Lifestyle Training

An Intro to Testosterone and TRT

trt testosterone replacement therapy

Note – This is the first of a four-part series.  Click here for Part 2 on symptoms,  here for Part 3 regarding my TRT results, and here for Part 4 on finding treatment.

Over the past two years, researching testosterone and testosterone replacement therapy (TRT) has played a very important role in the trajectory of my life.

After what seemed like a lifetime of beating my head against the wall dealing with various symptoms, I finally decided to get my hormone levels checked in the spring of 2014.

The results came back showing a level that my doctor could only interpret as a mistake.

A follow-up draw confirmed there was no mistake in the testing procedures – just woefully low testosterone levels.

I was 28 years old and for the first time, I felt like I had a solution to the problems that had been plaguing me for years.

In this and articles to follow, I want to share my low T journey and experience with TRT.

But before I get into my own experience, I need to give you a brief overview of what I’ve learned about low testosterone, the diagnostic process, and treatment.

What does testosterone do for you?

Stated simply, it makes you a man.

It’s responsible for everything that makes you strong, healthy, and powerful. As a man, without testosterone, you’ll be mentally, physically, and emotionally frail (I know this first hand).

Optimal levels of testosterone are associated with:

  • Confidence
  • Competitiveness
  • Low body fat
  • High muscle mass
  • Optimal bone density
  • Low levels of depression
  • Mental and emotional resilience
  • Abundant energy
  • Greater sense of well-being
  • Clear mind
  • Healthy sex drive and sexual function
  • Decreased risk of heart disease

Basically, every aspect of life is better with optimal levels of testosterone.

Symptoms of low testosterone

Men suffering from low testosterone (hypogonadism) frequently exhibit a selection of the symptoms below, and more often than not, they experience a large number of them.

  • Low muscle mass
  • High body fat
  • Depression
  • Brain fog
  • Low libido
  • Erectile dysfunction
  • Fatigue
  • Mood swings
  • Anxiety
  • Low bone density
  • Heart disease
  • Low self-confidence

In short, life with low testosterone is miserable.

Note – To get your testosterone levels checked, call the company I use, Primebody.com and get a free consultation, $25 off your monthly fee, and an additional 10% off your first month and when you use the code Lewis27.

Causes of low testosterone

There has been a rapid decline in testosterone levels spanning recent decades.

Men today have lower levels than previous generations did at the same age. And there are many theories to explain this.

The common suspected causes include inactive lifestyles, exposure to chemicals found in plastics, lack of quality food, and unhealthy levels of stress, to name a few.

Steroid abuse and the use of certain medications, like painkillers and antipsychotics, can also suppress testosterone levels.

However, since this decline is seen across the board in every age bracket and geographic location, I think it’s safe to say that a combination of all these factors is to blame.

Modern men simply are not living high testosterone lifestyles.

It’s important to note that when multiple lifestyle factors are improved all at once, testosterone levels often rise.

Not to the same levels as supplementing with synthetic testosterone, but they rise nonetheless.

This supports the notion that testosterone levels are a good indicator of overall health and can be corrected through lifestyle intervention in some cases.

If, for example, you go from being completely sedentary and eating nothing except junk food to an active lifestyle with a diet consisting of high quality whole foods, you can accomplish much of the same thing, minus the injections.

So resist the temptation to jump straight to hormone therapy.

The ABCs of TRT

First, while I'll do my best to not overuse abbreviations, here's a cheat sheet for you to easily refer back to if you need a quick reminder.

Don't feel compelled to memorize the chart, but it's here if you need it.

AbbreviationTermDescription
AIAromatase InhibitorA medication that binds to the enzyme responsible for converting testosterone to estradiol.
E2Estradiol The form of estrogen that results from aromatization of testosterone.
FSHFollicle-Stimulating HormoneReleased by the pituitary gland. Stimulates sperm production.
FTFree TestosteroneUnbound portion of testosterone.
GnRHGonadotropin-Releasing HormoneReleased by the hypothalamus. Signals the pituitary gland to release LH and FSH.
hCGHuman Chorionic GonadotropinA medication that mimics LH, thus signals the testes to produce testosterone.
LHLuteinizing HormoneReleased by the pituitary gland. Stimulates testosterone production.
SHBGSex Hormone Binding GlobulinBinds to sex hormones, making them biologically inactive.
TRTTestosterone Replacement TherapyReplacing natural testosterone with synthetic.
TTTotal TestosteroneTotal testosterone found in the body.

How testosterone is made

Don’t worry – I’m not going to give you an in-depth physiology lesson here, but a brief understanding of how testosterone is produced in the body will help the rest of this series make more sense.how testosterone is made trt

Key Values

When interpreting a hormone screen, doctors will most often focus on a few key values:

Total Testosterone (TT)

This is the total amount of testosterone in your blood, measured in nanograms per deciliter (ng/dL). It’s also the most commonly discussed number and the one most frequently used to determine the need for trt.

