Ep 6. Testosterone

This we we dive into the history, the effects, and the cultural baggage of our beloved bro hormone. 

And most importantly we'll talk about what science says about how big it'll get you. 

Transcript

Testosterone

This is Gay Bro shit- a podcast for people who dont mind sticking needles into their butt once a week or so, as directed by a licensed medical provider. 

Today we are talking about Testosterone- what it is and what it does or doesnt do, and how we might be able to change our levels to optimise our health and performance

But first a check-in, A few episodes ago I mentioned I was going into a bulk phase, and now I’m about 5 and half  weeks in. So, I’m up about 10 lbs- which means Im adding 2lbs, or almost a kilo a week and eating an average of 3400 to 3600 calories a day. And at first I thought it was going to be hard to eat that much- but no, once I just gave myself permission my body was like ‘fuck yes, this is awesome, keep feeding us’. 

Its interesting because I track my weight daily so I can look back and see a chart of how it fluctuates and theres definitely a pattern where it goes up a lot during the week, and then drops back down during the weekends when im working and espending the most energy. So I should probably eat even more on the days that Im working but I find that harder to do for a variety of reasons. 

And typically you would expect to see some fat increase when you bulk- most typically you would add mass at a 1 to 1 ratio- so about one pound of fat for every pound of muscle. But my waist circumference hasnt changed at all so its unlikely I’ve added 5 pounds of fat, so thats interesting. 

And the reason I’m able to do this is porbably because of the subject of today’s episode. 

Before we get into any conversation about hormones I need to clarify something- As I talk about this I’m going to talk about male and female, and men and women. I need to say up front that I’m using these terms to refer to biological sex and not gender. Sex and Gender are not the same thing and if you do not understand that then I’m going to go ask you listen to some trans or nom-binary folks explain the difference- but in short, gender is how you feel on the inside and how you present and sex is what your body looks like and how it functions reproductively. And there are more than two biological sexes as there are more than two genders- so this episode is going to ignore a lot of that complexity. 

I also need to clarify that I am not licensed to practice medicine, and this is not medical advice. If you’re looking to take testosterone, either for replacement as you age, gender affirming care, or performance or asthetic reason- you need to work with a provider and within the laws of your location. 

In the US, testosterone is legal with a prescription, in other places you may not need a prescription, or it might be banned entirely. 

But I can talk about my personal experience, the experiences of others and what the research studies show. 

So let’s get into it

Overview of sex hormones

First of all- what is this substance? Testosterone is naturally occurring hormone found in the body- both men and women have it. 

Hormones are signaling molecules that essentially get cells to act in specific ways based on their chemical structure. They are produced by the adrenal glands and by the sex organs- 

The three main hormones are 

Testosterone- our main character today- this is the chemical responsible for male sex characteristics, such as face and body hair, 

Estrogen- which in the body takes the form of Estradiol- is the chemical responsible for female sex characteristics 

Progesterone- this one is a bit harder to define because its primary role is in females- where it basically enables pregnancy and later breastfeeding- but in males its also critical for sperm production and synthesizing testosterone, among other things- Progesterone is also usually the main hormone in birth control medication 

So while we think of testosterone as the male hormone and estrogen as the female hormone- everybody has all three hormones but in different levels and they need to be in balance for optimal functioning- but the balance will be different for different people. 

In men we want to think of estrogen as being bad, because high estrogen levels make you retain water, it can make you store more fat, be less emotionally regulated, and of course the dreaded gynecomastia- or the growth of breast tissue in men- 

So we would think its something we would want to minimize-but that's a mistake because it has essential functions for men as well. For example while testosterone levels are the main factor of sex drive- testosterone only works to do this if estrogen is also present- so something that happens when people take estrogen blockers is that their sex drive can collapse. So if your testosterone level rises, your estrogen level will also need to rise to balance it out- to a point. 

Your body converts testosterone to estrogen via the process of aromatisation and about 0.3% of testosterone is converted this way. 

Another testosterone derivative we might be interested in knowing about is dihydrotestosterone or DHT- and this is the hormone responsible for the growth of facial and body hair- but it also what causes male pattern baldness- so medications to prevent hair loss work by blocking DHT

About 5-7% of testosterone is converted to DHT- so this is why higher testosterone levels lead to less hair on your head and more hair on the rest of your body. 

