A question mark

Answers to 15 Common Questions About Testosterone Replacement Therapy

Although I am not a medical professional, and these answers should be considered only as my opinions - I have been on TRT for over a decade, and have quite a bit of experience with it.

1. How does TRT differ from anabolic steroids?

The short answer: TRT differs from steroid abuse primarily due to the doses taken. The actual drugs are often the same, at least when it comes to the base substance of most steroid cycles, which is testosterone.

The long answer: While both TRT and anabolic steroids involve testosterone, TRT aims to restore natural testosterone levels in men with deficiencies. In contrast, anabolic steroids, such as those used by bodybuilders, can elevate testosterone levels far beyond the natural range.

Someone on testosterone replacement therapy might be taking 100mg-150mg of testosterone per week for the long-term. Meanwhile, a bodybuilder taking "steroids" could be using the same exact substance, but would be abusing it at 500mg, 800mg, sometimes over a gram a week. This is typically done in cycles of 8-12 weeks with significantly longer breaks between each cycle.

Learn more in the TRT eBook chapter about testosterone use vs. steroid abuse.

2. Can TRT improve athletic performance?

Yes, TRT can improve athletic performance in men with low testosterone.

3. Are there any dietary or lifestyle changes that can enhance the effects of TRT?

A balanced diet, regular exercise, and adequate sleep can complement TRT. Consuming foods rich in zinc, vitamin D, and omega-3 fatty acids might support healthy testosterone levels. However, if you are on TRT your body will have stopped producing its own testosterone because you are bringing it in from outside (exogenous). Therefore, your overall testosterone levels are unlikely to be affected by diet like they would be if you were not on TRT.

4. How does TRT impact mood and mental health?

Low testosterone can be linked to mood swings, depression, and irritability. TRT can help alleviate these symptoms for some men, but it is essential to monitor mental health throughout the treatment.

Too much testosterone can lead to too much estrogen, which can cause mood swings and other mental health issues. There are medications people take to keep this from happening, but overusing them can result in too little estrogen, which also causes mood irregularities. That's why it is important to get your bloodwork done regularly and talk to your doctor about any major shifts in mood.

Learn more about low estrogen and TRT.

5. Does TRT have any impact on memory and cognitive functions?

Some studies suggest that TRT might improve cognitive functions in men with low testosterone, but more research is needed. If you're experiencing memory issues, it's crucial to discuss this with your healthcare provider.

From an anecdotal perspective, I noticed significant improvement in cognitive function once I started TRT, which included a better memory and sharper thinking. IOW, it cleared up my cloudy mind, which was caused by Low T.

6. Can TRT affect hair growth or loss?

Testosterone can influence hair growth. While some men might experience increased body hair, others might notice accelerated hair thinning or loss on the scalp.

My family does not suffer from male-pattern baldness, yet I have thinning and receding hair. I am sure this is because of my use of testosterone, and it's conversion to DHT. After I started taking oral finasteride and using topical minoxidil my hair loss stopped, and even reversed after six months. I don't have the hair my brothers have, but I'm no longer going bald.

7. How does TRT interact with other medications?

TRT can interact with certain medications, including blood thinners and insulin. Always inform your doctor about any medications or supplements you're taking.

Personally, I notice TRT has an affect on my thyroid medication. The same amount of levothyroxine has different effects on my thyroid stimulating hormone (TSH) levels depending on how much testosterone I'm taking. When I take more testosterone, I need less levothyroxine. This is just one example of many I've experienced or heard about.

8. Are there any alternative treatments to TRT?

There are alternative medical treatments, such as clomiphene citrate and human chorionic gonadotropin, which stimulate the body to produce more testosterone naturally. You can discuss these options with your healthcare provider. There are also alternatives like OTC health supplements, and certain activities and exercises that are known to naturally increase testosterone levels in men.

Learn more about natural testosterone boosters in Chapter 8. of our TRT eBook.

Personally, I have found supplements like tribulus and horny goat weed to be next-to-useless compared to actual testosterone treatment.

9. How often should I monitor my testosterone levels while on TRT?

Regular monitoring is crucial. Most doctors recommend checking testosterone levels every few months, especially during the initial stages of treatment.

