Why Men Still Feel Bad on TRT: The Real Root Causes
By Dr. Andreas Boettcher, D.C., Functional Medicine, B.S. Health/Exercise Science
3x Ironman Triathlete, Master's Men's Physique Competitor
Why Many Men Still Feel Terrible on Testosterone Therapy — And What Most Are Missing
Over the past decade, testosterone replacement therapy (TRT) has exploded in popularity. You can’t scroll social media without being sold a clinic, an injection protocol, or a promise that “low T is the reason you feel tired, foggy, soft, unmotivated, or depressed.” And to be fair, testosterone matters profoundly. When levels drop, so does drive, confidence, energy, performance, and recovery.
So when someone is told, “Your testosterone is low, you should start injections,” it can feel like the obvious solution.
But here’s the uncomfortable truth that isn’t being talked about enough:
Hundreds of thousands of men start TRT every year… and still feel terrible.
Their bloodwork looks “high,” but their motivation, energy, and mood don’t meaningfully change. Some even feel worse.
Meanwhile, recent large-scale research like the TRAVERSE trial has helped clear the air on some concerns (such as removing the black box warning around cardiovascular and prostate risk), yet it simultaneously raised questions about increased incidence of atrial fibrillation, kidney strain, and clotting-related concerns in men receiving testosterone therapy.
{Check out my article on the conclusions of the Travers Trial - What the Traverse Trial Left Out}
But today, let’s set safety debates aside and talk about something simpler, more human, and far more common:
Why men can have “high testosterone” on paper and still not feel like themselves.
The Androgen Receptor Problem: Why More Testosterone Doesn’t Always Mean More Effect
Testosterone works by binding to what are known as androgen receptors inside your cells. You can think of testosterone as a key and the receptor as the lock that allows the key to take effect.
But here’s the catch:
If the receptor isn’t functioning well, it doesn’t matter how much testosterone is in the bloodstream.
This is why so many men see their testosterone levels go up… but their symptoms barely improve. They’ve increased the supply, but they never improved the sensitivity of the receptor.
This is the same biological phenomenon we see in another area of health:
Insulin Resistance
Eat too much refined sugar for too long → body produces more and more insulin → cells become less sensitive → blood sugar goes up → fatigue increases → metabolism slows → and eventually type 2 diabetes can develop.
High circulating insulin.
Low insulin effect.
Signal overload reduces sensitivity.
Now apply the same concept to androgens:
High circulating testosterone from injections.
Low androgen receptor sensitivity.
Same key. Different lock. Poor response.
This is why simply adding more testosterone rarely solves the real issue.
In fact, sometimes it makes things worse.
The Side Effects Men Don't Realize Are Connected to Receptor Dysfunction
When androgen signaling becomes imbalanced, the following issues commonly appear:
Acne and oily skin (excess DHT conversion)
Irritability or mood instability (large hormone peaks and troughs)
Sleep problems (especially if sleep apnea is present)
Elevated hematocrit / thickening of the blood (increasing clotting risk)
Shrinking of the testicles and suppressed fertility (testicular testosterone production shuts down)
Dependence on TRT (because the body stops producing its own)
And here’s something most men are not being told:
When you rely on injections without addressing metabolic health, receptor function continues to weaken.
Which means?
Men may often need higher and higher doses over time to feel the same effect.
Just like insulin resistance, only now…
It’s androgen resistance.
The Real Reason Most Men Have Low Testosterone in the First Place
For the overwhelming majority of men, low testosterone is not a primary issue.
It is a secondary result of deeper metabolic dysfunction.
The three biggest drivers are:
1) Insulin Resistance
When blood sugar is chronically elevated, insulin levels rise.
High insulin blocks the enzymes necessary to convert cholesterol into testosterone.
This alone can tank total and free testosterone.
2) Chronic Low-Grade Inflammation
Inflammation interferes with hormone signaling, disrupts the hypothalamic-pituitary-gonadal axis, and directly damages androgen receptor function.
3) Excess Body Fat (especially visceral fat)
Fat tissue is not inert. It’s hormonally active.