We also know that these same sex hormones are found in most vertebrae species, so we are not unique in any way

Natural levels- 

Ok - so how do we measure your hormones? Well, we do a blood test- and it's best to do this early in the day because that's when your natural levels peak- usually between like 4am and 9am- which is also why we get morning wood…

And in the US we measure levels in nanograms per deciliter- but in other parts of the world they sometimes use milligram per deciliter- so basically take the numbers I'm about to give and divide them by 100 for that number. 

So for most men under 40, their testosterone level will usually fall between 264 and 916 nanograms per deciliter. The higher the number the higher the level. The average level in American and European men is about 630. But that range may not be useful so let's look closer at percentiles. 

So the bottom 5th percentile would be 303 and below and the 95th percentile would be 852- so 90% of men are in between this range. And it also declines with age, so the median declines about 100 points between the ages of 20 and 60. 

Converting this to mg/dl reading found in Europe and other places we would get a 90% range of 3.03 to 8.52 with a mean level of 6.3- See I’m an American who loves the metric system even if I cant always visualize centimeters

For women the range is between 13 and 56 with a mean testosterone level is 32.6, so basically about one-twentieth of what it is in men- so we would think this would mean that women would be way less muscular than men- however, this is not the case as women can develop a pretty good amount of muscle so testosterone is definitely not the only thing responsible for muscle mass.  

Pre-science knowledge- ancient understanding of testicles as the source of male virility

The hormone was discovered formally in 1935 but going back throughout history there are legends that would indicate some knowledge of its existence, even if theoretical. One thing we definitely knew was that the testicles were important for the development of male sex characteristics and fertility- And we knew this because we knew what happened when we castrated people- i.e. removed their balls. With evidence of that practice going back about 6000 years. 

That practice continued in a variety of cultures, and today is an important part of sex reassignment surgery for trans women. 

Because we knew that balls were the source of male virility, it is alleged that some cultures consumed the testicles of bulls as a performance booster. It is said that the Huns of Central Asia at them before going into battle, and the 

Ancient Greeks were said to have eaten them before competing in the olympics- but of course, we don't know if this is true or not- 

And the thing about eating hormones in animal parts is that they get broken down by your stomach and liver in a way that very little if any of what you consume would actually enter your bloodstream. 

Discovery and synthesis

In the late 1800s we began to do some experiments to try and figure out what this hormone was- A German scientist by the name of Berthold expereimented with transplanting testicles in birds- and then a bit later a Harvard Professor and scientist named Charles-Édouard Brown-Séquard extracted something from dog and guinea pig testicles and tried injecting it in himself- only to report feeling more vigorous- but these effects faded quickly- so its likely it might have just been the thrill of the experiment rather than the actual substance of the injection. 

In the 20’s a University of Chicago professor named Fred Koch- no relation to the heinous billionaires- had a group of students extract 20mg of a substance- they didn't have a name yet- from 40lbs of bull testicles and when they tried injecting it in animals that had been castrated it seemed to remasculize the animals. So sex characteristics that had disappeared when they were castrated came back.

In the 1930’s a few European pharmaceutical companies funded research into this substance and in 1935 a group in the Netherlands working for the Organon company was the first to isolate and identify the compound and give it the name it has today. The name is a combination of ‘test’ for testes and ‘sterol’ because of the type of chemical it was. 

That same year the chemical structure of the hormone was identified, and it was quickly synthesized- earning a Nobel prize in Chemistry for the two main scientists- Adolph Butenandt and Leopold Ruzicka. And after that, we were off to the races in studying the effects of the chemical- even when a pesky little world war got in the way, 

History of supplementation

By 1937- The hormone was now available as a drug- either as pellets that could be placed under the skin or as Testosterone Propionate- an intermuscular injection with a half-life of 48 hours, so you had to inject it every other day.  Keep in mind we didn't have single-use syringes- so the risk of injecting every other day were much higher than they are now. So usage wasn't widespread. But it was allegedly used by Adolph Hitler during the war, and was also used on experiments involving concentration camp prisoners- which is troubling to say the least. 

And after the war, the Allies used the drug to treat malnourished camp survivors. 

In the 50’s we got two new forms of testosterone, Cyponate and Enanthate which had a much longer half-life- so people only need to inject every week or two. We also got single-use syringes which made injecting much safer and easier to do. So it became potentially more accessible- apparently, JFK used the drug before and during his presidency 

At the same time we developed synthetic versions which became the variety of anabolic steroids we have today that are used for performance and aesthetic reasons. 

