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Therapeutic Testosterone and Cardiovascular Training: The Necessity of Both At The Same Time

A while ago, I received this question from a reader about cardiovascular training (“cardio”) and therapeutic testosterone:

“My normal resting heart rate is about 56 but when I am on TRT, my RHR [resting heart rate] and average heart rate both increase by 5 to 8 beats per minute. Diet and exercise remain the same. I do strength training about 5 days per week.  Three days per week I do about 20 round of jump roping.

More specifically: I have run some experiments where I get off testosterone, when I do my resting heart rate gets back down to the mid 50’s base line. Within 1 day of injecting 40 mg’s it increases about 5 to 7 beats per minute.  I can get off, do a couple weeks of commit and let the testosterone get out of my system and my resting heart rate returns back to that mid 50’s mark.

I am on 40 mg of test cypionate every 4 days. This puts my Free T levels menstrual phase halfway between doses between 20 and 23 ng/dl and total at about 1,100 ng/Dl

DHEA-S is around 260, DHT in the low 50’s and Estrogen below 40.

The increase in my heart rate is quite concerning. I was wondering if you have ever addressed this with your community.

Should i be doing more cardio while on testosterone?”

I’m glad he brought this up because it’s one of the most commonly asked questions I receive about cardio.

And it brings up an interesting paradox — while women often opt for doing too much cardio, men will jump over tall buildings to avoid cardio.

So it’s time to lay down the gauntlet on the importance of cardio for fully optimized health… ESPECIALLY if you are on some form of testosterone optimization therapy.

My Super-Short Response To Doing More Cardiovascular Training While Using Testosterone

If you want the “too long, didn’t read” response to the reader, here is what I said.

Any increase in heart rate has to do with three things: Your body fat levels, systemic inflammation, and your heart rate variability (HRV).

If you’re living an insulin-controlled and low inflammation lifestyle, you should not be running into any problems with abnormal changes in heart health.

And as readers of my website already know, testosterone is cardioprotective and IMPROVES heart health.

But with respect to the reader’s question about doing more cardio, the answer is ALWAYS!

Injectable testosterone increases red blood cell (RBC) count, thus oxygenating the blood and increasing blood viscosity as a result.

It is a lack of doing cardio, being too fat, and having bad aerobic conditioning that results in the higher heart rate the reader was experiencing.

Additionally, regular cardio will reduce the thickening of the blood that comes about from therapeutic testosterone use.

The #1 Reason Therapeutic Testosterone Users ABSOLUTELY MUST Do Cardio

I want to expand on the last point I just made as it rarely gets discussed in the hormone optimization space.

In The TOT Bible, I mention that one potential side effect of supraphysiologic testosterone use is increased blood pressure, which gets worse with higher doses:

“This can be readily fixed by doing cardio, and even then some guys will still have chronically elevated blood pressure. If you gain a lot of weight, which is almost inevitable with a high dose of testosterone, your blood pressure will go up due to the increase in hematocrit and hemoglobin levels (high doses of testosterone also stimulate red blood cell production).

TOT is NOT a magic bullet. Also, if you think you can get away with skipping cardio and doing nothing else but training with weights, think again. You’ll end up getting average to below average results at best. You must do cardio on a regular basis to keep your blood supply oxygenated, and decrease the thickening of blood (via increased red blood cell counts) often caused when using injectable testosterone.”

Thus, anybody on therapeutic testosterone (via injections or trans-scrotal cream) needs to double down on cardiovascular training as exogenous testosterone is heavily oxygenated.

The process through which your blood becomes thicker — and consequently raises your hemoglobin and hematocrit levels — is known as erythrocytosis.

This is a very common occurrence in testosterone users and is no cause for alarm, yet it’s the reason why many of them find themselves feeling winded and tired more often.

And as I laid out in Living A Fully Optimized Life, cardio “helps push out the thicker blood, metabolic and cellular waste produced by training with weights at high intensity.”

I’ve already written an article talking about erythrocytosis in testosterone users and how it is different from a more lethal blood disorder, but here are the main takeaways:

Erythrocytosis: an increase in the red blood cells due to the stimulation of hematopoietic growth factors from testosterone therapy. Serum testosterone levels are most related to erythrocytosis, rather than erythropoietin (EPO) levels in hypogonadal men. Depending on the dose, testosterone can increase the hemoglobin and hematocrit rate but does not rise in EPO.

Erythrocytosis is harmless: It is also the same process that causes people who live at high altitude to have an increase in red blood cell counts. It is because it is a physiologic yet harmless increase in RBCs alone, not in any other cells or clotting factors

Elevated red blood cell counts are quite common among men who take injectable testosterone. It is most common among men taking injectable testosterone (67% of users) and less in those using non-injectable options (about 13%.)

