Top Facts You Need to Know Before Starting TRT

[Nelson Vergel]

Embarking on the path of Testosterone Replacement Therapy (TRT) often evokes a blend of enthusiasm and concern among men. The allure of renewed vigor, heightened sexual desire, and robust muscle growth is enticing. However, there are a lot of less well-known aspects that your healthcare provider might not immediately disclose. For instance, were you aware that TRT could affect your fertility or exacerbate your sleep apnea? While TRT heralds a new dawn for many, it doesn’t offer a universal remedy. In light of this, we have meticulously curated a comprehensive list of 18 pivotal aspects that might elude your doctor's attention but are indispensable for you to grasp. Venture further to unearth the profundities of TRT.

Here are several things that your doctor may fail to tell you when you start testosterone replacement therapy (TRT):

1- TRT decreases your sperm count. It decreases LH and FSH responsible for sperm production. If you want to remain fertile, talk to your doctor about clomiphene or adding hCG to TRT.

HCG plus TRT to Prevent / Reverse Testicular Shrinkage and Decreased Fertility

Human Chorionic Gonadotropin (From the book Testosterone: A Mans Guide, amazon.com) Short podcast: hCG: What Every Man Should Know Human chorionic gonadotropin (HCG) (not to be confused with human growth hormone, or HGH) is a glycoprotein hormone that mimics LH (luteinizing hormone), produced...

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2- TRT may increase your blood viscosity due to increased hematocrit, the amount of red blood cells in the blood. Some doctors may want to stop your TRT when this happens, but this side effect can be managed easily with blood donations or therapeutic phlebotomy. Just be careful: frequent blood donations can deplete iron and cause fatigue. More details here: High Hematocrit Caused by TRT: How to Lower and Manage it

3- TRT shuts down your own testosterone production. It may recover after a few weeks and up to 6 months after you stop.

4- TRT improves sex drive, muscle mass, and fat burning in most men. But it does not work for everyone, and dose and frequency are important along with other factors like side effect management. It is not a magic bullet. Average time to see benefits: How long does TRT take to show effects?

5- Testosterone can be injected under the skin with an 1/2 inch 27-29 gauge insulin syringe (Most doctors think you should inject deeply into muscle) or shallow IM (1/2 inch syringe, 90 degrees). More information about benefits : Where to Inject Testosterone: Intramuscular vs. Subcutaneous Injections

6- Many doctors still prescribe testosterone injections at 200 mg every two weeks. Many are moving towards 100 mg/week or 50 mg twice per week with an insulin syringe (27 to 29 gauge, 1/2 inch).

7- TRT improves erectile function in some men, but not all. It improves libido in most men, regardless of age, though. Some men take low-dose daily Cialis along with TRT. Daily low-dose Cialis can have cardiovascular benefits and also help with BPH. More information is here : The benefits of long term use of Cialis

8- You can monitor your own blood tests via companies like DiscountedLabs.com without a doctor visit. Order Discounted Lab Tests Online Without a Doctor Visit

9- You can access a testosterone doctor via telemedicine no matter where you live in the U.S. if you don’t have one close by. However, most of them do not take insurance. Looking for Hormone Doctors?

10- TRT does not cause prostate cancer or heart attacks (cardiovascular outcomes depend on proper monitoring of hematocrit, HDL, and blood pressure, though). However, recent data shows that AFIB or heart palpitations can increase in some older men. This issue is under investigation.

11- Many men do not know that you can ask questions to other men who have used TRT for a few years by visiting Forum list

12- Many doctors only measure blood levels of total testosterone but forget to include free testosterone, DHT (metabolite), and thyroid function tests. Men with very low T levels should also get their prolactin tested to rule out a pituitary adenoma.

13- Most insurance companies only pay for certain TRT products but not others. And most refuse to pay if your testosterone level is over 350 ng/dL. You can bypass insurance by having your doctor fax the prescription to a compounding pharmacy.

14- Urologists are quickly becoming the most knowledgeable doctors of TRT management. Urology conferences now have full days devoted to TRT studies. Looking for a doctor in the US?:

Looking for Hormone Doctors?

