Have any questions? 888.828.4300info@tctmed.com

Have any questions?
888.828.4300info@tctmed.com

How Long Does It Take For Low Testosterone Treatment (TRT) To Work?

We are frequently asked how long patients will have to wait before they start feeling better after starting testosterone replacement therapy. The best answer can get a little complicated, but there are definitely some factors that we have identified which help to predict success.

Testosterone Replacement Therapy 101

Testosterone Replacement Therapy (TRT) 101

This video is a rapid fire explanation of testosterone replacement therapy (TRT). It will provide a great foundation for those seeking to learn more about Low T treatments like testosterone gels, pellets, or injections.

First of all, it is important to be looking for the right things. Knowing what the real symptoms of Low T are is extremely important.

Making sure that your treatment is medically supervised by providers who know The Side Effects of TRT well, and being consistent with the prescribed therapy, plays the biggest role in how quickly you will respond.

Keep in mind that people are not cookie cutter clones of one another either — each individual is different, and your response will be too.

How Long Before Low Testosterone Therapy “Kicks In” — The Short Answer

Understanding that there is no hard fast rule here, most patients feel significant improvement in symptoms within 4-6 weeks of starting treatment for Low T.

It is common for symptoms like low sex drive and difficulty maintaining sleep to respond sooner. On the other hand, factors like obesity, chronic illness, or medications can make one’s response slower or more subtle at first.

It has been our experience that failure to respond to treatment (when the person is committed to staying consistent with appointments and recommendations) is very rare.

Especially with injections, response to therapy has nothing to do with “waiting for your testosterone levels to come up”.

If properly managed, your levels can be normalized with the first dose, possibly in just a few days.

The lag in symptomatic response represents the time it takes for your body to achieve balance. Making numbers look better is one thing — carefully balancing hormonal shifts and the potential side effects is where the art of medicine becomes crucial.

Below you will find some references to what the studies say on the subject, but ultimately, we have found the following to be true:

  1. For men with symptoms of Low T and confirmed low testosterone levels, treatment works
  2. Treatment typically begins to work some time before the 3rd week, but response becomes more noticeable after the first monthMan with Low T waiting on response to TRT
  3. Symptoms of decreased sex drive can be expected to improve first
  4. Most men on TRT report improved mood by the 6th week of therapy

What Does the Medical Literature Say?

In the study titled, “Timetable of effects of testosterone administration to hypogonadal men on variables of sex and mood” (Jockenhovel, Minnemann, et al, The Aging Male, December 2009: 12 (4): 113-118), 40 men with testosterone levels definitively established as low were evaluated for timing of response to therapy.

Specifically, the researchers wanted to know how long it took for men to experience improvement in total numbers of erections and ejaculations, indicators of improved libido such as sexual thoughts and fantasies, and perceived sexual interest/desire and satisfaction with their sex lives.

Additionally, several psychosocial parameters were measured looking for changes such as levels of agitation, aggression, depression, listlessness (avoidance of activity), sociability, and activation.

Activation, by the way, is defined by Britannica Online Encyclopedia as the “stimulation of the cerebral cortex into a state of general wakefulness, or attention”.

Essentially, you can think of activation as concentration and alertness in this context.

It is important to note that this study only evaluated patients at three-week intervals, so any symptomatic change occurring before that point could not be documented.  For the psychosocial effects assessed by the study, anxiety levels, aggression, and sociability all showed significant response at three weeks after the start of therapy.

The scoring for all three of these parameters continued to improve over the next 9 weeks, all plateauing around week 12.

When considering aggression, it is worth noting that when a man’s testosterone level is normal, he is usually appropriately aggressive. A total lack of aggression is most often a social liability and can sometimes lead to missed opportunities, especially in the workplace.

On the other hand, “roid rage,” which is frequently associated with anabolic steroid abuse (and the supraphysiologic levels that ensue), occurs in the setting of extremely elevated levels of testosterone.

This is not something seen when TRT is managed responsibly and safely. The goal should always be to improve symptoms while improving testosterone levels from deficient levels to normal ones.

Effects on Psychosocial Parameters

Depression and listlessness both decreased substantially by week 6 and remained fairly steady thereafter. For agitation and activation, both of these measurements showed sharp improvements at 9 weeks and stayed relatively stable thereafter.

Effects on Sexual Function

This study evaluated sexual function by tracking the number of spontaneous erections, total erections, and ejaculations reported by men. Other aspects that were quantified were frequency of sexual thoughts/fantasy, intensity of sexual desire, and overall satisfaction with sex life.

For the three measurements of sexual function, men reported positive changes for all at their 3-week evaluation. The number of spontaneous and total erections, as well as the number of ejaculations, increased to stable levels between weeks 12 to 21.

Sexual thoughts and fantasy rose considerably by week three and remained at levels approximately double initial scores thereafter. Sexual desire followed a similar track, reaching a plateau around the 9th week.

Finally, satisfaction with sex life rose sharply by 3rd week and continued on a dramatic rise through week-30 when the study concluded.

Conclusions

As the study says, “Treatment of hypogonadal men (men with Low T) with testosterone is rewarding, for the patients as well as the physician.

The patient experiences, to his satisfaction, profound changes in his physical appearance and his mental make-up.

The attending physician observes the changes the patient undergoes and rarely fails to be fascinated by the multitude of functions testosterone appears to have in [the] process of masculinization in the broadest sense.” The take home points are these.

The researchers behind this journal article looked only at sexual functioning and mood. There is often much more that is negatively impacted by Low T.

If you have questions or comments please take the time to contact us, we would be happy to sit down with you and discuss how testosterone replacement therapy can improve your quality of life.

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LOW T RESOURCES

(Augie) Juan Augustine Galindo Jr. MPAS, PA-C

(Augie) Juan Augustine Galindo Jr. MPAS, PA-C started his career in healthcare as a fireman/paramedic in West Texas where he served on the Midland Fire Department from 1998-2004.   He became interested in testosterone treatment after seeing how hormone replacement doctors helped those suffering from low testosterone.   After graduating from the Texas Tech Health Sciences Center Physician Assistant Program, he moved to DFW where he currently lives with his wife and three children.

188 Comments

  1. Christy on 12/27/2014 at 12:48 am

    Hi. I have a few concerns; my husband has been on TRT for at least 6mo. He has been getting injections of 100 t monthly. We just got the results from his quarly T level test and it was only 30…yes..3.0. THIRTY. Our family doc has now referred him to a Urologist for treatment. He is a recently recovered alcoholic. I know the alcoholism has made the most damage, but would like to know more of what to expect & how soon he should feel better. Thinking that stopping drinking would have more of a positive impact on his health, he has been let down & depressed. However finding out this has helped to explain a lot. I’m just worried for his health & want so much for him to feel better.

    Thank you for your time.
    Christy

    • TRT Provider on 06/09/2015 at 12:11 pm

      Thank you so much for your comment Christy! I’m really sorry that it has taken us so long to get back to you. We’ve been pretty swamped lately and this one just slipped through! As for your husband, wow! Those are pretty low numbers—I can see why you’re concerned. For many of our patients, they find that they start to feel a change after 4 to 6 weeks of therapy. However, each person is different and may experience different results. If you have any further questions, please feel free to email us back. If there’s anything else we can do to help, please let us know!

    • Sal on 08/18/2015 at 7:56 pm

      “100 t monthly”? I sure as HECK hope that’s not 100mg of testosterone MONTHLY… That would leave just about everybody with practically zero testosterone.

    • Kurt on 08/19/2015 at 12:43 pm

      He should be on 100mg each week not 100mg for a month!!! That’s gunna kill him.. Hope this helps. Google TRT protocols and you will learn a lot more.

    • Don on 09/08/2015 at 9:28 am

      The T injections could be converting to estrogen. Next blood work have that checked

    • Scott on 06/11/2016 at 10:27 pm

      100 mg a month is entirely too low. I am 34 years old and have been on hrt for approx 6 years. It took a good month to start feeling better but my doses were much higher. My best schedule came to be 1/2 ml every 5 days. It’s high but it’s what keeps my levels stable and my sex drive normal. Everyone is different and it’s what works for me. Also through my time on hrt I have come to find that several brands of testosterone cypionate aren’t worth a crap. The two brands that keep my levels the best are Watson, and Pfizer. Westward is a waste of money and I have written to them many times because I believe they are ripping people off, my test levels dropped to 0 after a month of use with this brand, the same can be said for a few other brands. Make sure you try changing brands before giving up. Whatever you do, stay away and refuse to take westward. It is pure junk in a bottle.

      • Pat on 07/30/2016 at 4:12 pm

        Have you ever used Perrigo brand?

        • Augie Galindo on 08/02/2016 at 8:44 am

          Pat,

          We have not ever used that brand.

          Best regards,
          Augie Galindo MPAS, PA-C
          Testosterone Centers of Texas | Founding Partner

    • Doug on 01/25/2017 at 12:51 am

      Ya I was on that boat mine was 12 yes. When my labs came back my doc and myself got a laugh out of it he put me on 200 weekly. It’s help quite a bit but considering an even higher dose. But he will fill much better than he is now. I am 43 yrs old. P.s. I would find a different doctor

  2. joe on 03/30/2015 at 5:24 pm

    my T level is 160 extremely tired sleep problems if I start shots at the low end how long before I feel better

    • TRT Provider on 06/09/2015 at 12:08 pm

      Hi Joe, thank you so much for your comment. I’m really sorry that I’m just now getting to your comment—we’ve been pretty busy lately! The amount of time it takes for someone to feel better varies from person to person, but generally 4 to 6 weeks is the amount of time necessary for someone to start feeling a change. Please feel free to email us if you have any further questions!

    • Brenda on 10/10/2016 at 9:31 pm

      Hello I just read your post about testosterone injections. Now that you’ve been on testosterone for a while now, did it help you with not feeling so tired? My husbands T levels are 150 (or closed to that) the only symptoms he has from his low T is extreme EXAUSTION. If he didn’t have to work, he would be able to sleep at least 20 hours per day. In fact he sleeps his entire weekends a way. He is a heavy equipment operator so he needs to be focused and awake all the time, but this past year he has become more and more exhausted. He gets so tired, he can hardly keep his eyes open while driving. So how long did it take you to feel the benefits and did it eliminate your constant feeling of exaustion? Thank you so much.

      • Bama on 11/17/2016 at 9:03 am

        Hi, mine was 150 and was 165 about 6 months prior. It was declining fast. I was tired, unable to concentrate like I use to, sex desire was down etc etc. I just took my first injection yesterday and I already feel a dramatic difference!! Everyone’s different they say but I’d paid 1k a shot of I had to to feel this much better! Hope that helps. I am on 1ml once a month..

