T Nation

When to Start TRT?


There was a thread on here recently where a guy was questioning if he should initiate TRT. He had decent labs (I think TT in the 700's) and was discouraged because his levels were good for his age. While TT in the 700's is good, I doubt that many would say it's optimal (such as the levels a healthy 20 year old would have). I would estimate optimal to be at 900 ng/dl or greater of TT and FT in at least the upper teens in ng/dl.

Since we are theoretically decaying each day, and we know T confers positive benefits on many cell types, is there a problem with being proactive and attempting to achieve optimal T levels as opposed to waiting until T levels deteriorate to a certain point? I would guess that there are many men in their 40's-50's with "good" T levels that still feel "good", but certainly not as good as they did in their 20's. Is there something philosophically or medically wrong with attempting to achieve optimal levels regardless of current levels?


TRT can be a complicated treatment. It's not just as simple as increasing ones T levels. There is a lot of room for things to go wrong on TRT, so it doesn't make much sense to start messing with an endocrine system that's working just fine.

That being said, as long as someone is willing to embark on a lifelong treatment and incur any potential risks that come along with TRT...it's their body and they can do with it what they please.


There is nothing inherently optimal about the T levels of a 20 y.o. (or any other T level, for that matter).

These estimates derive from what, exactly?

Again, there is no such thing as an "optimal" T level. And exogenous T is not a benign substance--its effect on some cell populations is decidely un-positive.

The main medical concern is a lack of information re the effects of long-term supplemental T in men not diagnosed with clinical hypogonadism. We simply don't have good data re what may result from 10, 20, 30 years of maintaining supranormal T levels. (That said, if the track record of HRT in women is any indication, it is likely significant negative sequelae will occur.)


I believe you are mistaken. 700-800 ng/dL is pretty good for someone in his 20s, and is considered a good target range for someone on TRT by many practitioners, though there is individual variation, with some needing less and some (few) needing more. I would be very suspicious of any sources claiming certain T levels to be "optimal."


The guy that you are referring to had very low FT, and based on that criteria, some intervention is needed. The objective is to find and fix the cause and TRT would be the last option for a young male.

Optimal is considered to be youthful T levels as found in young virile males.

For order males, the levels need to be higher to get:
- loss of fat
- gain of muscle [resistance training not required]
- restored vitality
- restored libido
- elimination of symptoms
- also possible is completion of virilization in males who never had high T levels before, typically more body and facial hair

Why higher levels? Simply an observation of individuals and informed doctors.


I am going to apologize in advance for being technologically challenged. I can't figure out how to answer individual quotes from people (like EyeDentist did with me) nor was I able to successfully cut and paste some info regarding "optimal T levels".

I readily admit that optimal T levels are subjective. I based my numbers mainly on information from the following article:

Simon, D., Nahoul, K., & Charles M.A. (1996). Sex Hormones, Aging, Ethnicity and Insulin Sensivity in Men: An Overview of the TELECOM Study. In Vermeulen, A. & Oddens, and B. J. (Eds.), Androgens and the Aging Male (pp. 85-102). New York: Parthenon Publishing.

The chart I wanted to post listed age levels ranging from <25 up through 50-59. Each age range listed, among other things, TT levels for men in the 95%ile. The lowest 95%ile TT level was 45-49 at 846 ng/dl and the highest was for 25-29 at 1005ng/dl.

I would imagine many men could have what most consider good T numbers, but still feel nowhere near as good as they did in their 20's. They may look and feel better than their contemporaries, but not like their old selves. This is why I posed the question of attempting to reach "optimal" T numbers. In reality, maybe it's more appropriate to say attempting to re-acquire the youthful qualities that T can deliver. All of this is assuming an otherwise healthy individual, no thyroid issues, etc. Just purely declining T levels over the years.

From a medical viewpoint, I can only think of 2 reasons not to pursue this. First, exogenous T will raise one's hematocrit level, which in some individuals would be detrimental to their health. Second, as mentioned by EyeDentist, there are no long term studies on TRT. I have been unable to find any conclusive evidence stating exogenous T kept at physiologic levels is harmful to the body(assuming E2 is controlled, etc). I'm really hoping for someone better read than I to provide any additional evidence stating the TRT for non-hypogonadal males is ill-advised/dangerous. Otherwise this becomes a purely philosophical debate.

