Meet Mark

Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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September 20 2017

Testosterone Supplementation: My Primal Take

By Mark Sisson
120 Comments

Stethoscope on notebook and pencil with TESTOSTERONE words as medical concept.After I turned 60, a routine checkup showed that I had lower-than-normal free testosterone levels. I hadn’t noticed anything that would have alerted me. No symptoms. No indication. Everything worked well. But it nagged at me. I knew testosterone did much more for a man’s health than just “build muscle”—which I had no real interest in at this point—so I decided to explore TRT, or testosterone replacement therapy.

I did a careful survey of the literature, coming away pleasantly surprised. The evidence was almost uniformly in favor, with the well-constructed studies showing major benefits for TRT. This is TRT, mind you. Not “juicing,” not steroid abuse. Restoration of biologically-appropriate levels of testosterone. Thus began my experiment….

In men with low testosterone levels, restoring those levels with TRT reduces the risk of atrial fibrillation.

In diabetic men aged 50-70, TRT improves muscle mass, reduces fat mass, and increases physical function.

In older men with low libido, TRT increases it. In men with diabetes, TRT increases libido and erection quality.

In older Japanese men, 12 months of TRT improved waist circumference, triglycerides, fasting blood sugar, body fat, and HbA1c.

Stepping back to look at the big picture, TRT starts looking even better:

Thirty-six months of TRT improves quality of life and sexual function while reducing anxiety.

In studies where TRT increases T levels to the normal range, all-cause mortality drops.

Not bad, right? Most people have a knee-jerk reaction to the notion of TRT. They think it means “cheating,” or “trying to look like one of those bodybuilding cover models.” But these are reasonable things to want as a person ages—no atrial fibrillations, an existent libido, lower body fat, strength maintenance, better metabolic health, and the ability to simply function in life. I’d go so far as to say everyone should have those things. It would take care of a lot of issues our world faces.

So, I talked to my doctor. He prescribed a small dose of supplemental testosterone, and (as I’ve mentioned on podcasts over the last few years) I began taking it.

What did I notice?

Really subtle things. My sense of “well-being” improved. Instead of ruminating on the things I wasn’t doing, I’d just move past them. Or take care of them, one way or another.

Maybe a small increase in overall energy. This wasn’t an issue, so it was difficult for me to perceive, but I think I felt a trifle more energetic throughout the day.

A boost to strength—with a caveat. It wasn’t that testosterone was making me stronger. It was giving me a more pronounced response to the training I was already doing.

Recently, I did two months without the TRT to see how I’d fare. It was fine. My free T got “up” to 6 pg and my total hit 600 ng. Free T is a little on the low end, but, again, there were no symptoms.

Using both ancient wisdom and modern science and technology, the Primal Blueprint seeks to restore ancestral metabolic health, emulate evolutionary movement patterns, and undo the damage modern living has wrought on our physiology and psychology. Testosterone levels in Western men have plummeted in the last few decades. We don’t have to just accept it.

To the extent you can find ways to improve your quality of life both short-term and long and not mess with delicate feedback loops, I suspect certain meds might be useful, like T3 for thyroid issues, despite one’s being full Primal, or metformin for life extension.

My wife, Carrie, has taken bioidentical hormones for years to deal with the symptoms of menopause. They’ve worked great for her. They weren’t available for most of human (pre)history, yet they’ve been an unequivocal boon to her life. 

I see TRT filling a similar role: as a modern tool to restore the ancestral baseline.

Just like taking antibiotics to eliminate a nasty infection you picked up at the hospital.

Just like using Meetup to find your tribe in your city.

Just like using iron barbells and weights forged in industrial metal plants run by robots to get stronger, fitter, and faster.

Being Primal is about utilizing modern tools to achieve ancestral health and wellness.

Once we hit a certain age, 50, 60, 65, “nature” doesn’t care about our ability to provide resources, hunt, fight, compete, or do any of the other things testosterone enables and enhances. That doesn’t mean we’re useless in an evolutionary sense—we still offer wisdom and leadership and grandparenting and our social support, all of which can improve the survival of our offspring—but our roles have changed. We just don’t “need” the same levels of testosterone.

That’s at a population level. Those are the selfish genes talking. We aren’t populations. We’re individuals. And as individuals, we don’t want to wither away into obsolescence. Live long, drop dead, remember?

But before you even think about TRT, confirm that you actually need it. And talk to a physician about risks, particularly if you have heart or prostate related issues.

Even if you get tested and your T and free T show up on the low end of dismal, consider other avenues you’ve been overlooking. First square away all the other factors that affect testosterone levels and ask yourself some questions. Are you sleeping 5 hours a night? Do you eat fast food every day? When’s the last time you picked up anything heavy or ran a sprint—or even taken a walk? Do you pamper yourself to the exclusion of ever feeling challenged? Do you blast the heat or air as soon as the temperature starts getting a little uncomfortable? Do you run from discomfort?

If you answered “yes” to any of these questions (or “never” to the third one), your lifestyle is the problem and TRT won’t address the real issue.

We live evolutionarily aberrant lives. Even someone like me, the Primal guy himself, can’t keep up with all the lifestyle tips and optimizations. I still work a lot, maybe too much. I still stress too much. I wish I could play more. I move around a lot and have streamlined my workstation to allow constant low level movement, but at some point there’s no getting around the fact that I spend an inordinate amount of time staring into a lit-up screen. As do hundreds of millions of people every day. And this all impacts our hormones.

Whenever we critique an observational study, we point to the confounding variables you can’t control. Because there’s always something screwing with the results that the researchers can’t quantify or detect. The same goes for life: We can’t control every variable that confounds our quest for optimal health. We do our part, certainly. We take responsibility. But then we also recognize we have modern choices as well. 

TRT, or thyroid hormone, or antibiotics when you need them, or a CrossFit membership might look evolutionarily novel or synthetic at first glance, but they seek to right a wrong perpetrated on the human body, to restore a balance, to achieve your genetic destiny.

Anyway, that’s my take on testosterone replacement therapy—and use of meds or hormones in general for the purpose of restoring what was lost or taken from you. It’s a messy world, this modern one, and we can use all the help we can get.

Thanks for stopping by today. What do you think, folks? What’s your take on the subject? Have a great week.

