Testosterone is synonymous with strong muscles, Viking-esque beards, and an intense sex drive. But T—a primary hormone produced in your testicles that regulates your reproductive system—affects a lot more than you may think. In addition to its muscle-building and sex-drive functions, it also plays a role in the clarity of your skin, the speed of your metabolism, and even your brain function. Go figure. “It’s a hormone that travels around the body and is metabolized into different hormones—dihydrotestosterone and estradiol,” says Robert Tan, M.D., professor of medicine and family medicine at the University of Texas Health Science Center and research director of the Low T Center. “So it isn’t just about sexuality or strength—it’s a very generalized hormone.”
Dihydrotestosterone, for example, initiates the development of male characteristics, while estradiol induces sperm production. These days, more and more men are turning to testosterone replacement therapy (TRT) for better gains in the gym, more energy, and a healthy sex life. Think you’re a candidate? Read on to learn more about TRT.
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What’s Normal When It Comes to Testosterone?
Guys in their late teens to early 20s (you know, that period when you feel invincible and have the sex drive of an elephant in mating season) are going to naturally have more testosterone. Once you hit 35 years old, those potent T levels start to drop, according to Abraham Morgentaler, M.D., author of Testosterone for Life, the director of Men’s Health Boston, and an associate clinical professor of urology at Harvard Medical School. “More important, there is a decline in free testosterone, which is the active, more bioavailable portion of testosterone in the bloodstream,” he says.
As your testosterone drops, your bones will begin to weaken, and you’ll notice more padding along your waistline. Unfortunately, no amount of working out or protein shakes will keep you lean and strong if you’re not in the optimal T range for your age. For men under 40, the normal range is between 450 and 650ng/ dL (nanograms per deciliter), though Morgentaler notes that anywhere between 300 and 1,000ng/ dL is still considered fine.
“Some men maintain good levels of testosterone well into their 80s, and others are low in their late 20s,” he says. “However, on average, T levels in men decline by about 1% per year.”
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How to Know If Your Testosterone Levels Are Low
If you think you may be experiencing low T (also known as hypogonadism or hypoandrogenism), then you need to go to your doctor and request a blood test—it’s the only way to know for sure. As far as symptoms go, fatigue is a telltale sign. Reason being that your T spikes in the morning and then trends down, so if you’re already low, you’re going to feel it hard by 4 to 5p.m.
The rest of the symptoms are a litany of ills that no man in the prime of his life would want to have visit him:
a dramatic decrease in sexual drive and sexual thoughts
an inability to gain strength or muscle (and even muscle loss) in guys who exercise and lift consistently
“I’ve even found that some very athletic patients, like NFL, MLB, and NBA players—all very big and tall, 250 pounds and muscular—can be hypogonadal,” Tan says. There are no hard and fast rules when it comes to a physical exam, so if you think you may be low on T, hit up your doc for a test to be sure.
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Boost Testosterone Naturally
You may find that although your T is on the low side, it’s not enough to concern your doctor. If that’s the case, then you should consider hitting the weights. Hard. According to Tan, a solid hour of pumping iron may double your T levels, but only for a short period of time.
“The reason isn’t quite understood,” Tan says. “But there’s certainly a stimulus.” Scientists think that when you do resistance exercises, the brain recognizes the exertion and then signals the testes, which then increases a gonadotropin, or stimulator, called luteinizing hormone (LH). That may be the mechanism that pumps up levels of testosterone, but because it’s not continuous, the levels drop after a while.
Studies say…
A 2006 study published in the International Journal of Sports Medicine found that young and old guys who performed seated chest presses, pec deck yes, pulldowns, curls, leg extensions, and leg curls for three sets of 15 reps at 60% of their one-rep maxes bumped their T for 15 minutes.
Men who performed steady state cardio and high-intensity intervals both showed bumps in testosterone levels, but again, they dropped down a er around an hour, according to a study in the Journal of Sports Science.
