What is testosterone and what does it do?
Testosterone is the primary male sex hormone. It is necessary for muscle growth and strength, body fat distribution, bone density, and the production of red blood cells and sperm. Every major organ in the body has testosterone receptors and needs testosterone to function normally.
Testosterone plays a major role in a man’s mood, as well as his sex drive (libido). In men, it is produced by the testicles (testes). While both men and women have testosterone, men have 10-20 times as much as women, on average.
Testosterone is responsible for the male characteristics that develop during puberty, such as a deeper voice, greater muscle mass, and body hair.
What are the symptoms of low testosterone (low T)?
When a man’s testosterone level is low, he basically feels terrible. He feels lazy, unmotivated, and depressed. He packs on belly fat, drops muscle mass, and loses interest in sex – or it’s difficult to perform. His brain is foggy and it’s harder for him to pay attention. He doesn’t sleep well. In addition, he’s at greater risk of developing cardiovascular disease, diabetes, and other health problems.
Often, these symptoms are attributed to getting older when really, an abnormally low testosterone level is the problem. The truth is, men should be able to feel healthy and alive at any age.
What is hypogonadism?
Hypogonadism is the medical term for low testosterone.
What causes low testosterone?
A man's testosterone level starts to drop significantly after age 30, and decreases progressively throughout his life. This condition is known as "andropause" and contributes to the loss of strength, muscle, and energy that many men experience as they age.
In modern times, this problem has been made even worse by pollution, unhealthy food, and an inactive lifestyle. Sadly, low testosterone is a vicious cycle. As testosterone levels decrease, body fat increases, which increases estrogen and drives down testosterone even more. Testosterone optimization therapy can help reverse this cycle.
Common causes of low testosterone include obesity, diabetes, sleep apnea, hypothyroidism, chronic kidney disease, alcohol abuse, liver disease, testicular injury, brain injury, congenital defects, other endocrine problems, certain medications, opioid use, and chemotherapy.
How common is low testosterone?
It's been estimated that 1 in 4 men today have less-than-optimal testosterone levels. Unfortunately, this problem is seriously underdiagnosed because "normal" testosterone ranges are based on averages in our unhealthy population, and not what is actually normal for men. For example, a typical testosterone level for an 80-year-old man is around 400 ng/dL. Would you think it was normal if a 40-year-old man had the same testosterone level? Of course not! And yet, his doctor would likely tell him it was normal because the normal range is considered to be between 300-1100 ng/dL. In reality, the "normal" testosterone level depends on the man, but typically, men feel best with levels in the middle to upper end of the range.
What are the benefits of TRT?
Testosterone replacement therapy reverses the effects of low testosterone. That means it can help men to lose weight, increase their motivation and outlook on life, give them more energy, increase sex drive, cause firmer and longer-lasting erections, make it easier to increase muscle mass and strength, improve athletic performance, help them think more clearly, and basically make men feel like themselves again. Optimizing men’s testosterone levels will often help to reduce their risk of obesity, diabetes, hypertension, and heart disease.
Is TRT safe? Does TRT shorten your life?
No studies have shown that TRT shortens lifespan, and many have shown that it benefits men’s health. In fact, low testosterone actually increases men’s risk of cardiovascular disease, stroke, obesity, diabetes, and osteoporosis. That said, there are always potential risks with any medical treatment, and it’s important to be aware of those before starting.
What are the potential side-effects of TRT?
The most significant side-effect of TRT is a condition called erythrocytosis, which is an abnormally high level of red blood cells and hematocrit. Left untreated, this condition could potentially lead to a blood clot. That’s why we closely monitor your blood counts when you are on testosterone. If your hematocrit goes too high, you’ll need to donate blood to normalize your level. However, we typically try to avoid this, as there are other ways to control hematocrit on TRT.
Other possible side effects include acne, fluid retention, hair loss, and testicular shrinkage.
Wait a minute, TRT is going to make my testicles shrink?
Medications like HCG or enclomiphene can help prevent testicular shrinkage, as well as maintain fertility. Enclomiphene is taken orally twice a week. HCG is injected under the skin twice weekly. Both medications have a low incidence of side-effects.
Without these, most men who are on testosterone therapy experience testicular shrinkage to some degree. This happens because when you are giving your body testosterone from outside, your testicles won’t be producing it on their own. They are less active, so they get smaller. Most men on TRT consider this a small price to pay for their increased libido and better erections, as well as other benefits, that they get while on testosterone therapy.
If I stop testosterone, will my testicle size go back to normal?
Yes. If you stop testosterone (or take HCG or enclomiphene), your testicles will go back to their normal size.
Does TRT cause infertility?
Taking testosterone on its own will significantly reduce the body’s production of sperm, which leads to infertility. If fertility is desired, you can take HCG to maintain sperm production.
Is TRT infertility reversible?
Yes. If you stop testosterone (or take HCG), your fertility will return.
What is the average dosage of TRT?
It varies, but approximately 125 mg per week is typical. This is split into two injections every 3.5 days to maintain a consistent testosterone level.
Can I increase my testosterone level naturally?
Yes. A healthy lifestyle, including a healthy diet, regular exercise (especially weightlifting), maintaining a healthy weight, and getting good sleep will all help to increase testosterone levels. It’s also important to avoid unnecessary exposure to toxins, like plastics and pesticides.
Testosterone replacement therapy can help you to start and maintain these healthy habits by making it easier to lose weight, increasing energy and motivation, and helping you sleep better.
If I start TRT, do I have to be on it forever?
No. If you stop testosterone, your body will start producing it on its own again, but your levels may not be as high as they were while on TRT. Many men simply feel better when their testosterone is at a higher level than what their body produces naturally.
What is the normal range of testosterone?
The so-called “normal” range of testosterone, for men, is considered to be between 300-1000 ng/dL. However, this range actually has little-to-no evidence behind it. It also doesn’t take into consideration the man’s age. A 35-year-old man should have a higher testosterone level than a 65-year-old man.
Most men feel better when their level is at the higher end of the range. If your natural total testosterone level is above 550 ng/dL, you likely do not need testosterone replacement therapy. That said, every man is different, and it’s worthwhile to look into TRT if you have symptoms of hypogonadism.
The reality is, men’s average testosterone levels were much higher 1-2 generations ago than they are now, because men were healthier then. A 2007 study showed that American men's testosterone levels had been declining by about 1% per year since 1987, even when adjusted for age. Assuming this trend has continued, that means a 45-year-old man today would have a testosterone level 20% lower than that of a 45-year-old man 20 years ago. A Danish study from 2010 had similar findings, showing that men who were born in the 1960s had testosterone levels 14% lower, on average, than men born in the 1920s.