Polycythemia: a condition in which all blood cells are elevated, including platelets… a stem cell disorder characterized as a panhyperplastic, malignant, and neoplastic marrow disorder. Its most prominent feature is an elevated absolute red blood cell mass because of uncontrolled red blood cell production.

THE MAIN DIFFERENCE: …erythrocytosis only causes increased red blood cells and no harm. Polycythemia causes an increase in platelets, which causes increased clotting. It is also associated with a defect in the blood vessel wall, which stimulates the clotting cascade of thrombosis. These two factors cause an increased risk of blood clots and strokes, thereby requiring treatment by phlebotomy or blood donation to lower blood counts and prevent the complications of polycythemia”

If you want more advanced information on this specific side effect of therapeutic testosterone and how you can work with your physician to manage it properly, Chapter 12 of The TOT Bible (Monitoring TOT For Optimum Health) has everything you need.

But long story short, this — and many other reasons I’m about to highlight — is why cardio cannot be skipped or disregarded as a non-essential form of exercise.

Other Important Health Reasons To Regularly Do Cardio

Whether you’re a casual gym-goer or a hardcore competitive bodybuilder, cardio can do a hell of a lot more than merely offset a common outcome of hormone optimization therapy.

Better Metabolic Health

I wrote about this in Living A Fully Optimized Life and will re-paste it here for your convenience:

“[Cardio] is essential for training your organs to process and breakdown the food you eat.

Regular and consistent cardiovascular training will also help scavenge free radicals found in your body that lead to inflammation and age-related disease.

Cardiovascular training allows your body to effectively dispose of waste products that build up in your body and metabolize the nutrients you consume.

Some people process food and macronutrients differently, but regardless of your unique biochemistry, your metabolism will change and slow down as you age.

By performing regular cardiovascular training, you can offset – to a great degree – the slowdown in metabolism that comes from aging.”

On top of ensuring your body’s metabolism is functioning optimally, you also need to practice metabolic flexibility to ensure your body is getting the right nutrients in the first place.

Increased Lifespan

In 2016, I listed cardiovascular endurance as one of the four main factors of human longevity alongside lean body mass, grip strength, and body mass index:

“Heart health matters. But how much exercise is required to be “heart healthy”. Contrary to popular perception, the amount of cardiovascular required to achieve the health benefits is NOT that much nor that intense. 75 minutes if aerobically intense activity a week, or 150 minutes of low intensity activity. Within the course of a week, walking for 20 to 30 minutes cumulatively fulfills the requirements. Three short aerobically intense workouts of less than 30 minutes fulfills this as well. Your heart health and cardiorespiratory fitness are the most readily improvable, and simple WALKING will give you the longevity benefits.”

One year later, I listed it again as one of the top 10 biomarkers of aging:

“… the worse your body is at using oxygen, the more unhealthy you will be. A low oxygen internal environment impairs metabolism at practically every level, and increases risk factor for cardiovascular disease, cancers, and weakens immune system.”

This is backed up by data from the American Heart Association that literally shows DECADES of life lost to unnecessarily poor heart health:

“For heart attacks alone, more than 16 years of life are lost on average, according to American Heart Association statistics. Researchers estimate people with heart failure lose nearly 10 years of life compared to those without heart failure.

…The risk of early death also is high for people with a history of diabetes, stroke and heart attack. Reporting in the Journal of the American Medical Association in 2015, researchers found people with all three conditions had their life expectancy cut by 15 years compared to those without any of the health problems. Even having just two of the conditions reduced life expectancy by 12 years.”

So if you want to live longer, make sure you’re doing cardio consistently and properly (more on that later).

Peak Cognitive Performance

Chapter 11 of The Metabolic Blowtorch Diet talks about this benefit in much greater detail and includes multiple peer-reviewed papers, but again I will summarize everything you need to know with respect to cardiovascular exercise.

There is a very well-established connection between high-intensity and the increased production of brain-derived neurotrophic factor (BDNF), a protein responsible for numerous functions:

  • Prevents neuronal cell death
  • Allows for new connections between cells in the brain
  • Grows existing neurons
  • Triggers the creation of neurons via brain cells

In turn, this leads to the following outcomes:

  • Lower stress levels via decreased cortisol production
  • Decreased risk and slowed-down progression of neurological diseases such as dementia, Alzheimer’s, and Parkinson’s
  • Far less likely to suffer from mental health disorders such as depression, bi-polar disorder, and schizophrenia
  • Improved ability to process, memorize and apply new (and existing) information
  • Increased learning capabilities
  • Higher levels of intelligence via neuroplasticity

All of these things are what lead to greater levels of creativity and tapping into the “flow state” so many productivity experts preach about… if you’ve ever experienced the “runner’s high” after a long run, you already know what I’m talking about.

