
There should be some compound German word for that sinking feeling you get when you realize how much disproportionate effort it will take to address the incredible amount of ignorance packed into such a deceptively short statement, but you’re resolved to do it anyway.
I started taking testosterone replacement therapy in January of this year, with levels of 282 (300-1,000 is considered normal range). I had initially refused it for various reasons, but especially because I had long heard that it was strongly correlated with an increased risk of prostate cancer. Given that my father has prostate cancer, I figured I was already at enough risk. But I spent several months reading up and doing more research, and it seems that the high testosterone/cancer link is nowhere near as clear as I’d thought; some evidence even points toward low testosterone being a bigger risk factor. Eventually I decided the overall benefits — improvements in fatigue, libido, mood, bone density, anemia, maybe body composition — justified the potential risk, especially since I’m already monitoring my PSA levels regularly.
I have noticed two benefits. One, I started losing a millimeter of fat around the belly each month when I went in for calipers/tape measuring. That started right away, and has stayed pretty consistent. I’d have to check, but I think I’ve exchanged about ten pounds of fat for a like amount of lean mass. I honestly don’t think it’s anything anyone would notice at a glance. I still have the same “shape” overall. I just look like “middle-aged guy who goes to the gym,” not “WWE wrestler/IFBB bodybuilder.” And two, I started to notice only last month that I was definitely recovering faster from the most taxing lifts, like squats and deadlifts. Squats in particular were always tough on me. I could count on three days, sometimes four, of tender hamstrings/adductors/glutes. Not excruciating pain, just hobbling gingerly upon standing up, and preferring to bend at the waist rather than the knees to pick anything up off the floor. Now, it’s one or two days to recover, and it’s not nearly as intense.
It is not a panacea or a fountain of youth. I still have to do the same amount of warming up and cooling down before and after workouts. I still do yoga, and still go for monthly massages with a therapist who does medical and sports-medicine massages, which are more akin to grueling physical therapy than someone gently kneading your trapezius muscles. I wear neoprene shorts for the beneficial warmth and compression on leg days and quicker recovery afterwards, one of the few training “hacks” which actually make a noticeable difference. (I recommend Nordic Training Gear for price, quality and insanely fast shipping from Sweden, and I’m saying that for free out of genuine conviction — no affiliate links or kickbacks.) I take supplements like curcumin and omega-3s and amino acids. I still need at least eight hours of restful sleep every night, and of course I follow a tailored meal plan from a dietitian. I can’t say I notice any difference in sleep quality from TRT, nor any noticeable surges of energy, horniness, or desire to pick a fight with traffic cones. My assumption is that my health baseline was already high, so TRT didn’t change much. Granted, it may be different for someone who starts it as a scrawny, sedentary depressive.
“But what about the gains?” you might ask. What about the massive strength increase and the new PRs? Honestly, again, it has been pretty subtle. An obvious confounding factor is that I got a hernia at the end of January and had surgery on it in May, so I spent from January to July doing almost no serious lower-body work at all. Still, my squat is only ten pounds heavier than it was last November. Even my deadlift, which had been stuck for a long time, only jumped to its recent new high thanks to a radical innovation: I loosened my lever belt one notch. It turns out lifting heavy weight is much easier when you can take in more oxygen before starting! Who knew? (Trainers hate this one weird trick!) I’m sure it doesn’t hurt to have higher testosterone levels, but it doesn’t lead to sudden fifty-pound jumps in personal records either. You still have to do just as much hard work as before.
The boring truth is that >90% of being strong and healthy is the same old stuff that everyone already knows and no one wants to do: eat balanced meals, get plenty of deep, restful sleep and keep building patiently on your previous work in the gym. TRT can improve things a little on the margins, but as with most things, if you go into it expecting miracles, you’ll be disappointed.
As for the original tweet, lots of things “naturally” decline with age: bone density, muscle mass, red blood cell production, estrogen/progesterone in women. We don’t look at an osteoporotic 70-year-old and say, “Well, you were supposed to have fragile bones, so bisphosphonates and calcium are bad for society.” Same for HRT in women. The “supposed to” line is just the old naturalistic fallacy. A guy getting 100-200 mg of testosterone weekly from his doctor is not remotely comparable to a young meathead furtively taking several times that amount of various synthetic testosterone-derivatives from shady sources. Low testosterone is actually associated with depression, fatigue, low motivation, and worse cardiometabolic health. Normalizing that doesn’t turn men into bar-fight goblins; it often makes them less irritable and more stable. I feel pretty confident in predicting that even widespread TRT will not lead to 75-year-olds brawling in the street with their grandsons over access to nubile young women.