We also around this time got the first use of sex hormones, both estrogen and testosterone as Hormone Replacement Therapy for gender-affirming care.  

So through the late 20th century, we saw usage slowly grow until it really started to blow up rapidly in the 90’s and early 2000s. Between 2001 and 2011 usage rates tripled. And by 2020 there were over 3 million people with prescriptions in the United States. 

Early on testosterone was primarily used to treat people with hypogonadism- meaning people who did not produce enough naturally, but over time usage has shifted. And now in addition to its role in gender affirming care, and its clandestine use as a sports performance enhancer, its marketed as an anti-aging treatment for people who don't fall below the clinical range. 

And if you’re listening to this, you too have probably wondered if you might benefit from using testosterone.

So aside from getting a blood test- what are symptoms we should look out for that might indicate we need to hop on some vitamin T?

Let's read the list of possibilities

Reduced sex drive.

Erectile dysfunction.

Loss of armpit and pubic hair.

Shrinking testicles.

Hot flashes.

Low or zero sperm count

Depressed mood.

Difficulties with concentration and memory.

Increased body fat.

Enlarged male breast tissue (gynecomastia).

Decrease in muscle strength and mass.

Decrease in endurance.

Source: https://my.clevelandclinic.org/health/diseases/15603-low-testosterone-male-hypogonadism

The thing about these symptoms is, while some of them like shrinking testicles and hot flashes are very specific, a lot of them are pretty general and could be signs of something else. 

For example, just having depression or other mental health issues might lead to a lot of these symptoms so it's really hard to parse out if it's low testosterone specifically. 

So the only way to know for sure is to get tested. 

Which leads me to my experience. 

So about a year ago, I was noticing that I had a lot of these issues- I had very little energy or drive, and I was also gaining body fat in a way that didn't make sense for the amount of food I was eating. 

I also was watching the movie Bros- and there's a scene where one of the main characters is caught by the other one injecting in the bathroom at their vacation house- and there's a brief conversation where he says ‘no, its not steroids, its just testosterone, and all his friends are on it’...I'm paraphrasing, but that definitely got me curious- in a way that probably wasn't intended by the filmmakers.

So I decided to get tested- I went through one of the many online providers- and I got my results back, and sure enough, I was on the lower end of the scale at about 400 ng/dl.

Now the thing was this isn't low enough to meet the clinical definition of low testosterone, but still I kind of felt like this was lower than I had been in the past. But as I had never been tested before I had no way of knowing how this compared to what would have been a baseline earlier in my life. But, this is one of my big points when we talk about TRT or testosterone replacement therapy- is that even if you’re number isn’t low clinically it might be low for you and so you might have to advocate for yourself hard. And I’ve heard stories of a lot of men who had to go through multiple providers before they could get prescribed because their numbers weren't low enough, only to have immediate relief of symptoms when they finally were put on it. 

But my provider was reluctant to put me on testosterone outright for a few different reasons, and they were being conservative and I can respect that- so we started instead with a medication called Clomiphene which acts to keep more of your testosterone in circulation. So I was put on this medication, and three months later I was retested and my testosterone levels had doubled to be closer to the top of the normal range- but….I didn't really feel better. 

Now I was also on another medication at the time, for mental health reasons, that also causes many of the same side effects as low testosterone including weight gain, low energy, etc.

 - So simultaneously I worked with my other provider to get off that medication, and when I did I definitely started to feel better, but not entirely. 

So I decided that maybe Clomid wasn't really doing the job, because I was still tired and unmotivated and fat. So I felt it was time to bring in the big guns and try actual testosterone-

And guess what? My energy and drive and ambition all came back. I started to lose fat and put on muscle again, and most critically for me- I felt like I was alive again and ready to make things happen. I’m making this podcast now because I was able to get my drive back. Like, I'm getting shit done again and that feels really good. 

Again, this is not medical advice, just my own experiences- My testosterone wasnt low by the medical definition but it turns out it was low for me, and I’m happiest and function best when its at the top of the natural range, or even a little above it….

Story time over. 

So what are the ways people can take testosterone? 

We covered a few already. 

We have pills- particularly testosterone undecanoate- but as previously mentioned when we talk about eating testicles, most of this gets metabolized by the liver and so it doesn't end up in your bloodstream- its also very toxic to the liver, and since liver damage is irreversible usually people only get prescribed this short term. But I'm sure people are working on better oral versions. 

