What is TRT? Experts weigh in on male ‘Manopause' and how to treat low testosterone, safely
There's no denying it. RJK Jr. has explored a few controversial ideas, particularly in the health and wellness sector. But, regardless of where you stand on his views, one thing is hard to deny.
Looking back at those viral videos of him pumping weights at Gold's Gym back in 2023, he was in phenomenal shape for a man his age — biceps bulging, chest chiseled, pecks defined. He could have been an amateur bodybuilder. For a nearly 70-year-old, he was ripped.
Shortly after the videos surfaced, rumors began buzzing that Kennedy was on steroids. He promptly denied it, instead crediting his disciplined 35-minute workout routine. There was one other thing he mentioned.
'I take testosterone replacement, which are appropriate to my age, and then I take a big fistful of nutrients,' he explained in an interview with Newsmax.
Hormonal changes associated with menopause are not so secret. Women are warned about hot flashes, mood swings, and decreased periods — all of which have been studied and scrutinized for as long as most of us can remember. But Man-opause? Until recently, it has remained a blind spot in the scientific community.
The age-related decline in testosterone levels, sometimes called Andropause — or 'Manopause' colloquially — has often been met with more questions than answers.
Emerging research has begun to spark conversations around male aging and hormonal health. A 2023 study in the Journal of Clinical Endocrinology revealed that testosterone levels in American men have dropped about 1% per year since the 1980s. The decline can not be attributed to aging alone.
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Some endocrinologists have studied the root causes, suspecting the decline is due to the increase in ultra-processed foods, pesticides, as well as drug use, and other environmental concerns. Others are focused on the best ways to raise levels back to the normal range.
For people like Deep Patel, co-founder of the telehealth company Ulo, the statistic was a catalyst for exploring Testosterone Replacement Therapy (TRT) as a potential solution.
'It's like the male version of menopause, except no one acknowledged it until recently,' Patel told the New York Post. 'And look, the data backs this up. Endocrinologists have documented a population-wide decrease in testosterone levels over the past few decades. It's not just in people's heads.'
Testosterone levels typically begin to decline when men reach their forties, at which point, some will start to experience a range of symptoms, everything from hair loss and lowered libido to decreased muscle mass and fatigue.
Some of these changes are to be expected, but others can reveal a larger condition, hypogonadism. Men with particularly low levels of testosterone — 'Low T,' as the guys say — could also suffer from erectile dysfunction, osteoporosis, and even infertility.
To determine whether levels are healthy or low, men can take a TRT test. These blood tests, typically administered in the morning when levels peak, examine the amount of the male hormone present in the blood. The normal range is considered to be anywhere between 300 and 1,000 nanograms per deciliter.
For men outside the normal range, some Doctors recommend trying TRT, the routine that RFK Jr. and millions of others have embraced as part of their anti-aging and health protocols. On TikTok, the tag 'TRT Before and After' has amassed thousands of videos and millions of views showcasing brawny men flexing their quads and joking about their sudden burst of energy and newfound sex drives. Unlike Kennedy, many of these men are still young, in their twenties and thirties.
TRT has become more accessible through providers and online TRT companies like Ulo, but it's essential to recognize that it's only FDA-approved for specific conditions, such as hypogonadism or diminished functional activity of the gonads. TRT is not FDA-approved for men with low levels due to aging or other non-medical reasons.
Medical experts still have varying opinions on treatment. Some believe that the 'normal range' does not sufficiently identify men who could benefit from TRT. Others take a more conservative approach, warning that the potential side effects outweigh the benefits and that TRT should be reserved for men with particularly low levels.
Testosterone Replacement Therapy FAQs
To break down the myths surrounding manopause and TRT, The Post spoke with three experts who have years of experience in the men's health field.
Testosterone levels naturally decline with age, but what's considered 'normal' can vary widely by individual. This chart shows average total testosterone ranges (measured in ng/mL) by age group. If you're experiencing symptoms of low testosterone, speak with a licensed medical provider to determine whether treatment is appropriate for you.
Peter Hermes Furian – stock.adobe.com
Is testosterone declining in America?
Testosterone levels have declined substantially over the last couple of decades, and experts believe several factors may be contributing to these changes.
