Testosterone Replacement Therapy: The Complete Guide

By Reviewed by Men Published on August 9, 2015 Updated on August 22, 2019
Testosterone Replacement Therapy: The Complete Guide

What is testosterone replacement therapy? How do you know if you need to avail of testosterone replacement therapy? What are its benefits and drawbacks? This guide seeks to answer all of your questions and then some.

Picture this: you are out with your guy buds and suddenly, this gorgeous woman enters the bar and walks in front of you. After gathering enough courage and a couple of tequila shots, you walked up to her and strike up a conversation. The next thing you know, you are taking each other’s clothes off for a steamy night. Thankfully, your man down there is in the mood and cooperated the entire time.

…and you realize that was more than a decade ago.

Aging has a way of slowly reducing your confidence until you wake up and realize you’re:

  1. Not as manly as you once were.
  2. No longer getting calls and girls approaching.
  3. Starting to think more about how to fix a painful area than anything else.
  4. At an age where the hottest girl in the bar might as well be your daughter.
  5. Lack of sex is more than just your choice.

Thing is, you’ve seen guys your age get girls way over their heads and you wonder how they do it. It’s like clockwork. Our old man goes into a bar, talks to some young women, have a drink with some of them, and walks out with at least one. They do this every time with what looks to be flawless succession.

How is that possible? Isn’t he someone your age? Well, there are a lot of factors but perhaps one of them is what we call the modern man’s secret: Testosterone Replacement Therapy or TRT for short.

Testosterone: Why Do We Lose It?

Why we lose testosterone

Without going too technical, you can say testosterone is the very essence of a man. Our testosterone determines the kind of voice we have, the hairstyle that looks good on us, whether we should grow a beard or go clean, defines how muscles will look when we train them, and how big our penises can get and how long we can last in bed – the two most important testosterone functions.

Sadly, time makes you lose your testosterone and with it your mojo, your hair, muscles, and probably even your ability to get an erection. Now that you are in or going on the 40s, testosterone levels drop and you start to enter the world of andropause.

Andropause

Andropause is considered the “male menopause” in a sense that the abrupt changes brought about by menstruation in ladies happen to men in a similar yet cruel fashion. [1]Parminder, S. (2013). Andropause: Current concepts. Indian Journal of Endocrinology and Metabolism, 17(Suppl 3): S621–S629. doi: 10.4103/2230-8210.123552

“In contrast to menopause which is universal, well-characterized timed process associated with absolute gonadal failure, andropause is characterized by insidious onset and slow progression…Testosterone levels decline with aging at the rate of 1% per year and this decline is more pronounced in free testosterone levels.”

As you can see, losing testosterone is just a part of living. You can’t always be the alpha when it comes to pickup lines and sex; all our flames fizzle out one way or the other eventually. That’s normal. In fact, it is part of the aging process. However, a drop in your T levels could mean many things such as loss or lack of sex drive, depression, a decrease in sense of well-being, and erectile dysfunction among others. [2]Kumar, P., Kumar, N., Thakur, D. S., & Patidar, A. (2010). Male hypogonadism: Symptoms and treatment. Journal of Advanced Pharmaceutical Technology and Research, 1(3): 297–301. doi: 10.4103/0110-5558.72420

“Male hypogonadism is characterized by a deficiency in testosterone – a critical hormone for sexual, cognitive, and body function and development. Clinically low testosterone levels can lead to the absence of secondary sex characteristics, infertility, muscle wasting, and other abnormalities.”

Aside from working on your sex life, what could testosterone do to your body? Consequently, how effective is testosterone replacement therapy in getting your groove back not just in bed, but also in life?

What Is Testosterone?

what is testosterone

Testosterone is a type of hormone the testicles produce and is responsible for the development of male physical and sexual characteristics. Testosterone is the very essence of your manhood, it’s what helped your fetus version of you grow a penis inside your mom’s womb. At the same time, it ensures that there are enough red blood cells in your body, proper bone, and muscle growth, and promote a sense of well-being.

So in short, testosterone does a lot of neat shit for men and women alike.

While Father Time may always be the number one reason why our testosterone declines, factors such as stress, excess alcohol, obesity, medications, and infection might affect the production of testosterone in a negative way.

With testosterone reduction slowly but surely chipping away at our youth and vigor as a man, you’d think the exact opposite. Adding more testosterone through testosterone therapy is the best way to combat this natural process, right?

Well, not really.

