Testosterone Replacement Therapy (TRT): Everything You Need To Know

As you get older things start to change. Staying in shape and keeping the same aesthetic you had when you were twenty-five, is going to be a lot harder to achieve when you’re forty. Your diet and training habits you had then, will not serve you now, that’s just a fact of life. As you age, hormone production and testosterone levels begin to decline, affecting body composition, energy levels, sleep, and the ability to put on muscle mass. Testosterone replacement therapy (TRT) is an often-utilized interventional therapy, that can help restore hormonal balance, and rejuvenate quality of life. We’re going to talk about the benefits, risks, and how you can qualify for testosterone replacement therapy (TRT).

What Is Testosterone

Testosterone is a primary androgenic and anabolic steroid hormone naturally produced by your body. Testosterone plays a critical role in the development of muscle mass and contributes to the activation of the nervous system, resulting in more power and strength, better mood, and improved libido [R].

How Does Testosterone Work 

Testosterone works in a pulsatile manner, meaning it’s released in pulses. Pulsatile secretion of gonadotropin-releasing hormone (GrH) from the hypothalamus activates the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the anterior pituitary gland [R]. Luteinizing hormone then binds with high affinity to luteinizing hormone receptors on the plasma membrane of testicular Leydig cells in men and of theca cells in women. This leads to a complex cascade of signaling events which results in testosterone synthesis [R]. Because testosterone is a steroid hormone and cannot be stored in the cells where it is produced, it is immediately secreted into the circulation.

98-99% of testosterone associates with hydrophilic binding partners while, the 1-2% of free testosterone (the most biologically active form of testosterone) binds with sex hormone-binding globulin (SHBG0 [R

After transport via circulation, testosterone exerts its effect by binding to the intracellular androgen receptor (AR) which subsequently is transported as the androgen receptor-testosterone complex to the nucleus where it induces gene transcription [R]. Activation of this hypothalamic-pituitary-gonadal axis has a robust anabolic effect, increasing muscle mass and strength, promoting muscle protein synthesis, and increasing bone mineral density [R].

Symptoms Of Low Testosterone

Testosterone deficiency affects 10-40% of the world population and is known to increase with age. A stark and progressive decline in testosterone production occurs at an estimated 0.4 – 2% after age 30.

It is estimated that men over age 70 will have 35% lower testosterone levels than those who are in their 30-40s. The failure to produce adequate testosterone levels causes symptoms such as a decline in sex drive (libido), the loss of muscle mass, and increase of body fat. It becomes harder to gain muscle mass as you get older due to what’s known as anabolic resistance, and as body fat accumulates, it becomes harder to lose, despite increased efforts in training.

Both men and pre-menopausal women experience a decline in DHEA and DHEA-S [R] which serve as precursors for the production of androgenic hormones like testosterone.

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Increasing testosterone levels has been shown to improve strength, reduce body fat, and increase muscle mass. The more testosterone, the more pronounced these effects become.

Low testosterone levels can have a dramatic impact on sex drive, physical appearance, and body composition. Some of the most common symptoms of low testosterone are

Increased Body Fat
Loss of Muscle Mass
Hair Loss
Reduced Sex Drive
Chronic Fatigue
Difficulty with Erection

In addition to the natural progression of aging, several factors can have a negative impact on testosterone levels such as sleep quality, alcohol consumption, micronutrient deficiencies, increased stress, and refined sugar.

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Optimizing testosterone levels by first correcting these factors and supplementing with a natural testosterone booster, with proven ingredients such as Swolverine’s ZMT can increase natural or endogenous testosterone production.

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Testosterone Benefits

Increases Lean Muscle Mass

Testosterone is an anabolic-androgenic steroid (AAS). This means it has a high affinity and selectivity for muscle and bone tissue. Testosterone activates the androgen receptor (AR). Activation of the androgen receptor stimulates muscle protein synthesis, which increases muscle growth, lean body mass and bone mineral density.

