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Testosterone is involved in important bodily functions such as muscle and bone health, cognition, red blood cell and sperm formation, and sexual and reproductive function in males.
Testosterone levels may decrease due to a range of factors, including stress, aging, trauma, and infections.
This article provides a comprehensive discussion on TRT, including its target audience, different types, mechanics, acquisition methods, expected outcomes, and additional information.
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Can you please explain what testosterone replacement therapy is?
TRT, also known as androgen replacement therapy (ART), is a medical treatment prescribed to males with testosterone deficiency who exhibit symptoms of hypogonadism.
Prescription testosterone can help restore hormone levels in the blood, reversing symptoms of low testosterone. Those who take it may experience improvements in alertness, sexual function, energy, mood, and overall well-being.
Who is eligible for testosterone replacement therapy and what is the mechanism behind it?
Doctors prescribe testosterone replacement therapy (TRT) to males diagnosed with hypogonadism. A definitive diagnosis requires blood tests that indicate low testosterone levels, specifically below 300 nanograms per deciliter (ng/dl) according to the American Urological Association. Additionally, the individual must exhibit other symptoms, including fatigue, breast growth, and sexual dysfunction.
Doctors typically do not recommend TRT as the initial treatment for low testosterone levels, even in males who exhibit symptoms.
When other conditions or medications lead to a decrease in testosterone levels, doctors typically address the underlying condition before suggesting TRC.
Benefits of TRT
Based on a study conducted in 2019, TRT has shown potential for enhancing sexual function, including:
libido
symptoms of erectile dysfunction
sexual satisfaction
Additional research conducted in 2019 and a study in 2022 have found that TRTs may have a positive impact on cognitive function and attention span.
The benefits of TRT were modest and ceased when the treatment was stopped. Approximately half of the participants in the 2019 study had osteopenia or osteoporosis while on TRT.
How to get TRT
Testosterone Replacement Therapy (TRT) can only be obtained with a prescription. When someone shows symptoms that align with low testosterone levels, a doctor will only prescribe TRT after conducting a comprehensive medical history evaluation, as well as physical and laboratory examinations.
Doctors typically collect two blood samples before noon to measure hormone levels, along with requesting imaging studies and additional tests, like tests for luteinizing hormone and follicle stimulation hormone, to identify the underlying cause of low testosterone levels.
Types of testosterone treatments
There are various methods of administering testosterone.
Injectable
Injectable testosterone is a commonly used and cost-effective method of TRT. Treatment options include short-acting injections administered every 1 or 2 weeks, or long-acting injections with the second shot given 4 weeks after the first, followed by shots 10 weeks apart. The dosage and frequency of treatment may vary based on individual needs.
Doctors administer short-acting testosterone through subcutaneous or intramuscular injections, while long-acting shots are administered into the gluteus muscles.
TRT can lead to changes in testosterone levels, which can impact energy levels, libido, mood, and the presence of symptoms such as breast tenderness.
Topical (transdermal)
Individuals typically use gels and creams daily, which leads to a gradual absorption and ultimately results in more consistent testosterone levels in the bloodstream.
People who use topical treatments should be cautious about coming into skin-to-skin contact with others for a minimum of 6 hours after applying the treatment. This precaution is necessary to prevent the potential transfer of medication onto other individuals' skin, which can pose risks, particularly for pregnant women and children.
Topical patches are applied to the skin and last for 24 hours. They usually contain doses between 2 mg and 5 mg. However, patches are not aesthetically pleasing and can cause skin irritations. When compared to oral medications, patches may be less harmful to the liver.
The recommended dosage for topical gel is typically between 40-100 mg per day, but it may vary depending on the specific product. It is advised to begin with the lowest recommended dose and gradually increase if needed.
Cheek or buccal patches
A buccal patch is placed above the upper teeth and releases testosterone for 12 hours. The patches typically have 30 mg. They should be applied twice a day, with a 12-hour gap between applications. However, they may cause headaches, gum irritation, and mouth irritation.
Testosterone implants or pellets
Testosterone pellets are plastic implants that doctors place under the skin, typically in the upper hip or buttock area. These pellets dissolve gradually, providing testosterone replacement therapy for a period of 3-6 months.