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120 thoughts on “Testosterone Supplementation: My Primal Take”

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  1. Low Testosterone can also lead to osteoporosis in men, which can be a slow, silent problem with equally devastating consequences. A normal T reading on a blood test can mask issues such as high SHBG which leads to low bio availability of testosterone in the body eventually leading to bone density reduction. Whilst the underlying cause is important, correcting these situations can be far more important in the short term.

      1. Serum hormone-binding globulin – if too much testosterone is bound to this protein, it is not ‘active’ and available to tissues for use.

      2. Sexual hormone binding globuline, it is a glycoprotein that binds to the two sex hormones: androgen and estrogen. Testosterone and estradiol circulate in the bloodstream, loosely bound mostly to serum albumin (~54%) and corticosteroid-binding globulin (CBG) (AKA transcortin), and to a lesser extent bound tightly to SHBG (~44%). Only a very small fraction of about 1-2% is unbound, or “free,” and thus biologically active and able to enter a cell and activate its receptor. SHBG inhibits the function of these hormones. Thus, bioavailability of sex hormones is influenced by the level of SHBG.

      3. Sex hormone binding globulin which binds to T for distribution through the body.

    1. Darren you drought up a good point about SHBG and I want to add more on this vital issue, mainly for men but women too. I agree with all of Mark’s points and thought of them all. “Confirm you need it” can be tricky. Conventional doctors consider repletion very conservatively. I go by “Life Extension Foundation” guidelines: 600-700 for total T and 20ng for freeT (check their website for the many good articles). With that said, I’ve been trying to get there for several years now and the best freeT I had was 15ng and it went down from there(I’m 68). Your body can turn T into estradiol. Your SHBG can tie up the free T and lower it. Both of those need to be tested periodically especially estradiol (males want estradiol between 20-30). By the way, I’m lean, muscular and eat healthy.

    2. Darren, I am glad you’ve mentioned it. My total T is 20.2 nmol/L (582 ng) and free T is 0.28 nmol/L (I couldn’t find a conversation chart) which is suppose to be good for my age of 60, but SHBG and Estrodial are over the top by a 5 points and I can use a little kick… Other then that I’m in good shape but I would like to bring those 2 to normal to mid range. And indeed, I was diagnosed with less the optimal bone density but my endocrinologist refuse to prescribe me a testosterone gel and doesn’t think that my E2 levels warrants the use of aromatase inhibitor (I agree on the later). I hope that the improvement in my hashi and T3 addition will improve matters, but do you have any knowledge of other interventions beside staying away from estrogen promoting foods?

      1. Regarding your point about do I know alternative ways to improve the situation – I’m afraid not – I’m not a doctor, but am experiencing some of the issues discussed – although I’m 10 or so years younger than you. Again as with Ken – I’m lean muscular, eat whole foods, no refined carbs, no sugary foods etc. My blood markers were all fine – bar partial LH deficiency and higher SHBG. The only scientific studies I could find related to these conditions – when there are no obvious causes (cushions disease etc.) – were linked to potentially under eating or not getting sufficient calories to satisfy your daily routine and exercise regime. In my case this may be true, however at no point did I ever feel that I lacked energy, in fact I am and always have had pretty consistent energy levels throughout the day. So potentially the body may be under nourished without the person feeling the effects – this could be a slight tip into the red zone which could cause a hormonal shift over a long period. Now I’ve no idea if this applies to me but I’m now more conscious of eating and supplementing higher density foods to ensure that if I exercise I pack in food to fuel recovery. Weight gain is just not an issue for me – but each end of the spectrum can cause issues.

        The important factor is resolving low bone density and that takes priority which is why sometimes you have to supplement with T to remedy the higher priority problem first. Of course I want to resolve the underlying issue which is why I’m focusing on diet, so that when I remove the T I want to see if my body will continue to operate as it should.

        What else am I doing, well looking at training, I’m a runner, so rather than just focusing on endurance I’m throwing in sprints, performing more weight training – to get exercise to provide the stimulus of testosterone and human growth hormone production. All just ideas, nothing really measurable and won’t be for a number of years – bone growth takes time…

        1. Thank you for your reply. You’re are on to something with regards to not getting enough nourishment. When I 1st entered primal eating, I went from 158lb to 136lb. I was eating clean anyway (lots of veggies and fresh foods) so I attribute the weight loss to cutting out most carbs (and gluten) and the fact that I started to eat lots of eggs and higher percentage of fats and protein, which kept me satiated for many hours but possibly wasn’t enough consider my activity (weights & running), even thought I felt great and had lots of energy. In retrospect, I should have eaten more, which would have helped me convert fat mass to muscles mass instead of just loosing it, even though I enjoy my feeling of lightness. Now I weight 152lb but my body composition is vastly different then when I 1st started out (more muscular). And here is the other interesting thing: my total T is higher now then before (up from 433 to 582 ng/dl but free T wasn’t measured at that time so I don’t know where it was) and that’s on mostly ketogenic diet (I dropped many foods to overcome my hashi). Could it be due to the fact that I switched from long distance running to mostly sprints? As you probably know, long distance running effect T levels negatively and also contribute to anemia. But I still can’t explain my high SHBG and E2 levels. So back to the start of your reply: eat more.. I also added Boron and I begin to feel a difference in the early morning hours if you know what I mean (started with 3mg and now 6mg), but still not where I think I should be.

          Best

        2. Thank you for your reply. You’re are on to something with regards to not getting enough nourishment. When I 1st entered primal eating, I went from 158lb to 136lb. I was eating clean anyway (lots of veggies and fresh foods) so I attribute the weight loss to cutting out most carbs (and gluten) and the fact that I started to eat lots of eggs and higher percentage of fats and protein, which kept me satiated for many hours but possibly wasn’t enough consider my activity (weights & running), even thought I felt great and had lots of energy. In retrospect, I should have eaten more, which would have helped me convert fat mass to muscles mass instead of just loosing it, even though I enjoy my feeling of lightness. Now I weight 152lb but my body composition is vastly different then when I 1st started out (more muscular). And here is the other interesting thing: my total T is higher now then before (up from 433 to 582 ng/dl but free T wasn’t measured at that time so I don’t know where it was) and that’s on mostly ketogenic diet (I dropped many foods to overcome my Hashi). Could it be due to the fact that I switched from long distance running to mostly sprints? As you probably know, long distance running effect T levels negatively and also contribute to anemia. But I still can’t explain my high SHBG and E2 levels. So back to the start of your reply: eat more.. I also added Boron and I begin to feel a difference in the early morning hours if you know what I mean (started with 3mg and now 6mg), but still not where I think I should be. Per bone health, I recommend reading 2 articles that I came across yesterday. Healthy Bones by Ron Rosedale [http://www.meandmydiabetes.com/2011/06/25/ron-rosedale-healthy-bones/] by Rone Rosedal and Bone, Serotonin and Leptin by Gerard Karsenty [http://www.meandmydiabetes.com/2011/08/06/bone-serotonin-and-leptin-gerard-karsenty/]

          Best

  2. Probably worth addressing the worry about heart and prostate issues. The prostate is SUCH a classic issue for the same population that might want TRT. (including me)

    1. If you search on “prostate cancer and testosterone treatment” you’ll find that modern research has determined there is no correlation between TRT and prostate cancer, and in fact men with the lowest rates of testosterone are more likely to get prostate cancer.

