All About TRT (Testosterone Replacement Therapy)
What is TRT?
Testosterone Replacement Therapy (TRT), is a class of hormone replacement therapy in which testosterone is replaced to bring levels into the normal range, 270-1070 for men. TRT is often prescribed to counter the effects of male hypogonadism. It typically involves the administration of testosterone, either by injection or by use of testosterone patches, skin creams or gels. Hypogonadism can cause:
- Low sex drive
- Difficulty concentrating
- Erectile dysfunction
- Decreased muscle mass
- Hair loss
- Low sense of well-being
Types of TRT
- Skin patches, applied daily.
- Topical gels, applied daily
- Injections, done weekly
The last form of testosterone replacement is not the preferred method because it does not allow the body to have the normal diurnal testosterone variation of healthy men as indicated in the above chart. The only reason it is used at all for TRT is because its so much cheaper than the patches, topical gels, and implants. In some countries, it is the only method covered by the healthcare system.
The last form of testosterone replacement (injections) is the most prone to abuse because its the only method that can raise the testosterone to the sky high levels required for elite athletes trying to win. With the other methods unless you cover your body with patches or swim in the topical gels, you are not going to reach these levels.
This is exactly why most people who do not understand TRT consider it to be cheating. Its because many high profile athletes found this loophole early on and exploited it, the most recent are the MMA athletes which lead to TRT being banned in MMA. Where there is big money, there are big cheaters – thats the way it is. This is why the olympics will never be natty, pro football will never be natty, baseball will never be natty, and MMA will never be natty. These rich pro athletes can afford to hire the sneakiest doctors and labs to help them stay 3 steps ahead of the regulators. With the MMA athletes it was simple – buy off a doctor, get blood tested by dubious lab to get diagnosed with hypogonadism, get a legal prescription for steroids, “accidentally” inject more than you are supposed to – whoopsy-daisy!
For pro athletes wanting to cheat, injectable testosterone is the method of “TRT” they will choose because once they have the big bottle, nothing stops them from using more than prescribed. With the other methods of testosterone delivery, cheating in this manner is much more difficult – they would have to take baths in the gel or cover themselves in patches. Then there is cost, TRT by injection is very cheap. From googling it appears that a months supply of injectable testosterone for TRT without insurance is under $100 whereas the gels and patches are well over $1000 per month. Its simply too expensive for all but the most elite athletes to cheat via gels and patches.
Lets start with a lot of the questions I have heard asked about TRT. Some of them are good and the rest indicate how little people understand about what TRT really is.
- Is TRT legal?
- Scooby, you are huge, are you on TRT?
- Should I do TRT?
- What are the pros and cons of doing TRT?
- Is it OK to do TRT under a doctor’s supervision?
- Does someone on TRT have a muscle building advantage over someone not on TRT?
- Are their recommended alternatives to TRT?
- What are some natural ways to boost Testosterone?
- Why does Scooby not give a direct yes/no answer when asked if he is on TRT?
- What is the difference between TRT and testosterone
TRT FAQ Answers
Because there is so much mis-information about TRT, answering question #1 is a great place to start.
Question 1: Is TRT legal?
Let’s start with the “legal” part by asking is alcohol legal? Is it? You need more information before we can answer this, how old is the person drinking the alcohol and where do they live? Alcohol by itself is neither legal nor illegal, there are legal uses and illegal uses. In most places, people under the age of 18 may no drink alcohol, some places its 21. Depends. Maybe some places its even illegal for pregnant women to drink alcohol, I don’t know. How about morphine, is morphine legal? Yes, but only under very extreme circumstances like surgery, because its the most addictive pain reliever their is. How about Equipose, Winstrol V, and tren, are they legal? Well if you are a licensed veterinarian and your patient is a horse, then yes, they are quite legal, otherwise not. So, is TRT legal? It depends.