Understanding Testosterone replacement therapy

You have to commend the experts for continuously looking for ways to improve not just your sex life, but also your overall well-being. A perfect example of this is testosterone replacement therapy or TRT. [3]WebMD Site. (n.d.). Erectile Dysfunction: Testosterone Replacement Therapy. Retrieved fromhttps://www.webmd.com/erectile-dysfunction/guide/testosterone-replacement-therapy#1

TRT is a type of treatment that helps restore serum testosterone back to its normal physiological levels. It does this while minimizing the symptoms of hypogonadism, a condition wherein your body does not produce enough testosterone.

Initially, doctors offered TRT to men with Klinefelter’s syndrome, a genetic disorder affecting men with an extra X chromosome (so they have XXY instead of just XY). Men who suffered the loss of testicles due to trauma or cancer and those who experienced the removal of tumors in the pituitary gland or hypothalamus also benefited from this treatment option.

Eventually and after a series of tests and experimentation, experts decided to use testosterone replacement therapy to increase testosterone levels among men. This leads to an increase in sexual desire, better mood, more energy, and improved sleeping patterns amongst other benefits. It is also a supplementary treatment for osteoporosis and improves bone health.

Benefits of Testosterone Replacement Therapy

The market for TRT are men who have a diagnosis of testosterone decline. So if you’re still on the fence on whether you need this or not, it’s best you check with your doctor since there’s a chance it won’t work on someone whose testosterone levels aren’t that low yet. Not to mention the recipient might suffer from risky side effects.

With that said, if your physician allows you to undergo TRT, listed below are some of the benefits you may receive.

1. Testosterone Replacement Therapy Improves Sexual Function

Testosterone for sexual performance

Recent clinical studies have provided considerable evidence that testosterone plays an important role in maintaining sexual function. The association of testosterone deficiency with erectile dysfunction and a reduction in libido in men is well-established. Observational studies, registries, and clinical trials also demonstrated that T therapy produced significant improvements in sexual function in men with testosterone deficiency.

2. Testosterone replacement therapy increases lean body mass, reduces fat and makes your body just look better

TRT in men with testosterone deficiency increases muscle mass and reduces fat mass. It also improves bone mineral density, reduces adipogenesis and improves anthropometric parameters. Most of the studies reported to date show that testosterone therapy increases lean body mass (LBM). Furthermore, long-term testosterone therapy reduces weight, waist circumference, and body mass index (BMI). This is not surprising since testosterone regulates the metabolism of carbohydrates, lipids, and proteins. Also, testosterone regulates muscle growth and function and inhibits adipogenesis.

3. Testosterone replacement therapy helps lower risk of cardiovascular disease

It may be a surprise to many that testosterone therapy in men with testosterone deficiency was used as early as the 1940s to treat angina pectoris and peripheral vascular disease.

The role of androgens in vascular physiology is well-established and it is recognized that testosterone plays an important role in cardiovascular function. A host of cardiovascular risk factors such as obesity, metabolic syndrome, dyslipidemia, hypertension, insulin resistance, and diabetes can deteriorate with testosterone deficiency.

Testosterone therapy improves body composition, reduces body weight, waist circumference, and BMI. Testosterone therapy also ameliorates metabolic syndrome components, improves lipid profiles, reduces blood glucose and hemoglobin A1c, improves insulin sensitivity and reduces inflammation, attenuates systolic and diastolic blood pressure, and improves cardio-metabolic functions. These benefits are of significance for reduction of atherosclerosis and improved cardiovascular health.

4. Testosterone replacement therapy boosts your mood and reduces symptoms of depression

testostosterone and mood state

The adverse impact of testosterone deficiency on mood and depressive symptoms is demonstrated in several studies. Although the magnitude of improvements differed among the various studies, a link between testosterone deficiency, mood and depressive symptoms exists. The association of increased depressive symptoms with testosterone deficiency is confounded by a host of comorbidities that contribute to depression as well as testosterone deficiency.

Other scientists demonstrated significant improvement in positive mood and reduction in a negative mood with testosterone therapy over a period of 36 months. Observational studies of 799 men on T therapy showed 22% reduction in fatigue scores over 6 months. A modest improvement on global cognition with testosterone therapy was also reported.

5. Lowers urinary tract symptoms

Testosterone protects the lower urinary tract from metabolic syndrome-induced alterations. Testosterone treatment in animals with metabolic syndrome counteracts the lower urinary tract alterations and attenuates the progression of lower urinary tract symptoms.