Free testosterone (FT)

This is the amount of testosterone in your blood that isn't bound by Sex Hormone Binding Globulin (SHBG) and is free to act on tissues, giving you masculine characteristics. Free testosterone is measured in picograms per milliliter (pg/mL).

FT is actually more important in diagnosing low T than total test, but is often overlooked by medical professionals. 

I had to specifically request that my previous doctor test for this value. And it's never a good sign when the patient has to guide the diagnostic process.

It's actually possible to have normal to high total testosterone, but have low free testosterone. In this case, men often have all of the symptoms associated with low total testosterone, despite normal looking lab results.

Estradiol (E2)

This value refers to your estrogen levels. Even though estrogen is the female sex hormone, some is still required in the male body.

It's not a terribly important value in the diagnostic process, but it's extremely important to monitor should you decide to undergo treatment.

Estradiol levels can give insight into many of the common side effects of TRT.

Reference range of “healthy” testosterone levels

A reference range is simply the set of values to which your blood test results get compared.

For testosterone levels, most doctors and labs will often use a reference range close to 300 – 1,200 ng/dl.

Labcorp, where I now get my blood tested, uses a reference range of 348 – 1,197.

For many doctors, if your TT falls anywhere within the reference range (or even a little below), they will consider you to be healthy and will not advise you to pursue TRT.

Problems with the reference range

The problem with this range is that it’s a compilation of test results and is much too broad. It includes men ages 18 to 80 living all types of lifestyles.

On the surface, using a compilation of test results sounds reasonable.

But who do you think is going in to have their hormone levels checked?

In many cases, it’s going to be men suffering from low testosterone symptoms, those with unexplained health conditions, and men having issues with infertility.

Healthy patients rarely go in for hormone screenings and doctors don't have any reason to order them.

So to create this reference range, they are actually including test results from men with low testosterone levels to determine what a normal testosterone level is.

You can see why this may be problematic.

According to the current range, a healthy, active 25-year old male with the same testosterone levels as a sedentary, 85-year old man is perfectly “normal” and will not qualify for treatment.

To further illustrate the issue, let’s compare the measurement of testosterone levels to blood pressure ranges.

In regard to blood pressure, an optimal reading will be under 120/80 mm Hg.

If, however, we included individuals with hypertension into the sample pool and used their values to formulate a “normal” range, the situation would be entirely different.

In that scenario, we would have doctors telling their patients that a blood pressure reading of 160/110 mm Hg (stage 2 hypertension) is perfectly fine and it’s just a normal part of aging.

When we look at testosterone levels adjusted for age, we find out that a young man near the bottom of the current reference range is very much below average.

Testosterone levels adjusted for age

(1) Average Testosterone Levels by Age in Men

testosterone levels by age trt

(2) Normal Testosterone Levels in Men (Non-diabetic)

testosterone levels by age 2 trt

Source for charts:  Androgens and the Aging Male
(1) Vermeulen A. Declining androgens with age – an overview, In: Androgens and the ageing male. Eds. Oddens B. Vermeulen A. Parthenon Publishing. New York. 1996
(2) Simon D. Nahoul K. Chades MA. Sex hormones, ageing, ethnicity and insulin sensitivity in men : an overview of the Telecom study. In: Androgens and the ageing male.  Eds. Oddens B. Vermeulen A. Parthenon Publishing. New York. 1996

What were my testosterone levels?

low testosterone trt blood work

As you can see, my first blood work revealed that I had a total testosterone level of 289 ng/dL.

I was extremely low, even when compared to a reference range that includes men with low testosterone!

This was low enough for my doctor to presume a mistake had been made even though blood was drawn under ideal conditions (which are after fasting for 12 hours and having the draw performed within 2 hours of waking).

My follow-up blood work was performed about a week later and came back at 287 ng/dL.

I was then referred to a urologist who ordered another blood draw. Those results came in at 292 ng/dL.

At least I was consistent…

And while I forget the reason, he had me do yet another blood draw which showed my total test at 225 ng/dL.

This was drawn about 3 or 4 hours after waking up, which explains why it was lower than the previous three. Testosterone levels are naturally highest in the morning and decline throughout the day, so that showed normal fluctuations.

I don't know what my baseline free testosterone levels were as my doctors didn't check them initially.

The first time I had it checked in July 2014, my total T had been raised up to 451 ng/dL through the use of hCG, but my free T wasn't even up to the bottom of the range yet. Yikes!

How do I stack up against my age group?

Excluding the outlier of 225 ng/dL, my average was 289 ng/dL at 28 years old.

According to the studies that actually included healthy males and have grouped results by age, well, I wasn't even close to being on the chart.

The bottom 5% of my age group (25 to 29 year olds) have a TT level of 388 ng/dL. The average TT for 354 subjects was 669 ng/dL.

My test levels were actually significantly lower than the 85 to 100 year old age group, who had an average TT level of 376 ng/dL.

No wonder I looked and felt like an old man!

Words can hardly express what a relief it was to find out the source of my problems. I didn't want to have low testosterone, of course, but at least now I had a course of action in sight.

