Tip: 18 Things You Need to Know About TRT

Things your average medical doctor either doesn't tell you (or doesn't know) about testosterone replacement therapy.

I recently saw a list compiled by author and advocate Nelson Vergel of "several things your doctor may fail to tell you when you start testosterone replacement therapy" (TRT). I prefer to think of it as a list of things your doctor doesn't know about TRT, but why quibble?

Anyhow, it inspired me to assimilate (polite word for steal) some of the tips and build on them, along with adding several of my own. Here they are:

  1. An analysis of over a quarter of a million men showed that TRT doesn't cause prostate cancer. More info here.
  2. You don't have to inject testosterone intramuscularly. You can inject it subcutaneously, and at least one study has shown that sub-Q injections lead to less aromatization (less conversion to estradiol).
  3. While some docs administer testosterone injections every two or even three weeks, that method leads to possibly problematic supra-physiologic blood levels of the hormone, followed by likely problematic low blood levels as the shot "wears off."
  4. The most common TRT dosage is 200 mg. every two weeks, but progressive self-medicators are using 100 mg. a week, or 50 mg. twice a week, administered through an insulin syringe.
  5. One of the earliest types of TRT involved transplanting human testicles from recently executed prisoners, and you're complaining about a little shot?
  6. TRT, when given in small doses (100 mg. or less), doesn't have to be administered in the glutes. You can just as effectively inject into the vastus lateralis (the big, lateral quad muscle) or around the umbilicus.
  7. The testosterone levels of athletes are often befuddling. Exercise, particularly weight training, should elevate testosterone levels, at least temporarily, but the blood tests of many lifters show them to be low in testosterone. A new theory suggests that what's happening is that exercise heightens the sensitivity of the steroid receptors, thereby temporarily "sopping up" a lot of the testosterone in the blood, giving the illusion of low levels of testosterone.
  8. TRT will reduce your sperm count. Depending on the dosage and the relative fecundity of your testicles, it might even be a reasonably effective birth control method. Sperm levels rise back to normal after cessation of therapy, though, usually within a few months.
  9. TRT will likely shut down your own production of testosterone, but normal production should resume within a few weeks after you stop. It may, however, take as long as six months to get back fully.
  10. Generally, the biggest danger from TRT is possible thickening of the blood due to increased hematocrit (and therefore, increased risk of stroke). If a blood test reveals your hematocrit to be much above 50%, you can easily take care of the problem by donating a pint of blood every so often.
  11. TRT heightens libido and strengthens erections almost across the board in younger men. Older men exhibit an increased libido from TRT, but don't gain as much in the erection department. Of course, heightened desire often equals a stronger erection, even in old coots, so it'll at least help in that regard.
  12. Doctors are far more likely to prescribe testosterone creams and gels because they figure that no sane person would want to give themselves shots if avoidable. However, creams and gels are hard to dose properly. Ask for a prescription for injectable testosterone if you aren't scared of a little shot.
  13. While TRT (using normal doses) generally leads to modest amounts of increased muscle, reduced fat, and heightened libido, it doesn't always work for everybody. If it doesn't work for you, it might be a question of dosage, high levels of steroid hormone binding globulin (SHBG), or high estrogen levels, all of which can be adjusted or managed, providing you have a competent and willing physician. More info here.
  14. Plenty of private labs offer discounted lab tests so you can monitor your own blood levels.
  15. When preparing a site for injection, take an alcohol swab and clean the injection site by making increasingly larger concentric circles on and around the site (this literally pushes away bacteria that don't get killed by the alcohol).
  16. The Journal of the American Heart Association published a meta study (over 100 individual studies) that found higher levels of testosterone (still within normal ranges, though) were essential to heart health.
  17. TRT may alleviate depression. Info here.
  18. You can often detect low testosterone in older men by changes in their voice. Laryngeal muscles start to decrease in size and the collagenous fibers decrease in quantity, leading to an overall stiffening of the vocal apparatus.