Introduction to TRT

What is TRT (Testosterone Replacement Therapy)?

TRT is exactly what it sounds like: replacing testosterone that your body isn't producing adequately on its own.

It's like glasses for your eyes or insulin for a diabetic. Your body should be making something, it's not making enough, so you supplement it from outside.

TRT involves introducing exogenous (from outside the body) testosterone to bring your levels into a normal, healthy range. The goal is to restore what should be there naturally, not to achieve superhuman levels.

What TRT is NOT

TRT is not the same as steroid abuse or bodybuilding cycles.

Bodybuilders and athletes who use steroids typically take doses 5-20x higher than TRT doses to achieve supraphysiological (above normal) levels. That's a completely different thing with different risks.

TRT aims for adequate free testosterone - not a specific total testosterone number. For many men, this means total testosterone in the 500-900 ng/dL range, but men with high SHBG may need 1000+ ng/dL to achieve the same free testosterone. Steroid cycles often push levels to 2,000-5,000+ ng/dL.

It's the difference between using caffeine to stay alert and using methamphetamine. Same category, wildly different dose and effect.

Who Should Consider TRT?

TRT is appropriate for men who have:

• Documented low free testosterone (or low total T with normal SHBG)
• Symptoms consistent with low testosterone (see Chapter 6)
• Confirmed on multiple morning tests
• No easily reversible cause (or reversible cause has been addressed)
• Understood the implications (lifelong commitment, fertility impact, etc.)

When TRT Should Be Considered Carefully

TRT may not be appropriate, or needs careful consideration, if you:

• Want to have children soon (TRT usually suppresses fertility, though not always completely)
• Have untreated severe sleep apnea
• Have uncontrolled heart failure
• Have untreated polycythemia (high red blood cell count)
• Have had hormone-sensitive cancer (prostate, breast)
• Are under 25-30 without clear medical cause

Young men (under 30) with low testosterone need thorough investigation before TRT.

Low testosterone at this age is unusual and often indicates an underlying problem that should be identified and addressed. Starting lifelong therapy without proper diagnosis could mask something important.

What to Expect Starting TRT

Let's set realistic expectations.

The Timeline

Effects don't happen overnight. Here's a general timeline:

Effect	When to Expect
Improved libido	2-4 weeks
Improved mood/motivation	2-4 weeks
Better energy	3-6 weeks
Improved erections	3-8 weeks
Noticeable fat loss	8-16 weeks
Muscle mass increase	12-20 weeks
Bone density improvement	6+ months
Full stabilization	3-12 months

These are averages. Individual responses vary widely.

The first 6-8 weeks can be a rollercoaster. Your body is adjusting to the new hormone source while your natural production shuts down. Don't panic if you have ups and downs. Most men stabilize after 2-3 months.

What You Might Feel

Early effects (first month):

• Improved mood and sense of well-being
• Increased libido
• Better sleep for some (worse for others initially)
• Possible water retention
• Possible acne

Intermediate effects (1-3 months):

• More consistent energy
• Improved gym recovery
• Better erections
• Mood stabilization
• Some body composition changes beginning

Long-term effects (3+ months):

• Noticeable muscle gain (if training)
• Fat loss (especially if diet is in check)
• Continued improvement in energy and mood
• Stabilized libido and sexual function

What You Won't Get

TRT is not a magic pill. It will NOT:

• Automatically make you jacked without training
• Fix a broken marriage
• Cure clinical depression by itself
• Turn you into a different person
• Make up for a terrible lifestyle
• Give you superpowers

TRT can dramatically improve quality of life for men with genuine low testosterone. But it's not a substitute for diet, exercise, sleep, and addressing underlying issues.

The Commitment Factor

TRT is typically a lifelong commitment.

Once you start, your natural testosterone production shuts down. If you stop TRT, you'll likely feel worse than before you started - at least temporarily. Natural production can recover, but it takes months and isn't guaranteed.

For the full discussion of what lifelong TRT looks like - including stopping TRT, long-term health considerations, and what to expect over the years - see Chapter 15: Long-Term Considerations.

Think carefully about:

• Are you prepared for ongoing injections or daily applications?
• Can you afford the medication and monitoring long-term?
• Do you have access to consistent medical care?
• Have you discussed fertility implications?

Starting TRT: The Smart Approach

If you and your doctor decide to proceed:

• Get comprehensive baseline bloodwork (see Chapter 5)
• Start at a conservative dose (100mg/week is a reasonable starting point for most)
• Use an appropriate delivery method (discussed in next chapter)
• Inject frequently if using injections (discussed in Chapter 10)
• Get follow-up bloodwork at 6-8 weeks
• Adjust based on labs AND symptoms
• Don't start an AI unless you actually need it
• Discuss fertility preservation if relevant

TRT vs. Other Options

Before committing to TRT, some men try:

HCG Monotherapy

Using HCG alone to stimulate natural testosterone production.

Pros: Maintains testicular function, preserves fertility, natural production route
Cons: May not work for everyone, requires frequent injections, can be expensive, often causes high estradiol

Why HCG monotherapy often causes high estradiol: HCG stimulates the testicles by mimicking very high LH levels. This cranks up intratesticular testosterone to extremely high concentrations - much higher than what you'd see in blood. Since the testicles contain aromatase, all that testosterone gets converted to estradiol right there in the testes. Many men on HCG monotherapy struggle with elevated estrogen symptoms even when their blood testosterone is only moderate.

Clomid/Enclomiphene

Blocks estrogen in the brain to increase LH and natural testosterone. Can work for specific situations (fertility preservation, borderline cases, younger men with secondary hypogonadism), but often disappointing as long-term monotherapy.

See Chapter 11: Fertility & TRT for the full discussion of when these work and when they don't.

For most men who genuinely need testosterone replacement, actual testosterone is usually the most effective option.

Quick Recap

What TRT Is

• Replacing testosterone your body doesn't produce adequately
• Aiming for normal physiological levels
• A medical treatment, not a performance enhancer

What TRT Isn't

• A magic solution to all problems
• The same as steroid abuse
• A quick fix

Key Points

• Symptoms AND low free testosterone should both be present
• Typical dose: 80-150mg/week (not 200mg like many clinics start)
• Dose depends on SHBG - high SHBG men may need more
• Effects take weeks to months
• It's a lifelong commitment
• Natural production will shut down
• Start conservative, adjust based on free testosterone levels

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Next up: TRT Delivery Methods - Injections, gels, patches, pellets - how do you actually get testosterone into your body?