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Testosterone Replacement Therapy (TRT) 101
Your Guide To Optimizing Your Health With TRT
This post is very important to me because I understand how essential optimal hormone health is for a high-quality life. I have seen first-hand the devastating effects low testosterone can have on men’s lives. The signs of low testosterone are as follows:
Erectile Dysfunction/Low Libido
Decreased Muscle Mass
Increased Body Fat
Decrease in Bone Mass
Increased Risk For Cardiovascular Disease
Honestly, this is just the tip of the iceberg, I just don’t feel like becoming redundant for your sake. Long story short, Low Testosterone is extremely detrimental, and if you do not want to fix it, you’re NGMI.
What Is Testosterone
Everyone has the general idea, but what *exactly* is testosterone and what is its function in the body? Testosterone is the primary male hormone in the body; it is essentially what makes you a man, biologically. It is a steroidal hormone produced in the testes and adrenal glands responsible for a wide array of functions to include things such as: hair, bone, muscle growth, deepening the voice, fat lipolysis, etc.
Testosterone is broken down into two different categories: bound and free testosterone. When testosterone is bound, this means its effects cannot be used within the body—it is not “free” to be used for it various purposes. 98% of the body’s testosterone is bound with the remaining 2% biologically free. Even though only 2% of the body’s total supply, Free Testosterone is just as important, or rather, even more important than total bounded testosterone. This is because Free Testosterone can bind to any cell and exhibit the effects of testosterone. This is an important characteristic to navigate because your total testosterone levels can be extremely high, but your free testosterone can be virtually zero, and this can cause a cascade of problems.
Normal vs Optimal Testosterone Levels
You have to be very careful here. The medical community says levels between 300-1100ng/dl total testosterone are normal levels… Now wait a second, how can a range of 900 make any sense at all? It’s because it absolutely does not. Normal and optimal have very different definitions and the general consensus amongst *real* experts is the optimal range is between 800-1100ng/dl. Most men will need to maintain a level above 600-700 to feel good/healthy. Anything below this is inimical to your lifestyle. You’d be surprised that the average male is walking around with 400 levels and thinks that is acceptable.
Optimal Free Testosterone is going to be within the 25-32ng/dl, again much higher than the normal range of 5-21ng/dl. My number is extremely high, but this is because free testosterone is the most important component of the testosterone equation.
Optimizing Natural Testosterone Levels
Lifting weights will have the most dramatic effect on your natural testosterone level. Increased muscle mass has a positive correlation with testosterone levels. Compound lifts will also have an acute role in testosterone levels when lifting weights—especially heavier weights.
A balanced-diet filled with nutrient dense food will have a positive effect on testosterone levels; this will be due to getting the micronutrients needed to maintain optimal hormone levels. You will need an adequate amount of protein to boost muscle mass and recovery, fats to regular hormone production, and leafy greens as these will help regulate your body’s estrogen in a positive manner.
Sleeping an adequate amount will also enhance optimal testosterone levels. You will want to get 7-8 hours of sleep at night to ensure you’re giving your body an appropriate amount of rest and recovery, as well as maintaining positive hormone health. Quality over quantity in terms of sleep is the goal—you want to ensure you’re getting the right amount of deep and REM sleep. I use a Whoop Fitness Tracker to obtain stats.
Cutting out alcohol is very important if you want to optimize your testosterone levels, Alcohol has a very depreciating effect on not only your hormones, but your recovery and sleep as well. Cutting out, or at the minimum, limiting your consumption will drastically improve your testosterone levels.
A healthy body-fat level is critical for optimal test levels. Maintaining the 8-15% body-fat range is the the efficient level for hormonal health. Excess body fat has a high estrogenic effect on your body.
Getting Your Testosterone Levels Tested
The first step in solving your issue if you believe you have low testosterone is to get blood work done. You will want to get a full-panel hormone test that will test the following:
Bioavailable testosterone (aka Free and Loosely Bound)
Estradiol (specify “sensitive” assay for males)
Complete thyroid Panel
PSA (age dependent)
Comprehensive Metabolic Panel
You will want to have a consultation with a medical provider about these numbers, I highly, highly suggest going through a hormone specialist as most General practitioners are not fully experienced with the TRT process. There are hundreds of TRT clinics, with staffed doctors that will provide the best evaluation possible. DYOR and figure out which method is best for you, if you are identified as having out-of-range numbers.
What Is TRT?
Testosterone Replacement Therapy is the process of administering exogenous testosterone via multiple mechanisms (injection, pellet, gel, etc) to replace your current natural testosterone production for a controlled-dose that will keep your numbers in the optimal range. This essentially makes your body rely on outside testosterone to fuel the body’s supply. This is extremely beneficial if you are producing low numbers naturally. This comes with its own stipulation—you will be reliant on the supply of exogenous testosterone. Most people understand and are okay with that, but I want to double-down so you are absolutely sure you know what you’re getting into if you decide to go down that path.