We have implants or pellets, which get injected under your skin where they slowly release medication- and these get replaced every 3 to 6 months- but in practice, these are suboptimal because they do not last as long as their designed to we get a crash inbetween dosages. They can also get infected or just pop out of the skin. 

We have gels that get spread on the skin- usually arms or legs. But these have to be applied daily and women and children can accidentally come into contact with them. And only about 10% of what is applied is absorbed through the skin so it's just not very efficient 

There’s also a nasal gel you rub around the inside of your nasal cavities, but this needs to be administered multiple times a day and irritates your nasal tissues. 

We also have troches or gels that go under the tongue or inside the cheeks, and this is supposed to absorb more easily into the bloodstream than through ingestion, but up to 70% of it gets metabolized right away so it’s again not very efficient 

Finally we have the preferred method which is injections. Sometimes this is injected subcutaneously, which means into fat tissue. This is how most people inject insulin, but it's done at a very shallow angle using a small needle. But more usually you would inject inter-muscular, meaning you take a longer needle and inject into the belly of a muscle where it sort of acts as a reservoir and slowly moves into the bloodstream.  If you’ve had a vaccine then you've had an intermuscular injection. 

And what you don't want to do is inject directly into a blood vessel because then it flood your body with it all at once. So when you inject into the muscles you need to do it in an area where there is not a lot of blood vessels. Usually the deltoid, the quads on the outside of the knee, or the glutes. 

So this is where the movie Bro was inaccurate, because in the movie the character Arron was injecting into the side of his thigh up near the top of the leg- and this is not an area you would ever inject into. And I noticed this when I rewatched it recently and it bothered me because I'm sure someone on set knew this… 

Of course, injections come with risks, most notably the risk of getting an infection at the injection site, so you need to be careful when prepping the site and your medication, and using good technique. 

I’ve heard horror stories of people developing giant abscess they have to go get drained- so don't take this shit lighty

Ok suppose we're not ready yet to jump to sticking needles in your butt. 

There are some things you can do to raise your testosterone levels naturally, but they only go so far. So according to an article in Healthline, here id what they suggest:

1. Exercise, particularly strength training- in one study weight training was shown to boost testosterone blood levels sharply, but only temporarily, meaning for just a few hours. For longer-term some studies show exercise boosts your overall base levels, but some others studies found it didn’t.
2. Eating enough food, particularly protein and fats. We also now that dieting, particularly low fat diets really tank your testosterone levels and when we test natural bodybuilders in a cutting phase, their testosterone levels are usually way below their baselines. 
3. Minimize stress- the stress hormone cortisol sharply reduces your testosterone levels, and raising testosterone lowers cortisol so they work like a see-saw. Of course as someone with an anxiety disorder- it’s definitely not effective to be like ‘hey you, stop being so anxious and stressed’
4. Take Vitamin D- some studies have shown that taking a Vitamin D supplement increases testosterone levels and improves erectile dysfunction. However other studies have not found this link. So maybe…or maybe not. But other than Vitamin D there's not been any real evidence that any other supplement works- so anything sold as a legal ‘T booster’ is probably just some random herbs that don’t do anything to raise your testosterone levels, Some people say Ashwaganda or fenugreek do this, but not according to any of the scientific literature. 
5. Sleep- a small 2011 study found that sleeping only 5 hours per night was linked to a 10%–15% reduction in testosterone levels. And another study involving older men found that an increased sleep duration of up to 9.9 hours was associated with increased testosterone levels.
6. Reduce Alcohol intake- Testosterone levels may drop as quickly as 30 minutes after you drink alcohol. Heavy alcohol use can lead to reduced testicular function and testicular atrophy. But there also seems to be correlation with higher testosterone levels and higher alcohol consumption meaning people with higher base levels are more likely to consume an excessive quantity of alcohol. And that certainly bears out in my experience playing rugby- where excessive drinking is very common. 

https://www.healthline.com/nutrition/8-ways-to-boost-testosterone

Ok, shifting back to TRT, assuming we are using injections. Most people are going to be injecting weekly, but some people will inject more or less often. 

In my experience and a lot of others as well, injecting twice a week makes it easier to keep levels stable- but it just means twice as much hassle. 

On the low end, you might use 100 milligrams per week, and on the high end, you might inject up to 200. 

Now of course you could do more- but anything above 200mg a week and you start getting into the territory of testosterone as an anabolic steroid. 

And testosterone is one of the most commonly used steroids, but it's also the best studied and probably the safest. 