Inserting implants is a surgical procedure that is typically done as an inpatient procedure. A doctor will make a small incision in the fatty tissue below the skin to insert the pellets, and the procedure is usually performed under local anesthesia.
Oral testosterone
Oral testosterone is a less commonly used form of TRT that tends to be more costly and less convenient. Prolonged use of this method may potentially lead to liver damage.
Tablets often include warnings about potential side effects like hypertension and stroke. Therefore, only individuals who are unable to use alternative methods of testosterone replacement therapy turn to oral testosterone.
A doctor may recommend a dosage of oral testosterone tablets ranging from 225-396 mg, with the typical frequency of twice daily.
Intranasal
A person applies nasal testosterone gel to the inside of the nose three times a day at intervals of 6-8 hours. It is recommended to apply at the same times every day. The usual dosage is 11 mg per application, totaling a daily dosage of 33 mg across both nostrils.
Common reactions to this treatment may include headaches, nosebleeds, a runny nose, and nasal discomfort.
What to expect
TRT aims to restore an individual's testosterone levels to normal. Improvement in blood testosterone levels can typically be seen within a week, although it may take longer for symptoms to improve.
One may observe additional benefits, such as an increase in bone density and lean body mass, improved well-being, and enhanced energy and libido. Positive changes may become evident within a timeframe ranging from 4 weeks to several months.
If not due to a medical condition, TRT is usually a lifelong therapy. Once someone begins TRT, their doctor will regularly evaluate their response to treatment. It is necessary for individuals to have regular checkups at least every 6-12 months to assess their blood testosterone levels.
A doctor will regularly assess changes in symptoms and side effects at specific intervals after the initial treatment.
Approximate costs
The cost of TRT can vary from $1,650 to $3,200 per year, depending on various factors.
type of medication
dosage
mode of administration
insurance coverage
doctor and laboratory fees
Is it safe?
Alongside potential short-term side effects, TRT may also present health risks, according to the Endocrine Society.
breast cancerorprostate cancer
The presence of prostate nodules or induration can be observed.
high prostate-specific antigen levels
elevatedhematocritlevels
untreated and severesleep apnea
The individual is experiencing severe lower urinary tract symptoms.
congestive heart failure
recentstrokeorheart attack
thrombophilia
The treatment is not recommended for males who have plans to conceive in the near future.
Certain individuals, such as males aged 40 years or older, preadolescent individuals, and those with migraine or epilepsy, may need to be given special considerations.
Who should avoid TRT?
The Endocrine SocietyTrusted Source
Obstructive sleep apnoea
Research suggests that clinicians should use caution when prescribing TRT to individuals with severe obstructive sleep apnea.
TRT can lead to hypoxia, resulting in symptoms like confusion, restlessness, difficulty breathing, rapid heart rate, and bluish skin.
TRD may also result in hypercapnia, which is a medical condition characterized by elevated levels of carbon dioxide in the bloodstream. This can cause respiratory acidosis and symptoms such as fatigue, drowsiness, or excessive sleepiness.
The individual is experiencing severe lower urinary tract symptoms.
Severe lower urinary tract symptoms can include urinary frequency and urgency, which may indicate an enlarged prostate or benign prostatic hyperplasia (BPH).
Previous research and clinical trials have provided evidence to support this theory, indicating that while TRT may have a positive effect on reducing prostate inflammation, it does not have a significant impact on lowering urinary tract symptoms and may potentially exacerbate these symptoms in the long term.
The individual has elevated hematocrit levels and thrombophilia.
Individuals with high red blood cell count and thrombophilia should refrain from taking TRT as it can potentially elevate red blood cell count, thereby increasing blood viscosity and the risk of blood clot formation, stroke, and ischemia.
A research study conducted in 2021 on trans men using long-term TRM found that TRM resulted in an increase in red blood cell count. Red blood cell counts were measured annually, and the results indicated a 10% increase after the first year and a 38% increase after 10 years.
Prostate cancer
Prostate cancer is dependent on testosterone for growth, meaning that taking TRT may potentially accelerate the growth of cancer cells. According to the National Cancer Research Institute, men with elevated levels of testosterone in their blood have a higher likelihood of being diagnosed with prostate cancer.
