Testosterone Replacement Therapy (TRT)
Welcome to r/steroids' wiki on testosterone replacement therapy (TRT). This wiki explores TRT for treating low testosterone (aka low T).

For a medical reference, see The Endocrine Society's "Clinical Guide: Testosterone Therapy in Adult Men with Androgen Deficiency Syndrome." ( Original PDF | Scribd )

Categorization of Low Testosterone (T)
Before we get into testosterone replacement therapy for treating low T, let’s look at the categories of male hypogonadism (low T).

Primary Hypogonadism
This type on low T is caused by a problem with your testicles. The testicles are still receiving the message from the brain to produce testosterone, but the testicles aren't working properly and cannot produce enough testosterone. This form of hypogonadism is usually due to injury to the testicles or radiation exposure from chemotherapy.

Secondary Hypogonadism
This type of low T is caused by a problem with you pituitary or hypothalamus, two glands in the brain that tell the testicles to produce testosterone. Basically, the messaging system is broken. [As a side note, physicians and online references generally group pituitary and hypothalamus problems together. If they don’t, problems with the pituitary may be referred to as secondary hypogonadism and problems with the hypothalamus may be referred to as tertiary hypogonadism.]

Secondary hypogonadism is far more common than primary hypogonadism and many more things can cause it. It can be caused by pituitary or hypothalamic disorders or a pituitary tumor. Fortunately, only about 0.25% of these pituitary tumors are cancerous, the rest are benign. But, they still may effect testosterone production. Secondary hypogonadism may also be caused by obesity, diabetes, and the use of certain medications.

Lastly, normal aging may cause secondary hypogonadism. The truth of the matter is that aging gradually wears down all the systems of the body. One system that gets particularly worn down is the messaging system for the production of testosterone. As a result, testosterone levels gradually decline with age. This natural decline in testosterone production leads to the prevalence of low testosterone in middle-aged and older-aged men. It is estimated that between 20-40% of older men have low testosterone and/or suffer from symptoms associated with low T.

Symptoms of Low Testosterone
Some advertisements for testosterone replacement products may lead you to believe that simply feeling tired or cranky is a sign of low T. In reality, symptoms tend to be more involved than that. Regardless of your age, low T symptoms can include:

Erectile dysfunction, or problems developing or maintaining an erection
Other changes in your erections, such as fewer spontaneous erections
Decreased libido or sexual activity
Infertility
Rapid hair loss
Reduced muscle mass
Increased body fat
Enlarged breasts
Sleep disturbances
Persistent fatigue
Brain fog
Depression
Many of these symptoms can also be caused by other medical conditions or lifestyle factors. If you’re experiencing them, make an appointment with your doctor. They can help you identify the underlying cause and recommend a treatment plan.

What is TRT?
Testosterone replacement therapy (TRT) is the administration of testosterone to men to treat low T. It is a prescription treatment overseen by a physician. The main goal of therapy is to reestablish normal testosterone levels. Physicians typically aim to reestablish a testosterone level between 500 ng/dL and 1000 dg/nL.

Men sometimes confuse anabolic steroid usage (testosterone cycles) for the purpose of bodybuilding with TRT. TRT uses normal, physiological dosages to increase low testosterone levels back to normal levels. The testosterone preparation is taken regularly, oftentimes for the rest of an individual’s life. On the other hand, testosterone cycles for the purpose of bodybuilding use above normal, supraphysiological dosages to increase testosterone levels above normal for a period of time. Users of testosterone cycles for the purpose of bodybuilding typically cycle on and off testosterone to give their bodies a break from these supraphysiological testosterone levels.

A Guide to Hypogonadism - National Library of Medicine
Androgen Replacement Therapy - Medscape
Testosterone Therapy in Adult Men - Endocrine Society
Testosterone Replacement Therapy - Elite Men's Guide
Testosterone Wiki - Testosterone Subreddit
Getting On TRT
To get a prescription to go on TRT, you're going to have to get blood work that shows that you have low testosterone. The blood work will at a minimum measure your total testosterone level. It may also measure your free testosterone and sex hormone binding globulin levels. Any test providing all three values will provide more information than the total testosterone level alone, so ask for the most comprehensive test possible.

The test requires a blood sample to be taken from a vein. The best time for the blood sample to be taken is between 7 a.m. and 10 a.m because testosterone levels fluctuate throughout the day and early morning tests offer the most reliable results. A second sample is often needed to confirm a result that is lower than expected.

Additional tests of use include a measurement of LH (luteinizing hormone) levels, FSH (follicle stimulating hormone) levels, prolactin levels, and a full thyroid panel.

Testosterone Testing - LabTestOnline
Testosterone Testing - MedLinePlus
Finding a Doctor; Getting Blood Work
TRT has really only recently gone mainstream. Some physicians know quite a bit about it; some know very little. Some physicians wholeheartedly support it; some look at it very skeptically. Most will be somewhere in the middle. Thus, it’s important to find a physician that you feel comfortable with and that has a good understanding of and respect for TRT.

If you suspect you have low testosterone because you have some symptoms of low T, start by talking about these symptoms with your doctor. Then, ask your doctor for a simple blood test to measure your testosterone levels. If your doctor won’t perform a blood test, either get a different doctor or get some blood work done yourself. Plenty of companies now offer hormone panel testing services Any Lab Test Now, DirectLabs, DiscountedLabs, ZRT Laboratory. While you can’t get a TRT prescription from them, you can arm yourself with the results by figuring out whether or not your levels are low.

Here are the different doctors that you can see that most often treat men with low testosterone (ordered by ease of access and knowledge of TRT). In any case, a male doctor is more likely to prescribe testosterone than a female doctor:

Low T Centers/Men’s Health Clinics – These clinics specifically cater to testing for and treating men with low testosterone. They charge a monthly fee for access to physicians. Insurance may or may not cover these providers, so check. (Companies with the most locations are Low T Center, BodyLogicMD, and LowTestosterone.com). Note: These centers and clinics do not prescribe testosterone to any man that comes in complaining of low testosterone symptoms. They perform blood tests and only prescribe testosterone therapy to men with clinically diagnosed low testosterone.
Anti-Aging/Longevity Clinics – These clinics typically also prescribe HGH as well as other hormones. They are expensive because they typically only take cash and do not charge to insurance.
Naturopathic Doctors (NMDs) – Some are licensed to prescribed hormones; some are not. If they are licensed to prescribe hormones, they are likely to prescribe TRT fairly easily. They are often cheaper than anti-aging clinics, but may not work with insurance, so check.
Endocrinologists - Can be covered by insurance; some specialize in TRT, but some are not as knowledgeable about TRT. They also help manage diabetes and obesity. If you have diabetes and/or are obese, they can help with both issues.
Urologists - Often treat low testosterone and other related men’s health issues like sexual dysfunction. If you have sexual dysfunction issues, they can help with both issues.
General Practitioner/Primary Care Manager – They may treat you if they are comfortable with prescribing testosterone and comfortable with you. They are also the most likely not to have a good deal of knowledge of or experience with TRT.

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