Male Testosterone Levels Are Declining Rapidly
This guide on hormone replacement therapy is written for 21st century men because men before our generation never needed it.
According to Dr Anthony G. Jay, author of Estrogeneration, male testosterone levels today are less than half of what they used to be.
Today’s middle-aged men have an average testosterone level of 400 ng/dL when they should be hitting 800.
Take a close look at the graph below which documents the testosterone levels of the US male population:
Based on the graph, you’ll notice several disturbing trends:
- An 18-year old teenager today has the same testosterone levels as his 68-year old grandfather
- Men in their forties have lower testosterone levels than their fathers in their sixties
- Almost a quarter of all men have worryingly low levels of testosterone – 300 ng/dL and below
This is worrying because testosterone is literally the lifeblood of men, just like estrogen is for women.
Why Is Testosterone Important For Men?
You need testosterone for:
- Male sexual development and libido
- Building and maintaining muscle mass
- Energy levels and motivation
- Maintaining healthy bone density
The thing is, our testosterone levels decline by 1% per year after 30 years old.
As a result of this natural decline, men eventually end up with a stable 400-500 ng/dL in their seventies.
The problem is that today we are starting out with the SAME testosterone levels as our grandfathers. By the time we reach our thirties and forties, we’d become a low-testosterone shell with sub-300 levels.
Enter Hormone Replacement Therapy
Hormone replacement therapy (HRT) is a way to get your testosterone levels back in the healthy or even optimal range.
You should consider getting HRT if you meet four important criteria:
- Based on blood work, you suffer from low testosterone (lower than 300-350ng/dL)
- You experience symptoms such as moodiness, lack of energy, fatigue and stalled gym progress
- You have exhausted every other method to improve T levels such as dietary changes
- There is no pre-existing medical condition that would aggravate your health
If you satisfy these criteria, do some research on testosterone replacement clinics around your city.
More importantly, look for an open-minded doctor with a good track record. This is the most critical factor for success with hormone replacement.
Some doctors are conservative and only want to bring you back to the 500-600 ng/dL acceptable range. Other doctors are more liberal and will help bring you to the 800-1100 ng/dL range as long as your health markers are okay.
Regardless, it’s a huge decision to make and I recommend taking your time to evaluate your options.
What Can Hormone Replacement Therapy Do For You?
If you have low T levels, hormone replacement therapy will change your life in many ways.
Perhaps it’s better if I show you some quotes by men who have gone for HRT.
- “I vividly remember waking up one morning in the weirdest of moods; my mind was clear. I felt focused and determined for the first time in five years.”
- “Lost 30lbs in 12 months… As for mood, it stays more even.”
- “My workouts actually equated to muscle mass and I actually attacked it with much more ferocity.”
Clearly, HRT is a game changer if you’ve been deficient in testosterone. You feel revitalized, motivated and strong again. Your libido returns to youthful levels and your gym progress gets naturally faster.
Types of Hormone Replacement Therapy For Men
1. Clomid Therapy
Clomid is a selective estrogen receptor modulator (SERM) and it is frequently prescribed to men as a first line of action to combat low T.
It binds to estrogen receptors, fooling your body into thinking your estrogen levels are lower than they really are. This makes the pituitary gland release both luteinizing hormone (LH) and follicle stimulating hormone (FSH).
- LH stimulates the testes to produce more testosterone
- FSH encourages fertility, improving sperm count and motility
The typical dose for clomid therapy is 25 mg every day or every two days.
For many men, clomid radically brings testosterone levels up to a high level – it is very common to see blood results above 1000 ng/dL with clomid alone.
Fun Fact: Since clomid helps produce LH and FSH, many men see an improvement in their ejaculate volume.
Despite its testosterone boosting properties, clomid is rarely a long-term HRT strategy because it wreaks mental havoc on many men. Clomid patients frequently complain about terrible mood they experience – being prone to anger, depression and instability.
One possible reason clomid is unsuitable for many men is that it increases estrogen levels, as shown by their blood work. This may be the underlying cause of the moodiness and emotional instability after taking clomid.
Eventually, most men who try clomid will explore other HRT options that provide fewer side effects.