Anything above 300 per week would be considered steroid abuse, but if you hop on the internet you’ll see people recommend 500 or 600 per week as a starting steroid dose. And that's because 600 is the maximum dose we’ve studied that was found to be safe. 

But of course many people take even more. Some very seasoned users will take 2000mg a week per more. So basically 20 times what the starting TRT dose is. 

And I watched a video from a bodybuilder on YouTube who did this, and the wildest thing was when he said, oh I didnt need to take much else other than the testosterone just these things and then a laundry list of other medications and supplements quickly scrolled across the screen before I could read it and I swear there was like 30 or so things on that list- 

And I’m planning another episode specifically on steroids, so were going to wait to dive into that because this episode is really meant to talk about testosterone as a medication. 

But yeah, don't listen to that dude, dont listen to random dudes on the internet.  Listen to your medical providers. 

On that note, let's talk about what you’re probably really here for and that is what testosterone does aesthetically. 

In my own personal experience does testosterone help reduce body fat and build muscle? yes, but….I combined it with an aggressive increase in workout intensity and a renewed focus on nutrition so I can't personally say what effect it had in isolation because there was multiple variables at play. 

But most other men who have gone on TRT have experienced the same thing, not everyone, but most. 

In a 2014 meta review of a bunch of different studies where men with low testosterone were given the drug in various forms including gels, patches, and injectibles, and ranging from as short as 3 months to as long as 16 years- they found that in every single study, on average men had a reduction in waist circumference lost fat mass and gained lean mass. 

Now these are averages so of course individual participants may not experience any weight loss or muscle mass gains, but on average people do. 

In one of the studies reviewed they specifically gave testosterone to men who were classified as obese over a period of 6 years. 

Now I need to point out these men were carrying more fat tissue so don't assume the numbers I'm about to drop would translate to someone who is already leaner. 

So in group 1- which had the smallest beginning weight the average weight dropped by 12.55 kg over the 6 years which is about 27.5 pounds- the middle group lost 20.67 kilos, or about 45 and a half pounds and the biggest group lost 27.15 kilos, or almost 60 pounds. 

And what was interesting was if you view the chart of weight lost year by year, it's pretty linear. You would maybe expect a big drop-off at first and then a leveling-off as the years went by, but that's not what happens. So it seems like to see the full benefits of TRT you need to continue using it. 

And these were the mean numbers so there were people who lost more weight and people who lost less weight, 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154787/pdf/coedo-21-313.pdf

But fortunately there was a really well-known study that might give us some insight onto what we can expect to happen at certain dosages. 

This study was done in 2001 by Bhasin and Colleagues on a group of healthy men with normal testosterone levels between the ages of 18-35 with prior weightlifting experience who had not previously used any anabolics. 

For 20 weeks they gave the participants one of 5 doses- 25mg, 50mg, 125mg, 300mg and 600mg 

They also controlled food intake and specifically instructed the participants to not engage in any moderate to intense exercise or strength training so they could look at the effects of just the testosterone doses independently. 

Now a big caveat here is the food intake was self-reported, and we know from episode 2 that people are very bad at reporting their own food, so that's definitely a potential source of error for this study. 

So for the men who received 25mg a week- on average, they actually lost 1kilo of muscle and gained about 3kg of fat mass- and this is probably because in the study the first suppressed testosterone levels completely, so these men were receiving less testosterone than the body naturally produces- which is about 30-40grams per week

The group that received 50mg a week did a little better, on average they gained about a half a kilo of muscle, or a little more than a pound, but they also gained an average of 3.5 kilos of fat- probably for the same reasons as the first group in that the level of replacement wasn't sufficient. 

The third group received 125 which is right around the average TRT dose- so this is where it gets more saucy. While this group didn’t lose any fat mass, they also didn't gain any. But what they did gain was 3.4kilos of muscle mass- so that's 7 and a half pounds of muscle in 5 months not working out. 

The fourth group that was put on 300mg a week and they on average lost about half a kilo of fat, which is really not very impressive- but they did add an average of 5.2 kilos or 11 and a half pounds of muscle

And finally, the 600mg group lost an average of 1 kilo of fat, which is still not very impressive- but they gained a whopping 7.9kilos of muscle or a bit more than 17lbs- just from testosterone, and not working out at all. 