Comprehensive TRT

So you find out you have low T, get a prescription for testosterone from your doctor, and start your treatment, right?

Not quite.

While synthetic testosterone as a standalone works just fine for some, most men find that they need a couple other medications to function optimally.

The body is an extremely complex organism and the manipulation of one hormone often causes others get out of balance.

When testosterone levels increase, the body will convert some of the excess to estrogen through a process know as aromatization. This process can result in some unwanted side effects (i.e., gynecomastia and water retention).

To prevent estrogenic side effects, an aromatase inhibitor (AI) will keep E2 levels in check and is a frequently prescribed and useful addition to TRT.

Another common side effect of introducing exogenous (from the outside) testosterone is testicular atrophy (aka, shrunken balls).

Since your body doesn’t need to make its own testosterone when supplementing, your pituitary gland will decrease its release of LH (see the diagram for a refresher).

When the testes aren’t receiving the the signal to produce T, they shut down or atrophy.

Human Chorionic Gonadotropin (hCG) is a medication that mimics LH and will keep your testes functioning.

This will help for cosmetic reasons (fight shrinkage!), maintaining fertility, and to preserve natural testosterone production in the event that one ever decides to cease treatment.

The use of testosterone, an AI, and hCG is widely recognized as the holy trinity of life-long, successful TRT.

The problem with the current state of treatment

Despite the increasing prevalence of low T across all age groups, many low T sufferers are still facing barriers to receiving optimal treatment, or even treatment at all.

Though the TRT industry is growing, doctors aren't all on the same page yet about what treatments and dosages are appropriate or whether TRT is pertinent at all.

Why are most doctors hesitant to provide adequate treatment?

After talking with several doctors, reading dozens of first-hand accounts, and listening to many horror stories, I've recognized a few patterns with the way certain medical professionals view TRT and why many men aren't receiving adequate treatment.

1. They’re undereducated in this particular field

Since testosterone replacement therapy is relatively new, in popularity at least, many doctors are still hesitant to provide treatment in the interest of protecting themselves.

TRT isn’t a major component of medical school, so doctors either have to specialize or simply rely on reference ranges and general guidelines (and we now know those are faulty).

There isn’t a whole lot of history in treating low T and if you spend any time on forums with guys discussing their treatment, you’ll see that methods and dosing have evolved drastically even since 2010.

Compare that to treating high cholesterol or depression and it's clear that TRT is basically in its infancy.

As recently as just a few years ago, doctors were giving large dose injections once per month and doing more harm than good (some are still doing this).

There is a very successful formula for treating low testosterone that's taking shape, but it just isn’t widely available.

Some doctors aren't willing to dig for information and to go outside of common procedures in the interest of treating a problem they view as insignificant.

2. Public perception of testosterone is negative

Society views anything associated with testosterone to be violent and in-your-face.

Just mentioning the word “testosterone” causes most people to conjure up images of anger and aggression – hairy, sweaty men swilling cheap beer, catcalling, and revving their motorcycles to scare the neighborhood children.

Doctors aren’t in a hurry to jump on board and have their practices associated with this image.

In addition, the patients themselves may not bother seeking treatment when spouses, family, or friends hold a negative opinion of the effects of testosterone.

3. Using testosterone is viewed as cheating

The media likes to highlight TRT in professional sports and lump it together with steroid use. And steroids are cheating (so we've been told).

Doctors instantly assume that a young guy complaining of low T symptoms is just fishing for a safe/legal steroid prescription.

They fail to take into account that athletes aren’t taking the same therapeutic, low-dose treatment as someone on TRT.

Not to mention the fact that the patient could have a desperate need for treatment and he's being discounted because of the doctor's own bias.

I’m not against steroid use or taking high doses of testosterone (I'm open to trying both at a later point in my life).

I’m simply pointing out that there’s a difference between using a small, therapeutic dose under the care of a medical professional to overcome a deficiency and taking large amounts of testosterone to drastically improve athletic performance.

Who should be on TRT?

Testosterone replacement therapy is presently viewed as an older man’s game.

You see the commercials featuring 50-year old men rebuilding an engine and dancing with their wives in the kitchen.

Basically, everything written talks about how testosterone levels start to decline after a certain age.

Whether or not the decline is a natural part of aging or the consequence of the average middle-aged man's lifestyle, there are absolutely older men who can benefit from TRT.

But what if you’re under 30 and having symptoms?

Low testosterone isn’t necessarily the result of a natural decline.

There are plenty of guys (like myself) who never reached optimal levels in the first place.

I’ve spent the last two years reading comments on blogs and discussions on various forums and have noticed that there’s an overwhelming number of young men under 30 experiencing severe low T symptoms.

Note – If you're having symptoms and want get your levels checked, call the company I use, Primebody.com and get a free consultation, $25 off your monthly fee, and an additional 10% off your first month and when you use the code Lewis27.

I get emails and comments from guys who are dealing with all of these negatives and are in their 20s!

