Beginner’s Guide To Testosterone Replacement Therapy

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At 58 years old, my body looks better, my mind is sharper and I feel better than I ever have in my life. Testosterone replacement therapy, or TRT, has played a significant role in reaching success in both my fitness goals and in my daily life. The Superman tattoo I have on my body is my motivation and inspiration and it’s also my message to others that they too can live a long, healthy and active life if they take care of themselves.

There’s nothing worse than watching your body change over the years. For me, it was a noticeable change from the ages of 42 to 52. I knew something was off, but did not understand what was going on. After all, I was in the gym 5 times a week training and doing lots of cardio. I remember thinking to myself that I was just getting older and there was nothing I could do about it. I found out later, after much anguish, that I had low testosterone, or “Low T”. This coupled with a poor diet and I was regressing at an alarming rate! It was very depressing to watch an attractive body slowly wither away. I know that many others are going through the same thing as I had experienced. An alarming 50% of men and women over the age of 40 have low testosterone and are experiencing the same side effects. It’s scary to think that 80% of men and women over the age of 50 have low testosterone. Low testosterone not only changes our bodies as we age, but it also causes many other health issues and is an indicator of early death.

Most people in these age categories mentioned above do not exercise enough and also have poor diets which makes matters worse. Many that fall into these categories really care about their health, but focus on the wrong things. Our bodies change as we age and our testosterone levels decrease. After the age of 30, most people experience a decrease in their natural testosterone levels by about 1.5% per year. The problem gets even worse for those that aren’t active and have a poor diet. Many people show up in the gym thinking their problems will be solved once they start working out a few times per week. Unfortunately, unless hormone levels are optimized, making significant changes in building lean muscle and decreasing body fat are minimal at best. Most individuals don’t understand what is really going on with their bodies so they are unable to engage their medical professional in a conversation about their own health. Low testosterone is clearly a health issue and can be a precursor to many other health issues. Most people will simply think that the decline in their physiques and overall health is just a result of getting older and there is nothing they can do about it. The reality is that if low testosterone levels aren’t addressed as a person gets older, the problem gets worse, not better. It’s up to you to dictate your own future and it’s really not worth gambling with your health. I’ll never go back to the way I used to look and feel before starting testosterone replacement therapy because my future is bright and I will only get healthier as I age.

Do You Have Low Testosterone?

  • Approximately 1 in 4 men under the age of 40 have low testosterone.
  • The average male will have a 1.5% decline in natural testosterone production after the age of 30.
  • 50% of all men above the age of 40 have low testosterone.
  • 80% of all men above the age of 50 have low Testosterone.
  • Individuals who are taking erectile dysfunction drugs may be treating the symptom and not addressing the main cause, which could be low testosterone.

Symptoms of Low Testosterone:

  • Low libido
  • Erectile dysfunction (ED)
  • Low energy
  • Loss of strength
  • Weight gain
  • Decrease in lean muscle mass
  • Problems sleeping
  • Mood swings
  • Increase in belly fat
  • Irritability

What should you do if you have these symptoms? You should visit a doctor or anti-aging clinic that specializes in hormone replacement therapy. These are specialists who are much more knowledgeable about low testosterone than your local family physician will be. Many people think that their general practitioner is testing for low testosterone, but they will only perform those blood tests if you personally request them. Most general practitioners will not even think about running these tests and they rarely ask specific questions or examine patient’s health records which would clue them in on why you might have a potential issue with low testosterone. Most men above the age of 40 should be tested, and especially if you’re experiencing the symptoms described above. I know several men in their early 30’s that have low testosterone. I highly recommend using well-known anti-aging clinics in your area that specialize in hormone replacement therapy.

Health Issues Associated with Low Testosterone:

  • 88% more likely to die an early death.
  • Increased risk of Alzheimer’s disease.
  • 2.4 times more likely to be obese or overweight.
  • 2.1 times more likely to have diabetes.
  • 1.8 times more likely to have high blood pressure.
  • Increased risk of cardiovascular disease.
  • Decrease in bone density.

Factors That Can Negatively Impact Testosterone Levels:

  • Age.
  • Diet.
  • Lack of sleep.
  • Drug and alcohol usage.
  • Chemicals in our food.
  • Lack of physical activity.