I get mine checked every six months, but it used to be every three months when I first started.

10. Can TRT influence sleep patterns or cause sleep apnea?

Some men report changes in sleep patterns or the onset of sleep apnea with TRT. If you experience sleep disturbances, it's essential to discuss them with your doctor.

I have sleep apnea, even though I'm healthy, don't drink much and have a low bodyfat percentage. I think this is because of my testosterone use.

11. Is there a "best time" of day to administer TRT?

Depending on the form of TRT, there might be optimal times for administration. For instance, testosterone gels are often applied in the morning, but injections might have a different schedule. Follow your doctor's recommendations.

I take mine after I shower in the evenings. It doesn't really matter, in my experience.

12. Can TRT affect one's voice?

While testosterone plays a role in voice deepening during puberty, it is uncommon for TRT to significantly alter an adult's voice. However, some subtle changes might occur.

It tends to affect womens' voices much more than mens'.

13. How does alcohol consumption impact TRT?

Excessive alcohol can lower natural testosterone levels and might reduce the effectiveness of TRT. It's advisable to moderate alcohol consumption while undergoing treatment.

14. Does TRT affect one's ability to have children?

Yes, TRT can impact fertility. Testosterone therapy can reduce sperm production, potentially leading to a lower sperm count. This reduction can affect one's ability to father children. If you're considering starting a family or adding to it in the future, discuss this with your healthcare provider before beginning TRT.

A few options:

  • Wait to start TRT until after you have had all the children you want.
  • Prior to going on TRT, freeze some sperm at the fertility clinic to use when you're ready to have kids.
  • Ask your doctor about taking Human Chorionic Gonadotropin (HCG) when you are ready to have children if you have been on TRT.

15. Once I start TRT, do I have to be on it for life?

Not necessarily. Some men choose to remain on TRT long-term to maintain its benefits, while others might stop after a certain period. If you decide to discontinue TRT, it's essential to do so under the guidance of a healthcare professional. Abruptly stopping can lead to withdrawal symptoms or a return of low testosterone symptoms. It's also worth noting that natural testosterone production might be suppressed while on TRT, and it can take time for the body to resume its normal production once the therapy is stopped.

Unofficially - Yes, TRT is for life. Any time someone asks me if they should "try" TRT, I ask them if they're ready to be on it for life. If they say no, then I say no as well. Unless you take HCG regularly, your testicles will shrink (unless you take HCG regularly) and your body will stop making its own testosterone. HCG has its own set of complications and most people don't take it long-term.

If you're looking for quick muscle gains and then hope to get off "TRT," then you're not wanting TRT. You want steroids. Same but different. See question #1.

Man injecting steroids

Ten Most Popular Anabolic Compounds

Here is a list of the top 10 anabolic compounds commonly used by bodybuilders and TRT clinics for hormone replacement therapy:

Testosterone: The most common anabolic compound used for hormone replacement therapy, testosterone is the primary male sex hormone responsible for building muscle mass and strength, as well as maintaining bone density and sexual function.

Testosterone medications come in many forms, usually differentiated by how long they last in the body. Here are a few of the most commonly prescribed testosterone compounds:

  1. Testosterone Enanthate: A long-acting testosterone ester that provides a slow and steady release of testosterone into the bloodstream.
  2. Testosterone Cypionate: A long-acting testosterone ester that is similar to testosterone enanthate in terms of its effects and duration.
  3. Testosterone Propionate: A short-acting testosterone ester that is commonly used by bodybuilders for its fast-acting effects and frequent dosing schedule.
  4. Testosterone Undecanoate: A long-acting testosterone ester that is taken orally and is known for its low impact on liver function.
  5. Testosterone Sustanon: A blend of testosterone esters that includes testosterone propionate, testosterone phenylpropionate, testosterone isocaproate, and testosterone decanoate.

Nandrolone: Also known as Deca-Durabolin or Deca, nandrolone is an anabolic steroid that is commonly used for muscle building and recovery. It is also used to treat conditions such as osteoporosis and anemia, as it can help to increase bone density and red blood cell count. People often take this to repair joint injuries faster.

