Congratulations on finding a treatment that worked, and thank you for encouraging others!
Nevertheless, I think that your first conclusion in part III relies on incorrect assumptions. The most important is that the difference in experience between an average man and an average woman is similar to the difference between an average woman and a hormonally deficient woman.
I'm not an expert in biology or chemistry, but I strongly suspect that, in some ways, males are far less sensitive to testosterone than females are. (argument below) Consequently, the effects of different testosterone levels within a sex (especially within one person) don't imply anything about the effects of different testosterone levels between the sexes.
The difference in testosterone concentration between men and women is *enormous*. Even when women's testosterone peaks in their 20s, the concentration for women at the 90th percentile is only one-fifth of the concentration for men at the 10th percentile. The medians differ by a factor of ~15. For most intents and purposes, these distributions do not overlap.
Despite this, the distributions of traits that are associated with testosterone--libido, aggression, and more--overlap considerably between men and women. This implies that men are less sensitive to testosterone.
The proper lesson isn't "men play life on easy"; it's "healthy people play life on easy". Incidentally, I've experienced very similar symptoms to those that you've described--poor sleep, fatigue, brain fog, impaired speech, introversion, and more--and my testosterone levels were fine. For me, it was caused by a combination of low iron, sleep apnea, environmental allergies, and other factors. When I had trouble concentrating at work, or gathering the motivation to exercise, I thought that I was being lazy. When a *single* iron pill alleviated all of my symptoms within 24 hours, I knew that I wasn't to blame.
MM - would LOVE to hear more about your iron story. As much as you want to tell. I've been donating blood to reduce ferritin (iron is a pro-oxidant, etc etc yada yada) but...last blood tests indicated low, no s u p e r low UIBC and other markers.
Pills on the way.
But...your little phrase exploded a bomb in my awareness -- this (fixing iron) is probably a major reason i felt so epically amazing on carnivore...
Feeling amazing on carnivore diet (ketogenic for other folks) can also be due to switching from glucose as your energy source to ketones. This clears up brain fog and helps with good sleep and mood regulation for a ton of people (see metabolic psychiatry).
Thanks, Trysa. I got it. Don’t have much ‘fog’ per se, but it did seem to even out ups/downs (again, glucose/insulin spike stuff…) . And while sleep is good in general (duration, onset, ample dreaming, yada yada) it’s a real bear to get significant deep sleep. raised it up from single digits (yes, single digits…) to the one hour/1.5 hr range…but boy I’d sure like to know what to do to get into 2-3 hour range of deep sleep.
I would quantify libido as "desired frequency of sex". A difference of 15 would imply that if the median man wanted sex every day (which seems too high), the median woman would want sex less than once every two weeks (which seems too low).
I'm not sure that aggression can be quantified as a ratio. Aggression is a very different kind of impulse because a) it doesn't continuously accumulate, and b) there isn't a granular, quintessential act of aggression. You might be thinking of murder rates, but that's entirely due to the behavior at the far end of one tail; it would be like concluding that men are 15 times faster than women because (hypothetically) the set of the 10,000 fastest sprinters has a gender ratio of 15:1.
I think it's plausible that the median man would prefer to have sex every day and the median woman would prefer to have sex every 15 days, yes. That's what I had in mind. I agree that if that's off, then I'm more likely overestimating the difference than underestimating it. It's plausible that the difference is half that much, 7.5x rather than 15x: perhaps the median man would prefer to have sex every 1.5 days and the median woman would prefer to have sex every 11 days.
That uncertainty between 15x and 7.5x for libido is why I averaged it with aggression, which I think could be 15x to 30x. I agree that the murder rate is not a good measure because it compares tails rather than medians. Perhaps we should consider something more common like "the urge, however fleeting or restrained, to punch, push, body-check, or physically intimidate someone." I think it's plausible that the median male feels a fleeting urge like that once every two weeks, and the median female feels it once every 30-60 weeks.
I think young males have that urge on a daily basis. I know I did. If anything, I think the removal of low-level violence has made our society more unpleasant. Men settle disputes better that way. It is repugnant to see men lie and gossip as they do today. I cannot help but to think school shootings are a direct result. A few low-key fights keeps everyone honest. Once unseemly behavior takes root, misbehavior can get out of hand and real violence occurs. We have made so many poorly thought out changes to society and instead of fixing them we get manipulative, dishonest movements like the simpletons who want to ban guns (bans sure worked great with drugs). Public school in most cities are like depression, anxiety and outright psychosis factories. I understand why people do whatever they can to pay for Catholic school. May public schools today are just plain evil. I am convinced I would have become a murderer if I had to suffer four years of group work, fake behavior, emasculating rules and moronic teaching styles.
There is a hypothesis going around that the only reason young men are not destroying everything is that they are sedated on video games and porn, and often directly via pharmaceuticals. It is shameful that our society is accepting of so many young people needlessly suffering. I cannot help but to think many modern female-dominated fields have created a toxic femininity that rivals the male version, only more sinister and indirect.
YES! One generation older than me used to settle things with fistfights in the schoolyard. We did less of that; the current generation gets to do almost none.
