In this 2025 YouTube monologue, a U.S. board‑certified physician with five years of experience treating low testosterone walks viewers through the five most common questions he receives about testosterone replacement therapy (TRT). He explains that stopping TRT usually allows endogenous testosterone to rebound to near‑baseline levels rather than dropping to zero. He discusses delivery options—intramuscular versus subcutaneous injections, daily creams, and pellets—concluding that the route of administration is largely a matter of personal preference, though subcutaneous injections often yield higher serum levels. He outlines what free testosterone levels are considered optimal in a healthy adult (over 10 ng/dL, with 15‑25 ng/dL on therapy feeling “optimal”) and emphasizes that target total testosterone is individualized. He reviews the most frequent side effects—acne, increased red blood cell mass, irritability/mood swings, and hair thinning—advocating regular lab monitoring and dose adjustments. He addresses the role of HCG, gonadotropins, and clomiphene for preserving fertility, noting they are optional and add cost. Finally, he examines the debated need for estrogen blockers, explaining that some men benefit from modest estrogen suppression while others may suffer libido or mood issues if estrogen is overly reduced. The doctor stresses the importance of individualized dosing, ongoing lab checks, and follow‑up videos on TRT risks and safe practices.
Chapters
I'm a board-certified medical doctor in the United States, and I've been treating guys for low testosterone for over 5 years now. Not every man is curious about testosterone replacement, but every man does want to know about their testosterone levels. And most of the time we end up talking about replacement, what it looks like, and if it would apply to them. I wanted to share with you the top 5 questions that I get asked about TRT. Number 1, once I start testosterone, will I ever get off of it? If you Google this question, you will inevitably get the answer that yes, once you start testosterone, you will never be able to make your own. And guys, I just haven't seen that to be true. I've taken several men off of testosterone. Once you get off of testosterone, more often than not, I see your levels returning back to baseline. If your level of testosterone was 200 when you started TRT, usually when you get off of testosterone, your levels will be around 200 or 300 again. They might be 20 to 50 points lower, kind of depending on where you would have naturally declined to. But in general, I don't see guys bottoming out to zero. That's just what I see in real life. Question number 2, is it better to do injections or creams? Is it better to do subcutaneous injections or intramuscular injections? I get this question all the time, and the answer is it really doesn't matter. If you want to do intramuscular injections once a week, that is the easiest way to do it. If you can't give yourself a shot or you can't get somebody else to give it to you, try a cream. Go ahead, it works. It doesn't always work on everybody, and not every man is satisfied with using a cream. It's, it's kind of messy, it's tedious, you have to do it every single day. But then I get guys who want to do injections every single day, not necessarily intramuscular where you're going deep into the muscle, but they'll want to do subcutaneous injections. So tiny injections every day or every other day or 3 times a week. Guys, I've seen it all. Most of the time when I see guys doing subcutaneous injections, their levels of testosterone will be higher. I don't think this is because of the fat versus muscle injection. I think this is because ultimately you're giving your body more testosterone more frequently. But ultimately, really, it doesn't matter how you give yourself the medication. It's gonna get into your body unless you have skin that's not going to absorb the creams. Pellets, on the other hand, I'm not a big fan of. Why? Because you shoot your levels up really high and then you let them decline over a period of 3 to 6 months, and by the time you're ready for another one, you're dragging quite a bit. Number 3, This question I get asked a ton is, what level should I be at naturally? Well guys, everybody's different and I can't answer this for you. Naturally, several decades ago, our testosterone levels were higher than they are now. It just is a product of our stress levels, our environment, our food, etc. Ideally, every man should have a free testosterone level over 10, and we can use that as a guide. Once you do replacement, if you can get your levels up to 15 to 25 of the free testosterone, you're probably feeling well. And that leads me to my next question, what level of testosterone should I be at on replacement? Everybody's gonna have a different answer here. A lot of guys are gonna think, hey, I need my testosterone to be 1,000. Some will lean more natural and say, I think my levels should be around the 700 to 800 mark. Some think the 500 mark. I think this is a very highly personal decision. You know, medically we can all argue like if your testosterone levels are 400 or 500, then you're in the normal range. But let's be real, who wants to be normal these days? Every guy is looking to feel optimal. And my goal for you is honestly for you to feel optimal without having too many side effects, or any side effects if we can do that. And usually you're going to feel your best with a free testosterone range of 15 to 25. And this is where it can serve you to have a medical professional looking out for you. I know a lot of guys get their testosterone on the streets. I'm not naive, but when you're getting your blood drawn pretty regularly, monitoring your red blood cell counts, your hemoglobin, your hematocrit, your testosterone levels, and you're talking to your provider about how you're feeling and whether you have any side effects, all of that needs to be taken into account. The next most common question that I get: what are the common side effects of testosterone replacement? The most common thing that I'll see, especially early on, is acne. You'll almost always get a level of breakout when you start testosterone, kind of like going through puberty. You're going to have that initial surge of your skin not knowing what to do with all that hormone. I try to be really careful with my dosing to make sure that guys don't experience that, but most of them will, and it will inevitably get better if we do your dosing the right way. If you're having breakouts all the time, especially cystic breakouts, especially on the chest or the upper back or the face, then your dose is too high. Cut Down. Another common side effect is increased red blood cell production, increased hemoglobin, hematocrit. Another really common side effect I'll see is irritability, and to me this is one of the most dangerous side effects because you can get really angry really fast for no good reason over small things. You never want an unstable mood when you're on hormone replacement. Other common side effects: hair thinning and hair loss. I'm sure I'm missing some, but those are the most common things that I see frequently. The next question I frequently get is, will I need HCG? HCG and gonadotropin and clomiphene— these are all things that are used to increase your FSH and LH levels. When you go on testosterone replacement, it's common to add these other things to keep your own natural production of testosterone and sperm up. And yes, that's important, especially if you want to stay fertile. If you're in your 40s, 50s, you've had all the kids you wanted to have, or you never want to have a kid, we really don't need to worry about it. And this is a heavily debated topic, and I'm sure I'll get some Flack for that, but I don't think you need it. And another reason is these medications can just add cost. And the last frequently asked question that I get almost every time is, will I need an estrogen blocker? This is a huge topic and it's heavily debated, and every provider that you meet will have a different opinion on this because anytime you artificially raise your testosterone levels, your body will convert some of it to estrogen. Now, it's not doing it all the time just to get rid of extra testosterone. Sometimes it's doing it to raise the ratio of testosterone to estrogen that you have in your body, and there's a reason for that. Sometimes you need estrogen for particular reasons, and sometimes that's libido. I've had men block out their estrogen so low that they have zero libido and erectile dysfunction. And so sometimes we need to keep it a little bit higher if you're going to have testosterone levels that are high. That being said, everybody's different. If you're experiencing mood lability, meaning you're crying for no good reason, or you're just feeling a lot of emotional ups and downs, your nipples are sensitive or puffy, those are reasons to block out your estrogen, and it's okay to do that. All right guys, those are the top questions I get on testosterone and TRT. If more information, I'm going to make another video on how testosterone replacement can go terribly wrong. I hinted at that a little bit in this video, but I'll make a more thorough explanation of that. I'll also have another video on how to do TRT safely, so you can look forward to those videos next. You guys have a good day.
