TRT or Testosterone Replacement Therapy is a standard, effective, and safe treatment for a deficiency in your natural testosterone levels. We all know that we need testosterone for our biological bodily functions, and even more so when we are looking at bodybuilding. This article aims to tell you everything you need to know about TRT in the UK, why you might need it, how it works, the pros and cons, and many other questions. However, before we get into the article, you need to know that you always recommend that you consult a doctor before taking any TRTs, no matter how much you research.
What is TRT in Brief?
Testosterone Replacement Therapy is a method of reviving the natural levels of testosterone into your body. Sometimes, you will see the same treatment being called Androgen Replacement Therapy. However, androgens are any hormone that controls the development and maintenance of males and their characteristics, including androstenedione. If you are looking into TRT, you need to know which of the two you will receive. This article is going to focus on Testosterone.
Why Would You Need Testosterone Replacement Therapy? Symptoms of Low T levels
While there are many benefits to increased testosterone, such as performance enhancement in sport, muscle building, etc., however, there are a few symptoms that you will look out for to conclude that you have low levels. If you do have any of these symptoms, especially more than one, you may want to consider TRT:
- Sex drive changes (usually a decrease)
- Erectile dysfunction (ED)
- Decreases in sperm count
- Anxiety and/or depression
- Increases in weight
- Hot flushes
- Changes in penis or testicle size
- Breast enlargement
- Loss of strength
- Lacking concentration and memory
- Decreased sense of wellbeing
- A decrease in body hair
The primary problem that people face is that they may have one or more symptoms, but not have low testosterone levels. It is always advised that you have a testosterone level test before commencing with any treatment and get the doctor’s results checked. As age is a determining factor, along with diet and exercise routines, you may think you have low test levels, but they are fine.
What Causes Low Testosterone Levels?
The primary cause of low test levels is age. After around the age of 30, men’s testosterone levels will drop at a rate of around 1% each year for the rest of their lives. Therefore, age is the most prominent reason why you would look at TRT at all. However, your doctor will assess many different causes of low levels before making a final decision. Some of them are:
- Alcohol abuse
- Rapid, extreme weight loss
- Type 2 diabetes
- Metabolic disorder
- Steroid use
- Head injury or brain surgery
- Injury or infection of the testes
- Certain medications (prostate cancer treatment, opioids, steroids)
- Kidney failure or Cirrhosis
- Primary hypothyroidism
- Delay in puberty onset
- Excess estrogen from external sources
- And some others
Many factors can cause low testosterone levels. However, unless you have any of the above, the primary cause is age, a factor that comes to all of us sooner or later. Next, we will talk about how TRT can help you, especially if you are experiencing some of the symptoms discussed at the top of the page.
What Affects Test Levels?
There are many thoughts about what can or cannot affect testosterone levels. The problem is, without a lot of tests at different times, you are unlikely ever to know if your levels are usually higher than your results, or lower. Harvard Edu has completed studies that show there may be less of a correlation between timing and levels as you get older. They conclude that, while the train of thought that levels are at their highest pre 11 am is likely to be correct, that is only for young, healthy men.
As you age, there is less of a difference throughout the day, and it is unlikely that a diagnosis will change based on any blood test done before around 6 pm. They also conclude that people with low protein diets may have lower test levels than those who consume a lot of protein. However, there is not enough evidence to make that a definitive conclusion.
How to Get Testosterone Replacement Therapy
The most reliable, accurate, and safest way to get TRT is through your doctor. However, there are tests that you can order online that you can do at home. Some companies will charge you around £50 to have a test completed and send you the results, either by post or email. You will only ever be considered for TRT if your T levels are sufficiently low enough to warrant the medication. The Endocrine Society recommends that you need testosterone levels lower than 300ng/dl and other symptoms of low test levels to be considered. Here at UKBolics.com, we have many brands of test that you can buy, even without a prescription.
When Should You Not Have TRT?
There are times when TRT is not recommended. They are if you have:
- Prostate cancer
- A noticeable prostate nodule during DRE (Digital Rectal Exam).
- PSA (Prostate-Specific Antigen) levels of more than 3ng/ml without evaluations
- Obstructive sleep apnea
- Severe urinary tract infections
- Heart failure
There may be other times that you should not use TRT. That is why you need some medical guidance about whether it is right for your personal circumstances or not.
Types of Testosterone Replacement Therapy
There are various ways in which you can administer testosterone for replacement therapy. Some of them are more suitable for people than others are. However, not all of them are easy to get hold of without prescriptions, and some are difficult, even if you do have one. Here is a quick look at each of the options that you have for TRT delivery.
External patches are a little like nicotine patches that you would have to stop smoking. They are often one patch per day applications, and the T is absorbed into your body through the skin. You would use them either on your arm or on your upper body.
Similar to the external patch in the method of delivery. However, mouth patches are applied to the inside of your mouth, above your incisors, and the testosterone is absorbed through your gums into your bloodstream.