It converts testosterone into estrogen, increases inflammatory cytokines, increases SHBG, and suppresses testicular output.
Meaning:
Most men don’t have a testosterone production problem.
They have a metabolic environment problem.
If you do not fix these, you have not fixed the cause of low T.
So Here’s the Real Question No One Is Asking
If a man starts TRT without correcting insulin resistance, chronic inflammation, and excess body fat, has he meaningfully reduced his long-term disease risk?
Or has he simply masked symptoms?
Because the data is clear:
Insulin resistance drives heart disease.
Chronic inflammation drives heart disease.
Visceral fat drives heart disease.
And these are NOT the only CHRONIC (PREVENTABLE) DISEASES these conditions cause
Injecting testosterone does not reverse any of these.
A man may feel better for a while…
but his long-term risk profile does not improve.
In many cases, it gets worse.
Which is why life expectancy for men in Western nations continues to decline, even in an era where testosterone prescriptions and prescriptions of all kinds are booming.
Because feeling better is not the same as becoming healthier.
The Hard Truth — And the Hope
I am not against TRT for some men.
There is a time and place for it.
BUT IT SHOULD NOT BE FIRST CHOICE.
In my experience working with 1000's of clients and patients in my 33+ year career....80–90% of men do not need TRT
when they:
Restore healthy insulin sensitivity
Reduce inflammation
Rebuild metabolic flexibility
Regain lean muscle and lower visceral fat
Optimize sleep, stress, micronutrients, and circadian rhythm
When this foundation is restored, the body turns its own testosterone factory back on.
Naturally. Consistently. Sustainably.
No lifelong prescription or prescriptions required.
The Foundation Always Comes First
If a man has not:
Cleaned up his nutrition
Corrected insulin resistance
Reduced inflammation
Optimized sleep
Eliminated visceral fat
Rebalanced micronutrients
Rebuilt muscle and mitochondrial efficiency
Then he has not tried everything.
He has tried the shortcut.
And shortcuts always come with interest charges or in this SIDE EFFECTS you don't want.
The Conclusion
If we want to truly increase men’s energy, vitality, libido, muscle, confidence, longevity, and performance…
We must stop reaching for the syringe first.
We must fix the metabolic environment in which testosterone operates.
We must address the cause, not the compensation.
Because your health is not saved by a chemical.
Your health is built by your daily choices.
And the second half of your life can be your strongest, fittest, and most capable years…
But only if you decide to take ownership of your biology.
It’s not about being perfect.
It’s about being responsible.
And that responsibility starts today.
⚡️ Ready To Take Charge of Your Health With the Most Comprehensive Natural Approach to Mens Health?
If you’d like to go deeper — to uncover the root causes behind your energy, hormones, metabolism, and performance — I invite you to book a complimentary consultation.
Together, we’ll review your health history and goals and determine if our Peak Performance Protocol based on your lab analysis, genetics, and lifestyle data is right for you!
👉 Click here to schedule your complimentary consultation.
To learn more about our approach and success stories, visit www.ItsOnlyHalftime.com where we help men like you turn your second half into your best half naturally!
Finish Strong,
Dr. Andreas
Still Kickin' A** Medication Free at 55 Despite What the "Narrative" Would Like You To Believe!
Medical Disclaimer:
The information provided in this article is for educational and informational purposes only and is not intended as medical advice. It should not replace professional consultation, diagnosis, or treatment. Always consult your healthcare provider before making any changes to your health regimen or lifestyle.
📚 References
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U.S. Food and Drug Administration (2025).FDA Drug Safety Communication: Removal of Boxed Warning for Cardiovascular Risk in Testosterone Products & Updated Labeling Requirements.
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Corona, G., et al. (2020).The Complex Relation Between Obesity and Hypogonadism in Men.Nature Reviews Endocrinology.
Kelly, D.M. & Jones, T.H. (2015).Testosterone and Obesity.Obesity Reviews.
Grossmann, M. (2011).Low Testosterone in Men with Type 2 Diabetes: Clinical Implications and Treatment.Diabetes, Obesity & Metabolism.
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