Regardless of age, from my experience, anyone with a need should seek getting better.

My first recommendation though is to examine and correct any glaring lifestyle issues. Consider whether these areas of your life are generally healthy and in balance:

  1. Diet
  2. Training
  3. Stress and rest
  4. Substance abuse problems

If not, work on these areas first and see if you experience a significant reduction of your low T symptoms.

For some though, even hitting these high T lifestyle factors isn’t enough.

For men with hypogonadism, taking natural testosterone boosters and adopting a Paleo diet just isn’t going to cut it.

That’s why I’m here to share my experience with you.

In the following installments in this testosterone series, you’ll get my perspective as a young man under 30 who’s suffered from a lifetime of low-T and is now getting treatment.

More to come,

Nate

Note – This is the first of a four-part series.  Click here for Part 2 on symptoms,  here for Part 3 regarding my TRT results, and here for Part 4 on finding treatment.

 

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56 Comments

  • Reply
    Sergie
    August 24, 2015 at 7:16 pm

    Nate,

    Very informative article. I have luckily a decent T level, but have experienced low T at points in my life. I have found that by keeping my diet right, working out 5 times a week, and having sex several times a week helps me keep optimal levels. It is good to see how you are developing your site. I look forward to more content

    Regards,
    Sergie Founder of Way of The Olympian

    • Reply
      Nate
      August 24, 2015 at 7:34 pm

      Living a healthy lifestyle is a huge component of maintaining healthy testosterone levels. In the following articles in this series, I’ll be going into detail about the very thing you’ve just demonstrated. Thanks for the support!

  • Reply
    Andrew
    August 24, 2015 at 9:04 pm

    Nate,

    Just wanted to inquire as to the symptoms you firstly mentioned about low T. I thought I’d be devoid of these seeing as I’ve some mass and reasonably low body fat, at least compared to the population.

    I’m assuming you were also in a similar situation though? Your test was in 2014 and I’m guessing you had mostly the physique you have now minus a years training or so?

    Also how is body hair symbolic of test? I’m kinda patchy, extremely hairy legs, patchy chest and facial hair just about coming round. As I said, I thought I’d be “alright levels” as I hit the gym with a lot of effort.

    Thanks.

    • Reply
      Nate
      August 24, 2015 at 10:10 pm

      I’m going to discuss my symptoms, treatment, and progress in the following articles so I won’t get into all that right now.

      For your situation, I’d say long as you feel good and can make progress in the gym your levels are probably good. You could get them tested just to be sure. It’s a good idea to have a baseline when you’re young in the event it becomes an issue later in life, you have your very own numbers to compare to.

      Body and facial hair is associated with high testosterone, but there are other factors such as ethnicity at work. For example, the vast majority of Asian men have very little body hair, but that doesn’t mean that they have low T.

  • Reply
    Nathan Lewis
    August 24, 2015 at 10:27 pm

    I saw this tweeted by Chris/goodlookingloser and I was like, wtf my name is on that bottle. Greetings fellow Nathan Lewis lol. Your site looks pretty interesting I’ll check it out.

  • Reply
    Brandan
    August 25, 2015 at 12:46 am

    Nate,

    I am so thankful for this article.

    My father’s crappy doctor put him on TRT way back in the day without any of the other supplements you mentioned and as a result my father endured the worst side effects possible. It was also the large dose once a month I believe. Turns out, the doc misread the chart and my dad’s T was actually normal from the beginning anyway.

    That being said, after his extremely strong warnings, I’ve been pretty shy about seeking treatment. However, I now feel there is hope. I didn’t want to risk shutting down my T production or ruining my testes, but it seems you found the workaround.

    As for the healthy lifestyle…that’s the part that concerns me the most. I went from chainsmoking, doing drugs, never eating, literally starving, completely COMPLETELY sedentary lifestyle 140lbs at 5’10.5″ to six months later: quit cigarettes, quit drugs, meal prepped with new gf eating almost entirely steak eggs and veggies for 5 months, lifting weights 4-5 times a week, and sleeping more than ever with an easier more fun job (making/selling custom clothing with Tom James Co).

    At the end, at the very peak, of this total transformation I got my T levels tested because I had hit a plateau at 170lbs at 6 ft tall (I guess growing up til age 25 is true).

    Even after all that I was under 300 ng, same as you, and my Free T was also just under the lowest level of the range at age 25.

    Now I know what I must do. Please finish this series quickly. I cannot wait to read it.

    PS huge shout out to Victor Pride for helping me find you. Both of you guys rule.

    • Reply
      Nate
      August 25, 2015 at 2:24 am

      Congrats on making all of those major life improvements at once. That takes some serious dedication!

      It sounds like we had VERY similar experiences and my sole purpose for writing this article was to help guys in our situation.

      It’s only natural for your father to warn against TRT. He had a terrible experience and wants to protect you from doing the same. But the blame should be placed on the methods.

