TRT at 35+: What Tony Huge Learned From a Decade of Bloodwork

I’ve been optimizing my testosterone for over a decade. I’ve run it every way it can be run — low dose TRT, higher therapeutic doses, cycles, blasts, cruises, and periods completely on my own natural production. I’ve had bloodwork done more times than most people have had checkups. And I’ve watched hundreds of men go through the same process.

Here’s what I’ve actually learned — not what the mainstream medical system will tell you, not what the bro forums will tell you, but what actually works based on a decade of real-world data.

The Problem With “Normal Range” Testosterone

The reference range for “normal” testosterone in most US labs is somewhere around 300–1000 ng/dL. That range was built by testing a representative sample of the male population — which includes sedentary, overweight, metabolically unhealthy men across all age groups. When the “normal range” is derived from a population where 70%+ of men are overweight and metabolically compromised, the range isn’t telling you what’s optimal. It’s telling you what’s common.

A 45-year-old man at 310 ng/dL is told he’s “normal.” Technically true. But he’s at the 5th percentile of a compromised population. He’s not thriving. He’s experiencing symptoms — fatigue, reduced drive, harder time maintaining muscle, brain fog, reduced libido — because his testosterone is nowhere near where it should be for a healthy, active man.

This is the gap between “not deficient enough for the system to care” and “actually optimized.” Most men with symptoms are in this gap and told they’re fine.

What Good Numbers Actually Look Like

Based on my own bloodwork data and observation of hundreds of men: the range where men feel and perform their best is generally 700–1000 ng/dL total testosterone, with free testosterone at the upper quartile of the reference range.

Total testosterone is the headline number but it’s not the whole story. You need to understand:

• Free testosterone — the fraction not bound to SHBG (sex hormone binding globulin) or albumin. This is the biologically active fraction. A man can have 700 ng/dL total testosterone but low free testosterone due to high SHBG, and still have symptoms of low T.
• SHBG — Sex hormone binding globulin binds testosterone and makes it unavailable. High SHBG (common with age, with certain health conditions, with alcohol use) reduces effective testosterone even when total levels look acceptable.
• Estradiol (E2) — Testosterone aromatizes to estrogen. Too much estrogen causes its own set of problems: water retention, mood issues, gynecomastia, libido problems. The ideal E2 range for most men on TRT is 20–40 pg/mL.
• Hematocrit and RBC — Testosterone stimulates red blood cell production. If hematocrit gets too high (above 52–54%), blood becomes more viscous, increasing cardiovascular risk. This needs monitoring.
• LH and FSH — Luteinizing hormone and follicle stimulating hormone. On exogenous testosterone, these will suppress to near-zero. If you’re assessing natural production or considering coming off TRT, these are critical.

Should You Start TRT? The Honest Checklist

Before anyone goes on TRT, they should do the work to rule out fixable causes of low testosterone. I’ve seen men go on TRT when they actually just needed to:

• Fix their sleep (sleep apnea tanks testosterone — get a sleep study if you snore)
• Lose body fat (aromatase enzyme in adipose tissue converts testosterone to estrogen — carrying significant excess body fat is an anti-testosterone factory)
• Fix vitamin D deficiency (extremely common, directly impacts testosterone production)
• Reduce chronic stress (cortisol suppresses testosterone through HPA-HPG axis competition)
• Optimize zinc and magnesium intake (both are critical cofactors for testosterone synthesis)
• Stop drinking alcohol or significantly reduce intake (alcohol is profoundly anti-testosterone)

Do these things. Get retested. If you’ve genuinely addressed lifestyle factors and testosterone is still low-normal with symptoms, then TRT becomes a serious conversation.

The threshold I use for TRT consideration: total testosterone below 500 ng/dL with symptoms, OR free testosterone in the bottom quartile with symptoms, after lifestyle optimization.

The Protocol That Works — My Approach

For TRT specifically (not cycles, not blasts — sustainable long-term hormone optimization), here’s the framework I’ve settled on after years of experimentation:

Testosterone Cypionate or Enanthate:

• Starting dose: 100–150mg per week total
• Injection frequency: I prefer twice weekly (every 3.5 days) over weekly. More stable blood levels, less peak-to-trough variation, better mood and energy stability.
• Some people do daily or every other day SubQ injections with smaller needles (insulin syringes, 27–29g). This gives the most stable levels. I’ve done this and it works well but requires more diligence.
• Let the protocol run 6–8 weeks before adjusting — it takes that long for blood levels to fully stabilize

Aromatase Inhibitor (AI) — Anastrozole or Aromasin:

Don’t use an AI prophylactically. Get your estradiol tested after 6–8 weeks on your TRT dose. Only use an AI if E2 is genuinely elevated with symptoms. Many men on 100–150mg/week don’t need an AI. The tendency to crash estrogen with AIs causes its own problems — low E2 in men is associated with bone loss, joint pain, cognitive issues, and cardiovascular risk.

