1. Testosterone Replacement Therapy -
a.k.a. “TRT”:
*Method to the Madness - Science not Speculation
*Different TRT Options
*Goal of Proper TRT Therapy
1
Quick Guide to Understand The
Basics of Testosterone
Replacement Therapy for Clients
By Rene Abreu M.S., ACSM,NASM,NSCA
www.reneabreu.com

2. Testosterone Replacement Therapy - aka
“TRT”: Understanding the Method to the
Madness and the Different TRT Options
As we age, we all lose hormones that are
responsible for healing and repair
these hormones are collectively known as “sex-
steroids”-testosterone,estrogen
the only steroid hormone that goes up with age is
the one most responsible for tissue break-down,
lack of healing, and “getting old”;
CORTISOL

3. Overall Goal of TRT: Although it is often known as
“Replacement” therapy the actual goal is “Optimization”.
Typical TRT aims to raise testosterone to the “youthful”
levels of a 30 year old healthy man.
• Overall Purpose of HRT: To balance and restore the
natural hormonal ratio in the body so that the accelerated
“break-down” that occurs with aging is partially reversed
towards “healing and repair”.
• The end RESULT: Better mental and physical
function, restoring, improving and sustaining a higher
quality of life, and most importantly - decreased risk of
age-related disease and illness.

4. Testosterone to Estrogen
Ratios In Aging Men
Total Testosterone Lab Reference Ranges (most labs) =
300-1100ng/dl
Typically as High as 50:1 In Healthy Young
Males Who Are Reasonably Lean and Fit

5. TRT: Restoring Optimal Testosterone Levels - Known to Be Effective for
Reversal of Quality of Life Issues Pertaining to Physical Strength, Vigor,
Energy, Libido and Overall
Testosterone Replacement Therapy (TRT) ‘corrects’ T-levels back within
the known optimal range.
A handful of hormones work together with testosterone to promote optimal
metabolism, energy, and overall well-being.
The most significant are: Growth Hormone (GH), Thyroxines (T3,T4),
Adrenal Hormones, and Insulin
Many of the ‘age-related’ quality of life issues directly or indirectly relate to a
deficiency of one or more of these hormones
Each of the hormones listed above can be a separate topic but the take home
point is: ALL function best when the body has a “high-healthy” testosterone
level

6. Bottom Line Take Home Point:
Cortisol is the body’s chief “tissue-break-down” hormone.
As we age it is the only ‘steroid’ hormone in the body
that INCREASES.
Testosterone is the MALE body’s chief “tissue-build-up
and repair” hormone (along with GH and something else
called IGF-I).
With Aging Comes a Progressive Decrease in Testosterone and an
Increase in Cortisol Which Accelerates the Aging Process By
Impairing the Body’s Ability to Heal and Recover from Stress of
all types.

7. Option #1: Transdermal Testosterone Formulations (i.e.
creams/gels)
How They Work Explained in 3 Simple Steps
Step 1: “Percent Strength” = the general potency of a T
product expressed as a fraction. Remember the % symbol
means “divided by 100”. ex. 5% T gel = 5/100.
Step 2: “Testosterone Delivered” - the amount or quantity of
T contained in a single dose of a specific formula or product
Step 3: “Percent Absorption" - amount of pure T that is
absorbed by the skin into the body
*****Note: author discourages creams/gels (collectively called ‘transdermals’
- if at all possible to use injections for the client/patient

8. Step 1 of Understanding T Gels and Creams:
“TOTAL STRENGTH”:
def.* = *the total amount of testosterone contained per
“dose” of product (as listed on the product label)
Most products on the market contain anywhere from
1g up to 10g of Testosterone per dose of of product
Most common are 5g, 7.5g, and 10g “total strength”
per dose of product

9. Step 2 of Understanding T Gels and Creams:
“PERCENT STRENGTH”(or CONCENTRATION)
The “CONCENTRATION” of the product - similar to
how alcohol concentration in beer is 3-6% alcohol, gives us the
quantity of testosterone in each gram of product
percent strength varies from 1-10% for most commercial
versions, brands, makes, etc.
1% = closer to female products, 10% = closer to male products

10. Step 3 of Understanding T Gels and Creams:
Testosterone “Delivered”:
The simplest way to understand this is to multiply the
number in Step 1 by the number in Step 2. Total
Strength x percent strength = Testosterone Delivered
def.*= “the quantity of testosterone actually rubbed onto
the skin.” ex. 10% T cream at 10 GRAM “TOTAL
STRENGTH” = 100mg of pure Testosterone
“Delivered” to the skin surface
Ex. 1: Testim: one of the main US commercial T-gel
products contains 5g of total testosterone per dose of
product and has a 1% CONCENTRATION. 1% of 5
GRAMS = 50mg. Therefore a single dose of Testim
“Delivers” 50mg of testosterone to the skin surface.

11. Step 3 Continued: another T product
example: AndroForte (Australian brand)
They make it simple and give you the T
“DELIVERED” right on the label...
product comes in 2 different potencies: each 1 milliliter
(ml) giving 20mg Testosterone for the 2% product,
and 50mg Testosterone for the 5% product.

