The 2021 Testosterone Replacement Therapy Guide

testosterone replacement therapy guide 2021

You can easily get overwhelmed when you begin researching TRT. There are several alternatives, data, arguments, research, and other factors to consider. It’s a big subject that already had 1,8-billion dollars in business. That is why marketing gimmicks come in handy.

If you are confused with the testosterone replacement guides out there, this is for you. In this post, a complete guide about the subject will be thoroughly discussed. Continue reading to learn more.

What Is Testosterone?

what is testosterone

Testosterone, the primary male sex hormone, is made in your balls. It is basically what makes you a man and responsible for many aspects of your life, including muscle mass, facial structure, sex drive, and mood.

The pituitary gland and the brain control testosterone production by the testes. Then testosterone works its way into your bloodstream.

The testosterone levels in your body fluctuate. Highs and lows in the morning and at night are typical.

In men aged 20 to 30, testosterone levels peak and gradually decline.

What Is Testosterone Replacement Therapy (TRT)?

Testosterone Replacement Therapy (TRT) is a treatment given to hypogonadism sufferers who lack testosterone. Prescription testosterone helps restore testosterone levels in the blood, curing low testosterone symptoms. It may help increase alertness, sexual function, energy, mood, and general health. This treatment was first developed in the 1930s when synthetic testosterone was created. It is part of Hormone Replacement Therapy (HRT).

A lack of certain hormones can cause health problems, other severe conditions, and decreased quality of life. You can exogenously fill in the gaps if your body decides to reduce or stop the natural production of a particular hormone (endogenous production). 

TRT: Reasons To Get Started

TRT is something you might consider if you have any reason to. You are not the only one. Hypogonadism is the most common reason why men get TR. It reportedly affects around 30% of men between 40 and 79.

Hypogonadism & Low Testosterone

Hypogonadism refers to your body’s inability to produce enough testosterone. It can happen at birth but can also develop in your 40s. Hypogonadism can be caused by anabolic steroids abuse or unhealthy lifestyle choices, stress, or mental disorders.

Are You Suffering from hypogonadism? Here are some ways to detect hypogonadism at home without having to visit the hospital:

  • Are you feeling depressed for no apparent reason?
  • Are you having trouble with erections?
  • Do you feel like your sex drive has diminished or disappeared altogether?
  • If you answered “Yes” to all three questions, then look at these red flags.
  • Do you sleep poorly?
  • Are you feeling tired during the day and then falling asleep at night?
  • Are you having problems with your body hair?
  • Are you aware that you may have low sperm count and fertility issues?
  • Are you feeling like you are not achieving any growth or results from your workouts?
  • Did your bones get weaker?
  • Are your nipples becoming too sensitive?

Hypogonadism can cause all of these problems. Although none of these symptoms is 100%, it could indicate that you need TRT.

Before you self-prescribe anything, make sure you have a medical check and have your blood tested.

Age Limit for Starting TRT

The short answer is that mandatory TRT is not required at any age. Although you are more likely to experience symptoms of low testosterone in your 40s, it is worth considering TRT.

The long answer is that your testosterone level closely correlates with your age. The range between 35 and 44 is when testosterone levels start to drop rapidly.

Is this to say that you won’t be able to acquire TRT if you’re in your twenties? No, you can, especially if your testosterone levels are much below average.

Other Justifications for TRT

“Man, my sex life has been a shambles for the last few months, I need TRT,” or “Oh, I have depression and social anxiety, I need TRT” are not acceptable excuses.

There’s only one problem to justify TRT, and that’s when your testosterone levels are low. Here are the common reasons found on online publications  why you should consider TRT: 

  • Depression
  • A lack of libido
  • Loss of muscle mass
  • Balding
  • Erection problems
  • Bone mass reduction
  • Increase in body fat percentage

Although, most of these publications exist just to get your clicks and admission at the clinic providing the content.  Here are the counter reasons:

  • There are several reasons for decreased libido.
  • You might be depressed due to a poor work-life balance.
  • Osteoporosis may cause bone loss.
  • You may go bald since your ancestors all became bald by their 40s.
  • Your muscle mass may diminish as you move from bed to kitchen, vehicle, workplace chair, and back, with little exercise and 90% sitting on your butt.

