It feels hypocritical to warn you about buying testosterone online when testosterone replacement therapy has made such a huge difference in my life. The benefit for me was instant – better energy, better mood, and the most lusciously hairy toes you can imagine.
But before you start googling “cheap hormones near me,” put down your credit card. The difference is that, as a trans person, I was ok with being infertile, the idea of taking medication forever didn’t daunt me, and I had a small army of medical professionals to make sure my heart didn’t pop like an heirloom tomato.
Buying medication from dodgy online clinics isn’t just expensive and risky; it’s literally not what the doctor ordered. There are plenty of people online (including me!) who’ll tell you all sorts of things about hormones – but the people who really know their stuff are the ones who’ve spent a decade in medical school.
Let’s sift through the hype, the risks and rewards of TRT, and how to actually optimise your hormones according to science.
Spilling the T
Testosterone gets a lot of hype, and for good reason. It’s essential to everything from boners to actual bones. Services offering testosterone online point to the hormone’s powers, reasoning that if some is good, more is better. But your body has a natural set point for how much testosterone is normal for you, and adding extra can wreck the joint (literally, as hormones also maintain the cartilage between your bones).
The biggest risk of testosterone replacement therapy is that your body will forget how to make its own.
When a man takes testosterone as a medication, “it will turn off his pituitary-testicular axis [the connection between the pituitary gland in the brain and the testicles], so he will stop producing his own testosterone, and it will also turn off sperm production. The sperm cycle is 72 days, and depending on how long a man has been on testosterone and what formulation, it might take many months for men’s sperm counts to come back to normal,” endocrinologist Carolyn Allan warns.
Testosterone has even been studied as a possible contraceptive because of the way the medication results in low sperm counts.
Then there’s the problem of diminishing returns.
“If you look at the literature, initially there is a [wellbeing] benefit” notes Allan. “But over time that benefit becomes less obvious. And it depends on how low the level is when you start. So if you’re starting off with a testosterone level of 5 – for example, a man with Kleinfelter’s syndrome – and treat him up to a level of 15, he’s absolutely going to feel better. There’s no doubt about that.”
“But when you look at those randomised control trials with those older men who have a degree of lower testosterone, that wellbeing benefit often isn’t maintained. You get that initial benefit, but it often isn’t maintained.” Allan notes.
While some men see an initial boost, the good times don’t last long, leaving them stuck with the side effects and none of the glow-up they were promised.
Coming off testosterone medication can also be an extremely rough few months, as the body tries to figure out how to make its own hormones again.
What if you suspect your T level is low?
Even then, TRT might not be the right course of action, and buying testosterone online could just be papering over a more serious problem.
As Carolyn Allan explains, “Testosterone is a window into men’s overall health. That’s the important thing – health is often about more than just the testosterone.” Low levels can be a sign of deeper health concerns like metabolic disorders, pituitary problems, or even genetic conditions such as Klinefelter’s syndrome.
“One in 200 men has low testosterone, and it has very significant implications for their health and their fertility,” says Allan. “So it’s important you have a full assessment, with an examination that includes testicular examination.”
Hormones are like the tiny postmen of the body, constantly delivering messages between organs to keep everything running smoothly. If your testosterone levels are off it’s likely to be a sign that something’s going wrong with the parts giving or receiving the messages, rather than the hormone itself.
This means that focusing on the testosterone level without looking for the actual underlying problem is like placating Lassie with a schmacko when she’s actually trying to tell you that little Timmy’s fallen down the well.
Do testosterone-promoting supplements work?
The short answer is maybe, but no one’s really studied it. Buying testosterone online is already pretty risky, but supplements are like the wild west.
“There’s really not any [scientific] literature to support those [herbs and supplements] in terms of your testosterone level or your sperm production” advises Allan.
“However, some of them, for example tribulus, may have some androgenic activity, so you can actually turn off your own axis. And it’s very much ‘buyer beware’ about what you’re getting.”
In short, some supplements can act like testosterone in the body and carry the same risks as medication, while others probably don’t do anything. On top of that, supplements aren’t regulated as rigorously as medication, so it’s a bit of a mystery what’s actually in those pills and powders.
While people might swear that some herbal remedy or supplement has worked for them, right now it’s impossible to say whether it’ll work for anyone else – or what the right dose, routine, method or combination might be.
Optimising testosterone according to science
It’s boring because it’s true – a healthy diet and regular exercise are the best way for you to keep your hormones in top form.
“Optimising your hormones is a great thing to do” espouses Allan.
“If you’ve got a man who’s got a BMI of 35, if you can reduce his weight then you’re almost certainly going to improve his testosterone. And along the way, you may well address his blood pressure, his cholesterol, reduce his risk of type 2 diabetes and cardiovascular issues, not to mention overall and sexual wellbeing.”
“So I would not disagree that optimising your hormone level is the way to go, it would just be about how one is optimising that hormone level.”
Testosterone levels are sensitive to lifestyle changes. “Shift work, jetlag, anything that throws out your circadian rhythm, will temporarily drop your testosterone level” explains Allan. “If you have been acutely unwell, that will drop your testosterone level.”
“There’s a huge range of what’s normal – and there’s different normal over time, because your testosterone level is highest in the morning. There’s a wide range of what’s normal for a particular man, and then there is within men there are differences over time. To know an individual’s profile is incredibly helpful. [That’s why] I like to know what testosterone looks like over a period of months.”
Breaking research has shown that ageing itself isn’t a major factor in testosterone decline. “Australian studies have shown that if men maintain good health as they age, they don’t necessarily have a decline in their testosterone.”
“The role of ageing itself is minimal – it’s the co-morbidities [other health problems] that men acquire along the way, and obesity would be the most significant of those co-morbidities.”
Where to go next
If you’ve been feeling run down for a while, it’s time to talk to a doctor. Start with a GP, especially one who lists men’s health, hormone health, or endocrine medicine as areas of interest. If you don’t have a regular GP, ask around for recommendations, research local clinics, and, if you can afford it, meet a few different doctors to find one you click with.
“The GP is absolutely the right person to go along and have that conversation with” says Allan.
“There’s often clues in a man’s health about what might be the cause of the low testosterone.” A good GP can connect your current hormone levels to your medical history, consider future fertility goals when planning treatment, and provide ongoing in-person care – something a dodgy telehealth clinic shilling testosterone online can’t do.
“So that’s number one, to go and have that conversation, have a full assessment of your health” Allan urges.
Buying testosterone online might seem like a rebellious hack, but in Australia, accessing testosterone cheaply and legally is actually a pretty straightforward process if you’re working with the right medical team.
For me, testosterone has been a lifesaver, but without the guidance of an endocrinologist I’d probably be one reddit post away from injecting olive oil by mistake.
It’s hard enough to buy the right size of shoe online, let alone a balanced hormonal profile. As slick as those insta ads are, your endocrine system is one area where it’s best to stick with prescriptions, not subscriptions.
