How to Get on TRT (Testosterone Replacement Therapy)

Testosterone replacement therapy is a treatment for low testosterone. If considering testosterone replacement therapy take labs to determine your need and then on an ongoing basis as discussed with you doctor.

1. What Labs Do I need to monitor while on TRT

Your physician will give you a form to order labs before starting a testosterone replacement therapy.

Labs to measure Testosterone

An average male produces 7mg – 10mg of total testosterone per day. These fluctuate and can peak depending on time of day (higher in the morning) and after a workout. Testosterone usually binds to proteins, for example sex hormone-binding globulin (SHBG), albumin, so some of the total testosterone will bind and will not be available floating freely in the blood. To measure testosterone floating freely in the blood reference th free testosterone levels.

Levels of testosterone vary naturally in the body, they are usually high in the morning and fluctuate throughout the day. Levels of testosterone can be boosted after a workout, but on TRT testosterone levels are usually more flat. Labs should be administered in a fasted state in the morning before 10am.

Labs to Monitor Fertility while on TRT

Lutenizing Hormone

Luteinizing hormone is another sex hormone produced by the pituitary gland that plays a key role in stimulating testosterone production in the testicles. Testosterone injections, used in TRT, can signal the brain to reduce LH production because the body doesn’t perceive the need for further testosterone production.

The hypothalamus and pituitary gland, through GnRH and LH production respectively, are involved in regulating testosterone levels. When testosterone is injected, the hypothalamus and pituitary gland decrease their production of GnRH and LH, respectively.

If a patient experiences significant testicular atrophy or other fertility issues, a doctor may consider strategies to mitigate the effects of LH suppression, such as human chorionic gonadotropin (hCG), which can stimulate testosterone production in the absence of LH. LH levels are also important in diagnosing the cause of low testosterone. Low LH levels, even in the presence of low testosterone, can indicate a problem with the hypothalamus or pituitary gland, rather than the testicles themselves.

The hypothalamus and pituitary gland also play a role in regulating thyroid hormone production through a feedback loop involving TRH (thyrotropin-releasing hormone) and TSH (thyroid-stimulating hormone). These hormones, produced by the thyroid gland, are crucial for maintaining energy levels, growth, development, and various bodily processes. While TRT primarily focuses on testosterone levels, thyroid hormones can be indirectly affected and may require monitoring during treatment.

Medicine that stimulate LH include clomid.

Prostate-specific antigen (PSA)

PSA is a protein primarily produced by the prostate gland, both in normal and cancerous tissue. It’s involved in liquefying semen. Liquefaction of semen is the process where freshly ejaculated, thick, gel-like semen transforms into a more watery, liquid state. This change is essential for sperm to become motile and capable of fertilization. If semen doesn’t liquefy or takes too long to liquefy, it can indicate a problem with the male reproductive system and potentially affect fertility. Delayed or abnormal liquefaction may prompt further investigation by a doctor, including a semen analysis to assess sperm motility and overall semen quality.

PSA can be found in two forms in the blood: free PSA (unbound) and bound PSA (attached to other proteins). Normal PSA levels typically range from 0 to 4 ng/ml, but can vary slightly based on age and race. Mildly elevated levels (4-10 ng/ml) are considered borderline, while levels above 10 are considered high. High PSA levels could indicate prostate cancer.

Estrogen

Estradiol is the primary form of estrogen in the body and it’s vital for sexual function, including libido and erectile function, as well as sperm production and overall testicular health. In men, a significant amount of estradiol is produced when testosterone is converted by the enzyme aromatase. This estrogen can then stimulate the pituitary gland to release more prolactin. High levels can lead to various side effects, including gynecomastia (breast tissue enlargement), erectile dysfunction, and mood swings.

If estradiol levels are high, your doctor may prescribe medications like aromatase inhibitors or selective estrogen receptor modulators (SERMs) may be used. This could be an optional aromatase inhibitor HCG dose of 250–500 IU 2–3x/week to maintain fertility or testicular size.

Labs to monitor general health while on Testosterone Replacement Therapy

Hemoglobin and Hematocrit

These are blood cell counts, and TRT can sometimes affect them.

Hemoblogin is an iron-containing protein found in red blood cells (RBCs), enabling the cells to carry oxygen and carbon dioxide in the blood.

Hematocrit measures how much of your blood is made of red blood cells (RBCs). A hematocrit measurement is useful in identifying anemia, the presence of liver disease, bleeding disorders and red cell production within the circulatory system. Hematocrit increases with altitude adaptation or dehydration. High levels of hematocrit can result in blood clots, so donating blood is recommended.

Kidney and Liver Function

TRT can affect these organs, so monitoring their function is important.

2. Options to Boost Testosterone

Oral TRT

Enclomiphene is a selective estrogen receptor modulator (SERM) used to treat secondary hypogonadism in men, where the body doesn’t produce enough testosterone and typically does not decrease fertility. It works by stimulating the brain to produce more testosterone, without directly replacing testosterone like other therapies.

Injectable Testosterone

Injectable testosterone is often a lifetime commitment.

Typical Dose: Testosterone Cypionate or Enanthate dosage of 50-100mg twice per week as a starting point. Intramuscular (IM) injections twice per week will provide more stability than doing double dosages once per week.

Important: Milligram is a measure of strength while milliliter is a measure of volume. Check the potency of your testosterone to make sure you are injecting the right amount of testosterone. Each testosterone has a milligram to milliliter conversion.

* The smaller number is a thicker syringe. With thicker, 23 gauge syringes it takes less time to inject but can be less pleasant.

Ancillary Treatments

Here is a complete Testosterone Replacement Therapy (TRT) plan, including supplement recommendations and a macronutrient-focused diet designed to support optimal hormonal balance, muscle growth, and fat loss.

Supplement stack: Vitamin D3 + K2 5,000 IU D3 + 100 mcg K2 in the morning for hormonal support, bone health with zinc of 30-50mg in the evening for testosterone and immune support as well as peptides to increase growth hormone.

Diet plan: This TRT meal plan is for lean muscle gain and fat optimization while on TRT assuming a 200 lb male (~15% body fat).

• Protein: 1–1.2g per lb of bodyweight → 200–240g/day

• Carbs: 1.5–2g per lb → 300–400g/day

• Fat: 0.3–0.4g per lb → 60–80g/day