Getting Past the Taboo: Testosterone Replacement Therapy
You wake up every morning wondering where your passion and drive went. You haven’t even thought about your wife or girlfriend in a sexual way in weeks, and even when you try to have sex, you’d rather be sleeping or watching TV. You feel unsure of yourself, and you are unhappy with your appearance. The energy you once had is gone, and you can barely make it through your day without feeling like you are digging yourself into a hole that you can’t come out of. You have low testosterone, and you need to do something about it.
For many of you, considering testosterone replacement therapy should be an option. In a perfect world you would go to your doctor, explain that you are constantly tired, feeling weak, and lack any sexual drive. In that world your doctor would have you tested and would evaluate you according to the normal level of testosterone for your age, and then he would get you the therapy you need to feel more energetic again.
The reality, however, is far different. Most doctors will not even entertain the notion that you have low testosterone, nor would they agree to have you tested. If you do get tested, they will evaluate your testosterone levels according to a standard range. This standard range includes averages from 18-year-old teenagers all the way up to 85-year-old men. So, at 34, you could technically have the same testosterone level as a normal 85-year-old male and still be considered to be within the normal range!
If you are an active male with life goals this should give you cause for alarm. To think that a male in his 30s, 40s, or even 50s should live with a lower end testosterone level is, in my opinion, preposterous and negligent. The current medical standards are failing thousands of men who want to continue living full and complete lives. Unless you seek a second opinion from a doctor who is sympathetic to the plight of lower range testosterone males (I will go over how to do this later), you will likely not get the treatment you need to live the life you want. This is the sheer stupidity of our medical system – unless its completely broken, they do not make an effort to fix it or prevent further breakdown.
Why Does Testosterone Therapy Have a Stigma?
Testosterone has a really bad name. It is associated with steroid abuse, being a meathead, being a chauvinist or misogynist, creating violence, and every other bad thing you can associate with male behavior. Despite this bad name, testosterone is actually responsible for a whole lot of good in this world including mental sharpness and increased cognition, energy, sexual drive, passion, enthusiasm for life, and better health. Health wise, a recent study of 83,000 military veterans found that men who’s testosterone rates were brought back to normal through therapy were immensely less likely to die from heart disease than those who’s testosterone levels remained low. The fact is that if you are experiencing the awful effects of low testosterone, you owe it to yourself, your significant other and the rest of the world to get your levels back to normal. So what is a law abiding gentleman supposed to do if he wants to get his levels back to normal without going to the black market?
Step 1: Exhaust All Potential Homeopathic and Natural Remedies
I want to make one thing clear here: I am an advocate for the increased availability of testosterone replacement therapy, but I am not an advocate for its abuse or overuse of these therapies. I am also not suggesting that you jump the gun and just start using them without first exhausting other options. Testosterone replacement therapy, like any medical therapy, has inherent risks including the risk of dependency. We will go into this further, but right now understand that if you start it, it will not be easy to come off. As such, I am going to give you seven strategies that you can use to increase your natural levels of testosterone without jumping right into synthetic testosterone replacement.
- Burn Fat
Think going on a permanent bulk will get you huge and muscular? Well it might get you huge, but not necessarily muscular. It can also cause your testosterone levels to plummet. People forget that fat is not just an inanimate and unattractive substance that hangs out underneath your skin. Fat is also a hormone secreting organ and emits aromatase, which serves to convert excess testosterone into estrogen. One study, conducted by the New England Research Institute found that excess belly fat is the single largest predictor of low testosterone levels. Additionally, belly fat is also used as a storage space for the body’s toxins to keep them away from the internal organs. Increased toxins means higher levels of inflammation, which leads to increased secretion of the stress hormone, cortisol. Cortisol is a catabolic hormone which directs the body to preserve energy during times of stress. To do this it works to get the body to burn muscle mass as energy and decrease testosterone rates.
So, if you are experiencing symptoms of low testosterone, the first thing you should do to take an honest assessment of your waistline. Tighten up your diet and add some cardio into your training to burn off some of that excess fat. I will shamelessly plug my ebook, Getting to Shredded, as a program you could use to burn fat while preserving your muscle mass.
- Lift Weights . . . Heavy Weights . . . and Use Your Legs
Another tried and true method of increasing your testosterone levels is to lift heavy weights while doing total body mutli-joint compound movements. In particular, you need to do squats, deadlifts, overhead presses, bench presses, and if you can do them, Olympic lifts. The best weight range for doing this, according to most studies, is at around 85% of your one repetition max.