These are not grounds to start TRT but to have your testosterone tested. A simple thing but sometimes misconstrued to increase TRT. Just look at how many private clinics provide it.

TRT Benefits

trt benefits

The significant advantage is to treat low testosterone. Here’s what it implies in practice:

Boost Sex Drive

Studies like this one from The Journal of Clinical Endocrinology & Metabolism have shown the impact of low testosterone on libido. It’s undeniable now.

Worse, TRT has been confirmed to work. Here is the 2019 research summary of the findings. Even better, TRT is shown to treat erectile dysfunction. TRT makes:

  • The quality of your erections improves
  • It’s much easy to obtain an erection
  • Your sex drive returns to normal
  • You perform better in bed and endure longer (a bit, but still)

If you’re under 30, you may underestimate the value of these advantages for men in their 40s and 50s, especially if they’ve continually cycled AAS with no PCT or ancillaries.

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Self-esteem and Mood

Testosterone is shown to improve confidence, but it does not convert your introverted ass into a walking Chad magnet for girls. The same research showed no association between increased testosterone levels and sexual intercourse frequency. Keep your expectations reasonable – you can get:

  • Less social anxiety
  • Easy to start a conversation
  • Simpler to suppress dread and fear while reacting to aggressiveness
  • More self-assured in your actions
  • Simpler to make a choice and stick to it

Just don’t become overconfident — it’s terrible, and it may lead to depression due to unreasonable performance expectations. It’s also connected to testosterone levels, as shown in another research.

Cardiovascular Health

The development of cardiovascular disease and testosterone levels have been linked, according to a study. A 17-year study of 3,518 men revealed that individuals with low testosterone levels were twice as likely to die from cardiovascular disease than those with normal or anticipated testosterone levels.

Increasing testosterone levels was connected to better cardiovascular health in middle-aged individuals, with greater levels of HDL cholesterol and lower levels of insulin, systolic blood pressure, and triglycerides.

Based on this research, men with low testosterone levels may be more prone to cardiovascular issues and benefit from TRT.

Muscle Mass

A loss of muscle mass and strength is one of the well-known side effects of low serum testosterone, impairing mobility. TRT was observed to partially reverse some of the above effects in a sample of hypogonadal males. The increase in lipid oxidation and muscle mass improved total lean body mass. These results improved the quality of life for many patients, particularly those with restricted mobility.

Enhanced Gym Performance and Fat Loss

Isn’t that the objective of steroid usage? TRT operates similarly, but with one significant distinction.

Bodybuilders’ testosterone dosages range from 300-700mg and 1-1,5g EW in short cycles. TRT dosages seldom surpass 200mg, and cycles may span months, if not years.

TRT provides the following with the same performance gains, although they are much less pronounced:

  • Muscle gain
  • Boosted power
  • Stamina enhancement
  • Improved pumping
  • Reduced fat tissue

You are less likely to develop (female) fat tissue placement on your tummy, breasts, and hips. Also, the more testosterone you have, the slower your fat tissue grows. This research indicates a link between testosterone levels and fat distribution.

TRT has these main advantages. It’s currently being investigated, so maybe additional topics like COPD (pulmonary illness therapy) may be included in the future.

Self-Administered TRT

Even though it’s legal in most nations, the method itself may not be what you need. Why do individuals choose self-prescribed TRT?

  • Cheaper than FDA-approved TRT gel ingredients.
  • Paperwork for official TRT might be pricey, depending on where you live.
  • Regular doctor visits might be costly for some — everyone has varied incomes, insurances, etc.
  • Official TRT may not meet your aims.
  • Some physicians may refuse to administer TRT due to age, test findings, limits, or legal issues. Nowadays, medicine entails 50% paperwork, which some doctors refuse to face.

Money, bureaucracy, and legislation are the elements for the “Fuck it. I’ll prescribe it myself” attitude.

TRT may be self-administered or recommended by a physician. But before choosing the latter, learn about the compounds you may require. Also, don’t start hating on hospitals (a terrible idea). Slick warnings from Health Canada about harmful pseudo-TRT substances are not uncommon. Some are pure poison, while others are anabolic steroids disguised as something else.

Most AAS are excessive for a basic TRT.