      • Ken on 11/18/2016 at 5:17 pm

        Hi Breda
        I read your question on here and I am having the same problems as your husband and have the same type of job. Have they figured out the reason why he is so tired.
        Looking forward to hearing back from you.
        Thanks
        Kengrahamhomes@yahoo.ca

        • Clayton Teyke on 08/25/2017 at 3:56 pm

          I think that Canada has a different level charts mine test was at 8 Canada’s test level score goes from 9 to 34 so my level was pretty low I was given 100mg for the first shot after an hour after the shot I was feeling very good. By the fifth day of the first shot I was already feeling it drop off I get my shots every seven days . Recieved my second shot I felt like I never had the short at all. So the dr boosted it from 100 mg to 150 mg . Today is August 25 2018, as of this day which is just one day after my lastest shot I’m still feeling good. But still feel tired with no energy .I talked to a sports dr and he told me that I need a estrogen level test he told me when you have no energy it could be a sign of high estrogen levels. Haven’t gotten my results yet but think my estrogen levels are high.

          • Augie Galindo on 08/31/2017 at 10:27 am

            Yes, units of measure differ and that DOES matter. Always make sure that you are making an apples to apples comparison. I definitely agree that your estradiol levels need to be monitored, but also, don’t forget that there will be some lead time needed before your T levels are consistent. I don’t recommend Nebido, but they do have a handy conversion chart on their website.

            Best regards,
            Augie Galindo MPAS, PA-C
            Testosterone Centers of Texas | Founding Partner



  3. Jan Hansen on 06/09/2015 at 4:52 pm

    Hi. How does 50mg androgel/testogel effect fertility? Could it be used as contraception?

    • Augie Galindo on 06/09/2015 at 5:16 pm

      Thank you for your comment/question, Jan. All testosterone treatments suppress fertility to some degree. How much is a question that no study has answered. Also, there is the question of fertility status prior to TRT. That being said, testosterone therapy cannot be relied upon as a form of contraception. You may find other helpful information here: https://tctmed.com/testosterone-replacement-therapy-trt-affect-fertility/

  4. […] How Long Does Testosterone (TRT) Take To Work? – We are frequently asked how long patients will have to wait before they start feeling better after starting testosterone replacement therapy. The best answer can get … […]

  5. How Fast Does Testosterone Work on 07/09/2015 at 7:02 pm

    […] How Long Does Testosterone (TRT) Take To Work? – We are frequently asked how long patients will have to wait before they start feeling better after starting testosterone replacement therapy. The best answer can get … […]

  6. Tony on 07/12/2015 at 8:53 pm

    Hi dr, I have been on injections for 8 weeks. I really haven’t noticed any changes. My level was 238. I’m 45 but prior to TRT I was in good physical shape. I may have noticed more mental focus. My question, I think my estradiol may be too high as I was retaining water and gaining a little weight. My dr said to take 1 estrogen blocker 48 hrs after injection. Why 48 hrs? Recommend any more or less? Injection is 200 cip

    • Augie Galindo on 07/21/2015 at 9:33 am

      Hello Tony,

      Thank you for your inquiry. I would definitely expect some improvement by 8 weeks into TRT, so it definitely warrants a close evaluation to see what the problem is. The decision to add an estrogen blocker should be made on both the lab data AND symptomatic presentation. So, hopefully dosing is being based off of your lab results as well. The reason we will often dose estrogen blockers 48 hours after injections is because your testosterone peaks at about that time, and your estrogen level peaks over the following 24-48 hours. Therefore, this allows the medication to have maximum effect, when you estrogen levels are at their highest, essentially allowing it to work the best.

  7. Phil Blackwell on 08/02/2015 at 8:53 pm

    Getting every 4 week injection of 400mg, end of 5 weeks and no noticeable improvement of libido, etc. what should I expect?

    • Augie Galindo on 08/06/2015 at 5:28 pm

      Phil,

      The dosing interval is determined by the medication. We use testosterone cypionate, and since it’s half life is only 8 days, 4 weeks would be far too long between injections. You may need to discuss this with your provider. Aside from that, if TRT is managed properly, you should start seeing subtle improvements (perhaps improved quality of sleep and increased libido) within just a few weeks. Most substantial change begins to manifest in the second month of therapy.

  8. al on 08/06/2015 at 10:50 am

    I’m a white male 56 yes old and have a 47 and 5.7 levels. I’m extremely tired run down. I went to a urologist and said I will start testosterone treatment in 2 weeks. The Dr. said I will be giving injections. I hate waiting and they said I’m considered castrated cause I’m so low. Is there hope

    • Augie Galindo on 08/06/2015 at 5:25 pm

      Al,

      The good news is that there is definitely hope! Regardless of the starting point, properly managed TRT can restore normal levels and relieve symptoms of deficiency. Make sure they look for potential secondary hypogonadism.

      • al on 08/06/2015 at 6:06 pm

        I will look into potential secondary hypogonadism. My question is my level being so low 47 how do I know what a normal level is and when do they stop giving me shots of test…

        • Augie Galindo on 08/07/2015 at 7:41 am

          The normal reference ranges remain the same, despite different starting points. Testosterone replacement therapy, like any other hormonal replacement therapy, must be continued for as long as you want relief from symptoms of deficiency.

          • al on 08/14/2015 at 9:57 am

            I started my treatment I’m on 200mg. every two weeks it’s been 5 days and I’m feeling better then I was. My test levels was 47 that’s right 47 and my free test levels were 5.7 I’m hoping this will be a game changer for years I felt so bad and I was told it was depression dam straight I was depressed I had no energy and really no reason to live at that time thank God I did my own research.



          • Augie Galindo on 08/14/2015 at 3:32 pm

            Al,

            I am glad you finally got the help you needed. Be sure to ask about dosing every 7 days instead of every two weeks.

            Best regards,
            Augie Galindo, PA-C
            Testosterone Centers of Texas – Founding Partner



          • al on 08/14/2015 at 3:58 pm

            I will and thanks for all the information. I’ll stay in touch again thanks



          • Augie Galindo on 08/14/2015 at 4:58 pm

            Of course!

            Best regards,
            Augie Galindo, PA-C
            Testosterone Centers of Texas – Founding Partner



    • Victoria McFadden on 05/08/2016 at 2:01 am

      Getting castrated is not the answer to ANYTHING, not the correct answer anyway. Hang in there 😉

      • Augie Galindo on 05/22/2016 at 10:13 pm

        Victoria,

        I agree.

        Best regards,
        Augie Galindo, PA-C
        Testosterone Centers of Texas | Founding Partner

  9. James on 08/07/2015 at 6:49 pm

    I am a 49 year old male. I was on testosterone therapy before and wound up having a blood clot. I am Not sure if the testosterone was the reason for the blood clot. My hematologist told me that as long as my blood is properly anticoagulated he has no problem with me taking TRT. I just had my level checked last week and I was a 51. My doctor prescribed me 100 milligrams testosterone cypionate per week. I still have some concerns about using testosterone with the history of blood clots. Could you provide your insight pleasê
    Thank you Dr for your time

    • Augie Galindo on 08/08/2015 at 9:14 am

      James,

      Thank you for this request. You are right to be careful and not just rush headlong back into treatment, but here is some information that may ease your concerns. Injury lawyers and other opponents of TRT have been standing on the claims made by two, very poorly done studies from late 2013 and early 2014. These studies, released in JAMA and PLOS ONE respectively, drew questionable conclusions, from questionably gathered data, using questionable methods. Since then, it has been assumed by many that testosterone replacement is dangerous. All this, despite the fact that when you look at the entirety of literature on the subject, it generally points in the other direction. As with any medical intervention, the way that TRT is managed is of utmost importance. But, recent studies have shown both that TRT is NOT linked to blood clots, and that normalized testosterone levels seem to reduce risk of adverse cardiovascular events.

      We do know that TRT can raise your red blood cell counts, and thereby your hematocrit, but increased red blood cells does not necessarily correlate with increased clotting. Although we often refer to this process as “blood thickening”, and medication to reduce the risk of blood clot formation as “blood thinners”, the two are not directly related. Medication like aspirin, warfarin, Plavix, and Xarelto (“blood thinners”), don’t actually thin the blood at all. Instead, they either make platelets less “sticky” or work to slow down some other part of the clotting cascade. On the other hand, when red blood cell counts or hematocrit goes up, without a commensurate rise in plasma levels, the viscosity of your blood does increase. Again, this must be managed appropriately by knowledgeable providers.

      You can read more about the studies I mentioned, here:
      http://www.rttnews.com/2525284/no-link-between-testosterone-therapy-and-blood-clots-in-veins-says-study.aspx
      http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology/52988

      I hope that helps!

      Best Regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  10. Cass on 08/12/2015 at 10:54 am

    My husband is now 50. His low-t set in about 3-3 1/2 years ago while he was deployed to Afghanistan. The doctors at the VA assumed it was just depression so they put him on an SSRI when he returned and also prescribed Viagra. They also checked his t-levels at that time and said they were “normal”. His libido tanked. Not good for me at all. I’m 9 years younger. When I found out that the SSRI could be to blame for his low libido he went back to the VA and switched meds. A year later it had not returned and he had also developed sleep apnea and was gaining weight. His mood was also very different and low. He was basically a completely different person. They checked his t-levels again, at my insistence, and again said they were “normal”. He retired in Jan 2014. By Jan 2015 the problem had not changed at all and he decided to see a GP. She had his numbers checked and said he was low, a 250. It frustrates me that the VA did not catch this. February 2015, he started using Androgel. At the end of June 2015 there was still no change and his numbers had actually dropped to a 235. He and the doctor decided to switch to injections. He gets a shot every 2 weeks. He had his third injection yesterday and still feels no different. My question… how long before he starts feeling different? Does the length of time we’ve been dealing with this matter? He is frustrated, wants to just give up on it. That breaks my heart because we aren’t as close as we were before.

    • Augie Galindo on 08/12/2015 at 11:17 am

      Cass,

      I can completely understand the concern and frustration. Unfortunately, TRT is just not well understood by most primary care providers. The numbers seen by the VA, and even his current provider represent only part of the picture. Your husband’s free testosterone levels are what matters most. Topcial medications like Androgel are a decent start, but studies show that up to 40% of people don’t absorb it at all. Others may not absorb enough to make a substantial difference. Dosing intervals and timing of testing is paramount to the proper management of testosterone replacement therapy. I typically say that patient’s receiving TRT, male or female, will see improvement in the second month of therapy. However, the medication half life is 8 days, so dosing every two weeks is what is leading to his numbers dipping below his baseline. The length of time that he has been symptomatic should not have any bearing on the response curve. I hope this helps!

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

      • Erich on 04/27/2017 at 11:34 am

        Cass,

        I too am a retired military NCO who has experienced a functional decline in almost all aspects of my life. For warriors who have been accustomed to a relatively high-performance lifestyle, this decline can be emotionally devastating. As Augie stated, many practitioner’s perception of “normal” levels is far below more experienced providers.
        Although he said I was in the normal range, my GP put me on a topical Testosterone which had absolutely no effect; so we quit the treatment. Three years later, I pursued the issue again through a Naturopath who was much better informed and aggressive than my GP. I’m on week two of 200mg/ml/week injections, and the effects are already noticeable; slightly increased energy and much more frequent spontaneous and morning erections. I have no doubt that with this current treatment, at around six to eight weeks I will be a completely different man….or more accurately,my “old self!” Specifically search for local testimonials for TRT providers and don’t give up!