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15- Some men fail to achieve benefits from TRT. Comorbidities and other issues can be to blame. Metabolic issues can increase the risk of water retention and high blood pressure in some men. Those men should consult a cardiologist for a full checkup. Water Retention While on TRT May Only Occur to Certain Men

16- TRT does not cause prostate cancer or heart attacks (cardiovascular outcomes depend on proper monitoring of hematocrit, HDL, and blood pressure, though). However, recent data shows that AFIB or heart palpitations, can increase in some older men. This issue is under investigation.

17- Emerging data shows that aromatase inhibition may not needed in TRT management. There is no data on what “high estradiol” is for men on TRT with higher testosterone blood levels, however. More details on estradiol are here:

estradiol lab test

estradiol sensitive test description

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Low Blood Levels of Testosterone and Associated Risks:​

< 450 ng/dl (15.3 nmol/l) - Risk of metabolic syndrome​

• Reference: Dhindsa, S., Miller, M. G., McWhirter, C. L., Mager, D. E., Ghanim, H., Chaudhuri, A., & Dandona, P. (2010). Testosterone concentrations in diabetic and nondiabetic obese men. Diabetes Care, 33(6), 1186-1192. PubMed

< 400 ng/dl (15.3 nmol/l) - Venous leakage (internal penile damage) risk​

• Reference: Yassin, A. A., & Saad, F. (2017). Testosterone Deficiency and Testosterone Treatment in Older Men. Gerontology, 63(2), 144–156. PubMed

< 350 ng/dl (11.9 nmol/l) – All-cause death risk and anemia risk​

• Reference: Khaw, K. T., Dowsett, M., Folkerd, E., Bingham, S., Wareham, N., Luben, R., ... & Day, N. (2007). Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men. Circulation, 116(23), 2694-2701. PubMed

< 300 ng/dL (10.2 nmol/L) - Lowered libido, weight gain & Diabetes risk increased​

• Reference: Traish, A. M., Saad, F., & Guay, A. (2009). The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction Journal of Andrology, 30(1), 10-22. PubMed

< 300 ng/dL (10.2 nmol/L): Quartile risk of fractures (osteoporosis), memory-related issues and depression risk increases​

• Reference: Orwoll, E., Lambert, L. C., Marshall, L. M., Phipps, K., Blank, J., Barrett-Connor, E.,... & Cummings, S. (2006). Testosterone and estradiol are common among older men. The Journal of Clinical Endocrinology & Metabolism, 91(4), 1336-1344. PubMed

< 250 ng/dl (8.5 nmol/l): Arterial plaque (arteriosclerosis) & sleep quality affected​

• Reference: Vlachopoulos, C., Ioakeimidis, N., Miner, M., & Aggelis, A. (2014). Testosterone deficiency: a determinant of aortic stiffness in men Atherosclerosis, 233(1), 278-283. PubMed

< 235 ng/dl (8.0 nmol/l) hardening of arteries (dialysis patients)​

• Reference: Carrero, J. J., Qureshi, A. R., Parini, P., Arver, S., Lindholm, B., Bárány, P., ... & Stenvinkel, P. (2009). Low serum testosterone increases mortality risk among male dialysis patients. Journal of the American Society of Nephrology, 20(3), 613-620. PubMed

< 200 ng/dl (6.8 nmol/l) morning erections decrease​

• Reference: O'Connor, D. B., Lee, D. M., Corona, G., Forti, G., Tajar, A., O'Neill, T. W., ... & EMAS Study Group. (2011). The relationships between sex hormones and sexual function in middle-aged and older European men. The Journal of Clinical Endocrinology & Metabolism, 96(10), E1577-E1587. PubMed

< 150 ng/dl (5.1 nmol/l) - Increased inflammation (TNF-alpha)​

• Reference: Malkin, C. J., Pugh, P. J., Jones, R. D., Kapoor, D., Channer, K. S., & Jones, T. H. (2004). The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. The Journal of Clinical Endocrinology & Metabolism, 89(7), 3313-3318. PubMed

The Unspoken Implications of TRT​

Your doctor might overlook mentioning certain ramifications when you commence Testosterone Replacement Therapy (TRT):

Fertility and TRT​

1. Sperm Count Drop: TRT lowers the levels of Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH), two hormones that help make sperm. If preserving fertility is a priority, discuss with your healthcare provider incorporating Clomiphene or hCG into your TRT regimen.

Hematological Effects​

1. Blood Viscosity Increase: TRT can escalate your blood's hematocrit level, thereby increasing its viscosity. Although some practitioners may advise halting TRT, this side effect can be managed adeptly through blood donations or therapeutic phlebotomy. Beware; frequent blood donations might deplete iron levels and induce fatigue.