      When given large, infrequent injections like that, guys are essentially dosed as if they were on a cycle, only the cycle doesn’t continue. They’re allowed to come down (the worst part of a cycle) after their natural production has been suppressed. After they suffer with basically zero testosterone for a couple weeks they’re given another large dose and the whole thing starts over again.

      You’ll see in my next article that we were living very similar lifestyles, but still had abysmal test levels. Everything you want and need to know is going to be out within the next week.

      Stay tuned!

  • Reply
    DKB
    August 25, 2015 at 1:01 am

    Nate,
    So how long did it take from skinny fat to ripped when you started TRT?

    • Reply
      Nate
      August 25, 2015 at 2:31 am

      I’ve been lifting consistently for about 7 years now, never taking longer than about a week off.

      The first year I went from skinny/fat to skinny/fit. I spent the next 5 years bulking and cutting but couldn’t shake the skinny/fit body.

      Now that my hormone levels are in the normal range, I’ve spent the last year making the “newbie gains” I’ve heard so much about but never experienced.

  • Reply
    Carlos
    August 25, 2015 at 5:20 pm

    Hey Nate,

    Do you know if exposure to phthalates happens only when plastic is heated?

    It’s great you’ve fixed this T problem. Looking forward to the next articles.

    • Reply
      Nate
      August 26, 2015 at 12:58 am

      Heating plastic is a major source of phthalates, but it’s also used in most toiletries. That stuff is in deodorants, lotions, and colognes. I make a reasonable attempt not to overdo it on the grooming products, but I put most of my effort into not eating out of plastic. I like to get the glass Pyrex containers for my pre-made meals.

      • Reply
        Carlos
        August 26, 2015 at 5:29 pm

        I didn’t think it was that bad. I’ll definitely buy some glass containers at least. Thanks, Nate.

      • Reply
        daniel
        January 6, 2016 at 3:14 am

        Nate, what’s going on. I was tested in the 600 range but have all the symptoms you listed.. not really motivated, depressed, not really feeling like a guy. Im going to try a low test. If my levels are 600.. I want to be in the 1000-1100 range. How many mgs a week should i use?

        • Reply
          Nate
          January 6, 2016 at 5:27 am

          Equal doses don’t always result in equal levels. I have a very close friend who started using 100 mg per week and that brought his levels from the 300’s up to the 900’s in only 6 weeks. I had to use 180 mg per week to see the same levels. So a common range for TRT is 100 mg to 200 mg. At 200 mg and above people start referring to your dose as a cycle.

  • Reply
    Indomitable Audacity
    August 27, 2015 at 12:14 am

    Alright Nate, You have sucked me in. I’m reading the next one tomorrow and I want to say, thanks for sharing your journey. I had NO idea about this issue before today.

  • Reply
    Sam
    August 28, 2015 at 9:51 am

    Can you just take hcg only to help you with testosterone?

    • Reply
      Nate
      August 28, 2015 at 10:21 am

      You sure can, Sam. That was my original treatment plan. I just published the third article and you can read my exact experience with that.

  • Reply
    Happy 1st Birthday Iron & Tweed! - Iron and Tweed
    October 30, 2015 at 3:59 am

    […] But enough of the mushy stuff…I’m sure you’ve had enough of that with My low-T Journey. […]

  • Reply
    Glenn
    November 30, 2015 at 8:29 pm

    Few months late but just found the site. This article has been super helpful. I have been working out for years intensely and even though I saw gains I never saw the gains others made. I had a feeling I had low testosterone due to this a year ago and forced my doctor (after arguing for 5 min) to give me a testosterone test. Unfortunately it didn’t include free testosterone. My results was 487. This came in the normal range so I moved on. But after looking at that chart and seeing that puts me at over 70 year old it has motivated me to go again and get a full panel including Free Testosterone. Hopefully I can now get confirmation either way. So thanks again for the articles!

  • Reply
    Skinny Dragon
    February 27, 2016 at 5:28 pm

    Great site Nate. Thanks to thoughtful & informative posts from you & Vic Pride, I got myself checked for low T @ age 45 last week. Results: 262 total testosterone (9am, no food beforehand), 37.3 SHBG (nmol/L). Seems my level would be significantly low even if I were a 90 year old man.

    I’m one of those guys who has been lifting weights for 33 years (weight set on 12 year-old birthday) and have remained skinny-fit the entire time. My waist has also increased from 28″ @ 8% BF in high school to 33″ @ 17% BF a few months back. I’m over 6′, btw. Since Xmas this year, I dropped 10lb and emphasized heavy lifting (DL, pull-ups, squats, bench) but my waist size only dropped 1/4″. Unbelievable – doing all the “natural” stuff right, I basically lost majority muscle versus fat.

    It’s only been a week, but my waist size already dropped 3/4″ (and my calorie intake has increased). I’m also looking forward to those “newbie” gains I’ve always heard/dreamed about but never realized. I’ll plan to check back in several months with an update on my progress.

    • Reply
      Nate
      February 28, 2016 at 11:29 am

      It’s great to finally have answers, isn’t it? You’ll definitely get those long overdue newbie gains you deserve! Keep me posted on your progress!