        Erich

  11. Jan Hansen on 08/14/2015 at 9:12 am

    Hi. Is there any reason why you don’t recommend Nebido injections for long term treatment? It seems like a better way to maintain healthy T levels without the need for weekly injections.

    • Augie Galindo on 08/14/2015 at 3:41 pm

      Jan,

      Nebido is an option, but not here in the US. Aveed is the American equivalent and is not in widely available. We are looking into incorporating it into our practice. The little data we have back from patients has been underwhelming. The listed half life of the medication is a surprisingly low 100 minutes.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

      • Jan Hansen on 08/17/2015 at 9:16 am

        Thank you for your reply.

        http://image.slidesharecdn.com/hypogonadismandtestosteronereplacement-140502080935-phpapp01/95/hypogonadism-and-testosterone-replacement-33-638.jpg?cb=1399018247

        It does look like one would only need an injection every 7-10 weeks or so to maintain levels above 18 nmol or 500 ng/dl. It seems like this has become the standard treatment for persons on long term TRT in Europe.

        • Augie Galindo on 08/17/2015 at 10:43 am

          No problem! That is the same data given for Aveed as well. The problem is that it misses the mark. By not focusing on your free testosterone levels, it is a bit like trying to determine and manage a vehicle’s speed while staring only at the tachometer and completely ignoring the speedometer. Our limited interaction with patients utilizing testosterone undecanoate is that their symptomatic response is less stable and less robust than with weekly injections of cypionate. Also, keep in mind that the injection is a whopping 3 mL depot, is more painful, and carries with it the higher risk of oil embolization. For this reason, you have to receive special training/certification to administer the injection, and clinics utilizing this medication must have a “crash cart” of sorts on hand (to manage potential respiratory emergencies associated with injections).

          Best regards,
          Augie Galindo, PA-C
          Testosterone Centers of Texas – Founding Partner

          • Jan Hansen on 08/18/2015 at 10:56 am

            Thank you for you answer!



          • Augie Galindo on 08/18/2015 at 11:13 am

            You’re welcome!



  12. Elmer Parker on 08/14/2015 at 2:17 pm

    Does having low testosterone cause testicles shrinkage or by having low testosterone cause testicles to be small

    • Augie Galindo on 08/14/2015 at 3:35 pm

      Elmer,

      These are related, but it is usually the other way around. Negative changes in the size or firmness of testicles often indicate reduced activity. This can happen with intrinsic disease, injury, acute infection, or lack of proper stimulation from the pituitary gland. Regardless of the cause, it can usually be expected that smaller/softer testes are “under-performing” and producing less testosterone than they should be.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  13. Jason on 08/17/2015 at 11:57 pm

    So do all doses of testosterone have an 8 day half life? My doctor started me on 200 every two weeks via injection. I noticed I started crashing at about day 10. So he ordered a blood test which came in very low at 221, so he upped to me to 300 every two weeks. My levels before treatment were 351. Will this extra hundred be able to carry me a few days longer until my next cycle or can I still expect to crash on day 10 like usual. I take it, it will only raise my initial levels for the first few days a little higher, but I still should expect to crash around day 10?

    • Augie Galindo on 08/18/2015 at 9:35 am

      Jason,

      For testosterone cypionate, yes. Other preparations will have an even shorter half life.

      The problem with increasing the dose to try to eliminate a day 10 crash on bi-weekly injections, is that sooner or later you will start having unnecessary side effects from the extremely high levels that a 300 mg dose will produce. Having to push your numbers to supraphysiolgic levels at the beginning of your interval, and dealing with the associated risks, is not a good trade off. This is why we utilize weekly injections. There is less risk, and more consistent symptomatic improvement.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

      • Jason on 08/18/2015 at 10:17 am

        Thank you! Just out of curiosity, how high are my levels going in the first few days at 300? I know everyone is different and will respond differently, but on average what I expect to be over the thousand mark on an injection that size? I take it the side effects would be things like roid rage, acne, excetra? Just want to know what to keep an eye out for. With what you’ve told me I think it would be a good idea to see if I could get my doctor to switch to a weekly schedule. What do you usually do for a week, 100 or 200? Again I know this is depend on the person and follow up blood test but just trying to get an idea of where to shoot for, thanks again I appreciate it!

        • Augie Galindo on 08/18/2015 at 10:24 am

          You’re welcome, Jason. I would expect a total testosterone level above 1,000 ng/dl with a 300 mg dose, but it will also be dependent upon where you are at the time of the injection. The main side effects you will wrestle with in that scenario would be increased estrogen levels and blood thickening (increased hematocrit). You would still be unlikely to achieve levels typically associated with “roid rage”.

          The vast majority of patients get great results with weekly doses between 100-200mg.

          • Jason on 08/18/2015 at 10:43 am

            Thank you! I am going to speak to my doctor about this.



          • Augie Galindo on 08/18/2015 at 10:49 am

            No problem!



    • Jose Louis on 11/14/2015 at 9:14 pm

      Hi,

      In my personal case My Doc said it takes like 12 days it doesn’t matter the dose. 7 years ago due to a problem with my prolactin my body stopped producing testosterone at age 47 so they started with Testim which did help but also increased my blood level, so they changed to testosterone and that did the trick. During 7 years I took 200mg by-weekly and all was great keeping me around 450 . (250 is the lowest before they say you are low) But then about a year ago My Doc said my levels were better than expected and did nothing – One day a few months back I got my lab test by email and I noticed my Hemoglobin and Hemocrit was high alone with my testosterone and free testosterone as well at 900 which is really high so they took me off testosterone for 3 months. Well, is now back to 225 so they put me back on it and I started today. He wanted to put me back on 200mg bi-weekly but I refused and told him I will try will 100mg by-weekly for 3 months which he accepted but wasn’t to happy. I decided to order my ned record for the last 5 years and found out that my hemocrit was high a long time ago and they never told me anything because it wasn’t extremely high. So I highly suggest when you lab test check everything yourself. As for how long it takes to kick in, I would say around 4-6 weeks.

      • Augie Galindo on 11/16/2015 at 2:41 pm

        Jose,

        I am glad you are keeping up with things. However, if you have to keep tabs on your own levels because things are being missed, you may want to have a conversation with your clinician. Total testosterone numbers can be very arbitrary. People will feel best, and be the safest, will monitored appropriately on 7 day intervals and with free testosterone, side effect maintenance, and symptomatic response driving treatment decisions.

        Best regards,
        Augie Galindo, PA-C
        Testosterone Centers of Texas – Founding Partner

  14. Bill on 08/19/2015 at 9:08 pm

    Have been taking Testim for about 1 month now. No noticeable changes at all except maybe more acne. Still feel tired and sluggish. Had 3 tests done and all fell within 240-275 range. Want to start on injections. What would you recommend? And I’m assuming I can administer the shots myself.

    Thanks

    • Augie Galindo on 08/19/2015 at 9:13 pm

      Bill,

      That’s a fairly typical response with topicals. Studies show that up to 40% of patients do not absorb the medication at all. I recommend seeing a provider who specializes in testosterone replacement therapy. Also, I always recommend injections as the most effective route for TRT. There are clinics that allow for self-injection, however, to maintain the highest standards of care, safety, and responsibility with controlled substances, we treat our patients with weekly in-clinic injections.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  15. Lamont on 08/22/2015 at 7:17 pm

    Hello, been on testim for a month. Have a low appetite a few hours after application and then I have a raging appetite the rest of the day. Also have moments I feel good then moments I’m sluggish and feel unwell. Also have had increased anxiety at times. Is this due to my body adjusting to trt dosage. I started on 1 pack of testim then doc increased to 2 after two weeks.

    • Augie Galindo on 08/22/2015 at 7:21 pm

      Lamont,

      This is likely due to side effects of estrogen production and incorrect dosing. The only way to know for sure is to draw labs. If your provider is properly familiarized with TRT, this could be easily addressed.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

      • Lamont on 08/22/2015 at 7:24 pm

        Besides , getting blood work for testosterone levels, what other labs should I request from my doctor?

        • Augie Galindo on 08/22/2015 at 7:25 pm

          Estradiol levels definitely need to be evaluated.

          • Lamont on 08/22/2015 at 7:36 pm

            Also , when you say incorrect dosing do you believe me dose is too high? My testosterone level was 141 before I started trt. After 1st 2 weeks of testim my level went up to 342. Then I crashed doctor increased to 2 tubes and I’ve done that for 2 weeks.



          • Augie Galindo on 08/22/2015 at 7:54 pm

            Actually, it could be either. Really depends on biochemical response.



  16. Lamont on 08/23/2015 at 11:50 am

    Been on testim for 4 weeks. Dr increased dosage to two tubes after two weeks. A few times past couple of weeks have had bp spikes. Usually avg 120s overy 70s. When. It spikes it goes to 140s over 80s and I feel ill. Is increased trt dosage causing the spikes and should I be concerned?

    • Augie Galindo on 08/24/2015 at 5:18 pm

      Lamont,

      If you have only been on TRT for 4 weeks, it is doubtful that your symptoms are present because of the Testim. That being said, it is definitely time to follow up with your provider. Blood pressure issues can get serious quickly, so please seek appropriate help based on your symptoms.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

      • Lamont on 08/24/2015 at 5:31 pm

        Well, I have anxiety disorder and these spikes are happening during panic attacks which was normal according to my doctor and psychologist. However, my attacks have increased since I began trt. I was told could be hormonal related. Can trt increase anxiety symptoms and is this just a short term effect? I went to my pcp today and had blood work done on testosterone levels and estradiol as you informed me to do.

        • Augie Galindo on 08/24/2015 at 5:39 pm

          I would definitely recommend focusing on your estrogen levels.

  17. Sam on 08/25/2015 at 12:00 pm

    So, I’m a 31 y.o. Pain management patients who started taking 20mg OxyContin bid w/oxyIR prn up to tid. I looked into Testosterone levels after seeing a precipitous decline in my memory and executive functioning along with the usual complaints and a faster than expected decline in opioid analgesic effectiveness and being in pain regularly when recently there was acceptable relief. This prompted an order for a testosterone test from my pain doctor that came back at 93ng/dl total and around 20ng/dl free. My two main concerns is how long will it take to see improvement in cognitive/memory functions and pain tolerance. The rest appears to be covered and, realistically, I’m not as imminently worried about the other things given that I almost failed my physics class last semester and I’m a physics major. If I have another semester like the last one, I fear that I will fail out of school and that’s not acceptable for me.

    Also, as I am 31 and about to get married in the nearish future, what are the odds of male infertility/hrt becoming an on-label use of human chorionic gonadotropin? I haven’t gotten my fertility test back, but if opioids are tanking my GRH levels enough to get my test levels that obscenely low and cause marked gonadal atrophy, the odds are against me ever having kids while on opioids without hCG or an effective alternative and hCG is apparently prohibitively expensive.

    • Augie Galindo on 08/26/2015 at 4:56 pm

      Sam,

      TRT via hCG, while not ideal, does not have to be cost prohibitive. You will want to make sure to do your homework and find a provider well versed in this management. Compounded hCG will allow for easier dosing, as you will need higher concentrations than are commercially available. Keep in mind that opioids have a suppressing effect on the entire hypothalamic-pituitary-gonadal axis, and not just GnRH.