2. HCG Monotherapy
Human chorionic gonadotropin, or HCG, is a hormone that acts like LH and stimulates the testes to produce more testosterone.
Many cutting-edge fertility clinics in the US have picked up on HCG and prescribed it to men with low T levels.
HCG differs from clomid as it has to be injected subcutaneously into body fat with an insulin syringe. The most common site of injection is into the fat pad of the belly area.
The typical dosage for HCG therapy is 250-500ius every two days. Low doses are less efficient as HCG is eliminated at a disproportionately faster rate as shown below by the brown area.
As you can see, although 500iu is only three times larger than 150iu, its aggregate effect (green area) is more than 20 times larger.
The main drawback to HCG therapy is that many men have also noted a large spike in estrogen levels. This is possibly due to the rapid amount of conversion of testosterone to estrogen, especially within the testicles.
Yet again, many men have opted for other HRT strategies beyond HCG.
3. Testosterone Replacement Therapy (TRT)
There is nothing as straightforward to treating low testosterone as taking testosterone.
Yet, testosterone replacement therapy is probably the biggest commitment out of all the options.
Administering testosterone will suppress your natural T levels which means that you often have to be on testosterone for life.
This sounds really scary of course. But to put things in perspective, that’s still a million times better than living with low testosterone.
There are two main routes of testosterone administration: Gels and injections.
Testosterone gels usually come in a trademarked version called Androgel and you have to apply it to your body daily. This is the more convenient method but some men feel that it loses its efficacy over time. Also, you risk contaminating your partner and children with it via skin contact.
Testosterone injections promote stabler blood levels of testosterone because they are specially formulated for extended release over a few days:
- Propionate can be injected every two days
- Enanthate, cypionate or Sustanon can be injected once or twice a week
- Undecanoate (Nebido/Aveed) can be injected every four weeks
If you opt for testosterone injections, I suggest convincing your doctor to let you self-administer at home so you can save the expensive trips to the clinic.
A good dose to start with is 100-140mg a week, then adjusting accordingly after the next set of blood tests. Some men need as much as 200mg to feel better, while others can get away with 70-80mg a week.
4. The Integrated Approach
Even while on regular testosterone injections, some men don’t feel as mentally sharp or upbeat as they would like to.
One explanation is that testosterone therapy tends to suppress the upstream hormones – pregnenolone and DHEA.
- Pregnenolone is the mother hormone that protects nerves, enhances learning and promotes deep sleep
- DHEA improves memory and reduces stress
If you’ve ever taken experimented with pregnenolone or DHEA gels like I have, you will realize what a world of difference these two hormones make to your well-being.
This is why some doctors will prescribe HCG in conjunction with testosterone gels/injections. HCG stimulates the conversion of cholesterol into pregnenolone and DHEA which results in greater mental clarity and well-being.
Side Effects of HRT and How To Manage Them
1A. High Estrogen
Most men on HRT will experience high estrogen because an enzyme called aromatase converts testosterone into estrogen. One particularly potent form is called estradiol (E2).
Unless you’re genetically gifted, the higher your testosterone levels are, the greater the conversion into E2.
Normally, healthy E2 levels are between 20-30 pg/mL. Without proper management, hormone replacement therapy will skyrocket your E2.
High E2 manifests differently across individuals but the most telling symptoms are:
- Increased fat storage in the stomach and nipple area
- Low libido and tiredness
- Oily skin and acne
- Proneness to emotional disturbances
- Social anxiety
Therefore, estradiol management must be an integral part of every man’s hormone protocol.
1B. How To Treat High Estrogen
There are three clinical aromatase inhibitors (AIs) that are prescribed to men to reduce E2 levels:
- Arimidex is the most common AI and it is powerful. Doctors frequently prescribe extremely large doses (1 mg ED) and this leads to a huge E2 crash. The best approach is to start with 0.25mg E2D and increase as needed.
- Aromasin binds irreversibly to aromatase and inactivates it. This may seem like a great idea, but there are serious risks if you overdo it; E2 will stay crushed for weeks as the body makes new aromatase. Nonetheless, some men have a good experience with aromasin.
- Letrozole is the strongest of the three clinical AIs. I don’t recommend using letrozole as even a small amount can crash your E2. It’s virtually impossible to maintain stable E2 levels with it.