- Supplement with Zinc
Studies have demonstrated that zinc supplementation have an important role in modulating serum testosterone levels in normal men.  The normal recommended daily intake for average males is 15 mg per day. You can also get zinc from food sources like oysters, beef, and liver.
- Optimize Vitamin D
If you aren’t running around in your underwear in the sun for forty minutes a day, then you are probably deficient in vitamin D. This is especially true if you come from an area where the sun does not come out much. Vitamin D is actually not a vitamin. It is a hormone that regulates over 1000 bodily functions. To get enough vitamin D, you should take between 2000 and 4000 iu per day.
- Eat Fat
Dietary fat is essential to healthy hormonal balance. This does not only mean so-called “healthy fats” but also saturated fats. In the study from the footnote in the title to this section, scientists demonstrated that diets with below 40% of calories from fats, male testosterone levels suffered. Many people are scared to eat saturated fats because of fears of heart disease, but much of the latest research demonstrates that many of these fears are unfounded as long as these fats are not ingested with sugar. Sugar, which will be covered in the next section, can cause inflammation which could lead to heart disease, diabetes, and cancer. I personally get 60-70% of my calories from fats, with around 50% of those calories coming from saturated fats. You can get fats from these foods: pasture raised eggs, grassfed beef, fish, coconut oil, flax, olive oil, and tree nuts.
- Limit Sugar
Sugar intake drastically increases production of insulin, which can lead to insulin resistance. In one particular study, serum levels of testosterone plummeted immediately following ingestion of sugar. If you are looking to increase your testosterone levels naturally, I would highly suggest limiting your sugar intake to 1 or 2 pieces of fruit per day. Avoid candy or other sources of processed sugar including that which may be present in your supplements.
- Have More Sex, But Don’t Watch Porn
“If you don’t use it, you lose it” definitely applies here. Having sex regularly will help to keep your test levels high. On the other hand, porn does not count here. Watching videos filled with women of breeding age is a bit too much for your primitive brain to handle and can really affect your sensitivity to dopamine. For more information on this watch YourBrainOnPorn.com.
If you are experiencing the symptoms of low testosterone, then try all of these strategies prior to going the medication route. If you’ve done all of these things and you’re still experiencing low T symptoms, then its time to consider alternatives.
Step 2: Augment and Regulate Your Health in Preparation for Testosterone Replacement Therapy
Prior to jumping into testosterone replacement therapy, you are going to want to prepare yourself and your body to minimize any health risks from the therapy. This should not be a complicated process that delays the therapy, but it is necessary to accomplish this to ensure that you remain as healthy as possible while on the therapy. This process includes the following points:
- Clean up your diet as much as possible. This will not only minimize your risk of developing any heart problems while on the therapy, but it will also help you with maximizing its benefits. Make sure that your diet includes lots of vegetables for maximum internal organ health. Minimize intake of sugar, and make sure you have healthy fats and good sources of protein.
- If you are not already, get on an exercise regimen. This includes cardio. This should include at least 3 or 4 lifting sessions per week and at least 3 cardio sessions for heart health.
- Get your blood work done, not only to determine testosterone levels, but also to ensure that your blood sugar, liver enzyme count, and cholesterol are all within the normal/healthy range.
- Do your research and know your options as far as which therapies to choose.
Step 3: Seek Testosterone Therapy
As stated earlier, it’s very likely that your family doctor will not even consider your case for testosterone therapy. As such, it’s pretty likely that you are going to need to see a testosterone replacement therapy specialist for a diagnosis and a consideration for prescription testosterone. Here are some things to know that will help to gain you access to testosterone and potentially to save you money.
- Hormone Replacement Clinics are Expensive, But Accurate
In many cases, the testosterone clinics know that their services in diagnosis are in demand. As such, if you cannot get your insurance to cover the visit, you are probably going to have to fork out plenty of money for an examination. Many clinics have an initial examination fee of anywhere between $100 and $500. Additionally, you can expect to pay anywhere between $100 and $1000 per month depending on the therapy you obtain.
The upside of going to an established clinic is that you can get very accurate on the minimum effective dose that you will need to see positive results in your health and energy. Note that while this dose may increase energy and sex drive, it will also have minimal impact on strength and muscularity. This is therapy, not abuse, and if you are seeking to be Mr. Olympia, then you may have to go another route.