'Right now, testosterone is declining in American men of all age groups, young and old. No one is talking about that,' shared Dr. Michael Aziz, the author of 'The Ageless Revolution' and an anti-aging internist and regenerative physician specialist at Lenox Hill Hospital in New York City.
Azis believes that the decline in level is tied to several environmental problems, dietary changes, and how men socialize. 'This has to do with increased consumption of ultra-processed food, use of pesticides, excess alcohol, legalization of recreational drugs, smoking, and trans fats,' he said.
What are the ideal testosterone levels?
Most medical centers and experts considered normal testosterone levels to land anywhere between 300 to 1,000 nanograms per deciliter.
However, age is also an important factor. Azis explained that it is important to look at each patient individually in order to determine whether their levels are considered normal.
'If testosterone levels are checked, the lab reference is wrong, as it groups all men. Lab levels are 300-1000 nanograms per deciliter, so men in their twenties who are supposed to have a testosterone of 1,000 are placed in the same category as 80-year-old men with levels of 300,' he stated.
As a result, Azis explained that some young people with low levels are told that their results are normal when, in reality, they could be ideal candidates for TRT.
'Many men suffer as doctors treat those men with drugs for depression or ED pills, versus looking at testosterone levels,' Azis warned.
What is TRT, and how is TRT used to treat low testosterone?
Mostafa Abu-Hijlih, a nurse practitioner practicing at Grand Central Men's Health in NYC, says that TRT has been a game-changer for her patients. She always felt there was a gap in clinical spaces for men to discuss issues that have been historically stigmatized, but TRT opened up the conversation.
'Testosterone Replacement Therapy is a medical treatment used to optimize testosterone levels in men and women when indicated, ' Abu-Hijlih explained. 'Testosterone is responsible for energy levels, libido, muscle mass, and bone density, and has been shown to improve REM sleep time when optimized.'
TRT works by replenishing the lost testosterone that the body is not producing naturally. It's not about taking extra testosterone but rather restoring the body to a healthy, normal level.
Abu-Hijlih pointed out that the dosage depends on what is needed for each patient, and testosterone levels should be continuously monitored to determine the appropriate dose.
How is TRT administered?
According to Abu-Hijlih, there are a few different options for TRT patients when it comes to how testosterone is administered and absorbed.
blackday – stock.adobe.com
TRT is administered through a variety of modalities, including weekly intramuscular injections, topical cream, implantable pellets, or even intranasal nose spray,' she noted. 'Really depends on a combination of clinical results, patient preference, and tolerability.'
It's not uncommon for patients to try different administration techniques until they find the one that works best for them. About 90% of Abu-Hijlih's patients undergo TRT via a weekly intramuscular injection into their arm or their glutes.
What are the benefits of TRT?
The benefits of TRT include increased energy, improved sleep quality, higher libido, enhanced intimate performance, and better results at the gym. Abu-Hijlih described how many patients begin to feel young again, with more motivation to participate in all the activities they used to love, but no longer had the energy for.
'The improvement in overall quality of life is always incredibly gratifying to witness,' she shared. 'They walk in standing taller, [with] higher levels of confidence, regained energy levels to work out at the gym again, and have a bounce in their step that makes it a very gratifying experience for both the patients and the provider.'
Research has also revealed that TRT is an effective option for addressing psychological and sexual symptoms associated with hypogonadism.
A 2019 study on prescription testosterone found that 52% of men claimed testosterone improved their energy, 42% saw improvements in their libido, and 29% reported muscle growth.
Who can benefit from TRT?
Deep Patel is not a physician, but he has built his career around solving real-world problems that men deal with every day. His telehealth company, Ulo, has been working to make TRT more accessible to men than ever before, and he says that their services are not bound to men over 50.
Younger men can benefit from TRT, too.
'More and more men in their twenties, thirties, and forties are dealing with low T,' Patel shared. 'About 40% of men over 45 have clinically low testosterone, but we're seeing younger guys affected too. If that sounds like you, it's worth getting your levels checked.'
