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TRT – The Key to the Kingdom?

| By: Dr Robert Stevens
TRT – The Key to the Kingdom?

One of the hardest aspects of my job is managing ideas, concerns & expectations.  This idea that if you take a pill, have the surgery, adjust your lifestyle; that suddenly everything is going to be ok, is unfortunately naive.  One of the problems with this modern ‘civilised’ world is the expectation of ‘now’, the unwarranted feeling of entitlement, the concept that you are owed anything.

The NHS was founded on a concept of need, a modern day collective Robin Hood for the masses!  Aneurin Bevan would turn in his grave if he could see what had happened to his beloved NHS.  I’m not going to turn this into a blame game because we are all to blame, all of us.  It’s all too easy to point the finger at someone else, it’s far more difficult to turn that finger around and admit you have been complicit or willfully ignorant.  It’s the path of least resistance and a path that is too easily taken because we’ve been indoctrinated by the lies and manipulated into thinking that we need, are entitled to and are owed the key to the kingdom.  We have a slightly distorted sense of perspective; the modern civilised world has made us lose sight of what really matters.  Health not wealth, communication not isolation, voice not silence.

The Dalai Lama, when asked what surprised him most about humanity, answered, “Man. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the the present or the future; he lives as if he is never going to die, and then dies having never really lived.”

There is no greater sense of achievement when you work your butt off for something, you make sacrifices to attain a goal.  The reward is great but the level of satisfaction dwindles with time as we are always chasing the next adventure.  It’s human nature, it feeds our hungry ego.  We did Tough Mudder in 2015, a mere 13 mile obstacle course.  We did Rat Race Dirty Weekend in 2016, Tough Mudder on steroids!  20 miles, 200 obstacles.  The Fearless Fairies pictured below:-

rat race

This year we are doing Rat Race Man vs Mountain, 22 miles up and down Snowdon.  When and where will it end?  Does it have to?  Surely one day the challenges will be that extreme that our physical bodies won’t be able to cope?  Well, we’ll cross that bridge when we come to it.  We’ll sit back, we’ll reflect and we’ll formulate a new plan, based on the good parts of the previous ones, build on learnt mistakes from past experiences, then imagination will take us the rest of the way.  My point, as I ramble on, is that the destination isn’t that important, it’s the proverbial carrot at the end of the stick.  Life can be a series of obstacles or challenges, as always it’s simply a matter of perspective.

So… TRT, the missing link in the chain?  Or the key that will unlock the door?

I’ve been struggling to think of a decent analogy for restoring testosterone and its subsequent impact on your health.  Most guys complain primarily of sexual dysfunction, whether it be loss of libido or weaker erections, or both.  Others complain of more psychological symptoms such as low mood, poor concentration, decreased mental focus, a loss of drive and determination.  The term ‘brain fog’ seems to fit most guys when I put it out there as a collective term for how they are feeling, a paradoxical eureka moment.  Guys rarely present with physical symptoms but upon further questioning they are often present; loss of lean muscle mass, increased visceral fat etc.  The thing is, it’s sometimes difficult for men to put their finger on exactly what’s wrong, they just know that something IS wrong.

Testosterone is pivotal to men’s health, it isn’t simply the male sex-hormone.  Restoring and optimising your levels can have a profound effect on your physical and psychological health.  The thing is, simply having a healthy testosterone will not make you healthy.  Health encompasses lifestyle, nutrition, exercise, genetics, medicine, environment and TIME.  There needs to be a level of consistency in all of these aspects, whose importance cannot be underestimated.

I must sound like a broken record to those who regularly read my blogs.  The body likes balance, it doesn’t like extremes.  It is an incredibly sophisticated machine that has evolved over millions of years.  It isn’t perfect by any means but it ain’t bad.  We have a blind spot in our retinas, we have a redundant appendix, we are susceptible to disease etc.  We are as fragile as we are strong, which in essence is as much it’s success as it is it’s failure.  We are often our own worst enemies.  The choices we make are often bad for our bodies, but our minds are such that the invincibility of youth and the quest for experiences and answers makes us ignore the calming yin to the raging yang.

So, what I’m trying to say is that testosterone is only PART of the solution.  An acceptance and understanding of this fact is pivotal in benefiting from TRT.  Patients who do best on TRT are those that come onto the programme with eyes wide open, and have an appreciation of the bigger picture.  If you pin all of your hopes on TRT being the spinach in Popeye’s can, you will be disappointed.  The guys that do best aren’t necessarily the guys who have the lowest numbers, they are the guys who are open to the idea that testosterone will help facilitate the choices they are striving to achieve, the guys who already have their houses in order, they just lack the finishing ingredient.

