Testosterone Replacement: Are YOU Fit Enough?

by Ali Gilbert


Testosterone replacement therapy (TRT) improves the health of those who need it. But are you fit enough to reap ALL the benefits? Info here.

Testosterone Replacement: Get Fit First

Editor’s Note: Ali Gilbert, the “Queen of Men’s Health,” has an interesting perspective when it comes to testosterone replacement therapy (TRT). She advises her clients to get healthy FIRST, primarily by leaning up and improving cardiovascular fitness, before starting therapy.

That way, the T will work even better and have fewer possible side effects. What do you think? Check out her strategy below.

High Obesity, Low Testosterone

If you were born in the 1980s, you remember a time when doing menial tasks warranted a greater physical demand than the present day. For example, changing the channel on the TV, rolling down a car window, and even stalking your current crush from the bushes. Today we can do all of that by just pressing a button.

We no longer have an inherent need to move as a society; we can literally sit on the couch and have everything delivered to us. This, of course, has contributed to our current obesity levels. But most importantly, it’s one of the reasons men’s testosterone levels have plummeted – about one percent a year since 1982, to be exact.

Obesity in this country has skyrocketed, and it isn’t likely to decline anytime soon despite access to gyms, information, and technology that can help improve it. This, in turn, has men showing up with lower and lower testosterone levels due to an overwhelming amount of body fat.

More body fat means more of the most inflammatory tissue. This brings with it conversion to estrogen, which makes the brain think there’s enough testosterone in the body if the natural conversion to estradiol is occurring.

Testosterone replacement therapy (TRT) can combat a lot of the health issues men experience. TRT can:

  • Increase insulin sensitivity
  • Reduce body fat levels
  • Reduce fasting glucose levels
  • Improve body composition
  • Improve metabolic syndrome
  • Help lower the risk of prostate cancer
  • Provide neuroprotection and cardio protection, despite the fear-mongers saying the opposite

Seems like the ultimate thing to combat poor health, right? Well, not so fast.

Health First, Then Testosterone

The problem is that many men see TRT as a panacea. They’re unwilling to work on the other aspects of their health. TRT is not a substitute for laziness. And going on TRT while still living in a highly inflamed, insulin-resistant state isn’t going to be smooth sailing. There’s no such thing as a free lunch, and it’s imperative to be in the best health possible at the onset of therapy.

If a man is over 20% body fat, TRT will not work as well and may even bring annoying side effects. The more body fat someone has, the more inflamed they are (fat is the most inflammatory tissue). This is especially true with visceral fat, which causes a cytokine response with anything coming into the body. The primary function of cytokines is to regulate inflammation; they play a vital role in regulating the immune response.

These men may experience what they perceive as “high estrogen side effects” such as irritability, sensitive nipples, water fluctuations, and mood/energy fluctuations. But it isn’t the estrogen. Estrogen is often demonized. We know men need estrogen, and blocking it is a bad idea. It’s their poor health, specifically the inflammation and insulin resistance, that’s causing these side effects.


In fitness and sports, GPP stands for “general physical preparedness.” Basically, having a basic fitness foundation before jumping into more advanced or specific training. Likewise, “GPP for TRT” is my way of prepping a man to become the most resilient, healthy version of himself so that when/if he embarks on TRT, it’s just the last piece to the puzzle.

How do you do that? First, get your metrics in order. There are several health metrics you can do at home to assess how stressed you are, despite what you subjectively “feel.” These include:

This is primarily tackled with aerobic conditioning, often thought of as the one thing that makes you weak and takes away your gains. But it’s the opposite.

The quickest way to lower blood pressure, resting heart rate, and blood glucose is aerobic work. It raises HRV, helps you recover in-between both workouts and sets, and sleep better.

The last thing you want to do is go into heavy training and higher intensity conditioning with already high blood pressure. Get everything sorted, and then you can layer on the harder stuff. Plus, it only takes about eight weeks of “front-loading,” and then you don’t have to continue with cardio for months on end.

This is paired with higher rep lifting and a low(er) carbohydrate diet. Why? If we’re dealing with some insulin resistance, we want to take the glucose load off the cells and allow the mitochondria to oxidize fatty acids. When you become leaner, you add more carbs in, which is sometimes seen as ass-backwards from what usually happens.

When you get leaner, you’re more insulin sensitive and you can handle more carbs. The more muscle you carry, the more storage forms of glycogen you have. Makes sense, right?

Resolving insulin resistance allows people to intuitively eat less, maintain stable moods between meals, reduce stress-induced fat deposition (hips and chest), reduce systemic inflammation, reduce postprandial fatigue (food coma), and lower stress.

Cruising Down Towards 15%

Once you improve the metrics above and are cruising down towards 15% or below body fat, THEN you can transition into more stressful phases that include hypertrophy training until you’re in a position that warrants TRT, which will restore the levels you should biologically be producing.

If you’re already on TRT, it will STILL benefit you to go through this type of phase if your metrics are all over the place and you don’t feel optimal.