A Man’s Guide To Testosterone Replacement Therapy – Illimitable Men

Self-Improvement

# A Man’s Guide To Testosterone Replacement Therapy

August 31, 2017June 1, 2022by IM

Contents:
1.) Introduction
2.) Why Do More & More Men Need Testosterone Replacement Therapy?
3.) What Are The Benefits of Testosterone Replacement Therapy?
4.) Your Questions on TRT Answered
5.) In Closing / Relevant Reading

1.) Introduction

I have tried to make this guide as comprehensive as possible. I am not above updating it and improving it in the future.

I do not claim to know everything, claim to go into the greatest biological and scientific detail on each point, nor be a medical expert, but I know enough to answer almost any question someone who is just beginning or thinking about beginning TRT could want to know.

I may know more than the average general practitioner, or even endocrinologist, but I am not a doctor, nor licensed to give medical advice.

So even if your doctor is a complete idiot who knows less than I do, it is he/she who is licensed with the necessary credentials that legally permit them to give you medical advice, so you should only take advice from them, not me.

This is a practical, rather than intellectual piece. I will employ a simple writing style accordingly.

The structure of this article will take a questions and answers format from section 4 onward, with some background into the importance of TRT beforehand.

I have fielded questions from across the internet (email, blog, Twitter, Reddit) and the purpose of this article is to answer the plethora of questions put to me on TRT in a single, centralised location despite the controversy my thread fielding questions for this post generated. TRT is, unfortunately, something of a taboo mired in ignorant fearmongering.

There’s a lot of interest in TRT in the men’s part of the internet, and as a website dedicated to the betterment of man, I do not believe Illimitable Men would be complete in fulfilling the vision I have for it if I shied away from covering this topic simply because its controversial.

Men don’t shy away from things just because it’s going to elicit some outrage and disapproval.

I have no doubt that, upon the publication of this piece, there will be additional questions in the comments. Valuable questions that haven’t already been answered may be added to the article in future revisions, time permitting.

I want this piece to be as helpful, truthful and comprehensive as possible.

It’s taken me awhile to publish this since I first announced I would be working on it, but alas, you will see it has been worth the wait. Reading this will tell you many of the most relevant things you need to know about TRT.

But before we begin, let me reitrate the following: any test recommendations, health services or health information provided by illimitablemen.com, written or verbal, is for educational purposes only and is not intended to diagnose, treat, or cure any disease or condition.

2.) Why Do More & More Men Need Testosterone Replacement Therapy?:

There is a generational decline in testosterone levels amongst men independent of typical age expected decline.

This means men aren’t just losing testosterone as they get older, but men of all ages have lower testosterone than men who were their age the year before. So 2012’s 20 year olds would have 1% greater testosterone than 2013’s 20 year olds.

The later you were born, the lower your testosterone is likelier to be at any given age relative to men who were your age in a previous year.

The average 20 year old man in 2017 has less testosterone than the average 20 year old man in 1997 who has less testosterone than the average 20 year old man in 1977.

This is true for men in every age bracket. Men of all ages across the board have lower testosterone levels. Your grandfather will have higher testosterone at 75 than your father, and your father will have higher testosterone at 75 than you will.

Male hormonal health and fertility is in crisis, and little is being done about it. In fact, blood testing laboratories continually lower their “acceptable range” of blood serum testosterone levels as the population’s testosterone decreases year on year.

They do this, because they devise the range based upon a sample of men from the population.

But if the average man’s health is deteriorating over time due to poor lifestyle choices and inhospitable environmental factors, then the quality standards for male health are effectively decreasing over time.

Men who would’ve gotten help with old reference ranges will no longer get help with newer, revised reference ranges because most doctors will not treat men who fall within the reference ranges even if they’re symptomatic.

And naturally, if the reference range was taken from a population whose health is deteriorating over time anyway, and there is a long-term trend in testosterone decline that hasn’t been fully investigated, then revising the range downward is foolish, as it makes it harder for men with ever poorer health to get the treatment they need.

Look at these recently revised testosterone ranges from LabCorp in July 2017 for instance.

A 25 year old man with say 400ng/dL of testosterone and showing symptoms of hypogonadism (low T) might’ve gotten help back in June from a sympathetic doctor, because although he was in range, he was barely within range.

Now in September 2017, the same 25 year old would be “much more deeply entrenched” within the accepted range, and therefore, although his symptoms of low T remain the same as they did back in June…

He is now far less likely to get the treatment he needs because the revised range makes him appear healthier, even though he isn’t.

The reference ranges really skew the frame of reference doctors use in deciding whether treatment is necessary or not. And the reference ranges are continually lowered to permit an ever declining state of health in men.

Likewise, the WHO (World Health Organisation) keeps downward revising what constitutes an acceptable quality and quantity of sperm.

Lower natural testosterone levels, means lower sperm count, and poorer sperm quality.

In 1968, around 38% of sperm was abnormal in the average man. In 2008, 97% of all sperm was abnormal.

So effectively, there is an epidemic in male hormonal health and fertility and little if anything being done by the medical establishment to redress it.

If you don’t take your health into your own hands and look after yourself, no one else will.

The doctors are busy fiddling numbers downwards instead of helping those who need it by basing their testosterone ranges on erroneous population samples that reflect the state of societal health as it is, rather than reflect an actual desirable healthy state in the body.

The fatal flaw in this is the presupposition that the current state of health in 18-39 year old men with a BMI under 30 is desirable, and that it is wise to gauge reference ranges based upon a large sample derived from this population.

The downward trends over time in both testosterone level and sperm quality and quantity suggest otherwise.

Perhaps one day male health will be taken seriously and society will do something to rectify this truly shocking state of affairs.

But until that time, it’s good to be a man that’s ahead of the curve, and proactively taking matters into his own hands instead of waiting for his nuts to shrivel into nothingness.

3.) What Are The Benefits of Testosterone Replacement Therapy?:

There are two primary reasons to take TRT. Replacement, or optimisation. Replacement applies to men who have low testosterone, and so wish to replace their body’s poor natural production with a higher level in order to reap the benefits of high testosterone.

Optimisation applies to men who are not low in testosterone, but want an edge in life. Not only low testosterone men want to enjoy the benefits of testosterone. Mid testosterone men often do too.

This is a controversial and unorthodox reason for taking testosterone, and is shunned by both the public and much of the medical establishment, yet many men take testosterone for precisely this reason. I’m not here to sugarcoat or hide information from you, so here it is.

What benefits are to be had from a high testosterone level?