And short of high-intensity aerobic exercise, the only other way to naturally maximize BDNF production is through intermittent fasting.

Quite literally, regular cardio will make you a smarter and sharper person!

Faster Fat Loss

I want to put several caveats here as I am NOT discounting the importance of cardio for rapid fat loss.

It is an essential staple of both The Metabolic Blowtorch Diet and Guaranteed Shredded protocols.

However, it is very possible to perform cardio in a way where you end up losing hard-earned lean muscle, and I wrote about this in my first article dispelling the myth that cardio alone is sufficient for successful fat loss:

“Fat loss is an outcome of an energy deficit. If you create one through eating less, you will lose fat. If you create one through EXERCISING, you will lose fat. That said, fully understanding this requires nuance. Calories In, Calories Out is thermodynamics, and yes that is always in effect, but HOW you create this matters immensely. The major issue with “cardio” for fat loss is that it does not change your actual metabolism/physiology. Yes, it creates a deficit and yes you can lose weight.


And even further, cardio can become catabolic, meaning your body starts eating itself. Especially if you don’t eat enough protein. Less lean skeletal muscle mass = slower metabolism while at rest. Remember-muscle is the ultimate metabolic equalizer. The more you have the more calories you will burn at rest.”

And when Alexander Juan Antonio Cortes wrote a guest blog for me a year earlier, he expanded on why this happens:

“Practically anyone will lose weight very quickly if they do enough of it.

The problem is that it is exercise induced WEIGHT loss, but its not what you might call “physiological fat loss”

Meaning you are using activity to almost artificially keep your weight down. But your Lean body mass, which is the “secret” (so to speak) with changing how your metabolism functions, NEVER changes.

So the running creates an energy deficit, makes you sweat, and the pounds come off initially.

But you stop running, pounds come back, and metabolically you can be in a worse place than you were prior.  Not to mention the potential injuries and debilitation you face from the hard surface pounding on your joints and soft tissues.”

Which means you need all of the fundamentals in place for fat loss: Intelligent weight training, smart use of cardio, and a proper dietary plan in place.

How To Properly Do Cardio For Longevity And A Lean Body

So with all of this in mind, how can we create a plan for cardiovascular exercise in a way that helps our fitness goals instead of hindering them?

I’m going to reveal my optimal strategies and tactics for doing so, including:

  • How many times to do it per week
  • How long to do it each session
  • How intense each session should be
  • The best types of cardiovascular exercise (and the ones to avoid if you are 40 years or older)

But if I can sum it up in one sentence, it would be as follows:

The ideal cardio protocol is performing low-impact endurance training 2-7x per week (30-45 minutes per session) at a low to moderate intensity (65-80% of maximum heart rate, so ~125-140 BPM) depending on your body fat levels.

You should calculate your target heart rate with a reliable calculator while using your cardio machine and/or a high-tech wearable device such as an Apple Watch to track your heart rate in real-time.

Athletes with more body fat to lose can speed up the rate of fat loss by (a) spending more days out of the week fasted, (b) reducing the duration of rest period during weight training, and (c) increasing the frequency (and possibility the intensity) of cardiovascular exercise.

What Types Of Cardio Should You Do?

What you want to do is LOW-IMPACT endurance training, which includes any of the following:

  • Walking outside
  • Walking on a treadmill at an incline angle
  • Riding a stationary bike (my personal favorite)
  • Using a Stairmaster
  • Using a rowing machine
  • Using an elliptical machine
  • Swimming

If you are an aging athlete of 40 years or older, you MUST minimize if not avoid all forms of explosive and/or high-impact endurance exercises.

Examples include ballistic movements found in programs like CrossFit and running on hard surfaces.

Given enough time, these exercises can (and will) damage your soft tissues and spine, potentially leading to significant joint problems… especially within the hip and knees.

The video below explains why:


How Intense Should Cardio Be?

Here is where my recommendation differs depending on your circumstances…

For the majority of people reading this, steady-state cardio at the low-to-moderate intensity I specified earlier will be more than sufficient for maximal fat loss and minimal muscle loss.

But for athletes with higher body fat levels AND lean muscle content, high-intensity interval training (HIIT) may be a more suitable option.