This doesn't work for women. It's also the reason why boys of single moms are woefully unprepared: they think they can escalate every confrontation. Boys who grew up with "low level violence" know that every confrontation between males can easily escalate to an ass-beating or murder, so they escalate carefully, intentionally, and selectively. The female playbook is escalate, escalate, escalate, because men aren't (socially) "allowed" to beat women up, and women typically resort to character assassination, not assassination, in their female-female conflicts.
I mean I’m a woman and this seems pretty crazy to me. Once every 11 days? I mean it’s not that I can’t go without for that long, but I’d prefer not to. I don’t think I’m that unusual- I think people get busy and tired, and especially women with kids can feel burned out and touched out which might lower their libido. But the idea that a sexually healthy woman wants less sex is really funny to me bc the ancient Greeks thought of women as the horny ones. The myth of Tiresias is all about that.
Median man wants it at least once a day. Why does that "seem to high" to you? I want it once every 18 hours (1.5x/day), until I die, and I'm pretty low T, I'd guess I'm around the 40th percentile man.
To other readers: the symptoms of low testosterone are pretty non-specific. I am a guy and got finally my testosterone levels tested after a thread by Cate (https://x.com/catehall/status/1875744698754809994).
It turned out my testosterone levels are higher than that of 85% men. Which on one hand surprised me and on the other hand it triggered a form of self-acceptance of some of my personality tendencies (like competitiveness, status-seeking, etc). Alas, my issues with brainfog and sleep remain unfixed.
Scott Alexander also just writes a lot of "canonical" posts that get passed around as common knowledge because they're so simple and yet insightful. Expect to see his ghost in your comments section often 😂
This happened for me also, back in around 2022, male in my early 40s I thought my T may be low because of various symptoms (lower energy, more irritability, waning libido, the usual) and it turned out I was near the top of the range. I was pretty upset to find that out, since it would've been good to have a biological explanation, but I had to just accept that maybe this was aging and it would never get better again.
I have an alternate theory that despite my high-T some of these symptoms could be produced by alcohol consumption, alcohol being known to cause elevated estrogen levels, but it seems to be mostly an effect in women and is disputed how much this impacts males.
The one thing I ever took that gave me an experience like Cate had was when I got prescribed steroids for some kind of skin inflammation I had. First couple days of that steroid pack I felt normal again for the first time in years. Every part of me that had been feeling sore since I hit 40 was fixed at once. I know that's not a real solution, so I've never tried to get them through backchannels, but that sure was pretty great.
@psyschotechnology – So, if I understand you correctly, you were feeling symptoms of low testosterone, but once you got tested, it turned out you have relatively high testosterone?
"I feel sharper now than I did at 30; my memory is much better; the brain fog is gone."
I'm trans female, and your post reminds me in some ways of how I felt before and after starting feminizing HRT (estradiol). I'm 33 now, been on HRT for 2 years. Pre-HRT my total testosterone was ~500 ng/dL, post my T is ~22 ng/dL and DHT is ~17 ng/dL.
I'm simplifying for brevity, but within 9 days after increasing my daily dose from 2 to 6 mg of estradiol (pills) I noticed profound subjective cognitive and mood changes, 90% less brain fog, easier time focusing on intense tasks, just happier, calmer, with no perceptible downsides. I did become less irritable though; T and E (just like masculinity and femininity) are not mirror opposites.
This really shook me existentially. I was very depressed at the time, still have depression (since 13), and HRT didn't magically fix my life. But it did cut my suicidal ideation by over 50% almost overnight, with no side effects, while also making me smarter, happier, and calmer. Which still feels pretty insane to me.
I don't think this is physiologically similar to your case. Fixing T-deficiency for an otherwise healthy cis person is different than a trans person starting HRT. I've also seen cases of T-deficient trans women who benefited from T supplementation. The similarity is the existential impact of going through such a profound cognitive change simply from supplementing a sex hormone.
My case shows that higher T is not better for everyone but I do agree with you that cis men probably have physiological advantages on average in many competitive fields, due to a combination of their T levels, and from having brains that run well on T.
Overall, IMO, even if we only look at cis people, there is likely wide variability in what an individual's optimal hormone levels are, and also in how strongly a deficiency will affect someone. There is still a lot of FUD around hormone supplementation, and probably many people could benefit from giving it a try.
I really appreciate you writing this. Just wanted to share my data point.
I'm also a trans woman and I just want to second this. I haven't taken regular intellectual benchmarks like the crossowrds but I have found it much easier to do regular exercise on E, have lost substantial weight and have been running longer distances for the first time since the beginning of college. I'm slower, probably because I'm older and my T is low, but I find exercise gives me much more of a mood boost.
It was also very funny to read the 'men live life on easy mode' because my own feeling starting E was that it was massively better mood and focus wise than the sort of numb dissatisfaction and irritability of T. It can be really destabilizing to have every aspect of your life very suddenly improved and to realize how little really stood between you and a much better life.
all super interesting. Maybe each person's physiology has a unique optimal (desired) state of hormonal levels, and being further away from this causes cognitive friction.
Do you know your estrogen before? The general experience of people taking hormones for non-trans reasons is that somewhat higher levels of both are nice. And nine days into estrogen, youd still have your natural testosterone production as well, so a different experience from long-term use.