– Improved mood/confidence
– Improved energy
– Reduced anxiety
– Improved erections (occur more frequently, and when they occur, are stronger)

– Increased penile girth/length (for some TRT users, but not all)
– Deeper voice (for some TRT users, but not all)

– An increase in muscularity and a decrease in body fat (not instantly, but over time) – even occurs in men who don’t work out, but the effect is even more pronounced in men who do

– Increased insulin sensitivity, meaning greater protection against diabetes
– Greater exercise tolerance (greater strength and endurance)
– Increased ability to gain muscle mass

4.) Your TRT Questions Answered:

“I don’t want to inject testosterone, but am doing everything right with my diet, sleep and exercise and believe I can no longer increase my T naturally. Are there any other options aside pharmaceutical testosterone for increasing my natural testosterone levels?”

Yes, you have three options that I’m aware of, which, despite not being natural methods, will increase your testosterone level without requiring you to inject testosterone.

The first two options are applicable to any man, whilst the final option is context dependent in that it will help increase testosterone levels in some men, but not in all men due to its method of action.

The first option is clomid monotherapy, clomid is a drug which increases your luteinizing hormone (LH) and follicle stimulating hormone (FSH). It is your LH and FSH that are responsible for communicating to your testicles how much testosterone (and sperm) they should be making.

Think of them as hormonal signal instructions that biologically dictate to your testicles how hard they should be working.

The higher your LH and FSH, the more testosterone your testicles will make, the lower your LH and FSH, the less testosterone your testicles will make.

Now despite not being a “natural method to increase testosterone”, clomid increases your body’s endogenous (internal) production of testosterone as opposed to shutting it down by introducing an exogenous (external) source of testosterone.

The first advantage to this treatment method is it’s an oral, so it gives the needle phobic a way of treating their low testosterone without injecting.

Secondly, the body’s natural ability to produce testosterone is not reduced by this treatment method, but rather, for the duration of the treatment, is ramped up.

The downside is that many men who employ this treatment method feel absolutely horrendous while on it. Reports of fatigue and a general poor sense of well-being are not uncommon.

Having high T but feeling terrible seems completely pointless, and that’s why I wouldn’t recommend clomid for this purpose.

The second option is HCG monotherapy. Rather than injecting testosterone intramuscularly (into a muscle), you would inject HCG subcutaneously (into stomach fat).

HCG is not luteinizing hormone, but rather mimics it and tricks the body into thinking it is it, this causes the testicles to produce more testosterone and sperm.

Men often take HCG as an ancillary drug when injecting testosterone in order to maintain their fertility, but it can be used alone.

Men who take HCG by itself, as well as in conjunction with TRT, often report a greater sense of well-being.

For those on HCG monotherapy, this is because their testosterone levels are higher.

For the men on TRT who already have high testosterone, this is because the precursor hormones that were depleted (the hormones necessary to synthesise testosterone naturally) have been replenished.

The third option is an aromatase inhibitor.

An aromatase inhibitor will increase testosterone significantly in a man who has low testosterone and high estrogen, but will have little to no effect in men who have low testosterone and normal estrogen.

Before supplementing with an aromatase inhibitor, you should get blood work to see your total testosterone and your estradiol (E2).

If estradiol is in the high range whilst total testosterone is in the mid-range or lower, you may see significant increases in testosterone without going on TRT by opting for an aromatase inhibitor protocol.

Naturally, as with TRT and HCG, the dosage and frequency with which the aromatase inhibitor is to be taken is person dependent. What works for one does not necessarily work for another.

“If I start TRT, will I have to stick a needle in my vein like junkies do? How does the injection work?”

No. Testosterone is not injected intravenously (into the vein). It is injected intramuscularly (directly into the muscle) or subcutaneously (directly into the abdominal or love handle fat tissue).

Doctors at the forefront of developing TRT practice via experimentation (primarily, Dr. John Crissler of allthingsmale.com) recommend subcutaneous injections as the safest and most effective method of administering testosterone replacement.

This method of administration allows you to pierce the fat layer with a tiny 29, 30 or even 31 gauge needle that reduces the injection pain associated with larger needles and avoids muscle scar tissue.

Intramuscular is more common and is still preferred by many as it was the standard for many years.

There are numerous muscles you can inject into, such as the deltoid (beneath the shoulder on the outer arm), the ventrogluteal (the hip) and the gluteus maximus (ass cheek).

Personally I prefer to inject subcutaneously into the abdominal fat, as it’s not at an awkward angle to inject and I’m not tearing up my muscle tissue by sticking a needle in it.

“My doctor has given me a 300mg/ml vial of testosterone to self-inject 100mg per week at home, how do I inject 100mg if the vial is 300mg per ml?”

Very simple. You don’t need to inject an entire millilitre of oil.

If you were injecting 100mg once every 7 days, you’d draw 0.33ml of oil into the syringe because 100 is a third of 300 and 1ml of oil contains 300mg of testosterone.

If you were injecting 50mg twice a week, you’d draw 0.165ml of oil into the syringe, because we know 0.33ml of oil contains 100mg of testosterone which naturally means 0.165, which is half of 0.33, will contain 50mg of testosterone.

When drawing such small amounts of oil, you’re best off using a 1ml syringe so that you can better titrate the dose.

If you use a bigger syringe, say a 2.5ml one, the measurements for each line on the syringe will go up in 0.1’s (0.1ml up to 0.2ml up to 0.3ml) rather than 0.01’s (0.10ml, to 0.11ml to 0.12ml) making it very hard to accurately dose between hundredths of a millilitre rather than tenths.

So for small injection volumes (1ml or less) you’re better off with a 1ml syringe so you can more accurately titrate the dose.

Typically, testosterone propionate has fewer milligrams of testosterone per millilitre, at a ratio of 10mg of testosterone to each 0.1ml of carrier oil.

Whereas testosterone enanthate and cypionate tend to have 20mg, 25mg, or in your case, 30mg of testosterone to each 0.1ml of carrier oil, allowing you to get higher testosterone for a smaller injection volume.

You will never need to inject more than 0.5ml at any one time when doing TRT level doses of testosterone.

Larger volumes (and thus bigger syringes that can accommodate a greater volume of oil) are for steroid users.

“I’ve had big issues with acne in the past, mostly on my back. Will TRT cause this to inflame?”

Yes. Testosterone converts into estrogen via the aromatase enzyme, and into dihydrotestosterone (DHT) via the 5-alpha-reductase enzyme. The higher your DHT level, the more acne you will have.

You can use alpha-reductase inhibitors (ARIs) to block the 5-alpha-reductase enzyme from converting your testosterone into dihydrotestosterone, but they are not very well tolerated TRT ancillary drugs.

DHT is likewise responsible for things such as voice depth and overall body hair growth – thus I cannot, in good conscience, recommend the use of alpha-reductase inhibitors.

“Does taking an estrogen blocker mean I need to have an additional injection?”

No. Estrogen blockers (known as aromatase inhibitors) are orals, not injectables, and thus the control of estrogen does not require an injection.

“How does TRT affect fertility?”