6. Reduces progression of muscle loss or sarcopenia

Testosterone benefits

Clinically, sarcopenia is defined as loss of muscle mass due to age with associated deterioration in physical function. Sarcopenia is attributed, in part, to loss of muscle fiber number and size concomitant with loss of limb motor neurons. It also correlates with slow gait speed and low grip strength and is central to the development of frailty.

Other co-morbidities sarcopenia is associated with is limited mobility, a higher risk of falls and fractures, impaired physical function, disabilities, loss of independence, institutionalization, hospitalization, and increased mortality. Reduced T levels are associated with observed loss of muscle mass and strength. This along with sarcopenia is prevalent in the older population.

Considerable evidence exists suggesting that testosterone therapy improves some of the components contributing to frailty and physical declines, such as sarcopenia, muscle strength and physical function. A number of interventional and observational studies have demonstrated consistently that testosterone therapy improves body composition and contributes to increased lean body mass and reduced fat mass.

Additional evidence is surmised from studies in which testosterone therapy in men with medically induced testosterone results in a dose-dependent increase in muscle mass and reduction in fat mass in young and elderly men.

7. Testosterone replacement therapy vastly reduces the risk of dying from cardiovascular disease

A meta-analysis by scientists in which 16,184 community-dwelling men with a mean follow-up of approximately 10 years showed that low testosterone was associated with an increased risk of cardiovascular-related deaths.

No studies have unequivocally established a direct relationship between low testosterone and mortality. It has been shown that higher testosterone levels were correlated with reduced mortality and the lowest testosterone levels are associated with increased mortality.

All the evidence available to date suggests that low testosterone, free testosterone, and bioavailable testosterone are associated with increased risk of cardiovascular-related and all-cause mortality.

8. Testosterone therapy is just good for improving the quality of life

testosterone and overall quality of life

Testosterone deficiency greatly reduces the quality of life while availing of testosterone therapy greatly increases it. [4]Khera, M. (2016). Male hormones and men’s quality of life. Current Opinions in Urology, 26(2):152-7. doi: 10.1097/MOU.0000000000000256 Getting testosterone therapy helps improve symptoms of depression. It also increases bone mineral density, energy, libido, erectile function, muscle mass, lower urinary tract symptoms, and even helps reduce insulin resistance.

Studies also concluded that men with T levels ≥400 ng/dL reported some improved measures of health-related quality of life including greater satisfaction with treatment outcome. [5]Cohen, A., Lapin, B., Wang, C. H., Helfand, B., Victorson, D., & Novakovic, K. (2016). Variation in Testosterone Levels and Health-related Quality of Life in Men Diagnosed With Prostate Cancer on Active Surveillance. Urology, 94:180-7. doi: 10.1016/j.urology.2016.03.056 Lower testosterone and greater severity of erectile dysfunction independently correlated with poorer physical function, social function, vitality and decline in general health domains.

Forms Of Testosterone Replacement Therapy

TRT comes in various forms, which you can use according to your needs and what works best for you. This includes –Skin patch – You wear this on the arm or upper portion of your body and use it once a day. However, there are instances where you have to use two patches to ensure that you meet the normal physiological range required.

Mouth patch – This is a type of tablet, which you stick on the upper gums, just above the incisors. The oral tissues will help release testosterone from your mouth and into the bloodstream. Use it twice a day.

Gel – Apply this packet of testosterone gel once a day and absorb directly through your skin. There is also a type of gel, which you apply inside the nose.

Pills – This is something you take orally. However, experts agree that this form of testosterone supplement could have negative effects on your liver. [6]Nazem, B., Saad, A., & John, E .M. (2009). The benefits and risks of testosterone replacement therapy: A review. Therapeutics and Clinical Risks Management, 5: 427–448. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2701485/ This study says:

“Benign and malignant hepatic tumors, intrahepatic cholestasis, hepatotoxicity, and liver failure have been reported with testosterone replacement therapy. These unfavorable hepatic effects do not appear to be associated with transdermal or intramuscular injections. For this reason, the oral forms of testosterone, with the exception of testosterone undecanoate, are discouraged. Other liver abnormalities associated with TRT include Peliosis hepatis, hepatocellular adenoma, and carcinoma.”

Injection or implant – This option is either an insertion directly into your muscles, or an implant in the soft tissues in a form of pellets. The advantage of this form of testosterone replacement therapy is that it bypasses the liver and goes directly in your bloodstream.

injection into the muscle

Are You a Candidate For Testosterone Replacement Therapy?