If needed: Anastrozole 0.25–0.5mg twice weekly. Start low. Check labs 4 weeks later.

HCG (human chorionic gonadotropin):

TRT suppresses your natural LH production, which means your testicles stop receiving the signal to produce testosterone (and importantly, stop producing intratesticular testosterone and other hormones). Over time, testicular atrophy occurs and fertility is impacted.

HCG mimics LH and keeps the testes functional. If fertility preservation or testicular size matters to you, use HCG alongside TRT. 250–500 IU twice weekly is the standard range. Some TRT-only protocols skip HCG if fertility isn’t a concern and the person is comfortable with the changes — it’s a tradeoff.

The Bloodwork Schedule

This is non-negotiable. TRT without regular bloodwork is irresponsible.

• Baseline before starting: Complete metabolic panel, CBC, lipid panel, Total T, Free T, SHBG, E2 (sensitive assay), PSA, hematocrit, LH, FSH, thyroid panel
• 6–8 weeks after starting or changing dose: Total T (trough — draw right before injection), Free T, E2, hematocrit
• Every 6 months ongoing: Full panel including PSA and liver enzymes
• Annually: Full comprehensive panel, bone density if over 40

I get my bloodwork done in Thailand. It’s easy, fast, and cheap — a full hormone panel costs a fraction of what it costs in the US. If you’re going to live an optimized life, you need the data. There’s no guessing in optimization.

What Nobody Tells You About Being on TRT Long-Term

A few things I’ve learned that you won’t find in most guides:

It’s a lifestyle, not a treatment. When you go on TRT, your natural production suppresses. Coming off is possible but requires a proper PCT (post cycle therapy) with SERMs like Clomid or Nolvadex, and recovery to natural production takes months and isn’t guaranteed at the same levels you had before. This is a long-term commitment for most people.

Dose creep is real. There’s a tendency over time to push the dose higher — you adapt to the current dose, you want more of the benefits, you incrementally increase. Maintain discipline about staying at your prescribed therapeutic dose if TRT is your goal, not cycling.

The mental effects are underappreciated. Optimized testosterone — not supraphysiological, just genuinely good levels — affects cognition, drive, confidence, and mood in ways that are profound. Men who’ve lived with suboptimal testosterone for years and then get properly optimized consistently report that they feel like themselves again. Or better than they ever have. This isn’t just about muscle. It’s about quality of life.

The cardiovascular question. There’s ongoing debate in the medical literature about TRT and cardiovascular risk. The current evidence suggests that properly managed TRT — keeping hematocrit below 52%, maintaining healthy estradiol levels, monitoring lipids — does not increase cardiovascular risk and may actually reduce it versus untreated hypogonadism. Don’t panic about this, but do monitor.

Finding the Right Doctor

Most general practitioners will not help you optimize your testosterone. They’ll tell you you’re “in range” and that’s it. Seek out: a urologist or endocrinologist who specializes in men’s health, a men’s health or TRT clinic (many of these operate via telemedicine now), or an anti-aging physician. Do your homework on whoever you go to. You want someone who will actually engage with your labs, your symptoms, and your goals — not just decide you’re “not deficient enough” and send you home.

Self-managed TRT exists as a category. I’m not going to endorse or condemn it here. I’ll say: if you go that route, be more rigorous about bloodwork than you would be with a doctor managing you, because there’s no external check on your decision-making.

The Bottom Line

If you’re a man over 35 who’s never had your testosterone properly evaluated — not just a single total T lab but a complete panel with free T, SHBG, and E2 — get it done. The information costs almost nothing and could change how you understand your own body and wellbeing completely.

Optimized testosterone isn’t about building muscle or chasing some performance goal. It’s about feeling and functioning the way a healthy human male should feel and function. Most men today are operating at a significant deficit they’ve normalized. You don’t have to.

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For the complete anti-aging protocol, also read my breakdowns of CJC-1295 and Ipamorelin for GH optimization, rapamycin for longevity, and NAD+ and NMN for mitochondrial function. Testosterone is the foundation — everything else builds on top of it.