Negatively. TRT makes you subfertile, lowering the quality and quantity of your sperm because your body is sending far below normal amounts of LH and FSH to your testicles.

The reason this is happening is because TRT is suppressive of your body’s natural production of testosterone, that’s why it’s called testosterone replacement therapy – it is replacing your body’s natural testosterone.

So because you have high testosterone from injections, your body sees this, and your testicles decide they don’t need to do any work because you have more than enough testosterone in your body.

The side-effect of this is the testicles are not only responsible for producing testosterone, but likewise sperm. So your fertility is negatively impacted.

You can run HCG concurrently with TRT to increase the quality and quantity of your sperm, and failing that, come off TRT in order to conceive.

By doing this, the body’s natural sperm and testosterone production will begin again. Permanent infertility is incredibly rare.

People who say TRT will make you infertile are fearmongering and do not know what they are talking about. It makes you temporarily subfertile for the duration of treatment and there are concurrent treatments you can use with TRT in order to abate this entirely.

“How do I know my estrogen is high without getting blood work done?”

If you start getting general fatigue, fatigue after eating meals that don’t have a high glycemic index, a sense of social anxiety, sore/itchy nipples, no morning erections, or weaker erection strength when stimulated, your estrogen is probably spiking via aromatisation of the extra testosterone in your body.

The more of these symptoms you have, the likelier excess estrogen is to blame. And at the same time, you could have none of these symptoms, and still have high estrogen.

The more body fat you have, the more you aromatise testosterone into estrogen and the likelier estrogen is the cause of your problems.

Be mindful not to crash your estrogen levels with large doses of aromatase inhibitors, as this will lead to general fatigue and joint pain.

Only people who are very experienced with TRT and know their bodies very well are able to accurately gauge if their estrogen is high or low without blood work. In short, you’re going to need to get regular blood work, otherwise you’re just playing guessing games.

“I’m 24 years old with 576ng/dL testosterone. Can Modafinil/Ritalin or Nootropics in general make up for low T?”

You have suboptimal testosterone for your age, but not low testosterone. If you have the symptoms of low T, you might have low free T or high estrogen. You need to run blood work to determine this.

You can’t really compare CNS (central nervous system) stimulants to a hormone. If you’re thinking of using stimulants, I will assume fatigue is the main thing you’re looking to fix.

The stimulants will alleviate fatigue for as long as tolerance to said stimulants remains low, but they will not alleviate any of the other issues associated with low T. Your body does not build up tolerance to testosterone like it does stimulants, so from a tolerance perspective alone TRT is superior.

And that’s not even the main reason TRT is better.

Higher testosterone has a whole range of benefits, including but not limited to: improved mood, insulin sensitivity and erections. In a nutshell, don’t look for a band-aid to fix issues caused by suboptimal testosterone, address the root cause of the problem.

“I’ve read that TRT before 25 isn’t advisable because your brain is still developing, is this true?”

Most physicians won’t prescribe TRT if you are under the age of 25 out of fear it will permanently screw up your hypothalamic pituitary testicular axis (HPTA). Unless you have extremely low levels, say 100ng/dL, or are missing a testicle or something, they are unlikely to prescribe you testosterone.

“Will TRT make me go bald?”

Only if you have the male pattern baldness gene. If you have the male pattern baldness gene, no matter what you do, you’re going to go bald.

Higher levels of testosterone will make it happen quicker and sooner.

Are any of the men in your family bald? If not, more testosterone isn’t going to make you magically go bald either.

If you want to know for definite, get your genes analysed by 23andme.com to see if the MPD (Male Pattern Baldness) gene is present in your genome.

Men who do not have this gene will not go bald irrespective of whether they use TRT or not.

“What is the maximum allowable interval between injections?”

This depends on the type of testosterone you’re using. If you use testosterone propionate, every 2 days. If you’re using testosterone enanthate, every 7 days. If you’re using testosterone cypionate, every 8 days.

Injecting this infrequently will not give most men optimum testosterone levels, but will instead start you off high and leave you mid level before you next inject.

If you want to keep your level high all the time, you would inject more frequently. The propionate daily, and the cypionate/enanthate every 3-3.5 days.

There is a form of testosterone known as testosterone undecanoate that would allow you to have a single injection every 3 or 4 weeks, but it is not approved for use in the US and does not keep your testosterone levels as stable as the faster acting esters, so is not recommended.

“My doctor gave me 23 gauge needles to inject my testosterone, but I’m in considerable pain when I inject. I don’t understand all the different needle sizes. Can you explain how the needle sizes work, and which ones I should use to inject my TRT?

The gauge is the thickness of the needle, the inch measurement is the length. The lower the gauge, the greater the thickness. An 18 gauge needle is a lot thicker than a 25 gauge needle.

The largest available needle is a gauge 6, and the smallest is a 34, although gauges outside the 18 – 31 range are so uncommon there’s an extremely low chance you will ever use them.

Needle length varies, and is proportional to the gauge. Thicker needles with lower gauge numbers have greater lengths than thinner needles with higher gauge numbers.

Your average 18 gauge needle is 1.5 to 2 inches long, whereas a 25 gauge needle is usually 5/8th’s of an inch and a 27 gauge needle is usually 1/2 an inch in length.

I would recommend using an 18 gauge needle to draw the fluid into the syringe, and nothing bigger than a 25 gauge 5/8″ to inject it.

A number of men prefer to use 29-31 gauge 1/2″ needles subcutaneously to minimise pain when injecting.

“What would the optimal TRT protocol look like?”

Firstly, you run blood work and see what your levels are. You get your testosterone checked, you get your SHBG checked, your PSA, your LH, your FSH, your prolactin and your estrogen (E2) checked.

You get your free testosterone calculated included in the test otherwise you’re going to be working it out manually with a calculator such as this one when you get your blood work back.

You get put on 100mg of testosterone enanthate or cypionate per week.

You do 2 injections per week, once on Monday, once on Thursday.

You inject 50mg each time into the subcutaneous fat tissue, rotating between the left and right abdomen.

You do this for 4-6 weeks, then you get more blood work done.

You time the blood test so your sample is taken just before you’re due for your next injection. This allows you to see the lowest level your testosterone reaches between injections.

You’ll be mainly looking at testosterone, estrogen, prostate specific antigen, hematocrit and hemoglobin to see if they’re at desirable levels. You don’t want your blood getting too thick.

If your blood gets too thick, you will have to have a therapeutic phlebotomy (give blood), you may have to do this regularly.

If your testosterone is too low (say 500ng/dL when you only injected 3 days ago) – you increase your weekly dose to 150mg of testosterone, splitting the dose to 75mg twice weekly.

If estrogen is too high, you introduce an aromatase inhibitor. A starting protocol is 12.5mg of exemestane every other day.

If you plan on having children in the future, you add HCG into the mix, usually 1000IUs per week split between two 500IU injections.

