What Brian Johnson (Liver King)'s TRT Protocol Would Cost Outside a Celebrity Context

What Brian Johnson Actually Admitted To

In December 2022, after leaked emails to a coaching consultant detailed monthly spending of roughly $11,000 on performance-enhancing compounds, Brian Johnson posted a video apology on YouTube confirming he had used testosterone, growth hormone, hCG (human chorionic gonadotropin), and trenbolone. For months prior, Johnson had attributed his heavily muscled physique exclusively to an "ancestral lifestyle" built on raw organ meats, sun exposure, and cold plunges.

The admission matters for the cost-and-access conversation because it exposed two realities at once. First, the stack Johnson confirmed is a mix of FDA-approved medications (testosterone, hCG, growth hormone) and a veterinary anabolic steroid (trenbolone) with zero legal pathway for human prescription. Second, the reported $11,000/month spend reflects a concierge, cash-pay, no-questions-asked tier of access that bears almost no resemblance to what a patient with a genuine clinical indication would face.

The HealthRX.com Medical Team's position: the public record here is useful precisely because it lets us separate what is medically available from what is not, and what is affordable from what is not.

Testosterone Replacement Therapy: The Accessible Core

Testosterone cypionate and testosterone enanthate are the two most commonly prescribed injectable forms of TRT in the United States. Both are FDA-approved for male hypogonadism, a condition defined by serum total testosterone consistently below 300 ng/dL combined with clinical symptoms (fatigue, reduced libido, loss of muscle mass, depressed mood).

Cost with insurance: Most commercial plans cover generic testosterone cypionate. A 10 mL vial of 200 mg/mL (enough for 8 to 10 weeks at a standard dose of 100 to 200 mg/week) runs $30 to $75 in copay. Some plans require prior authorization or proof of two low morning testosterone levels drawn on separate days.

Cost without insurance: The same vial at a retail pharmacy costs $40 to $120. GoodRx-style discount cards routinely bring this under $50. Compounding pharmacies, which have become a major channel for TRT patients, sell testosterone cypionate for $50 to $150 per 10 mL vial depending on concentration and carrier oil.

Topical gels and patches (Androgel, Testim, Natesto) are more expensive. Without insurance, Androgel 1.62% runs $500 to $700/month at retail, though manufacturer coupons and compounded alternatives can cut this to $75 to $150/month.

A 2020 study in the Journal of Urology found that out-of-pocket TRT costs varied by a factor of ten depending on formulation and pharmacy channel, with injectable generics remaining the cheapest option by a wide margin.

hCG: From Cheap Add-On to Regulatory Gray Zone

Human chorionic gonadotropin was, until 2020, a common and inexpensive adjunct to TRT. Clinicians prescribe it to maintain testicular volume and intratesticular testosterone production (and, in younger patients, fertility) during exogenous testosterone use.

In March 2020, the FDA reclassified hCG as a biologic under the BPCIA (Biologics Price Competition and Innovation Act). This removed it from the compounding pharmacy market in many states, dramatically increasing cost and reducing access.

Before the reclassification: Compounded hCG cost $30 to $80/month for a standard 500 to 1,000 IU three-times-weekly protocol.

After the reclassification: Brand-name Pregnyl or Novarel now costs $150 to $300/month without insurance. Some compounding pharmacies in states with 503B outsourcing facility exemptions still produce hCG, but availability varies. Several TRT clinics have shifted patients to alternatives like enclomiphene or gonadorelin, which are less studied for this specific purpose.

For a non-celebrity patient, the hCG portion of a "Liver King-adjacent" protocol went from a minor line item to a genuine access barrier in the span of one regulatory change. Insurance coverage for hCG in the TRT context is inconsistent. Many plans cover it only for fertility indications in women, not for testicular preservation in men on testosterone.

Growth Hormone: The Price Wall

Recombinant human growth hormone (rhGH, somatropin) is FDA-approved for adult growth hormone deficiency (AGHD), a diagnosis that requires provocative stimulation testing and confirmation by an endocrinologist. It is not approved for anti-aging, bodybuilding, or general performance enhancement.

This distinction matters because insurance will typically cover somatropin for confirmed AGHD but will deny it for off-label use. The Endocrine Society's clinical practice guidelines define the diagnostic criteria tightly: patients need both biochemical evidence of GH deficiency and a plausible etiology (pituitary tumor, surgery, radiation, traumatic brain injury).

Cost with insurance (for approved AGHD): Copays range from $50 to $300/month depending on the plan's specialty tier. Many require prior authorization and step therapy.

Cost without insurance: Brand somatropin (Genotropin, Norditropin, Humatrope) runs $800 to $3,000/month depending on dose. A typical AGHD replacement dose of 0.2 to 0.4 mg/day sits at the lower end. The doses reportedly used in bodybuilding and performance contexts (2 to 4 IU/day or higher) push toward the upper range.

Compounding and gray-market GH: Some patients obtain somatropin from compounding pharmacies or overseas sources at $300 to $600/month. The HealthRX.com Medical Team notes that quality control in these channels is variable. A 2017 analysis of gray-market GH products found that a significant percentage contained less active ingredient than labeled, and some contained no somatropin at all.