I do! Pre-HRT, my estradiol IA test returned 23 pg/mL (normal for adult males). I also tested my FSH, LH, and SHBG, which were all normal (for cis men, pre-HRT) as well.
I saw a study at one point IN MICE (but still) which, IIRC showed the highest maze-running performance when the mice had supra-physiological levels of both sex hormones, regardless of natal sex. So you may be on to something!
However! The subjective data I have doesn't seem to support this in my case. I left some info out of my original comment, just so it wouldn't be boringly long. I noticed the cognitive improvements on estradiol not when I started the 2mg (buccal) dose but when I increased it from 2 mg to 6 mg. I was already on a 1mg, then 2mg dose for a month before going up to 6mg, so presumably I already had some suppression of T production at that point. I was also taking 12.5mg/day of bicalutamide at the time, which blocks androgen receptors.
Another data point: due to an unrelated eye issue (meibomian gland dysfunction), I was totally off estradiol for a month, 6 months after starting HRT (I stopped the E2 cold turkey, sex hormones crashed and I felt awful, then my T production and male physiology rebounded rapidly), and then gradually titrated my E2 dose back up for 4 months after. At the end of that 4 month period, my labs were:
E2 125 pg/mL
E1 876 pg/mL
DHT 41 ng/dL
T 291 ng/dL
E1 is a weaker estrogen receptor agonist than E2 so maybe it's not a fair test but I didn't feel any better with those "androgynous/non-binary" levels than I do now with my androgens down in the cis female range. Take it with a grain of salt since it's n=1 and I'm definitely biased because I absolutely love and adore my feminized body-- but I haven't found that higher T levels do anything additional mentally for me if I already have enough estrogen.
For me, they were life changing in the same way that your experiences with TRT sound. I went from regular spirals of negativity, self-hatred, anger, violent thoughts, to basically just never feeling those things. They don't necessarily make you feel "happy", but they make your mood incredibly stable. The best comparison is like an inflatable ball in a pool - even if you submerge it into the water briefly, it will immediately pop back up to the surface.
In terms of life benefit to cost/effort ratio, I don't think there's anything higher. For me, they were more effective than any type of exercise or meditation.
You can start very easily - dump some cold packs in your bathtub, fill it up halfway (just enough to cover your stomach, you don't need to cover your legs completely). Ideally you get the water to around 52-55 F. Start at 1 minute or so, work your way up to 3 minutes. The water doesn't have to be that cold to get the benefits. I do 3 min @ 52 F every morning, and that works great for me.
If you get into it more, you can get an inflatable tub and a chiller off amazon/ebay for ~$500.
Hi! I’m intrigued by this suggestion. Would you mind please sharing a YouTube creator or link you like? When I searched all I could find was “spend $1000+ and buy a chiller, pump, and chest freezer which gets moldy though no one seems bothered by this”. Any videos on adding cold packs to a normal bathtub like you describe would be appreciated. Thank you!
You don't need any videos, you can Just Do It (Nike). It doesn't have to be perfect. I had ~5 large ice packs from ordering bulk chocolate, so I just used those
Interestingly, cold water immersion seems to decrease testosterone immediately after, but the studies I could see from a cursory google all look at its effect post exercise and don’t look at long term testosterone levels (i.e. whether it effects baseline). So there could be an initial dip and then an increase but there is no evidence for that.
There are many different mechanisms that affect mood so it’s likely mediated by a different pathway (noradrenaline and dopamine have been shown to be released with cold water immersion) but it’s not fully understood. There aren’t the studies showing it has a significant effect on mood yet either, but a lot of small pilot studies and anecdotes pointing toward it having a positive effect.
Thanks for writing this, Cate! I've been doing HRT for just under a year (I'm 48) and recently got tested and found my T levels are super low. Asked my doctor, who is generally very knowledgable about HRT and is a menopause certified practitioner, to prescribe me T and she's been hesitant, which is depressing. Even the ones who know are holding out! According to her, it only affects sex drive. But you just game me more ammunition to keep pushing.
Also I agree re men having it on easy mode, hormonally. I've long thought that if I could exist in the follicular phase only I would be living a very different life. But then I also appreciate the ebbs and flows, and I do think the luteal/menstrual phase is for integration of all the work we do in the early part of the cycle. But that's a topic for another day.
It feels like the kind of thing that needs to hit some threshold of social proof before doctors will start prescribing broadly, but then it will become common -- I hope! Like cortisone shots or botox for migraines ...
I'm a hormone researcher who has studied testosterone in the context of the transition to parenthood so I was very interested in this article. Partnered men typically show declining testosterone levels around the birth of a baby, and this is adaptive-- it helps men shift their focus away from competing for mates and towards investing in the family. My lab finds that new mothers have worse relationship quality and higher postpartum depression risk when they are partnered with higher-T men, possibly because those men are less engaged in coparenting. Mothers with higher-T partners also reported greater intimate partner violence.
Although going on T had clear benefits for you, my question is whether you felt like there was anything lost in terms of your empathy, social cognition, or motivation to care for vulnerable others. I'm a little wary of a world in which everyone wants to be on T because there is a lot of value in nurturing traits as well, and those may be suppressed by T; without being too much of a gender essentialist, I worry that we celebrate stereotypically masculine attributes and traits (like agency) at the risk of de-valuing traditional feminine ones (like connectedness).