So this study is why people on the internet like to suggest 600mg as the starting steroid cycle- but when comparing the fourth and fifth groups you start to see that the relationship between dose and muscle mass gained is not directly correlated.  You would expect the people receiving 600mg a week to build twice as much muscle as those on 300- but they only gained 46% more by taking twice as many drugs. And above this dose, the results seem to really taper off so that if you see a graph it looks more like a curve, with it leveling off fairly quickly once you get into the high doses. So it's tempting to take more but it just isn't effective and probably not worth the risk of negative side effects. 

In another great article by James Krieger from weightology, he ran a regression of the existing studies and found that once you increase your testosterone more than a thousand over baseline you don’t build any additional muscle. 

I’ve referenced James Kreiger's work in two episodes now so I guess that makes him our first official Friend of the Pod- Hey James, stellar work, hit me up, bro. 

So if you start with a base level of 400 in my case, once I reach 1400 in blood testosterone levels I won't get any additional mass gains if I go beyond this. 

Incidentally, my most recent blood test on 200mg a week of Test was 1450, so I was able to hit that on just a high TRT dose. Now I should probably take my dose down a bit so I’m not above the natural range, but on the other hand, all my other blood work and health stats are good, so I might as well enjoy the extra bump in mass gains for a while. 

 In that same study the average blood level of the men on 300mg weekly raised by 700 points, whereas mine went up by over a thousand on a third lower dose- But the real reason for this is probably because I’ve continued to take a lower dose of clomid and that medication keeps more testosterone circulating 

https://journals.physiology.org/doi/full/10.1152/ajpendo.2001.281.6.E1172?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org

https://weightology.net/the-members-area/evidence-based-guides/how-much-do-variations-in-physiological-testosterone-matter-to-your-gains/

Now in that study they did not work out at all-so we might wonder what happens when we work out while taking testosterone. And fortunately, there was another good study done on that. Also by Bhasin and colleagues, but done a bit earlier in 1996. 

This study was done over 10 weeks and they randomly assigned 43 men to one of four groups:

1. Placebo with no training
2. Testosterone with no training
3. Placebo with training 
4. Testosterone with training 

So there were two variables, whether or not they received testosterone or a placebo, and whether or not they did strength training. 

So the first group didn't see much change. The second group that received 600mg a week of testosterone for 10 weeks saw an increase of 3.2 kilos of lean mass. 

The third group that did strength training with the placebo saw an increase of 2 kilos over the 10 weeks, so not as good as the testosterone-only group, but still fairly good. 

So with the fourth group that received the testosterone and did the strength training you might assume they gained way more muscle mass- but on average they gained 6.1 kilos over the 10 weeks. 

So while this is definitely the biggest of any group, when you add up groups 2 and 3 you get 5.2 kilos, so the synergistic effect is not as powerful as you might think. The group that did both only gained about 17% more than combining the gains from the strength training alone and testosterone alone groups. 

​​https://www.nejm.org/doi/full/10.1056/nejm199607043350101

Alright, so you can probably tell I’m fairly enthusiastic about the aesthetic results here, so I’m biased- but I definitely don't think you should be hoping on TRT if you already have healthy levels.

And also would strongly caution anyone who does start TRT to expect that results are going to be slow- but if you combine TRT with diet and exercise then you can start seeing results pretty rapidly. And I also suggest trying to get your food and fitness, and your sleep in order first because it may just be that that's all you need to do to start feeling better naturally. It's great to have a full tool kit, but not every tool is needed for every job

If you want advice on how to optimise those things please go back and listen to episode 2 where I explain how to do that.

Now of course there are risks and downsides to Testosterone therapy and I need to go over those. 

A big one we have to cover is that testosterone affects your blood lipids, particularly your cholesterol. Especially in high doses, it tends to raise your LDL or ‘bad’ cholesterol, and lower your HDL or ‘good’ cholesterol. That is something you definitely want to keep an eye on if you’re using Testosterone. 

Similarly, blood pressure is something you will want to keep an eye on as well because it can elevate that as well. I tend to have borderline high blood pressure so I bought an inexpensive cuff on the interwebs and the good news is when I check my blood pressure, as long as I haven't had any caffeine yet, it's in the normal range- but once I cafe caffeine all bets are off

Incidentally I find I’m way more sensitive to caffeine now. I used to have like 3 big cups of coffee to get me going and now I can have like one cup of black tea and feel a little cracked out. 

While there seems to be no evidence of increased mortality in middle-aged men from testosterone, there have been a few studies that have found that in older men on TRT- they were 30% more likley to die of cardivascular issues. So if you’re and older man, keeping an eye on your lipids and blood pressure are veen more critical. 