  3. How concerned should we be that introducing exogenous hormones will downregulate our body’s production of same?

    We know what happens to steroid abusers: reduced gonad size, etc.

    Would TRT similarly cause faster age-related decline of natural T production?

    It sounds like the above N=1 experiment of cycling off TRT was inconclusive, suggesting that such an effect in Mark, if any, is small.

    For those of us with low T, but no symptoms of insufficiency, who would simply like 10% more androgens (and after that, 10% more, etc.) would it be productive to use TRT to restore T to “baseline” — as problematic as that definition is, which does not consider T sensitivity, tissue (as opposed to serum) concentration, DHT conversion rate, diurnal variation, etc.?

    Or ought we to focus on improving our bodies’ endogenous production of T/DHT through nutritional manipulation and herbal supplementation?

    Sincerely,
    Dr. Jekyll

    1. Indeed introducing exogenous testosterone can downregulate your natural production; generally there are a set of 3 prescriptions with TRT, the testosterone, an estrogen modulator ( to prevent the rise; the actual cause of so called roid rage and man boobs), and the third (the name is currently escaping me) that maintains normal endogenous production to prevent downregulation.

        1. I have taken T injections for nine years. I am 71. My doctor suggests skipping a week after every 4 wks of injections to allow whatever natural T production to work. Some men do not need the estrogen modulator (Tamoxifen etc) as our systems do not turn T into E.

    2. Why would anyone want to use T to return to ‘normal’? This is about optimization pure and simply. Using exogenous T will shut down your normal production. Living in first world coastal population centers will inevitably do it as well. It’s always an individual choice whether one wants to live OPTIMALLY or suffer the age related decline MOST MEN ultimately undergo when dealing with suboptimal levels of T

      1. Insightful perspective. What is it about living in first-world coastal population centers that will inevitably shut down normal T production? I’m curious if you mean avoidable or unavoidable factors.

  4. A couple of the things you mention support my idea, that testosterone is linked to lower anxiety, which would be useful for me.

    TRT isn’t relevant for me, though, but I found the discussion of DHT in the comment section of your last post on testosterone interesting.

  5. I have just this week hopped on the TRT train, my free was tested around 7 and for my age (mid 30s) that’s pretty low. It’ll be interesting to see how it goes over the next few months.

  6. I’m 46 and my total testosterone is in the 800’s but my free testosterone is very low, 40’s or .6%, can you address this scenario. Also curious as to what type of testosterone you use for TRT. Thanks Mark.

  7. This research might explain: “Instead of ruminating on the things I wasn’t doing , I’d just move past them. Or take care of them, one way or another.”

    http://authors.library.caltech.edu/77049/ (Single dose testosterone administration impairs cognitive reflection in men)

    Possible it makes us rely more on our primal instincts. Not necessary a bad thing imho.

    1. thanks Tomas, that is a very interesting result..

      when still fantasizing about being a competitive triathlete the T supplementation was not possible for me.
      Now I’d be happy to take anything that would stop the ruminations..

  8. I’m curious about HPTA suppression and whether TRT is an all-or-nothing decision. From my understanding, once you are hop on the “TRT train” and it leaves the station, you suppress your natural ability to generate T. If you discontinue TRT with your natural HPTA is suppressed, you are worse off than before.

    Has anyone had _actual_ experience with with this?
    (Please , no theoretical replies or opinions. They will be ignored).

    1. “They will be ignored”

      LOL … nice. Are we maybe a little grumpy, a sign of low testosterone?

    2. Yes, I’ve actually done this, as have many other people (Dave Asprey to name one very public example) and you are not necessarily worse off. In rare cases you may be better off, in most cases you will be the same (with a proper restart protocol) and in some case you may be worse off, likely on the libido dimension. It is not a simple answer.

      1. Thanks Superchunk I appreciate you sharing your experience.
        Aspery does horrible science, I get great results doing pretty much the opposite of what he markets lol.

    3. Hi Jeff. I have an experience that may be helpful.

      Four years ago my naturopath prescribed T cream after I tested a bit low (Free T at about 5, total at about 380). Spent the next 10-12 months tinkering with dosages. Was using a cream custom-made by a compounding pharmacy. I eventually got up to 22 free and 996 total, but had black hair growing all over my back and the backs of my arms. Was also pretty quick to anger, as I recall.

      I backed off a ways – cut my dose in half, I believe. Didn’t get any tests during this time, so not sure where I ended up. After a while, I noticed that my testicles had shrunk considerably. That really bothered me, so I simply stopped using it, cold turkey. (No restart protocol as Superchunk mentioned, below. Probably should’ve looked into that.)

      Anyway, now, 5 or so months since quitting, I find myself with Free T at 3.6, and Total at about 310. It’s a problem, and I need to do something about it, for sure.

      I just ordered a bottle of Boron as MarkT suggested down below. Maybe it would have helped if my compounded cream had an estrogen modulator and HCG as Adam and Josh mentioned, above.

      But, at this point, I’m certainly worse off than I was when I started.

      1. Hi Andy, thanks for sharing your experience, it is excellent real-world feedback.
        My sense is that TRT makes sense if you are chronically low and willing to get on it and stay on it.
        But I just don’t see the benefit of an acute TRT approach (boost and then get off). No only does there seem to be no residual benefit, you need to deal with HPTA restart and the various side-effects.

  9. Using hormone replacement isn’t as synthetic as we think – think about our ancestors who ate the whole animal, including glands which would have contained hormones. There is a myriad of reasons why reproductive hormones may be out of alignment, there are natural sources but in this world we live in today our bodies are being bombarded with new chemicals and exposures daily and we have to figure out new ways to counter these changes.

