Nelson Vergel
Founder, ExcelMale.com
General Information
What is testosterone replacement therapy (TRT) and why is it used?
Testosterone Replacement Therapy (TRT) is a medical treatment for men with testosterone deficiency, often called “low T.” It involves introducing testosterone into the body to raise levels into a normal, healthy rangeexcelmale.com
excelmale.com
. Doctors may prescribe TRT when a man has symptoms of low testosterone (such as low libido, fatigue, depression, or loss of muscle) and blood tests confirm low hormone levels. The goal of TRT is to improve quality of life by alleviating symptoms caused by low T
excelmale.com
excelmale.com
. TRT can be administered in various forms, including injections, gels/creams applied to the skin, patches, pellets implanted under the skin, or oral tablets that dissolve in the mouth
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. Each method delivers testosterone into the bloodstream, and the choice of method can depend on patient preference, convenience, cost, and medical advice
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. By restoring testosterone to normal levels, TRT can help reverse the effects of hypogonadism and improve energy, mood, sexual function, muscle mass, and bone density over time.
Who should consider TRT, and how do I know if I need it?
Men who have clinical symptoms of low testosterone and consistently low testosterone levels on blood tests are candidates for TRTexcelmale.com
. Common symptoms include low sex drive, erectile dysfunction, fatigue, depressed mood, difficulty concentrating, loss of muscle mass/strength, increased body fat, and irritability. Doctors typically diagnose low T (hypogonadism) if a man has these symptoms and at least two early-morning blood tests showing low total testosterone (often below ~300 ng/dL, depending on the lab’s reference range)
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. Before starting TRT, a thorough evaluation is done to rule out other causes for symptoms and to determine the type of hypogonadism. This evaluation often includes measuring LH and FSH hormones to see if the problem is in the testes or the pituitary gland, checking prolactin (to rule out pituitary tumors), and assessing overall health. Guidelines recommend checking for issues like enlarged breasts (gynecomastia), sleep apnea, or other hormonal imbalances that might cause low T symptoms
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excelmale.com
. If you have classic low T symptoms and your lab tests confirm low levels, you should discuss with a knowledgeable doctor whether TRT is appropriate. Men who plan to have children in the near future should mention this, as TRT can affect fertility (see the fertility question below). Generally, TRT is considered when the potential benefits (improved symptoms and health) outweigh the risks, and it should always be supervised by a physician with regular monitoring.
What are common causes of low testosterone in men?
“Low T” can result from a variety of factors. Aging is a major cause – testosterone levels naturally decline about 1% per year after the 30s, so many older men develop low levels. However, younger men can have low T as well due to other causesexcelmale.com
. Primary hypogonadism (problem in the testes) can be due to genetic conditions, past infections (like mumps orchitis), injury or trauma to the testicles, or chemotherapy/radiation affecting the testes
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. Secondary hypogonadism (problem in the pituitary or hypothalamus signaling) is also common; it can be caused by obesity, chronic stress, poor sleep, use of opioids or steroids, pituitary tumors, or severe illnesses. Certain medications and anabolic steroid abuse can suppress the body’s testosterone production. A sticky thread on the ExcelMale forum lists numerous potential causes, including normal aging, metabolic conditions like diabetes, thyroid disorders, as well as lifestyle factors
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. In many cases, low testosterone is multifactorial. For example, an overweight, middle-aged man with untreated sleep apnea and high stress may have significantly reduced T levels. Identifying and addressing underlying causes (like weight loss for obesity or treating a medical condition) is important, because it might improve testosterone levels naturally or at least improve your overall response to TRT.
What is considered a “normal” testosterone level, and how is low T diagnosed?