      If properly managed, and if baseline fertility is normal, I would think that the threat to your ability to father children would be minimal; this is, however, a guess. It is entirely possible to improve testosterone levels with hCG treatment, and you can therefore expect improvement in cognitive function to follow. Levels achieved with traditional TRT may be better, but hCG is not known to have negative effects on fertility and is therefore a safer option.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

      • Lamont on 09/03/2015 at 5:35 pm

        Hello, I’ve been on trt for about 5 weeks. I started on testim but for past week I’ve been on androgel 1.62% . I’ve noticed over the past month since started my feet stay cold. I had this issue before trt but it seems more frequent. I read cold hands and feet could be an effect of trt. Is this correct and will it go away?

        • Augie Galindo on 09/09/2015 at 7:59 am

          I’ve not seen this as an issue with TRT. You may want to have your provider look into thyroid function.

          Best regards,
          Augie Galindo, PA-C
          Testosterone Centers of Texas – Founding Partner

  18. Jmoore on 09/06/2015 at 9:03 pm

    Good evening I have been trying to find information on testosterone supplements. I am a 32 year old woman and have been put on 40mg 2x daily of androl. I had a ton of symptoms prior to my hormones being tested. Bone, joint, muscle weakness, zero libido, anxiety/mild depression, rapid weight gain etc. My numbers were 7…yes 7. So I have been put on hormone replacement. I feel a bit better as far as my bones, joints and muscles feel stronger but that’s it. I feel like it has made me put on more weight since starting 5 weeks ago. I still have no libido and I’m having a bit of anger issues. Is this all normal? When will I see positive results. I am aware that this is most likely a life time therapy for me as my body just won’t make it anymore after having my 2 children. Thank you for your help.

    • Augie Galindo on 09/09/2015 at 8:08 am

      Jmoore,

      Thank you for your inquiry. We don’t ever use oral steroids due to their side effects (especially on the liver), so my insight here may be limited. Weight gain is common early on, probably even more so with oral medication. Most mood issues, when TRT is done right have to do with estrogen level fluctuations as opposed to testosterone. However, you might be on a higher dose of testosterone than you need. Generally, women only need about 1/10th of what men need for replacement.

      Again, if done correctly, TRT typically produces positive results in around 4-8 weeks.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  19. PJ on 09/10/2015 at 10:06 am

    When is the best time during a two-week cycle of TRT to have your blood test levels checked ?
    For example if my last shot was last Saturday when is the optimal time to check my levels, how many days from then?

    • Augie Galindo on 09/14/2015 at 10:09 am

      PJ,

      We always check labs at the trough, or when levels are at their lowest. For my patients, this is on day 7 because we don’t use 14 day intervals. You will find it very difficult to maintain good trough levels with 14 day dosing, unless you use a huge dose. In turn, you would then see more side effects.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

    • Jose Louis on 11/14/2015 at 9:21 pm

      The day before your next shot-

  20. […] How Long Does Testosterone (TRT) Take To Work? – We are frequently asked how long patients will have to wait before they start feeling better after starting testosterone replacement therapy. The best answer can get … […]

  21. david on 10/14/2015 at 9:55 am

    I work in mental health, and have many clients in recovery. Is there any literature on, or do you have experience with a history of dextromethorphine and/or ETOH abuse affecting T levels long term after 6+ years of sobriety?

    • Augie Galindo on 10/19/2015 at 9:11 am

      DAvid,

      There are some articles that reference in vivo lab experiments that suggest that dextromethorphan has a suppressive effect on fertility, and promotes testicular oxidative stress ().

      Similarly, alcohol can have a negative effect on testosterone now AND later. This will be largely dependent on the duration and severity of ETOH abuse. See these studies.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  22. Charles Ssekyaaya on 10/18/2015 at 12:27 am

    Hey I just bought a tin of testosterone tablets, but I’m a sports man. I need to know more about it, how it works? how long does it take to work? How long do I have to use it for? How long will it stay in my body after my last dose?

    • Augie Galindo on 10/19/2015 at 8:56 am

      Mr. Ssekyaaya,

      Unfortunately, we don’t ever use oral testosterone because of its well documented propensity for production of side effects, so I am not able to answer those questions for you.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  23. Matthew Smith on 10/27/2015 at 6:09 am

    Hi my name is matt i have a question for you dr iv been on testim for a month now for my very low testosterone my levels are 00 i really have no testosterone at all i am a 28 year old male i dont know if this has anything to do with my low T or not but i abused alot and i mean alot of opioid pain meds mainly oxycodones 30 mgs i took them like candy but that was a couple of years back im currently on 100 mgs of methadone for my drug problem i am doing better in that regard but im wondering if my past deug problem made my testosterone the way it is now horribly low what do you think? And also does methadone make testosterone go down aswell? I have been feeling really bad for along time now i feel really tired all day long and i have no energy what so ever its just terrible to feel like this every single day for about 2 years now iv been feeling like this i mean its gotten worse over the past 2 years and i couldnt take it anymore so i went to my doctor and they got me to take a blood test for alot of stuff including testosterone and like i said earlier my numbers were very low they were in the single digets if that much. My question is why havent i felt anything from the testim that im taking once everyday? When will i finally get some energy? And be less tired? I just want to feel better and feel normal. The only thing i have noticed from taking testim for a month now is iv been getting more erections lately and my penis seems larger but other than that theres nothing positive from taking this testim for a month. I hope you can answer my question i just feel depressed because im still not feeling any better i just want some energy i just dont want to feel tired all day long anymore.

    • Augie Galindo on 10/28/2015 at 9:20 pm

      Matthew,

      Your past opioid abuse AND current methadone use can both be affecting your testosterone levels. Studies show that up to 40% of patients don’t absorb the gels well enough to improve levels satisfactorily. Also, you may just need a higher dose. The important thing is to be patient and let the labs and sound clinical judgment guide any changes.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  24. […] How Long Does Testosterone (TRT) Take To Work? – We are frequently asked how long patients will have to wait before they start feeling better after starting testosterone replacement therapy. The best answer can get … […]

  25. Zman on 11/12/2015 at 6:29 am

    Hello and thank you for this information. I have tried weekly injections but they are uncomfortable so I have been on daily Androgel 50mg and keeping it up for a couple of years. I am mostly symptom free, though my total T is still very low, around 160. Discussed with my doctor and doubled the dose for 2 months – level stayed at the same 160. Does this mean I am not absorbing much or the gel OR is my body producing less when I supplement? Is there a spot where better absorption can be expected (thinking of the calf instead of the stomach area)?

    Incidentally, I have noticed that my level of exercise influences my T levels strongly: heavy exercise will raise it to about 300. (Heavy exercise: 3-4 times of swim of 1-1.5 miles per week in a swim team.) Does this coincide with your experience?

    Thank you.

    • Augie Galindo on 11/12/2015 at 8:03 am

      Zman,

      It’s hard to say with limited information, and without the benefit of a thorough evaluation, but based on what you are telling me, it appears that you are a non-absorber. While on TRT, if responding appropriately, natural fluctuation in levels (due to things like heavy exercise) are largely limited. So, a level of 160-300, is essentially evidence that despite us of Androgel, you are in essence going without treatment.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  26. Stephen Greenberg on 11/19/2015 at 1:50 pm

    I live in Las Vegas. My Free Testosterone was at 4.2. I now take 1 ml shots every 2 weeks. You video said the half life is 7-8 days. Am I taking enough, too much and should I be taking the shots every week? I am 67, 6’4″ tall, 185lbs. Good shape . I look forward to your reply or questions.

    • Augie Galindo on 11/25/2015 at 9:32 am

      Mr. Greenberg,

      I always recommend weekly injections over bi-weekly. As far as dosing is concerned, the appropriate amount will be determined by your individual metabolism, clinical response, and manifestation of side effects as opposed to body composition. Your current dosing, if moved to weekly injections, would be “in range” with typical replacement protocols.

      Best regards,
      Augie Galindo, PA-C
      Founding Partner – Testosterone Centers of Texas

  27. […] How Long Does Testosterone (TRT) Take To Work? – It is entirely possible to improve testosterone levels with hCG … how it works? how long does it take to work? How long do … Does Cold Increase Testosterone … […]

  28. William on 12/03/2015 at 7:01 pm

    I am a 33yo male. My testosterone was a 147 on my last test. My Dr started me on cypionate 200mg weekly. My question is, is this a normal starting dose? Everything I seem to read says starting dose is usually 100g weekly.

    • Augie Galindo on 12/03/2015 at 7:10 pm

      William,

      That is pretty high for a starting dose. Most patients won’t need that much weekly for TRT.

      Best regards,

      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

    • Patrick on 12/09/2015 at 5:52 pm

      Wow, that is high. Mine was about 200 and I started at .5mg per week and as I was losing weight and getting in shape after a month of retesting mine was at 1250 which got the doctor very concerned so had me drop it down to .4mg per week. Overdosing can be bad for you too so be sure to get it checked and if you do drop a lot of weight get it rechecked as you’ll likely not need as much.

      • William on 12/11/2015 at 12:44 am

        Patrick did u mean .5ml? Because .5mg would be impossible. Cypionate most common bottle is 10ml and has 200mg per ml. So .5mg would be so small of a dose u couldn’t measure it with the needle. Just want to make sure this site has accurate info. To many places with false data when it comes to testosterone.

  29. Sean on 12/09/2015 at 3:09 pm

    I’m a 46yo male. I’m 5’6″ and 172lbs and for the last few years I’ve been noticing a fast decrease in happiness, motivation, mental acuity and libido. I went to a urologist a year ago and after some blood work he found I had low T (157). Instead of taking a shot I tried the Androgel but had to stop a few weeks into it because of the immense headaches. And so, for the past year I’ve tried moderate cardio and weight lifting 5-6 days a week to try and naturally increase my T levels as well as my happiness, motivation and etc. You’d think that I would feel great from a good exercise regimen but I don’t. I actually feel worse than when I started 1 year ago.

    As of last week my testosterone level was 137. The doc suggested T injections and so he’s put me on a 0.5ml/50mg “monthly” injection of “TESTOST CYP” with another injection in 4 weeks and then a checkup with blood work 4 weeks after that.

    I was wondering if a 50mg monthly injection is too small of a dose to make any difference? Can a small dose like this actually make things worse? So far I feel no different. Thanks!

    • Augie Galindo on 12/10/2015 at 11:32 am

      Sean,

      While it is common to not feel better after just the first few weeks of therapy, a 50mg monthly dose is not a dose that I would expect to provide adequate treatment. In fact, your assumption is correct, it could even make things worse. It is possible that you are being given just enough to suppress your natural production, but not enough to raise your already low levels.

      Best regards,

      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

    • William on 12/11/2015 at 12:28 am

      Monthly injections make no sense medically. Testosterone cypionate has a half life of 7-8 days meaning the effects of the injection stop after that time. Unless he is injecting a pellet implant that releases medication slowly of a month. I can not speak to the pellet treatment as I’m not educated on that treatment route.

