What to Know About Testosterone Replacement Therapy

Your hormones have a profound effect on your health and wellness. They can certainly help you look and feel younger. 

Hormone levels naturally fall as we age. Typically, the pituitary-based hormones, including the hormones of the adrenals, ovaries, and testes, decline after peaking during our 20s or 30s. (1)

In 2006, when I was 44, I was volunteering for the bone health division of the American College of Sports Medicine. The lab was testing the bone health of cyclists and was discovering that the bone health of many cyclists was poor. I was asked if I wanted my bone density measured via a DEXA scan and I agreed. My scan showed I had osteopenia (low bone density). This diagnosis was both surprising and fortunate since it was discovered while I was still young. 

Osteopenia and the more severe osteoporosis are serious health issues and often are not diagnosed until a person breaks a bone. If the fracture is a hip, the repercussions can be fatal. A 2010 study found that 37.1% of men with hip fractures died within 12 months.(2)

The technician suggested that I consult with my doctor to discuss strategies for addressing this issue. My doctor ran blood work and discovered that my testosterone was low. He said, “We have found the smoking gun.” He said this because my measured testosterone was below 200 mg/dl. The low range of testosterone for men is generally listed from 160 to 300 mg/dl. (3)

I was prescribed testosterone, also known as testosterone replacement therapy (TRT). Testosterone is an anabolic steroid. Anabolic means tissue building, including bone tissue. I was also prescribed inexpensive anastrozole to limit the conversion of testosterone to estrogen, because too much estrogen in men can cause problems. (4)

Low Testosterone and Your Health

Being low in testosterone is a serious health problem. Implications of low testosterone in men include: (5)

Disturbed sleep
Increased body fat
Increased fatigue
Loss of sex drive
Lower bone density
Lower muscle mass and strength

I did not realize I was low because I was not aware of the symptoms of low testosterone, and I felt fine. The situation is like the first time you get glasses: you generally don’t know you need glasses until you experience the difference.

If you have not had your hormones, at least testosterone and estrogen for men and estrogen and progesterone for women, tested in a few years, I suggest you get proactive and have a hormone test. Certainly, everyone over 50 should know their hormone levels. 

Since physicians are reluctant to order tests without clear symptoms, you may want to get tested in advance of seeing your practitioner. In most states, you can order the test yourself and pay out of pocket. The tests are usually less than $100. With your results in hand, and if you are low, your primary care physician usually will not ignore or deny the data and you can have a conversation about options and risks on the spot. If your doctor is not knowledgeable about TRT they may refer you to an endocrinologist.

You can also utilize a TRT clinic. The advantages of the TRT clinics are that they usually can test and prescribe TRT immediately if you are low. Any prescribing physician or clinic should provide the appropriate follow-up care to ensure your testosterone blood levels are in the normal range, and look at other factors such as estrogen and PSA (prostate specific antigen). 

There are several TRT options available for men

There are several TRT options available for men including daily applied gels and compounded creams, injectables, and sub-dermal pellets which last for several months. The FDA defines compounding as “a process of combining, mixing, or altering ingredients to create a medication tailored to the needs of an individual patient.” (6)

I started TRT with gels and creams and switched to an injectable because it was cheaper since I was willing to self-inject. With injectables, there is no concern with cross contamination to other people as there is with gels and creams. I self-inject once per week. 

The downsides to the TRT clinics are the inconvenience of having to travel to the clinic regularly for injections and the expense when compared to self-injection. For me, the prescriptions and ongoing care are about $20 per month cash. Since it is so inexpensive, I don’t use insurance.

In addition to TRT, I started to lift weights to improve my bone health. I responded quite well to the therapy and my bone health is now normal. The University of Colorado Health Sciences department published a paper describing my experience and results.(7) My muscularity improved also, but for me that was an additional benefit. I also experienced improved libido.

Almost all the men I have talked to, who have been prescribed testosterone replacement therapy, say it is the best thing that ever happened to them and they are not interested in stopping the therapy.

Common Objections to TRT

A real concern from any treatment is side effects. The only negative side effects I have noticed are the growth of some body hair and my blood hemoglobin and iron levels have risen. I shave the hair and give whole blood twice a year to normalize my blood levels. 

Some men are reluctant to start testosterone replacement therapy because they are told that they will be on it for the rest of their life. I consider it a privilege to be able to have TRT available forever.

Another objection sometimes brought up is the thought that testosterone is not bioidentical. Bioidentical hormones are those that are molecularly identical to hormones produced by humans. The products I have used have been bioidentical. Injectable testosterone cypionate decays into bioidentical testosterone.

There has been controversy over whether TRT causes prostate cancer. The 2016 meta-analysis of 26 trials concluded it does not. The study authors state, “TRT for symptomatic hypogonadism does not appear to increase PSA levels nor the risk of prostate cancer development.” (8) In some circumstances, hormone therapy can be an adjunct in treating cancers.(9) This is great news, but not everyone is a candidate for TRT. Have the conversation about your cancer risk with your doctor. 

