It is time for another episode of the Balls Deep podcast! In this episode, Dr. Joe Pazona is joined by Dr. Howard Aubert, a board certified urologist and the Director of Men's Health at Pazona MD, as he tries to debunk the myths surrounding testosterone replacement therapy. This episode contains everything from red blood cell counts, estrogen myths to overdosage and hyped expectations. It provides no nonsense tips for men who are thinking of undergoing TRT or are currently on TRT. Here’s what to know about TRT:
TRT Mistake #1: Letting High Red Blood Cell Count Panic You
One of the most significant concerns associated with TRT is the increased level of hemoglobin and hematocrit, which makes blood thicker. Traditionally, this has led to therapeutic phlebotomies (aka donating blood every month) to bring those levels down.
🚨 Why It’s A Problem
- Overcorrecting this can lead to anemia — You may have started TRT because you’re tired, and now you’re once again tired because red blood cell counts have dropped.
- Lack of water makes it look worse than it actually is — Many men on TRT don’t drink enough water, which falsely elevates levels of hemoglobin.
✅ The Solution?
- Drinking more water — Helps improve hydration to dilute blood naturally.
- Changing your dose — Occasionally, high levels suggest you are taking too much testosterone.
- Keep an eye on symptoms, not just numbers — Mildly elevated red blood cells aren’t necessarily worrisome if you’re otherwise healthy.
TRT Mistake #2: Ineffective Dosing of Testosterone
Testosterone dosing is both an art and a science. Most guys tend to be underdosed while some rely on ‘bro science’ and go crazy with overdosing.
Underdosing
A lot of guys get prescribed a single shot every two weeks, which creates a rollercoaster effect—feeling great every few days, then crashing before the next dose.
✅ The Solution?
- Strive for smooth and optimized levels between 600-900 ng/dL total testosterone with a free T level of 90-250.
- Dosing more frequently (1-2 times weekly) eliminates the peaks and valleys.
Overdosing
Then comes the guy who is running at 1,500+ ng/dL, feeling on top of the world—until he crashes.
❌ Too much testosterone leads to:
- Rising blood pressure
- Roid rage/mood changes
- Acne, back-acne, and other harsh skin consequences
- Risk of hurting the heart
✅ The Solution?
Finding a sweet spot where you feel great but aren’t overloading your system.
TRT Mistake #3: Killing Estrogen with Aromatase Inhibitors
The myth has spread throughout locker rooms that all estrogen is bad for men, so men started taking aromatase inhibitors (AIs) to lower their estrogen levels.
🚨 Why It's a Problem
- You need estrogen for bone health, fat metabolism, and even erections.
- Too little estrogen can cause erectile dysfunction, infertility, and additional complications.
- Body fat plays a role — Overweight men convert more testosterone to estrogen, so losing weight is a better solution than blocking estrogen.
✅ The Solution?
- If estrogen is high, check your testosterone dose — You could be taking too much.
- Shed some weight — Body fat turns testosterone into estrogen.
- Only use AIs in rare cases — Be sure to only do it under the guidance of a physician.
TRT Mistake #4: Adding a Combination Of Androgens & Peptides
It may be tempting to stack DHEA, pregnenolone, peptides, and other androgens on top of TRT, but most of these lack solid research.
🚨 The Risks of DIY Hormone Stacking
- Unpredictable effects — These additional substances can convert into other hormones that can have undesirable effects.
- Possible long-term damage — Many androgens and peptides are not approved by the FDA and can have unknown consequences.
- Where’s it coming from? — Many of these compounds come from unregulated black markets online.
✅ Stick to the Basics
Testosterone is a powerful hormone and should be respected as such. Make sure to only use hormones under the guidance of a trained professional.
TRT Mistake #5: Aiming Too High
A lot of middle-aged guys jump onto TRT thinking they will experience instant weight reduction, an increase in erections, and boosted energy levels. Unfortunately, the reality is different.
🚨 TRT is NOT:
- A magic fat-burning pill (dieting and exercise are still needed).
- A guaranteed solution to every case of erectile dysfunction (TRT won’t help with vascular disease).
- A “get out of jail free” card to eat poorly and stop exercising (It does not replace a healthy lifestyle).
✅ What TRT CAN do:
- Enhance mental sharpness and energy levels.
- Aid in building muscle with weight training.
- Improve sexual desire and activity (when the cause is low testosterone).
🚨 Pro tip: Consult & follow a doctor that is not confined to monitoring numbers strictly on lab results; be prepared to take steps to improve your health overall, not just showing up to take a shot and wishing for the best.
You now have a better understanding of the risks, rules, and realities of TRT. If you’re considering TRT as an option, be sure to check out our guide to low testosterone and TRT!
Disclaimer: This blog is for informational purposes only and does not substitute professional medical advice. Always consult with your healthcare provider for personalized guidance.