Do you control for estrogen levels in these observations? A lot of men on T replacement (TRT) need to take aromatase inhibitors to keep conversion to estrogen in check, and find that they become paranoid, antisocial, and aggressive/violent when estrogen climbs high, but not with just high T and reasonable estrogen levels. I wonder if men with naturally high T may also have naturally high estrogen for the same reason as men on TRT. I would imagine just having more 'energy' and motivation/agency could help someone be a better partner and father if that was already a key goal of theirs.
"First, men play life on easy. The degree to which this is true embittered me for a while. How much better I could have been at poker, without working any harder. How much more clearly I could have spoken in meetings. How much more easily everything could have come to me, had testosterone lowered the bar of what life required."
Your risk of heart disease goes up, and women do live longer, so it's not an unalloyed good. There's also aggression, the risk of getting into fights, etc. and minor annoyances like hair loss (reversible in your case) and unwanted hair in other places. I've often thought of *removing* mine, but balked at doing anything so irreversible. What if I changed my mind and wanted kids?
Still, I'm happy you were able to overcome the gender stereotypes to do something that let you live your personal best life. If you were made to be a tomboy, then that's who you should be. We should all be so lucky!
(not an expert but) I've read that longer lifespan in women is probably not caused by lack of testosterone, and is more likely related to higher levels of estrogen. Testosterone supplementation in moderate doses does not appear to shorten lifespan.
Thank you for writing this. I fully understand why you hesitated, but anyone who screenshots it in the cause of men's rights activism was already a lost cause. I hope (and suspect) that the more meaningful outcome of you sharing your experience will be people (women, I'm sure, but maybe also men) exploring the state of their hormones and how it's affecting their lives and psychology. And that's wonderful.
Thank you for this! I’ve been begging multiple doctors to consider this for me for 5 years. In 2020 I had a full hysterectomy (cancer). They took everything- uterus, cervix, ovaries, and some lymph nodes. Since then my life has declined dramatically. I had to beg to be on estrogen because of the high risk of cancer reoccurrence. Like your mom, my quality of life was so poor, I’d risk anything, even cancer, to gain some of my quality of life back.
My doctors have me on estrogen and progesterone, but refuse to add testosterone. 4 days ago a trans male friend gave me some testosterone cream. I took 1/8 of his dose for 4 days. It’s the first time in 5 years that I had any desire for sex. And the first time in 5 years I didn’t have to go to extreme measures to have an orgasm. This is 4 days. I can’t wait to see what other symptoms go away. Brain fog, lack of motivation, ADHD symptoms, muscle weakness, and so many more. Your story gives me so much comfort. Thank you.
I had to stop immediately at the crossword times. I thought 15-20 mins for Thursday was pretty good and I’ve been doing them for like a year now. <5 mins sounds incredible.
As someone who is ignorant in the matters of poker, I am curious about one thing. What exactly was the advantage testosterone could have given you in the game? Logical thinking? Thinking ahead? Risk taking? Confidence?
Are you actually smarter now, as in, better in fluid reasoning/working memory/processing speed? Would you probably score higher in IQ tests?
As a fellow former lawyer/poker player, I do wonder if we always thrived on more testosterone than average, and so when it declined it was more noticeable? Love my pellets! For those of you in Vegas, Dr.Keller is great.
Could be. I know someone who's an excellent poker player, but you could hardly pay him to play (he finds it very, very, very boring). He's definitely not your average guy though.
Interesting. My wife has had chronic fatigue for a few years now. Was debilitating at first but now just kind of sucks for her and limits her a lot. Maybe I'll tell her to get checked!
Congratulations on finding a treatment that worked, and thank you for encouraging others!
Nevertheless, I think that your first conclusion in part III relies on incorrect assumptions. The most important is that the difference in experience between an average man and an average woman is similar to the difference between an average woman and a hormonally deficient woman.
I'm not an expert in biology or chemistry, but I strongly suspect that, in some ways, males are far less sensitive to testosterone than females are. (argument below) Consequently, the effects of different testosterone levels within a sex (especially within one person) don't imply anything about the effects of different testosterone levels between the sexes.
The difference in testosterone concentration between men and women is *enormous*. Even when women's testosterone peaks in their 20s, the concentration for women at the 90th percentile is only one-fifth of the concentration for men at the 10th percentile. The medians differ by a factor of ~15. For most intents and purposes, these distributions do not overlap.
https://www.researchgate.net/figure/Testosterone-distribution-10th-25th-50th-75th-and-90th-percentile-in-men-A-women_fig1_283326530
Despite this, the distributions of traits that are associated with testosterone--libido, aggression, and more--overlap considerably between men and women. This implies that men are less sensitive to testosterone.
The proper lesson isn't "men play life on easy"; it's "healthy people play life on easy". Incidentally, I've experienced very similar symptoms to those that you've described--poor sleep, fatigue, brain fog, impaired speech, introversion, and more--and my testosterone levels were fine. For me, it was caused by a combination of low iron, sleep apnea, environmental allergies, and other factors. When I had trouble concentrating at work, or gathering the motivation to exercise, I thought that I was being lazy. When a *single* iron pill alleviated all of my symptoms within 24 hours, I knew that I wasn't to blame.
