About Hormones Men When do I start?
When is the right time to start TRT?
As previously mentioned, extensive evidence shows that replacing testosterone to treat ‘hypogonadism’ is not only warranted, but is also FDA approved. At some time during their lives, men will begin to experience drops in free testosterone and total testosterone levels. It may happen in the mid-thirties, forties, or not until the fifties. However, eventually, testosterone production will drop to a lower level than when they were twenty. If it drops below 300 (and a man was fortunate enough to have his doctor check it), there is no controversy—everyone agrees such men should be treated. But what about the 50-year-old, otherwise healthy male with a total testosterone at 500 ng/dl and a free testosterone level of 9 ng/dl? What if he had a level of 800 when he was in his early twenties? Should he have to wait until his total testosterone level reaches the “magic” number of 300 before he starts TRT? Is it sufficient that his level has already declined over 30%, he’s not progressing with his weight-lifting program at the gym, and he’s putting on a bulge around his waist? The controversy rests on whether we treat for the standard or for the individual.
Two questions immediately spring to mind:
1. Will the man benefit from raising his testosterone level from 500 to 800 ng/dl?
2. If so, are there any substantial long and short term risks involved in this level of testosterone replacement?
The first is a question of “Where’s the beef?” The second is a question of healthy scepticism because “there’s no free lunch.”
A number of studies were done using healthy young men given TRT to raise their testosterone levels to the high adolescent range of 1000 to 2000 ng/dl. In every one of the studies, lean muscle mass increased and fat mass decreased. Similar studies treated moderately obese men with lower doses and still, lean muscle increased and fat decreased even further. Not only that, but also the pre-diabetic state of insulin resistance improved, energy increased and triglycerides decreased. In case you’re wondering, not one of these studies noted any increase in the infamous “aggressive behavior” that many people expect from high doses of testosterone.
Many more studies have been published showing similar effects in men over 65 with mildly low testosterone levels. The National Institute on Aging (NIA) published the research studying results of TRT on body composition (lean muscle and fat ratios) in 108 men. The studies demonstrated a 6 lb. fat loss and gain of 5 lb. lean muscle mass when testosterone levels were raised to 640 ng/dl from an average of 370 ng/dl for 36 months. If they had started with low bone density, the same men experienced increased bone density.
Accumulating evidence shows that whenever the testosterone level is raised (regardless of the starting level), men achieve benefits in body composition. Frankly, we think the dose of testosterone used in the NIA study was too low and, with a higher dose even more impressive results would have been revealed, with no significant increase in adverse effects.
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