TRT Compounds of the Highest Quality

TRT compounds of the highest quality have “Anything with Testosterone”, but that’s not entirely correct. TRT currently has four kinds of compounds:

  • Pills
  • Pellets
  • Gels and patch
  • Injectables

In the present day, these are the most common. For one thing, the number of substances you can utilize is enormous. The popular ones are:

  • AndroGel
  • Action
  • Fortesta
  • Testim
  • Vogelxo
  • Bio-T-Gel
  • Enanthate Testosterone
  • Cypionate Testosterone
  • Undecanoate Testosterone

That’s a lot of chemicals to select from, right? We can assist you with that. Let’s start with the compound’s kind.

The drug may be given intramuscularly or transdermally, unlike tablets, which are unpopular and mildly liver damaging. Which do we think is more reliable? (and why).

Testosterone Products and How They Work

To treat low testosterone, many testosterone treatments are available on the market. Numerous compounds pose risks to consumers and provide negligible benefits.

The testes and adrenal glands create testosterone. It causes a deep voice and body hair in males. Some men suffer from erectile dysfunction or reduced sex desire because testosterone levels drop after adolescence. 

Patches, gels, and injections are available from certain firms to replace or boost testosterone levels. Each testosterone product contains hazards. Before starting therapy, men should understand the products and consider the risks and advantages.

Gel Testosterone

In terms of sales, testosterone gels are among the hottest new items. Prescription medications come in pouches or pumps. Some FDA-approved testosterone gels are:

  • AndroGel
  • Axiron
  • Fortesta
  • Testim
  • Vogelxo
  • Bio-T-Gel

Men (and occasionally women) apply gels to their arms, armpits, abdomen, or thighs, depending on the prescription brand.


AndroGel is a popular low testosterone treatment. The blockbuster gel is administered as a testosterone replacement medicine, especially to men who lack the male hormone.

The medicine was created by Solvay Pharmaceuticals of Brussels and licensed by the FDA in 2000 for males with hypogonadism, a low testosterone level caused by injury or illness.

AbbVie’s parent firm, Abbott Laboratories, purchased the medicine from Solvay in 2010 and immediately started promoting it aggressively. After many men got prescriptions to recover their youth or just improve energy and sex drive, physicians began warning about the drug’s hazardous adverse effects for older users.

AndroGel and other testosterone products have a high risk of heart attacks and strokes. Men who had strokes, heart attacks, or blood clots after taking AndroGel are now suing the drug’s producers. Abbott and AbbVie are accused of not warning customers about the hazards.

How Does AndroGel Work?

AndroGel is a daily application of synthetic testosterone combined with alcohol. A 24-hour supply of testosterone is delivered via the skin. It might cost up to $500 each month; however, some insurances cover it.

It comes in two strengths: 1% and 1.625%. Patients may utilize a multi-dose pump or single-dose packages. It dries clear and unscented.

The two dosage strengths are applied differently. The 1% gel may be applied to the upper arms, shoulders, and both sides of the belly. Apply the 1.62 percent gel solely to the upper arms and shoulders.

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The medicine raises the overall quantity of circulating testosterone in the body to a healthy level in men with low testosterone. The medication package says this range is 298 – 1043 ng/dl (nanograms per deciliter). Men who use lotion or sunscreen absorb more testosterone.

Men should wash their hands thoroughly after using AndroGel. The medicine is also combustible until dry, so patients should avoid flames, smoke, and fire.

Warning: Male testosterone gels may reduce sperm count and raise prostate cancer risk. Women or children should not use gels since they might produce significant adverse effects such as mood swings, skin issues, and diarrhea. Drugs like these may affect fetuses.

Testosterone Injections

These medications, like gels, aid men who no longer make enough testosterone, but they are also recommended to treat young guys who have delayed puberty. Some women use them to treat breast cancer. Testopel, for example, is a pellet injected under the skin. It is also available as a liquid injectable.

In clinics, doctors usually inject patients. Historically, they were the most abused supplements. Prevalent testosterone injectable brands are:

  • Depo-Testosterone for testosterone cypionate
  • Delatestryl for testosterone enanthate
  • Aveed for testosterone undecanoate
  • Testopel for testosterone pellet
  • Ditate-DS for testosterone enanthate
  • Depo-Testadiol for estradiol cypionate; testosterone cypionate


Depo-Testosterone is an injectable hormone (androgen) replacement used to treat males with Low T. The drug is sold by Pfizer’s Pharmacia & Upjohn Co.

