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Starting testosterone next week. What should I expect?
Mar 26, 2014

Nelson, I know you wrote the book "Testosterone: A Man's Guide". I was diagnosed with low testosterone and do not know if I should do injections or gels. Also, what should I expect when it comes to sex drive and energy, etc? Thanks for your great work educating us in simple terms we can understand. Ah, my friends also told me I should be careful with heart attacks while on testosterone. Is that true? I do not want to screw myself up, just want to feel better since I have been tired and sex sounds impossible for me. My bf thinks I am not interested in him but I am really attracted to him but just lost my mojo and motivation.

Response from Mr. Vergel

I hope getting your testosterone blood level up will help you regain your mojo and stamina. But testosterone replacement therapy (TRT) is no magic solution and a cure-for-all. Some men expect huge differences right away and get easily discouraged.

To answer the question about how long TRT, a group of researchers reviewed a lot of the TRT studies published to date. Here is what they found:

Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, no further increments beyond.

Changes in erections/ejaculations may require up to 6 months.

Effects on quality of life manifest within 3-4 weeks, but maximum benefits take longer.

Effects on depressive mood appear after 3-6 weeks with a maximum after 18-30 weeks.

First effects on erythropoiesis (increased red blood cells) after 3 months, peaking at 9-12 months.

Prostate specific antigen and volume rise, marginally, plateauing at 12 months; further increase related to aging rather than therapy.

Effects on lipids appear after 4 weeks, maximal after 6-12 months.

Insulin sensitivity may improve within few days, but effects on glycemic control become evident only after 3-12 months.

Changes in fat mass, lean body mass and muscle strength occur within 12-16 weeks, stabilize at 6-12 months, but marginally continue to improve over years. Effects on inflammation occur within 3 to 12 weeks.

Effects on bone detectable after 6 months but continue at least for 3 years.


So, as you can see, you have to be patient.

The decision of whether to use gels or injections is a personal one based on several factors:

- Cost and insurance coverage. Injections are cheaper by far but less convenient than daily gels. For best results, weekly injections of 100-150 mg of testosterone are better than 200 mg every two weeks since there are less pronounced peak and valleys.

- Fear of transferring testosterone to female sexual partners or kids by contact (gels). For many gay men, this is not an issue unless you have kids.

- Personal commitment. Are you OK with daily application? Are you afraid of needles?

You can read more about how to chose the best testosterone replacement options and how to prevent potential side effects on my new education website:

Best of

About your question on heart attacks: Two studies were published in the past 6 months that suffer from the same flaws of lack of monitoring. I reviewed them here:

Nelson Vergel Asks for Change in Testosterone Guidelines After Another Negative Study

So, you can see that the conclusions of those studies are not what I would consider "clean". I am amazed how some researchers are eager to publish data that does not even meet minimum criteria on monitoring!

I am here to answer any questions you may have as you get more deeply educated about hormones and your health, so do not shy away from sending me updates and questions.

Good luck in your new journey.

In health,


Intermittent Fasting
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