Your points here are really well taken.
One of the very best Author responses to a comment I've ever read. Also, I'm a man and am going to look into this for myself, so THANK YOU.
MM - would LOVE to hear more about your iron story. As much as you want to tell. I've been donating blood to reduce ferritin (iron is a pro-oxidant, etc etc yada yada) but...last blood tests indicated low, no s u p e r low UIBC and other markers.
Pills on the way.
But...your little phrase exploded a bomb in my awareness -- this (fixing iron) is probably a major reason i felt so epically amazing on carnivore...
thanks a bunch for leaving your comment....
Feeling amazing on carnivore diet (ketogenic for other folks) can also be due to switching from glucose as your energy source to ketones. This clears up brain fog and helps with good sleep and mood regulation for a ton of people (see metabolic psychiatry).
Thanks, Trysa. I got it. Don’t have much ‘fog’ per se, but it did seem to even out ups/downs (again, glucose/insulin spike stuff…) . And while sleep is good in general (duration, onset, ample dreaming, yada yada) it’s a real bear to get significant deep sleep. raised it up from single digits (yes, single digits…) to the one hour/1.5 hr range…but boy I’d sure like to know what to do to get into 2-3 hour range of deep sleep.
I would guess that the male and female medians for (libido and aggression, averaged) also differ by a factor of ~15.
How are you quantifying libido and aggression?
I would quantify libido as "desired frequency of sex". A difference of 15 would imply that if the median man wanted sex every day (which seems too high), the median woman would want sex less than once every two weeks (which seems too low).
I'm not sure that aggression can be quantified as a ratio. Aggression is a very different kind of impulse because a) it doesn't continuously accumulate, and b) there isn't a granular, quintessential act of aggression. You might be thinking of murder rates, but that's entirely due to the behavior at the far end of one tail; it would be like concluding that men are 15 times faster than women because (hypothetically) the set of the 10,000 fastest sprinters has a gender ratio of 15:1.
I think it's plausible that the median man would prefer to have sex every day and the median woman would prefer to have sex every 15 days, yes. That's what I had in mind. I agree that if that's off, then I'm more likely overestimating the difference than underestimating it. It's plausible that the difference is half that much, 7.5x rather than 15x: perhaps the median man would prefer to have sex every 1.5 days and the median woman would prefer to have sex every 11 days.
That uncertainty between 15x and 7.5x for libido is why I averaged it with aggression, which I think could be 15x to 30x. I agree that the murder rate is not a good measure because it compares tails rather than medians. Perhaps we should consider something more common like "the urge, however fleeting or restrained, to punch, push, body-check, or physically intimidate someone." I think it's plausible that the median male feels a fleeting urge like that once every two weeks, and the median female feels it once every 30-60 weeks.
I think young males have that urge on a daily basis. I know I did. If anything, I think the removal of low-level violence has made our society more unpleasant. Men settle disputes better that way. It is repugnant to see men lie and gossip as they do today. I cannot help but to think school shootings are a direct result. A few low-key fights keeps everyone honest. Once unseemly behavior takes root, misbehavior can get out of hand and real violence occurs. We have made so many poorly thought out changes to society and instead of fixing them we get manipulative, dishonest movements like the simpletons who want to ban guns (bans sure worked great with drugs). Public school in most cities are like depression, anxiety and outright psychosis factories. I understand why people do whatever they can to pay for Catholic school. May public schools today are just plain evil. I am convinced I would have become a murderer if I had to suffer four years of group work, fake behavior, emasculating rules and moronic teaching styles.
There is a hypothesis going around that the only reason young men are not destroying everything is that they are sedated on video games and porn, and often directly via pharmaceuticals. It is shameful that our society is accepting of so many young people needlessly suffering. I cannot help but to think many modern female-dominated fields have created a toxic femininity that rivals the male version, only more sinister and indirect.
YES! One generation older than me used to settle things with fistfights in the schoolyard. We did less of that; the current generation gets to do almost none.
This doesn't work for women. It's also the reason why boys of single moms are woefully unprepared: they think they can escalate every confrontation. Boys who grew up with "low level violence" know that every confrontation between males can easily escalate to an ass-beating or murder, so they escalate carefully, intentionally, and selectively. The female playbook is escalate, escalate, escalate, because men aren't (socially) "allowed" to beat women up, and women typically resort to character assassination, not assassination, in their female-female conflicts.
I mean I’m a woman and this seems pretty crazy to me. Once every 11 days? I mean it’s not that I can’t go without for that long, but I’d prefer not to. I don’t think I’m that unusual- I think people get busy and tired, and especially women with kids can feel burned out and touched out which might lower their libido. But the idea that a sexually healthy woman wants less sex is really funny to me bc the ancient Greeks thought of women as the horny ones. The myth of Tiresias is all about that.
Median man wants it at least once a day. Why does that "seem to high" to you? I want it once every 18 hours (1.5x/day), until I die, and I'm pretty low T, I'd guess I'm around the 40th percentile man.
To other readers: the symptoms of low testosterone are pretty non-specific. I am a guy and got finally my testosterone levels tested after a thread by Cate (https://x.com/catehall/status/1875744698754809994).