The FDA authorized this medication in 1979 to treat males who lack testosterone naturally. Most physicians prescribe it for this purpose, but people often take it for unapproved purposes including muscular development and sports performance.

Having too much testosterone may be harmful to guys. Cardiovascular disorders including heart attack and stroke are risks of androgen treatment medicines, as is an increased chance of prostate cancer. Pfizer continues to profit on Depo-Testosterone. It has recently regained popularity.

Due to multi-million dollar advertising efforts from major medication firms, the testosterone industry has reached $2 billion in yearly sales. Prescriptions for these medications surged, and physicians are worried that many men may be taking them to restore lost youth as advertised.

The Use of Depo-Testosterone

Unlike AndroGel, Depo-Testosterone is not a topical gel. It is a liquid that is injected into the muscle. A white or creamy white powder coupled with additional substances forms the active ingredient, testosterone cypionate. It comes in two strengths, 100 mg, and 200 mg. Each bottle has:

  • Testosterone cypionate 
  • Benzyl benzoate
  • Cottonseed oil
  • Benzyl alcohol (preservative)

Injecting testosterone cypionate dissolved in oil into the muscle lasts many days. Typically, a patient will be injected every two to four weeks. Hormones then bind to bodily receptors. The body then excretes 90% of the testosterone in urine and feces.

Depo-Testosterone is exclusively for males with congenital or acquired testicular failure, such as prostate cancer. Unfortunately, many Low T clinics administer testosterone to men who naturally produce less testosterone as they age.

Warnings: Despite this, the drug’s label advises against taking it to improve athletic performance. The solution’s benzyl alcohol is connected to preterm newborn respiratory issues.

Testosterone Patches

Both Androderm and Testoderm were FDA-approved testosterone patches in the 1990s. 24-hour testosterone patches are available.

Men with little or no testosterone due to specific medical issues may utilize prescription patches. Patches come in various dosages and sizes.

Who Can’t Use Testosterone Patches?

Men should not use testosterone patches with or at risk of breast or prostate cancer. It’s also not safe for pregnant or nursing women. Male hormone patches may affect unborn or nursing infants.

Tell your doctor if you have:

  • Breast cancer
  • Prostate cancer
  • Urinary problems because of enlarged prostate
  • Kidney and liver problems
  • Heart problems
  • Sleep apnea
  • Diabetes
  • Other diseases

Applying Testosterone Patches

Apply the adhesive side of a patch to clean, dry skin. Ensure the patch is firmly pushed into place and has excellent skin contact, particularly around the edges. 

Do not apply it to the scrotum, buttocks, or bony region. According to the drug’s label, the patches may not adhere well to greasy, perspiring, or hairy skin.

Remove patches and apply fresh ones every 24 hours, about midnight. Ensure that you rotate the application site every day and every seven days.

Warnings: Testosterone patches have been linked to significant adverse effects, including heart failure and leg or lung blood clots (although this is rare). They may also generate more erections or longer erections than usual, or in high dosages, can reduce sperm count.

Other Testosterone Products

Besides gel, injections, and patches, testosterone is available as creams, nasal gels, capsules, and tablets, known as buccal systems. Buccal systems are used to apply this medication to the upper gum.

Other testosterone prescriptions:

  • Metandren
  • Virilon
  • Testred
  • Natesto
  • Striant 
  • Oreton (discontinued)
  • Methyltestosterone (discontinued)
  • Android (discontinued)

Ingredients in testosterone boosters may include:


Inconsistencies in the research abound. DHEA is touted as a way to increase testosterone and muscle growth. Symptoms include breast enlargement, cholesterol abnormalities, and hair loss.


High doses of zinc have been linked to an increased risk of prostate cancer, more elevated cholesterol, and liver or kidney issues.

Aspartic Acid

This amino acid supplement has been linked to adverse effects including bloating, anxiety, headaches, and disorientation.