Stanozolol: Also known as Winstrol, stanozolol is an anabolic steroid that is commonly used by bodybuilders for its ability to increase muscle size and strength, as well as for its fat-burning properties. Stanozolol is often used in cutting cycles, as it can help to reduce body fat while preserving muscle mass.

Oxandrolone: Also known as Anavar, oxandrolone is an anabolic steroid that is commonly used for its ability to increase muscle mass and strength, as well as its fat-burning properties. It is also used to treat conditions such as osteoporosis and muscle wasting, as it can help to increase bone density and muscle mass. Like nandrolone, this is often used for joint injuries.

Trenbolone: is an anabolic steroid that is commonly used by bodybuilders for its ability to increase muscle mass, strength, and endurance, as well as its fat-burning properties. Trenbolone is often used in bulking cycles, as it can help to increase muscle mass and strength while reducing body fat. This is not commonly prescribed by TRT clinics.

Methandrostenolone: Also known as Dianabol or Dbol, methandrostenolone is an anabolic steroid that is commonly used by bodybuilders for its ability to increase muscle size and strength. Methandrostenolone is often used in bulking cycles, as it can help to increase muscle mass and strength quickly. It is not commonly prescribed and is known to cause liver damage if abused.

Boldenone: Also known as Equipoise, boldenone is an anabolic steroid that is commonly used by bodybuilders for its ability to increase muscle mass and strength, as well as for its ability to improve recovery and endurance. Boldenone is often used in long cycles, as it has a slow and steady effect on the body. It is actually a steroid made for veterinary use so you won't find this at a TRT clinic.

Masteron: An anabolic steroid that is commonly used by bodybuilders for its ability to increase muscle size and strength, as well as for its fat-burning properties. Masteron is often used in cutting cycles, as it can help to reduce body fat while preserving muscle mass.

Primobolan: An anabolic steroid that is commonly used by bodybuilders for its ability to increase muscle size and strength, as well as for its fat-burning properties. Like masterone, primobolan is often used in cutting cycles, as it can help to reduce body fat while preserving muscle mass.

There are many other anabolic, androgenic and non-anabolic compounds that are commonly used by bodybuilders, some of which are sometimes prescribed by TRT clinics. These include:

Human Chorionic Gonadotropin (HCG): HCG is a hormone produced by the placenta during pregnancy and is commonly used by bodybuilders to maintain testicular function and fertility during a cycle of anabolic steroids. This is sometimes prescribed by doctors for TRT.

Human Growth Hormone (HGH): HGH is a hormone produced by the pituitary gland that stimulates growth, cell reproduction, and cell regeneration. Bodybuilders use HGH to increase muscle mass, reduce body fat, and improve recovery time. Although sometimes prescribed by anti-aging clinics, HGC can be a particularly dangerous substance to use over time, as it can cause your heart and other organs to increase in size, and can change the bone structure, especially in the face.

Insulin: Insulin is a hormone produced by the pancreas that regulates glucose levels in the bloodstream. Bodybuilders use insulin to increase muscle growth and improve recovery, as insulin helps to transport glucose and amino acids into muscle cells. Unless they are diabetic, doctors will strongly discourage people from injecting insulin, as it can - and has - killed people who abuse it or take it incorrectly.

Clenbuterol: Clenbuterol is a stimulant that is commonly used by bodybuilders for its fat-burning properties. Clenbuterol increases the metabolic rate, which helps to burn fat more efficiently. This typically comes in a gel form that is taken orally. It can be particularly dangerous for people with cardiovascular disease.

Dehydroepiandrosterone (DHEA): DHEA is a hormone produced by the adrenal glands that acts as a precursor to testosterone and other hormones. Bodybuilders use DHEA to increase muscle mass and strength, as well as to improve overall well-being. This is one of the few steroid-like substances that can be purchased legally without a prescription.

Drawing oil for a testosterone injection

TRT Dosage Calculator

Use the simple calculator below to easily figure out how much to draw for each injection based on the number of injections per week, the strength of the testosterone oil, and your desired dosage. This could be used as a steroid calculator or for testosterone replacement therapy.

Testosterone Dosage Calculator

If I want to take 300 mg per week divided into two shots, and the oil is 250mg per mil, how much would I need to take for each shot?