  30. John on 12/14/2015 at 9:26 am

    My testosterone levels are in the low end of The normal range. I have many symptoms of low-t. Namely low libido, erectike dysfunction, depression, brain fog. I’m 37 years old. I eat really well, try to exercise regularly. Would trt help with my symptoms?

    • Augie Galindo on 12/17/2015 at 3:03 pm

      John,

      It certainly sounds like that would be the case. However, your medical history, current state of health, and labs would all need to be evaluated by a qualified clinician to make that determination. We recommend having labs checked on two separate occasions, before 10 AM to make sure that the diagnosis is accurate.

      Best regards,

      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  31. William on 12/15/2015 at 12:34 am

    U answered a question above for me about starting dose for cypionate. I’m on 1ml weekly. U stated it is a high starting dose. I have 2 follow up questions. 1 my pcp doesn’t have me coming in for a repeat blood test for 3 months, with my starting dose at 1 ml a week I’m concerned my levels will be to high should I ask to be seen sooner for a repeat blood test? 2 are patients usually put on other medications along with testosterone to control estrogen? 3 what are your thoughts on bio identical testosterone? Is it a better treatment option in your opinion? Thank you so much for your time. Sincerely,
    Concerned patient

    • Augie Galindo on 12/17/2015 at 3:07 pm

      William,

      Any changes to your current regimen should be discussed with your prescribing clinician. I can tell you that your current treatment plan differs greatly from what we typically recommend, and our plan would include at least one other medication and involve more frequent lab testing. Bio-identical vs synthetics matters greatly when replacing estrogen and progesterone, but has ultimately no significant impact when it comes to testosterone.

      Best regards,

      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  32. […] How Long Does Testosterone (TRT) Take To Work? – We are frequently asked how long patients will have to wait before they start feeling better after starting testosterone replacement therapy. The best answer can get … […]

  33. Don Linterman on 01/11/2016 at 5:55 am

    Augie,

    My T levels are at 130. Feels like I’m numb “down there”. Will TRT help with that? I’m 52 and have tons of other symptoms that fall within the realms of low T levels.

    • Augie Galindo on 01/11/2016 at 5:17 pm

      Don,

      Issues with penile sensitivity could be linked to decreased libido, and/or poor erectile quality. Since these are symptoms I expect TRT to improve upon, I would further assume that TRT would have a positive impact on your sensitivity decrease.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

      • Don Lanterman on 01/12/2016 at 4:37 am

        Augie,

        Thanks for the speedy reply, you don’t always get that on the web. I can see you are very knowledgeable on this subject and you truly care. The urologist has put me on 2MG of Testosterone cypionate once every 4 weeks. In watching this video and reading your replies, I am not being managed correctly. I am going to take the information here to him and see what his response will be. Seems like for someone in your position, it’s common knowledge for the 8 day cycle and he should know that. This is a real condition and it should set off alarms in his head. I have no energy, no stamina, skin is turning “old”. This needs to be reversed NOW! I wish I lived close to where you are as you would have another patient. I’ll follow up with you after my next visit. Thanks again!

        • Augie Galindo on 01/12/2016 at 7:39 am

          Don,

          You are most welcome! I hope that the advice helps to improve your treatment and symptoms. I look forward to your update!

          Best regards,
          Augie Galindo, PA-C
          Testosterone Centers of Texas – Founding Partner

          • Don Lanterman on 02/06/2016 at 5:39 am

            Augie,

            Ok, had blood tests. Saw urologist and endocrinologist. They put me on 0.5 cc IM injection every week. I was getting 200MG every 4 weeks, so looks like the same amount, only broken down over 4 weeks. At blood tests, my testosterone measured 125.1, Sex hormone binding globulin measured 19.10, free testosterone measured 2.99L and bioavailable testosterone measured 73.3L (both these last tests it says were calculated). I guess my question now to you is, is this the correct dosage? Seems low to me or is he maybe just starting to see where it goes? My last three tests sow my T hovering around 125 or so, so it’s not changing. Also now see triglycerides are up to 393 and norepinepherine is up to 658 (he tested a lot). I have high blood pressure. He wants to do a salt loading test for the norepinepherine levels. Thyroid is on the low end too, although I take synthroid and glycohemoglobin is 5.7. They said I am close to being a bit diabetic. So that’s my update so far. Thoughts?



          • Augie Galindo on 02/11/2016 at 3:20 pm

            Don,

            The new dose of 0.5 ml (cc) every week equates to 100 mg/week or 400 mg over 4 weeks, so your dose has actually been doubled. Based on my typical units of measure, a calculated free testosterone of 2.99 is very low. My labs are resulted in ng/dl so there may be a conversion discrepancy. At any rate, you are much closer to where you should be. An A1c of 5.7%, as a diabetic, is great! I prefer a naturally dessicated thyroid medication (like Nature-Throid) to Synthroid. There is quite a bit to that though. You can learn more about that here:

            Best regards,
            Augie Galindo, MPAS, PA-C
            Testosterone Centers of Texas | Founding Partner



  34. TommyBoy on 01/15/2016 at 6:32 pm

    Just started TGel therapy today Fingers crossed….

    • Augie Galindo on 01/19/2016 at 12:19 pm

      Good luck TommyBoy!

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas – Founding Partner

      • Micb on 01/27/2016 at 3:59 pm

        I was tested twice with a total score of 350 and 650 within a few days. My free was only 6. How do you increase free without making the total too high?

        • Augie Galindo on 02/11/2016 at 12:25 pm

          Micb,

          Unfortunately, there is no reliable way to isolate free testosterone increase. Sex hormone binding globulin (SHBG) is the most dynamic factor in this, and while there are many things that influence its production, controlling it with any degree of specificity is just not possible in my experience. What makes a difference for your health is free testosterone; both from a symptomatic response and side effect perspective. Therefore, if your total is higher, but your free is normal, you need not be concerned about the total being too high.

          Best regards,
          Augie Galindo, MPAS, PA-C
          Testosterone Centers of Texas | Founding Partner

  35. Shawn on 01/29/2016 at 9:10 pm

    Hello i was recently diagnosed with really low T. I am a 41 yrd old male. I had my first injection in december 200 mg for a month. I went in at the 3 week mark and had bloodwork done again. Before my first shot my test level was 86. When i went in for my second shot the bloodtest showed my level dropped to 56. I am really confused and not sure what to think. I am consatntly loosing weight. I work out in the gym at least 4-5. I was teading on the internet about side effects from i drug i was for acne and now im scared this is a bad side effect from taking the medicine for 5 months. Claravis a Isotentoin I like my doctor but wondering if i should go see a specialist. Please help

    • Augie Galindo on 02/11/2016 at 12:34 pm

      Shawn,

      Unfortunately, what you have experience is exactly what I would expect. Your dosing interval is entirely too long, which means it leaves you worse off than when you started by the time your next injection is due. We manage our patients with weekly injections. In typical TRT ranges, problematic acne is rare and I usually have great success treating this with over-the-counter products. Using a smaller, weekly dose helps to minimize side effects as well.

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  36. Jessie on 02/02/2016 at 9:06 pm

    My urologist started me on axiron 2 weeks ago I’m applying 2 x daily and my libido has actually went down couldn’t achieve an erection after starting this therapy I was on shots with another Dr got my level of testosterone up to 800 and did not see any improvement in libido I had always had a very active libido up to a year and a half ago I’m 43 I had sex 3 to 5 Times daily I’m getting frustrated with the therapy talked to my urologist about hcg in addition to testosterone he was not opposed he said but didn’t issue a script wants to check me in three months there’s no way I’m going through three months of this what are they missing I wanted hcg because I read of its benefits my testicles have shrunk and they are just an ornament Lol at this time what do I do thanks Jessie

    • Augie Galindo on 02/11/2016 at 1:02 pm

      Jessie,

      The use of hCG with TRT is not mandatory, and is more of just a cosmetic/aesthetic intervention. The focus of your therapy should be on metrics other than your total testosterone, and given your response, it is likely that you are having issues with estrogen conversion (the most common side effect of TRT). Definitely don’t wait three months to recheck, you may need a fresh set of eyes on this altogether.

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  37. Erick on 03/14/2016 at 4:13 am

    I started TRT for 3 months where my doctor prescribed 250mg per months. initially I was 6.2nmol/l but after three months on TRT it went down to 0.1nmol/lt what could be the problem

    • Augie Galindo on 03/19/2016 at 1:12 pm

      Erick,

      Unfortunately, monthly dosing won’t work. Google “TRT 101” and watch my video to see why.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  38. Justin on 04/06/2016 at 5:52 pm

    I started testosterone therapy when the doctor found that my levels were below 200 and I stopped 8-9 months later when I started to experience hair loss. Since then I made some lifestyle changes and started taking zinc and vitamin d. When I was tested again my levels came back at 404. I still feel a lot of the symptoms of low t but my doctor says that I’m in the normal. I read that the average level for someone my age (24) is around 650. I’m wondering if I should remain off the therapy or if it’s safe enough that I should start it back up? I felt more energized, motivated, confident, happier, and stronger when I was on it. I was also hoping to get more information on this medication I read about called clomephine citrate. Supposedly it’s been shown to increase your endogenous testosterone to the same levels that the injections can provide.

    • Augie Galindo on 04/06/2016 at 7:00 pm

      Justin,

      Your provider seems to me making judgments based off of your total testosterone alone. Your calculated free testosterone should definitely be evaluated. There is no widely accepted “age-based” range, so each patient needs to be evaluated as an individual, not just a number. I recommend that you stay away
      from Clomid (clomiphene). It’s side effect profile just isn’t one that I am comfortable with. Make sure that you also consider the fertility issues associated with TRT before restarting as well. This is most important for young patients like yourself.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  39. Emmanuel on 04/20/2016 at 11:10 pm

    I started TRT a month ago with 120 mg a week. I haven’t seen any big difference so far in the sexual aspect. The energy has improved. I am probably getting a little desperate because my wife love sex. I am 47 years old in an amazing physical shape. 5’11 and 190 pounds, I kickbox 5 times a week. Do you think that I really need another medication or is too early to tell. My testosterone was in the low end 223. Thanks for your help!!!

    • Augie Galindo on 04/21/2016 at 9:06 pm

      Emmanuel,

      Your dosing seems fine. I would definitely give it a little more time. Just make sure to share these concerns with your provider, and make sure that your lab results are discussed with you. This will make sure that you and your provider are on the same page. Most improvements start to manifest in the second month of therapy.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  40. rehan on 04/30/2016 at 4:12 pm

    I am 26 of age and I have 320 total testosterone I have starte t therpy before one munth I feel good when I was takeing t therapy but when I stop taking therpy I I feel same like taking before I want to that can I use this therpy life time or up to some years plz do reply me

    • Augie Galindo on 05/07/2016 at 2:02 pm

      Rehan,

      When managed properly, TRT should be continued indefinitely. No cycling on/off is necessary, and in my opinion, not advisable.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  41. Travis on 05/10/2016 at 3:01 pm

    As a 33 year old male my level was at 135. My doctor started me on 2 pumps AndroGel a day. I have been on it about a month now and haven’t noticed much if any change. When should I try and get my blood work redone to see if its working properly or not? I think switching to the injections would be more effective in the long run for me but I’m not sure. Thanks, I appreciate your time.