You run blood work again in 4-6 weeks and adapt your dosages and frequency of injections/consumption of aromatase inhibitor as necessary.

This is called “getting dialled in” – adjusting the dosages of what you take and when you take them so you feel good and get good blood work back. It takes time, money and patience.

It will take a while to optimise your TRT protocol. You will not be fixed instantly. This is hard work. It’s for men who are mature enough and frankly bold enough to take control of their health, and can handle all the responsibility that comes with that, and would prefer that rather than spend their lives in a low testosterone state because injections are scary and monitoring blood work sounds like a lot of effort.

5.) In Closing / Relevant Reading:

Tired all the time? Depressed for no reason? Go and get your blood work done. I’ve already told you what to check.

When you get your blood work done, make sure you actually have a physical copy of the results so you can interpret your own blood work.

The number of times doctors have said “your levels are normal” to sick people is so off the charts, it’s criminal.

If you’re in the continental US, there are some online mail order TRT clinics you can use (I have no affiliation to declare):

http://primebody.com/

If you want to do further reading on TRT before committing yourself to what is ultimately a lifelong endeavour of injections and blood work monitoring, I recommend the following books:

Testosterone: A Man’s Guide
The Definitive Testosterone Replacement Manuel

Godspeed.

If you have a problem you wish to discuss with IM, you can [seek a consultation here]

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## 73 thoughts on “A Man’s Guide To Testosterone Replacement Therapy”

1. Just a word of warning: Prostate cancer feeds on testosterone. Men need to be tested and examined by a physician before they take this stuff, or they run the risk of dying a very miserable death.

   Be careful what you suggest.

   Brian

   [IM EDIT: Complete and utter nonsense, read the rebuttals below.]

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   1. You and your physician will monitor PSA (prostate specific antigen) whilst on TRT. It is likewise looked for in the initial blood test you have before you begin your testosterone protocol.

      I’m of the opinion more men will die of diabetes and depression related suicide caused by low T than men who will die of prostate cancer exacerbated by TRT. Basically, if you have prostate cancer, you can’t do TRT. This is not most people. If your PSA gets too high whilst you’re on TRT (rarely happens, but it can) – you cease TRT and take ancillary drugs to reboot your natural production.

      What you’re saying isn’t wrong, but it’s not common. It’s something you monitor when you run your blood work as a precautionary measure. It’s about as probable as getting hit by a car when crossing the road, possible, and a risk factor, but not common.

      Most of the people who are quick to warn about the potential dangers of TRT have never actually done it, and are rationalising their own fears into legitimate reasons for why it should not be done.

      You don’t need your prostate examined, blood work measuring the presence of the antigen is sufficient.

      Everything carries an element of risk, and I believe it’s riskier to be low T than on TRT. Not doing something because it has an element of risk (as do most things) is neither wise nor brave.

      But even under the rationale “risk is bad!” – you’re taking huge gambles with your health if you’re low T and you have the opportunity to do something about it, but decide not to.

      Do a cost-benefit analysis on health risk factors and quality of life for low T vs TRT. TRT will win.

      I appreciate your concern, but this is the only fearmongering comment I will address.

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      1. As a Urologist with an interest in bodybuilding I will second what Illimitable man has said here. Research well known amongst urologists states that prostate cancer is incredibly common. The rough numbers I quote to my patients is that 30% of men at the age of 30 have prostate cancer. 50% at the age of 50, and 80% at the age of 80 have prostate cancer. 100% of men at the age of 90 have prostate cancer. This is from large scale studies of trauma patients dying from car accidents, etc, with post mortem prostates being examined. To clarify, NONE of these patient died of prostate cancer.
         https://www.ncbi.nlm.nih.gov/pubmed/8326560
         https://www.ncbi.nlm.nih.gov/pubmed/8875194

         Prostate cancer mortality is a different beast all together. To start off with, prostate cancer mortality is incredibly low. 5 year survival is 100%, 10 year survival – 98%, and 15 year survival 96%. This is for prostate cancer that has NOT spread. If it has spread then it is the aggressive form of the disease and 5 year survival is 29%.
         http://www.cancer.net/cancer-types/prostate-cancer/statistics

         Furthermore, the PSA is a test of variable accuracy which we use LOOSELY to determine whether prostate cancer is present. It should be less than 4 (realistically). Low risk is a PSA of 1-10, medium risk 10-20, high risk over 20. It goes up if you have a UTI, big prostate or prostate infection. We use examination, PSA and MRI scans to determine whether cancer is present or not. And even still all these tests aren’t accurate. So we get biopsies to remove the doubt. And the biopsies aren’t 100% accurate. They might miss the prostate cancer. And also have side effects like bleeding, infection, inability to pass urine etc.

         I’ve NEVER heard of a bodybuilder coming in with prostate cancer. And all muscle bound bodybuilders have supraphysiological levels of testosterone (that is higher than normal levels). They ALL have infertility or subfertility (poor quality or non-existent sperm).

         So before worrying about prostate cancer and testosterone, the only relevance from a medical point of view is that we use anti-testosterone medications to treat prostate cancer (not anti-DHT meds like finasteride, they don’t reduce the risk of prostate cancer). If someone has pre-existing aggressive prostate cancer, then I probably wouldn’t advise having TRT but for the vast majority of people (like 99% of men), they’ll be fine.

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      2. Your work is so deep and true. I cant wait for your book to come out. Im looking more forward to your the JP.

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   2. You are mistaken:
      “…low testosterone, defined as a value of less than 250 ng/dL (current normal range is 264-916), was associated with nearly double the death rate compared to men with normal testosterone.

      …testosterone in the lowest quartile (fourth) was associated with a 40% increased risk of death over the following 20 years. Low testosterone predicted increased risk of death from cardiovascular and respiratory disease, “independent of multiple risk factors and several preexisting health conditions”, but was not significantly related to cancer. …

      In men with low testosterone, men who had ever used any form of supplemental testosterone for however long, had about a 30% decreased risk of adverse cardiovascular events….

      Testosterone may even be protective against high-grade prostate cancer.”

      There are lots of links to papers in the linked article.

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   3. You are 100% right Brian!
      Amazing how many sites dedicated to men issues are constantly pushing the Testosterone thing….but NEVER talk about Prostate Cancer.
      “The Surgeon” dude is right with his statistics….but he missed one thing: Prostate Cancer kills as many men (in the West) as Breast cancer kills women. God knows what would happen if you added TRT to the mix!
      EVERY MEN on the planet will get Prostate Cancer…it is just a question of when and how aggressive it will be (there are 27+ types)……and if you have just one microscopic Prostate Cancer cell …you will be feeding it by taking additional Testosterone.