12. The Fun Part - Making the Math Count: Absorption
Through The Skin - Quick and Easy Calculation Method
(hint – its always 10%!)
Take the TOTAL STRENGTH and
multiply by %STRENGTH to get
Testosterone Delivered.
ex. 1% = 5 x .01 = .05 GRAMS or 50mg
Testosterone Delivered.
10% is the Standard absorption for T
products through the skin
50mg (DELIVERED) x .10 absorption = 5mg
absorbed into the body (healthy young men
typically produce 6-8 milligrams per day)

13. Second Main Option for TRT: Intramuscular
(I.M>)Testosterone Preparations (author preferred)
Carbon Chain ‘Esters’ yield the half-lives of various
oil based solutions (hydrophobic)
Half-lives range from as little as three days
(propionate) to as much as 3 weeks or so in the
literature (testosterone undecanoate)
Quantity is measured in cubic centimeters (cc’s) or
milliliters (ml’s) (1cc = 1mL) and strength range from as
low as 50mg/ml to 250mg/ml and higher in some
‘underground’ preparations
Many Docs still dose TEST far too low to have an
effect and can actually LOWER the Baseline level
by inducing negative feedback

14. Massive amounts of misinformation based strongly on
opinion has propagated a field of pseudo-science that has
evolved into ‘subjective fact’
All testosterones ultimately become the EXACT
same form once the enzymes in the blood remove the
‘shell’
the ‘shell’ is often known as an “Ester” - a chain of
carbon atoms attached to the TEST molecule at a
specific functional position to make it last longer in a
hydrophilic (water loving or water-based environment
etc. - blood)
These carbon chains or tails attached at the “roof-
top” or 17th beta position of the TEST molecule
are more commonly recognized by terms such as
propionate, enanthate, cypionate, decanoate, etc.
These are chemistry terms describing the # of

15. Testosterone Injection Rules: #1 and #2:
English Please? Sorry, that is the correct way to say it - in
layman terms the longer the ester chain (i.e. # of carbons)
attached to your TEST formulation the longer it will last in
your bloodstream
Why? Purpose of ester is to slow absorption of TEST into
the bloodstream from minutes to hours, days and weeks.
You don’t have to be a chemistry wiz to know that a longer
chain of carbons is p-r-o-b-a-b-l-y going to weigh more than a
shorter chain...
Although this is a simple concept, the truth and accuracy of
this topic has been slaughtered on the internet blogs, forums,
1. The Length of the “Ester” is #1 factor influencing the half-life of the
drug. An ester is made up of a “carbon chain”.
2. Just as the length of a chain is determined by the number of individual
links it has in its physical structure, the life of the testosterone ester is
determined by the number of ‘carbons’ it has in its structure.

16. Testosterone Injection Rules: #1 and #2:
English Please? Sorry, that is the correct way to say it - in
layman terms the longer the ester chain (i.e. # of carbons)
attached to your TEST formulation the longer it will last in
your bloodstream
Why? Purpose of ester is to slow absorption of TEST into
the bloodstream from minutes to hours, days and weeks.
You don’t have to be a chemistry wiz to know that a longer
chain of carbons is p-r-o-b-a-b-l-y going to weigh more than a
shorter chain...
Although this is a simple concept, the truth and accuracy of
this topic has been slaughtered on the internet blogs, forums,

17. RELATIVE POTENCY? The weight of a single
TEST molecule (molecular weight) divided by the
total weight of the TEST + ESTER
Remember we said earlier that the longer the ester the
longer it lasts in the body - this is by design, and is the
sole purpose of the ester (think more links, longer chain)
Recall that we also mentioned that longer carbon chains
weigh more than shorter carbon chains - ex. Cypionate (8
carbon ester chain is heavier than propionate (3 carbon
ester chain)
Does this mean that the longer lasting
TESTOSTERONE products are...Less Potent than
the shorter acting ones? Answer: ON a mg per mg basis
– ONLY…YES. This is by simple math - addition and
subtraction

18. Example: Testosterone Enanthate
Long, heavy ester 8 carbons in length
69% Testosterone
Comes in 100mg/ml, 200mg/ml strength on the
general market
Simple Math says 69 or if we round up, 70 of every
100mg of TE is actual ‘pure’ Testosterone

19. Testosterone Cypionate
If we round up after the decimal, TE and TC
are the same % testosterone
TC is a bit heavier than TE 420 vs 418
Daltons
This will equate to an insignificant 2mg
difference between products which makes them
interchangeable

20. Testosterone Cypionate(TC): The Most Commonly
Prescribed Testosterone Formula in the US
Testosterone ester formulations are abundant
internationally and some of these preparations offer
convenience, efficiency and better overall quality of
life benefit than TC
The laboratory process of attaching the ester(s) is a
simple one for any trained lab chemist and is very
inexpensive - probably less than $50/month to
maintain for the average TRT dose range of 200-
300mg every 7-12 days
Society here in the US along with media
propaganda and the American fascination with
“Steroids” has created red tape preventing all but a
handful of less effective products from being
‘scripted’ by US Docs