Trenbolone: No Legal Pathway Exists

Trenbolone acetate is a Schedule III controlled substance approved exclusively for use in cattle (brand name Finaplix-H) to promote weight gain before slaughter. There is no FDA-approved human formulation. No pharmacy, compounding or retail, can legally dispense trenbolone for human use.

Johnson confirmed using trenbolone in his December 2022 video. For the cost-and-access analysis, this compound sits entirely outside the medical system. It is obtained through underground labs, and the HealthRX.com Medical Team will not detail sourcing or pricing for an illegal, unregulated product with no quality assurance.

What we will note: trenbolone carries a severe side-effect profile even in clinical animal literature. Androgenic and progestogenic activity far exceeding testosterone's, cardiovascular strain, hepatotoxicity risk, and neurotoxic effects in animal models make it a poor candidate for human therapeutic use under any circumstances.

The Real Monthly Budget: A Side-by-Side

At a glance

• Medically indicated TRT (testosterone cypionate): $30 to $120/month. Covered by most insurance with a hypogonadism diagnosis.
• hCG (fertility/testicular preservation adjunct): $30 to $300/month depending on compounded vs. brand and state regulations. Insurance coverage unreliable.
• Growth hormone (somatropin, for confirmed AGHD only): $50 to $3,000/month. Insurance covers the diagnosis, not the desire. Off-label use is cash-pay only.
• Trenbolone: $0 through legitimate channels. It does not exist as a legal human medication.
• Reported Liver King monthly spend: ~$11,000/month per leaked correspondence. This reflects concierge pricing, premium formulations, and compounds with no legal pathway.
• Realistic non-celebrity TRT-only cost: $30 to $200/month with a proper diagnosis and a willing prescriber.

Insurance Realities for TRT Patients

Getting testosterone covered is usually the easy part. The American Urological Association's 2018 guidelines codified the diagnostic standard most insurers follow: two morning total testosterone levels below 300 ng/dL, symptoms consistent with hypogonadism, and exclusion of reversible causes (obesity, opioid use, sleep apnea).

Where patients hit walls:

Prior authorization delays. Many plans require the prescriber to submit lab work and clinical notes before approving coverage. This adds one to three weeks to the process.

Formulation restrictions. Insurers often cover injectables but not gels, or vice versa. Switching formulations for clinical reasons (injection anxiety, skin reactions to gels) can trigger a new authorization cycle.

Monitoring costs. The Endocrine Society recommends checking hematocrit, PSA, and testosterone levels at 3 to 6 months and then annually. These labs are typically covered under preventive care, but patients on high-deductible plans may pay $100 to $300 out of pocket for the panel before meeting their deductible.

Age bias. Men under 40 sometimes face more scrutiny from insurers, who may request additional testing to rule out secondary causes or question the clinical necessity.

The HealthRX.com Medical Team Take

The gap between what Liver King was spending and what a legitimate TRT patient pays is not a gap in pharmacology. Testosterone cypionate is the same molecule at $40/vial and at a concierge clinic charging $500/month for "optimization." The gap is in access architecture: who prescribes, what gets bundled, and how much markup the patient tolerates.

For patients with genuine hypogonadism, TRT remains one of the more affordable chronic medications in endocrinology. The barriers are diagnostic (getting the right labs, finding a prescriber comfortable with TRT) rather than financial.

Growth hormone is a different story. Unless you meet strict diagnostic criteria for AGHD, you are paying entirely out of pocket, and the monthly cost can exceed many patients' rent.

The Liver King episode is instructive not because his stack was exotic. Testosterone and GH are real medications with real indications. The cautionary lesson is that a public figure spent years denying use of compounds that, for the legal ones, he could have discussed openly and, for the illegal one (trenbolone), should never have been using outside a veterinary context.

Frequently asked questions

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References

• FDA. Testosterone cypionate prescribing information. accessdata.fda.gov.
• Mulhall JP, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018. pubmed.ncbi.nlm.nih.gov/29366513
• Bhasin S, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018. pubmed.ncbi.nlm.nih.gov/29562364
• Molitch ME, et al. Evaluation and Treatment of Adult Growth Hormone Deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2011. academic.oup.com/jcem/article/96/6/1587/2833851
• Hsieh TC, et al. Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. J Urol. 2013. pubmed.ncbi.nlm.nih.gov/30428372
• Smurawa TM, Congeni JA. Testosterone precursors: use and abuse in pediatric athletes. Pediatr Clin North Am. 2007. pubmed.ncbi.nlm.nih.gov/21266670
• Graham MR, et al. Counterfeit-Loss analysis of human growth hormone. Growth Horm IGF Res. 2017. pubmed.ncbi.nlm.nih.gov/28359087
• Jasuja GK, et al. Out-of-pocket costs of testosterone replacement therapy. J Urol. 2020. pubmed.ncbi.nlm.nih.gov/31009305
• FDA. Trenbolone acetate: product safety information (veterinary). fda.gov.
• FDA. Human Growth Hormone (HGH) distribution restrictions. fda.gov.
• Brian Johnson (Liver King). Video statement, December 2022. YouTube.