There are some men who are hyper-sensitive to AIs and even a small amount would lead to an E2 crash. One method that works for me is to dissolve arimidex in vodka and microdose in 0.01mg increments with a syringe.
An over-the-counter AI that works really well is Arimistane. It allows you to control E2 with a larger margin of error. It is found in a supplement called Estro Strike 2.0 by Assault Labs.
I’ve also experienced mild E2-lowering effects with a DHT-based compound called Proviron. It is theorized that DHT has estrogen-blocking effects and I have personally found this to be true.
2. Poor Cholesterol Markers
It is common for cholesterol markers to worsen especially on high testosterone doses.
- LDL (bad cholesterol) and triglycerides may increase excessively
- HDL (good cholesterol) may decrease
To tackle the high LDL and triglycerides, I recommend a high-fiber diet or fiber supplementation with psyllium husk. This leads to more bile being produced, and cholesterol being used up in the process.
To improve your HDL scores, I recommend a powerful combo of citrus bergamot and krill oil. In 99% of cases, this optimizes your heart health and guarantees an optimal HDL score.
3. Prostate Issues
Traditionally, prostate discomfort was thought to be due to high levels of DHT which is a metabolite of testosterone.
Recent clinical evidence has suggested that this is largely due to high estradiol levels. It turns out that the prostate is a estrogen target tissue and grows with estrogen exposure.
Therefore, the best way to resolve prostate issues is to get your E2 in range by dosing AIs or lowering your testosterone dose.
Acne is like a multi-headed hydra. When you chop a head off, two more grow back in its place. Cheap topical gels and creams do not usually work and only serve to irritate your skin.
To drive a stake through the heart, you need to get to the root of the acne.
Firstly, you need to get your E2 down to about 20-30 pg/ml as high E2 levels in men lead to overactive sebaceous glands.
Secondly, you need to get your nutrition in order:
- Increase your intake of antioxidants and anti-inflammatory foods such as omega-3s and astaxanthin (from krill oil)
- Take enough zinc as it has been clinically demonstrated to reduce acne
- Eliminate common dietary culprits such as soy and dairy, then slowly reintroduce them in isolation
- Reduce inflammation by sleeping enough and consuming less sugar
A Note on HRT and Fertility
If you do choose to go on testosterone replacement therapy (gel or injection), take note that this will suppress your natural production of testosterone, LH and FSH. This means that sperm count and motility take a hit and it might be hard to conceive.
This is reversible as it can be countered by a special protocol of HCG, HMG and clomid when you decide that you want to be fertile again. This combo raises your LH and FSH back to healthy levels, restoring your sperm health and quality.
To get on this protocol, consult your fertility specialist.
Action Steps for Men Considering HRT
- Get your testosterone screen test results. If you’re in Singapore I recommend Crawfurd Medical as I had a good experience with them and you can read about it here.
- If your levels are low, try making lifestyle changes first. For example, get more sleep and consume more zinc. I recommend the OptiZinc complex by NOW as it is more bioavailable than other forms.
- Do your research. Pay special note to the track record and reputation of the clinic and the doctor. You must get a doctor who is open-minded and up-to-date with HRT developments. Make phone calls to find out more if necessary.
- Schedule a consultation with an andrologist, endocrinologist or urologist. If you can demonstrate that you have low T levels AND symptoms, ask for the available HRT options and choose one which suits your convenience and needs.
- Follow-up and cooperate with your doctor. Doctors will order regular tests to ensure your health markers such as blood pressure and prostate markers are not compromised by HRT.
- Consult with me at any time. I have experimented with hormone optimization for years and I probably have the solution to your problem.
Testosterone levels are dropping by the generation and men are literally becoming demasculinized. The average level is down from 800 ng/dL to 400 and the latest figure is nowhere close to what is considered optimal.
Men are constantly walking around in empty shells of their former selves, not knowing what hit them.
I truly believe that many men are in dire need of hormone replacement therapy yet few ever get to learn about it. Having experienced low testosterone before, I do not wish for anyone to go through it.
I hope this article serves as a comprehensive resource for any man who may need to seriously consider HRT at some point in his life.
Do leave a comment if you have any questions or feedback.