- Online Clinics are Less Expensive, but You Need to Do Your Own Dosing
If you are over the age of 34, however, there are some less expensive options for obtaining legal prescription testosterone. Online clinics, like Wellness, Fitness, Nutrition Network (www.wellnessfitnessnutritionstore.com) will readily provide prescriptions to patients over 34 years old without documentation of blood work. This is legal because a little known aspect of the law is that a doctor can prescribe a medication if the preponderance of evidence suggests that a subject is within a population that requires medical therapy. Because males over the age of 34 are increasingly affected by low testosterone, doctors may prescribe them therapy without prior clinical testing. So if you are over the age of 34, you can just go to this site, place an order, have your prescription emailed to you, and your testosterone will show up in the mail several days later. The prices at this company are very good, and the products are all tested at the University of California for accuracy and potency. As such, this is a safe and easy alternative to the more expensive hormone replacement therapy clinics popping up all over the country. Additionally, they have a fantastic live chat option on their site that will allow you to get advice on different compounds from qualified experts on hormone replacement therapy. You can still order from this company if you are under the age of 34, but additional documentation may be required before orders can be fulfilled if you are under 34.
The only downside if you go this route is that you will need to do your own dosing (Of course, this may be a positive if you are one of those Mr. Olympia guys, but be careful!). My advice here is to start at a brick and mortar clinic, get tested, get your minimum effective dosing strategy, and then save money by ordering off line.
Step 4: Decide Your Options
Deciding your options for therapy is simple, but there is much misinformation out there. Many people are skittish about injecting themselves, not just because of the pain but because there is a real stigma attached to it. If you decide to use the online clinic option, you will have access to oral steroids and these will be tempting. Don’t fall for the easy temptation. Oral steroids are not only less effective, they are more dangerous because they are much more liver toxic.
If you are really really skittish on needles, you can go the androgel route. The downside here is that dosing with topical testosterone is not nearly as accurate.
My advice here is to bite the bullet and take the shot.
The most common type of testosterone used in hormone replacement is Testosterone Cypionate. This is a long acting ester, which means that it builds up in your system over the course of a week, peaks after around 6 or 7 days and then is out of your system in 12-14 days. The beauty here is that, unlike testosterone propionate, you only need to inject once per week.
Step 5: Ancillaries and Post/On-Cycle Therapy
There are several other compounds that you will need to take while you are on testosterone. The first is Human Chorionic Gonadotropin, which is a drug that is used to treat infertility in men. For low dose testosterone therapy, doctors will normally prescribe this compound to keep natural production of testosterone, so you will take it on cycle. Note: if you are on high doses of testosterone, your testosterone production will shut down no matter what you do, so it would be best to take it when you are off cycle.
Additionally, you will also need to take an aromatization inhibitor to prevent the body from converting the exogenous testosterone into estrogen. Normally this will be arimidex (it’s chemical name is anastrozole) and the normal dose is 0.5 mg every other day.
There are definitely other PCT compounds out there, but as this article is about hormone therapy and not general steroid usage, we are not going to cover them here. We’ll save that for another article.
I am not advocating the abuse of steroids. I want to make that clear. I am, however, 100% in favor of making any drug that can improve peoples’ lives and their sense of well-being available to them. Testosterone has a bad name, but this should not dissuade you from using it in a responsible manner under the supervision of a physician after other attempts to raise your testosterone have come unsuccessful. One last thing I also want to make clear: if you are under the age of 30, really really try to raise your testosterone levels naturally. As I said earlier, these substances are an investment, and once you’re on them, it is really hard to come off. On the other hand, if there is an issue, these compounds can change your life.
 Kraemer et al. 1999. Effects of heavy-resistance training on hormonal response patterns in younger vs. older men. Journal of Applied Physiology. 87, 3. pp. 982-992
 Prasad et al. 1996, “Zinc Status and Serum Testosterone Levels in Healthy Males” Nutrition, 12(5), pp. 344-8
 Wehr et al. 2009. “Association of Vitamin D Status with Serum Androgen Levels in Men” Clinical Endocrinology. 73(2), pp. 243-8.
 Hamalainen et al. 1984. “Diet and Serum Sex Hormones in Healthy Men” J. Steroid Biochem. 20(1), pp. 459-64
 Volk et al. 2014. Effects of Step-Wise Increases of Carbohydrate on Circulating Fatty Acids and Palmitoleic Acid on Adults with Metabolic Syndrome. PLoS ONE 9(11): e113605. doi:10.1371/journal.pone. 0113605
 Caronia et al. 2013. Abrupt decrease in serum testosterone levels after an oral glucose load in men: implications for screening for hypogonadism. Clinical Endocrinology. 78(2), 291-6.