It turned out my testosterone levels are higher than that of 85% men. Which on one hand surprised me and on the other hand it triggered a form of self-acceptance of some of my personality tendencies (like competitiveness, status-seeking, etc). Alas, my issues with brainfog and sleep remain unfixed.
To Cate: your later points about biology remind me of Scott Alexander's post "Society is fixed, biology is mutable" (https://slatestarcodex.com/2014/09/10/society-is-fixed-biology-is-mutable/)
Oh nice! Part of the constantly unfolding process of realizing everything I write has been written before 😄
Scott Alexander also just writes a lot of "canonical" posts that get passed around as common knowledge because they're so simple and yet insightful. Expect to see his ghost in your comments section often 😂
This happened for me also, back in around 2022, male in my early 40s I thought my T may be low because of various symptoms (lower energy, more irritability, waning libido, the usual) and it turned out I was near the top of the range. I was pretty upset to find that out, since it would've been good to have a biological explanation, but I had to just accept that maybe this was aging and it would never get better again.
I have an alternate theory that despite my high-T some of these symptoms could be produced by alcohol consumption, alcohol being known to cause elevated estrogen levels, but it seems to be mostly an effect in women and is disputed how much this impacts males.
The one thing I ever took that gave me an experience like Cate had was when I got prescribed steroids for some kind of skin inflammation I had. First couple days of that steroid pack I felt normal again for the first time in years. Every part of me that had been feeling sore since I hit 40 was fixed at once. I know that's not a real solution, so I've never tried to get them through backchannels, but that sure was pretty great.
I mean this in a totally non-value-laden way: Why is that not a real solution?
Possibly because long-term corticosteroid use has some really bad health consequences, like diabetes and osteoporosis.
Were you drinking pseudoestrogen? (Aka IPAs?) If so, that's what's causing the elevated "estrogen" levels, not the alcohol.
There's a very big industry to get guys to imbibe pseudoestrogens.
Anti-estrogens work very well. A Femara a day keeps the bloating away. Femara is the brand name of Letrozole.
The end of this post made me think of that Scott post too!
(Great post btw Cate, very happy that you found something so helpful!)
Mold.
@psyschotechnology – So, if I understand you correctly, you were feeling symptoms of low testosterone, but once you got tested, it turned out you have relatively high testosterone?
"I feel sharper now than I did at 30; my memory is much better; the brain fog is gone."
I'm trans female, and your post reminds me in some ways of how I felt before and after starting feminizing HRT (estradiol). I'm 33 now, been on HRT for 2 years. Pre-HRT my total testosterone was ~500 ng/dL, post my T is ~22 ng/dL and DHT is ~17 ng/dL.
I'm simplifying for brevity, but within 9 days after increasing my daily dose from 2 to 6 mg of estradiol (pills) I noticed profound subjective cognitive and mood changes, 90% less brain fog, easier time focusing on intense tasks, just happier, calmer, with no perceptible downsides. I did become less irritable though; T and E (just like masculinity and femininity) are not mirror opposites.
This really shook me existentially. I was very depressed at the time, still have depression (since 13), and HRT didn't magically fix my life. But it did cut my suicidal ideation by over 50% almost overnight, with no side effects, while also making me smarter, happier, and calmer. Which still feels pretty insane to me.
I don't think this is physiologically similar to your case. Fixing T-deficiency for an otherwise healthy cis person is different than a trans person starting HRT. I've also seen cases of T-deficient trans women who benefited from T supplementation. The similarity is the existential impact of going through such a profound cognitive change simply from supplementing a sex hormone.
My case shows that higher T is not better for everyone but I do agree with you that cis men probably have physiological advantages on average in many competitive fields, due to a combination of their T levels, and from having brains that run well on T.
Overall, IMO, even if we only look at cis people, there is likely wide variability in what an individual's optimal hormone levels are, and also in how strongly a deficiency will affect someone. There is still a lot of FUD around hormone supplementation, and probably many people could benefit from giving it a try.
I really appreciate you writing this. Just wanted to share my data point.
this is super interesting! i appreciate you sharing your perspective
I'm also a trans woman and I just want to second this. I haven't taken regular intellectual benchmarks like the crossowrds but I have found it much easier to do regular exercise on E, have lost substantial weight and have been running longer distances for the first time since the beginning of college. I'm slower, probably because I'm older and my T is low, but I find exercise gives me much more of a mood boost.
It was also very funny to read the 'men live life on easy mode' because my own feeling starting E was that it was massively better mood and focus wise than the sort of numb dissatisfaction and irritability of T. It can be really destabilizing to have every aspect of your life very suddenly improved and to realize how little really stood between you and a much better life.
all super interesting. Maybe each person's physiology has a unique optimal (desired) state of hormonal levels, and being further away from this causes cognitive friction.
Do you know your estrogen before? The general experience of people taking hormones for non-trans reasons is that somewhat higher levels of both are nice. And nine days into estrogen, youd still have your natural testosterone production as well, so a different experience from long-term use.
i tried increasing estrogen first, but didn't experience any effects at all from it.
I do! Pre-HRT, my estradiol IA test returned 23 pg/mL (normal for adult males). I also tested my FSH, LH, and SHBG, which were all normal (for cis men, pre-HRT) as well.