      • Reply
        Skinny Dragon
        February 22, 2017 at 6:19 pm

        Hi Nate,

        Checking in one year later. :-) I’ve tracked my weight, waist, testosterone levels, and strength levels regularly since last year. A few observations:

        1. If you have legitimately low T-levels (as I did) the testosterone alone with provide an immediate effect in terms of fat reduction and muscle increase.

        2. You can still get fat if you are on T (even with estrogen blocker – I take that too). I was sick for several weeks and busy with work… still on T…. my waist expanded 1″ and I got no stronger. I was able to maintain more strength in this phase than I would have otherwise.

        3. Diet matters. My achilles heel, ha. The best thing about T (for me – one of the best things…) is that you can drop calories down to 1,000 to 1,500 per day and STILL not lose muscle – IF you eat protein and keep lifting. Over 3 weeks, I lost 5lb in total AND 1.5″ off my waist (not water weight – I measured daily), while gaining in strength. Drinking a few beers had no negative impact; I think alcohol is no worse than any other carb. At that time I was aiming for a beach body/6-pack abs.

        4. The mental impact of T is amazing. So much of my social anxiety just dissipates. I look people in the eye in public, find it easier to flirt with women, etc. WORTH IT just for this, in my case (genuinely low T).

        5. You will reach a new (higher) plateau of strength and body comp on regular T, and to surpass this you MUST change diet. I’ve gone up and down several times with my gains because of work stress and lost focus on lifting. Going into the summer (beach season) I’m starting to refocus again, and have banned junk food from my kitchen.

        6. Strength gains over one year (low to max, according to my daily spreadsheet – note I was already lifting and exercising regularly for years BEFORE starting on T):

        Compared to 1 year ago (exactly) I am 8 lb heavier, but my waist is 1/4″ smaller (with a bad diet – it had been down up to 1.5″ – including 3/4″ after one week!).

        Chest has gained 3/4″, biceps 1/2″, quads 1/2″, neck 1/2″ (and not fat!). A relative at Xmas said, “your arms look bigger”. Another said, “you look younger than you did the last time I saw you (three years prior)”.

        Deadlift max up 50 lb. (over 300lb).

        Bench press max up 30 lb. (well over 200lb). Had a couple of injuries – at 40+, best to limit BP to 1 x per week.

        Pullup max up from 13 to 18 (somewhat wide grip too). I think I could do 20 if I was motivate – with full extension and no body sway.

        Squats from ZERO (could not even do bodyweight deep squat with proper form) to 200lb (still horrible… but better than 0). NOTE: with heavy squats, my ab definition has improved like crazy! I used to do crazy, stupid core routines and got NOTHING but soreness. Now I never do even 1 situp. Squats, DL and pullups take care of the core! Got

        Military press max from 110lb to 145lb. Fun to lift the heavy plates when all the young guys are using 25lb dumb bells, lol.

        The above has come despite uneven access to a gym (I do bodyweight stuff then – pushups, pullups only) and severe work stress. From this point forward, I want to bulk up another 10 to 20 lb and get up to repping 225lb on BP and squats (just a personal lifelong goal). Will have to focus more on diet to do this.

        Side-effects: I should note the negatives of T – red blood count was too high, so I give blood 2x per year; moderate acne on back unless I treat it; giving yourself a shot in the butt for life is a drag; balls have shrunk about 30%. Not concerned with fertility. All other bloodwork good.

        I’ve gotten some good ideas from your site (appreciate your honest perspective), and even some tips on denim and shoes LOL. Hope all goes well with the family, fatherhood, fitness, and life in general.

        A Less-Skinny Middle-Aged Dragon

  • Reply
    ben H
    April 25, 2016 at 1:17 pm

    Hey Nate, I didn’t see it anywhere listed, but do you actually use HCG now with your TRT protocol, or just TRT injections?

  • Reply
    ben H
    April 26, 2016 at 1:41 pm

    Thank you for these articles BTW. I feel like I’m in the same boat, as my total T has always come back in the normal range 500-650 ng/dL; however, I’ve always had low T symptoms, but doctors tell me I’m fine looking at total T, saying that free T doesn’t matter. So I started running my own lab tests and including SHBG. My SHBG is always at the top of the Labcorp reference values or even HIGH/off the scale, which I believe is rendering the testosterone my body does make inactive. My last FT levels were at 7. 62 ng/dL. It fluctuates between 7-10 ng/dL . I’m going to try a consultation with testosterone.com. I’m hoping a combination of HCG/test cyp can get my FT up while preventing atrophy.

  • Reply
    John
    June 18, 2016 at 10:06 am

    Do you know what caused your low testosterone in the first place?

    • Reply
      Nate
      June 18, 2016 at 10:30 am

      I don’t have any idea. I had all of the symptoms even in high school (a complete inability to gain muscle or strength being the major red flag) so it isn’t like I’m suffering from a decline with age or cumulative exposure to some chemical. I just never had high levels in the first place. It’s something I’ll look into in the future when I have better insurance though. I was completely uninsured when I started TRT so extensive testing was out of the question.