      By the way…..http://www.renalandurologynews.com/aua-2016-misc-urinary-problems/mortality-rate-higher-among-bodybuilders/article/495038/

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      1. I know quite a few people with prostate cancer, and they were blindsided by it. While it’s true that prostate cancer is common, it’s especially aggressive in men under 60. That’s considered young. And it’s difficult to detect. Cancer is insidious. When you finally field the symptoms, you’re a gonner.

         So all these dudes who think they need to jack up their egos and build their bodies (who cares, really?) may be aiding the cancer. Working out increases the odds of arthritis. The joints really suffer.

         In my experience, consistency wins. A good diet, too. You’ll never feel like your Superman if you’re spinning your wheels trying to be Superman.

         Women don’t dig that anyway. They know confidence, and they know bullshit.

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         1. I do not understand your obsession with prostate cancer, nor your thinking that testosterone is something purely for bodybuilders, rather than for men in general, you know, considering testosterone is the primary sex hormone FOR ALL men, and not any one particular niche of man.

            Furthermore, we are not talking about bringing testosterone up to supraphysiological bodybuilding levels that are 2000…. 3000… 4000ng/dL or higher, which is where adverse effects on blood lipids can be found.

            We are talking about bringing men’s testosterone back up to levels that were historically prevalent amongst men, the 800-1200ng/dL range (where the greatest quality of life and health benefits are found)

            Prostate cancer is easy to track, you monitor your PSA when you get your blood work done. This has already been said, yet you restate it’s difficult to detect, which is simply untrue.

            Know why the men you knew were blindsided by their prostate cancer? Because they weren’t getting regular blood work that was looking for prostate specific antigen. Men hate going to the doctors, and men on TRT are more regularly monitored than men who aren’t, because they’re seeing their physician more often and thus are more mindful of their state of health.

            It is not normal for men in their 20’s, 30’s or even 50’s to have testosterone levels in the 0-500 range. Testosterone has been declining 1% a year for many multiple decades, and TRT seeks to rectify the damage caused by the industrial and chemical revolution to men’s endocrine systems by restoring them to levels that were typical in traditional men.

            By your logic, the men of the 1950’s would of all had prostate cancer because their T levels were the levels TRT aims to put the men of today at!

            Likewise, you completely discount how unhealthy it is to be in a low testosterone state, ignore the seriousness of this condition, and replace the focus with “avoiding prostate cancer” rather than say, I don’t know “avoiding obesity, avoiding type 2 diabetes, curing chronic depression, curing chronic fatigue etc” and then proceed to caricature men on TRT as body conscious gym monkeys rather than men concerned with living a healthy, productive and vibrant life.

            This is the height of ignorance, and I do not welcome such low level discourse on this blog based on nothing but prejudice, closed-mindedness, anecdote and the odd cherry picked out of date study (which is easily refuted by a more recent counter study)

            You do not appear to be taking any of of this into account whatsoever, as you continue to restate points that have already been refuted and ignore all evidence and logic counter to your immovable position of ignorance.

            Want to know how absurd your line of reasoning is? It’s like suggesting women stop taking birth control pills, because the pill is heavily estrogenic, and estrogen feeds breast cancer.

            This is not technically wrong to say, but your conclusion presupposes that mortality from such cancer is an inevitability or extremely likelihood when using hormones, and therefore treatments that are otherwise beneficial are to be avoided entirely.

            You know what the more reasonable position is? To improve your life by replacing hormones you’re lacking in, and to get regular blood work done to monitor your state of health.

            It really is this simple, and you don’t need to be so rabidly anti-testosterone that it borders on the rhetoric of an ideologue.

            But it’s like you said, you “know quite a few people who got prostate cancer” which would explain why you’re so ideologically zealous on this topic, and lack openness to reason, evidence and good sense which undermines your opinion.

            http://www.ascopost.com/issues/june-25-2017/testosterone-replacement-therapy-and-the-risk-of-prostate-cancer/

            “In multivariate analysis, there was no association between the use of testosterone replacement therapy and overall prostate cancer risk”

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709428/

            “However, some groups have reported an inverse relationship between baseline testosterone levels and prostate cancer risk. A prospective study of 206 patients found the incidence of prostate cancer to be higher in men with low compared to high testosterone levels (38.9% vs. 29.5%) [11]. Another study of 345 hypogonadal men also found that men with the lowest T levels had the highest risk of prostate cancer ”

            Unless you demonstrate even the remotest inkling of intellectual openness, your future comments will be deleted, for this blog is not here to indulge the irrational drivel of obstinate zealots.

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2. What about TRT applied daily via a dermal cream?

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   1. For me it’s easier to do “once a week injection” rather than daily cream. Plus it would be a bummer (for them) if that cream got on your kids or your woman. =)

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3. Your posts are invaluable IM. I’m extremely grateful.

   My energy levels have dropped significantly in the past six months. I had my blood work done after reading your other article.
   Age – 25Y/0
   TT – 18.2 nmol/L or 526 ng/dl
   Free T – 2.8%
   SHBG – 18 nmol/L
   E2 – 27 pg/ml
   Albumin – 43 g/L
   Prolactin – 13 ng/ml
   TSH – 0.85 mIU/L

   Diabetes, Vit D/B12, Ferritin, FBC – Everything is normal.

   The doc said I’m tired because of stress or lack of exercise/ sleep. The T levels are good and I don’t need TRT.

   Would you have any idea what might be the cause of my tiredness? Is this purely due to T levels?

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   1. I think you have suboptimal levet of T

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   2. Your free T is pretty decent as is your TSH, and low free T/a slow thyroid is usually the culprit when it comes to fatigue. I’d get more comprehensive thyroid blood work done though as TSH isn’t a catch-all. Get FT3 and FT4 done. Free T3 is the most important. If you’re not in the higher end of the range for FT3, you’d benefit from supplementation there.

      As for your testosterone, it’s mid-level, but it’s low for a man in his 20’s and it’s only going to drop as you age. Will probably hit the 400’s by your 30’s. The average 60 year old was around 600 back in the 80’s and the upper end of the range was higher, but now 500’s in ones 20’s is meant to be perfectly acceptable. Take from that what you will.

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4. Thank you, appreciate it. Best, Christiaan

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5. Thanks for posting, this is both timely and relevant as a 24 year old who is currently working to resolve this issue. My total T has been tested four (!) times this year, starting at a low of ~120 ng/dL total T in January and ending in a high of ~380 ng/dL last month, with the other two tests showing <300 ng/dL. Free T is better (~8 ng/dL in July and 13 ng/dL in August) and yet, still can’t shake the feeling there’s something off. You mention FT3 and FT4 levels in a response above, which were both at the low end (~28% and ~0.7 ng/dL, respectively) as of last month and yet the doctors want even more blood work done to confirm there is a problem that needs treating.