Impact on Natural Testosterone Production​

1. Suppression of Endogenous Testosterone: TRT suppresses your body’s natural testosterone synthesis, which may rebound anywhere between a few weeks and six months post-cessation.

The Multifaceted Benefits and Varied Efficacy of TRT​

Muscle Mass, Fat Reduction, and Sexual Health​

1. Sex Drive and Physique Enhancement: TRT predominantly augments libido, muscle mass, and fat metabolism in men. However, its effectiveness varies, and meticulous dosage and frequency adjustments along with side effect management are imperative. It’s not a panacea.

Administration Techniques​

1. Methods of Injection: Contrary to what most people think, testosterone can be injected superficially (IM) or deeply (subcutaneously) into the muscle using a 1/2-inch, 27-29-gauge insulin syringe.

Topical Testosterone​

1. Efficacy of Gels and Creams: Testosterone gels and creams are efficacious but often under-dosed by physicians. More concentrated compounded products or dosage adjustments based on blood levels can rectify this.

Dosage Frequency​

1. Optimized Injection Schedules: Shifting from biweekly 200mg injections to weekly 100mg or twice-weekly 50mg dosages can often yield better results.

Addressing Concerns and Optimizing TRT Outcomes​

Sleep Apnea and TRT​

1. Sleep Apnea Dynamics: TRT could exacerbate central sleep apnea but might alleviate obstructive sleep apnea over time as weight loss occurs.

Erectile Function​

1. Erectile Function and Libido: TRT enhances erectile function and libido in a majority of men. Some may benefit from adjunctive low-dose daily Cialis, which also harbors cardiovascular advantages.

Self-Monitoring and Telemedicine​

1. Monitoring Blood Tests: Companies like DiscountedLabs.com enable self-monitoring of blood tests without a doctor visit. Moreover, telemedicine facilitates access to testosterone doctors nationwide, albeit mostly without insurance coverage.

Debunking Misconceptions and Enhancing TRT Knowledge​

Prostate Health and Cardiovascular Effects​

1. Prostate Cancer and Heart Attacks: Contemporary evidence refutes the notion that TRT triggers prostate cancer or heart attacks, though vigilant monitoring is crucial for optimal cardiovascular outcomes.

Community Support and Knowledge Sharing​

1. Leveraging Online Communities: Engage with seasoned TRT users on platforms like the ExcelMale forum or Testosterone Replacement Discussion Facebook group to broaden your understanding.

Comprehensive Testing​

1. Holistic Blood Analysis: Ensure your doctor conducts a thorough blood analysis encompassing total and free testosterone, DHT, thyroid function, and prolactin (especially for those with extremely low T levels) to rule out pituitary adenomas.

Insurance, Professional Expertise, and Addressing Common Hurdles​

Insurance and TRT​

1. Insurance Coverage: Insurance coverage for TRT products is often restrictive, but utilizing a compounding pharmacy can be a viable alternative.

Expertise in TRT Management​

1. Urologists Leading the Charge: The burgeoning expertise of urologists in TRT management is notable, with extensive TRT-centric discussions now a staple at urology conferences.

Identifying and Addressing Co-morbidities​

1. Co-morbid Conditions: Men with co-existing health issues may encounter challenges in reaping TRT benefits, warranting a thorough cardiovascular assessment for those experiencing water retention and hypertension.

Estradiol Management​

1. Misconceptions About Estradiol: People often get the wrong idea about this hormone, which plays a big part in libido, bone health, and brain function, because it is not given enough attention when it comes to management. Emerging evidence suggests aromatase inhibition might be unnecessary in TRT management.

Armed with this extensive knowledge, you’re now better positioned to make informed decisions on your TRT journey. Remember, individualized consultation with healthcare professionals is indispensable for optimizing your TRT experience.

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[Dagerrt23]

Great info, I want to add one more interesting fact, Testosterone Replacement Therapy (TRT boosts low testosterone levels, improving mood, energy, and muscle mass. Consult a healthcare professional for personalized advice.

Globally Discussed:

Serey Dié: Footballer has spoken about how TRT helped him with low energy levels and depression, check Serey Dié Fortune: Serey Dié Fortune, Salaire & Biographie - LaCélébrité.