Testosterone Replacement Therapy (TRT)

Testosterone replacement therapy is used to treat men who have a low testosterone level (hypogonadism). Testosterone is a male hormone that is produced in the testicles. It is responsible for typically male characteristics and for maintaining a man’s sex drive and the ability to get an erection.

Testosterone also supports bone and muscle health. TRT can be a gel, liquid, or patch that you put on your skin. It can also be in the form of a tablet or an injection. In some cases, your health care provider may insert long-acting pellets under your skin.

In most men, the level of testosterone starts to decline gradually after age 45. Low testosterone can also be caused by certain medical conditions, medicines, and obesity. Your health care provider can diagnose hypogonadism with at least two blood tests that are done early in the morning.

Low testosterone may not need to be treated. TRT is usually a choice that you make with your health care provider. Your health care provider may recommend TRT if you have low testosterone that is causing symptoms, such as:

• Low sex drive.
• Erection problems.
• Breast enlargement.
• Loss of body hair.
• Weak muscles or bones.
• Shrinking testicles.
• Increased body fat.
• Low energy.
• Hot flashes.
• Depression.
• Decreased work performance.

TRT is a lifetime treatment. If you stop treatment, your testosterone will drop, and your symptoms may return.

What are the risks?

Testosterone replacement therapy may have side effects, including:

• Lower sperm count.
• Skin irritation at the application or injection site.
• Mouth irritation if you take an oral tablet.
• Acne.
• Swelling of your legs or feet.
• Tender breasts.
• Dizziness.
• Sleep disturbance.
• Mood swings.
• Possible increased risk of stroke or heart attack.

Testosterone replacement therapy may also increase your risk for prostate cancer or male breast cancer. You should not use TRT if you have either of those conditions. Your health care provider also may not recommend TRT if:

• You are suspected of having prostate cancer.
• You want to father a child.
• You have a high number of red blood cells.
• You have untreated sleep apnea.
• You have a very large prostate.

Supplies needed:

• Your health care provider will prescribe the testosterone gel, solution, or medicine that you need. If your health care provider teaches you to do self-injections at home, you will also need:
  • Your medicine vial.
  • Disposable needles and syringes.
  • Alcohol swabs.
  • A needle disposal container.
  • Adhesive bandages.

How to use testosterone replacement therapy

Your health care provider will help you find the TRT option that will work best for you based on your preference, the side effects, and the cost. You may:

• Rub testosterone gel on your upper arm or shoulder every day after a shower. This is the most common type of TRT. Do not let women or children come in contact with the gel.
• Apply a testosterone solution under your arms once each day.
• Place a testosterone patch on your skin once each day.
• Dissolve a testosterone tablet in your mouth twice each day.
• Have a testosterone pellet inserted under your skin by your health care provider. This will be replaced every 3–6 months.
• Use testosterone nasal spray three times each day.
• Get testosterone injections. For some types of testosterone, your health care provider will give you this injection. With other types of testosterone, you may be taught to give injections to yourself. The frequency of injections may vary based on the type of testosterone that you receive.

Follow these instructions at home:

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Lose weight if you are overweight. Ask your health care provider to help you start a healthy diet and exercise program to reach and maintain a healthy weight.
• Work with your health care provider to treat other medical conditions that may lower your testosterone. These include obesity, high blood pressure, high cholesterol, diabetes, liver disease, kidney disease, and sleep apnea.
• Keep all follow-up visits as told by your health care provider. This is important.

General recommendations

• Discuss all risks and benefits with your health care provider before starting therapy.
• Work with your health care provider to check your prostate health and do blood testing before you start therapy.
• Do not use any testosterone replacement therapies that are not prescribed by your health care provider or not approved for use in the U.S.
• Do not use TRT for bodybuilding or to improve sexual performance. TRT should be used only to treat symptoms of low testosterone.
• Return for all repeat prostate checks and blood tests during therapy, as told by your health care provider.

Where to find more information

Learn more about testosterone replacement therapy from:

• American Urological Foundation: www.urologyhealth.org/urologic-conditions/low-testosterone-(hypogonadism)
• Endocrine Society: www.hormone.org/diseases-and-conditions/mens-health/hypogonadism  

Contact a health care provider if:

• You have side effects from your testosterone replacement therapy.
• You continue to have symptoms of low testosterone during treatment.
• You develop new symptoms during treatment.

Summary

• Testosterone replacement therapy is only for men who have low testosterone as determined by blood testing and who have symptoms of low testosterone.
• Testosterone replacement therapy should be prescribed only by a health care provider and should be used under the supervision of a health care provider.
• You may not be able to take testosterone if you have certain medical conditions, including prostate cancer, male breast cancer, or heart disease.
• Testosterone replacement therapy may have side effects and may make some medical conditions worse.
• Talk with your health care provider about all the risks and benefits before you start therapy.