The purpose of this article is to educate middle-aged people about this life changing therapy. Currently, most middle-aged individuals are not aware of this amazing medical advancement that can prolong life and improve the overall quality of your daily life. Unfortunately, most middle-aged people are not doing the first step of getting their testosterone levels checked and are not even aware that hormone replacement therapy is available to them. These individuals will continue to suffer and unknowingly increase their health risk. Low testosterone levels that are left untreated can be a precursor to many other health issues. I find it interesting that most doctors do not even engage their patients in conversations about this major issue with Low T.

At the age of 52, I was ready to make a change and a friend of mine at the gym had mentioned that I might want to have my testosterone levels checked. I decided to go see a doctor that specialized in hormone replacement therapy and that decision changed my life. Up until the age of 52, I never had a medical doctor even come close to discussing the possibility that I had low testosterone even though I experienced most of the symptoms for over 10 years. The specialized doctor at the anti-aging clinic had me fill out a questionnaire and did a complete blood workup on me. The results of the blood test clearly indicated I had low testosterone levels.

What is Testosterone Replacement Therapy (TRT)?
Most middle-aged people experience a loss of lean muscle mass and an increase in body fat as we get older. Testosterone replacement therapy brings these levels back to an optimal range where are bodies can once again function normally. Normal testosterone levels in healthy men generally range between 300 ng/dL and 1050 ng/dL. Most anti-aging doctors consider treatment when a patient’s total testosterone in the blood stream is 400 ng/dL or lower. If you have low testosterone and you seek hormone replacement therapy, remember that the therapy will be ongoing for the rest of your life as long as you want to have optimized testosterone levels.

Options for Testosterone Replacement Therapy (a few of the popular methods):

  • Testosterone Shots – These are intramuscular injections (IM injections) that are usually performed once a week either by the anti-aging clinic’s doctor or self-administered by the patient. Most people who are on TRT, perform the injections themselves since it’s relatively easy to do. The anti-aging doctor or nurse will show you how and where to inject, and will usually perform the first injection for you. The most popular injection sites are located in the gluteal region (upper, outer quadrant of the butt) or the quadricep (thigh muscle). The normal syringe is 3CC and the needles can range between 23-25 gauge (thickness) and 1 to 1.5 inches (length). The most typical type of testosterone that is prescribed is either testosterone cypionate or testosterone enanthate (different esters) and they usually come in 200MG dosages. The typical testosterone replacement dosage for most patients is 100-200MG per week (0.5 to 1 CC) depending on your current testosterone levels. A bottle of testosterone (10ML) normally ranges between $125 to $150 per bottle depending on your anti-aging clinic and lasts about 10 weeks (at 200MG per week injections). You can also use prescription discount cards (GoodRX) and get a bottle of testosterone for around $45 at your local Walgreens or Rite Aid. If you opt for the prescription discount card route, you will also have to pay a prescription fee to your anti-aging clinic for an additional $25 to $40 for them to send the prescription into the local pharmacy, but it still comes out to be a savings of about 50% when you purchase it this way.
  • Androgel – This comes in a cream form and is very easy to apply. It’s great for people who don’t like injections. Dosage can be inconsistent due to the application and must be applied daily. You also must be careful to avoid applying the cream where others can be in contact with your skin (playing with children, touching your wife, etc.) since the cream is easily absorbed through the skin and can cause unwanted side effects if others are in contact with it. The overall cost is higher than the testosterone shots.
  • Testosterone Pellets (Testopel) – These are injected every 3 to 4 months and cost about $150 to $300 dollars per month (plus anti-aging clinic fees). This is the least used method for administering testosterone replacement therapy.

Benefits of Testosterone Replacement Therapy:

  • Increased lean muscle mass.
  • Reduction in body fat.
  • Increased sense of well-being.
  • Better mental focus.
  • Improved sleep.
  • Maintain bone density and strength.
  • Increase strength and general conditioning.
  • Improve mood.
  • Improve sex drive and performance.
  • Increased energy and motivation.

