given too much (200mg) too infrequently (every two weeks).
If possible, request weekly dosages to ensure smooth fluctuations between visits. Understand that there will be some trial and error before getting your optimal hormone dosage just right. Any girl who’s been on the pill can relate!
If you’re administering injections yourself, people will often split up the weekly dosages to two a week for optimal hormone stability. As always, consult with your physician before making any changes to your dosages or frequency.
If you’ve been working alongside a physician for a few months and still feel like you aren’t seeing an improvement in your health, don’t hesitate to discuss with your doctor about switching up the dosages or frequency of administration. If you feel like he/she isn’t listening to you, try getting a second opinion. You need to make sure you and the physician are on the same page and that they’re receptive to how you’re feeling.
This goes without saying, but things like smoking, drinking, or drug use will negatively impact your hormones even without TRT. Throw in someone who rarely exercises, sits all day at work, and is on a first name basis at every local fast food spot, and you’ve got a recipe for disaster. If you’re serious about improving your health, you need to sort yourself out before getting on TRT. It’s not a magic wand that undoes all your bad decisions. At minimum, you’ll need to put in effort to make sure you’re keeping up on your doctor’s visits or your routine if self-administering, which brings me to my next point.
The majority of men seeking TRT tend to already be on some type of diet/exercise routine, meaning the addition of self-dosing or religiously visiting the clinic won’t be too difficult to maintain. However, for those who aren’t in that category, it’s extremely important to understand that what you’re committing yourself to is long term, possibly life-long.
This isn’t something you “cycle” like a bodybuilder who’s taking large amounts of Testosterone would. If you’re naturally low on Testosterone, staying on for a few weeks/months then hopping off isn’t going to do the trick.
Similar to someone on cholesterol meds or Metformin for diabetes, treatment is indefinite unless stated by your physician. If for some reason you need to come off of TRT, you’ll need to work with your physician to slowly adjust your dosages to avoid any nasty side effects.
The majority of side effects that the media loves to portray as “common” or “inevitable” from using exogenous Testosterone almost always is the result of someone not knowing what they’re doing. This is mainly in reference to those who are self-dosing without any medical advisement, usually teenagers experimenting or the gym rat who listened to the advice of other users without properly considering their own weight when measuring dosages. Issues like hair loss, acne, moodiness are all signs of hormone imbalance.
Normal metabolism of testosterone results in its conversion into two primary metabolites, dihydrotestosterone (DHT) and estradiol (E2, a form of estrogen). However, when the body has elevated levels of testosterone, it results in elevated levels of DHT, which can cause benign growth of the prostate (cancer), increased oiliness of the skin and acne, as well as male pattern balding.
Elevated estradiol production will lead to moodiness, breast tissue changes, and fluid retention, all things that we tend to see in people who are Testosterone deficient or suffer from hypogonadism. Aromatase inhibitors such as Arimidex are necessary to keep estrogen levels in check and maintain a proper Testosterone/Estrogen ratio.
Proper dosing amounts and frequencies, as well as taking additional supplementation to manage excess DHT and estradiol production (which can occur when adding exogenous testosterone) should keep any scary side effects in check.