  • Reply
    Mark
    July 29, 2016 at 11:47 am

    Nate,
    I was told I had low testosterone about 4 years ago (around 300) when I went to my primary care physican for fatigue. He did put me on androgel and I took it for a few months, but it was expensive and I wasn’t seeing any changes. A month ago, went back to the same DR and was retested and my level came back at 235. I decided to research shots instead of the gel and came across your site. Reading your blog, I have many similar experiences. The difference now is that I’m 47 years old. I have extreme brain fog, lack of stamina, depression, and sexual disfunction.
    My dr referred me to a local mens click for shots. I was extremely excited about this, but the tests performed by the mens clinic came back at 400. It was deflating as I thought I may have found the answers I have been seeking for years. I started getting weekly shots 200mg two weeks ago at a mens clinic. I haven’t felt any changes with the exception of the day after my 1st shot I started having morning erections. This was new as I couldn’t remember the last time this had happened. I feel a litte ignorant, but I believe I’ve had this issue since my teenage years. I remember having mornng erections on occasion, but it was a normal occurance. Do you think the quick response to the shot in relation to the onset of morning erections is a positive thing? I would assume that it confirms that I have an issue somewhere….I just want to make sure I’m going in the right direction. The mens clinic has more of a “wait 6 weeks” until they do their next labs.
    I hoping improvements in mental fog and stamina will follow soon, but am slightly discouraged. While the sexual function is important, i feel my mood, mental fog, and overall stamina are more important at this time to my marriage and family.
    Sorry to ramble, but as you can relate this is a very personal and real problem. Thanks and great site.

    • Reply
      Nate
      July 31, 2016 at 1:29 pm

      I would definitely say that the morning reaction in response to the shot is a good sign. Right now, I say that you just stay the course. I remember waiting for an abrupt change when I started TRT but it was more gradual. Hang in there and keep me posted!

  • Reply
    Chris
    September 7, 2016 at 12:45 pm

    Hi
    Could you tell me if I have checked my blood test with doctor and it came up low but doctors are not happy to prescribe injections for some reasons ,would be good idea to buy same injections and post cycle tablets as you and do 3 months cycle but very carefully, with monthly blood test( in uk for free ) saving money,I have checked I could get whole 3 months cycle for around 100-150 GP pounds

    • Reply
      Nate
      September 12, 2016 at 1:27 pm

      I would look into a different doctor first. I’m not sure what the laws are like in the UK but in the US I’m pretty sure getting caught with testosterone is the same as cocaine or heroine. Definitely exhaust your other options first but if you’re willing to take the risk you can set up your own TRT. Just remember, you’ll become dependent on the medication and if your supplier ever moves or gets busted, you’ll be scrambling to find another source. Good luck!

  • Reply
    Chris
    September 18, 2016 at 2:19 pm

    Thanks for reply, Could you tell me what do you think about SARMS like LGD ITC. available on market these days
    Are they increasing testosterone same like injections ?

  • Reply
    Chris
    October 4, 2016 at 9:36 am

    Hi Nathan

    I know you do not know about Sarms but what about pro hormones to use to increase testosterone does not seems more safe ? Or convenient because if you will stop take injections hormones will back to normal in your situations ?

    • Reply
      Nate
      October 6, 2016 at 10:27 am

      Pro hormones will only raise your levels while you’re on them and your natural levels will be suppressed once you discontinue use and you can only use pro hormones for 1-2 months at a time. Injectable testosterone will have the same raising and suppressing effects, but can be used constantly with no need to ever discontinue use.

  • Reply
    David Thomas
    October 12, 2016 at 12:00 pm

    You should really use a San’s serif font for online reading. (Ca$hvertizing)

  • Reply
    Alex
    October 17, 2016 at 7:39 pm

    Nathan,
    Very inspiring, educational and motivational story. I would like your and everyones opinion: I am 55 yr old male– a serious Crossfit competitor training for next years Games. However low T stands in the way. I have been measured three times w/ average score of 150 and range is 200- 767 n/dl. I look great and am still highly athletic, but I am getting tired very easily during a workout, generally fatigued and my strength is noticeably decreasing. Proof of this–was able to power clean 155# a few months ago and now am down to 125# despite still working out at a high level. Bench press same thing 155# a few months ago and now 135# is a real struggle. It’s ridiculous! I need my 1 RM’s to be going up, not down.

    Still okay on the Metcon stuff, but tire easily and faster.

    Am starting injections tomorrow. What dosage should I be looking at? Doctor wants to play it conservative, I don’t. I’m in a a hurry and need this turned around in 8 weeks. The Open starts early February,. I’m screwed if I can’t improve by then. What is the improvement timeline. I know it varies, but generally….

    Of all the symptoms, the loss of strength is most alarming.