300 mg / 250 = 1.2 mil per week

Answer: I would want to inject 0.6 milliliters per shot, twice per week to reach the desired TRT dose.

Related: Find out how many shots you'll need to take over your lifetime of TRT.

Testosterone injection needle

The Half Lives of Different Forms of Testosterone

The following table lists the half-life of the most popular forms of testosterone used in testosterone replacement therapy from longest to shortest.

Form of Testosterone Half-Life
Testosterone cypionate 8 days
Testosterone enanthate 4.5 days
Testosterone undecanoate 20 days
Testosterone propionate 2 days
Testosterone gel (transdermal) 2-4 hours
Testosterone patches (transdermal) 24 hours
Testosterone pellets (implanted subcutaneously) 3-6 months
Buccal testosterone 10-12 hours
Nasal testosterone 2 hours

How long does it take to reach peak testosterone levels with TRT?

The table below shows how long it would take for testosterone to reach peak levels in the bloodstream for each type of testosterone. After the peak, testosterone levels will gradually decline until the next administration.

Form of Testosterone Time to Reach Peak Levels
Testosterone cypionate 2-3 days
Testosterone enanthate 2-4 days
Testosterone undecanoate 7-14 days
Testosterone propionate 1-2 days
Testosterone gel (transdermal) 2-6 hours
Testosterone patches (transdermal) 24 hours
Testosterone pellets (implanted subcutaneously) 1-2 weeks
Buccal testosterone 30 minutes
Nasal testosterone 30 minutes

How often do you take testosterone for TRT?

The table below shows how frequently each form of testosterone is typically administered.

Form of Testosterone Typical Administration Frequency
Testosterone cypionate Every 7-10 days
Testosterone enanthate Every 7-10 days
Testosterone undecanoate Every 10-14 weeks
Testosterone propionate Every 2-3 days
Testosterone gel (transdermal) Daily
Testosterone patches (transdermal) Daily
Testosterone pellets (implanted subcutaneously) Every 3-6 months
Buccal testosterone Twice daily
Nasal testosterone Twice daily

I personally split up dosage of testosterone enanthate into two shots per week because it provides me with more stable testosterone levels and reduces side effects.


Why are testosterone enanthate and testosterone cypionate taken at the same frequencies when they have very different half-lives?

Testosterone enanthate has a half-life of approximately 4-5 days, while testosterone cypionate has a half-life of approximately 8 days. This means that it takes longer for testosterone cypionate to be eliminated from the body compared to testosterone enanthate. However, both forms of testosterone have a similar duration of action, which is why they are both typically administered every 7-10 days in testosterone replacement therapy.

In this context, "duration of action" refers to the length of time that a drug remains active in the body after administration. For testosterone replacement therapy, the duration of action refers to the length of time that the testosterone levels remain within the therapeutic range after a dose of testosterone is administered.

The duration of action of a drug can depend on many factors, not just the half-life of the drug. While testosterone enanthate and testosterone cypionate have different half-lives, they have a similar duration of action because they both have a similar pharmacokinetic profile.

While testosterone cypionate has a longer half-life than testosterone enanthate, the duration of action is not solely determined by the half-life. Other factors, such as the rate of absorption and metabolism, can also impact the duration of action. Additionally, the frequency of administration can be adjusted to achieve the desired duration of action.

Ultimately, the appropriate form of testosterone and the frequency of administration should be determined by a healthcare provider based on the individual's specific needs and medical history.


How Some Health Supplements Can Drop Testosterone Levels

I was going to title this post:
How So-Called "Natural" Testosterone Boosters, Prohormones and Other Over-The-Counter Health Supplements for Building Muscle May Cause Hypogonadism

But that's a little long ;-)

4-chloro-17a-methyl-androst-1-4-diene-3b-17b-diolWhile the FDA does a pretty good job of regulating "medicines" they don't do such a good job of regulating health supplements, which generally fall under "food" guidelines, which are much more lenient than what prescription-grade pharmaceuticals have to deal with (e.g. years of laboratory testing, human trials, etc...). The FDA has tried several times to expand the definition of pharmaceutical drugs and thus their jurisdiction over health supplements. Some see this as a good thing; others see it as a bad thing. I'm going to stay out of that argument. But I will say this: There's a big difference between something like vitamin B, whey protein, or acai berries and things like 3,17-keto-etiocholetriene and 4-chloro-17a-methyl-androst-1,4-diene-3b,17b-diol.