“Normal” testosterone levels can vary by lab, but generally for adult men the normal total testosterone range is roughly 300–1000 ng/dL (nanograms per deciliter)excelmale.com
. Levels tend to be highest in the morning; that’s why doctors often test testosterone between about 7–10 A.M. Low T is typically diagnosed when total testosterone is consistently below ~300 ng/dL, especially if the man has symptoms
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. Many doctors also consider free testosterone (the active fraction not bound to proteins) – if free T is abnormally low, that can indicate a problem even if total T is mid-range, particularly in men with high SHBG (sex hormone binding globulin)
excelmale.com
. It’s important to have at least two separate blood tests on different mornings showing low levels, since testosterone can fluctuate day to day
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. For example, the American Urological Association defines testosterone deficiency as a total T < 300 ng/dL on two occasions with symptoms
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. Keep in mind that “normal” ranges also vary with age; younger men tend to be in the higher end of the range. Many physicians will treat if levels are below ~350 ng/dL and symptoms are present
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. In fact, one forum contributor noted that many doctors treat men who have total T under 350 ng/dL and symptoms of low T
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. Ultimately, the decision to diagnose low T considers both lab values and clinical symptoms or signs.
How long does it take to see results from TRT, and what improvements should I expect first?
TRT is not an overnight fix – benefits appear gradually, and different symptoms improve on different timelines. According to a review of studies on TRT’s time-course of effects, some changes can be seen within weeks, while others take monthsexcelmale.com
excelmale.com
:
- Libido and sexual interest often improve within 3 weeks, with a peak or plateau by around 6 weeks
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. Many men report increased sex drive fairly soon after starting TRT. - Erections and ejaculation improvements may take longer – up to 6 months to fully manifest
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. (If erectile dysfunction is due to low T, TRT can help, but if ED has other causes, it might require additional treatments.) - Energy and quality of life enhancements can be noticed in the first month. General vitality, mood, and motivation often start picking up in 3–4 weeks, but full benefits may continue developing over several months
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. - Mood and depressive symptoms may begin to improve after about 3–6 weeks, with maximum antidepressant effect often around 18–30 weeks (4–7 months) of treatment
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. Men with low T sometimes feel a lift in mood and reduction in anxiety after a couple of months on TRT. - Strength and muscle mass gains build up gradually. Some increases in muscle fullness or response to exercise can appear in the first 8–12 weeks, but significant changes in body composition (more muscle, less fat) usually take 6–12 months of consistent therapy and exercise. For example, clinical studies show lean body mass can increase several kilograms over a year on TRT in men who had low T
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. - Red blood cell count (hematocrit) starts to rise by about 3 months, sometimes peaking around 9–12 months
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. This can be a positive for anemia, but it means blood tests for hematocrit are important (see monitoring section). - Bone density improvements are slow; they might require 6 months or more to begin and can continue over 2+ years. TRT helps strengthen bones, but a DEXA scan would only show changes after long-term therapy.
- Prostate-specific antigen (PSA) may increase slightly in the first few months (since testosterone can stimulate the prostate), then usually levels off by 12 months
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. This rise is typically small and related to prostate growth that comes with normal aging, not just TRT
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.
excelmale.com
excelmale.com
. It’s important to have realistic expectations: some men feel better within a month, but for others, it can take 3–6 months to really notice big improvements. Patience and consistent therapy, along with healthy lifestyle changes, will yield the best results.
If I start TRT, will I have to be on it forever?
TRT is usually considered a long-term or lifelong commitment if the underlying cause of low T is not reversibleexcelmale.com
excelmale.com
. Once you begin TRT, your body’s own testosterone production will diminish (because the external testosterone signals the brain that enough hormone is present). If you stop therapy, your testosterone levels will drop again – often to the low levels you had before, or potentially even lower for a short time until your natural production recovers
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. Many forum experts emphasize that you should not “cycle” on and off TRT as one might with bodybuilding steroids; instead, think of it as a continuous therapy if you truly have testosterone deficiency
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. Stopping TRT can lead to the return of low T symptoms (fatigue, low libido, etc.) until your body resumes making adequate testosterone, which for many men with hypogonadism, it never did in the first place
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That said, TRT is not addictive – you can discontinue if necessary, but you’ll likely feel the effects of low hormones again. Some younger men who start TRT elect to stop in order to restart fertility or see if lifestyle changes can maintain their levels; in such cases doctors may use medications like hCG or Clomid to help “restart” natural production. But for most men who truly need TRT, therapy is open-ended. As one TRT specialist on the forum put it, “This is a lifetime commitment. If you stop, your levels will crash…you’ll basically go back to where you used to be before testosterone.”