    Essentially the old ways may no longer work, new ways may be needed, especially if used for real purpose such as adding vitality back into your life, and not abused for other purposes such as cosmetic.

    But I will say that going on TRT or any hormone replacement should only be considered when there are no other routes to improve the hormones, because once your on them your natural production will shut off (there are ways to retain natural production alongside supplementation, but its not cut and dry). And if you stop supplementation, you might be able to restore your prior levels, but it will be slow and depressing – and you might possibly never regain 100% of the prior levels. It is just a word of caution because generally speaking hormone replacement is for life – its going to be something with you that you may not enjoy, especially if you realize you might have been able to resolve it with diet, lifestyle, avoidance, or other methods in the first place.

  10. My testosterone was measurably low. Under the care of a Functional MD I tried first various precursors, then direct supplementation. First we tried increasing doses in a “troche”, a custom formulated kind of waxy lozenge which delivers into the bloodstream via the gums. No help. Then we tried a liquid that is applied to the armpits. No help. I got all the downsides: seriously cranky, non-stop sex on the mind, but no measured increase in T nor any of the other benefits that are supposed to accrue. Eventually I gave up.
    I wonder what delivery system Mark used, as well as if there are other failure stories out there like mine.

    1. My question exactly. My husband went on testosterone a transdermal and it made him angry. He’s normally so nice and mellow. It also made him break out. He could use it though. What’s the cause of this?

  11. My test showed T was at 200 and my doc would not give my a scrip for trt said it would make my mean and angry, also had a pounding heart ,felt like it was coming out of my chest,,long story made short went to another doc, got my script and in 3 days my heart stopped pounding after 3 months strength has came back along with more energy

    1. I am also curious about this. I did the Dutch test for comprehensive hormones this summer and my estrogen levels were high, progesterone normal and testosterone basically non-existent! My Vitamin D level is also very low, so I am supplementing with fermented cod liver oil, Primal Blueprint capsules, as well as eating lots of wild salmon. I’m hoping this will help balance out the hormones a bit.

      1. You might try low dose DHEA to raise testosterone (both men and women).

      2. Have your doctor check your DHEA levels! If you can supplement to saturate your DHEA levels in your body, it should raise your testosterone levels. My integrative doc had me do that and it’s been really helpful

    2. I find supplementation helpful. Low levels of T after menopause was destructive to my well being. Low levels may also be stress-related as I swing between third and second shift. Whatever the case, for a long as I live this crazy life, I need my T. Women do need it as well as men.

    3. If your doctor deems your T too low (even the low end of the spectrum can be low), they will most likely check your saturation of DHEA. In those of us with ovaries, if this is not saturated, it’s an easy (and cheap, over-the-counter) way to significantly increase testosterone.

  12. nice, but female hormone replacement therapies had just as glowing study results many decades ago. it takes decades to find out that these therapies may be dangerous. my personal feeling is it would be better to follow the ancestral example and supplement through your foods.

    1. Non bioidentical hormones (eg Premarin) are harmful, yes, but bioidentical are not.

      1. Not true according to breastcancer.org.

        “The higher breast cancer risk from using HRT is the same for so-called “bioidentical” and “natural” hormones as it is for synthetic hormones. “Bioidentical” means the hormones in the product are identical to the hormones your body produces. Bioidentical hormones are said to be “natural” — derived from plants. Synthetic hormones are made in a lab and are also chemically identical to the hormones in your body.”

        1. I’d do more research on this. From what I’ve read, most of the studies support bioidentical hormone therapy as not increasing cancer risk. breastcancer.org is being conservative by lumping all hormone therapies together.

  13. I’m 51 and on my last test my T levels were sky high… like 900 range… but my FREE T levels were LOW…
    A biochemical mystery that my doc is way out-gunned for resolving. Any ideas?

    1. Test your other hormomes. SHBG, estrodial, DHT. You can’t just take T without knowing these other levels. If SHBG levels off…low free test. estrodial too high, too much test is being converted to estrogen so low free test. U need to go to a doc that specializes in hormone replacement therapy. Good news is ur total test is awesome so fixing the other stuff will be relatively easy.

  14. My total testosterone is over 800 but I don’t know the free count. Will supplementing at my level increase free. I have read proper level is 25. My age is 73.

  15. Completely agree with the message in this article–our world today is difficult on our bodies and emotions, meaning we have outside influences on our body’s function whether we want them or not. It’s not a “bad thing” to use outside influences to help put our bodies back into balance. I use desiccated thyroid replacement for example. And yes, that means my own body doesn’t produce thyroid hormone much, if at all, and I am completely dependent on the medication to survive. However, that doesn’t mean I should suffer with low thyroid function. I’ve lived a healthy lifestyle for years, but sometimes we just can’t escape some shortfalls and we need outside help. We should embrace the help that is available–this is different than indulging in “help” that is not necessary.

  16. Hey Mark,

    Did all of this happen while you were in ketosis? Perhaps prolonged ketosis can lower testosterone

  17. A caveat to anyone considering TRT: Most doctors have no idea what they are doing when it comes to TRT.

    It’s pretty common for a physician to prescribe a 300mg injection every 3-4 weeks. Since Testosterone (T for brevity’s sake) has a half-life of about a week, a man experiences what is probably supraphysiological levels at first and by the time he’s due for another shot, his levels will be in the toilet. It’s an up-down roller coaster.

    More progressive doctors prescribe smaller injections, given weekly or even multiple times weekly. This eliminates the extreme up-down cycle and results in more level concentrations. HCG and an aromatase inhibitor (to prevent conversion of T to Estrogens) are often used, as well.

    I ended up going with an online medical clinic and my prescription is three self-injections per week; M-W-F. I tried for years and couldn’t find a local physician to who would even let me self-inject, much less three times weekly.

    Dr. Crisler is one of the leaders in TRT therapy and I highly recommend his book and he has videos online as well.