There are various types of gel that you can get for TRT. Most of them are in pump form, which will dispense the right amount of hormone for your prescription. Some of the gels will need to be applied to the skin, and others will need to be used inside the nostril.
Of course, the most common and readily available method of test delivery is through injection. This is the method that bodybuilders will use as there is more control over how much you get and when. Testosterone injections are the only type of test that we have available.
Like the injections, you have a “capsule” implanted into the skin, a lot like the progestogen implant used for contraception called Nexplanon. They require fewer administrations, but you cannot have them without a prescription.
Yes, you can get testosterone tablets, but they are extremely hepatoxic (damaging to the liver). All other methods get into the bloodstream without going through the liver. Therefore, you have a lot of lower risk of complications.
What Is The Best Testosterone Replacement Therapy?
The only way to determine the best testosterone replacement therapy method is to speak to a doctor. However, the most common form of treatment is through injection, as they are the cheapest and easiest way to get a known amount of testosterone straight into the bloodstream.
Most companies will use testosterone Cypionate or Enanthate for TRT as the ester is a short, fast-acting one. While that may not sound the best way to manage TRT, as you will get a rollercoaster effect (high and low levels depending on the time between injections), the plus side to using them is that the adverse effects are easier to manage with dosage regulation.
Pros and Cons of Testosterone Replacement Therapy
As with all medical treatments, there are pros and cons to the decisions that you make. It is best to understand them as fully as you can before you undertake any treatment, and TRT is no different. Over the next few sections, we will look through the benefits and risks.
Benefits of Testosterone Replacement Therapy
Of course, the primary benefits of TRT are to reverse the symptoms that you have read above. People have reported complete reversal of things such as fatigue, irritability, sex drive decreases, etc. Others have noticed considerable changes to their physical health, too. For example, higher testosterone levels, closer to young adulthood, will increase muscle mass and, thus, lower fat levels.
As testosterone is essential for both your physical and psychological health in the long term, you can feel much healthier mentally and physically. Furthermore, you are more likely to decrease your recovery time after hard workouts and even injury. As TRT is more about revitalising your natural male androgen levels to a normal state, you will feel younger and more vitalised. So, here are some positive points that you can expect from test replacement therapy:
- Better mental well-being
- Lower irritability
- Increased cognitive function
- Higher energy levels
- Increased sexual function and libido
- Higher fertility
- Fat loss
- Muscle development
- Increased bone strength
- Faster recovery from injury
Although people use testosterone as a performance-enhancing steroid, there are many more benefits to it than only muscle increase.
Risks and Side Effects of Testosterone Replacement Therapy
The risks and side effects should be pretty low considering the formulation of testosterone is the same as what your body already produces, and has done for many years. All you are doing is increasing the concentration of testosterone in the body back to a state it has already experienced. However, the reality is, you will be at a higher risk of some side effects. They are:
- Possible increase in the risk of prostate cancer. – This risk is something that has an age of thought behind it. However, it is only that, a thought. Back in the 1940s, people believed that the lower your testosterone levels were, the better the condition of prostate cancer was. It was thought that, if you reduced testosterone levels enough, you could almost make prostate cancer go away for a while. If you increased the levels, you were making the situation worse. However, that is not exactly the truth, as no recent studies are proving the fact. However, it is still something that you should think about.
- Oily skin and acne. – Remember when you were a teen, and your testosterone levels were high? You may have experienced oily skin and acne. Well, the risk of those is there whenever you increase your levels, even with testosterone replacement therapy.
- Decreased sperm count and fertility. – Yes, believe it or not, testosterone can reduce your sperm count and fertility. When you use testosterone, you are stopping your own bodily production of test. That stops the hypothalamic-pituitary-gonadal axis from producing T, which reduces the intra-testicular concentration, thus reducing spermatogenesis (sperm production).
- Possible risk of blood clots. – As the hormone increases your red blood cell count, it also increases the viscosity (resistance to flow (thickness)) of your blood. Furthermore, it also increases the platelet count, which is the blood cell responsible for clotting.
- Heart attack and stroke risk. – For the first two years of TRT, you face the increased risk of heart problems and stroke. However, after those first two years, the risk does decrease.
- Testicular atrophy. – Much like the decrease in sperm count, testosterone replacement therapy can cause your testes to shrink. That is because you are stopping the production of gonadotropin-releasing hormone (GnRH). When GnRH production stops, your pituitary gland will stop making LH (Luteinizing Hormone), and without LH, you stop producing your own testosterone in your gonads.
- Gynecomastia. – Although rare, TRT can cause gynecomastia because testosterone is relatively high in its aromatising ability. However, if you start developing breasts through gynecomastia, you have the option for aromatase inhibitors such as anastrozole.
Each of these risks is dependant on personal circumstances. Furthermore, the treatment of them will be different for individuals, too. That is why you need to have professional medical input into your treatment.