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. Therefore, before starting, it’s critical to have a candid discussion with your doctor about the long-term plan. In summary, you should plan to be on TRT indefinitely unless a clear reason arises to stop; stopping and re-starting can put your body through hormonal rollercoasters which is not ideal. TRT can greatly improve your well-being, but you need to be mentally prepared that it’s a ongoing therapy requiring regular injections or application and periodic monitoring (much like how someone with thyroid disease stays on thyroid hormone for life).
Benefits of TRT
What are the main benefits of TRT?
When administered correctly to men with low T, TRT can provide significant benefits across various aspects of health and well-beingexcelmale.com
excelmale.com
. Key benefits include:
- Improved Sexual Function: This is often the first benefit men notice. TRT can increase libido (sex drive) and frequency of sexual thoughts/desire. It also often improves erectile function (morning erections and overall rigidity) especially if low T was contributing to ED
excelmale.com
excelmale.com
. Many men report regaining a healthy sex drive and better performance after therapy. - Higher Energy and Better Mood: Low testosterone is linked with fatigue, low motivation, depression, and irritability. Bringing testosterone back to normal can lead to higher energy levels, motivation, and confidence, as well as reduced feelings of depression or anxiety
excelmale.com
. Men often describe a general sense of well-being or feeling “like myself again” after some weeks on TRT. Cognitive benefits like improved focus and memory are also reported. - Increased Muscle Mass and Strength: Testosterone is an anabolic hormone, so TRT helps reverse the loss of muscle mass that comes with low T. Over months of therapy (especially combined with exercise), men typically see improvements in lean body mass and muscular strength
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. One analysis noted TRT can increase lean body mass by several kilograms in a year in hypogonadal men. You may find it easier to gain muscle at the gym and recover from workouts. - Reduced Body Fat: Along with building muscle, TRT can aid fat loss, particularly reducing visceral fat (belly fat). Restoring testosterone can shift body composition to a healthier balance of muscle to fat. Many men on TRT notice their waist circumference decreases over time, partly due to increased metabolism and activity levels.
- Better Bone Density: Testosterone is important for bone health. Long-term TRT can improve bone mineral density, reducing the risk of osteoporosis. This benefit isn’t immediately felt, but it’s an important health outcome (fewer fractures in older age, etc.).
- Cardiometabolic Health: There is evidence that normalizing testosterone can have positive effects on cholesterol and insulin sensitivity. Some men see improvements in HDL (good) cholesterol and modest reductions in LDL or triglycerides. TRT may also improve blood sugar control in men with type 2 diabetes
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. Additionally, observational studies of men with low T suggest that those treated with TRT have lower risks of heart attack, stroke, and mortality compared to those who remain untreated
excelmale.com
excelmale.com
. (This is likely because testosterone deficiency itself is associated with worse cardiovascular health, so treating it helps – ongoing research like the TRAVERSE trial is investigating this further.) - Cognitive and Mood Benefits: Testosterone can affect brain function. Men often report clearer thinking, better memory recall, and less “brain fog” on TRT. Mood improvements include feeling less irritable and more resilient to stress. For men with clinical depression linked to low T, TRT can have an antidepressant effect in some cases
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. - Overall Quality of Life: Summing up the above, TRT can lead to a marked improvement in quality of life – better ability to exercise, higher sexual satisfaction, more vitality day-to-day, and possibly even longevity benefits. One large veteran study showed a significant reduction in all-cause mortality among men on TRT versus those not treated
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(Remember: TRT is not a “magic bullet” or a substitute for a healthy lifestyle
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. It works best in combination with good diet, exercise, sleep, and medical care – more on that in “TRT and Lifestyle” below.)
Will TRT help with sexual health (libido and erectile function)?
