Here are the most common mistakes doctors or patients make when starting testosterone replacement therapy (TRT):
1. Using a Treatment Option That Doesn’t Fit Your Lifestyle or Personality.
Many TRT doctors just prescribe whatever protocol they’re familiar or comfortable with, be it injections, gels, or even pellets. Unfortunately, all protocols don’t mesh with all lifestyles or personalities.
For one thing, if you’re needle-phobic, injectable testosterone sure isn’t going to work.
Maybe you’re fine with needles, but what if your doc doesn’t want to teach you how to self inject? That means you’ll have to drive to his office once or twice a week for an injection. Does that fit in with your schedule?
Or perhaps your doc prescribes gels or creams instead of injectable T. Do you have enough time every day to apply the gel after showering and let it dry? Are you confident that, while waiting for the gel to dry, you won’t come into contact with your wife or children and inadvertently boost their testosterone levels?
Find a doctor who’s familiar with all TRT protocols and is conscientious enough to question you about your lifestyle and personality. Otherwise, you might settle on a TRT protocol that you end up discontinuing because either it didn’t work well enough, or it didn’t fit your lifestyle.
2. Using the Incorrect Dose.
When you stumble on the rare individual who says that testosterone replacement therapy (TRT) didn’t work for him, it’s almost always a question of dosage or frequency of dosage.
The thing is, the use of testosterone is extremely patient-variable. A dosage that brings one guy’s total T levels to 700 might only bring yours up to 500. Furthermore, a total T reading of 700 might be perfect for one guy, allowing him to reap all the benefits of TRT, but that same level might not be right for you.
Cookie-cutter, one-size-fits all might work in picking out a Roman toga, but it won’t work in TRT. Dosage and frequency of dosage have to be tweaked and perfected so you get the most you can out of TRT.
3. Cycling On and Off Testosterone.
Some patients, maybe because they read too many bodybuilding magazines back in the 90’s, assume that testosterone – as part of TRT – should be cycled.
Cycling may be appropriate for users of anabolic steroid users whose sole goal is to increase muscle mass or increase performance, but it’s not appropriate with TRT.
Here’s the thing: When you start TRT, your testicles go on vacation. In other words, they stop manufacturing testosterone. If you stop TRT abruptly, you’re left with virtually no testosterone in your system, at which point things go south fast. Libido takes the first train out. Depression and weight gain move in. In short, all the good things achieved with TRT reverse or revert
True, your hypogonadal axis usually normalizes in a few weeks to a few months, but it may never normalize if you go cold turkey. Who needs that kind of grief? If you decide to stop taking testosterone for some reason, you need to work with your doctor to do it safely and effectively.
4. Not Managing Potential Side Effects.
Almost all of the potential side effects of TRT therapy are easily manageable, whether they include acne, hair loss, moodiness, or increases in PSA (prostate specific antigen) or hematocrit.
Knowing how to manage these side effects — if they occur — is crucial to the long-term success of your TRT. After all, no one really wants to trade in one set of problems (low libido, low energy, etc.) through TRT only to have them replaced by another set of problems (acne, moodiness, etc.).
Most of the time it’s just a question of adjusting the dosage or the delivery system, but they may also require additional medications. Only the most competent doctors know how to treat these potential problems without overreacting.
5. Drinking, Carousing, Not Exercising, and Not Living a Testosterone Friendly Lifestyle in General.
Testosterone replacement therapy can change your life. It can make you feel like you did 20 or 30 years ago. It can also convey a sense of invulnerability that may cause you to think you can treat your body like a rental car instead of the one and only body you’ll ever have.
Things like smoking, drinking in excess, being overweight, shortchanging yourself on sleep, not giving a hoot about your blood sugar, and avoiding exercise are not part of a testosterone lifestyle.
All of those aforementioned things can deplete your testosterone well, and all the testosterone replacement therapy in the world isn’t going to do much to offset that kind of lifestyle.
No one’s suggesting you retire to a monastery that runs Zumba classes out of the spare chapel, but practicing as many aspects of a healthy lifestyle as possible will only enhance your TRT experience.
6. Poor Compliance.
TRT is a commitment. Forgetting to give yourself an injection or rub gel on yourself after a morning shower is obviously going to give you less than stellar results. It’s the same thing with any medication – forget to take it and it won’t work and the long-term outcome will be unpredictable and unsatisfying.
Furthermore, forgetting your TRT has its own inherent problems. If your T levels are high one week and low the next (because you forgot to give yourself your injection), you could potentially have enormous swings in energy and functionality. You wouldn’t expect a vampire to miss his dose of blood, would you? It would make him feel pale, tired, and cranky — same as you if you miss your dose of T.
There are plenty of ways to keep you from forgetting your injection or application schedule. You can fill your calendar ahead of time, use Post-It note, place notes on the fridge, or utilize smart phone apps. Find one that works for you and use it.
7. Picking the Wrong Doctor.
A good number of dentists now offer Botox injections. It’s definitely not part of their medical school training, and they certainly aren’t more qualified, education-wise, to give Botox injections than a dermatologist or plastic surgeon. However, many dentists see Botox injections as a cash cow and they’re eager to augment their income.
Similarly, many physicians have hopped on the TRT train by becoming franchisees of national TRT businesses. They don’t necessarily have the expertise to administer testosterone, but they simply might have seen it as an easy way to increase their monthly paychecks.
The trouble is, there’s more – much more – to TRT than simply writing a prescription. For one thing, you don’t just want someone to elevate your testosterone levels, you want them to help you find your optimal T levels! This is what makes TRT both a science and an art.
Furthermore, you want someone who’s knowledgeable in managing any potential side effects of TRT. You also want someone who’s knowledgeable in all aspects of TRT science, including adjunctive therapies that are only just starting to be whispered about in medical circles.
Lastly, you ideally want someone who practices what he preaches, or in this case, what he prescribes. A physician who’s under TRT himself, who exercises and lives a healthy lifestyle, has worlds more insight into TRT than a conventional doctor who only administers TRT on the side, with a 3-hour slot allotted for it on Friday afternoons.
You should also know a little about the potential costs before choosing a physician. Some charge $1,000 for an initial consult, along with a monthly “membership” fee. Others, however, like Michael Nielsen, MD, at Optimal Health Medical Center, don’t charge for initial consultations or initial lab work.
Do a little homework and find the right doctor for you. Your long-term satisfaction will be all the greater.
8. Not Managing Estrogen Levels.
As mentioned above, the number one reason for having less than optimal results with TRT is incorrect dosage. The second most common problem in patients who say that TRT isn’t working for them is a failure to monitor estrogen levels.
As the body metabolizes testosterone, it converts it to other chemicals like DHT and estradiol, among other things. Estradiol is itself a metabolite of estrogen, the hormone that makes a woman so, well, womanly. While men need a certain amount of estrogen for vascular health and other things, too much can lead to gynecomastia (male breast tissue), additional body fat, and subtle mental changes. Too much estrogen can also, to a certain degree, negate the desired benefits of TRT.
This potential problem is very easy to control, but you need a capable TRT physician to recognize and treat it.
