To understand the benefits of testosterone replacement therapy, it is important to have an appreciation of the role of testosterone within the body and the impact a deficiency can have on your health. It is important to understand the philosophy behind male hormone optimisation and to recognise that an essential part of both physical and psychological health is related to your hormones.
To benefit from TRT you need to have a true androgen deficiency, recognise the symptoms of low testosterone and appreciate what positive steps are needed to get better. This may or may not include male hormone replacement therapy. You must to have realistic expectations, which is one of the reasons why it is so important to work with an experienced clinician. It is vital to address the cornerstones of health; your lifestyle, nutrition and exercise, before committing to TRT which should be considered a lifelong therapy. Prevention is better than cure.
Most definitions are in fact rather simplistic, there’s often no mention of the influence of testosterone throughout your adult life. Testosterone is needed for both physical and psychological health in adulthood and it’s importance can never be over-emphasised. We have over 300 patients who can testify to the fact that being optimised on Testosterone Replacement Therapy has had a significant positive impact on their sense of well-being and overall health.
Testosterone is the precursor to your bioavailable androgens that your body can utilise, namely free testosterone, oestradiol and dihydrotestosterone. Total testosterone remains a useful marker and should be a part of your diagnostic work-up, however it doesn’t tell the full story. How you subjectively feel and your state of health is primarily down to these free androgen hormones, not total testosterone. Another important consideration is a glycoprotein called Sex-hormone Binding Globulin (SHBG), which is produced by the liver. It helps modulate not only the transfer of testosterone into the target cell, but also enhances the expression of the hormone within the cell. It is so important to adopt a holistic approach to patient care in order to facilitate the best outcome from intervention with hormone therapy.
Our bodies work hard to try and regulate our internal physiological state through complex mechanisms so that we can remain healthy despite ever-changing outside conditions, a process called homeostasis. The body also has periods where it is predominately catabolic and periods when it is predominantly anabolic. So not only does the body have the ability to adapt to external change to keep us healthy, it also has to adapt to internal factors so that an equilibrium is maintained.
Testosterone is an anabolic hormone; it is a chemical messenger that promotes metabolic activity within its target organ. This helps optimise function and helps to facilitate growth and repair.
Testosterone’s target organs (with links to research) are as follows:
To put it simply, the primary purpose of TRT is to correct your androgen deficiency so that the body can function properly. A healthy sex-drive, strong erections, increased lean muscle mass, mental clarity and well-being are all possible if you are realistic. If you’re shattered, working all hours of the day, you will not have a high libido. You’ve heard the saying “you can’t out exercise a bad diet”, in the same way TRT cannot give your body the necessary building blocks if you do not have a healthy diet. If you’re out partying all-night, drinking and doing drugs your body won’t thank you, just ask Generation X.
Male hormone optimisation is about titrating those androgen levels to a figure that helps facilitate your body in maintaining homeostasis, it sounds boring but that’s not a bad thing. You cannot separate physical and psychological health and my objective goals are the same as your subjective goals. Long term health is about sustainability, you will only appreciate the qualitative benefits of hormone optimisation when your hormones are stable and balanced.
TRT provides you with a platform, the rest is up to you…
These are going to be discussed in order of relevance, as per how the typical patient presents to our clinic:
Low testosterone can have a dramatic effect on your psychological well-being. Lots of my new patients have already presented themselves to their GP and been offered antidepressants, although most have declined as they did not feel that was the solution. TRT has been shown to improve depressive symptoms. It is important to note that mental health is a complicated field and that TRT should not be considered the cure.
There is a association with low testosterone and declining cognitive function. A universally accepted term is ‘Brain Fog’, it seems to fit. TRT can blow that fog away, what it unlikely to do however, is make you a candidate for Mensa if you weren’t one before low testosterone.
Loss of libido is a useful and common sign, but it can be complicated by fatigue and chronic illness. I personally think that loss of regular Nocturnal Penile Tumescence or ‘morning wood’ is a good sign your androgen levels are deficient. The stresses and strains of life can take their toll on your psyche, but morning erections shouldn’t be affected as they serve a biological function.
