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How Long For TRT to Work?

In this article we will address the question of how long for TRT to work.  Many of my patients ask similar questions about how long it is going to take before they see the benefits of testosterone injections or topical testosterone.  The answer really depends on a few different things.  I will say right out of the gate that initially it is going to take about three weeks before you notice the benefits.  However, you may not get the full benefits for almost three months.  In between that time there are a few different things that you want to make sure are optimized and a few different things that can accelerate the benefits.  That's what most of this article is going to be about. 

So if this interests you keep reading, we are going to get into the details. 

How Long For TRT To Work

Many people starting testosterone replacement therapy wonder how long for their TRT will start to work.  On average I expect people to feel some improvements in about three weeks.   For some it can take longer up to three to six months.  In the case you start feeling better early on, you may not get the full benefits until several months down the road.  Firsts let's look at  what symptom improvements  you are expecting to see on TRT or testosterone replacement therapy. 


Benefit Timeline of TRT

The main benefits I expect to see when someone has low testosterone and they start testosterone replacement therapy are  increased energy, drive, and mood.  Along with this you will also typically see improvements in erectile dysfunction and libido.  The benefit that most people notice first is with energy mood and drive.  How long it takes depends on:

  • If your dose is correct.
  • If your estrogen levels are not going up.
  • What's happening with your androgen receptors. 


These three things are important but I also wanted to point out that most of us think a little bit is good, so more is even better.  That's not always the case for testosterone replacement therapy.  The reason it is not in this case, is tied in with the downstream hormone metabolites of testosterone and other hormones.  If you're on a high dose of testosterone and your levels are really high,  your enzymes will be saturated.  These are enzymes like alpha five reductase and aromatase.  The alpha reductase turns testosterone into dihydrotestosterone (DHT) and the aromatase makes estrogen or estradiol. The more testosterone in your system the more DHT and estradiol.  These can cause some side effects. 


The Role of Estradiol 

In the case of estradiol, it can diminish the positive effects of the testosterone.  So if you're getting a lot of estrogen production with the increased testosterone, it may negate some of the benefits.  Sometimes you just decrease the dose testosterone and things even out.  Most people know that high estrogen negates some of the benefits of their testosterone replacement therapy.   What they sometimes forget is that, you have to check the levels at different times.  You have to make sure you check it mid week and several months into the treatment.  Once you get the estradiol optimized, you will see more of the benefits.  A high estradiol will delay the time it takes you to see benefits.  That doesn't necessarily mean you have to discount the total time and start back from square one.  Once optimized it may take an additional 3 weeks after the estradiol is normalized. 


The Role of Your Dose

The other thing to look at when we're trying to understand how long this might take for you to realize the full benefits, is your actual dose of testosterone.   The benefits of testosterone replacement therapy are all tied in with the androgenic and anabolic effects of testosterone.  One of the metabolites of testosterone is DHT which has stronger androgenic effects.  Testosterone replacement therapy can lead to higher levels of DHT.  If it gets too high, this can lead to more irritability and anxiety.   The outcome will really depend on how active your enzymes are.   Regardless of your enzymes, higher levels of testosterone will lead to higher DHT levels.  If you are taking it for mood reasons, pay attention to your mood in relation to your dose.  Generally it helps with mood and positive outlook but it can make things worse too. 

If your testosterone levels are still low after you check it six weeks later, your tissues may not be getting fully saturated with those androgens.  In this case, it will take longer than you expect to get to the full benefits.   Typically it's going to take about two to threes months to get the full benefits if everything is optimized. 

Another thing that is important is the number of androgen receptors.  The main two hormones are testosterone  and dihydrotestosterone.   The dihydrotestosterone binds to the androgen receptor stronger than the regular testosterone.  As you're saturating your tissues with more androgens from the testosterone replacement therapy that saturation has the effect on the cells and the tissues.  However, if you don't have very many androgen receptors then you have less tissue saturation.  You can enhance the saturation and shorten the duration of time we expect to see benefits when you have more androgen receptors.   These receptors increase with more resistance exercise and to a lesser extent exercise in general.  The exercise likely creates more androgen receptors in all of your tissues, but it is specifically documented in muscles. 

The last thing i wanted to note is about cortisol levels.  Very high testosterone levels can cause high cortisol.  When your testosterone levels are low you may notice difficulty sleeping and waking up sluggish.  When your testosterone levels get too high the high cortisol can interfere with your sleep.  If you are having more issues with sleep when you start the testosterone that may be a problem.

If you have checked off all these boxes and you are not noticing the benefits of testosterone replacement therapy maybe there's another problem going on.  That doesn't necessarily mean you don't need the testosterone at all.  If your levels started off  low it may be just a piece of the puzzle.  You may feel ten or thirty percent better but you're still not quite where you think you should.  In this case, there's probably another thing going on there you haven't figured out yet.  If all the hormone levels are optimized, you know you have to look at other possibilities to what could be going wrong.

That should answer the question, how long for trt to work.  If you have specific questions about testosterone replacement therapy and how long it might take to work, ask in the comment section below.  If you want a customized plan on optimizing your testosterone replacement therapy, click on the link below to get started. 

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