Have you ever taken an over-the-counter, legal supplement - like pro-hormones - only to find out afterwards that you have low testosterone?
Did you gain  lose fat while taking a supplement, only to gain all of it - and more - back when you stopped taking it? Did you get steroid-like side effects (e.g. gynecomastia, hair growth...) from legal bodybuilding supplements? You may be surprised to find out that many of those so-called supplements actually break down into the same ingredients found in "real" illegal or prescription-grade steroids, aromatase inhibitors, estrogen blockers, erectile dysfunction drugs and other pharmaceutical substances. If you find this difficult to believe, just read some of these recalls, which are just the tip of the iceburg (those that got busted) when compared to how many are still out there:

Recalled Health "Supplements":

Gaspari Nutrition Recalls Novedex XT, Marketed as a Dietary Supplement Containing ATD
(AKA 3,17-keto-etiocholetriene, an anti-aromatase used to lower estrogen-related side-effects in men taking steroids.)
iForce Nutrition Recalls Reversitol, a Dietary Supplement Containing ATD
(See above description RE: ATD)
Bodybuilding.com Supplements Recalled: May Contain Steroids
(Big recall in 2009 involving dozens of supplements that the FDA said should have been classified as steroids like Trenbolone, Androstenedione and Turinabol.)
Good Health, Inc. Recalls Vialipro – Contains Prescription-Only Ingredients
(These recalls in which sexual enhancement drugs sold at gas stations, truckstops and online contain real erectil dysfunction medications like sildenafil -aka Viagra - or substances like Sulfoaildenafil, that break down into Sildenafil, are quite common.)
IDS Sports Conducts a Voluntary Nationwide Recall of Bromodrol, Dual Action Grow Tabs, Grow Tabs, Mass Tabs, and Ripped Tabs TR
(Similar to the Bodybuilding.com recall, there were several supplements that were found to contain ingredients the FDA deemed should have been classified as steroids.)

Want to see hundreds more like this? Check out US Recall News' Dietary Supplement section

If something is being marketed in the back of a bodybuilding magazine with steroid-sounding names like Bromodrol, Dbolz, Testosterone Booster Tripple X... you should think about what that marketing is trying accomplish. I'm not anti-steroids when it comes to adults making their own health decisions. And I certainly don't think the government should be telling us what vitamins we can take without a prescription. But neither should teenagers, women or unsuspecting male athletes be conned into taking health risks and job risks under the false pretense that they are taking "legal" supplements that don't have any side effects.

So if you've ever taken a health supplement that produce too-good-to-be-true results, only to find that you crashed when you came off, or that your testosterone levels were low after long-term use of these drugs, you may have actually been taking steroids, or something analogous to them in effects and side-effects. It makes me wonder how many guys end up on lifelong testosterone replacement because of these supplements, especially since they probably didn't take appropriate post-cycle-therapy precautions.


Stockpiling Testosterone and Thyroid Medications

Apotek © by Sunfox

I'm the type that plans for the worst and hopes for the best. We have a pantry full of canned food from the garden, a gas generator for power outages, and long-term supply of clean drinking water and several first-aid kits throughout the house. That's why I read this blog, which inspired me to write my own post about stockpiling medication. I don't think the zombie-apocalypse is coming and I'm only half-sure that we could face some kind of long-term economic meltdown. I'm not a conspiracy nut and I don't have a bomb shelter. I'm a pretty normal guy, actually. But in the event that something catastrophic does happen - economically, socially or environmentally - I wouldn't want to be put in the situation where I only have 1-3 months worth of medication on-hand. In my case, I depend on testosterone and thyroid hormones. Without them life gets pretty bleak for me. With them I not only feel "normal" - I feel great.