Deciding If You Want TRT
Testosterone Replacement Therapy is not a quick fix, rather this is a lifelong decision you will have to make based on your own research and comfortability with the process. There are many benefits to TRT yes, but as I will get into in a later section, TRT comes with its own risks and side effects.
Who Is TRT For?
TRT is for anyone with low testosterone, however I do have some general guidance for those weighing the option of going on TRT:
You are over 25 years old
You have Testosterone levels below the optimal range
You have tried everything to naturally increase your testosterone
You have weighed the risk/reward and have come to the conclusion you are an ideal candidate
You realize this is a lifelong commitment
Types of TRT
As mentioned above there are a few main mechanisms for administration of testosterone. However, I will first and foremost say injectable is far superior and it isn’t even close. This is because it will keep your levels consistent and you will not go through a giant shift in your levels between doses. The following are you options:
Creams/Gels (poor absorption)
Pellets (fluctuations between dosing, harder to manage)
Lozenges (multiple dosing a day, again harder to manage)
Oral Testosterone (not used in the USA, for good reason, usually ineffective)
Collectively, I would never suggest any of the above except injectable testosterone in the form of enanthate or cypionate as these will be small injections (100-200mg) 1-2 times a week. This is by far the best way to maintain optimal levels.
A good clinic will give you ancillaries, or different compounds that will help support your body’s hormone systems with the inclusion of TRT. There are 3 major ancillaries associated with TRT:
SERMs, or Selective Estrogen Receptor Modulators. These mimic and block estrogen in a way that support estrogen’s functions on the body (yes, you absolutely need some estrogen for health/hormone purposes) in a selective way to maintain a type of homeostasis within the bodies hormonal systems. 2 popular SERMs are clomiphene (Clomid) and Tamoxifen (nolvadex).
Aromatase Inhibitor (A.I) blocks the conversion of testosterone into estrogen. These can be necessary because exogenous testosterone can be converted into estrogen—which obviously has its own set of problems when that level becomes too high. There is a sweet spot for estrogen that you want your body to maintain. Too high as well as too low presents a plethora of problems within your body. This is why it’s absolutely crucial to go through a good doctor that will continuously monitor your bloodwork and ensure you are within the optimal ranges. Popular A.I’s include Aromasin (exemestane) and Arimidex (anastrozole). Both have their own mechanisms of function, Arimidex being more potent, Aromasin giving you more margin of error.
Human chorionic gonadotropin (hCG) is a fertility drug that is commonly used to coincide TRT to maintain fertility. This is extremely important as a side effect of TRT can be the loss of fertility. This also has the added side effect of maintaining the testicles size and keeps testicular function even when administering exogenous testosterone.
Benefits of TRT
This section is slightly redundant because all you would have to do is reverse the negatives of the effects of low testosterone as I mentioned above, but I’m not lazy so I will list the benefits!
Increased Muscle Mass
Decreased body fat
Increased Bone Mass
Overall Better Quality of Life
Side Effects of TRT
I refuse to give the good without the potential bad; therefore, I will list common risks associated with TRT. These can be mitigated with the observation of a medical professional, but nonetheless are potential risks.
Increased red blood cell count, which can cause thicker blood and increase chance of clotting. Mitigated by regularly donating blood.
Infertility. Due to the body’s natural production of testosterone being interrupted, this can potentially lead to problems with fertility, though this is typically reversible when stopping TRT. This can be mitigated through ancillaries such as hCG.
Altered lipid levels. This is due to the effects of testosterone and cholesterol. This can slightly raise your LDL (bad cholesterol) and slightly lower your HDL (good cholesterol). This too can be mitigated through proper diet and use of citrus bergamot and krill oil.
Gynecomastia - this is the growth of breast tissue through elevated estrogen levels. This is easy to mitigate through use of A.I and/or SERMs like Nolvadex.
Typically, despite the first 2, the only side effects will mimic those of some one with naturally high testosterone. I personally do not know anyone who has ever had a major problem when on TRT, but with all things DYOR.
Where To Get TRT
There are hundreds of clinics popping up all around the world due to the major increase in the decline of natural test levels. I have personally vetted many, but the companies that trump the others is Primebody and Marek Health.
Primebody is my number one suggestion, as I trust the people behind the company. I know first-hand they offer high quality service that produces life-changing results for their clients.
A week ago, they announced their launch of an ambassador program—which I immediately enrolled in the opportunity because I believe in their service tremendously. Please do your own due diligence, but this is my recommendation! Below I will provide a link and my discount code.
Primebody.com Code: BowTiedOX
I hope this was enough to provide some knowledge behind not only TRT, but testosterone health in general. This is a very, very important topic for me as I have personally seen the negative effects of low testosterone and the absolutely life-changing results of finding a solution. As always, I am open for any questions, please reach out by DM or email.
This is not Legal, Medical, or Financial advice. Please consult a medical professional before starting any workout program, diet plan, or supplement protocol. These are opinions from a Cartoon Ox.