TRT Gel versus Injection

The community has a protracted debate, but most favor injections. Here’s how to compare them:

Testosterone Gel or patches Testosterone Injections
Price ExpensiveGenerally, they are less expensive.
Safety The FDA and Health Canada have authorized Pharmaceutical-grade substances.It depends on your source; it might be waste or something of excellent quality.
DosageIt’s a gel, so it’s simple.It requires accuracy and a degree of expertise.
FrequencyIt should be used daily.Depending on the compound, it may range from twice a week to once every 2-4 weeks. Rare injections of this kind are sometimes provided, but they are not advised.
PainZeroPrimarily moderate, depending on your ability and expertise.
EffectivenessMany things influence it, and it might be unexpected at times.If you obtain the appropriate dosage, it’s effective.
Natural effectIt can be used to simulate natural Testosterone levels throughout the day.You can’t duplicate anything; it simply works, bursts, and disappears.
DangersMildly (personal intolerance)Mildly (infection or PI)
Anecdotal experienceUsually, the first medication is administered, although it is ineffective.It is effective and worth learning all elements, but it requires more effort.

That said, you realize this table is somewhat skewed (based on anecdotal evidence and certain unquantifiable elements).

You should do your research since the prices and quality of the substances vary based on where you live.

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TRT Dose 

trt dose

Short answer: For most people, the sweet spot is 125-150mg/week.

Long answer: It depends entirely on the chemical. It is usually 50-100mg twice a week for Testosterone Enanthate/Cypionate. The length of this section depends on the chemical chosen.

Apart from that, it’s a personal choice. One big 600-700mg long ester injection every month (yup, it’s occasionally recommended) is OK for confident guys.

TRT Dosage Considerations

Your testosterone dosage will mirror your free testosterone level if you are low on it. Keeping an eye on estrogen is also vital. Estrogen increases sex hormone-binding globulin (SHBG). To know how much testosterone to take, you must regulate your estrogen levels and monitor your free testosterone.

On average, one to 0.4 cc of testosterone 200mg/ml is administered every week. 0.4 cc gives you 80mg, one cc gives you 200mg, 0.4 cc is a low dose, and one cc is high. Between those criteria lies a wide range of natural testosterone. Some that require one cc are rare. Based on the experienced individuals, around 10% of testosterone replacement treatment patients need this dosage; 0.5-0.7ml is normal. Everyday factors like exercise, stress and new medications can affect your dose.

Non-Laboratory TRT Considerations

Other factors include how you react to your testosterone replacement therapy. The main idea is not to get too caught up with the test results. It is not suggested to “take as much as you want till you feel good.” Typically, the aim is for the lowest effective dosage for symptom relief. The objective is to be high in free testosterone to boost sex desire, libido, and vitality. It is not advised to take testosterone over the maximum limit of the free testosterone reference range. The 200-240 ng/dl is already enough. Some folks feel worse at the top. So you have to monitor your stress, sleep, and other factors. If these things are disturbed, or you feel worse on more significant levels, take heed.

TRT Side Effects 

Not a free ride for you! TRT, like any other hormone treatment, has specific adverse effects. However, most men do not have these negative effects. But the bad aspects remain a danger.

The FDA states that the advantages and risks of TRT for addressing low testosterone related to aging are unknown. The organization mandates that testosterone products contain warnings about potential heart and stroke risks.

A 2017 study indicated that TRT increases men’s risk of cardiovascular events like stroke. Other testosterone side effects include:

  • Itchy rashes and acne
  • Excessive hair growth
  • Hair loss or baldness
  • Anxiety
  • Bladder irritability
  • Priapism
  • Deep vein thrombosis
  • Rage and aggression
  • Achy or enlarged breasts (gynecomastia)
  • Hypertension
  • Prostate enlargement
  • Fewer sperm
  • Prostate cancer worsens
  • Testicular shrinkage
  • High red blood cell (RBC) count, which may cause blood clots
  • Liver dysfunction
  • Oily skin 
  • Headaches
  • Chest pain
  • Nosebleeds
  • Sleep problems  (insomnia or sleepiness during the day)

One complication is high cholesterol. Research from 2021 reveals TRT may improve overall cholesterol. 

TRT may aggravate breast and prostate cancer, according to recent research. TRT may assist persons with early-stage prostate cancer without causing recurrence or progression.