    Please give me your input.
    Thanks.
    Alex

    • Reply
      Nate
      October 24, 2016 at 8:14 pm

      Sorry to hear you’re feeling this way, Alex. I first have to ask if you’ve been overtraining or have lost a lot of weight in preparation for the games? I only ask because one of my good friends is a competitive natural bodybuilder who hovers around 800 total T but comes in in the 100s just before his competitions.

      Other than that, most guys seem to get in the optimal range on doses around 150 – 200 mg per week. How is everything going so far?

  • Reply
    Chris
    December 5, 2016 at 5:12 pm

    Hi Nathan

    Thanks so much for your blog it is very good website with a lot information and comments.
    I have problem I am only 32 but last 4-5 years I see big change in that department , I have checked my hormones and hormones as doctor said are ok total testosterone is 421 ? Seems low for young guy ? When I ask for total testosterone doctor said because total testosterone is in range so there is no point to check free testosterone , my symptoms are erection problem can not be as hard as I was 4-5 years ago ,I am tired all the time no energy for gym ,no motivation ,no passion for anything, boring of life,loss of strong libido, sleeping problem, anxiety, lack of energy for life to change myself for better person ,memory problem, concentration problems , can not handle stress on airport when I work, no girlfriend because fear of erection dysfunction and no positive view for world , I am just locked inside my head and house , would you know whether injections would help me I can get that easily in UK online the think is if I will never try inject testosterone I will never know how is to feel with high testosterone around 900/1090 help me please bro

  • Reply
    Chris
    December 6, 2016 at 12:06 pm

    Hi Nate
    I would like to set TRT on my own as I have source to get everything online and much cheaper than 220 USD per month. My doctor does not want to listen anyway , I would like to basically copy your regime with TRT.
    I am willing to do same as you but before putting myself for life with TRT, would not be better to do long cycle
    Like I do not know maybe 12 weeks to see whether that what I want for whole life energy motivation stamina ITC.
    My doctor said they would not give me even because my levels are in range 421 seems is 75 year old guy lol
    So the idea is to only check with doctor hormones and mention or not to mention about taking therapeutic doses of TRT. What hormones I should check in case starting injections on my own ? Total T free T anything else ?
    I can improve my life without doctor who does not want us to feel great they want us to be weak ,weak person is easy to manipulate. What syringes sizes and needles (long,short)you using ? Do you do injections of HCG 250 using same needle, syringe what testosterone ? Is it the same spot near belly button ,I want to do it for 12 weeks or longer to do muscle and increase testosterone but I may stay on it longer. Anastrozol 25 uq you using tablets ? From Balkan pharmaceuticals ? What about HCG and T cypionate brand company

  • Reply
    Chris
    December 6, 2016 at 12:40 pm

    If I can help boron in range 6-12 mg daily increasing free T not many people to know that :)

  • Reply
    Chris
    December 8, 2016 at 9:48 am

    Well ,we all thank you for your help and great blog, what is best
    Levels of total T and free T you feel best every day is it when is high like 1090? Or lower how body feels mentally in this range as I am in range 421 only and I am feeling like you before TRT

  • Reply
    Mark
    March 12, 2017 at 7:58 pm

    Hi Nate, did you ever experience muscle weekness even with minor activity? I notice if I spend a couple hours working in the garage my muscles ache and I’m sore for days over some basic garage work, feels like I’m 80 years old and I’m only 37!

    Also, is low t a cause for feeling weak and horrible every morning? It takes me couple hours every morning to feel semi normal, I feel like a sore old man with a hang over every morning.

    Thanks for all you’ve shared.

    • Reply
      Nate
      March 13, 2017 at 7:06 pm

      I definitely felt weaker than I should’ve for my size and lifting experience and yes I was always tired in the morning. And also very angry before I even got to my first cup of coffee. All of those things have cleared up now.

  • Reply
    Mark
    March 14, 2017 at 10:49 am

    Thanks , Nate.

    Is it true that you run the risk of your blood getting thicker with treatment?

  • Reply
    John Ryan
    July 4, 2017 at 10:36 am

    Hey Nate,

    These posts on TRT have really made an impact on my life. Two years ago at the age of 21 my total t got measured at 360, for a guy who’s supposed to be in his prime the skinny fat look was killing me. I’m 6′,6″ and weighed 260lbs at the time. Fast forward two years and I’ve lost 30lbs from working out like a maniac (I was extremely sedintary in HS but have been working out hard for about 6 years now), but I still can’t away from the symptoms. Recently I’ve been feeling like an old man, my joints click I need like 10 hrs of sleep a normal and I’ve exhausted every other medical affliction possible for my hormone level and nothing works. I haven’t gotten my t levels checked again for 2 years because of a bad experience with an endocrinologist who said I was fine when I got retested with a tt @ 500 (380-1200 range) , and free T level below the range. I tried contacting primebody a few times but never heard back from them. Ultimately it doesn’t matter but I am thankful for you describing your symptoms and giving me some peace of mind in knowing there might be a brighter future. Because like you said, the worst symptom is the depression for no reason. All the best man, keep doing your thing.

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