Hormones regulate the body, thats pretty damn important, which is why you cant buy them at the grocery store. Some of the regulating hormones that most of us have heard of are thyroid, insulin and testosterone. Why have we heard of them? Because its very common for people to have diseases where the body does not pump out enough of these hormones. These diseases have some pretty horrible symptoms that make normal life very difficult. What is the “normal” range for each of these hormones varies widely which is why doctors do not treat test results, they treat symptoms. The hormonal system in the body is very delicate and minimum intervention is always the best policy. Doctors will *not* prescribe a hormone just because someone has a low lab test reading. Only if its clear that the symptoms of the disease are causing problems will a doctor prescribe the medication for the low hormone (thyroid, insulin, or testosterone). In fact, it is not legal for a doctor to prescribe them for any other reason. The doctor cannot prescribe them because someone asks. The doctor cannot prescribe them just because of a low blood test result.
Having said all that, is TRT legal? Yes, if prescribed by a licensed physician to treat the symptoms of a disease. So what about all those “Longevity Clinics” that basically promise people prescriptions of GH and TRT for aspiring older bodybuilders if the patients just write big checks? There are criminals in every single profession and that includes doctors. Just because a doctor prescribed something does not make it legal. Just because its a beautiful, clean, white, medical clinic doesn’t mean that activities occurring there are legal. These clinics probably have their spouses set up expensive “labs” that mysteriously report that every blood sample sent to them is “very low testosterone”. Take Dr Conrad Murray who was Michael Jackson’s doctor who prescribed the powerful anesthetic propofol as a sleep aid – not legal. I am sure that every year the FDA shuts a batch of these longevity clinics down, sends them to jail, and another batch opens up.
When many people ask “Is TRT legal” they are confused about what TRT is. Many people seem to think that TRT is the name of a drug and that they can go to their pharmacist and ask for a vial/bucket of TRT. There is not bottle labeled “TRT”. TRT is not a product nor a thing, its a therapy – specifically “Testosterone Replacement Therapy”. They ignore the “RT” in “TRT” and what they are asking is if testosterone is legal. Yes, but only under a very, very narrow set of circumstances to ameliorate the symptoms of very serious diseases, not for recreational or cosmetic purposes.
Question 2: Scooby, you are huge, are you on TRT?
People who ask this question do not know what the acronym TRT stands for, it stands for Testosterone Replacement Therapy. You can’t go to your pharmacist and ask for a vial of TRT, its not a product, its a therapy. TRT doesn’t stand for Testosterone Enhancement Therapy nor does it stand for Testosterone Megadose Therapy. All TRT does is put the levels of testosterone back into the normal range and keeps it there on a daily basis. TRT does not flood the system with rage causing testosterone which causes the testes to shut down either, just a trickle to bring levels up to normal. It is instructive to compare TRT to the steroids which bodybuilders use for muscle building. The illegal injectable and oral steroids used for muscle building spike testosterone levels to tens or hundreds of times their normal levels, exactly what shortcut seeking bodybuilders want. The hormonal system is smart though so when the body senses this flood of testosterone, it shuts down production … all the way. Shrinking testes and complete testicular shutdown is one of the common and very serious problems caused by steroid usage because when these people go off their cycle, their testosterone levels plummet.
So back to TRT, can’t that be used for muscle building? Well, you can abuse anything but then its no longer TRT, its just illegal drug usage. It’s no longer “Replacement Therapy” if you are intentionally spiking your testosterone level out of the normal range. I suppose you could fill your bathtub up with a years supply of TRT medication and wallow in it every day like a pig and you could probably get the 10X to 100X testosterone levels like the pros bodybuilders use and gain muscle. But that is steroid use, not TRT, and the signs of its abuse would be exactly the same as for all other steroid use with the most accurate indicator being rapid muscle gain. Will legitimate TRT cause you to gain muscle? It depends on the situation. If you have never lifted and start TRT with a good lifting program – sure, you will gain muscle. If you are an intermediate lifter diagnosed with hypogonadism and get put on TRT by your doctor, sure, you will continue to make muscular gains. If you are an over 40 advanced lifter whose gains have stagnated and get put on TRT by your doctor, then no, you will not gain. You will be lucky if it halts your strength/mass decline. With TRT you could re-gain previously lost muscle caused by the hypogonadism. If a patient lost a lot of muscle mass because of testosterone production problems, then was prescribed TRT, my guess is that they would regain their previous muscle mass but no more. If the person starting TRT is a middle aged man who has never worked out their entire life because of the depression caused by very low testosterone, of course they are going to gain muscle. They will get their newbie gains and build up until they have a normal amount of muscle mass for someone this age who works out, no more. So, will TRT make you gain muscle? Its a very complicated question and the answer depends on the precise circumstances. One thing is for certain though, it will NOT make you huge – it will give you normal gain potential.
