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One of the primary reservations many men have to initiate a testosterone replacement therapy protocol is fear of having to be on TRT (testosterone replacement therapy) for the rest of their lives.  I have heard doctors who are completely clueless about hormone optimization reinforce these fears by stating that starting TRT is a big decision because once you start you will have to be on it for life. First, it is untrue and second generally when TRT is the only efficacious option to get your levels into the optimal range it is something you will want to stay on for the rest of your life. When it is the only option you should be ecstatic that it is even available as testosterone is incredibly crucial for men to feel their best. Otherwise, you will be miserable suffering with terrible testosterone levels indefinitely and that is no way to live! I see many men over forty and definitely over fifty who no longer have any zeal for life. They complain about being lethargic, accept that they are in a decline, and don’t get excited about anything other than the latest deals at Costco. Many of these men probably have depleted testosterone levels yet because everyone they know is in the same situation they accept it as part of aging and don’t think there is anything that they can do about it. Sedentary living and increased alcohol consumption often follow but I digress. Now I am the first to say all effective measures to ramp up your own production should be utilized. However, the reality is if you live long enough, natural production measures will most likely not be effective alone and TRT is a viable option to keep you feeling your best and enjoying life fully.

TRT does not have to start as a lifelong commitment. You’re not getting married to TRT and even if you were, with every marriage divorce is always an option. You could start a TRT protocol and test drive it for three to six months and decide from there if you want to continue.  Three to six months is long enough to assess the benefits as well as the negatives and also not long enough to shut down natural production beyond the point of no return. If you decide it is not for you, you can gradually reduce the dosage and wean yourself off over time. If you were taking  Enclomiphene citrate, HCG (Human chorionic gonadotropin), or ASTB with your TRT regimen then you likely kept natural production going and will continue to produce testosterone when completely off TRT.  You could also choose any of these options after desisting TRT to get your own production pumping again. If ASTB or Clomid for example produce high levels of LH (Luteinizing hormone) in which levels are at the high end of the scale or even past it and you still have low testosterone levels then natural methods alone are unlikely to get you to where you want to be. At this point, you may want to consider combining natural production methods with some exogenous testosterone for ideal results. 

It makes sense to use TRT with a treatment option that will mitigate natural production from shutting down completely. Dr. Mark Gordon uses Clomid with many of his TRT patients for this purpose. An additional benefit of using Clomid with TRT is you generally won’t have to use as much testosterone to get your levels into the optimal range. For example, if your total testosterone is 550 ng/dl and free testosterone 85 pg/ml with Cloimid but you need to get over 800 ng/dl and over 120 pg/ml to feel your best then you will likely need less testosterone then someone who has a starting total testosterone level of 250 ng/dl and barely detectable free testosterone levels. Using protocols to keep your own production from shutting down will reduce the likelihood of testicular shrinkage as you aren’t relying completely on exogenous testosterone.  Using the lowest TRT dosage to get you feeling your best is also prudent to avoid negative side effects. Also, if you decide to stop using TRT, you can continue with Clomid, HCG, or ASTB to bring your levels back up as much as possible. 

Many of the side effects of TRT such as high blood pressure, gyno, hair loss, acne, liver stress, and prostate stress are the consequence of too high of a dosage. Many TRT clinics that are becoming more ubiquitous (I can think of at least three within a ten-mile radius of where I live in Vegas) arbitrarily give patients 200mg a week! This is way too high of a dosage for most men and is very inconvenient as well. You have to go to the clinic once a week to get your intramuscular shot which is easy money for the clinic. A once-a-week shot leads to a big increase in testosterone and then a decline over the course of the week until you are finally ready for your next shot. A more progressive regimen that Dr. Gordon and many other cutting-edge doctors use is subcutaneous injections two to three times per week. Instead of injecting a big needle into the muscle a much smaller needle is utilized to inject into body fat such as stomach fat. For example, rather than 120mg injected once a week IM, two 60mg injections subcutaneously or even 40mg injected three times per week. For most patients, this will be something they can learn easily from a physician and do at home. I have used peptides for many years and while I was intimidated initially as I had never used a needle for anything, I found it painless and very easy to learn. This would definitely be my preferred method of TRT. Subcutaneous injections with a smaller needle done a few times per week also allow for steadier testosterone levels. 