Alternatives to Testosterone Replacement Therapy – What Are Your Options?
There are options that you have to consider before taking testosterone replacement therapy. If you are suffering hypogonadism, then your doctor may opt for TRT anyway. However, they are likely to ask you to change some of your habits before they do so.
Natural TRT includes the changes that you can make yourself without injecting testosterone. There are many things that you can do that have reported to increase your levels without medical intervention. Here are some of those things that you might want to try:
- Get enough, sound sleep. – Reduced sleep is directly linked to the amount of readily available testosterone in the blood. If you lack sleep, then getting between 7 and 9 hours is recommended.
- Keep your weight under control. – Being overweight is the best predictor of low testosterone levels, and that is because fat cells contain high levels of aromatase. Aromatase will turn testosterone into estrogen, thus reducing your available test levels. Abdominal fat is the type that creates the most aromatase. So, if you have a few too many pounds on your belly, you may want to get that under control first.
- Reduce or remove sugar. – No matter what tolerance levels you have for glucose, the Endocrine society have found that sugar can decrease your testosterone levels bu a huge 25%.
- Resistance training. – While any exercise is good, resistance training has been proven to increase your testosterone levels more than any other. That is because it promotes muscle growth which, in turn, promotes the production of testosterone.
- Supplements. – Low Zinc levels have been associated with hypogonadism, and vitamin D has shown to increase testosterone. So, supplementing with both Zinc and Vit-D are likely to increase your testosterone levels. Eating a diet of foods high in both, such as nuts, whole grains, etc., are recommended if possible.
Ensuring that you have the above all in order may reduce the need for medicinal TRT completely. It is always a good idea to start there and see how your levels change before opting for testosterone replacement therapy.
Extra Questions About TRT
Of course, this article has probably still left you with some questions. We will try to answer all of the most common questions here. If you have any more, please let us know to answer them and give a better understanding of Testosterone Replacement Therapy.
Does Timing Affect T Levels?
Yes and no. Timing has been proven to affect your testosterone levels in your blood. However, in young, healthy males, there is a drop from around 11 am. Sleep helps the creation of testosterone, and your levels are highest straight after waking. They then decline over the day. Therefore, if you want to know if you have low levels, it is best to do a test at about 8 am.
Does Testosterone Replacement Therapy Work?
The American College of Physicians has set out guidelines that show there is little definitive evidence for TRT to do anything other than improving sexual functions in some men. However, there are a lot of people who would disagree with their personal experience. Therefore, whether it works or not is a subjective experience.
How Much Does Testosterone Replacement Therapy Cost?
Depending on where you go for treatment, the average starting price is around £50 per month. However, that price is likely to change depending upon dose and frequency.
Is Testosterone Replacement Therapy Safe?
For most men, yes, TRT is safe. However, it is not safe for those who have any issues that we have already spoken about earlier in the article. If you are prone to any of the side effects, then you may also consider TRT unsafe. However, continuous monitoring from a doctor will help you get the dosage right for your requirements and tolerance.
What Is BioIdentical TRT?
Bioidentical TRT is the same as “regular” TRT. The difference is that bioidentical hormones are humanmade from plant estrogens instead of being taken from animals. It is usually bioidentical hormones that you find in patches, gels, creams, etc.
What Is The Maximum Dosage of Testosterone-Replacement Therapy?
There are varying dosages depending on your own testosterone levels at the time of testing. However, here is a baseline that is often observed.
- Injectable enanthate: 200mg/ml per week.
- Injectable cypionate: 100-200mg/mL per week.
- Injectable undecanoate: 250mg/mL per week.
Stopping Testosterone Replacement Therapy
There are a few reasons why you might want to stop TRT. That is a difficult decision to make, as there are some unknowns that you have to contend with. The main problem you will have to face is; when you provide your body with testosterone from injections, your body stops producing its own hormones. Therefore, simply stopping your treatment may well leave you with lower than usual levels of testosterone. That is not always the case, but it is certainly a possibility. So, how do you stop? You have two primary options:
- Stop. – That’s it. Sometimes you can just stop and see your body return to how it was pre-TRT. However, that is not always the case, and it can take a while for your body to realise that it is low on testosterone and produce it itself.
- Speed up the production of testosterone. – PCT (post cycle therapy) will help your FSH (Follicle-Stimulating Hormone) and LH Luteinizing Hormone) levels increase thus signal to your testes to produce more testosterone. The most common way to do that is by taking hCG (Human chorionic gonadotropin) to begin stimulating the testes to produce the testosterone before you stop TRT. After that, you can take Clomafine (brand name Clomid) to increase the brain’s signal to the testes.
However, if you stop Testosterone Replacement Therapy, you are only ever likely to get back to the production levels you were at before TRT. Therefore, your symptoms from before TRT will come back, and likely a little worse than before. That is something that you seriously need to consider, especially if you have hypogonadism.