This post will walk you through the ups and downs of testosterone replacement therapy and give you an idea of how long it takes testosterone to work and what to do if it isn't.
Testosterone replacement therapy can be used to help patients lose weight, improve their mood and more - but what if you don't experience those benefits? How long should you wait?
Learn more about how long you should be waiting for results and learn about which factors may be limiting your results in this guide...
Testosterone Replacement Therapy
Testosterone replacement therapy is used to treat patients who may have low circulating levels of testosterone in their body.
This condition is often referred to as hypogonadism which simply means that your sex hormones are no longer being produced at normal and optimal levels.
The unfortunate truth is that this condition will occur over time in both men and women.
The reduction in testosterone in men is referred to as andropause, while the reduction in both estrogen and progesterone in women is referred to as menopause.
Women also experience low testosterone (just like men) but the difference is that the decline in testosterone may not be noticed as much in women compared to men due to the relative importance of other sex hormones.
Because of this testosterone replacement therapy has become widespread in both male and females, but not everyone tends to experience all of the benefits that testosterone replacement therapy has to offer.
Does that mean that testosterone simply doesn't work in some people?
Maybe, but there are actually many common reasons that testosterone may not be working in your body and much of it has to do with 3 simple reasons:
Reasons why Testosterone May not be Working in your Body
Whenever we use hormones as medications it's always helpful to consider the body as a template with which we should try to emulate.
We know that men and women have different levels of testosterone circulating in their body - therefore it makes sense that dosing should be different between male and female.
We also know that testosterone levels differ among individuals within the same gender, so there really shouldn't be a "one-size" fits all testosterone dose for ALL males or for ALL females.
In addition to these basics, we also know that there is variability in how individuals metabolize hormones, medications, and nutrients.
Some people are considered to be "fast metabolizers" which means that their livers can chew through medications and hormones faster than others.
This means that the amount of testosterone someone takes will be unique but also HOW they take it, meaning how they put it into their body.
With these basics under your belt, you can begin to understand some reasons why standard TRT may not work in certain individuals.
The first and most common reason that testosterone may not be working in your body is simply because of dosing.
You may not be taking enough testosterone.
Because there is no "standard" dosing this means that each person will need a slightly different amount.
Having said that we (Doctors) have to start somewhere when we start someone on Testosterone and unfortunately we don't always get it right on the first try.
If you haven't noticed an improvement in your symptoms then it's a good idea to re-evaluate your serum testosterone levels (both free and total testosterone) to determine if your dose is adequate.
Sometimes it's really just as simple as altering your dose.
#2. Route of Administration
The next big important topic has to do with how you are taking your testosterone.
There are 3 main ways to do this and each has its limitations:
- Gels & Creams: Gels and cream need to be absorbed into the skin and then into the bloodstream in order to be effective. Absorbing through the skin allows for a constant supply of testosterone to the body but has its limitations in that each individual may absorb medications and hormones at different rates. It's also difficult to get fat soluble hormones through the skin without certain carriers which may cause a reaction in certain people. Gels/creams tend to offer the best stability in terms of testosterone serum levels but they require frequent administration (such as up to twice per day) which can be a problem for some people. Also, gels/creams may be absorbed by other people that you come into contact with.
- Shots and Injections: Shots and injections have the advantage that they bypass transdermal (skin) absorption because they are delivered directly into the subcutaneous tissue or muscular tissue (depending on the length of the needle). On the flip side shots and injections may cause problems in that they deliver massive quantities of testosterone all at once which results in unstable serum testosterone levels depending on how frequently they are used. As a result, some people experience excess testosterone symptoms initially after the injection and low testosterone symptoms right before their next shot. Each one also requires an injection which may not be optimal for each person.
- Oral medications: One of the biggest disadvantages of using oral testosterone is that it is metabolized first by the liver immediately after absorption. This may result in partially metabolized (but biologically active) testosterone metabolites which may cause problems such as liver damage over time (2).
- Pellets (very similar to shots and injections): Pellets have the advantage in that they do not require daily or weekly dosing, but it comes at a price for certain people if the dosing is wrong after they are implanted. Some individuals may experience no benefits or symptoms of testosterone excess if the pellet concentration is not appropriately tuned for the body. In addition, any surgery (even if minor) carries it with certain risks such as infection.
The moral of the story?
If one form of administration is not working for you then it may be worth trying a different route.
Sometimes it's just a matter of time and all you need to do is have some patience!
When you start digging into patient stories regarding hormonal therapy you will quickly start to understand that no two people are alike.
The dosage, amount of time it takes for benefits to kick in, and even which benefits tend to appear, vary wildly from person to person.
I've found in some of my patients that simply waiting a few weeks is the answer.
Always be patient and try not to make any snap decisions regarding your dose because it may lead to negative long term consequences down the road.
Because testosterone is a hormone, which acts through genomic changes in each cell, it can take weeks to months for certain beneficial effects to kick in.
Genomic changes refer to the ability that testosterone has to literally alter genetic transcription and change which genes are being transcribed into proteins in your cells.
Certain benefits which are the result of these changes will, therefore, take some time to experience.
On the other hand, testosterone also has non-genomic effects such as its effects on skeletal muscle which result in an almost immediate increase in athletic performance (and sometimes weight loss).
