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.
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.
No.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 their 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 to 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.
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.
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 refers 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.
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. It may however take up to 12 weeks to see 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.