Before You Jump on Testosterone, Pump the Brakes
Testosterone therapy looks pretty shiny from the outside: more energy, more drive, better gym sessions, maybe even better erections. TRT can absolutely help the right guy, at the right time, for the right reason. But here is the honest truth men in their 20s, 30s and 40s may not be told.
If you and your doc do not know the cause of your low testosterone, you are flying blind and risking lifetime dependence.
In my work across hospitals, mental health services, injury management/chronic pain clinics and now as a GP registrar, I have seen a wide spectrum of hormone issues. Misdiagnosis. Overdiagnosis. Normal testosterone labelled as low. And blokes who unknowingly became dependent on TRT because the underlying problem wasn't properly established first, or they got carried away with their #gains.
You deserve better than guesswork. Especially given what's happening in the online world (selling testosterone like miracle hot chips).
This article is NOT for you if you've had testicular cancer, testicles removed for some reason, a brain tumour, brain surgery or a genetic disorder like Klinefelter or Kallman syndrome.
It IS for you if you've been told or think you might have low testosterone associated with
Being overweight/obese
Sleep apnoea
Diabetes
Previous testosterone use
Previous or current Anabolic steroid use
Long-term opioid use (Oxycodone, patches etc.)
Not All Testosterone Tests Are Created Equal
Testosterone is annoyingly tricky to measure. It fluctuates with sleep, stress, sickness, gym sessions and even how late you were scrolling TikTok last night. Sir, put the phone down, now, and do 20 squats immediately.
A lot of men get caught out because they only had a single, total serum testosterone, usually drawn after 10 am, often in a stressful week, and sometimes done with older lab assays that underestimate the real value.
Here is what you should know.
1. Serum Testosterone (Total T)
The standard test. Measures all testosterone floating around in your bloodstream. Cheap and easy, but affected by everything from bad sleep to a rough week at work.
2. SHBG (Sex Hormone Binding Globulin)
This little protein is the bouncer at the club door. It grabs testosterone and stops it being usable (getting inside the cell club).
High SHBG can make your total T look normal even when your free T is low.
Low SHBG can make your total T look low even when you are fine.
A heap of guys only get total T checked and get misdiagnosed.
3. Free Testosterone
This is the good stuff. The testosterone your cells can actually use.
More accurate for diagnosing real androgen deficiency but harder to measure. The best method is equilibrium dialysis, but most Aussie labs use calculated free T, which is OK but not perfect like you.
4. Tests That Underestimate T
Some older immunoassays still used in smaller labs can give falsely low testosterone readings, especially if SHBG is high. There are several papers discussing the inaccuracy of some immunoassay kits. A commonly cited review is Rosner et al., JCEM 2007, which highlights major limitations in direct immunoassay testosterone testing.
If your results look weird, they might be.
Bottom line: Always get
Two morning testosterone tests
SHBG
Free testosterone (calculated or dialysis if available)
LH and FSH
Prolactin
Thyroid function
Full sleep and medication history
This is the difference between smart medicine and getting stuck on lifelong TRT for no reason.
Find the Real Cause First
For men under 50, low testosterone is often secondary hypogonadism, meaning your brain has turned down the dial. This is usually reversible.
Common causes include:
crap sleep
untreated sleep apnoea
stress and burnout
depression
calorie restriction
overtraining
alcohol
recreational drugs
opioids
obesity
shift work
anabolic steroid withdrawal
If you jump straight to TRT, you skip the root cause. That puts you at risk of feeling worse long term.
TRT Dependence Is Real
If your testes stop producing testosterone because they sense external supply, that is fine if TRT is lifelong and medically indicated.
But if the cause was reversible and you go on TRT anyway, your natural testosterone production can switch off.
Then you are stuck on therapy you never needed.
This is exactly the business model of a few questionable subscription clinics in Australia and overseas. Sign up. Get tested poorly. Diagnosed too quickly. Hooked on a product. Reorder every month. Rinse and repeat.
Hormones are not meant to be a subscription box.
A large proportion of men on TRT in their 20s and 30s never needed it. Some were withdrawing from anabolic steroids. Some were stressed. Some had sleep apnoea. Some were just tested wrong.
Chasing gains and health is fantastic and good-on-you for being here. But don't be part of the coming wave of normal, young dudes, falling for unrealistic images on socials and becoming dependent on testosterone unnecessarily. Some people need TRT injections (see above it), many do not. Choose wisely. Get proper testing and advice.
TRT Is Not Thyroid Replacement
This part is critical.
Thyroxine replaces a missing hormone in a system that is damaged. It is like topping up a car with oil if the engine leaks. Straightforward.
Testosterone is different. Your system is usually intact. It is not a replacement. It is a decision to override your natural hormonal axis, possibly for life.
That requires careful diagnosis, not vibes.
The Smarter First Steps
Before starting TRT, every bloke should do this:
1. Get proper morning testosterone testing, including SHBG and free T.
2. Rule out sleep apnoea.
3. Check mental health properly.
4. Fix sleep, nutrition, stress and alcohol intake.
5. Talk honestly with a GP who understands men’s health, sexual health and long term consequences.
Prevention is always cheaper than recovery.
A highly cited paper worth reading:
Wu et al. (2010), European Male Ageing Study, one of the most influential population studies on testosterone and symptoms.
“If one does not know to which port one is sailing, no wind is favourable.”
- Seneca
Same goes for hormones. Do not set sail without knowing where you are going.
If something feels off, get it checked properly.
Do not rush into testosterone because someone online said it changed their life.
Good diagnosis protects you from lifelong medication you may not need.
Read more, sign up, and follow me 👇for more straight up Australian men’s health advice.
⚠️ Disclaimer
This article is general information only and is not personalised medical advice. Always speak with your GP for assessment, diagnosis and recommendations tailored to you.
#MensHealth #Testosterone #TRT #MensHealthAustralia #HolisticHealth #Hormones #SleepHealth #MentalHealth #FitnessAU #EvidenceBased #DrJamesAU
0 comments