    1. I am 52 years old. I had my T tested around one year ago and it was around 200. I was 5’10” and 205 pounds. Walking up the stairs to bed would make me out of breath. My interest in sex had waned and ability to perform was less than desirable. I felt a great deal of anxiety and sometimes depression. I started once a week injections and also started following a low carb/low sugar diet. In November of last year I started working out with a Trainer twice per week for an hour. Today I am 170 pounds. My sex life is better than when I was in my 30’s. In the gym we have monthly challenges where everyone competes. I regularly place in the top 5 of every challenge, besting teens and guys in their 20’s and 30’s. I am able to play sports like I played in my 20’s and my mental outlook on life is completely different than a year ago. TRT has, along with diet and exercise, played a huge role in getting me back on track and looking forward to my next physical challenge. I wish that I had been tested sooner! I wasted a lot of years thinking that my mind wasn’t right when it was both mind and body that were not functioning as they should. I would encourage every man struggling with low energy to get tested and deal with their T levels.

  18. Your endocrine pathway starts with the hypothalamus, affecting your pituitary, which in turn affects the function of your thyroid, then adrenals, gonadal hormones, and finally gut. The SAD lifestyle drains your hormones through your adrenals (a process called “cortisol steal”), in combination with leaky gut and gut dysbiosis because of the typical American’s diet, hormone depletion and imbalances are common. If you fix the gut and adrenals through supplementation, the rest of the system will usually fix itself. Our bodies were made to be healthy, but taught to be sick.

  19. Just wondering Mark, are you injecting T or taking T in a pill form?
    I am in the process of doing the necessary tests to determine my free T etc.
    Also have ostopenia which scares the heck out of me!
    If all checks out I will start with injections of bio identical THT with small doses.
    Thanks,
    Jim

  20. I am copying and re-posting my comment from Mark’s Blog “9 Factors that Influence Testosterone Level.” Which, if you have not read you should.

    “Just wanted to point out that Boron is a primary nutrient in the production of the precursors for Testosterone and several other hormones. Studies have found Boron in a value of 10-12mg daily can increase Testosterone levels in women. Better yet they found through urine analysis that 100% of the Boron was eventually cycled out of the body so it did not build up at these levels.

    I was diagnosed low T about five years ago and my studies lead me to Boron. I did blood testing of serum and free testosterone pre and post supplementation with 12mg of a high quality boron supplement. My testosterone levels pushed back up into normal ranges, rising by about 20% on Boron Supplementation alone. More importantly, I felt a big difference.

    I continue to supplement with Boron and test annually. I have continued to stay in the lower ranges of normal. If I stop supplementation for three weeks or more, my energy levels start to crash and I develop other mild symptoms of low T.”

    I would add to my previous post that for me it is more effective to take it at night about an hour before bed. I am currently taking 9mg of Twin Labs Tri-Boron (any good supplement would do) 1 hour before bed and have noticed it is more effective for me than 12mg in the morning. By notice I mean I am recovering much faster from strenuous workouts and have more energy throughout the day.

    1. Any particular downsides, risks or side effects when supplementing with boron?

      1. Having been on it for many years I can report no side effects. Boron studies usually find that Boron is secreted from the body in your urine. Boron is not fat soluble like A,D,E,K; it is water soluble so is eventually flushed from the body. Most studies show 100% of what was ingested is secreted in 24 hrs.

        It is approved at levels of 20mg daily supplementation for pregnant and breast feeding women. (see side effects tab on this page)
        http://www.webmd.com/vitamins-supplements/ingredientmono-894-boron.aspx?activeingredientid=894

        Mean daily intake form food was reported to be about 1.28mg daily.
        https://www.atsdr.cdc.gov/toxprofiles/tp26-c2.pdf

        Toxicity level in this same pdf article is upwards of 15-20 grams or 1,500 to 2,000mg for adults. Minimal Risk Level are established at .2mg/kg/day For my weight of 195lbs that is 17.5mg per day. Minimal Risk Level is defined as “likely to be without an appreciable risk of adverse effects (noncarcinogenic)”

        So at 9-12mg a day I don’t think twice about it.

  21. I haven’t had T checked, but even if it is low I would consider it doping as I am very close to a world age-record for over-60 athletes. I don’t have a problem with non-competitive athletes like Mark using it.

  22. Definitely would like to know what kind of TRT you are using.
    I managed a BHRT clinic for 2 years. We used BHRT in the form of pellets for both men and women. Completely natural, derived from the yam plant.
    Good results but very costly.

  23. Not s fab of HRT or TRT. The hormonal feedback loop is a very complex and sophisticated process. Much better to address every/any lifestyle change possible, before adding TRT. Considering that hormones may downregulate in response to the presence of exogenous testosterone, you’re really messing around with a system that if far more complex than just ‘adding in’ some testosterone.

    Barring dangerously low levels that are like that for some medical reason, best to follow Mark’s last piece of advice to address the many lifestyle issues that affect overall hormone balance and regulation.

  24. I always crank up the heat/ac when the temps change. Is that bad?

  25. Mark,
    What are you doing for TRT? Injections? Cream? Clomid? Any issue with estradiol levels increasing?

    1. Most men on TRT are using a gel – Testim, Androgel, and the like. It’s applied topically in measured amounts, daily.

  26. Androgel is expensive, injections hurt, and cause occasional bumps, deeper intramuscular shots may last longer, but the swings are higher and lower between. Pellets aren’t much better than injections, only benefit is you don’t have to think about it in between. I use compounded Testosterone cream. The word “compounded” means it is made in a local lab, typically used more by naturopathic doctors. Why? a drop of cream can be your entire daily dose, but it is much cheaper than androgel or other big pharma options that can be hundreds or thousands a month. The mark up is insane. I pay a few hundred dollars for 6 months. The cost is reasonably better. Some days, I work out too much and I add another dose later in the day, or another dose before bed, no big deal. I can feel when I’m low or kinda sputtering. And yes, if you have shut off your natural production on purpose, like I did because it wasn’t high enough, I have also done the HCG injection/Estrogen inhibitor restart of natural production. You do a self applied thigh injection every other day of HCG over two weeks, also while orally taking small pill like anastrozole, which prevents the brain from seeing estrogen. That forces your pituitary to start producing LH, which is the hormone that asks your nuts for more T. So, you get the combination of HCG doing the job LH normally does, directly activating the testicular production of T, while also boosting the brains natural way of asking for it, and there you have it. On a restart, my T was at 650 and LH was in good range. But, as I went on from there, my natural levels settled back at <300, so I had to go back on T. Sometimes your brain is the problem, sometimes the testicles.