   I’m hesitant to take matters into my own hands, but starting to question whether these doctors are being cautious or have a vested interest in not treating this condition. I understand this is potentially an irreversible decision to be making a young age. However, as someone who lives a very healthy and active lifestyle already, I don’t see my symptoms “resolving themselves” with time. Anyway, will check out the books recommended in the OP and appreciate you bringing awareness to a phenomenon that’s continually growing more prevalent in our modern world.

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6. I appreciate all this info, but do we know what accounts for the societal decline in testerone over the years?

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   1. It’s multivariate. The birth control pill in the water supply is just one of many causes.

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7. More on testosterone and prostate cancer:

   https://protons.com/proton-treatments/prostate-cancer/risk-factors

   Brian

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8. two comments:

   subQ injections (into belly fat, etc) are MUCH EASIER than intramuscular injections.
   i honestly believe that “big pharm” and “big food” businesses are bombarding the USA population with estrogen precursors… which negatively affect men by killing our testosterone and affecting women by driving up their estrogen too high (look at their behavior).

   just look at all the products, from food (soy) to body lotions, sprays, etc. they all contain estrogen pre-hormones (precursors) etc.

   … biological warfare to keep the pills flowing and hospital beds warm.

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   1. Definitely agree subcutaneous injections are easier to perform than intramuscular ones.

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      1. The idea of sticking a needle into the abdomen scares the heck out of me. Fuck that up and breach the intestinal wall and you are in big trouble. Stick it in the big muscle on the outside of your thigh and there’s nothing disastrously bad you can hit by mistake.

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         1. I’m guessing you use a tiny needle for the fat injections.

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            1. Typically 25 gauge 1″ and higher. Using a 31 gauge 1/2″ I don’t think it’s even possible to breach the intestinal wall as the needle isn’t long enough. If it were possible, then there’d be less than half an inch between your skin and your intestinal wall.

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9. I use a dr prescibed testosterone compound that i run into my scrotom. Went fro. 400 to 1200. You don’t mention this option. Thoughts?

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10. Good post.

    Do you have any advice on men travelling whilst taking non prescribed testosterone? I’ve cycled Test and some steroids in the past. I’ve found they’re great while on them, but then ending a cycle is horrible, and off cycle you’re just basically back to how you were before. Because of this I want to take T in smaller TRT like doses long term. My only problem is that I will be travelling outside the UK, possibly for multiple months at a time. I don’t really want to take needles and test through passport control without a prescription (can lead to serious prison time in many places), so was just wondering how people handled this.

    Thanks.

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    1. Entering and leaving the UK with testosterone in your possession is fine even without a prescription because it’s legal for personal use here. If the police raided your house and found 5 vials of testosterone enanthate, they would not prosecute because you didn’t have a prescription. Likewise, the border agency would not even cease your 5 vials, let alone detain you for such a small volume.

       It’s only illegal to distribute/sell testosterone in the UK, not to possess it in a quantity low enough it can be reasonably deemed to be for your personal use. Your main concern will be the destination country, not UK customs. If you’re going to a country where they sell testosterone over the counter, say Mexico or Thailand, you’ll be fine. If you’re going to America, the TSA/DEA will probably have an issue with it.

       Your best bet is to go and see your doctor, tell them you’ve been doing TRT non-prescribed because you had low T and the NHS wouldn’t help you, but now you need to travel and you want a prescription. You’ll be surprised how far you can get with honesty. Say you need your T to feel good to provide for your woman and kids. Doctors dont tend to be sympathetic to men, but are more cooperative if they think you’re a family man who is depended upon (whether this is true or not.)

       This will ensure you get no issues when travelling as you have a prescription. If your GP won’t refer you to an endo because your blood work shows high T from the TRT, you’ll have to crash it, get blood work done showing it low, and then get your referral. The NHS only prescribes Sustanon 250 (blend of 4 esters) and Nebido (undecanoate) anyway, no testosterone enanthate, which is a pain in the ass. To be honest, I wouldn’t bother crashing my T to get a green light from an NHS GP, as it’ll be terrible for your mental health and productivity.

       If your doc says no, see another doc and try your luck until you get the referral. NHS go slow with everything and chances you have to fight your corner instead of getting a cooperative doctor is high, so it may take you awhile to get a script. The alternative is finding a men’s health clinic and paying them a ton of money for a script (you want a test-e script, not a nebido/sustanon one if you’re going to pay out the ass.) If you are open and honest and say you’ve been treating yourself with black market test and just want a prescription for travel purposes, they’ll play ball for the money. Like anything, money talks. Health clinics are the quick and expensive way, the NHS is the slow and cheap way (getting vials of test for £8.60!).

       All the best.

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11. 1) What are the risks and dangers of TRT?
    2) What is the difference between propionate and enanthate?
    3) what about an “unblock”? I ve heard it is necessarily?

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12. “I’m of the opinion more men will die of diabetes and depression related suicide caused by low T than men who will die of prostate cancer exacerbated by TRT. ”

    Not necessary, stress reduction is crutical (I suggest using a float tank). Fasting is another tool if a man is over weight and weight training testerone was be elevated so it’s not necessary.

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13. Here is another great compilation of TRT-related info – https://www.reddit.com/r/steroids/wiki/trt/list
    I’ve been using it a lot while I’ve been getting into TRT.

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14. Where did you learn formal English? I hava already searched for many books and I did not find a good one.

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    1. I’m a native speaker. No book learning.

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15. How long does one do this in order to restabilize? Is there a point where one has been “treated”, or must it go on for life?
    Also, if it is necessary to go on for life, what would the effect be of suddenly not being able to continue the routine- through a drop in financial resources or a distant excursion where circumstance take you away from the availability of re-up before running out?

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16. What’s a good range for free test to be at?

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    1. The higher, the better. 3%+ of total test as free test will have you feeling great.

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       1. Thanks.

          I am 26 now. I got my free test tested last year but not total test. My free test was 19.5 pg/mL and since I don’t have total test done, I don’t have anything to compare to. I have just got fresh lab tests done and we will see what happens after an year. I was actually 100kg at 5’7 height and I was living a lazy lifestyle and now I am at 87kg with an year of lifting (5 hrs/week) under my belt, good sleep and way better eating habits so I am hoping for positives.

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17. “But to answer the question: nothing’s selfless.
    The world’s a jungle.
    There’s winners and losers.
    It’s this simple.”

    True. It is impossible for a human (or any other living creature) to perform a selfless act.

    All behavior to some extent is self motivated, otherwise the behavior would not occur.

    Acts that are ostensibly charitable, are intended by the actor. Otherwise, they would not occur. Action does not occur without intent. Intent is never selfless, it originates from the self, including when the perceived result is not originated by the actor (and it usually is not).

    Why should any intent be selfless? What makes “selflessness” better than self concern under any circumstance?

    Who promotes this false and impossible modus operand of “selflessness” other than those who seek to manipulate the intent of others?

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18. How much low T is attributable to bad diet, lack of exercise, and depression?

