Female psychologist consulting mature man during psychological therapy session

How Long Before Testosterone Therapy Starts Working?

How Long Before Testosterone Starts to Work?
A surprising issue for many men starting HRT (TRT) is that they don’t “feel” something right away.  This can be quite stressful, because going on testosterone was a big decision and no symptom relief can obviously create a lot of self-doubt.  In addition, many men know that most testosterone delivery systems raise plasma levels almost right away, so they expect results to be just as rapid.

In reality, that is simply not usually the case.  In fact, I am in the minority in the sense that I quite literally felt different on the first night that I had cypionate.  I was low testosterone for lliterally decades and so, when my T levels probably doubled or tripled, I felt like fireworks were going off between my ears.  I remember telling my wife, “This is a really weird feeling.  I can actually feel this in my brain.”  And cypionate had powerful positive effects for me that have only increased over the months and years.  (Not every one is so fortunate however.)

Most men, though, follow a very different trajectory and see some relief after a few weeks and then continued symptom reduction over the next 2-3 months.  Before we show some research that shows just how long testosterone therapy typically takes to work, let’s cover the classic low testosterone symptoms.  These will look familiar to many of you:

  • Lowered libido
  • Erectile dysfunction
  • Decreased morning erections
  • Venous leakage
  • Loss of muscle and increased body fat
  • Fatigue
  • Depression
  • Mental fog

Of course, there are many more, but these are the ones that usually drive men to see out diagnosis and treatment. If no changes occur in these, then most men will be very disappointed to say the least.  So let’s look at what a meta-analysis of sorts actually said about all of this. First of all, this 2011 study performed the Herculean task of going through every relevant HRT study on men in the last 35 years and painstakingly estimated, when possible of course, the time until symptom relief occurred. [1] If you’ve read through many of these studies, you’ll appreciate just how daunting of a task this must have been.

Fortunately for us, they perservered and came to the following conclusions:

  • “–Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, with no further increments expected beyond.
  • –Changes in erections/ejaculations may require up to 6 months.
  • –Effects on depressive mood become detectable after 3 6 weeks with a maximum after 18 30 weeks.
  • –Changes in fat mass, lean body mass, and muscle strength occur within 12 16 weeks, stabilize at 6 12 months, but can marginally continue over years.”

Now there is much, much more and I urge you to read this study when you get a chance, but I pulled out the above commentary, because these are the “red flag” symptoms than men are most concerned about and that are the most incapacitating usually.  Notice the pattern here, and I have seen this many times on Peak Testosterone Forum:

  • 1) First mental / psychological symptoms improve (libido, altertness/energy, mood/depression)
  • 2) Then improved workouts (due to #1) and body composition
  • 3) And, finally, improvements in erectile strength (probably due to slow improvements in venous leakage)

NOTE:  Venous leakage is a condition that causes a loss of erectile strength and time-to-erection when blood escapes too easily from the penis, not unlike a leaky boat.  For more information, see my page on The Basics of Venous Leakage.

Important Conclusions for Men on HRT (TRT)
Men that have just put on testosterone therapy often feel that the rug has been pulled out from under their life.  Frequently marriages, relationships and careers are in jeopardy.  So, on top of feeling terrible, they feel that they have a lot riding on their treatment.  Here are some things for such men to keep in mind:

a) Patience Is a Virtue For a Reason. The study above noted that the earliest one usually experiences any signifiicant change whatsoever is at about 3 weeks and many issues take much longer.  So the solid majority of men must be patient.  Yes, this is tough when you have erectile dysfunction and your dopamine is lows.  But there simply is no other choice in most cases.

b) Stairs Not an Elevator.  If HRT works for you – and in my opinion well done HRT on men with truly low testosterone is generally successful – then improvements in various sympoms occur one at a time instead of all at once.  Your libido might improve after a few weeks.  Then a couple of weeks later you’ll notice that you’ve lost some of the stomach fat that has been plaquing you.  And then a few weeks after that, you’ll notice that morning erections have finally returned.  Again, it is not usually going to happen all at once.

c) Hurry Up and Wait for Your Erectile Strength.  Of course, priority number one for most guys with erectile dysfunction is to get their hardness factor and morning erections back.  This study shows that this can often be one of the slowest things to repair.  Again, venous leakage repair often requires that the inside of the penis be rebuilt and that is just going to take time.  A good analogy is that you are watering a garden that must re-grow and come back to life.  Unfortunately, it is not usually just a tree transplant that is done in an afternoon.

d) HRT Failure.  The above study did not really address the issue that sometimes a man waits and waits for HRT to fix his issues and it simply never happens.  This is not necessarily a disaster, because it often a) means that one has other more critical underlying issues such as hypothyroidism, or b) that the protocol needs tuning.  In the case of the latter, high estradiol is a common culprit, since it essentially negates the beneifts of the increased testosterone levels.  In both of these cases, it pays to have a knowledgeable and experienced physician overseeing your therapy.

By the way, sometimes men are given downright horrible protocols and this completely sabotages all reasonable results.  For example, look at what this poor man wrote on the forum:

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs.

“I am 35 years old. I just started trt. My test levels 280 ng/dl. Immediately doc put me on 2cc of 400mg of test cyp once a month. I dont have blood results. I just know that I really start feeling terrible after about 2 and a half weeks. I know this is vague info. But does this sound normal? Feel so down and out. Any help or opinions will be greatly appreciated.” [3]

Cypionate has a half-life of around 5-8 for the great majority of guys, so this poor guy had little testosterone in his system after about 10 days.  Furthermore, he was given a massive dose – 100 mg is normal – so this would have sent his testosterone and estradiol through the roof!  In fact, you can argue that it is dangerous, since that massive estradiol spike could possibly cause clotting issues.

e) Testosterone Undecanoate Can Take Longer.  What I have heard is that testosterone undecanoate, which is an ester with a much longer half-life than either cypionate or enanthate, can stretch out the time-to-heal factor.  This includes brands such as Reandron, Nebido and Aveed.

This seems to be vefifeid by one man who wrote:

“–1st shot – brutal come down from the patches. Felt like garbage. DIDNT get a booster at 6 weeks.

–2nd shot after 12 weeks – started to feel better. probably on par with before i started patches (i guess the patches shut down the little production i had and the needle didnt pick it up much).

–3rd shot – only 8 weeks later. I’m about 3 weeks in and I feel amazing – the same euphoric feeling I had on patches. I feel like I want to go for a run and then maybe bench press a car 🙂 From now on I will have a shot every 8-9 weeks.

–Apparently it takes 5 shots to really get levels up. So, we have gone from a “reandron failure” subject line to – Reandron rocks!!!” [2]

If you add up all the weeks and months, you’ll see it took him about six months to feel good.  Again, patience can be a virtue.

REFERENCES:

1) Eur J Endocrinol, 2011 Nov, 165(5):675 685, “Onset of effects of testosterone treatment and time span until maximum effects are achieved”

2) https://www.peaktestosterone.com/forum/index.php?topic=2432.0

3) https://www.peaktestosterone.com/forum/index.php?topic=121.0

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