All of this is to bring up the topic of stockpiling testosterone, thyroid hormone and any other medication you have to take long-term. Here are some options we can consider:

  1. Ask your doctor if he/she would prescribe you enough to last a year. I don't mean enough "refills" but enough at once. A refill does precious-little if the pharmacies have all been pillaged. Pro: It is perfectly legal. Con: Fat chance you'll get them to agree, and it would be very expensive if you did because insurance is unlikely to cover that.
  2. Head down to Mexico or another country that has cheap meds and shady doctors who will prescribe you whatever you want. Pro: It comes with a vacation. Con: Crossing the border with a year's worth of any medication is going to be risky - especially controlled substances like testosterone.
  3. Find a compounding pharmacy or HRT clinic (if hormone meds are what you need) and ask for the year's supply. Pro: They tend to be a little more understanding than the average endocrinologist and, when it comes to uninsured meds, a little cheaper than the local pharmacy. Con: You have to find one you can trust.
  4. Start skipping a dose now and then, or taking less for awhile, and gradually build up a stockpile. Pro: Easy, cheap and legal. Con: It would take a very long time and I don't like the idea of skipping doses.
  5. Tell your doctor you're on vacation and forgot your prescription next time you're out of town. Pro: They'll usually write you a new prescription, which is often covered by insurance. Con: You can only use this trick once or twice a year without raising suspicions.

In the end I think I'm going to combine several of the options above for a multifaceted approach to stockpiling my meds in case of a long-term shortage or emergency. Hopefully it will never come to the point where I'd not be able to obtain my medications, but I'd rather be safe than sorry when it comes to something as important as access to my thyroid medication or testosterone.

A note about expiration dates: The pharmaceutical companies like to make money. That much is obvious. One way they generate more revenue is by making expiration dates much sooner than they need to be. This keeps them safe from lawsuits regarding under-dosed meds (they start gradually losing potency after expiration, but don't just suddenly become "no good") and keeps you buying more medication. The best thing to do once you build up a stock-pile is to rotate your meds so you are using the oldest from the shelf and replacing them with the ones you just got from the pharmacy. In this way you'll never be using expired medication, and will always have a surplus to cover you for long-term shortages and emergency situations.

Anyone have any better ideas about this topic, or anything else to ad?

DIY Testosterone Injection

502 – My Lucky Number

Normal Testosterone Levels for Me - 502After one month of testosterone injections of 100mg per week (.5 mil of 200mg/mil injectable oil) using testosterone enanthate my test levels are at 502. I wanted to take what was prescribed for awhile to see where that would put me. This was also near the end of the week so I'm guessing that is the lower end of the spectrum, although when injecting enanthate (generic form of Delatestryl) every week the spectrum probably isn't too wide. My guess is I'm anywhere from between 500 and 800 ng/dl. The government website Medline Plus puts the "normal" range for men at 300 to 1,200 ng/dL. Given that this includes 25-year-old guys at the peak of their physical condition, I think maintaining somewhere between 500 and 800 is going to work out well for me healthwise. I feel good in this range.

Now... with that said, I am hereby embarking on the "Blast" phase of my year, where I will be taking double that amount for several months before tapering back down to 100 mg per week. I believe at 200mg per week I will still be within safe-enough levels to avoid any major side effects (hopefully) associated with steroid use, as bodybuilders frequently start at a minimum of 500mg per week (up to more than 2 grams in some cases) in addition to several other androgenic / anabolic steroids like nandralone, stanozolol, dianabol and equipoise. At this point one needs to take a whole host of other medications to combat the side effects, both during the "cycle" and during the post-cycle-therapy (PCT) phase, including things like tamoxifen citrate (generic Nolvadex), clomophene (Clomid), and anastrozole (Arimidex). Since I don't plan on having any more children, I am not even taking HCG. Right now it's just testosterone, although I do plan on having some Nolvadex and/or Arimidex on-hand just in case I feel any estrogen-related side effects.

So that's the plan. If I'm going to be on testosterone for the rest of my life, I might as well enjoy the benefits of being able to have a great sex drive and physique for the rest of my life without having to hassle with the crashing testosterone levels experienced at the end of normal testosterone cycles for men who aren't on lifelong TRT.

Please keep in mind that A: I am not interested in being a bodybuilder and do not need to take 500mg of testosterone to be "in good shape". B: I want to avoid as much ancillary medication as I can without experiencing estrogen-related side-effects. C: I do plan on tapering from 200 mg/week, to 150 mg/week for one month before going to the normal 100 mg/week to give my body time to metabolize some of the estrogen and catabolic hormone build-up while staying in the proper balance of having more testosterone in relative amounts to the other hormones.