I saw a study at one point IN MICE (but still) which, IIRC showed the highest maze-running performance when the mice had supra-physiological levels of both sex hormones, regardless of natal sex. So you may be on to something!
However! The subjective data I have doesn't seem to support this in my case. I left some info out of my original comment, just so it wouldn't be boringly long. I noticed the cognitive improvements on estradiol not when I started the 2mg (buccal) dose but when I increased it from 2 mg to 6 mg. I was already on a 1mg, then 2mg dose for a month before going up to 6mg, so presumably I already had some suppression of T production at that point. I was also taking 12.5mg/day of bicalutamide at the time, which blocks androgen receptors.
Another data point: due to an unrelated eye issue (meibomian gland dysfunction), I was totally off estradiol for a month, 6 months after starting HRT (I stopped the E2 cold turkey, sex hormones crashed and I felt awful, then my T production and male physiology rebounded rapidly), and then gradually titrated my E2 dose back up for 4 months after. At the end of that 4 month period, my labs were:
E2 125 pg/mL
E1 876 pg/mL
DHT 41 ng/dL
T 291 ng/dL
E1 is a weaker estrogen receptor agonist than E2 so maybe it's not a fair test but I didn't feel any better with those "androgynous/non-binary" levels than I do now with my androgens down in the cis female range. Take it with a grain of salt since it's n=1 and I'm definitely biased because I absolutely love and adore my feminized body-- but I haven't found that higher T levels do anything additional mentally for me if I already have enough estrogen.
You should do cold plunges, Cate!
For me, they were life changing in the same way that your experiences with TRT sound. I went from regular spirals of negativity, self-hatred, anger, violent thoughts, to basically just never feeling those things. They don't necessarily make you feel "happy", but they make your mood incredibly stable. The best comparison is like an inflatable ball in a pool - even if you submerge it into the water briefly, it will immediately pop back up to the surface.
In terms of life benefit to cost/effort ratio, I don't think there's anything higher. For me, they were more effective than any type of exercise or meditation.
You can start very easily - dump some cold packs in your bathtub, fill it up halfway (just enough to cover your stomach, you don't need to cover your legs completely). Ideally you get the water to around 52-55 F. Start at 1 minute or so, work your way up to 3 minutes. The water doesn't have to be that cold to get the benefits. I do 3 min @ 52 F every morning, and that works great for me.
If you get into it more, you can get an inflatable tub and a chiller off amazon/ebay for ~$500.
i will try to make myself do this!
Awesome! The first ~3 times of doing it might kind of suck, but after that you get used to it and it's no big deal.
People recommend letting your body warm up naturally afterwards (no hot showers), but getting in bed under some warm blankets helps to recover.
Watching some youtube videos of people doing it will help program your mind into thinking it's a good idea
Thank you!!!
Hi! I’m intrigued by this suggestion. Would you mind please sharing a YouTube creator or link you like? When I searched all I could find was “spend $1000+ and buy a chiller, pump, and chest freezer which gets moldy though no one seems bothered by this”. Any videos on adding cold packs to a normal bathtub like you describe would be appreciated. Thank you!
>adding cold packs to a normal bathtub
You don't need any videos, you can Just Do It (Nike). It doesn't have to be perfect. I had ~5 large ice packs from ordering bulk chocolate, so I just used those
That said, I saw her:
https://www.instagram.com/p/DGIdA6VoFiD/
This what I bought -
https://www.amazon.com/dp/B0DTTNKP3H
https://www.ebay.com/itm/405590420208
https://www.ebay.com/itm/316024735879
Plus a gallon of 12% hydrogen peroxide - I add 2 cups every week, and run the ozone generator for 30 min after using the plunge
OK so let me ask the obvious question - what effect, if any, do cold plunges have on testosterone levels or the body's sensitivity to testosterone?
Interestingly, cold water immersion seems to decrease testosterone immediately after, but the studies I could see from a cursory google all look at its effect post exercise and don’t look at long term testosterone levels (i.e. whether it effects baseline). So there could be an initial dip and then an increase but there is no evidence for that.
There are many different mechanisms that affect mood so it’s likely mediated by a different pathway (noradrenaline and dopamine have been shown to be released with cold water immersion) but it’s not fully understood. There aren’t the studies showing it has a significant effect on mood yet either, but a lot of small pilot studies and anecdotes pointing toward it having a positive effect.
No idea lol. All I know is they work for me.
Like most things in life, you have to do your own n=1 experiment and see if it works for you.
really appreciate this comment <3 I have cold plunged intermittently for years, but something about how you put things together here was helpful
Thanks for writing this, Cate! I've been doing HRT for just under a year (I'm 48) and recently got tested and found my T levels are super low. Asked my doctor, who is generally very knowledgable about HRT and is a menopause certified practitioner, to prescribe me T and she's been hesitant, which is depressing. Even the ones who know are holding out! According to her, it only affects sex drive. But you just game me more ammunition to keep pushing.
Also I agree re men having it on easy mode, hormonally. I've long thought that if I could exist in the follicular phase only I would be living a very different life. But then I also appreciate the ebbs and flows, and I do think the luteal/menstrual phase is for integration of all the work we do in the early part of the cycle. But that's a topic for another day.