On another potentially serious note- while there is no evidence that increasing your testosterone can cause you to develop cancer- if you already have prostate cancer cells, it fuels their growth. As we get older we should be getting screened for that anyway- so I don't think this is something to be concerned about unless you have prostate cancer or have had it in the past, or have a high PSA level. 

We also need to mention, that when you start taking testosterone at most any dose- your body will eventually stop producing it on its own. So it can become very hard to get off testosterone because once you stop taking it youll experience a dramatic crash and a return to symptoms. In that way, it can be addictive. 

You’re committing to sticking a needle in your butt, once or twice a week, forever. Which is small compared to what a type 1 diabetic needs to do- but it can cause any number of complications when traveling because you have to travel with your medication and needles- getting through security and possibly customs- and figure out how to dispose of your needles safely. So that becomes very complicated. 

Because testosterone is produced in the testicles- those will atrophy, meaning they will shrink. Some people will tell you they shrink down to nothing- but its more likely they’ll rescue by a third or a half. 

Another consequence of this is that your sperm production also decreases so the likelihood of infertility increases. 

Now my audience probably doesn't care about that, but its something to know

However, natural production will start up again in most cases, but your new baseline production will probably be lower than it was before starting the medication. And the good news is your balls enlarge again. 

That being said there are two medications that will help restart production fairly quickly and you can even take them while you’re on testosterone to keep your natural production going. One of those I already mentioned, and thats Clomiphene or clomid. And the other one is Human chorionic gonadotropin or HCG. So definitely something worth talking about with your provider.

Another possible side effect is mood swings- and this is something we will talk more about when we talk about steroids in general- but Testosterone is a Psychoactive substance, and especially in higher doses can make you more emotional, impulsive, anxious, and even manic in some cases. So sticking to a replacement dose will mitigate that risk. 

Insomnia is also a possibility- and I notice whenever I try and cheat my dose upwards my sleep goes to shit. And for me not getting enough sleep is a one way ticket on the high-speed train to crazy town- so I’ve gotta be really careful about that. 

We also already mentioned Gynocemastia- or male breast tissue development- because of the conversion of Testosterone to Estrogen your body can get real confused. This generally doesn't happen at TRT doses but it could if you’re someone who aromatizes, or converts at a higher rate. I know of some bodybuilders who can't take more than 200 of TRT without getting this. And so if you experience any firmness or swelling around the nipple- then you gotta lower your dose or possibly introduce another medication to limit that conversion. 

It might also make you hornier- which is not really a problem unless it leads you to having riskier sex. Oddly enough Im less horny now, but I dont really mind because I still have a fairly normal sex drive, im just less distracted by it- but that seems to be really unusual. 

Finally, we have hair loss and Acne- As I also previously mentioned some Testosterone gets converted to DHT- which can lead to male pattern baldness, oily skin, and acne. 

Whether or not this will happen to you depends on how sensitive you are to DHT- so if you’re already experiencing hair loss, Testosterone might speed that up. If you’re already prone to acne- Testosterone might make it worse. And this is definitely a reason you might want to wait until later in life. 

I’m already well past the point of no return with my scalp, so for me, it wasn't a big deal to risk that when I'm probably not going to have any for much longer anyway and I’ve already started shaving it down. 

Well that was fun- now to talk about something way less fun..

We can't talk about Testosterone in a vacuum because unfortunately the far right has become obsessed with the notion of Testosterone being a key driver of manliness and conservative thoughts and opinions. 

I'm not interested in giving to much weight to this way of thinking but I'll give a summary:

According to the manosphere- men with more testosterone are more likely to be conservative, rugged, manly men, providers, gun shooters, etc. and liberals therefore must have low testosterone. 

And theres also obsessed with the notion that testoterone rates are declining, and going as far as to theorize there is a conspiracy affoot to make men softer, weaker and more liberal by lowering their testosterone levels. 

Now theres two things they point to as evidence- and the first one is unfortunately probably true. 

According to a few, well done studies- Testosterone rates in American males do seem to be declining over time. One study looked at rates over a 17 year period and found that in 1999 and 200 the average level was 605. In 2003-2004 it had dropped a little to 567. Then in 2011-2012 it had dropped further to 424. It then goes back up a little to 431, and then up a little again in 2015 and 16 to 451. 