How to get TRT
Many providers and telehealth sites offer TRT services. In many cases, the first step is taking a TRT test and speaking with a doctor about symptoms. Companies like Ulo treat patients holistically, considering their specific needs and tailoring the treatment to their individual symptoms.
'The biggest mistake people make is doing TRT without medical guidance or buying unregulated testosterone products online,' Patel said.
'At Ulo, we monitor every guy's complete bloodwork regularly, not just testosterone, but also things like hematocrit, estradiol, and lipid profiles — and adjust treatment accordingly to catch issues before they become problems.'
Patel explained that the best way to minimize risk is to work with a legitimate provider who actually looks at your bloodwork and adjusts your protocol based on how your body specifically responds.
How long does it take to see results from TRT?
Patel explained that symptom relief can look different in everyone, but you shouldn't have to wait long to see the results.
gn8 – stock.adobe.com
'As for results, most guys feel a difference within four to six weeks,' he noted. 'More energy, better mood, stronger libido. The body composition changes, like more muscle and less fat, usually take a bit longer, around two to three months.'
Patel cited one TRT patient who knew the treatment was working when he woke up one morning and actually wanted to go to the gym for the first time in years.
Is TRT safe? What are TRT risks?
When properly monitored, research indicates that TRT can be safe long-term for most men. That said, every patient needs regular blood work to ensure their levels stay within a healthy range, according to Patel.
'TRT does come with risks that need to be taken seriously. The most common side effects include acne, water retention, or elevated red blood cell counts, which can thicken your blood,' he shared. 'Some men experience testicular shrinkage or reduced fertility. There are also concerns about cardiovascular risks in certain populations, particularly men with existing heart conditions.'
Can TRT affect fertility?
Yes, TRT can affect fertility, especially if you're not using anything to counteract it. TRT significantly suppresses natural testosterone production, which can also reduce sperm production.
'But if fertility matters to you, there are medications like HCG or enclomiphene that can be taken
alongside TRT to preserve it,' Patel pointed out.
In a 2021 study, over 90% of men maintained normal sperm counts when using these fertility-preserving medications with TRT. Patel stressed the importance of telling providers that fertility is a priority before they begin treatment.
How much does TRT cost? Does insurance cover TRT?
The cost of TRT varies depending on factors such as your insurance coverage, provider, treatment needs, and the location of the clinic.
Some insurance providers do cover TRT, but patients must meet specific thresholds. Most providers require TRT candidates to have medical documentation that indicates their testosterone has fallen below the normal levels, as well as recorded symptoms like fatigue or low libido.
If you're paying out of pocket, the cost of TRT will depend on the type of treatment. Most testosterone injections cost between $50 and $150, oral tablets around $300, and patches can reach $400. Some telehealth companies offer a range of treatments for a monthly subscription cost, which can range from $100 to $300 per month.
Should you try TRT? Is it worth it?
Patel has seen many men suffer from low testosterone firsthand. It's not uncommon for him to hear them say things like 'I can't focus like I used to,' 'I feel flat mentally, physically, sexually,' 'I've lost my drive,' or 'I just don't feel like me anymore.'
Even after optimizing for sleep, diet, and everything else, their low testosterone was still impacting their everyday lives. Once they received treatment, things began to shift.
'They're not looking for shortcuts. They're looking to feel normal again,' Patel said. 'And, often they've tried everything else — better sleep, different diets, supplements, lifestyle changes. TRT is rarely the first thing they try, but for many with genuinely low levels, it's the solution that finally works.'
TRT could be right for you, but, as with any new health treatment, it's important to consult your physician and explain your symptoms prior to making any changes to your regimen.
This article was written by Miska Salemann, New York Post Commerce Writer/Reporter. As a health-forward member of Gen Z, Miska seeks out experts to weigh in on the benefits, safety and designs of both trending and tried-and-true fitness equipment, workout clothing, dietary supplements and more. Taking matters into her own hands, Miska intrepidly tests wellness products, ranging from Bryan Johnson's Blueprint Longevity Mix to home gym elliptical machines to Jennifer Aniston's favorite workout platform – often with her adorable one-year old daughter by her side. Before joining The Post, Miska covered lifestyle and consumer topics for the U.S. Sun and The Cannon Beach Gazette.
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