TRT (Testosterone Replacement Therapy)

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What is TRT all about?

The goal of any sound TRT program should be to restore a man’s most positive sense of himself to a level that fits with the most balanced point in his lifetime… the age when he felt best because the hormonal milieu was in a state of harmony where testosterone production closely matches the body’s demands.

For most men, this hormonal harmony occurs sometime between the mid-20’s and mid-30’s, and while not every man will be able to fully return to feeling as if they are 28 again, the goal of TRT is move as far in that direction as is physiologically possible without disrupting the body’s natural homeostasis to a point that it causes more harm than good.

A successful TRT program will restore that competitive edge from your younger years that will put you back at the head of the pack at work, and at home.Competition

Testosterone production begins to decline in the mid-to-late 30’s, and will continue to decline throughout a man’s lifetime. This is not a question of “if” testosterone levels will decline, it’s more of a question of “When?” and “How will that decline affect me personally?” Every man experiences declining testosterone levels differently, so in order for Testosterone Replacement Therapy to be successful, it needs to be tailored to the individual in question. Just as men have differing experiences when testosterone production begins to decline, they also have different experiences when it is replaced. Because of this, there is no such thing as a “catch all” program or protocol that works the same way for every individual.


The Symptoms of “Low T”, and the Benefits of TRT

As stated above, every man experiences a drop in testosterone production differently, but one of the most classic patterns is a 35-50 year old man who, on most days, has several of the following symptoms:

  • Feels much older than his actual age
  • Feels depressed about feeling older than he should
  • Finds that it is much harder to deal with stressful situations at home and work
  • Finds himself feeling anxious about trivial matters when he never did before
  • Finds himself falling behind on important tasks because he can’t concentrate or focus like he used to
  • Finds himself struggling to find motivation for things he used to enjoy
  • Feels worried about his sudden lack of a sex drive
  • Finds himself gaining weight because he doesn’t have the motivation to exercise like he used to, or fight food cravings like he used to
  • Finds himself tired all the time no matter how much he sleeps, and finds his sleep more restless and uncomfortable than before

This is not to say that these are the only symptoms of low T, nor is this the only age that low T can pose a problem for a man. Some men experience only a few of these symptoms in very mild forms at this age, and some don’t experience any of these until much later in life. The is only meant to represent the “most common” profile of a man who should consider TRT.

The “Symptoms” of low T are grouped with the “Benefits” of TRT because any successful TRT program should eliminate or reduce a fair percentage of these symptoms, and therefore the elimination or reduction of each symptom is also how the benefits are defined. Within 4-6 weeks of beginning TRT, most men can expect to feel younger, less tired, less depressed and anxious, more enthusiastic about sex and exercise, and that their sleep is much more restful. This naturally contributes to a snowball effect (a positive one) where feeling better overall leads to better habits, a better work ethic, and a more rewarding life in general. Once a positive outlook and a general sense of well being is established, TRT becomes more of an experience than a “program”, and that is truly a success.


How to Diagnose Low T

You may find it ironic that a low blood level of testosterone was not the first item listed in the previous section about the symptoms of low T, and in fact, it’s not mentioned at all. Why is that? First of all, blood levels are not “symptoms”. People don’t notice that their testosterone level is 302. They notice that they feel tired and depressed, and that they’ve lost their sex drive. So, in line with this train of thought, the syndrome of “low T” is not necessarily diagnosed by a low blood level as you might think, and blood levels are not the key determinant of the necessity or the success of a TRT program. The presence and the severity of the symptoms are the most important indicator of whether or not a man should consider TRT, and likewise, the absence or reduction in severity of those same symptoms are the key determinant of whether or not a TRT program is successful.

Symptoms of low TThe range of blood levels that is considered “normal” is quite large, so the only values that are consistently meaningful are those that are either SIGNIFICANTLY too high (supra physiologic levels found in performance supplementation or testosterone abuse) or SIGNIFICANTLY too low (developmental problems in children and adolescents. The vast majority of men do not fall into either of these two categories, so nearly every man interested in TRT can expect his lab values to be within, or very close to, the normal limits. Therefore, lab values have little to no bearing on whether or not you will benefit from TRT, unless you have a comparison level from a time in your life when none of your symptoms existed (which of course no one has). Likewise, blood levels of testosterone cannot be used to determine the adequacy or success of TRT, and many men make the critical mistake of focusing exclusively on their levels without considering the most important measurement… how they feel.

A man can be diagnosed with low T based solely on his age, the appearance of symptoms, the gradual worsening of these symptoms to the point that they are affecting his life, and a blood level of testosterone that is anything other than “the high end of normal” or “high”. On the flip side, many men feel completely fine with blood levels that midrange or “low end of normal”, so clearly lab values are not the end all be all of TRT. This is crucially important to keep in mind if you wish to avoid the very common problem of becoming obsessed with lab values as you have likely seen excellent examples of while doing your online research. This obsession with blood levels at the sake of all else will guarantee a TRT failure, which is the exact opposite experience we hope for you as a patient in our practice.


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Are you considering testosterone replacement therapy? We offer several of today’s latest treatments. Please feel free to contact us online or call our office at 917-703-7069.


