Testosterone… The fountain of youth. The cure for all of your aging problems.
Tired? No energy? Take a shot of testosterone.
No sex drive? Take a shot of testosterone.
Gaining weight around the midsection no matter what you do? Take a shot of testosterone.
Depressed? Can’t seem to get out of your funk? Take a shot of testosterone.
Losing strength? No stamina? Take a shot of testosterone.
Despite all of these purported benefits, if I had a nickel for every guy that started testosterone and then subsequently stopped it within 3 months, I’d be able to swim in my piggy bank like Scrooge McDuck.
Yet the science is pretty clear – Guys with low testosterone (T) and symptoms of low T who then start testosterone replacement therapy (TRT), improve.
So, what gives? How can one guy with low T and symptoms of low testosterone be reborn while another guy with the almost exact same T blood levels and symptoms actually get worse when TRT is started?
- Not every problem can be solved with a hammer: Obviously, we’re all different. There’s not a drug on the market today that’s 100% effective for everyone. And when it comes to hormones and very generic, subjective symptoms like low energy, there can be an entire book written on possible causes. It could very well be high cortisol, low B12, an extremely low-fat diet, lack of sleep, or at least 30 other different causes that even injectable testosterone can’t cure.
- A firefighter or a fire starter: I’d be willing to argue that this is the most often cause of a poor response to TRT. Because of the purported benefits and lovely TRT ads from pharmaceutical companies, when we inject T, in our mind, we feel like we’re injecting the blood of a lion, and not just any lion, the biggest, baddest lion in the jungle. Instantly we expect to become the alpha male, oozing strength, stamina, and sex. And worse yet, we expect that without changing anything else. We eat the same crap we’ve eaten for the last 10 years. We don’t exercise. We get 5 hours of sleep a night. We expect testosterone to literally be a magical cure. Guys, that’s not going to happen. In fact, I’d be willing to argue that adding testosterone, especially injectable testosterone, to a poor diet, a lack of sleep, and a lack of exercise just adds fuel to the fire. That’s also why we probably see a study published every so often that says testosterone is dangerous. Because it is if the lifestyle that led to the low testosterone isn’t improved too. However, when added to an improved lifestyle, it’s as close to the fountain of youth as you’re going to get.
- It’s testosterone and…: Testosterone doesn’t act alone. In fact, there isn’t a hormone in the human body that acts alone. Instead, it acts in concert with a team of hormones like estradiol, DHT, insulin, and progesterone. So when testosterone is added to the human body, we have to make sure the other players are within their boundaries too.
Here are a few ways that you can have normal T levels but still feel like like you suffer from low T:
- Estrogen needs to be included in lab testing. Because testosterone can convert to estrogen in the human body via the aromatase enzyme, men can actually produce too much estrogen when they start taking testosterone. When that happens, they become moody, gain weight, experience pain in near their nipples, and overall just feel worse than when they started. A simple aromatase inhibitor like Arimidex can take care of that.
- Most guys will only look at their total testosterone. That’s slightly deceiving because it’s actually the free testosterone that does all of the work. Because testosterone can’t freely float around in our blood, it’s often transported by proteins. One of these proteins is called SHBG, and when bound to SHBG, testosterone has very little activity. So, a guy may have normal levels of total testosterone and still feel like crap because he has elevated levels of SHBG binding up much of his testosterone leaving him with a low free T level.
- Finding the right dose is tricky because normal levels are highly variable, ranging from 270ng/dl to 1000ng/dl. Some guys feel great when their testosterone blood levels are 400ng/dl, while other guys feel awful until their blood levels reach 600 ng/dl or greater. So what happens? A guy starts injecting testosterone for a few weeks, gets his blood tests back, has a level of 450ng/dl which is normal, still feels awful, and assumes because his T blood level is normal, it’s not a T issue. Plus, Billy Bob took T and felt better by his 2nd week and his blood levels were 400. So he stops taking T, and feels awful for the rest of his life. When in reality, the dose should have been changed so he can try higher or lower blood levels until he finds the level he’s comfortable at. For some guys, it just takes time.
- When you inject testosterone, it’s not released into the bloodstream equally. Initially, a lot spills into the blood and creates a peak, and then over time it levels out to what we call steady-state, and then as it’s metabolized, it reaches its low point called the trough. If you inject 200mg every 3 weeks, you can take a blood test each week and your blood T levels will vary greatly even though it’s the same dose.It’s just a different time point for the blood draw from when the dose was injected. So the first week it could be 700 (the peak), the 2nd week it could be 400 (steady-state), and the third week it could be 200 (the trough). So if you accidentally test your blood on week 3, the test would show you still suffer from low T despite you had normal T two-third’s of the time. What happens? Your dose increases to 300mg and now your peak hits over 1000 ng/dl and you actually start feeling worse. You’ll notice this happens when you feel really good for a week or two and then feel worse for a week or two. Usually, the peak is too high or the trough is too low. Often times, it can be alleviated by shortening the time in between shots.
Although it may not seem like it, I’m actually a big fan of T. I read everything I can about it – studies, books, and seminars. In fact, the current spin room in my gym was actually set up to be a compounding pharmacy that specializes in T.
Unfortunately though, it’s often abused and/or misused too often and gets a bad wrap. Hopefully, this clears some things up so the blame isn’t on poor, little T.
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