Question 3 – Should I do TRT?
How should I know? Seriously! There is a very good reason that TRT requires a doctor’s prescription and is not available over the counter, its because there are so many factors involved in deciding if it is appropriate for a given individual. How bad are the symptoms? Family history of prostate problems? The list goes on and on. The only person qualified to have this discussion with you is is your doctor. If you are having medical problems, see your doctor!
Question 4 – What are the pros and cons of TRT?
Again, like the above question, the only person qualified to answer this question in your particular case is your doctor. There is a very good reason that you can’t buy “TRT kits” at the drugstore, its because there are a lot of issues to be weighed to know if the health benefits of TRT outweigh the risks of going on TRT and only a doctor is qualified to determine that. Having said that, in general terms, as I say in the answer to question 1 “Is TRT Legal”, TRT is used to treat some serious symptoms. The advantage of TRT is that it reduces or eliminates those symptoms. It will also help re-gain (not gain) muscle mass that was lost. What are the disadvantages? Again, discuss the health risks with your doctor but three indisputable disadvantages are: 1) the cost, 2) the inconvenience and 3) the fact that you would be on the medication for life.
Question 5 – Is it OK to do TRT under a doctor’s supervision?
Epic Pillow-Scream! Please go back and read the answer to question 1 again if you are wondering the answer to this question. There is no other way to do TRT other than under a doctor’s supervision. Doing TRT without a doctor has a name, it’s called “illegal schedule 3 drug use“, and you get jail time if you get caught doing it! You can’t just waltz into your doctor and ask for a prescription for TRT any more than you can ask for open heart surgery. If you are having severe health problems that warrant it, your doctor will *suggest* it. People who ask this question are really asking if its ok to use testosterone, not TRT, under the supervision of a doctor. If its just for muscle building purposes, its no longer “Replacement Therapy” but is now illegal drug use under the supervision of a doctor who is a drug dealer and a criminal. You might as well as walk into your doctor and ask for a prescription for GH, deca, tren, and heroin while you are at it.
Question 6 – Does someone on TRT have a muscle building advantage over someone not on TRT?
Identical twins both with all the symptoms of low testosterone, one does TRT and the other doesn’t. Of course the TRT twin has a muscle building advantage. Again though, all TRT does is put you in the normal range. TRT does not put you in the 10X-100X testosterone levels that illegal bodybuilding steroids do. The TRT twin will be able to regain any muscle mass he lost as a result of the low testosterone. Nobody is going to get huge on legitimate TRT, ever.
TRT is not about advantage and disadvantage, its not about fair and unfair, its about reducing/eliminating the symptoms of low testosterone. Who is to say what is “fair” and what is not. If someone has test levels of 100, is it fair for them to go thru life with all the problems caused by this? Why isn’t it “fair” for them to bump their level into the middle of the range for their given age so they can live a normal life?
Anything can be misused. TRT misused becomes steroid use (aka PED), pure and simple. As sports have become bigger and bigger money even at low levels the incentive to cheat has never been higher. The “men’s physique” contests and the potential lucrative sponsorships cause cheating even at the lowest competitive levels. Is it fair for a MMA fighter to use “TRT” to bump their testosterone levels to 1500 to win the championship? Certainly not, but again, this is not “Testosterone Replacement Therapy”, its simply drug use.
Question 7 – Are their recommended alternatives to TRT?
Again, a great question for your doctor!! Discuss this with them. One very good option is always simply not to do it. You are the best one to weigh the pros and cons that your doctor lays out for you and decide what is the right decision for you. One thing that people often fail to realize is that the normal range for testosterone is that – a NORMAL RANGE. That means that readings anywhere in that range are NORMAL. If you are on the “low side of normal” – that is NORMAL. Another thing to realize is that doctors to not treat test results, they treat symptoms. Just because your testosterone comes in at 200 does not necessarily mean you need TRT! See also the below question.
Question 8 – What are some natural ways to boost Testosterone?