    • Augie Galindo on 05/22/2016 at 10:27 pm

      Travis,

      Typically, with topicals, I recommend labs after just a few weeks from the start date. This is because of two reasons; up to 40% of people don’t absorb the medication at all, and the half-life of AndrGel is 10-100 minutes, meaning that it reaches it’s steady state in your body very quickly.

      I strongly encourage injections for my patients. I believe it to be the best overall treatment for hypogonadism currently available.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas | Founding Partner

  42. Mike on 05/22/2016 at 3:51 am

    I am 58 and for 30-40 years have been running on 2 or 3 cylinders (automotive term for sluggish). Got worse in the last 10 years when insomnia started. I can sleep without pills most nights now but do not wake refreshed.

    Anyway, loss of weight happened 40 years ago after a gut infection and has not recovered since. I have been 58-61 kgs since then.

    The last few months I have dropped to 55 kgs. I am 5ft 10ins.

    Lack of muscle strength, apathy, procrastination, lack of stamina, mental fogginess, depression, lack of appetite and libido, poor erections, recent osteoporosis/osteopenia diagnosis…. Felt better after a Food Intolerance test in 1981 so can’t eat milk cheese onions garlic – boring !

    Had my T tested over the years and has been always higher, so has been dismissed as a cause.

    March 2016:
    SHBG – 74.6 nmol/L (19-76)
    T – 22.5 nmol/L (6-25)
    Albumin – 45 g/L (35-50)
    FSH – 6.8 iu/L (1.5-12.4)
    LH – 6.9 iu/L (1.7-8.6)
    Prolactin – 241 mu/L (86-324)

    I used a website to work out :

    Free T = 0.272 nmol/L – 1.21%
    Bioavailable T = 6.66 nmol/L = 29.6%

    Not sure if that is good or bad.

    A saliva T test from 3 years ago revealed low T….

    Also had a Short Synacthen Test to see how I react to a call for Cortisol production – this was borderline. (I had found that taking Prednisolone stopped me from suffering too much with headaches and aches and pains after exerting myself physically – also prevented hangovers from bothering me too much too !)

    Finally went to see an Endocrinologist in the UK last month privately (mainly because of the possible prednisolone improvement). Although nothing really stood out about my situation, he suggested I start a course of Testogel to see if I improve, as I seem to be exibiting most of the symptoms of low T (apart from man boobs and fat belly). Have been on it for 5 days now with no improvement.

    His assumption was that possibly the higher SHBG was eating up available T. If this is the case – why don’t doctors just test AVAILABLE T ??

    I did a T saliva test before the Testogel and it came back 34.7 (31-148)

    What are your thoughts about the above (assuming people are still awake after reading it !)

    What’s going on [

    Will I have to wait some time for improvement (if any) to show ??

    Thanks

    • Augie Galindo on 05/22/2016 at 10:52 pm

      Mike,

      I share your frustration. I too wonder why providers don’t just focus on free testosterone. That being said, your endocrinologist’s assumption was correct. Your high-normal SHBG is leaving you with a below normal free T based on your labs. I use different units of measure, but after conversion, a free T below 0.3 nmol/L is considered low. I would give the topicals a little more time, but not too much. Up to 40% of people don’t absorb that medication, so you need to keep an eye on your symptomatic and biochemical response. That being said, I do always recommend injections over other modalities for TRT.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas | Founding Partner

      • mike on 05/23/2016 at 12:43 pm

        Thanks for that.

        The Endo I am seeing only relies on Blood Tests – I had to do the saliva test off my own back. Last year a Free T revealed 9.3 pg/ml (4-30).
        If I am doing the topical T, will not my feedback system say that oooh, that’s too much T, lets stop some of your natural T production – therefore leaving me with little change in my useful T ?

        Mike

        • mike on 05/26/2016 at 2:06 am

          Well, I have been on the Testogel for just over a week, and the only thing I have noticed is morning erections have come back – not much use to me !

          Hoping for some more energy, but not seen it yet – is this normal – what should I expect… ?

  43. […] How Long Does Testosterone (TRT) Take To Work? – This video is a rapid fire explanation of testosterone replacement therapy (TRT). It will provide a great foundation for those seeking to learn more about Low T … […]

  44. Tim on 06/05/2016 at 7:42 am

    54 year old male. Was on TRT for ~ 5 years. Starting T was 92, self injected 60mg every Monday, 40mg every Friday. Had many blood tests done in trough and peak and achieved good 500-700 ranges consistently. Had major surgery (long story) and stopped treatment ~ 6 weeks ago as I felt it may be contributing to agitation. Chronic insomnia got worse, tired, no sex drive, sex impossible, depressed, etc. T tested and now 27 (lowest my PCP has ever seen). Immediately restarted previous regimen of bi-weekly IM injections 2 days ago. Based on previous results expect positive response but will ensure the other labs you have mentioned are also performed as my testicles are now bb size. My rationale for bi-weekly IM injections of cyp is to normalize peaks by breaking 100mg into two separate injections, in your experience does this have merit or is 100mg once a week just as good? I’m a former diabetic so have done thousands of shots so, while the IM shots are not pleasant if two/week are better than one I’m fine with it. Thank-you very much for this excellent reference and feedback!

    • Augie Galindo on 06/20/2016 at 2:32 pm

      Tim,

      I am glad you are back on the road to good. I do prefer once weekly for “most” of my patients. I find value in the achievement of higher levels at peak as long as the trough is maintained appropriately. If you had issues with agitation, it was much more likely to be due to estradiol levels than standard TRT doses.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

      • Tim Peterson on 06/20/2016 at 2:54 pm

        Thank-you very much for your kind response.

        I will switch to weekly injections of 100mg to get the peak a little higher.

        I’m interested in your comment regarding high estradiol levels. I start every day with a soy based protein shake and know that may increase estrogen levels. What do you recommend to block estrogen? From comments above I know dosing is recommended 48-96 hours following injection but am not sure if you are talking about a natural blocker (grape seed, etc) or something pharmaceutical? I will discuss with my PCP but like to be informed and take control of my condition the best I can on my own.

        Again, thank-you very much for your reply.

        • Augie Galindo on 06/20/2016 at 4:21 pm

          Tim,

          You’re very welcome. I utilize a pharmaceutical treatment. My treatment of choice is anastrozole, but as with everything, your provider must be careful with it’s dosing.

          Best regards,
          Augie Galindo MPAS, PA-C
          Testosterone Centers of Texas | Founding Partner

  45. John on 06/10/2016 at 10:08 am

    I have been on Androgel and then Fortesta for the last 4 years. Two years ago my doctor upped my dose to 150mg/day of Androgel to keep me in the normal range and it was costing me $1,650/month then he switched me last year to Fortesta at 150 mg/day (15 pumps) to keep me in normal range and my insurance covered this brand. Since last year my testosterone went from 650 to 335 on the same dose. He decided to switch me to injections this month. My first injection was on 3 days ago of 200mg. He said I should have them every 4 weeks. I am concerned because everything I have read states that will not work. Since my first injection, I feel worse. I have no libido and low energy. How long does it take the injection to take effect? Also should I be taking them every 2 weeks?

    • Augie Galindo on 06/20/2016 at 2:41 pm

      John,

      With injections only every 4 weeks, I doubt it will ever improve your symptoms. I am a big proponent of weekly injections. Navigate to our videos or just Google “TRT 101“. You will see why the longer regimens don’t work.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

      • John on 07/29/2016 at 2:38 pm

        I have switched to 200mg every 2 weeks. I still don’t feel any difference. Should I start injecting 200mg every week or 100mg every week.
        Thank you, John

  46. Chris Snipes on 06/27/2016 at 7:47 pm

    Hello,

    I’m a 41 year old male. 5’8″ 175lbs with a BMI of 21-23. I’m a police officer who works out (CrossFit) 4-5 days per week and run the other days.

    I just found your site and watched your video. I also just started TRT with my physician after my test results came back as follows:

    PSA was 0.4.
    My serum T was 370 and my free T was 3.1.

    My doctor has started me on 1 injection of testosterone cypionate 200 mg/mL intramuscular oil every 14 days. I just received my first injection today 6/27/16.

    My primary concern is keeping my estrogen within normal male ranges so that I can avoid any side effects e.g., gynecomastia. My doctor is not currently using an aromatase inhibitor. Is there an over the counter product that you could recommend?

    If you have any other recommendations for topics I need to discuss with my doctor, I would greatly appreciate it.

    Thank you for this valuable resource.

    • Augie Galindo on 07/12/2016 at 10:27 pm

      Chris,

      I am very glad that you have found the site helpful. The biggest hurdle is getting your doc to understand that 14 day intervals just don’t work. PDerhaps you could suggest using the same amount and moving your 200 mg every 14 days to 100 mg every 7 days. It will likely not be ideal but will be better than injections every 14 days. As for estradiol levels, the best you are going to do over the counter is DIM+CDG (Jarrow makes a good one), but it is no substitute for a prescription aromatase inhibitor. If you can get your doc to watch the video, it may help more than anything else.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  47. Mike on 06/30/2016 at 1:07 pm

    Good afternoon Doctor. I am 42 years old, my total testosterone level is 164. Yesterday, my doctor put me on 200mg of testosterone cypionate every 3 weeks at .75ml’s. Will this work or do I need to speak with her about increasing interval’s/dosing? What’s your point of view on that? Thanks!

    • Augie Galindo on 07/12/2016 at 11:04 pm

      Mike,

      Decreasing the days between injections will be your most effective change.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  48. Doug on 07/05/2016 at 7:23 pm

    I have a pituitary tumor and have been on TRT for 23 years now. Lately, I’ve noticed that the weekly injections have not been as effective in raising my energy and libido levels as they once did. I tried the new Natesto nasal and it quickly raised libido and energy. However, it was raising my spouse’s levels as well from the constant nasal drip and with handling with trash, kissing, etc. Now I’m back on less effective shots. Question: Could Natesto be administered rectally once daily instead? No secondary contamination, no post-nasal drip etc. Would liver or prostate issues increase using this method? Thanks.

    • Augie Galindo on 07/12/2016 at 11:56 pm

      Doug,

      Unfortunately, I have experience with Natesto, but the rectal delivery modality is far different from the nasal so I wouldn’t imagine the dosing to be interchangeable. It may be wise to first revisit why the injections ceased to be as effective as they once were. There may be a simple tweak that could get you back to where you once were.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  49. Peter on 07/06/2016 at 2:09 am

    Hello . Ok I watched the video great. Question , you mentioned ” the suppression on natural testostone by the therapy , what happen with this suppression ?, and would the natural testosterone would ever work to normal levels again ? .

