One Year of TRT

My Low Testosterone Symptoms

In September 2019, I was diagnosed with low testosterone and started Testosterone Replacement Therapy, or TRT. I first wondered if I had low testosterone a few years prior to my actual diagnosis, after I had read a list of possible symptoms. For some reason, I just always thought that it would be a noticeable lack of libido or constant erectile disfunction. I didn't really notice those things, so I never really considered it as a possibility. The hardest part about sifting through the symptoms of low testosterone is that any individual symptom can also be a symptom of something more common.

My biggest symptom that I remember was a clear drop in motivation to really do anything that I enjoyed. I felt like I was just floating along in sort of a mild depression. This alone wouldn't have tipped me off, but I was also having some memory problems and trouble remembering details in the middle of a conversation. It felt almost like a 'brain fog', where I knew stuff was still there but I just couldn't grab it. This was affecting my personal life and my work, as I was giving poor answers to customers since I couldn't always remember the right things. Other mental symptoms included a generally poor mood and a hard time concentrating on the task at hand.

As a big believer in personal data collection, especially around weightlifting, the physical symptom I noticed most was a multi-year plateau in all of my lifts. From 2016-2019, my overall lifting numbers were basically flat. During this time, I wrote it off as a sign that I needed to change my workout routine or that I needed to really push myself and just work harder. I also was holding on to a lot of body fat and had a hard time building muscle. Again, I explained this away by telling myself to try harder, but looking back after knowing the results of TRT, I can see that this was certainly affected by low testosterone.

Diagnosis and Treatment

I first got my testosterone checked in 2016 by my primary doctor, mainly because I directly asked about low testosterone and was told that normally they don't check testosterone in healthy 30-something males but if I wanted to get it checked then they could add it in to the bloodwork. It came back as a total testosterone of 447 ng/dl (with a normal range of 348-1197) and a free testosterone of 8.4 pg/mL (with a normal range of 8.7-25.1). I was told to try to increase my testosterone naturally by working out more, losing weight, and taking vitamin D. I got my testosterone re-checked in 2017, and had total of 538 and free of 12.2, so my doctors just assumed it was all good since it was in the "normal" range, even though my symptoms hadn't improved.

In 2019, I got my testosterone rechecked. It came back as a total of 504 and a free of 9.0. I talked to a hormone specialist and described my symptoms, and was told that while my numbers were technically within a normal range, they were at the bottom of the range for my age and the free testosterone being at the bottom of the range can cause my symptoms. It was suggested that having diabetes for 30 years might be a cause, as they both affect the endocrine system, but it's impossible to definitively associate the two. He said that TRT was a lifelong commitment, but said that we could start it and see if it helped my symptoms. I was started on 200mg via one shot per week.

After 3 months, I switched to a telemedicine clinic. They had me get more bloodwork done, and my testosterone came back at 1500 total and 50.0 free. Clearly the testosterone was working, but they suggested that I could scale back my injections to 160mg and try splitting them to twice per week to smooth out the absorption. They also had me start injecting hCG, which helps natural testosterone production continue and boosts some other hormone production to help balance things. I also started taking an aromatase inhibitor to help balance estrogen conversion. After another few months, my total was still 1500 but my free was 36.0, which is much closer to being at the top of the "normal" range instead of the bottom of "normal". We're continuing to tweak things, but optimally I'll take as little as I need to be in a good range.

Benefits and Changes Experienced

Within the first couple of weeks of testosterone injections, I noticed a shift in my mood and cognitive functions. I'm sure part of this was placebo effect from expecting a change, but hey, placebo effect is real so I'm not going to discount that. My motivation and concentration continued to improve week after week, and I felt like "my old self" again in regards to hobbies and leisure. My memory seemed to improve (but hasn't become perfect!) and I could recall things quicker. It also felt like my mood was less "flat", in that I felt a wider range of emotions than I was before.

Physically, the changes were much more gradual, but noticeable. The first thing I noticed was that during workouts, while I still got tired, I felt like I could keep going much deeper into a workout than before. I broke through all plateaus on all lifts within 6 months and have continued to have fairly consistent progress. It has become much easier to lose weight by changing my diet slightly. I have gained muscle and lost fat, which is hard to track but I can tell by looking at progress photos of myself at the same weight. I also feel like my diabetes management has been easier, as it seems like my body is more stable and my blood sugar is less likely to go crazy in one direction or the other.

Being on TRT also exposed a few symptoms that I didn't recognize and changes I didn't expect. The biggest example is that my sex drive had decreased, but it was so gradual that I thought it was just a part of getting older. I also didn't realize how little body hair I had until it started growing faster and thicker. My beard was very patchy pre-TRT, which I just assumed was how it was, but now it actually comes in fuller and thicker. I need a haircut now every 4 weeks instead of 6 weeks to maintain the length I like, and my nails all grow faster than they did before. Mentally, my confidence is through the roof and I'm more comfortable being myself. I'm more likely to speak my mind, move on from negative thoughts or things I don't enjoy, and jump in to something that interests me (which is why I started blogging here).

Overall Thoughts and Recommendations

The mental changes alone have made TRT worth it for me, with the physical changes I've experienced being a nice side effect (that I'm not going to complain about). I think this is interesting, as I always thought that most people who inject testosterone do it for the physical effects. However, I feel like my mindset has rebounded from the decline I experienced but wasn't aware of throughout my late 20s and early 30s. It's also enabled all of the work I put into exercise and diet to pay off more visibly, which contributes to my mental well-being and confidence.

There's an unfortunate social stigma around taking steroids and talking about hormones. My hope for putting this personal information out there is that it might help others realize that there are a lot of mental and physical effects of low testosterone that don't have to just be accepted. While I don't think everyone should start injecting testosterone, I do think it's worth knowing all of the symptoms of low testosterone and asking your doctor for bloodwork to at least get a baseline for what your total and free testosterone levels are. I wish I had those numbers throughout my 20s, as it would show any decline instead of guessing when it happened.

I will also clarify that TRT is not a magic bullet. I've experienced amazing benefits, but it also takes effort and work to maximize those benefits. It also doesn't 100% "cure" some of the mental aspects, as depression and concentration are still things that I struggle with. That said, the effects are much smaller, and TRT is a tool that I can use to help me with those struggles. After one year of TRT, I can confidently say that the benefits and effects are absolutely worth the couple of shots per week.