Potential Side Effects
Since testosterone replacement therapy is a medication, potential side effects can occur from using this drug. This is why it’s so important to have your blood labs completed every 6 months to ensure your blood work is normal. Your anti-aging doctor will closely monitor your blood results and adjust the medication and dosages if needed. The doctor will keep a close eye on your PSA numbers (prostate levels), your H&H levels (hemoglobin and hematocrit) and your estrogen levels (estradiol). When testosterone is administered exogenously (outside the body), an enzyme called aromatase is released which converts excess testosterone into estrogen which can cause your estradiol levels to increase and may result in unwanted side effects like water retention and breast enlargement (gynecomastia). If your estradiol levels get too high, your anti-aging doctor will prescribe an aromatase inhibitor (Anastrozole is the most popular) to bring these estradiol numbers back down in the normal which is 20 and 30 pg/ml. Some of the potential side effects of testosterone replacement therapy include:

  • Acne or oily skin.
  • Hair loss.
  • Increase viscosity of the blood (high hemoglobin and hematocrit levels).
  • Increase in estrogen levels (estradiol).
  • Mild fluid retention.
  • Increased red blood cell count.
  • Reduced sperm count.
  • Breast enlargement (gynecomastia).
  • Stimulation of prostate tissue (increase in PSA levels).

How Much Does It Cost?
Most insurance companies do not cover hormone replacement therapy, so you will be “out of pocket” and will need to spend your own money for most of the services and products they provide. There is a possibility your insurance plan might cover the blood labs but make sure you call them and provide the specific “codes” for each blood test that will be performed to avoid getting a huge bill later on down the road. Most anti-aging clinics provide full blood labs at a very reasonable cost, so it’s usually better to go through them versus risking a denied claim and extra costs when using your own insurance company. Below are the typical costs involved when using an anti-aging clinic for a TRT program:

  • New Patient Evaluation Fee (one time fee): $249 to $399 – This covers the first visit to the doctor which includes the initial consultation with all of the new patient questionnaire and forms needed. Some anti-aging clinics also include the first set of blood labs with the initial fee. Having your blood labs completed before you start testosterone replacement therapy is crucial for getting your baseline readings of your current natural testosterone levels in order to know where your dosages should be started at to optimize your hormone levels with your TRT program.
  • Medication (about every 10 weeks): One 10ML bottle of testosterone cypionate or testosterone enanthate (200MG) will cost anywhere from $125 to $150 per bottle when purchased through the anti-aging clinic. You can get a bottle of testosterone as low as $45 using a discount prescription card, like GoodRX, but you will also need to pay the anti-aging clinic $25 to $50 for a “script fee” in order for them to call it into your local pharmacy. Depending on how high your estrogen levels get when you’re on TRT, you might also need to purchase an aromatase inhibitor, like Arimidex (Anastrozole), for about $1 to $2 per 1MG tablet. The usual dosage is about 0.5MG twice per week if your estrogen levels get too high while you’re on TRT.
  • Blood Work Every 6 Months (with doctor follow-up and consultation): If you can’t get your blood work covered by your insurance company then look to spend about $200 to $250 for the general HRT/TRT lab panel and another $50 to $100 for the doctor consultation to go over the results. You need to do blood work twice per year with most anti-aging clinics.

My TRT Story
I was feeling run down back in November of 2012 and was frustrated by my inability to add any muscle and size to my physique. One of my friends at the gym suggested that I go in and get my testosterone levels tested. I was 52 years old at the time and my blood labs came back with a total testosterone level of only 286 which is on the low end of the testosterone spectrum. I also found out that my body was naturally producing a very high level of human growth hormone (HGH). My doctor actually mentioned that it was the highest level he had even seen! The blood test also revealed a very low component in my blood that affected my memory.

How Long Does It Take To See Results on TRT?
I started feeling positive results in how I felt and my overall mental clarity had increased almost immediately. Within a week, I was feeling much stronger in the gym and clearly had higher energy levels. At 3-4 weeks, I was seeing some weight loss and could see some improved muscle definition. 3 months into my therapy, I continued to see improvements in muscle size and definition while I continued to become even leaner. 6-12 months into TRT and my body continued to evolve with even more added muscle and a decrease in body fat. I’m now 5 years into TRT and I’m still seeing improvements. Most of the guys I personally know who are on TRT have also experienced similar improvements. Remember, we are all genetically different so everyone may not progress the same way. TRT has definitely changed my life for the better. My quality of life has improved and my physique has changed dramatically!

