The Truth About Testosterone Therapy

Symptoms of Low Testosterone

You may have low-T if you are having these signs:

• Calcium loss in bones
• Depressed mood
• Fewer and weaker erections
• Less muscle mass
• Less strength
• Low energy
• Low iron (anemia)
• Low sex drive
• More body fat

Speak with a physician if you are having any of these symptoms. If you are a candidate for it, testosterone replacement therapy (TRT) may help improve the symptoms of low testosterone.

How Is Low-T Diagnosed?

Your physician will need to make sure low testosterone is the correct diagnosis and that TRT is safe for you. They will check your medical history and do a physical exam. You may also need to have blood tests, including but not limited to:

• Two testosterone tests you will take in the morning
• Hemoglobin
• Hematocrit
• Liver function
• Prostate-specific antigen (PSA)

TRT is not approved for every case of low testosterone. The U.S. Food and Drug Administration has approved testosterone products only for males who have low testosterone linked to an associated medical condition. TRT is not FDA-approved when testosterone levels are lower due only to natural aging.

How Does Testosterone Replacement Therapy Work?

When you are on TRT to manage your levels of testosterone, you take the hormone in its manufactured form. Doing this can help improve the signs of low testosterone.

TRT does not cure the underlying reason (for example, diabetes) that is causing your low testosterone. It is important to note that it will cause your testicles to stop producing the hormone. What this means is that you will need to keep taking the medication to maintain a normal level of testosterone in your body. If you stop TRT, your body will have to try making its own testosterone again.

There are different forms of TRT, including:

• Nasal gel — Placed in each nostril three times a day
• Oral — Twice daily pill
• Patches — Applied to skin every day as directed
• Pellets — Implanted under skin every 3 to 6 months for consistent, long-term dosing
• Shots — Injected into a muscle every 1 to 2 weeks or under skin every week
• Skin gels — Applied to clean, dry skin daily
• Tablets — Sticky pills applied to gums twice daily absorb into the bloodstream

Work with your health care provider to figure out which option is best for you. After you start TRT, you will have regular testing to monitor your testosterone level. You may have added blood tests to make sure TRT is not harming your health.

Once you start TRT, it typically takes a few weeks before you notice changes in your body and mood. Everyone responds differently to the therapy. Physicians usually say to wait 30 days after you start TRT to allow the therapy to take full effect, and before getting your testosterone levels checked.

Possible Benefits of TRT

This form of therapy can help reduce many symptoms of low testosterone. TRT may improve your:

• Bone mineral density
• Energy levels
• Lean body mass
• Mood
• Sense of well-being
• Sexual function

Possible Side Effects and Risks of TRT

The side effects of this hormone therapy may include:

• Abnormal lab results, including higher PSA levels and higher red blood cell counts
• Acne or oily skin
• Breast enlargement
• Fluid retention
• Lower sperm count
• Skin irritation
• Smaller testicles
• Stimulated prostate leading to urinary symptoms
• Worsening sleep apnea

Risks of TRT

Some health conditions make TRT unsafe. Those include heart failure, prostate cancer and breast cancer. Safety is why your physician may perform several evaluations and tests before approving you for TRT. Also, if you think you may one day plan to have biological children, you should avoid TRT. That is because it can cause fertility problems and lower your sperm count. 

How Long Should You Stay on TRT?

TRT is a long-term therapy. If you do not have risks associated with TRT or its side effects, it is generally safe. You can stay on testosterone replacement therapy for as long as it benefits your symptoms and does not cause health issues. If you stop taking testosterone, your levels will go back to where they were when you started TRT.

Before You Try TRT

You and your physician may discuss other ways to deal with low testosterone. They may include:

• Avoid environmental toxins
• Eat a balanced, nutrient-rich diet
• Get seven to nine hours of sleep each night
• Include workouts for your heart
• Limit or avoid alcohol
• Maintain a healthy weight
• Manage stress
• Quit smoking or chewing tobacco
• Stay physically active
• Treat sleep apnea
• Weight train

Think of these as the first treatments for low testosterone. If they do not help after six to 12 months, or you have severe symptoms, speak with your doctor about other treatments, such as TRT.

“If symptoms of low-T are affecting your quality of life, you do not have to live with it,” said Dr. Bedell. “TRT may be the right option for you. The main thing is to ask questions and share your concerns with your physician.”

Together, you and your physician will weigh the benefits, risks, and side effects of TRT to determine whether it can help.