42 Year Old with Low Testosterone

Hi Christian,

First of all, I’ve loved reading your excellent material for many years, going right back to the Dr Squat forum days in the early 2000s.

My testosterone has been consistently low for a number of years now. I’ve never taken any performance enhancing drugs. I suspect that my low T levels may have been caused by taking large doses of Accutane and Prozac during the mid 1990’s.
Unfortunately, nothing I’ve tried (i.e. low volume training using heavy compound movements, diet, supplements, sleep, lots of rest etc) have been able to make much of a difference to my T levels.

I’ve been offered TRT from 4 different doctors, but have knocked it back because I have an interest in competing in Masters Track and Field competition and I’m afraid that it would make me fail a drug test if I ever had to have one done. None of the doctors, however, could confirm for me whether this would happen or not on such a low dose of testosterone.

Although I’ve managed to compete fairly well with low T levels, my libido this year has been pretty much non existent so I am considering trying a small replacement dose of testosterone in the form of a compounded cream.
I wanted to ask you, would just this small replacement dose disrupt the allowable 4:1 testosterone:epitestosterone ratio and therefore make me test positive?
If so, is there anything that can be done to even out the ratio? My intention is not to cheat, I just want to have a normal libido for someone my age and a good quality of life and still be able to compete in the sport that I love.

Many thanks for your time,

Well I’m a bit hesitant to answer your question, especially the last part because it is essentially asking me to show you how to get away with cheating. I’m not against PED per se, but I’m against their use in events where they are prohibited.

Can a TRT dose lead to a positive test? Yes it can. Several master athletes have tested positive due to TRT.

Could you get away with it without having to stop prior to a competition? Yes you cpuld because a TRT dose (which can be anywhere between 100mg/week to 200mg/week in most cases of injectable testosterone… the dosage can be even lower if testosterone cream is used in which case a dose of about 20-40g is used but only about 10-20% is bioavailable, leading to an increase of maybe 4-8g per day, which is right around what a normal male produces daily). With a dose that low it is possible to avoid going past the 4:1 ratio.

The WADA tests can now differentiate between natural and synthetic testosterone. This means that in the past if you didn’t exceed the T:E ratio you were fine. But now they can actually decide to test of your T level is from your natural production or exogenous. However this is a separate test and normally they only use it if someone exceeds the T:E ratio, is very close to it (3.8:1 for example) OR if there is a legitimate reason to suspect exogenous T use (for example if a 70 years old master competitor has high normal T).

Some athletes have gotten away with using synthetic testosterone by switching to short esters (or testo cream or oral test, “andriol”) around 6 weeks prior to a competition and stopping 1-2 weeks prior. That couldn’t be done with a steroid that is foreign to the body and for which the slightest level of metabolites could be detected… that’s why a lot of athletes were popped recently: the tests are now A LOT more sensitive and can detect an extremely low level of metabolites… this screwed up the “detection time” that was know by coaches and athletes. But since they don’t test for testo metabolites even if there is still some residual left in the body the athlete MIGHT be okay.

But I will be honest, if one of my client who was a master athlete decided to go on TRT, and if it is medically justified for his health and well-being I would tell him to do the right thing and petition for a medical exemption. And if it is refused I would advise them to either go on TRT and have a better quality of life and NOT compete OR don’t go on TRT, be miserable and compete. I would personally not accept helping someone go against the rules of his federation (the fact that many others don’t follow the rules is not a justification). If the athlete’s demand for medical exemption is refused, going into competition using TRT IS against the rule.

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Using exogenous testosterone, even if it is to go back up to normal levels, IS cheating unless the federation and WADA grants the athlete an exemption. “Cheating” is not about dose, it’s about using a compound that cannot be used according to the rules of the sport.

You have to understand what the 4:1 ratio means.

I does NOT mean “testosterone use is allowed as long as it doesn’t lead to a T:E ratio higher than 4:1”… The rules is that “ANY exogenous testosterone use is PROHIBITED/against the rules”. The 4:1 ratio is only a way to test for the use of exogenous T since, unlike synthetic steroids, T doesn’t have foreign metabolites you can test for. A normal ratio is 1:1 but they accept up to 4:1 for LEGAL reasons because some EXTREMELY rare people will have some physiological anomaly that give them a 3:1 or 4:1 ratio.

So again ANY use of testosterone if it is not granted a medical exemption IS cheating. Even though a lot of athletes justify their actions by “believing” that as long as they are not above 4:1 it’s not against the rules… IT IS! It’s just that they don’t have another way to test for testo use (well they have one now, but it is extremely expensive and they don’t use it often, but in the future it might replace the T:E ratio test).

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