    Certainly, T is reduced. Men in general could not have biologically changed (devolved) enough in the past few decades to reduce T as much as the data indicates.

    Maybe more men with genetically low T have been allowed to breed more than ever because higher T men have been effectively mitigated from breeding relatively as much as in the past. Perhaps relatively fewer offspring are sired by high T men because more low T men are contributing to the reproduction cycle than ever before. Possibly, relatively fewer healthy higher T males are producing offspring; as more and more sissy males with naturally lower T are reproducing in our now gynocentric, Marxist, “everybody is a winner” social decomposition. If this is so, TRT is not a long term solution for humanity. But then neither is homosexuality, transgenderism or bestiality. Perhaps returning to a natural social structure that accepts and complements human dimorphism would be a better solution. But then how can that be accomplished without exterminating the low T problems?

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19. Posting update.

    I’ve been going gym for a month now. Eating right. 4 eggs everyday as suggested by Lord IM.

    Supplements:
    1. Zinc Picolinate – 15 mg
    2. Magnesium Citrate – 320 mg
    3. Vitamin D3 – 2000 IU
    4. B Complex – Twice a week.
    5. Omega 3 – 1g

    Total Testosterone – 526 ng/dL to 603 ng/dL. I feel better (not a significant difference, but it’s a good start). I think I could get to 700 ng/dL if I keep this up.

    Thank you IM. Keep up the good work.

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    1. All the best.

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20. Excellent post IM. The clear and simple prose is a nice counterpoint to your more intricate theoretical pieces.

    Now, I am of the opinion that TRT is a last resort, but if levels are below a certain threshold then it is absolutely necessary. And as you say, this threshold is well above this 264 ng/dL nonsense. More like 600-700. (I’m 30 years old. Last bloodwork result was 1009 ng/dl. I can’t imagine life below 800.)

    As to the reasons for this generational decline, you have to ask yourself what do the masses of men do today that they didn’t do a generation or two ago? To my eyes obvious culprits include:

    *Consume soy
    *Eat sugar and other childrens food on a regular basis
    *’Diet’ (IMO fat loss should be short term and brutal. More ‘Lyle McDonald’s PSMF’ and less *’500 cal deficit for months at a time’)
    *Eat insufficent (animal) fat.
    *Drink beer (show me a craft brew lover who has higher than geriatric test levels. If you have to drink, then go for the hard stuff. Neat)
    *Perform excessive gentle cardio. A few miles a few times per week is all you need for roadwork.

    I could go on and on. The point is observe the soyboys on the street and do the opposite.

    Furthermore, I believe that the mind/body connection is real and has a part to play. So stop listening to music with whining and needy lyrics, aim to become part of a better social circle, sit with your damn legs open. Etc, etc.

    There are a thousand things that can be worked on. And if they fail then TRT is, of course, the way to go.

    And the article above is the gold standard on how to do so.

    Good luck gents.

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    1. Exactly!

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    2. Thank you for the great comment Tom!

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       1. hows twitter fam

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21. +————————————-+———-+——-+——-+
    | test | obtained | min | max |
    +————————————-+———-+——-+——-+
    | albumin blood | 51 | 35 | 50 |
    | cholesterol total | 3.8 | 0 | 6.5 |
    | HDL cholesterol | 1.26 | 0.9 | 1.7 |
    | cholesterol / HDL-cholesterol ratio | 3.02 | | |
    | LDL cholesterol | 2.1 | 0 | 4.5 |
    | triglycerides | 1 | 0 | 2.2 |
    | zink | 14.84 | 11.48 | 19.98 |
    | LH luteinizing hormone | 3 | 1.5 | 9.3 |
    | FSH follicle stimulating hormone | 3 | 1.4 | 18 |
    | testosterone | 13.09 | 6.1 | 27.1 |
    | SHGB sex hormone binding globulin | 29.2 | 13 | 89 |
    | Free testosterone index | 44.83 | | |
    | estradiol | 0.07 | 0.04 | 0.2 |
    | prolactin | 0.14 | 0.05 | 0.4 |
    | homocysteine | 7.7 | 5.5 | 16.2 |
    | vitamin d | 63.6 | 50 | 150 |
    | folic acid | 21.4 | 5.9 | 35.4 |
    | C-reactive protein (CRP) | 0.3 | | |
    +————————————-+———-+——-+——-+

    Finally got my blood work done, IllimitableMan.
    Not sure how to read all of this.
    If the conversion I need to make is from mnol to ng/DL, my test is only 377.

    Barely above buzzfeed level.
    Eating eggs every 2 days at least, but trying to be more consistent on it, sleep and lifting (2,3 per week).
    And vitamin d pills.
    I’m in my early twenties.

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22. It’s interesting that you mention that men just in general have lower testosterone than men that same age the year before. I’m not sure what the cause of that would be, but I can see why it would encourage some men to do testosterone therapy. There are a lot of benefits to it, so I think it’s worth looking into.

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23. I’m 21 years old. Haven’t got my T levels checked yet. If my levels turn out low, should I consider starting TRT? Do you think I can convince my physician to have me start?

    My diet, exercise and sleep are on point.

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24. Thank you for this. My T and Free T are above average. but a bit high on E2, and very high on prolactin (2.5 times the upper reference level). As I understand it, both of these reduce T, so instead of getting a replacement therapy by injecting T, do you think it would be a better idea to lower prolactin to very low, thus increase T production that way?

    I have no idea why my prolactin is that high, do you think chaste tree fruit high doses is a good way to do it or go to a doctor for prescription drugs to aggressively address this? Prolactin hasn’t quite been the focus of the blog hence why I ask.

    Thank you very much for your time

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25. you should write an article about reputation

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26. Hey, haven’t been here for a year or so but what do you make of this…

    Walking across a bridge over the Thames here in London yesterday, I overheard a random couple walking behind me.

    The female, a hipster looking chick, late twenties I’m guessing, mentioned the phrase ‘dark triad’. Which pricked my ears up.

    The guy was obviously stunned that she had heard of the DT and went on to say… oh you know about that? Yes, she said, I’ve been studying it.

    Oh, he said, then you know about Roosh and CH? Yes, she said I’ve read many of them. They are such awful misogynists. But the worst one is the illimitablemen, she said. LOL.

    Turns out her ex-boyfriend busted a few dark triad moves on her but then nexted her. You could tell she was still carrying a torch for him. So she was checking out some of the manospere sites she knew he was into.

    I was on the verge of turning around and saying… hey don’t knock the illimitableman, he’s the best of the best. But I let it go as I was already late.

    But hey, you are a lot more famous than you think.

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27. No discussion of the positive effects of bolstering natural testosterone production / preservation, through regular, vigorous, long duration exercise, and the avoidance of enviro-estrogens (e.g. in consumer products) and toxins (e.g. alcohol)? My info on this is limited and anecdotal, but it works for me.