Low testosterone is associated with loss of lean muscle mass and increased fat distribution. TRT can increase muscle volume and strength, especially when combined with appropriate diet, training and lifestyle.
“It is a shame for a man to grow old without seeing the beauty and strength of which his body is capable.” – Socrates
This is not an exhaustive list, I just thought some perspective may useful as it’s hard to see the wood for the trees sometimes.
If you can relate to any of the symptoms above and are concerned that you may have low testosterone, I would strongly recommend either approaching your GP to request the necessary blood tests or ordering the ‘TRT Check Plus’ blood test through an online company such as Medichecks – a link can be found on the Online Blood Tests page of our website. I would also recommend reading our impartial and independent blog TRT Wars – How to Get TRT in the UK.
In 2017 we launched the independent closed Facebook group ‘TRT in the UK‘. It currently has over 800 members who are all passionate about the subject of Testosterone Deficiency Syndrome and encouraging safe and effective care. I recently asked them for a list of the real-life benefits of TRT:
The onset of the effects of testosterone treatment and time span until maximum effects are achieved have been published as follows:
Three weeks plateauing at six weeks, with no further increments expected beyond. Changes in erections/ejaculations may require up to six months.
Manifest within three to four weeks, but maximum benefits take longer.
Becomes detectable after three to six weeks with a maximum after eighteen to thirty weeks.
Evident at three months, peaking at nine to twelve months.
Plateauing at twelve months; further increase should be related to ageing rather than therapy.
Effects appear after four weeks, maximal after six to twelve months.
May improve within few days, but effects on glycemic control become evident only after three to twelve months.
Occurs within twelve to sixteen weeks, stabilises at six to twelve months, but can marginally continue over years.
Occurs within three to twelve weeks.
Already detectable after six months while continuing for at least three years.
It isn’t uncommon for men to feel an improvement in some areas such as mood, libido and energy within the first few weeks. This is in part due to the placebo effect and the impact of HCG on the LH receptors in the brain. Your androgen levels will be fluctuating over the first few weeks until your levels stabilise.
In order to know how you are going to ‘feel’ on TRT, your levels need to be both stable and optimised. Pharmacokinetics and pharmacodynamics play an important role, this is something that is discussed further in Gold Standard TRT. Our gold standard protocol includes Testosterone Enanthate and HCG. It typically takes 4-6 weeks for your levels to stabilise, but attaining optimised levels can take longer.
When on TRT, it’s important to be aware of potential side effects and to appreciate their implications in testosterone optimisation therapy. Notable side effects from rising hormone levels include:
Side effects are rare with the correct TRT protocol, however everyone is unique and it is therefore imperative for your TRT protocol to be tailored to your individual requirements based on your personal genetics, physiology and utilisation. There are numerous factors that need to be taken into consideration when designing a TRT protocol. These are detailed in The Men’s Health Clinic Management Guidelines. Add in genetic factors such as the genetic variation in the phosphodiesterase 7B gene affecting the bioavailability of testosterone enanthate, I hope you can see why you can’t have a cookie-cutter approach to TRT, my patients certainly understand that.
The long-term qualitative changes can only be fully appreciated when your levels are both stable and optimised. Most men note some improvement in energy, mood and libido, even if it’s only subtle, at their first formal Follow Up TRT Consultation.
The Men’s Health Clinic has been open since January 2016. We’ve had the luxury of growing organically, I’m not a fan of aggressive marketing, in fact I’m very much against it. Testosterone Deficiency Syndrome is a medical condition, clinicians should adopt a holistic approach to Testosterone Replacement Therapy and recognise that therapy should be tailored to the individual requirements of the patient sat in front of them. My role is to support you in your journey to male hormone optimisation, to manage your expectations and to adopt a holistic approach to your care so that you can achieve your desired outcome.
“Waste no more time arguing about what a good man should be, be one.” – Marcus Aurelius
Dr Robert Stevens MBChB MRCGP Dip.FIPT