I'd appreciate any feedback you might have on this, especially if it sounds like something you have tried yourself in the past.

The End of Hope for Natural Testosterone Production & The Beginning of Lifelong TRT

Between the Testim yesterday and today, and the HCG I've been taking - I feel great. I'm not back to "normal" yet, but I'm getting there and it's not just placebo. I'll probably have to switch to Androgel if I want my insurance to cover it, but there isn't much of a difference, other than smell and stickyness.

A long hard road.It has been a long, hard, six-month road of trying to get my natural testosterone production back up. I've tried several alternative treatments for low-T, including - for six months - only natural things like zinc, magnesium, tribulus and deadlifts at the gym. I didn't want to go on life-long TRT at my age, so my hope (once it was clear that my secondary hypogonadism was here to stay, and that I wasn't going to produce enough LH and FSH to make adequate testosterone) was that I could take Menopur or HCG instead of testosterone. That way at least my testes would stay "normal" and I'd be treating the problem at its source, rather than the symptom down below. But, alas, the US medical system wore me down. I just couldn't live like that anymore. I was depressed, losing more weight every month (185, 182, 179, 175, 170, 169... how low can I go?); was losing motivation and memory by the day; and generally just felt like CRAP.

The doctor still won't prescribe me injectable testosterone, and I'll be damned if I'm going to give those idiots $40 twice a month to stick a needle in my ass. So I'll continue to get my Testim or Androgel so I can stock-pile it away (because I'm paranoid about not having access to testosterone at some point in my life now that I'll be on it forever and life is miserable without it) and will instead be ordering injectable testosterone online from a compounding pharmacy somewhere. I'll be sure to use up the gel stuff before it expires, but they generally last 2-3 years unopened under the right storage conditions. And that's just the labels expiration date. They probably last a lot longer than that.


I'm back on TRT. For good this time... unless something better comes along that is affordable (unlike menopur) and works without shutting down my testes directly (testosterone), or downregulating / desensitizing the leydig cells in the testes indirectly (HCG).

I feel good. I'm sure in six months I'll be back to feeling like I wish I didn't have to take this damn shot, or rub this damn gel in all the time - but right now I feel good. I'm looking forward to getting my life back. If you want to follow along the journey of a young man (33 now, 30 when I was first diagnosed, 31 when I started TRT, 32 when I tried to come off it and use alternatives) who has to take testosterone for the rest of his life - stick around. This blog is going to be up a looooooooooong time - providing, of course, that I don't get prostate cancer at an early age and die. If I do I'll try and let you know.


Who Might Know More About HRT Than Your Doctor? Hint: Big Biceps & Speedos

No this is not a real bodybuilder. It has been photoshopped.When it comes to diagnosing and treating any hormone deficiency - including testosterone, growth hormone and thyroid - your doctor should be the first stop. A primary care physician may run some tests, but eventually he or she will probably send you to an endocrine specialist (endocrinologist). The primary care doctor needs to know a little about everything, while the specialist needs to know a lot about a little, and that little happens to be the well-studied, FDA-approved, time-tested treatments for problems with your endocrine system (aka your hormones).

What the endocrinologist may not know, however, are the many alternative treatments, unapproved (by the FDA) ways to combat side effects, and other tidbits that come with the territory of injecting yourself with more than ten times the amount of male hormones (androgens) that would be found naturally in any human being. Bodybuilders have been doing exactly that for a very long time. Think back to when the governor of California was a teenager living in Austria and television was black and white. And yes, Arnold Schwarzenegger did steroids (he has admitted to taking them, including Dianobol).

Once again, I want to make this very clear: Your DOCTOR is who should be consulted when it comes to your health, including Hormone Replacement Therapy (HRT). But what I'm getting at here is that there are decades of accumulated, anecdotal information and opinions to be had out there on the web. All you have to do is look up "bodybuilding forums" on Google and find the steroids section.