So in order to get these benefits, you need to make sure you are:
A) Getting the right amount of testosterone (dose)
B) Using the right route and getting proper absorption
C) Waiting enough time for the effects to kick in if they require changes to cellular transcription
Even if all of these factors are taken care of some results appear quicker than others.
You can use the list below to help you understand how long it takes for testosterone to work.
How long Does it take for...
- Weight loss? If testosterone is going to help with weight loss it may start to work within 6-8 weeks after starting therapy. Remember that testosterone will simultaneously help you build muscle mass while reducing fat mass which may not result in an immediate drop in the scale. A better way to measure this fat loss is by assessing waist/hip measurements and ratios. You can read more about using testosterone for weight loss here.
- Improved muscle mass? You should notice a change to muscle contraction and the force you are able to lift almost immediately, but it may take your body weeks to months to build up lean muscle mass. This has less to do with testosterone and more to do with the time it takes your body to hypertrophy muscle. In order for this benefit to take place, you must also ensure that you are eating a proper and healthy diet! You won't gain muscle mass unless you are also exercising and eating right.
- Increased libido? Initial changes to libido are often seen within the first month of therapy and you should notice changes within 3 weeks after starting therapy (3). It may, however, take up to 12 weeks to see a complete resolution or the total benefits that testosterone will provide. As a quick tip for women: you can increase the efficacy of testosterone at improving libido by applying transdermal testosterone vaginally.
- Changes to your mood? Changes to mood including a reduction in depression are usually seen within 6-8 weeks and should reach maximum effect by 9 weeks. It's unlikely that you will notice an improvement after 3 months unless your dose is off or some other reason.
- Improvement in erectile dysfunction? If you are a male taking testosterone for ED then you should notice an improvement within 3 weeks.
- Energy? Most people experience an increase in energy when taking Testosterone within 2 months after starting therapy (assuming they have fatigue at baseline). If you don't have any issues with energy then it's not likely to improve your baseline energy level.
Remember that these are simply guidelines and the exact time frame may vary between individuals.
If you are ever concerned that your testosterone may not be working then you should discuss other options such as your dose or route of administration with your prescribing physician.
How long does it take for Testosterone Cream to work?
Because each route of testosterone delivery is different there are also differences in terms of how quickly these "types" of testosterone tend to work.
Testosterone cream often works better in females and studies have shown that daily use of testosterone cream (5 to 10 mg per day) should result in normalization of total testosterone and free testosterone in the serum (4).
What's interesting is that increasing your dose via the transdermal route won't necessarily increase your serum testosterone as there seem to be some diminishing returns via this route.
The best place to apply this type of testosterone is to the upper arms or forearms.
How long does it take for Testosterone Gel to work?
Testosterone gel tends to work better in men and most men who use this type of gel will notice normalization of serum testosterone levels by 3 months of daily use (5).
The best site for application tends to be the arms or shoulders.
How long does it take for Testosterone Pellets to work?
Because testosterone pellets are designed to work for several months (up to 6 months) they necessarily need to contain a large amount of testosterone.
The delivery device of the pellet also changes how quickly testosterone is released into the body.
After the first 60 days, the testosterone tends to drop.
Compared to testosterone, estradiol levels tend to peak around day 40-42 which is relevant to both men and women and should be monitored.
You will likely notice a rather fast change in your symptoms if you use testosterone pellets assuming that your dose is correct.
How long does it take for Testosterone Injections to work?
Much like pellets, testosterone shots tend to reach a peak in the serum within 24-48 hours after injection which then begins to decline to by 6-7 days to low-normal levels (7).
Testosterone injections, therefore, work fairly rapidly but need to be administered every 6-7 days for optimal results.
A better route may be to take testosterone injections in smaller doses by twice per week which may allow for mores table testosterone levels.
In general testosterone injections work better for men.
Boosting the Effect of Testosterone with Supplements
What if testosterone still isn't working for you?
There are certain supplements that may be able to help you with symptomatic control.
While some supplements have been studied and shown to increase testosterone, in general, most testosterone supplements modulate the symptoms of low testosterone without altering free and total testosterone.
This may not be a problem, however, if you are interested in benefits such as libido control, weight loss and increased energy.
It's worth looking at some of these supplements to determine if they have any place in your current regimen.
The good news is that they can also be safely added to an existing testosterone replacement therapy program.
Supplements that may improve the symptoms of low testosterone include:
- Maca - Maca doesn't have any direct effect on serum testosterone but it has been shown to help improve mood, increase sex drive and balance sex hormones (including estrogen and progesterone).
- D-aspartic Acid - This amino acid may directly stimulate the release of testosterone in patients who are deficient.
- Fenugreek - Fenugreek help promotes healthy testosterone levels by improving testosterone conversion by acting like a 5 alpha-reductase inhibitor.
What to do Next
Testosterone replacement therapy is a safe and effective way to improve many symptoms associated with low testosterone such as weight gain, fatigue, and decreased libido.
Using TRT appropriately means you need to have the right dose as well as the right route of administration for your body.
If you are taking testosterone and not noticing any improvement then make sure you discuss other options with your doctor.
It's also a great idea to assess both your serum total testosterone, free testosterone, estradiol and SHBG which all may potentially interfere with testosterone function.
Make sure you are allowing enough time for these benefits to kick in (in some people this may take up to 3 months).
Now I want to hear from you:
Are you taking testosterone?
Is it working in your body?
Why or why not?
Leave your questions or comments below!
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