My Past and My Future
From 2012 to 2017, my body has continued to evolve allowing me to improve my physical appearance every year. TRT is one of the 3 main components of my overall fitness regimen. The 2nd component is my diet. I eat a very clean and healthy diet, which is critical to achieving success when it comes to building lean muscle and decreasing body fat. I eat plenty of nutrient dense calories with lots of lean proteins, vegetables and salads with very little sugar and processed carbs. The 3rd and final component is my exercise plan. I am very consistent with my workouts which are balanced and allow me to maintain that lean, muscular look. I always set fitness goals for myself which help to motivate and push me to the next level. I wake up every morning excited about the day and feel amazing!

Over the years, I have been able to place in 15 bodybuilding competitions while winning two of the contests and finishing 2nd six times. I have a couple more shows slated for this year and they include the Muscle Beach Classic in May and the NPC Las Vegas Classic in November. I’m not really sure how long I’ll be competing, but I know I will continue to expand my health and fitness knowledge. I’ve been so fortunate to find my way and I want to continue sharing my experiences and knowledge with others by writing articles like this one. I want others to experience the benefits of living a healthy and active lifestyle!

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About Author

Timothy Roach

My name is Timothy Roach and I'm a Certified Master Trainer, Certified Personal Trainer and I'm certified in sports nutrition. I'm also an accomplished amateur bodybuilder and have competed in 16 bodybuilding competitions. See my profile page for more information!

10 Comments

  1. It is my understanding that TRT will show up in PED drug testing for bodybuilding and other strength competitions. Is this the case?

    • ShapeFit

      Hi Rick – Testosterone therapy (TRT) should not cause an issue as long as your testosterone levels (free and total) do not go over the high end of the range when doing a blood test (around 1,100 to 1,200 ng/dl). However, other substances and different types of steroids could cause red flags when getting tested.

  2. I learned from a doctor that if you take this testosterone replacement treatment, you will make your testicles stop producing it. Therefore, as it is stated in the article, you will have to take it for the rest of your life and if you stop, your body will start having feminine side effects because your estrogen levels will not be inhibited.

    • ShapeFit

      Hi Jose – Once you start taking TRT, which is an exogenous (outside of the body) form of testosterone, your natural production will cease unless you take an ancillary drug like HCG (Human Chorionic Gonadotropin). HCG mimics leutenizing hormone (LH). LH stimulates the Leydig cells in the testicles to produce testosterone. This will trigger your testicles to keep making your own natural endogenous (inside the body) testosterone. Some men who are on TRT like to take HCG since they might experience a decrease in the size of their testicles when their natural production shuts down. If you stop taking TRT, your body will eventually kick-start your own natural production of testosterone. If a patient had not been on HCG during their course of TRT, then they will prescribe HCG to the patient if they decide to discontinue TRT treatment to help with this process. Once your natural testosterone production kicks back in, the patient should be fine although their testosterone levels will not be at the same levels to what they were before they started TRT treatment. In regards to staying on TRT for the rest of your life, this completely depends on whether you want to have elevated levels of testosterone to feel and look your best. If you want to live with testosterone in a high range, then you will need to continue TRT treatment to achieve this. If you get off TRT, a patient should eventually get their natural testosterone production back to normal within a few months, however it will usually be a little lower than what it was before the patient started TRT. In regards to having feminine side effects of too much estrogen, this is easily handled by an aromatase inhibitor (Anastrozole is very popular) when a patient is on TRT. Everyone is different and that’s why it’s very important to have your blood labs checked every 6 months by the anti-aging clinic in order to monitor your estradiol levels to make sure they are in the optimal range. If you stop taking TRT then you will simply get on HCG to kick-start your natural testosterone production. Elevated estrogen should not be an issue once the patient is off the TRT treatment.

  3. My doctor has me injecting 100cc every other week. I am a 68 year old male. I have had three injections so far. Will this help me or is it a waste of time?

    • ShapeFit

      Hi John – Do you mean 100 MG every other week or 1CC every other week? 100CCs every other week would be quite a lot of testosterone 🙂

        • ShapeFit

          Hi John – 100 mg every two weeks is pretty low for TRT. The “normal” dosage is about 200 mg per week. However, it really depends on what your testosterone levels (free and total) are when you take your blood labs. Have you gotten your results back yet? Your goal is be on the high end of the range.

    • ShapeFit

      Hi Kathy – ShapeFit.com is for everyone 🙂 Low T is a real issue with the aging population and this is why we decided to showcase this topic. We hope the information can help men who might be experiencing the symptoms and let them know that they do have options to feel and look better as they age. Hormone deficiencies also affect women as they age and we are working on creating content to target this subject as well.

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