Thanks for your input.


I think I might be the guy you're referring to. I ruled out low TT as a cause of my symptoms and therefore have no interest in exogenous testosterone. At this point I'm trying to identify any problems and solve them. My TT level is not one of these problems.

These are my thoughts in relation to your questions: yes, there are benefits to boosting testosterone beyond average physiological ranges. Thats why some guys use steroids. However, there are also many known and (likely) unknown side-effects of maintaining these levels. That is why guys cycle their steroids or blast and cruise.

"I would imagine many men could have what most consider good T numbers, but still feel nowhere near as good as they did in their 20's. They may look and feel better than their contemporaries, but not like their old selves."

I would say that this is true because testosterone is only one piece of a huge biological puzzle. Hell, its only one piece of the hormone optimization puzzle. But lets say that someone were able to reach "optimal" levels of TT, FT, E2, TSH, and any other hormone you could name. That person would still be subject to DNA damage, telemere shortening, metabolic waste accumulation, wear and tear, and all the other degenerative processes that happen when we age. Unfortunately, we're pretty far off from solving that whole aging and dying thing so for now its just something that we all have to deal with.

If you want to raise your testosterone beyond what is generally considered "healthy," there are definitely ways to do it. Just realize that its not some sort of panacea, and beyond that there are almost certainly going to be undesirable side effects -- some that we are aware of and probably many more that we are not. Personally once I get everything into a reasonable, healthy range I'll be happy to leave well enough alone.


There are many studies that show long term use of normal physiological levels of Testosterone to be safe. That doesn't mean there isn't the chance of adverse effects but it's more likely that they will occur in te presence of other factors ( ie familial issues, excess stress, existing tumors etc). And these studies have been assessed by one of the highest levels of scholarly scrutiny, the Cochrane Collaboration. TRT still requires a proactive and responsible approach.

I would disagree that TRT based on TT numbers, especially alone, is a good approach. I think it would be foolhardy and a bit reckless. I think it's better to treat based on response. I would also disagree that a young male must have 1000TT in order to feel verile and able to gain muscle.


One problem with this reasoning is the assumption (which I think you are implicitly making) that men in the 95% percentile are the ones who feel the best and are the healthiest. That is not necessarily the case.


It has been determined that men with higher T levels live longer. The experiment has been done.

We also have the long term experiments with untreated low T levels and accompanying estrogen dominance:
- loss of muscle
- gain of fat
- insulin resistance and type II diabetes
- loss of libido and lost of sexual connection to one's mate
- lower survivability after a MI
- bone loss
- hip fractures and one year mortality is then very high, women survive these fractures much better, when one has muscular frailty, one is more likely to fall down
- mood problems, apathy and depression
- loss of energy/vitality
- low hematocrit, anemia
- high cholesterol, TRT can lower total cholesterol
- social disconnection

If exogenous T causes high HTC, why? Injected T becomes bio-identical T. Perhaps its not the T that is the problem in the way that you think. Injecting once a week or less often than that creates high T peaks that might be a significant factor and then its the delivery method that is also a factor. Frequent injections with steadier levels may lead to less HTC. Perhaps T losses with age compensate for an age driven tendency for increased HTC. Note that one "indication" to Rx T is to deal with anemia! The anemia is from low T.

TRT can have problems with undetected/untreated thyroid and/or adrenal issues. TRT should be part of a wider age management approach that looks at all aspects of hormone health. We have seen the problems with TRT done wrong over and over again. So the subject of whether TRT having any long term negative effects is not a simple yes or no.

After the flawed study last year that suggested that TRT increased heart attacks, the lawyers were all running ads trying to get juicy law suits to make them selves rich. Remember those lawyer ads stopped suddenly? Someone looked at mortality of something like 80,000 men on TRT, examining the Medicare records. The men on TRT had way less heart attacks. So that is settled. TRT prevents heart attacks and that would be TRT mostly done really bad.