Yes, one of the primary reasons men pursue TRT is to improve sexual health. Low libido (reduced sexual desire) and erectile dysfunction are common symptoms of low testosterone, and TRT can significantly help in these areas if low T was a contributing factor. Most men on TRT experience a notable increase in libido – often within the first several weeks of treatmentexcelmale.com
. They report more frequent sexual thoughts, fantasy, and desire for intimacy. In fact, a medical review found sexual interest typically improves by week 3 and peaks around week 6 of therapy
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For erections, testosterone is one piece of the puzzle (alongside blood flow, nerve function, etc.). Men with low T often have weaker or fewer morning erections and may struggle with ED. By raising testosterone, TRT can improve the frequency and quality of erections over time
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. However, this effect may take a bit longer – up to several months. Clinical observations note that erectile function may show improvement within 3–6 weeks in some men, but significant changes (especially if ED was moderate) can require 6 months or more on TRT
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It’s worth noting that if ED has other causes (like vascular disease or diabetes), TRT alone might not fully fix it, but it can still improve response to ED medications (like PDE5 inhibitors). Libido, on the other hand, is very testosterone-dependent, so TRT often has a dramatic effect on sexual desire. Many forum members have reported regaining a “teenage-like” sex drive or at least returning to their previous normal interest in sex after starting testosterone.
Beyond libido and erections, TRT can enhance overall sexual satisfaction and performance. Men often report better orgasm quality and more sustained sexual energy. Restoring T can also address related issues like low confidence or performance anxiety that stem from hormonal imbalance.
To maximize sexual benefits:
- Ensure your TRT dose is optimized (both too low and too high testosterone can affect sexual function). Generally mid-normal levels are the goal.
- Monitor estradiol (E2): Some men blame high estrogen for sexual side effects; while E2 management is sometimes needed (see the estrogen question later), having some estrogen is actually beneficial for libido and erectile function
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excelmale.com
. Over-suppressing estrogen with an AI can harm sexual function. - Address other factors: good cardiovascular health, pelvic floor strength, and mental health all contribute to sexual performance. TRT helps but is part of a holistic approach.
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, with continued improvements for erections over ensuing months. It’s one of the most reliably reported benefits of testosterone therapy.
Can TRT help increase muscle mass and reduce body fat?
Yes. Testosterone is a key hormone for regulating body composition – it supports muscle growth and fat loss. Men with low T usually notice it’s hard to gain or maintain muscle and easy to accumulate fat (especially around the belly). By correcting the deficiency, TRT provides a more anabolic (muscle-building) and metabolism-friendly environment:- Muscle Mass & Strength: TRT will make it easier to build lean muscle when combined with resistance training. Even without exercise, studies have shown that hypogonadal men on TRT gain some lean body mass. For example, one study found men on TRT increased lean body mass by up to ~4-5 kg over 12 months
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. Most of this is muscle (plus some water/glycogen in muscles). You might notice your workouts become more effective – you can lift heavier, do more reps, and recover faster. Over time, strength improves as muscles hypertrophy. (Many forum users report substantial strength gains after several months on TRT, basically regaining the muscle they lost during low T years.) Keep in mind that you won’t turn into a bodybuilder overnight – exercise and dietare necessary to maximize this benefit – but TRT removes the hormonal barrier that was holding back your fitness progress.
- Fat Loss: Restoring testosterone can help reduce fat mass, especially visceral fat. Low T is associated with higher body fat percentage and insulin resistance. With TRT, men often see their waist size shrink and pants fit looser as abdominal fat decreases. Fat loss might not be very rapid, but over the span of a year, studies note significant drops in fat mass with TRT compared to placebo. In one study, men with testosterone therapy lost more fat (while gaining muscle) than those without, when both groups did the same amount of exercise
. Testosterone increases metabolic rate slightly and improves insulin sensitivity, which can help weight loss efforts. Many men find they have an easier time dieting and see better results from exercise once their T is optimized.
- Body Recomposition: The combined effect is improved muscle-to-fat ratio. For instance, a clinical trial might show TRT users gaining a few kilograms of muscle and losing a couple kilograms of fat – the scale might not change dramatically, but the mirror shows a leaner, more muscular physique. On the forum, men have shared before-and-after experiences where over months their weight stayed similar but they traded fat for muscle thanks to TRT (and training).
Overall, if you stick to a healthy diet and workout regimen, TRT can absolutely help you become leaner and stronger than you were with low T. Many hypogonadal men describe a reversal of the “skinny-fat” appearance: muscles become more defined, and stubborn fat (like love handles) becomes easier to lose. This not only improves appearance but also metabolic health.