The likelihood of experiencing any of them varies. You may either receive the complete set or a smooth ride with no side effects. It depends on your health and performance.

TRT Risks 

Experts claim testosterone treatment may aggravate a few health conditions. It would be unjust not to warn you. Every guy in history has not experienced TRT. It’s new to many of you. That’s why you should go in knowing the dangers.

TRT For Life

That’s the big one. If you get on the TRT train at 45, you’re probably on it for the rest of your life. Yes, pinning or applying the gel every day or numerous times a week till you die. Harsh, unpleasant, yet honest. Stop it; you’ll be worse off than you were before the TRT.

If you’re wondering how guys can even consider it, remember this: no TRT for life means low testosterone for life.

You can’t have it both ways. Injecting testosterone to improve the situation temporarily is the alternative to feeling lousy due to low testosterone levels.

Insufficient testosterone has consequences beyond your health. Mental health has been found to deteriorate. Some athletes are obliged to utilize TRT for the rest of their lives following years of overdosing and abusing anabolic steroids. That’s a terrible situation, but for some individuals, it’s the only alternative.

Benign Prostatic Hypertrophy (BPH)

The prostate develops when testosterone is present. It causes urination issues. Many men’s prostates enlarge with age, constricting the urine tube (urethra). Through hormone treatment, it may exacerbate BPH.

Prostate Cancer

Testosterone may increase prostate cancer. Most specialists advise prostate cancer screening before testosterone replacement. Men with prostate cancer or high prostate-specific antigen should avoid testosterone therapy.

Sleep Apnea

Replacing testosterone might aggravate this issue. Men may not be able to tell, but their sleeping companion can. Polysomnography (sleep study) may be required if you will undergo the therapy.

Blood Clots

The FDA mandates that testosterone replacement products warn about the danger of venous clots. It may raise the risk of deep vein thrombosis and pulmonary embolism, a potentially fatal lung clot. Polycythemia, an abnormal increase in red blood cells, is occasionally associated with testosterone therapy. The warning now includes males without polycythemia.

Congestive Heart Failure

The issue may worsen if men with severe congestive heart failure take testosterone supplementation.

Extensive clinical studies on the long-term benefits and hazards of testosterone treatment will take years. You and your doctor must decide if the potential advantages exceed the probable risks.

TRT Injections 

You’re probably not a doctor and have no clue what intramuscular injections are. If you do, great, but most men didn’t have the chance to learn them correctly. Injections include many risks:

  • Infection at the site of injection
  • Vessels and arteries are unrepairable
  • Non-replacement injection sites cause pain, discomfort, and irritation. Many respected medical institutions provide intramuscular injection instructions. 

Many respected medical institutions provide intramuscular injection instructions. And it’s not the most challenging skill to master. 

Doubts concerning infections may be eased by disinfecting twice. Don’t want intramuscular injections? Subcutaneous injections are also an option. In addition, sub-q injections work similarly.

Treatment Alternatives To Improve Your Testosterone

Suppose you don’t have hypogonadism but want to feel younger. The following non-hormone treatments may help you enhance your testosterone levels.

Keep a healthy weight.

Overweight males have lower testosterone levels. Weight loss may boost testosterone.

Regular exercise.

Sedent males have lower testosterone levels since their bodies don’t need it. Weightlifting may boost testosterone levels. The idea is to keep moving and exercising your muscles.

7–8 hours of sleep.

Sleep deprivation impacts hormones.

Invest in vitamin D.

In 2011, a study of 165 males found that 3,300 IUs of vitamin D per day raised testosterone levels.

Drink coffee.

Caffeine may enhance testosterone levels, according to 2008 research.

Get zinc.

Men with zinc deficiency have hypogonadism.

More nuts and beans.

These foods include D-aspartic acid, which aids in testosterone synthesis.

Final Thoughts

It’s not something you can do casually for a month or two. Authentic TRT works in 6-12 months. Despite its risks and unpleasant side effects, it is unquestionably one of the most significant medical advances ever made.

TRT has never been as accessible today, with private clinics, research, and hundreds of substances on the market.

TRT saves many men’s lives, and it’s your choice if you will be joining them. Just be sure you can’t keep your life any other way, that you’re healthy, and that you’re ready.

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