Another consideration is that TRT may reduce sperm counts. If you are considering TRT and are planning on having children, have this conversation with your doctor.(10)

Another objection related to TRT is that men say they want to be natural. Sometimes the term “natty” is used. Their argument is that anyone on TRT is not natural and has an unfair advantage over people who do not supplement. I suggest that the opposite is true. TRT, performed as intended, puts men into the normal testosterone range, leveling the playing field. 

The abuse of testosterone, a schedule III controlled substance, like the abuse of any substance, can be dangerous.(11) In 2021, at least fifteen high-profile bodybuilders died. The root cause of all the deaths is not clear, but drug abuse appears likely in several.(12) Steroid drug abusers take enormous volumes of the drugs, on the order of five to ten times that prescribed for TRT. The dose defines the outcome. Consider the difference of drinking one beer compared with drinking five or ten beers. 

The natural label is irrelevant to me. I would rather be healthy. I would rather look and feel younger than be ‘natural’ as the term natural is currently construed. 

Be proactive. Do not let fear mongering or shame, sometimes associated with TRT, hold you back from being tested and getting treatment, if needed.

I have a four-step plan for helping anyone look and feel younger at any age. Managing hormones is a part of the step Own Your Health. To learn more please visit www.absat60.com.

Important Note/Disclaimer: I am offering general information and my own opinions based on my experience. Always contact your physician or a health professional before starting any treatments, exercise programs or supplements.

1 Decaroli, Maria Chiara, and Vincenzo Rochira. “Aging and sex hormones in males.” Virulence, vol. 8,5 (2017): 545-570. doi:10.1080/21505594.2016.1259053.

2 Kannegaard, P.N., et al. “Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival.” Age Ageing. 2010 Mar;39(2):203-9. doi: 10.1093/ageing/afp221. Epub 14 Jan 2010.

3 Margaret Le, David Flores, Danica May, Eric Gourley, Ajay K. Nangia, Current Practices of Measuring and Reference Range Reporting of Free and Total Testosterone in the United States, The Journal of Urology, Volume 195, Issue 5, 2016, Pages 1556-1561, ISSN 0022-5347, https://doi.org/10.1016/j.juro.2015.12.070.

4 Faloon, William, “Misguided Medicine.” Life Extension Magazine, June 2014, www.lifeextension.com/magazine/2014/6/misguided-medicine/page-01. Accessed 23 October 2022.

5 Gotter, Ana, et al. “Low Testosterone in Men.” Healthline, Reviewed 27 November 2019, www.healthline.com/health/side-effects-of-low-testosterone. Accessed 23 October 2022.

6 Compounding and the FDA: Questions and Answers.” U.S. Food and Drug Administration, 21 June 2018, www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers. Accessed 4 November 2022.

7 Barry, Daniel W., Gerlach, Amanda, Damian, Greg and Kohrt, Wendy M. “Bone Density – Triathlete.” Medicine & Science in Sports & Exercise: May 2007, Vol. 39, I. 5, p. S106. doi: 10.1249/01.mss.0000273339.18490.55.

8 Boyle, P., et al. “Endogenous and exogenous testosterone and the risk of prostate cancer and increased prostate-specific antigen (PSA) level: a meta-analysis.” BJU Int, 2016 Nov;118(5):731-741. doi: 10.1111/bju.13417. 

9 “Hormone Therapy to Treat Cancer.” NIH National Cancer Institute, 29 April 2015, www.cancer.gov/about-cancer/treatment/types/hormone-therapy. Accessed 23 October 2022.

10 Patel AS, Leong JY, Ramos L, Ramasamy R. Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility. World J Mens Health. 2019;37(1):45-54. doi:10.5534/wjmh.180036

11 “FDA approves new changes to testosterone labeling regarding the risks associated with abuse and dependence of testosterone and other anabolic androgenic steroids (AAS).” FDA, November 25, 2016. https://www.fda.gov/drugs/drug-safety-and-availability/fda-approves-new-changes-testosterone-labeling-regarding-risks-associated-abuse-and-dependence. Accessed 24 December, 2022.

12 “Dead Bodybuilders.” HeartWise Fitness & Longevity Center, November 30, 2021. https://www.heartwise.com/whatsnew/2021/11/30/dead-bodybuilders. Accessed 24 December, 2022.

The above are the opinions of the author and are not researched or verified by AGEIST LLC, or anyone associated with AGEIST LLC. This material should not be construed as medical advice or recommendation, is for informational use only. The ideas expressed here are solely the opinions of the author. We encourage all readers to discuss with your qualified practitioners the relevance of the application of any of these ideas to your life.

Written By Gregory Damian