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28. How about testosterone and zinc?

    https://hghinjections.us/testosterone/zinc-and-testosterone.html

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    1. Zinc works really well. Zinc, vitamin D, Ashwagandha, and D-Aspartic Acid have all been shown to have a positive (and natural) effect on testosterone. Here’s a good writeup: https://www.masculinedevelopment.com/7-scientifically-proven-ways-boost-testosterone/

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29. I’ve never really been able to hold on to any noticeable muscle mass, and over the past ten years or so I’ve developed what I can only describe as a Dad bod’! I suffer terribly with fatigue, both mental and physical and over the past few years those around me have suffered too, from my irritability, mood swings and acting ever more ‘soy’.

    The Dad bod’ I put down to becoming a Dad ten years ago, the fatigue to being a shift worker in the oil & gas industry and the mood swings a symptom there of.

    The fatigue got so bad that I took to the internet in search of a legal chemical solution. It was around the time that the TV show Limitless was on in the UK. Inspired, I searched for a real life NZT 48 and I stumbled across your article: master-monk-mode-with-modafinil

    Not only did the concept of monk mode really help me out, so have many of your other articles. Through you I’ve learned about the red pill and a whole host of other invaluable self development information. Along with your own fantastic material, by reading your essays and twitter feed, I have also found other inspirational people too, such as Ed Latimore and Alexander Cortes.

    Anyway, I’ve spent the past year trying everything to increase my mood, concentration and general well being with limited success. I finally bit the bullet and went to see my GP. He listened to me and tested my blood for just about everything you can imagine, except hormones! I suggested that I might be suffering from low T or low free T and he said it was unlikely. He went on to suggest some measures I could take, all of which I had already tried.

    Taking your advice I bought a kit through Medichecks….. (drumroll)
    My total testosterone is 5.69 nmol/L which works out to 164 ng/dl – I’m 37 years old – My free testosterone works out to 2.69%, but at 0.151 nmol/L (calculated) and the total T being so low, something isn’t quite right. Back to the doctor I go!

    Thank you Illimitable Man

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30. Alot of people I think are low in one or two vitamins or
    mineral and dont know it…

    and they jump straight to more fancy fixes…

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31. Great post.

    IllimitableMan, I have a couple of questions about getting aromatase inhibitors in the UK and Ireland.

    I live in Ireland. I asked my GP to test my estrogen levels. He looked at me like I just asked him if I could diddle his dog, just confusion and horror.
    “We don’t test estrogen in men!”
    “Really, there are no tests for estradiol?”
    “No, it’s just not done”.
    Is this just some retarded Irish-specific practice? I presume that in the UK getting your estradiol levels tested is routine and normal?

    In short, I don’t know how to get my hands on an aromatase inhibitor. Irish customs (at the airport) are outrageously strict, so shipping anything in from abroad is a no-go. They will seize modafinil or anything that might run the risk of improving the quality of your life.

    Any advice would be great to hear.

    PG

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    1. Hey, pinging you one more time on this, on the off-chance you see it and have a chance to share your thoughts. Cheers.

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32. Great article. How much money does it cost to test your testosterone level? It can be done by a regular blood test, right? Thank you very much.

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33. Can I call you Machiavelli?

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34. really nice post

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35. I’m 22 years old and I’m 5’9” 247 pounds. 38% body fat.
    Last time I checked my T-levels last year on May 8, 2017 the following were my results.

    Testosterone, free calc – 127 pg/mL
    Testosterone, pct free – 2.6%
    Total testosterone – 487 ng/dL
    SHGB- 16.5 nnmol/L

    This was when I was 230 pounds. I got a depressive episode and I just let myself go as I got a injury on my lower back due to deadlifting. It was a mild herniated disk at my lower lumber spine. This was due to a weak core and shitty form and ego lifting… something I regret.

    I’m back now at the gym doing full body workouts 3x a week and doing steady state cardio 3x a week. Should I just continue to go this route… or should I go on TRT? Any advice is appreciated.

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36. So, is this blog just dead now? Where’d you go? This was one of the best on the net (well, still is, as an archive).

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    1. Not dead. Sleeping. Will awaken.

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       1. You have no idea how glad I am to hear that.

          I’ve been planning to print the entire thing, article by article, so that I’ve got a hard copy that can’t be vanished down the memory hole (so long as you have no objections).

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       2. Me too, a year ago saved the whole website just in case

          Reply

37. Look into Boron supplementation as it relates to free testosterone and prostate health. It is absolutely essential, and if deficient, a therapeutic dose will produce visceral relaxation effects in the prostate. A box costs $5 and will last you a lifetime, practically. Tell sons, you magnificent bastard. We love you.

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38. hi thanks for the post

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39. Wanted to report to you all that a family friend and natural alpha has been able to quit his TRT at 65 or so as a result of Boron supplementation. I found out about it via Cole Robinson of Snake Diet.

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40. Good listen
    https://youtu.be/6mI_vyUAb-E

    Reply

41. Great article! I am however more for increasing your testosterone naturally like in this article: https://vivacityandvigor.com/how-to-naturally-increase-testosterone/

    TRT is applicable in older males though if the situation calls for it. Low testosterone goes unnoticed by many and it is imperative we bring light to the matter. Most men don’t even know they are victims of it.

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42. Can you please provide a link to the 1986 and 2009 Menkveld references? I would like to take a closer look at the research of decline sperm morphology. I tried to find them but was not successful.

    Best

    Reply

43. Follow up to my last comment (which is still in moderation as I write this)

    It looks like that figure is from a presentation Menkveld put together (Slide 12, https://www.slideserve.com/nitara/re-evaluation-of-sperm-morphology-assessment-and-results-in-light-of-new-who-2010-manual-reference-limits). In the references of that presentation appears that he incorrectly cited himself (Menkveld etal., 1986; Menkveld, 2009).

    He referenced Menkveld 2009. His 2009 publications are not on this topic. However, his 2010 paper has the relevant data and figure: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3739680/

    Best

    Reply

44. For people not yet convinced of TRT or HOT looking into supplementing 50mg pregnenolon and 50mg DHEA could be worth giving a try.

    All the Best

    Reply

45. Hi guys – would you mind opining on my results? I am a 27M, ~180 lbs, ~12% BF, energy levels are pretty solid. That said, it looks like most of my stats here are “average”. I am hoping to do better than average and considering 100-150mg Test E / week. What do you guys thinks?

    1) Testosterone – 643 ng/dl (decent I think)
    2) Free Test – 12 ng/dl, 1.9% (don’t think this is ideal)
    3) Prolactin – 13 ng/dl
    4) Estradiol – 25 pg/ml
    5) SHBG – 47.9 nmol.l
    6) Free Adrogen Index – 49.52

    Reply

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