High prostate-specific antigen levels
Research has indicated that there is a connection between TRT and an elevation in antigen levels among males who are 65 years of age or older. A clinical trial was conducted on a group of men in this age range who underwent a 12-month period of TRT. Upon completion of the trial, findings revealed a 4.0 ng/mL increase in antigen levels for 5% of the participants.
Ischemic stroke
Researchers conducted clinical trials on a sample of 15,401 men over the age of 45 with low testosterone levels. The findings revealed that those who received testosterone replacement therapy (TRT) had a 21% higher probability of experiencing cardiovascular conditions like cardiac arrest and cerebrovascular disease, in comparison to the men who did not undergo TRT.
Side effects and warnings
The Food and Drug Administration (FDA)Trusted Source
A 2019 reviewTrusted Source
Additional side effects of testosterone supplementation include:
rashes, itching, and acne
male pattern baldness
The person experiences either hair loss or excessive hair growth.
anxiety
bladder irritability
priapism
deep vein thrombosis
anger and aggressive behavior
Breast soreness or enlargement (gynecomastia) may be experienced.
high blood pressure
increase in prostate size
decreased sperm production
worsening of prostate cancer
shrinkage of the testes
A high red blood cell count can potentially increase the risk of blood clots.
liver dysfunction
High cholesterol can potentially be a side effect, but a recent study in 2021 suggests that TRT may have a positive impact on total cholesterol levels.
According to current scientific literature, TRT has been found to potentially worsen breast and prostate cancer. However, it may offer benefits to individuals with early-stage prostate cancer without causing the recurrence or progression of the disease.
Alternatives to TRT
There are various methods individuals can use to increase their testosterone levels without relying on medical intervention.
getting enough sleep
eating a balanced diet
losing weight
getting enough exercise
reducing stress
Taking vitamins and minerals, such as vitamin D and magnesium, is beneficial for one's health.
avoiding drugs and alcohol
Individuals who take medications that may lower testosterone levels should consider discussing this with their doctor.
Discover additional information about natural methods for increasing testosterone levels here.
Common inquiries about TRT
The following are frequently asked questions about TRT.
What is the cost of TRT?
The cost of TRT varies from $1,650 to $3,200 per year, depending on factors such as the type of TRT, how it is administered, and a person's insurance coverage.
Does insurance cover TRT?
Insurance companies generally cover all types of TRT, but individuals may still have out-of-pocket expenses. It is important to confirm coverage with the insurer to avoid any unexpected costs.
What is the recommended duration for testosterone replacement therapy?
The length of TRT treatment is not defined unless low levels are caused by a treatable underlying condition.
What are the effects of TRT on the body?
TRT can lead to physical changes such as increased muscle mass and bone density, as well as decreased body weight.
Is TRT included in insurance coverage?
If a person undergoes TRT as a treatment for a health condition, their medical insurance is expected to cover the cost.
What is the process for undergoing testosterone therapy?
TRT can be administered through various methods, including oral intake, intramuscular injections, implants, transdermal patches, mouth patches, topical creams or gels, as well as intranasal gels or pellets.
Certain options may necessitate daily, weekly, monthly, or quarterly administration.
The available options vary based on an individual's medical needs and lifestyle. It is recommended to discuss these options with a healthcare practitioner before starting treatment.
What methods do doctors use to monitor TRT?
Doctors use various methods such as blood tests, physical examinations, and scans to monitor TRT treatment.
Blood tests are conducted to measure total serum testosterone, complete blood count (hematocrit), and prostate-specific antigens (PSA). These tests are typically done at the beginning of the treatment, followed by another round three to six months later. If the results remain stable, doctors may repeat these tests annually.
Individuals with osteoporosis or a history of low trauma fractures are recommended to undergo a bone density scan within one to two years of starting TRT therapy.
Summary
Testosterone Replacement Therapy (TRT) is a commonly prescribed treatment for individuals with low testosterone levels, although its suitability may vary depending on individual circumstances.
Individuals seeking TRT should obtain a prescription and seek guidance from a doctor or qualified healthcare professional.