While injections are considered the ideal option for TRT by many experts it is definitely not the only option. If even shots with a small needle injected subcutaneously are not a fit for you there are numerous other options such as creams, nasal delivery, touches, and pellets. Some of the side effects such as hair loss and acne are more likely with the cream as the cream tends to increase conversion of testosterone to DHT (Dihydrotestosterone). DHT is very beneficial for increasing sex drive and function but too much can cause the skin to get very oily and subsequently excessive acne. It can also increase the likelihood of hair loss for those with a genetic predisposition. Of course, this in most cases is likely dose-related and you can always take saw palmetto if there is too much conversion of testosterone to DHT. 

One thing is for sure, TRT and just about anything else you may want has never been more accessible than it is right now. In addition to TRT clinics popping up all over the United States, there are many online TRT/anti-aging options. I have seen dozens of these advertised on Instagram. Recently, I did a consult with one of these companies just to see what they would recommend. After reviewing the blood work I sent over for less than five seconds the doctor I spoke to recommended 200mg of TRT once a week via IM injections, Oxandrolone (otherwise known as the steroid Anavar) at 35mg a day! And a potent Aromatase inhibitor called Anastrozole at .25mg three times per week. Now keep in mind my total testosterone is over 700 ng/dl, free is over 100 pg/ml, and my estradiol was at 28 pg/ml.  The Dr said my estrogen levels were too high in comparison to my testosterone levels and that I would need to have a total testosterone of 2000 ng/dl to be in balance with an estradiol level of 28 pg/ml. This is ludicrous and completely erroneous.  

While I think most medications should be available for adults, you really have to be well-researched to avoid falling prey to terrible advice. If I didn’t know better I would have just followed this physician’s advice and paid the highly likely negative consequences. Of course, the good news is if I want TRT and anabolics I know where to go! 

The medical industry regarding hormones and testosterone tends to be at oscillating extremes. On one hand, some physicians especially general practitioners tend to be very reluctant to prescribe testosterone treatment if the patient is in the statistical range. Even if you have symptoms such as low sex drive, poor motivation, difficulty building muscle. On the other extreme, you have online options that recommend high dosages of TRT and anabolics with no reservations at all even if your levels are in the optimal ranges. You really have to be your own best doctor in this bizarro world we live in and be as well-researched as you can be.

Is TRT a fit for you? It really depends on how badly you feel. Some say you should explore all-natural options first and I am all for that but if you’re depressed with no sex drive and have a hard time even waking up to face the day, you need the fastest course to feeling better not a regimen that will take many months or even years and may end up being to no avail. TRT is the fastest way to improve your testosterone levels and the most guaranteed approach to utilize. Whether you use TRT or not you should focus on healthy nutrition (Just eat real food most of the time whatever your predilection is with a balance of protein, healthy fats, and low glycemic carbs) and daily activities such as long walks which are incredible for mood and overall health, strength training as the more muscle and body fat you have the less conversion you’re likely to have of testosterone to estrogen, regular deep sleep, addressing vitamin and mineral deficiencies. Low Vitamin D, selenium, zinc, and magnesium all contribute to depleted sex hormone levels.  If you decide to give TRT a shot make sure to check your blood pressure once a week to ensure it is not elevating too much and get blood work done after four to six weeks to see how kidneys, liver, red blood cells, cholesterol, and fasting glucose are being impacted. Every problem has a solution and what works for others can be useful to know for what may work for you. However, everyone is different and it will take some time to determine the ideal approach that is suited for you. Life is too long to live with depleted testosterone levels. Why feel like a shell of yourself when you can take advantage of effective protocols to feel your best for as long as possible?


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