Warning! Red flag alert! More money is wasted on “natural testosterone boosters” than on any other supplement. Let me ask you this, if these products worked then why would TRT even exist? It wouldn’t. These products are designed simply to separate you from your hard earned money. Sometimes they point to ‘research’ that they claim proves their products effectiveness – poppycock! The ‘research’ is often paid for by the manufacturer of the product, no bias there, or its some third rate online journal without any peer reviewing. Don’t believe what you hear in the locker room, what you hear from the salesman at GNC, or what you read in the forums – don’t waste your money.
There is one proven way to boost testosterone, LIFT BIG WEIGHTS! The heavier the weight you lift, the more the testosterone boosting effect which is why curls don’t help but things like squats or heavy leg press do. These exercises *do* raise the testosterone levels short term but it still has not been shown that it has any muscle building advantage … beyond the fact that lifting heavy weights builds big and strong muscles. News flash! Lifting heavy weights makes you big and strong :)
Question 9 – Why does Scooby not give a direct yes/no answer when asked if he is on TRT?
Excellent question, two reasons and a perfect opportunity for a teaching moment. You know me, I am big on practicing what I preach with cardio, with time management, with nutrition, and everything else in my life. There is a very good reason not to share medical information, or private information of any sort on the internet, please read “Nothing To Hide“.
Second reason is that it is simply not relevant to what I have achieved in the fitness arena any more than it would have were I on thyroid medication or on insulin as a diabetic. Please see the answer to question 6 – “Does someone on TRT have a muscle building advantage over someone not on TRT?”
I know that by this point, some people who are “TLDR” still think that TRT makes you get huge and muscular, so let me repeat what I say on my page “Does Scooby Use Steroids“. I don’t care what you believe. If it comforts people to think that I got big and ripped by using steroids or TRT rather than 30+ years of lifting 5 days a week, that is fine by me. People often have these crazy expectations for bodybuilding and when they fail to get the body “they deserve“, then they just naturally assume that anyone who has gotten that physique has somehow cheated. Again, whatever comforts them is fine with me. I still consider it the ultimate compliment when someone asks if I use steroids.
Question 10 – What is the difference between TRT and testosterone use?
Lets start with an analogy. Insulin is actually one of the most potent anabolic hormones of them all and bodybuilders have been using it for years get the mass building edge. A good estimate is that one in four steroid using bodybuilders also use insulin. Its also very dangerous and more than a few bodybuilders have died using it. Bodybuilders injecting large muscle building doses of insulin bears no relation at all to what diabetics do. Diabetics use very small doses, just enough to keep things in balance and regulate their blood sugar. So is taking insulin cheating? It would be crazy to call a diabetic a bodybuilding cheater simply because they use insulin to keep their blood sugar levels in check. On the other hand, the bodybuilder taking megadoses of insulin solely for the purpose of gaining lots of muscle mass has certainly lost their natty card in my book. Testosterone is exactly the same situation. If your doctor recommends TRT then you are simply putting your levels into the normal 250-1000 range where they should be. If you inject anabolic steroids then your testosterone level is 5x-10x normal and you build massive amounts of muscle. Yes, its the same thing being put into your body – testosterone. The issue is dosage. For TRT, its micro-doses. For bodybuilding or strength enhancing purposes, its large syringes.
Testosterone, muscle, and TRT
Yes, hormones in the body determine its muscle mass. The amount of testosterone determine how muscular someone will be if they do not workout and it will also determine what their natural limit is if they do workout. A woman can lift just as intensely as a man but yet she will only gain a small fraction of the muscle that a man would, why? Because her testosterone levels are lower, much lower. Testosterone is the primary hormone which regulates the bodies ability to get stronger and gain muscle when subjected to resistance training. The higher the levels, the bigger the muscles. Thats why the current crop of IFBB pros dwarf the Arnold era bodybuilders, because of stratospheric levels of testosterone.
Similarly, if for some reason a man is not producing testosterone in the normal range, they will have trouble gaining muscle. One common misconception is about TRT and muscle gain. Two identical brothers, one has a disease which causes his testosterone to be 100, the other brother is at the normal level of 700. If the brother with the disease starts TRT which puts him up to 700 and the brothers start working out together, they will gain exactly the same amount of muscle. It matters not whether the testosterone level gets to the middle of the normal range thru TRT or thru natural production, thats why its called “replacement therapy”!