Our 3-Phase TRT Program

The two main reasons for a TRT failure are: 1) the program is overly simplified and not customized to the individual (i.e. a “standard” protocol is prescribed for every individual, and minimal to no adjustments are made… the protocol either produces a success or a failure and that’s it), or 2) the program is overly complex and aggressive (which leads to a preponderance of side effects and an overwhelmingly complex routine that cannot be realistically maintained long term).

Just as the term “replacement” implies within the TRT name, the true goal is to replace a level of testosterone (and it’s other supporting chemical compounds) that a man feels is close to what it was at the time in his life when he felt most in balance. TRT is not about pushing the limits of physiology, creating further imbalance, and treating the imbalances by creating more imbalance. This is the reasoning behind our 3-Phase approach to TRT:

  • PHASE I (six 1-week cycles)
    The goal of Phase I is to establish the minimum number of medications and dosages that eliminate or reduce a man’s low T symptoms to a level that he is happy with. Phase I is typically 4-6 weeks long, and involves weekly office visits for Wellness Assessments with the doctor, injection training, actual treatment injections, and controlled (but progressive) dosing adjustments. Doses will likely be adjusted weekly until the desired effect is achieved, and then a maintenance program will then be established for the purpose of transitioning into Phase II. At the conclusion of Phase I, our typical patient will be on a weekly or biweekly injection schedule that usually includes a high-purity solution of testosterone and human chorionic gonadotropin (HCG). All injections in Phase I are done in the office setting with physician supervision. In the first half Phase I, the doctor will administer the actual injections while training you to do them properly at the same time, and in the second half of Phase I, you will be doing the injections yourself in the office with guidance from the doctor (if you wish to learn of course… doing your own injections is not a requirement of our program… it is simply the most popular option). Again, the goal of Phase I is to find the minimum number of medications, and the minimum doses of those medications, that restore balance and sense of well being that you are pleased with, without inducing any side effects from an overly aggressive or complex regimen.
  • PHASE II (three 3-month cycles)
    The goal of Phase II is to shift the program from the office to your home. If Phase I was successful, this transition should be a simple, pleasant, and convenient experience. Since you will be on a regimen that has been proven to produce the results you want in a stable fashion, and since you will know how to safely and properly administer your own injections, you’ll feel confident about transitioning from weekly office visits to monthly visits instead. You’ll be provided everything you need to treat yourself at home, and you’ll still have access to our guidance if you need it at any point along the way. At the end of each month, you’ll come in for a Wellness Assessment with the doctor, and any subtle adjustments that may or may not need to be made will be take care of. You will be expected to progress a three-month cycle of Phase II, with Wellness Assessments scheduled at the end of each month, and repeat lab work schedule at the end of the third month. One month supplies of your medications will be dispensed to you during each Wellness Assessment. Some subtle changes in dosing can be expected in Phase II, but this will be for refinement purposes only as opposed to the major adjustments that occurred in Phase I. After completing three uninterrupted 3-month cycles of Phase II (a total of 9 months), you will be eligible to enroll in Phase III.
  • PHASE III (unlimited 4-month cycles)
    The goal of Phase III is to transition from a monthly home schedule to a quarterly home schedule for maximum convenience, but also maximum safety and confidence since you will have now had close to a year of close supervision and a very stable medication schedule. You will be provided with a 4-month supply of your medications at your quarterly Wellness visits, and your lab work will also be checked during these assessments to monitor for any long term abnormalities like high cholesterol, liver enzyme elevations, unexpected changes in testosterone levels. It is possible to have to make small adjustments to your regimen over long period of time like this, and you’ll have the assistance of the doctor any time you feel that something needs to be adjusted. If all goes well, you’ll be visiting us three times a year as a Phase III participant for a Wellness check, lab work, and a resupply of your medications.

Over and over again we’ve heard about TRT failures because a physician will only prescribe a standard regimen of 200mg every two weeks for every man who walks though his door, and even though these men find the “roller coaster” effect of this regimen intolerable, the physician refuses to customize the protocol to their particular needs. We’ve heard of men treating themselves with overly complex and dangerous regimens after following advice found on internet forums that don’t differentiate between actual TRT and performance hormone supplementation for athletics or bodybuilding. We’ve heard of men who have put themselves in harms way by self-treating with black market products, and simply giving up on TRT because the side effects and complications are too numerous.

Our 3-Phase approach avoids all of those scenarios with a highly customizable, safe, and supervised environment that allows each individual to find the most simplistic regimen that produces the best, most-stable results.


Schedule a TRT Consultation

Schedule A TRT ConsultationTo schedule a one-hour personal consultation, please contact us online or give Manhattan Aesthetic Surgery a call at 917-703-7069 to schedule a visit. You may find it beneficial to have a routine set of lab tests done before your consultation so the doctor can speak specifically about your physiology, but this is not a requirement. If you are interested in having lab work done before your consultation, simply ask your primary care doctor to order a set of tests that include the following: CBC (Complete Blood Count), CMP (Complete Metabolic Panel), LFT’s (Liver Function Tests), Cholesterol Panel, Free Testosterone Level, Thyroid Function Tests, and LH/FSH Levels. If you prefer to wait until after your consultation, we can easily give you a prescription for these studies.


Learn more about TRT

  • To read more about TRT, please click here.
  • To read the experience of a 37 year old man on TRT, please click here.

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