Frequently Asked Questions About Testosterone Replacement Therapy

Author: Brian Hildebrandt, Last Updated: Feb. 8, 2017

1. Do I have to be on testosterone replacement therapy for the rest of my life or should I cycle on and off?

Since your body isn’t capable of producing enough testosterone on it’s own anymore, treatment will have to be the rest of your life.

You may chose to go off therapy, but you’ll only go back to your old sick, tired, and depressed self.

And once you’ve felt great for awhile, most likely you won’t want to go back to the old you.

You’re still yourself, just with a little tune up. A more energetic, happy, and motivated you.

Unfortunately our bodies aren’t able to repair the machinery responsible for testosterone production. It’s a natural part of aging for some. With others, testosterone deficiency may have resulted from a head injury, infection, or blow to the groin.

2. How long will it take me to feel better once I’ve started androgen treatment?

It’s differant for some people, but generally you should notice an increase in energy, mood, and libido after 3-4 weeks. The increases will be subtle at first, but will culminate at a peak around 12 weeks.

If you have had low testosterone levels for awhile (which is usually the case), your increase in health may take even longer. Your body needs to repair the dysfunctions caused over the years, from the effects of low testosterone (bad cholesterol, decreased muscle mass, low libido, etc…)

3. My doctor gives me testosterone injections every two weeks. Is it really necessary to do them every third day like you’ve suggested?

You should aim for every third day (E3D) dosing, which minimizes fluctuations of testosterone levels to the greatest reasonable degree. If you have a lower conversion of testosterone to estrogen, you can generally get away with longer dosing periods.

But, there will be larger variations, which may result in greater ranges in energy, mood, and sexual function throughout the dosing period.

If you absolutely can not dose E3D, I would suggest finding the longest practical range where you start feeling bad. Usually the max is around 1 week.

If you are not doing self testosterone injections, I would definitely push for them. Coming to your doctor’s office every 2, 3, or 4 weeks for an injection is not healthy in the least. It will most likely make you feel worse than what you started.

You may end up feeling like an emotional roller-coaster, not to mention having much higher estrogen levels. Those long protocols are from the stone age. Don’t let your doctor strong arm you in to them! Now that you’re on testosterone, this shouldn’t happen anyways right?

4. What type of needles should I use for T injections?

It depends on the level of pain you want to endure, and the amount of scar tissue you want to build up over time. Since testosterone replacement therapy is for life, scar tissue should be of concern.

Traditionally a 21G or 23G, 1″ needle is used for the draw (getting the solution into the syringe). You can choose to inject with a 21G or 23G (G stands for guage) needle, which will cause more pain and scar tissue. Or you can switch to a smaller needle 30G 0.5″ (the larger the number the smaller the needle).

It may take more time to inject (30 seconds opposed to 5), but your body will thank you over the long haul. 20, 30, 40 years of injections can cause a lot of scar tissue.

If you would like to speed the injection time, you can also run the syringe over warm water (making sure the cap is on the needle of course). Warming the oil will make it less viscous, resulting in less resistance when it passes through the needle.

5. While my male hormones remain elevated with therapy is there anything else I should be looking at as well? Also, should testosterone replacement always be started first?

Most importantly you should be checking your adrenal and thyroid hormones first. Many times low testosterone can be fixed when the adrenals (primarily cortisol) and thyroid (primarily T3) are at the top of the normal range.

Both the adrenals and thyroid are responsibly for indirectly raising testosterone levels. If your testosterone levels still aren’t up to par afterwards, then testosterone replacement is the next best strategy.

Ideally, it is best to optimize cortisol, then T3, followed by testosterone at the end. This will give you the most bang for your buck in terms of energy, libido, and well-being.


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