So, what can you expect from optimising your testosterone levels?


Improvement tends to occur after 3 weeks and stabilises at 6 weeks.  Anecdotally, lots of my patients return saying it happened sooner than this.  This may entirely be a placebo effect, but since there is obviously a massive psychological element to libido, there is no harm enjoying the placebo effect!

Erectile Function

Changes may take up to 6 months.  You need to remember, achieving an erection and sustaining an erection for long enough to have intercourse is an incredibly complex neuro-vascular mechanism under hormonal influence.  Testosterone is not the band-aid for erectile dysfunction, there are so many other factors involved.

Quality of Life

Improvements in QoL tend to coincide with increased libido, what a surprise!  I’ve said it before, men are simple creatures with simple needs.  A healthy sex drive is paramount to psychological health.  We seem to forget that we are base animals at the end of the day.  We live in communities out of a survival need, the civilised world is a masquerade.  We are conditioned to believe that material possessions have meaning, which is utter nonsense.  I’m not sure if it’s a blessing or a curse, but I’ve sat with too many people to remember just as they took their final breath.  They never reach for their iPhone or watch, they reach for a hand, the touch of another human being.

Improvement in Mood 

Again normally 3-6 weeks, but it can be as long as 18-30 weeks, if at all.  Our psychological health can be likened to a spider’s web and you might be the unfortunate fly struggling to escape.  On the flip side, most of my guys are super happy on TRT and optimising testosterone has a noticeable effect on their psychological health.  Better to be the spider than the fly.


TRT is an anabolic hormone which can stimulate erythropoiesis causing a rise in haemoglobin.  This is brilliant as that therefore increases the amount of oxygen that can be delivered to your tissues.  Just look at the Lance Armstrong, Tour De France scandal.  This is good news, unless it gets too thick and causes a clot or infarction.  I always liken it to pouring water through a straw, and then trying to pour oil through the same straw and noting how much more difficult it is.  Haematocrit changes tend to occur after 3 months, peaking at 9-12 months. More testosterone more erythropoiesis.

Prostate Specific Antigen

And volume rise, marginally, plateauing at 12 months.  Testosterone in part gets broken down into DHT, healthy DHT levels optimise prostatic function.  Excess DHT has a negative effect on the prostate.  It always comes back to the body’s need for balance for optimal function.

Lipid Profile

Appears after 4 weeks, maximal after 6-12 months.

Insulin Sensitivity

May improve within few days, but effects on glycemic control become evident only after 3-12 months.  I have a number of diabetic patients who have reported both improved glycaemic control and decreased insulin requirements on TRT.

Physical Changes

Such as decreased fat mass, increased lean muscle mass and strength occur within 12-16 weeks, stabilises at 6-12 months, but marginally continues to improve over years.  These improvements come not only from the physiological effects of optimised testosterone, but also the positive effects testosterone has on your overall psychology.  This allows you to address other aspects of your life such as your lifestyle, nutrition and activity levels.

Inflammatory Marker

Improvement tends to occur within 3 to 12 weeks.

Bone Mineral Density

Detectable after 6 months, but continues for at least 3 years.  Clearly beneficial to everyone, especially the older gentleman at risk of osteoporosis.

Most guys aren’t prone to making grandiose statements unless they really mean them, so I’ve honestly been taken aback by what a profound effect TRT has had on some of my patient’s lives.  It’s great, and it makes going to work a pleasure.

“The results have been truly spectacular”

“It’s made me feel like a man again”

“I feel amazing”

“Brilliant, absolutely fantastic”

“It’s been fun!”

“TRT has changed my life”

“Without sounding cheesy, it’s the best thing I’ve ever done”

I think TRT is a no-brainer.  The argument that accepting a declining testosterone because it is all part of aging is frankly negligent.  Surely restoring your levels to a point in time when you were at your most healthy makes perfect sense?  It’s a shame that the NHS is so short sighted, it’s a shame that the medical profession is still naïve to the health benefits of testosterone replacement therapy, it’s a shame that current guidelines don’t take age into consideration, it’s a shame that guys in the UK aren’t offered choice.  From my perspective it’s great, the guys that come to me are more often than not, well-informed, motivated and receptive.  Their emphasis is health, they are not looking for the key to the kingdom, they are just looking for some help.  These are the guys that do best on TRT.

Dr. Robert Stevens MBChB MRCGP Dip.FIPT