Now the study theorized why that might be, and they list out the following:

increased obesity/BMI, assay variations, diet/phytoestrogens, declined exercise and physical activity, fat percentage, marijuana use, and environmental toxins.

So when I first encountered this my first thought was that our technology for taking the readings has maybe changed, but they used blood samples they had collected and stored so the tests were done at the same time and using three different methods. So yeah it does genuinely look like mean testosterone levels are declining, but Im not going to sit here and say thats a problem

But for the right, of course it is a problem because to them this means men are getting weaker and more liberal, 

And they point to a second study that found a link between testosterone levels and political views. 

In this study they had a sample of 136 men, and they gave them either a testosterone gel, or placebo and asked them about their political views before and after. And the group that was weakly pro-deomcrat ended up more likely to be weakly republican after receiving the testosterone. 

So the right latched on to this as proof that testosterone makes men conservative, but of course thiy didnt really look at the details. 

The men in the study who reported being strongly liberal, or strongly conservative didnt change at all. So it had no effect on the truly liberal in the group. So this destroys that hypothesis- 

And also becuase this study was done using del-reported political leanings- what more likley happened, is the men who reported leaning democratic, were actually lying to save face and always leaned conservative- and after the testosterone they were just brave enough to be honest about what they always thought. 

So the right has become obsessed with this idea that things like soy in the food supply and microplastics and BPA’s are being deliberately weaponised to lower mens testosterone levels.  And they love to call their opponents ‘low-t’ or ‘soyboys’ or any number of insults that conflate hormonal levels with manliness. 

But the thing is- aside froem this one very small study there is no evidence that conservative men have higher levels of testosterone on average at all. Conservative men can have low testosterone as often as liberal ones- and if there was a direct corelation than we would have lot more right wing gay muscle boys….

There’s also no actual evidence that men at the higher end of the normal range are manliner than men at the lower end of the range- Testosterone doesnt account for personality, aggressiveness, 

In the same vein- there’s zero correlation between hormones levels and sexual identity. Sometimes the femmeist gays actually have really high testosterone and the butch jocks have low testosterone. Its completely random. 

And  unless your testosterone is actually low- theres not a huge difference in strength or muscle mass or fat mass within the normal range. Its only when someone who is low uses TRT, or when you get above the normal range through supplementation that those things start to manifest. 

Now I’m on TRT so I clearly think it has benefits, but we cant ignore this toxic-masculinity that goes into our perceptions about what it does or doesnt do. 

https://www.urologytimes.com/view/testosterone-levels-show-steady-decrease-among-young-us-men

https://www.vice.com/en/article/pkadwv/testosterone-hormone-politics-research

https://eejjbair.medium.com/the-manosphere-and-the-testosterone-cult-19b7c2c04960#:~:text=Through%20hormone%2Ddisrupting%20microplastics%2C%20anti,the%20biochemical%20source%20of%20masculinity.

https://www.psychologytoday.com/us/blog/political-animals-and-animal-spirits/202307/testosterone-and-politics

https://www.theguardian.com/global/2019/jul/28/looking-for-mr-t-the-politicisation-of-testosterone-and-toxic-masuclinity

And the final point I want to to make here- and I’m certainly not the first person to make it - is that when a cis man goes on TRT as he gets older in order to feel more like a man again, that is the same reason why a trans men would take testosterone. 

TRT is gender affirming care in the same way that that hormones for trans and non-binary people are. 

And its wild becuase when its a cis man taking testosterone, or a cis women taking estrogen or progesterone almost nobody seems to have a problem with it. But when its a trans person suddenly its ‘unatural’. The double standard is obvious. And it’s really fucking gross. 

Maybe just mind your own damn business when it comes to what other people do with their bodies? 

Well that should do it for today- but dont be surprised if this subject gets brought back for a part 2, a part 3, and beyond- possibly quite soon depending on how things shake out- as I’m going to expand on these topics that have a huge capacity for intrigue

Thanks for listening again, if you’re not already be sure to follow us on instagram and threads @ gaybroshit where i'm hopefully going to be posting more regular updates on what I’m working on and maybe I’ll post what I look like eventually. 

And as per usual I ask that you leave a rating or review if you like the show- or share it with people you think might get value out of it- that helps me grow the audience. I spend a lot of time writing and researching these episodes and I could see how it could become a full time job but I need to grow an audience first. 

Or I’ll continue to do it for just the joy of doing it, because I fucking love the research and writing and love getting lost in it.