That’s certainly one school of thought that sounds very sensible and has many advocates, but I think real world circumstances are often complicated so I offer a counterpoint. This is also one of those issues where I think patient experiences should outweigh what doctors think makes sense in some idealized world that doesn’t exist. It’s really the kind of statement that few who have suffered from very low testosterone would make.
Most men who start thinking about hormone replacement have a reason: they feel like crap. They tend to be in their 40s or older, have gained weight, are at the peak of their careers so have a lot of stress, have children in the house or in college, and are starting to have to deal with aging parents. Sleep is often poor, life is busy, and it’s hard to fit in exercise. So, yes, all these things combined with less than ideal diet lead to weight gain and low testosterone. But note that it’s often multi-factorial.
So yes, GLPs can get the weight off, but that takes a few months or longer and there’s a risk of muscle loss if testosterone is low. Maybe muscle can be maintained with resistance training and protein even with low T, but adding more exercise when in a caloric deficit and when already in a low-energy state because of low T can be very difficult to sustain. Contrary to popular belief, it is not easy to add muscle once in the 40s or beyond, so you really do not want to lose any. If a man has decent testosterone levels and does everything exactly right, with consistency, he would be lucky to gain 5 lbs of lean muscle his first year of hard training unless starting from a very low baseline.
What if he does get the weight off first, though? Stress and sleep issues may still be present, and a caloric deficit will kill libido and hamper testosterone production while in the weight loss phase also. Even once the weight is off, there is no guarantee that levels will dramatically increase if stress and sleep are still issues.
The other thing to consider is that he’s probably going to go on HRT at some point anyway. So why delay a few years? I think it makes more sense for many men to start HRT and GLPs at the same time, get healthy, retain the muscle, and just stay on the HRT. They are unlikely to lose muscle while dieting and will get the energy and emotional benefits of the testosterone that make it easier.
Now there are other options that aren’t discussed enough if one doesn’t want to go straight to testosterone. One is using high doses of HCG for a period of time. This is uncommon and I’ve never heard a doctor recommend it, but it is something that is done and it works. Enclomiphene is another option, though many who do it note that their testosterone increases yet they don’t feel good.