Improves Sex Drive (Libido)

Testosterone is the main active male hormone, that controls sexual desire. Testosterone is a synchronizer of sexual activity regulating libido and enzymes as nitric oxide synthase (NOS) and phosphodiesterase type 5 (PDE5), which are crucial for the erectile process [R].

A study, investigating the effects of exogenous testosterone on sexuality and mood of normal men, randomized 31 male participants into a placebo or control group. One group received 200mg of testosterone enanthate, weekly through intramuscular injection, for 8 weeks, while the other received placebo injections once weekly for the first 4 weeks followed by testosterone enanthate, at 200 mg weekly for the following 4 weeks. Various aspects of sexuality were assessed using sexuality experience scales (SES) questionnaires. In both groups there was a significant increase in scores in the Psychosexual Stimulation Scale of the SES (i.e. SES 2) following testosterone administration, but not with placebo [R].

Helps With Weight Loss 

Optimizing your testosterone production is one of the most efficient and effective ways, you can burn body fat.

Low testosterone levels reduce muscle mass and resting metabolic rate or calorie expenditure. The more muscle mass you have, the more calories your body burns at rest. Therefore, low testosterone levels can attribute to a loss of muscle mass, which translates into more accumulated body fat over time [RRR].

Visceral fat contains high levels of the enzyme, aromatase. Aromatase converts testosterone into estrogen, the female sex hormone. High aromatase levels and estrogen activity reduces the production of gonadotropin-releasing hormone (GRH). Lower GRH leads to lower levels of luteinizing hormone, which in turn reduces the production of testosterone [RR].

How To Qualify For Testosterone Replacement Therapy (TRT) 

Your physician might recommend looking into testosterone replacement therapy if they identify you as a viable candidate. Age-related declines of hormones are normal, and can be remedied, with TRT, as well as other treatments, such as herbal supplements, exercise, and nutrition, however testosterone levels can also decline due to other conditions such as hypogonadism.

Male hypogonadism is a condition, in which the body does not produce enough testosterone via the gonads. This can cause a decrease in libido, fertility issues, as well as cognitive function and vitality. TRT is a very efficacious and common way to help treat hypogonadism, to increase free and active testosterone.                            

TRT Treatment Options

Ideally, TRT should provide physiological testosterone levels, typically in the range of 300-800 ng/dL.

The goal of testosterone replacement therapy is to

Restore sex drive, libido and well being
Produce and maintain virilization (masculinity)
Improve or optimize bone mineral density
Normal hormonal levels
Restore fertility
Improve mood, sleep and body composition

To achieve these goals, there are several TRT delivery options and systems such as transdermal patch, topical testosterone gels, implantable pellets, intramuscular injections, and oral tablets.

TRT Risks

Testosterone treatment does come with some risks. One of the major risks of testosterone is its effect on the prostate due to its androgenicity. This can cause fertility issues as well as a shrinkage of the gonads.

AAS have diverse and numerous effects on the cardiovascular system. Supra-physiological and chronic use of AAS, can cause myocardial infarction, heart failure, coronary disease, and stroke.

The use of testosterone in synthetic or bio-identical form, will suppress natural testosterone levels. This means, once TRT is started as a treatment, you will need to continue treatment, often indefinitely otherwise, endogenous testosterone levels will be greatly affected, if and when treatment is stopped.

The use of anabolic androgenic steroids (AAS) suppresses the secretion of the pituitary luteinizing hormone (LH), sexual binding hormone binding globulin (SHBG), and follicle stimulating hormone (FSH). This effect results from negative feedback of androgens on the hypothalamic-pituitary–gonadal (HPG) axis.

The proven adverse effects of AASs include suppression of the gonadal axis and infertility, hirsutism and erythrocytosis.

Testosterone is aromatic, and will aromatize to estrogen, which may cause a hormonal imbalance, between testosterone and estrogen. Excess estrogen may lead to gynecomastia, or an enlargement of the breasts, which can be seen in 10-25% of men on TRT [R]. Excess estrogen may also cause an increase in visceral fat. However, with monitoring of this by a physician, TRT has been shown to lead to weight loss [R].

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