From The Metabolic Blowtorch Diet:

“High-intensity interval training (HIIT), also called high-intensity intermittent exercise (HIIE) or sprint interval training (SIT), is a form of interval training, a cardiovascular exercise strategy alternating short periods of intense anaerobic exercise with less intense recovery periods. HIIT is the concept where one performs a short burst of high-intensity (or max-intensity) exercise followed by a brief low-intensity activity, repeatedly, until too exhausted to continue. Though there is no universal HIIT session duration, these intense workouts typically last under 30 minutes, with times varying based on a participant’s current fitness level.”

I explain why I make this distinction in The TOT Bible:

“This type of cardiovascular training (HIIT) increases the rate of fat loss and enhances the potential number of calories burned per unit of time.

There is newer research about supramaximal interval training (SMIT) being the most effective for fat loss [Source] and lean muscle tissue growth. SMIT involves interval training at 100-130% of your maximum aerobic capacity for roughly 30-60 seconds, followed by 4-5 minutes of active recovery (20-25% max capacity). 

Anyone choosing to perform HIIT/SMIT cardiovascular training should have a good amount of existing muscle tissue, as either form of cardio can break down muscle protein (especially in newer and less conditioned trainees).”

As you can see, INTENSITY is a separate factor from IMPACT: The former describes how difficult the exercise is, the latter describes the force being applied to your joints.

How Often Should I Do Cardio?

For individuals who are on a maintenance or lean mass gain program, doing cardio once a day on non-training days (or fasting days) should be enough for your cardiovascular efforts.

It is important to keep cardio separate from weight training in order for you weightlifting program to be most effective for building and maintaining muscle

However, you do decide to fit in an extra cardio session on training days, make sure it’s a quick 15-20 minute session done immediately after weight training.

Steady state cardio and HIIT cardio are both acceptable in this circumstance as the body is already experiencing an ample amount of calories that day, plus your elevated heart rate will lead to additional caloric burn per unit of time.

If you’re doing a more extreme fat loss program such as Guaranteed Shredded, 2 sessions a day — morning and evening on fasting days (i.e. days without resistance training) are optimal.

Fasted Cardio: Yay Or Nay?

Here is the one part of cardiovascular exercise where people really love to go after each other’s throats.

In short, my stance is fully outlined in the video below:

With this being said, I do have some important rules around fasted cardio:

  • More cardio is better than none at all, yet fasted cardio is better for fat loss than non-fasted cardio
  • For the most optimal fat loss on a fasting diet, TWO fasted cardio sessions should be performed before breaking your fast
  • If you do fasted cardio, it should be steady state to prevent burning glucose (which can lead to muscle loss in the absence of glycogen from long fast windows)
  • Fasted cardiovascular endurance training MUST be done in the early mornings to attain peak effectiveness
  • Also, if you’re doing fasted cardio on fasting days, make sure you are NOT weight training!

But like I’ve said numerous times in the past, don’t obsess too much over it:

“Heres the answer. If you think it works, DO IT. If you don’t, do not. And if you’re not even lean to begin with, your opinion is stupid anyways. Arguing over something you are not even willing to do is a waste of mental energy.”

CONCLUSION: Bro, Do You Even Do Cardio!?

I firmly believe cardiovascular exercise will become the new thing amongst bros in the fitness space.

It’s simply too important to discount for any serious athlete who wants to become fully optimized.

Every single gym has numerous cardio machines for you to use, and you can do cardio for free without any equipment if you can’t access a gym.

There just aren’t any more excuses at this point and anybody who is “cardio-phobic” needs to ask themselves if they truly care about living a longer and healthier life.

To discover more of my essential rules for overall fat loss and deciding how much cardio is appropriate for your fitness goals, read this article.

If you want to learn more about why cardio is mandatory for therapeutic testosterone users, read The TOT Bible and Living A Fully Optimized Life.

Looking for a sustainable lifestyle program to help you stay lean 365 days a year? Pick up a copy of The Metabolic Blowtorch Diet.

And should you want an extreme diet and training protocol for losing fat ridiculously fast in time for a big event, grab Guaranteed Shredded (takes less than 30 minutes to read and understand).

As always…

Raise Your Vibration To Optimize Your Love Creation!

PS – If you want access to my most intense fat loss hacks, grey-market supplements, and exercise protocols for maximum health and longevity, sign up for The Fully Optimized Health Private Membership Group.

In addition to full-on access to me, you’ll be able to reach new levels of physical and well-being with a group of high-conscious, like-minded men and women.

You’ll also get access to my best-selling books and webinars for free, state-of-the-art testosterone optimization, cutting-edge research on peptides and supplements, interviews with spiritual masters, and my “black book” Rolodex of the world’s best hormonal health physicians.

Until my new courses on Hormonal and Peptide Optimization launch in early 2022, you can get exclusive access to the group for only $49/mo.


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