Testosterone Replacement Therapy (TRT)

What is testosterone replacement therapy (TRT)?

Testosterone replacement therapy (TRT) is a treatment offered to men who have been diagnosed with low testosterone (also known as hypogonadism).

TRT aims to raise testosterone levels to the normal range, and improve the symptoms of low testosterone, which can include low sex drive (libido), erectile dysfunction, low mood, fatigue and more.

TRT is associated with benefits and risks, which your doctor will discuss with you in detail.

Who is testosterone replacement therapy offered to?

TRT is offered to some men who have clinically low testosterone levels, caused by a condition called hypogonadism.

Hypogonadism happens when you don’t produce enough sex hormones. Some people are born with hypogonadism, while others can develop it later in life as a result of an injury, damage or infection affecting organs that produce testosterone. This includes the testicles, pituitary gland and hypothalamus.

TRT can help treat some types of hypogonadism. It is not suitable for certain men, including those who have certain existing conditions, such as heart failure and prostate cancer.

Before you are given TRT, your doctor will confirm low testosterone with blood tests, usually taken in the morning on separate occasions. They will also review your medical history, symptoms and perform a physical examination to make sure it is safe for you to take.

How does testosterone replacement therapy work?

TRT can be taken as an injection, patch, gel or oral formulation. You receive a manufactured form of testosterone that helps raise your testosterone levels.

Your brain regulates your hormone levels and tells your testicles to produce testosterone. If you take TRT, the brain senses that levels are sufficient and testicular testosterone production may decrease, and sperm production may be reduced.

While TRT can help improve the symptoms of low testosterone, it doesn’t address the underlying cause.

What are the benefits of testosterone replacement therapy?

TRT aims to improve many symptoms associated with low testosterone, which may include:

• Mood
• Energy levels
• Sexual function
• Muscle mass
• Bone density.

The effects of TRT may take a few weeks to become noticeable. Your doctor will monitor your testosterone levels after starting treatment, with timing based on the formulation and treatment plan.

What are the side effects of testosterone replacement therapy?

Like all medications, TRT is associated with side effects and potential risks, including:

• Smaller testicles
• Reduced sperm count
• Changes in prostate-specific antigen (PSA) levels
• Prostate symptoms
• Acne/oily skin
• Swollen ankles
• Breast enlargement (gynecomastia)
• Worsening of sleep apnea in some people.

Who can’t use testosterone replacement therapy?

TRT may be contraindicated or require careful assessment in people with the following health conditions:

• Prostate cancer
• Male breast cancer
• High red blood cell count
• Untreated sleep apnea
• Heart failure
• Recent cardiovascular event
• Elevated prostate-specific antigen (PSA) that has not been evaluated.

TRT can also cause reduced sperm count and fertility issues, so is not recommend for men who are trying to conceive.

How long will I stay on testosterone replacement therapy?

The duration of TRT will depend on the underlying cause, benefits, risks and ongoing monitoring.

Your doctor will assess you regularly to make sure TRT isn’t causing any health issues. If TRT causes adverse side effects or isn’t improving your symptoms, you can stop taking it and your testosterone levels may fall. It may take a while for your body to begin producing testosterone naturally again.

When should I see my doctor about testosterone replacement therapy?

If you are on TRT, your doctor will see you regularly to discuss the therapy and perform blood tests.

Contact your doctor if you do not see any improvement in your symptoms, if the therapy is causing unwanted side effects or if you are thinking about stopping the therapy.

Always tell your doctor if you have any health conditions that may make TRT unsafe.