It feels like the kind of thing that needs to hit some threshold of social proof before doctors will start prescribing broadly, but then it will become common -- I hope! Like cortisone shots or botox for migraines ...
I'm a hormone researcher who has studied testosterone in the context of the transition to parenthood so I was very interested in this article. Partnered men typically show declining testosterone levels around the birth of a baby, and this is adaptive-- it helps men shift their focus away from competing for mates and towards investing in the family. My lab finds that new mothers have worse relationship quality and higher postpartum depression risk when they are partnered with higher-T men, possibly because those men are less engaged in coparenting. Mothers with higher-T partners also reported greater intimate partner violence.
Although going on T had clear benefits for you, my question is whether you felt like there was anything lost in terms of your empathy, social cognition, or motivation to care for vulnerable others. I'm a little wary of a world in which everyone wants to be on T because there is a lot of value in nurturing traits as well, and those may be suppressed by T; without being too much of a gender essentialist, I worry that we celebrate stereotypically masculine attributes and traits (like agency) at the risk of de-valuing traditional feminine ones (like connectedness).
Do you control for estrogen levels in these observations? A lot of men on T replacement (TRT) need to take aromatase inhibitors to keep conversion to estrogen in check, and find that they become paranoid, antisocial, and aggressive/violent when estrogen climbs high, but not with just high T and reasonable estrogen levels. I wonder if men with naturally high T may also have naturally high estrogen for the same reason as men on TRT. I would imagine just having more 'energy' and motivation/agency could help someone be a better partner and father if that was already a key goal of theirs.
"First, men play life on easy. The degree to which this is true embittered me for a while. How much better I could have been at poker, without working any harder. How much more clearly I could have spoken in meetings. How much more easily everything could have come to me, had testosterone lowered the bar of what life required."
Your risk of heart disease goes up, and women do live longer, so it's not an unalloyed good. There's also aggression, the risk of getting into fights, etc. and minor annoyances like hair loss (reversible in your case) and unwanted hair in other places. I've often thought of *removing* mine, but balked at doing anything so irreversible. What if I changed my mind and wanted kids?
Still, I'm happy you were able to overcome the gender stereotypes to do something that let you live your personal best life. If you were made to be a tomboy, then that's who you should be. We should all be so lucky!
(not an expert but) I've read that longer lifespan in women is probably not caused by lack of testosterone, and is more likely related to higher levels of estrogen. Testosterone supplementation in moderate doses does not appear to shorten lifespan.
Thank you for writing this. I fully understand why you hesitated, but anyone who screenshots it in the cause of men's rights activism was already a lost cause. I hope (and suspect) that the more meaningful outcome of you sharing your experience will be people (women, I'm sure, but maybe also men) exploring the state of their hormones and how it's affecting their lives and psychology. And that's wonderful.
Thank you for this! I’ve been begging multiple doctors to consider this for me for 5 years. In 2020 I had a full hysterectomy (cancer). They took everything- uterus, cervix, ovaries, and some lymph nodes. Since then my life has declined dramatically. I had to beg to be on estrogen because of the high risk of cancer reoccurrence. Like your mom, my quality of life was so poor, I’d risk anything, even cancer, to gain some of my quality of life back.
My doctors have me on estrogen and progesterone, but refuse to add testosterone. 4 days ago a trans male friend gave me some testosterone cream. I took 1/8 of his dose for 4 days. It’s the first time in 5 years that I had any desire for sex. And the first time in 5 years I didn’t have to go to extreme measures to have an orgasm. This is 4 days. I can’t wait to see what other symptoms go away. Brain fog, lack of motivation, ADHD symptoms, muscle weakness, and so many more. Your story gives me so much comfort. Thank you.
It's infuriating that they won't prescribe testosterone!
Have to appreciate someone being honest about being wrong and changing their mind.
I had to stop immediately at the crossword times. I thought 15-20 mins for Thursday was pretty good and I’ve been doing them for like a year now. <5 mins sounds incredible.
Comparison is the thief of joy, don’t give up something you enjoy just because there’s someone out there who’s faster than you at it! :)
Wasn't planning on stopping :)
3 sigma+ genius level. Bet there's a good story here....
As someone who is ignorant in the matters of poker, I am curious about one thing. What exactly was the advantage testosterone could have given you in the game? Logical thinking? Thinking ahead? Risk taking? Confidence?
Are you actually smarter now, as in, better in fluid reasoning/working memory/processing speed? Would you probably score higher in IQ tests?
Thanks for this. Seriously appreciate the courage and clarity
This is so cool and interesting and vulnerable. Makes me so curious to try it myself... Thank you for sharing
As a fellow former lawyer/poker player, I do wonder if we always thrived on more testosterone than average, and so when it declined it was more noticeable? Love my pellets! For those of you in Vegas, Dr.Keller is great.
Could be. I know someone who's an excellent poker player, but you could hardly pay him to play (he finds it very, very, very boring). He's definitely not your average guy though.
Interesting. My wife has had chronic fatigue for a few years now. Was debilitating at first but now just kind of sucks for her and limits her a lot. Maybe I'll tell her to get checked!