    1. Also, increasing T is safe, but too much is also not great, your body will make too much estrogen, you’ll retain water, and grow boobs. And more T does not cause massive or easy body comp changes. Genetics, inflammation levels, and estrogen levels have a lot more to do with that than T does. Think of T like nitro in your car engine. If your engine has heart disease, is already 75+ years old, and you aren’t very fit, you may give yourself heart issues by over exciting a system that can’t handle it. But for most people, T supplementation should be a big boost to health, assuming you are otherwise healthy. If you have Lymes, or other chronic infections, increasing T will suppress cytokines and other immune factors that may worsen your infection, so with you CFS or other complex cases out there, be mindful of the immune effects. Otherwise, keeping your immune system in check is a good thing. Same benefit of cold water therapy, or vagus nerve stimulation.

  27. Great article, we totally agree. I think there is great magic in longevity and health when we combine modern science and ancient health principles.
    Thank you for your 21 Day Program, we recommend your books to many of our patients.
    I love your cookbook, I use it every week.

    Thank you again,
    Sincerely Dr. Le Provost
    Men’s Health Specialist
    Phoenix Men’s Health Center

  28. Thanks Mark for your take on T. Your educated opinion always sheds light on complex issues.

    Testosterone:: A Man’s Guide- Second Edition by Neslon Vergel, is a excellent resource for TRT information as is Dr Crisler. https://www.amazon.com/gp/product/B003JBI22A/ref=kinw_myk_ro_title

    I’ve been on TRT for just under 2 years, primal for 4 years and am 52 years old. I currently take 120mg Testosterone Cypionate / week split into two injections every 3.5 days. The best way to inject is with a small needle 28g into the SubQ Fat. Way less pain than inter-muscular. Numbers went from 400 Total T and 7 Free T to 900 TT and 25 ng FT. My estradiol went high 72 from to much T conversion by aromatase am now on 1/4 mg of anastrazole (arimidex) once a week Estradiol now at 25. The following all drastically improved: Mood,energy,libido, sexual quality, body fat , muscle gain, strength, endurance, assertiveness, determination, less living in the past.

    5 years prior i went to a General Practitioner to be test for T and at 400 TT he said I was in the normal range. Turns out through further research that 400 TT is normal for a 85 year old, not for a 47 year old. Of course that doc also wanted to put me on a statin for good measure. Most Docs are woefully un-knowledgeable when it comes to TRT and other hormones for that matter. Look for a anti-aging clinic in your area or a online regenerative medicine or anti-aging clinic if you want any chance of getting educated help with low T. Even most endocrinologist aren’t up to speed in my locality.

  29. Why are doctors only concerned with testosterone for men and not for women?

    1. My doctor is concerned with T for women. My wife sees him as well and he has her on Testosterone as her T levels are low even for a woman. Hormone Balance is absolutely key to health. The biggest problem is that many people have no idea what their levels were when they were in their prime. There wasn’t a problem so they never had them tested. It would be much easier for a knowledgeable doctor to dial in your levels if he knew your peak levels when you were young. There is a wide individual variability in symptom free levels for each person. My doctor has repeatedly stated that he is treating the patients symptoms, not treating the blood values. While useful blood values are only a tool to move the patient to a symptom free state. Testosterone testing results are wildly variable lab to lab and even within in the same lab over time which complicates the matter further. https://www.ncbi.nlm.nih.gov/pubmed/24548716

  30. Hi guys and gals. So what is Mark taking? What is the actual prescription and dosage? Can I evaluate TRT without knowing that? I have recently started taking John Gray’s Tongjack 100 (eurycoma longifolia; which probably can be found in a hundred health stores) and “Myomin” which interrupts the enzyme aromatase that may convert testosterone to estrogen. But most importantly is the issue (implored by Gray) of the body loosing its ability to produce its own T if “artificially” supplemented. What say you folks about that concern? I am now 67. My blood T is around 400. I would like it to be 600. I have the symptom of not sustained energy throughout the day. Feel best after the gym (don’t we all.) Thanks for you input!

    1. Wow! I’m quite shocked at how far off and artificial this thread is from the typical wonderful primal advice we receive on Mark’s site.

      Seems like we should be able to regulate this all with food, lifestyle, even attitude and enhance the body’s ability to heal/regulate itself.

      Plus, at some age we do decline. Primal lifestyle probably keeps most of us way ahead of the curve compared to humans of similar age living like the Korgs, and that’s enough for me.

      Age fit, but gracefully

      1. Some things can’t be fixed completely with even the best diet, attitude, and surroundings. There is nothing wrong with wanting to feel your best at any age.

  31. What supplements do you recommend, over the counter or prescription?

  32. Thanks so much for sharing this. My husband has low testosterone levels and I’m going to send him this article. Also, I appreciate you sharing Carrie’s use of bio- identical hormones. I’ve just started reading information on this. Now ready for it but this gives me more intel.

  33. Sorry to gush here–I’ve been in the mountains and now suddenly the 21st century is here–but if you read my tale of the woman I hold up in the forest (too much testosterone? too little?), well, she’s “plant-based,” is all I know, and going backwards through Mark’s articles to see what I missed while vision-questing in the high peaks and the very next one (going backwards) is about what we can learn from plant-based people. Don’t forget us: two silver-haired strong ones in the depths of the forest! Sleep is taking me now. I am gone.

  34. Interesting article, but didn’t drill deep enough. would like to know how you applied TRT; what kind of product. i would also like to know the potential risk factors for: prostate cancer, PSA > 3ng/ml, hematocrit > 50% etc.
    thx for feedbacking.
    d

    1. Thx Daniel for having awareness of risk factors.
      What does TRT DRUG do to the body… suppress it’s normal function?
      What’s the main issue with western medicine?
      I’d say the Bandaid approach is broken.
      What do you do when you have a stone in your shoe?
      Seems mark would suggest pain pills. 🙁
      Disappointing approach to health challenges!

    2. Daniel. I agree with Mark supplementing T in a non-primal way, as T is so central to a healthy life and living the Primal Blueprint, just isn’t sufficient for this 70-year old. DID YOU GET AN ANSWER FROM MARK ON HIS TRT PRODUCT TYPE?

    3. Check out this article on prostate Cancer and Testosterone levels. http://www.lifeextension.com/magazine/2008/12/destroying-the-myth-about-testosterone-replacement-prostate-cancer/Page-02

      On TRT my Red Blood Cell count has risen some, but not to unsafe levels. This is a common side effect that can easily be mitigated by giving blood. I give double red at the red cross twice a year mostly for humanitarian reasons, but it has the added benefit of keeping my RBC count and Hematocrit at optimal levels.