While I would never take some random bodybuilder's advice over that of my doctor's (at least the one I have now, who I happen to trust - unlike the last one) some of the stuff I've read in these forums has given me the necessary background and confidence to ask my doctor the tough questions, such as: "Why are we treating the symptoms of secondary hypogonadism with something that will cause the much worse condition of primary hypogonadism?" Or how about the question: "Could you check my estradiol levels please? Because I read online that high estradiol levels can suppress testosterone production".

Menopur - An alternative to TRT for men with secondary hypogonadism?

Two Alternatives to TRT for Secondary Hypogonadal Men

Menopur - An alternative to TRT for men with secondary hypogonadism?As I posted before, I have secondary hypogonadism. Read more about the difference between primary and secondary hypogonadism here if you don't already know what that means. Basically, if you have primary hypogonadism (testes are not producing enough testosterone) what you would probably end up doing is taking testosterone for the rest of your life. If you have secondary hypogonadism (testes are fine; problem is elsewhere, such as LH and FSH), taking testosterone will give you primary hypogonadism. However, that doesn't stop doctors from prescribing testosterone to treat secondary hypogonadism. They are comfortable with the medications available; have seen them work wonders for hypogonadal men; and have probably noticed relatively few side-effects for a huge improvement on quality of life.

But there ARE other options. I'm not talking about taking tribulus or zinc supplements; I mean real treatment alternatives that have been anecdotally shown to help some men return their system to its proper balance. The two I have been reading about are listed below....

#1 - Block Estrogen Production
What I'm doing is taking a drug called Arimidex, which was designed to reduce estrogen in women at risk of, or for early treatment of breast cancer. One of the places on which I've found a lot of anecdotal information are the various steroid forums frequented by amateur and professional bodybuilders. A lot of bodybuilders take this drug to combat the side-effects of juicing up with ten times or more of the "natural" levels of testosterone men are supposed to have. The body responds to this much testosterone by making more estrogen (or estradiol to be more precise). I am not doctor, but my understanding is that the male body turns some of the excess testosterone into estrogen. This is called aromatization. Aromatase inhibitors like Arimidex keep that aromatization from happening.

It has been theorized by many in the bodybuilding community, based on limited studies and decades of personal experience, that estradiol is more to blame for shutting down the natural production of testosterone than the actual testosterone that is being injected. It has also been theorized that bringing your body's estradiol levels to near-zero will stimulate your body to produce more testosterone so that it can aromatize it and make estradiol. Although I'm not going to link out to online steroid conversations, there are lots of threads on bodybuilding forums outlining some of the concept and sharing some anecdotal evidence as to the efficacy of this approach. Use Google and I'm sure you'll find them. But keep in mind this approach is using a medication for purposes other than what it was intended for, and for purposes which the medication was not tested for.

With full understanding of the above, I am currently trying this alternative with the knowledge and support of my primary care physician. If it doesn't work within 6 months I will move on to the second alternative below. By the way, an endocrinologist isn't going to want to let you try this approach. He will claim it has to do with these medications not being tested on men, but given the relatively low risk of side effects (when compared with permanent testosterone replacement) of temporarily taking aromatase inhibitors - my guess is it has more to do with the fact that this could FIX your problem. Then your endo would be out of a job. ;-)

#2 - Treat the Problem, Not the Symptom
One of the readers here pointed me to a drug called Menopur. Again, this is a drug for women. It is a fertility drug used to induce the development of multiple eggs and pregnancy in women who are able to produce and release eggs (ovulate). In other words, this is the kind of stuff to blame for Octamoms. But really the active ingredients are two hormones that are produced in men called follicle-stimulating hormone (FSH), and luteinizing hormone (LH). These two hormones are responsible for telling your testes to make testosterone. In my case, as is often the case with secondary hypogonadal men, my body is not producing enough of either of these hormones. So why not take THIS drug instead of taking testosterone? Why not replace what I'm missing instead of replacing the hormone that what I'm missing is supposed to be producing?

If one of the two above alternatives to permanent testosterone replacement therapy (TRT) works for me I'll let you know, at which point I'll probably give up the blog. If neither works for me I will resign myself to a life of testosterone injections (I'm done with the creams; they give me terrible chest acne, and sometimes boils, not to mention the danger of contaminating surfaces like the faucet and towels, which my wife also touches) and you will have an author here at the testosterone replacement therapy blog for a long, long time...