    Thanks in advance

    • Augie Galindo on 07/13/2016 at 12:08 am

      Peter,

      The suppression of natural testosterone production with TRT happens very quickly. This is something that continues throughout therapy and for some time after therapy is discontinued. This process can last weeks to months, but, in my experience, production is restored to baseline. Now, notice I said baseline. The likelihood that someone will ever again have normal production after they have been established as having hypogonadism, is extremely low.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  50. Amy on 07/19/2016 at 10:35 pm

    Can you tell me what type of Doctor is the best to treat TRT. Unfortunately our primary care doesn’t know enough about this to help. Only wanting to do monthly injections.

    • Augie Galindo on 07/28/2016 at 2:57 pm

      Amy,

      That’s a great question! The quick answer is, someone who is well versed with the management of TRT and who has established a great track record with their patients. Understand that this might not be a physician. I myself am a PA not a doctor, but I have been exclusively treating hormonal issues since 2012. Hormonal specialists are endocrinologists, women’s health specialists are gynecologists, urological specialists are of course, urologists; however, simply because we might think a particular specialty knows TRT well doesn’t mean that this is the case. Find someone who can educate you on the process, instead of the other way around.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  51. Joshua Wirht on 08/08/2016 at 1:04 pm

    I have been on 100mg weekly of Testosterone Cyp for 8 weeks. The first shot was on a Friday. After a day or so I started to feel really good and felt great. Lots of energy and motivation sleeping improved and everything was better until the Thursday before my next shot. That Thursday and Friday I felt so exhausted. I have almost never felt that tired. That Thursday my wife had major surgery and so I thought it was just a coincidence. The next week same thing Thursday and Friday no energy but to top it off I was back to feeling crappy during the week. This has gone on for 8 weeks now. However at week 5 I stopped getting so exhausted. I still get noticeably more tired but not like I was. I’m 35 6ft 1 360 lbs. My Total T was 354 on a scale from 250 to 1100. My free T however was 43.0 pg so very low and my Bio available T was 84.6ng so again very low and Estradiol was 37. I know that with TRT there is a peak and a tail could the dose be so low that the peak isn’t high enough to make me feel any better, and by Thursday my T is so much lower then it was naturally and that’s why I feel so much more tired? If so what should I talk to my doctor about changing the dose to? If you don’t think that is it what do you think it could be? I am scheduled for blood work 9/29/2016.

    • Augie Galindo on 08/22/2016 at 1:55 pm

      Joshua,

      What you are going through does sound most like a dosing issue. Also, however, make sure your doctor plays close attention to your estradiol level. The onboarding process often has its ups and downs, but with the half-life that testosterone cypionate has, its common for things to balance about 5-6 weeks in. I can only make assumptions, but your case is similar to those that have routinely required a dose increase in my practice.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  52. Jack on 08/13/2016 at 6:09 pm

    Regarding alcohol intake, how much is too much if I were already on TRT?
    A beer or glass of wine a day okay??

    • Augie Galindo on 08/22/2016 at 4:55 pm

      Jack,

      Yes, limited intake is fine. Technically, any alcohol will increase conversion of testosterone to estradiol, but especially when on properly managed TRT, small amounts of alcohol shouldn’t pose a big problem.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  53. Graham on 09/04/2016 at 5:47 am

    Hi,

    I’ve been diagnosed with low total testerone with low SBHG and free androgen index in the normal range. Height: 1.76, Weight 114.2kg, BMI 36.9. This is after a reduction of weight loss 6 months ago being a BMI of 40.

    My total testosterone is 3.6 with SHBG 12 and free androgen index of 30.

    I’ve just been given Tostran 2% gel and to use 4 depressions (40mg) of gel once a day. I’m currently on my 2nd day of use so not expecting sudden changes but I was very surprised that I was not given a weekly injection considering the vast improvement it offers over gel, what would your opinion on this be? Thank you.

    • Augie Galindo on 09/07/2016 at 8:44 am

      Graham,

      Providers have different comfort with the different modalities available for TRT. While I greatly prefer injections over other choices, topicals can work well for the right patient. I would encourage you to give it some time and reassess 30-60 days after starting treatment.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

      • Graham Lee Compton on 09/07/2016 at 8:49 am

        Thank you, I’m well aware that it doesn’t start to really kick in until at least 3 weeks. Was more concerned if I was being given the right amount to start with.

        I can confirm that their certainly is subtle changes happening and for the better. At this rate I can imagine the changes after three weeks will be fantastic.

        Thanks again for the reply.

  54. John on 09/07/2016 at 10:59 am

    I have been injecting weekly 100 mg of cyp. I was tested after 4 weeks and my free testosterone was 778. I don’t feel any different. I don’t have any more sex drive than I did when I was at 335. My doctor was very concerned that my red blood cell count was high as well. I asked about my estrogen levels, and he stated that they wouldn’t make a difference. He lowered my weekly dose to 75 mg per week. My main two concerns are that I really didn’t feel any better at 778 and I my doctor didn’t think estrogen was a concern. He was only worried about my red blood cell count being too high, hence the lower dose now. I will note that when I was previously taking fortesta (150 MG/day) I was at 665 free testosterone and felt great.

  55. Jenny on 09/13/2016 at 7:56 pm

    My SO was diagnosed with y chromosome microdeletion and started trt approximately 10 years ago. The shots seemed to work well, until recently. Now his numbers are low again (235 at most recent test) despite weekly shots, and he was diagnosed with polycythemia, which they are saying is a result of the trt. They are telling him he has to stop the shots, and have phlebotomy therapy to get his hematocrit and hemoglobin levels normal, and then he can restart the shots. He is concerned the shots aren’t working anymore, so why bother. Do you have any suggestions, please?

    • Augie Galindo on 10/02/2016 at 3:18 pm

      Jenny,

      Polycythemia is the second most common side effect we deal with in TRT. I have found it possible to adjust dosing, perform phlebotomy, and ensure patient safety without having to stop TRT in cases like his. As far as the low numbers go, any outlier test that doesn’t make sense with the clinical picture should be repeated, but if his injection intervals are too long, levels like his can be somewhat common.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  56. Marc on 09/14/2016 at 2:12 pm

    Hi,
    I have been on TRT for about 5yrs now (I am 43), however July 13 I had an injection and July 14 I had 2 cortisone shots, one in my wrist and one in my elbow. 2.0ml in each tendon which is 2-3x over the recommended dose by the drug manufacturer. So needless to say I had horrible adverse side effects to the cortisone that sent my system into a fight or flight mode. The first 20 days were super bad and debilitating. 80% of the side effects listed I had in a bad way. As of now they are still lingering, which would be the anxiety. (Never had any issues of anxiety before these cortisone shots, never) and trouble getting and staying asleep.
    Well I stopped the TRT all together thinking it may add the what was going on.
    Finally had blood work done and T is 93.2 and Free Test at 2.16 so I resumed TRT on Aug. 29th
    From the video (thanks by the way) you are saying my T level should almost jump to normal levels over night?
    Not sure if my hormones (all) are just completely messed up, or if these Cortisone shots complete destroyed my adrenals.
    So far my new Dr. is doing process of elimination I suppose, because next blood work is in 6 weeks?
    I’m having a hard time in finding the cause of the lingering anxiety and other side effects other than I am experiencing PTSD which adds a “freeze” mode to the “fight or flight” mode.
    Any thoughts or ideas would be greatly appreciated.
    I will travel for the right help, I’m up north almost to Durant, Ok.
    So after about 2 weeks can’t say I feel much better except maybe the day after a shot. I was told I can split my dose, so .5cc of T twice weekly.
    Thanks

    • Augie Galindo on 10/02/2016 at 3:26 pm

      Marc,

      I would continue to focus on your adrenal function. The best way to help here is with diet, behavior modification, and supplementation. While your testosterone levels do increase significantly right after injections, it may take some time for your body to recalibrate. Also, the speed at which your liver breaks down the medication my have changed dramatically. Estradiol levels could even be impacting your anxiety.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  57. Erin on 10/09/2016 at 2:08 am

    My husband is 32 and has an overactive thyroid so we blamed his low sex drive on that until he finally went to the Dr to get on his thyroid medicine again, but instead they determined his testosterone level was 113!!! Yes…113 at 32 yo!! (Dr said it’s the level of a ninety year old man, and the lowest he’s ever seen). He’s had one injection so far and will go every two weeks. The Dr decided to not put him on his thyroid meds even tho they were higher than normal. Could his untreated overactive thyroid cause his testosterone injections to not work? It’s been months since…you know what…and I need it!!! Please tell me this won’t make me wait longer!!!
    -a needy wife

    • Augie Galindo on 10/10/2016 at 4:33 pm

      Erin,

      The biggest threat to your husband’s response to therapy is that his doctor has chosen to only dose once every two weeks. Also, you both need to have a long, serious talk about the effects TRT has on fertility. If he is being monitored carefully, watchful waiting of the hyperthyroidism should not have a huge impact.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  58. Joe Giannone on 10/16/2016 at 11:42 pm

    How do I know if my problem is low t or a thyroid issue? I have seen numerous changes in my body that point to both.

    • Augie Galindo on 10/20/2016 at 3:43 pm

      Joe,

      The best method of differentiating between the two is to have a focused history, physical exam, and lab analysis done.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  59. Christian on 11/09/2016 at 8:27 am

    Hello,
    What is the recommended starting dose of Testosterone Cypionate? And is this weekly or every 2 weeks? I am 45 and my total is 99 ng/dl. I have classic symptoms and am about to start treatment. Also, what are the recommended mandatory baseline labs that should be drawn? Thanks.

    • Augie Galindo on 11/22/2016 at 10:56 am

      Christian,

      I don’t give dosing recommendations in this setting, but I am a big proponent of weekly dosing. I recommend having baseline levels done for total and free testosterone, estradiol, pituitary function, prostate health, thyroid studies, lipids, and CBC & CMP.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  60. Testosterone Injections And Warfarin on 11/09/2016 at 6:07 pm

    […] How Long Does Testosterone (TRT) Take To Work? – Starting treatment for Low T? While some patients with low testosterone do respond faster than others, most patients feel improvement in symptoms within 4-6 weeks of … […]

  61. Brandon Thomson on 11/23/2016 at 12:58 am

    Hello, to make a long story short I have been diagnosed with depression anxiety etc. But about a year ago diagnosed with sever sleep apnea, I would stop breathing 34 times an hour, went on CPAP and now down to 8 times an hour.I am on Suboxone for past opiod addiction, i was using crack, crystal meth and opiods. I got blood test for testosterone level and it came back at 70, my doctor said it is a little low so I’m going to be getting a ingection every week. My question is will it effect my sleep apnea? Thank you

    • Augie Galindo on 11/26/2016 at 5:36 pm

      Brandon,

      Studies do suggest that TRT can worsen untreated sleep apnea. So, with that said, tread with caution. On the other hand, if you are properly treated, and your CPAP settings are appropriately adjusted, my experience with TRT patients who have sleep apnea is that they still do see a positive response with therapy.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  62. Pat Hendry on 11/27/2016 at 12:28 am

    I’ve been a compounded topical test/dhea cream for almost a year. 125mg test/50mg dhea per mg, 1mg of cream daily. Tested mid 800 in may after about 6mths of use, was thrilled, felt great. Just tested in nov. and i’m 225 on the same doseage, and was noticing a lack of umph in my work outs, and lack of concentration, all that goes with low t. I’ve taken a day off doseing once a week, and probably 5 days off a couple times in this period per Drs orders. In Aug. prescription was refilled and we’ve had various issues with this pharmacy prior. I have switched pharmacies just this week, wondering if there was even any test in the prior script. The new script was bumped up to 150mg test/50mg dhea per mg per day. Have to wait and see i guess if the former pharmacy forgot to put test in my last batch. Have told the Dr. i want more frequent blood tests, and she agreed. I did read about a possible condition of the carrier in the cream, and found some info on being “saturated” thus not absorbing it. Have yet to find someone to test the last tube of that batch, I just hadnt read of anyone not responding to test until today. So i’ve assumed they screwed up the batch. What Would a drop from 880 to 225 in six mths say to you?

