Is HRT Natural?
I cannot think of anything more “unnatural” for a man than to be than low testosterone. Low libido, mild depression, medium anxiety, erectile dysfunction, venous leakage, mental fog, elevated insulin levels – all of these are very common side effects or symptoms of reduced testosterone levels. (Been there!) For men struggling with Low Testosterone Symptoms, low testosterone is just miserable and no way to live. One can often barely function and merely surviving the workday and home life.
Furthermore, men who go on HRT often experience a kind of renaissance. One poster with major health issues found that he was likely going to have to go off of HRT (testosterone therapy) and wrote “I started my T replacement 3 months ago and feel better than I’ve ever felt in my life.”  This enthusiasm for testosterone therapy is a very common reaction on the Peak Testosterone Forum. Yet another man wrote:
“Well, I have been on the 1st injection for only 48 hours and I actually do feel significantly better! Happier, full of energy, even after my lunchtime gym workout! I realize placebo can be powerful, however, I doubt that is what is going on here, at least for the most part. My cardio output on the life cycle today was noticeably up in cal/minute as well as rpm with less fatigue afterward than what I had prior. I also woke up a couple of times during the night with wood that hasn’t been around in that way for years! I don’t really have ED even before the HRT. Just no automatic or random wood. I could get wood if I got busy with the wife pretty easily, but I just had no interest in getting “busy”. Now half the girls that I previously barely noticed look pretty good. Getting that animal like feeling again! Lastly I seem to be more clear headed, but this could be placebo. I wasn’t terribly foggy prior to be honest.” 
Clearly this description of “life with testosterone” is the natural way a man is supposed to live, that is with a strong libido, clear head, etc. But can we go a step farther? Can we actually say that HRT is a natural solution?
This is actually an important and pertinent question. For example, I get asked in one way or another why I am supportive of HRT when my site is supposed to be a natural men’s health site. Well, that question makes a big assumption and that is that HRT is not natural. I don’t think it’s that easy and I discuss both the pros and cons below.
NOTE: I am only supportive of HRT when it is well done by a physician (on a man with verifed low or lowish tesetosterone) with proper monitoring and estradiol management.
1. Testosterone Replacement. Again, there is nothing natural about low testosterone. It is a miserable existence for many men that negatively impacts their career, relationships and sex life. So why not restore a man’s testosterone levels to a more youthful level? This is what is meant by Testosterone Replacement Therapy: you are simply replacing the testosterone that is “missing” and should be there in the first place.
CoQ10 levels fall precipitously with aging and most men would have no trouble taking some CoQ10 to boost their plasma levels to a higher, more youthful level. Furthermore, there is a lot of research that taking CoQ10 can help with many key health parameters.
Is taking testosterone really any different? Testosterone is just as ubiquitous of a molecule and every bit as important. So why pay attention to antioxidants and ignore hormones? Does that make any sense?
2. Bioidentical. Remember that most of the standard testosterone therapies out there now use bioidentical testosterone, i.e. your body could not tell the difference between the testosterone molecule in the drug and one that circulates in your plasma. This includes the topicals, such as Androgel and (generally) compounded creams along with pellets and patches. The one small exception are the esters of testosterone (cypionate, enanthate and undecanoate). In the case of these injectibles an ester is attached to the testosterone but is easily broken off immediately leaving one with bioidentical testosterone.
Of course, talk to your doctor, but, from what I have read there is a broad consensus that the esters are not harmful to the body in any way. The real concern is with some of the synthetic steroids that are close to testosterone but not quite the same. These can cause liver and other issues and are anything but bioidentical. From what I have seen, these are rarely prescribed by physician for HRT and are pretty much the exclusive property of steroid users.
And excess estradiol is probably the single biggest reason for problems during HRT. It can lead to bloating, prostate issues, gynocomastia, depression, loss of libido and so on. And, when estradiol goes too high, many HRT clinics and physicians will put their patients on low dosage Arimidex. This is extremely common on the Peak Testosterone Forum .
Now the minute that you introduce a pharmaceutical into the equation, things definitely become unnatural. However, it can be argued that this is of minimal concern for two reasons:
—Dosage. The Arimidex required is very low dosage and almost all the side effects that are experienced from this medication are in patients taking much higher amounts, such as men with prostate issues or women with breast cancer. The typical male on HRT will be taking a 1/2 mg twice per week as opposed to the typical male/female with cancer who is taking maybe a gram per day.
—Short Term. Many HRT men can actually get off of Arimidex after 6-9 months, because a) testosterone helps them to lean out and lose weight and b) a natural “settling and rebalancing” process seems to occur. This makes Arimidex a shorter term issue.
2. Improper Delivery Methods. It can also be argued that HRT does not always properly mirror the body’s natural way of releasing testosterone. For example, in a healthy male, testosterone is released in the early morning hours and then decreased significantly (~20-40%) by evening. This does not really occur with many of the delivery methods such as injections and pellets. In addition, topicals may be particularly “unnatural” in the sense that there is some evidence that that they unnaturally raise testosterone and estrogen levels in the extremities. See my link on Testosterone Risks for more information.
3. DHT. Some of your testosterone is converted to DHT through the 5-alpha reductase enzyme. DHT is very important for many “male” functions including libido. However, too much DHT can lead to accelerated male pattern baldness and enlarged prostate. So one concern that early practitioners of HRT had was: would some men given testosterone therapy experience negative results from the increased DHT?
As far as I know, there are no studies that show this to be a statistically significant issue. However, some men do report hair loss and enlarged prostate as a side effect of their HRT. So it is definitely possible that a small percentage of men have trouble with this issue. And so one could ask if giving T to these men is really a natural solution since it seems to elevate their DHT to unneeded levels. (The rebuttal is that these men may have something in their lifestyle that is causing them to be “high converters” – we just don’t understand this pathway well enough yet.)
4. Proper Level. There is also the issue that men have significantly varying baseline testosterone levels in their teens and 20’s. So how do you know what is the correct level to restore them to, i.e. what will be natural for them? Some men probably peaked around 1000 ng/dl, some 800 and some maybe even 600. Their body’s and brains are probably tuned differently.
5. Testes Function. If you are low testosterone and raise your T substantially, you will usually lower your fertility and in some cases even experience some shrinkage of the testes. Many men would argue that is unnatural because it is extinguishing a natural process of the body. And, for this reason, many men take supplement HCG during testosterone therapy to avoid testicular shrinkage. See my link on Testosterone and HCG.
And, in all cases, probably none of them have baseline testosterone levels from that time period. I have seen a few weird reactions on the forum from men who have undergone testosterone therapy and it is probably for this reason. The change is testostserone created mood and mental issues for one man, in particular, who probably should not have had his testosterone pushed so high so rapidly.