      1. What’s the side effect?
        Great you donate.
        Confused how so many dismiss that this is still a big pharmaceutical synthetic drug?
        There’s a better way-
        How about just doing hiit training?

    1. Bringing Testosterone back to healthy youthful levels is completely different than a bodybuilder taking them to supraphysiological levels. A typical Testosterone REPLACEMENT Therapy (TRT) dose is 120-200mg per week. Many bodybuilders dose at 1000-2000mg a week.
      The medical community doesn’t think twice when Replacing female hormones after menopause or a hysterectomy. But, somehow when a man’s hormones wane it’s juicing or roids. This Roid, Testosterone, is a steRoid hormone that has been in a males body his entire life. It is not an extraneous molecule. It is essential to a man’s health and well being.

      1. It’s tempting to think that bringing testosterone back to “healthy youthful levels” will mean that a return of overall youth and fitness will follow. But it probably doesn’t work that way UNLESS the person in question actually IS youthful with a medical problem that has resulted in abnormally low testosterone. For the older man (say 50+), youthful levels may be neither normal nor healthy in a body that is no longer young in every other respect. The point here is, tread with caution. There could be serious, unforeseen downsides–just as there have been with HRT for women.

  35. Hey Mike.

    Interesting read as always.

    I am wondering though if you have experimented with sustained adaptogen use, coupled with a ketogenic lifestyle, to see if it helps Testosterone at the age frame you are at?

    I find that adaptogen use, Maca in particular, works in synergy with a keto lifestyle when it comes to achieving the perks associated with healthy T levels.

    Of course I am much younger at the moment but I am curious to see if it helps in modulating stress at an older age, especially when you have other lifestyle factors in check.

    1. Apologies for the typo, *Mark.

      Busy morning shuttling between e-mails and multiple work windows!

  36. Mark,

    I was intrigued to learn more from you after catching you on Fat burning man podcast with Abel James.
    Your journey is inspiring!
    You shared some great insights and I believed took a natural approach to live a happier healthier life.
    This post caught me attention being a make going into mod thirties, a time in which Testosterone levels can begin to decline.

    I guess I will Need to look more and read through your Primal Blueprint but as far as this goes and promoting what I gather is synthetic drug for TRT, I am confused and disappointed this is your approach!
    Not to mention saying it’s a primal approach along with Antobiotics and prescription for Thyroid support, Is that your belief?
    You do know 50% of antibiotics are wrongly prescribed and like dropping a hang grenade in your gut.
    Which is where 70% of our immune system lives!

    There’s nothing primal about taking something that occurs naturally in nature and producing it in a lab. That’s the money circle that is killing people and part of the broken healthcare system especially in the USA. Why is every major disease on the rise? Why do 1 in 4 now suffer auto-immune disease?
    I am sure you most know the underlying task of nearly all prescriptions?

    There are safer and more effect ways to support the body!
    Come on with your reach you have know what impact you can have?

    Do you have an incentive for promoting something that has more risk that gain?

    You did read about the side effects right?
    Or maybe be kind enough to share with your audience!

    There’s a better way and I believe health is your greatest asset. If you disagree I’d love to hear from you. Or perhaps you can educate me more on this TRT out weighing the risk for benefit.
    Be careful what and who you trust and look into prevention, pro active healthcare rather than quick fake fix.
    Not all Doctors sadly these days have the education or your best intention in mind.
    I feel for those who don’t know better.
    Educate yourself before popping another pill. It’s not the answer any more.
    It’s to to empower yourself.

    Nk

  37. Love this “Being Primal is about utilizing modern tools to achieve ancestral health and wellness.” and couldn’t agree more. I think the lack of T these days has other severe issues as well. For example a study showed that a lot of men (dont remember the exact %) have less sperm than normal.

    1. So the answer is quick fix drugs that are hardly primal? Come on
      Have u even looked at the risk?
      This is a Drs approach-
      Pill for every ill!

      1. @Nate. Your devotion to primal is wonderful. I would point out however that devotion to health is what I have always felt Mark was all about. Primal is the way to better health. We know this because of science, a modern day invention, and our personal experience proves it out.

        However, if GroK developed cancer or had a rock smash his hip, Grok died. In today’s modern age you can get cancer treatments and you can get a hip replacement. Using these modern wonders does not make one a traitor to primal.

        I have low T. If I was living in Groks age this would lead to my early death. However, I can use science to try other things to handle this. I approach it Primaly; I lift heavy things, adjust my diet and as mentioned above, through scientific research I have found Boron supplementation works for me. When Boron no longer works I will go the testosterone supplement route as Mark has. I am not selling out on my primal ways or beliefs. I am using the best of science to live the best life I can (even in my choice of a Primal approach to life as science is what has clued us into Primal being the right approach) . To me, Primal versus Modern is not the issue. I see Primal as merely a word to describe a viewpoint on life, a healthier approach to living based on the exploration of the roots of man through the eyes of scientific study and research. Truly yours and not against you, Just sharing my thoughts. Grok on.

    1. Yes, there is. When I began peri-menopause I started researching BHRT. Found that all BHRT is not created equal. Too many doctors use a static dose for everyone. Finally found one I believed to be superior to all the rest. The dosing schedule is the key! My husband’s T was very low and he had tried Androgel and the shots which just made him miserable. Went to see a doctor who did the BHRT we wanted to use and it changed both our lives for the better. We have both been on our BHRT for over 8 years and would not be without them. Our BHRT is in cream form. I use Estrodial and Progesterone and hubs uses Testosterone and DHEA. We have been Primal for 4 1/2 years, which has also been a big plus. Neither of us has ever had a bad or questionable report being on this BHRT. Research is the key. I still have never seen one that is even close to the one we are on. Four years before we started BHRT, I had a bone scan and it showed some osteopenia. When I had my next bone scan a year after starting BHRT it showed I had the bones of a 20 year old, no osteopenia. Our journey with BHRT has been nothing but positive. I don’t remember what the hubs free T was but his Testosterone level was just under 700. Not bad for an ‘old’ man and woman of 62. Very healthy and happy and living life large!

  38. @Mark – I’d be interested in a guest post from Carrie on her experiences with bio-identicals. I’m just about to start them.