    • Augie Galindo on 11/27/2016 at 2:58 pm

      Pat,

      There are many, many variables here. With the medication alone it could be human error, a change in substrate ingredients, degradation due to storage environment at any point from manufacture to use, prolongation of use beyond efficacy limitation, or even a change in how your body is reacting to the preparation. Secondly, many things can limit your ability to properly absorb the medication; if you shower too soon, sweat too heavily, get dressed before it dries, absorption will be negatively affected. All that aside, the symptomatic and numerical changes you have seen most likely do have something to do with the medication. I do sometimes use compounded medications for issues not related to testosterone, but generally try to avoid them when possible. It does tend to add more human hands (and chances for human error) into the mix.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

      • Pat on 11/28/2016 at 8:48 am

        Thank you for the quick response Augie. I can take a couple variables out of the process, in that i shower before I apply the cream, and i’m not sweating after applying, and dress after it dries. My wife told me that she had a conversation with the new pharmacist and he said he could have made the current batch with a gel that dries quicker, I wish he had told me that before he made it. Where can I get info on questions to ask the pharmacist before he makes it? I need to become my advocate, and not be so at the mercy of others.

        • Augie Galindo on 12/03/2016 at 6:36 pm

          Pat,

          The best place to come up with questions is probably a rival compounding pharmacy. That being said, here are some questions I was given by a friend of mine to assess compounding pharmacies that we were evaluating for BHRT referrals:

          1) Check the Texas State Board of Pharmacy for the status of the pharmacy license, even if they are out of the state they will have to be licensed in Texas. This will also tell you if they are licensed to provide compounds, and or sterile compounds. https://www.pharmacy.texas.gov/dbsearch/phy_search.asp

          2) Check the FDA website to see if they have had an inspection with violations. Keep in mind these federal inspections are not based on pharmacy rules, however, tey are inspecting the pharmacy as a manufacturer. However, they are useful to look at as far as product quality issues. http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/PharmacyCompounding/ucm339771.htm

          3) What professional accreditations does the pharmacy hold?

          4) Quality assurance steps….

          A) Pharmacy/Outsourcing facility is to provide a C of A (certificate of analysis) for all ingredients used in the finished product; I would recommend you keep these on file in your office as well.

          B) Pharmacy/ Outsourcing facility is to provide a test report on the first batch of compounded medications they are making for you that validates both sterility (if applicable) and potency.

          C) Pharmacy/ Outsourcing facility is to inform the clinic of how often they will be testing subsequent lots of medications for sterility and potency.

          Best regards,
          Augie Galindo MPAS, PA-C
          Testosterone Centers of Texas | Founding Partner

  63. Tom on 01/20/2017 at 12:22 pm

    Mr. Galindo,

    Thank you for all of the effort you put into this site and responding to comments – I read every single one of them.

    A few days ago I received my first injection of Test Cyp 100mg. This is the only injection I have received. For various reasons, I have decided not to continue treatment.

    Generally speaking, would I be able to simply not receive my 2nd injection and stop treatment and have my T levels return to where they were before my first shot? I would assume that the risks of stopping cold turkey after only one 100mg injection would be somewhat low, but would really appreciate your opinion.

    • Augie Galindo on 02/06/2017 at 6:36 pm

      Tom,

      It looks like I may have missed the window to respond in a timely fashion, but your assumption is correct. Your single injection would make “rebounding” to normal production and essential “non-event”. Thank you for your feedback, and I hope you find a solution that works great for you.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  64. Mark Kirby on 02/18/2017 at 7:47 pm

    Hi interesting article, just curious do you feel there is a link between low T and vasectomy?

    • Augie Galindo on 02/24/2017 at 1:44 pm

      Mark,

      Great question! Here is some great information on that topic in THIS BLOG POST on vasectomies and low T.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  65. Ariel on 04/04/2017 at 12:52 pm

    Hi, my family doctor put me on compounded testosterone cream 100 mg daily and Arimidex .5 M,W,F. Before any TRT my T was 426 and E2 52 then a repeat test T 356 and E2 58. Are my numbers bad to have to start treatment?
    Isn’t the Arimidex dose too high?

    • Augie Galindo on 04/13/2017 at 6:32 pm

      Ariel,

      Unfortunately, I don’t really have enough information to go on, and evaluating more really gets into making treatment recommendations which I cannot do in this setting. Your total T’s alone don’t meet the criteria for treatment that I adhere to, and other factors have to be considered to know if that dose of Arimidex is appropriate.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

      • Ariel Rodriguez on 04/13/2017 at 6:51 pm

        Thank you. Before the cream I was like total t 429 free 92 and e 52. A second time still no cream total t 356 and free 71 and e 58.
        Now after 5 weeks on t cream the total 798 free 192 and e 45.
        How is it looking now?

        • Augie Galindo on 04/15/2017 at 12:27 pm

          Ariel,

          It certainly looks like there is some improvement, but following symptom improvement and serial measurement of biochemical response will definitely be needed.

          Best regards,
          Augie Galindo MPAS, PA-C
          Testosterone Centers of Texas | Founding Partner

  66. Dave on 05/19/2017 at 5:28 pm

    I have been placed on 1ml every 3 weeks of Cypionate. my T level is 318. 1) Is that a good starting dose and 2) how much will it increase my level?

    • Augie Galindo on 05/25/2017 at 6:38 pm

      Dave,

      Honestly, if that’s what they chose to start you at, I would recommend finding another provider because that regimen indicates a lack of understanding of the basic fundamentals of TRT. At trough, your level will be lower than they were when you started.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  67. Syed on 06/18/2017 at 3:45 pm

    Hi Dr
    My age 31 male
    I am using sustanon 250 mg from 3 years , on 3 weeks cycle suggested by sr.endroconologist

    2 months just married

    Sex drive is low, if i use tazzale 10mg tablets, i am very very happy with intercourse and this effect/ impact till 3 to 4 days after that again low Drive

    Some where i read tazzale 10mg tablets not good for long run, is it so??

    With out tazzale, by increasing testosterone can my life will be happy ??

    Please advise Dr

    • Augie Galindo on 06/24/2017 at 7:44 pm

      Syed,

      Unfortunately, these are not medications that I am familiar with as we do not use them in the states.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  68. Vincenzo on 08/17/2017 at 7:49 am

    I’ve had sporadic ED issues for a few years, had my PC take blood, always came back that my T was “in a normal range”, sent me off with Viagra or Cialis. I finally made a decision to see a SPECIALIST. My first Uro was not nice, says “you have anxiety issue, go see a therapist”. Yeah.. Really? It’s called anxiety from having no libido and your wife being upset… So, I went to a SPECIALIST. Let me tell you… First off, FULL PHYSICAL. Run if all you’re getting is blood work. I had 3 sets of hands on my “junk” on day one, checking to make sure there was no tumors or lumps. Then a nerve check, which provided no surprises that the right side of my shaft was not as sensitive (I had back surgery) but the doc said this has no effect. Next was a arterial flexibility check (fingers in a device, blood flow cut off to one arm) to check for any arterial hardening. Normal range, if it wasn’t, they send you to cardiologist. EKG. I had a 6 mo. old blood test that said my Free T was 390. Doc said it’s not just a numbers game, and interviewed me and asked me a ton of questions about sleep, libido, well being, etc. He said you’re suffering from low T, took a blood test, send me home with a rigiscan device to monitor nocturnal erections. Next office visit, my T came back at 127. Checked liver function tests, Estradiol (Estrogen), Prolactin, everything. My data from the Rigiscan said my penis wasn’t fully getting erect on a normal pattern for 2 nights, normal for 3rd night. I was then injected with prostaglandin E-1 to measure arterial flow and had a doppler test. Mostly normal, EXCEPT for some minor corporal venous occlusion disorder (CVOD), i.e., blood flowing back out of my penis. 2nd blood test. 3rd visit, T came back at 172. Doctor explained that low Testosterone (and the associated anxiety it is creating in me) is linked to CVOD, I opted for pellet insertion. He explained that some of this is just due to the anxiety and behavior modification (me shutting down sexually) is also contributing due to anxiety releasing epinephrine into my blood, which is the same response the body has after you climax to kill your erection. Epi is sex killer. So, started the Test, may introduce a low dose beta blocker if the Test doesn’t help me overcome some anxiety. On my 3rd day now, do feel some a bit better, no libido effects just yet. But… THIS is what your call a THOROUGH EXAM, not just blood work

    • Augie Galindo on 08/17/2017 at 8:49 am

      Vincenzo,

      I do agree that what you went through was a very thorough work up for complete to near-complete erectile dysfunction, but it is quite a bit more than is prudent for the mild ED issues I see in the patients who come to see me. Understand that ED exists on a spectrum, and that it is only one symptom of hypogonadism. Our focus is not to diagnose, grade, or treat ED, but rather, to identify when true testosterone deficiency is present and causing problems. The history and physical does include a physical exam, but the interview includes the evaluation for sleep quality, libido, erectile function, well being, and many other points of concern. Laboratory-wise, we look at two separate testosterone tests, on two separate occasions. The battery of initial tests include a total serum testosterone, sex hormone binding globulin, calculated free testosterone, estradiol, prolactin, follicular stimulating hormone, luteinizing hormone, complete blood count, comprehensive metabolic panel, lipid panel, and thyroid panel. Additionally, we test every male patient’s PSA and every female’s progesterone level. At the end of this all, it appears you’ve seen two specialists, had multiple procedures done (some invasive), and yet still ended up with the same treatment that you might have if your PCP would have understood the importance of your clinical presentation and your calculated free testosterone, not just your total. The exhaustive workup certainly has it’s place, but it is expensive, time consuming, and when only transient ED issues are present, it most often fails to identify treatable structural anomaly or physiological deficit.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  69. Farhan on 09/26/2017 at 1:45 pm

    I am M 32, I have Low Testosterone level 235 with zero sex drive and low libido… i am thinking of TRT after consulting with specialist. Beside i want to know main reason for my low testosterene level. Also i want natural recovery for my testosterene production.

    • Farhan,

      Those are common questions. Unfortunately, finding the specific causes is not so common. Once your body stops making enough testosterone, I very rarely see it get back to optimal production naturally.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

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