Frequently our patients ask about the amount of time it may take for them to first experience noticeable improvement of their symptoms once they have started testosterone replacement therapy. Certainly, the results people experience do vary in both timing and intensity, but there are studies that help shed some light on this particular query.
Below you can view a video that will quickly introduce you to the ins and outs of therapy.
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.
The Short Answer
Most patients feel significant changes after about one month of therapy. While some respond faster, it is unclear what leads to this variance. Often, it is speculated that other factors like obesity, chronic illness, or medications can slow or dull the response. Many people feel improvements as soon as this first week but this is certainly not standard. Beyond that, upon questioning, most patients will state that they have noticed positive improvements in symptoms such as cognitive function, or libido, or difficulty maintaining sleep by the third week or so.
Keep in mind that this 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, the lag in symptomatic response is representative of the time it takes for your body to reach steady return. Maintaining testosterone levels in the mid-normal range is what promotes the best overall result.
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” that 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.
As the studies 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:
1. For men with symptoms from low testosterone levels, treatment works.
2. Treatment typically begins to work some time before the 3rd week of therapy.
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.
The researchers behind this journal article looked only at sexual functioning and mood. In future posts we will present evidence from more studies, which document several of the numerous improvements seen with the treatment of 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.