If you’re overweight—research shows that obesity contributes to low T—getting back into the gym or just being consistently active can bring your depressed levels of testosterone back up closer to baseline, says a Japanese study presented by the American Physiological Society in 2016.
Guys who train often have been shown to have higher amounts of T and other helpful hormones compared with those who lead a mostly sedentary life, according to a 2004 study published in the International Journal of Neuroscience.
For maximum testosterone stimulation, implement compound movements—like bench presses, squats, thrusters, and deadlifts. They build strength, increase power and endurance, boost metabolism, and may spike T levels.
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When to Talk to Your Doctor
When chronic fatigue hits you, along with the other symptoms of low T, such as decreased libido, muddled thinking, and failure to make gains in the gym, it’s time to talk to your doctor. If your test—which should analyze amounts of total testosterone, free testosterone, luteinizing hormone, and prolactin (a hormone that can decrease T levels)—comes back with a number lower than 250 to 300ng/dL, then your doctor should consider starting you on testosterone replacement therapy (TRT), or what is now more commonly called testosterone therapy, or TTh, since nothing is really be ing replaced, says Morgentaler.
“Testosterone is a controlled substance and must be pre scribed by a health care provider,” he says. “And now, many urologists, endocrinologists, and an increasing number of primary care physicians prescribe testosterone.” Insurance o en does cover treatment, but only if testosterone levels are very low and a number of other conditions are met, such as the patient is showing symptoms of or has a diagnosis of primary or secondary hypogonadism and doesn’t have prostate cancer. If you are on the edge of acceptably low T, your doctor can argue on your behalf to cover treatment, though it often doesn’t work, says Tan. “Doctors, like myself, are part of a board, and we came out with these guidelines, and then the insurance companies took these guidelines as gospel truth. There has to be some flexibility, but unfortunately they don’t always want to give any.”
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Methods of TRT
Most men will experience improved libido, strength, and stamina and a sense of well being. “They feel very good after an injection,” Tan says. “Then, toward the end of five, seven days, they feel sluggish—that’s the disadvantage of the injection—but they get a good high. With the topical treatment, the reaction is a little bit milder, but it’s a more consistent improvement.”
Side Effects
Acne, breast tenderness or swelling, fluid retention, swollen feet, reduced fertility and testicular size, and increased red blood cell count can occur, but these side effects are uncommon, and usually your body returns to normal once treatment ends. Your T levels will also return to about where they were prior to treatment, with symptoms usually returning. “There have been concerns raised regarding prostate cancer, strokes, or heart attacks—however, current evidence suggests TTh may actually protect against them,” says Morgentaler.
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How Much Does TRT Cost?
Cost for TRT, or TTh, will vary greatly depending on the form of treatment your doctor prescribes you, but here are some estimates with insurance kicking in.
CREAMS: $10-$30 per month
GELS: $40-$100 per month
IMPLANTABLE PELLETS: $600-$1,000 every 6 months
INJECTIONS: $30 per month
Without insurance, you’re going to be digging a lot deeper into your pockets. Here’s what you can expect to shell out sans help.
CREAMS: $75-$100 per month
GELS: $250-$400 per month
IMPLANTABLE PELLETS: $1,400 every 6 months
INJECTIONS: $40-$60 per month
As far as how often you have to take TTh, it depends on the form of treatment.
CREAMS: Daily
GELS: Daily
IMPLANTABLE PELLETS: Every 3-4 months
INJECTIONS: Every 1-2 weeks, or for long-acting treatment, every 10 weeks
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The Illegal Side of Testosterone Use
If you’re seeking out testosterone just to get “swole,” then be warned: Not only can unregulated T injections see you taking in 50 to 100 times more than what regulated users ingest, you can land yourself in serious trouble. It’s illegal without a prescription, and penalties can range from one year in prison and a $1,000 fine to five years in prison and $250,000 if caught selling it. Another reason to avoid getting T from the street is that you don’t really know what you’re getting. It could just be some kind of food oil like sesame or peanut oil and filled with contaminants that increase your risk of infection.