    1. Same here! Am only considering so far….just moved to a new state and have no docs here yet.

  39. Congrats Mark! This is well written and evidence based. Your contribution helps men the world over understand the TRUTH about TRT. Would love to do a Podcast with you to discuss the finer nuances. To your ultimate health!

  40. One topic missing here is plastics… remove them and other endocrine disruptors from your life as much as possible.

  41. A surprise post from Mark. 7 years ago I was on a topical gel for low testosterone, but also overworked, overweight, overstressed. When I had talked about low libido to my doctor, he had me tested and I had the T-levels of a 92 year old. My doctor said I have something for that and prescribed a gel, but no other life style changes. Decided to change my life after two years on the gel. I started working out, eating cleaner, worked less, got out from some stressful projects came across Mark’s Primal Blueprint, and ate even cleaner. Also went to a natural path, and supplemented with magnesium since and other supplements, ate for oysters for zinc based on readings from the Weston Price Foundation. Dropped from 205 lbs to a low 167 lbs, and now averaging 182 lbs, having put on a bit of muscle doing Crossfit for last 3 years. A little over 5 years ago stopped using the topical gel as did not need it, but feeling a bit low now at 52. I’m not eating as clean, not supplementing, and work and stress is ramping up lately. I’m somewhat disappointed/disillusioned that Mark is using TRT, but if it helps him, so be it., Each person is different. I kind of wonder if in the broader sense, TRT is just addressing natural decline that should be accepted and lived with? Just because we have the means to address it does not mean we should use it.

    Hopefully, I can get back on a cleaner living, less stress and see if that helps and not fall back on TRT. That stuff is expensive and the court is not yet out on its long term side effects.

  42. My doctor recommended testosterone implants to increase bone strength. I am a 70 year old female and have refused to take HRT because I am a breast cancer survivor, so he then suggested the testosterone implants. What is your opinion on a female doing this?

  43. TRT is great but is not a Panacea. I’m 53 and tried it several years ago. T levels went up wonderfully but my boys shrank and estrogen level sky rocketed. Then had to get on the ever changing cocktail of other drugs flumoxitim(?) and the HCG. Felt great when my levels were all in sync but c’mon…my boys were literally the size of raisins! So decided to quit cold turkey after 6 months…very tough 2 month withdrawal but my boys grew back and I went the natural route and feel fine now. I don’t feel as great as when I was on the cocktail but as with anything in life and nature there is a give and take. If you and your supportive wife/partner don’t mind severe shrinkage and being a frequent patient of your doctor and phlebotomist (person who draws blood) then go for it. But I recommend exploring all natural options first (zinc, fenugreek, proper paleo diet, living heavy stuff and sprinting as Mark recommends) or doing the natural with TRT.

  44. I am 38 years old and a little over a year ago went to my Dr. armed with enough info and symptoms to get blood work done to check my T levels, and, as expected, they were low… off the charts low… like that of an 80-year-old man low. I have a year of TRT under my belt, and I feel better than I have in a decade. A lot of mysterious issues that plagued me for years (fatigue, depression, lack of focus, brain fog, etc.) have all but disappeared, and I feel like a completely different person. I don’t think it is for everyone, and I think a lot of people are too quick to turn to TRT even though they are in a normal range and could try more natural ways of creating the environment for increased hormonal support… however, for men like me who had severe symptoms and are completely out of a normal range, I think it is the way to go.

  45. Mark, two questions:
    1) Do you think your chronic cardio years contributed to low T later in life?
    2) There are a ton of herbal supplements that purportedly improve T. Any chance of a post reviewing some of the more legitimate ones? (Personally, I’d rather spend money on steak and eggs, and do resistance training and sprinting, but if there is a legit supplement, I’m willing to experiment)
    Thanks for this post and thanks for all you do!

  46. With all due deference to Mark Sisson I believe he is being slightly myopic in his approach to this issue. I believe one of the primary goals of our lifestyle is to help keep us off any and all medications as much as possible for as long as possible. Hormonal therapy/replacement is tricky business. Why treat lab results if you have no clinical symptoms? How does he know the slight improvements he felt aren’t psychosomatic? He cites studies that show TRT to be safe but how many times have we been told some drug is safe till it isn’t?

  47. I really appreciate Mark talking about Carrie’s use of bioidentical hormone therapy and I’d love to hear more about her experience and the science/research behind that!

  48. I am a medical professional and have been on TRT for 10 years with great results, one thing I would add to your article is that Estrogen monitoring and control is crucial in this situation (TRT can lead to rise in E) . Elevated Estrogen kills men slowly but surely.

  49. I’d appreciate a second column on low testosterone in women, which, at least in the US is more controversial even than its use in men. From what I have read I discovered that women make more testosterone than estrogen in their childbearing years and that menopausal and post-menopausal difficulties (lowered sex drive or ability to orgasm, osteoporosis, batwings under the arms, loss of energy, hot flashes, sleeping difficulties, etc., etc.) is becoming attributed to low testosterone in women rather than previously thought low estrogen levels. Its use in women also does not carry the health risks estrogen supplementation does. Of course, this has long been prescribed in other countries (in implant form), but its use in women is not recognized by the FDA, so testosterone supplementation in women is not covered by insurance. I have it compounded for a very reasonable cost (compounded = $45/month whereas being prescribed the commercially available men’s patch is $500/month)…and it has been a total gamechanger for me.

  50. I’ve done the primal paleo thing for many years. All my blood work has pointed to low normal in total T (think of this as your NET worth) and low free T (your cash on hand). After doing everything else possible I turned to an FM Dr who specializes in hormone replacement. He made me deal with several other things including parasites before he put me on HRT (first round was an implant in the back). He included an estrogen blocker. I felt awesome, was able to lift literally 20% more within a few days (my experience yours likely to vary) and had great energy and sex drive. The pellets wore off and I felt kind of crappy so now I am on a lil for blocking estrogen and doing injections myself (low dose of 100mg). I guess my point is that a lot of you do not seem like you were working with skilled practitioners. If you want to read a little more and get better familiarized find Jay Campbell and his TRT Manual. There’s lots of “bro science” in it but he is really talking to us normal folk not muscle heads. Personally, I am not going quietly into the night!

    1. Do more High intensity interval training, down plenty of high quality whey isolate protein and when the sex drive and the thing that goes with it drops you probably don’t need it anymore – you’re done with that, and It’s OK!

  51. Why did you not adddress TRT for women? Artist has to run levels decline as we age also