You might think that anyone who experiences low testosterone could avail of this therapy. Apparently not.

If you have prostate cancer, then it is strongly advisable not to take this treatment. It could worsen your condition. This is why you must do a thorough prostate screening and rectal exam. It ensures that you could benefit from the treatment rather than it causing further illness.

Are you are suffering from chronic conditions such as diabetes and cardiovascular diseases? It is best not to take this form of treatment unless your doctor gave you a go-ahead signal.

This type of treatment is advisable for men with unusually low levels of testosterone. They may be experiencing erectile dysfunction, decreased spontaneous erections, and low libido. Do you have symptoms of hypogonadism or a type of condition resulting from low T? Then you could opt for this treatment.

In other words, men with androgen deficiency could benefit from this form of treatment.

Risks of Testosterone Replacement Therapy

Despite its benefits, testosterone replacement therapy doesn’t come without any side effects. The side effects are mixed, which is normal since the effect of this therapy varies from person to person. In general, side effects include but not limited to –

  • Physical changes such as acne or oily skin and breast enlargement. [7]Harvard Health Publishing Site. (2014, February). Is testosterone therapy safe? Take a breath before you take the plunge. Retrieved from https://www.health.harvard.edu/mens-health/is-testosterone-therapy-safe-take-a-breath-before-you-take-the-plunge

“A relatively small number of men experience immediate side effects of testosterone supplementation, such as acne, disturbed breathing while sleeping, breast swelling or tenderness, or swelling in the ankles.”

More Possible Side Effects of Testosterone Replacement Therapy

sleep troubles

  • Sleep apnea. This a type of condition that leads to daytime sleepiness and frequent nighttime awakening. This is more prevalent in men than in women. [8]White, D. P., Schneider, B. K., Santen, R. J., McDermott, M., Pickett, C. K., Zwillich, C. W., & Weil, J. V. (1985). Influence of testosterone on ventilation and chemosensitivity in male subjects. Journal of Applied Physiology, 59(5):1452-7. doi: 10.1152/jappl.1985.59.5.1452
  • A decrease in testicular size. Diminished testicular size and compromised fertility during testosterone replacement therapy occur because of the down-regulation of gonadotropins.
  • Mood swings. Though rare, there are some men who may have issues with their mood particularly being aggressive without much provocation. Thankfully, this is temporary, and once the testosterone circulates on its own, the mood improves dramatically. [9]Wang, C., Alexander, G., Berman, N., Salehian, B., Davidson, T., McDonald, V., … Swerdloff, R. S. (1996). Testosterone replacement therapy improves mood in hypogonadal men–a clinical research center study. Journal of Clinical Endocrinology and Metabolism, 81(10):3578-83. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8855804
  • Mild fluid retention. Because testosterone replacement therapy is can cause water retention, caution with testosterone use in patients with chronic renal insufficiency is advisable.
  • An increased risk of blood clots. Testosterone-induced polycythemia is one of the proposed mechanisms for this increased clotting propensity. [10]Steven, M. N., Nway, K. K., Nguyen, S. M., Ko Ko, N., Sattar, A. S., Gucuk Ipek, E., & Ali, S. (2017). Pulmonary Embolism Secondary to Testosterone-Enhancing Herbal Supplement Use. Cureus, 9(8): e1545. doi: 10.7759/cureus.1545
  • A decrease in sperm count. Testosterone replacement therapy decreases sperm production and has detrimental effects on male fertility. However, after discontinuing testosterone supplementation, studies of hormonal contraception indicate that most men have a return of normal sperm production within 1 year. [11]Crosnoe, L. E., Grober, E., Ohl, D., & Kim, E. D. (2013). Exogenous testosterone: a preventable cause of male infertility. Translational Andrology and Urology, 2(2): 106–113. doi: 10.3978/j.issn.2223-4683.2013.06.01 Avoid exogenous testosterone if you are desiring future fertility.
  • Increase in red blood cells. When this happens, the blood becomes too thick and result to clotting events or stroke. [12]Ernani, L. R. & Abraham, M. (2004). Risks of Testosterone-Replacement Therapy and Recommendations for Monitoring. The New England Journal of Medicine, 350:482-492. DOI: 10.1056/NEJMra022251

Cardiovascular Disease?

testosterone and cardiovascular health

An increased risk of developing cardiovascular disease. If you are diagnosed with cardiovascular disease and other chronic conditions such as diabetes, then taking testosterone replacement therapy in whatever form could worsen your condition. [13]National Institute of Health (2010, June 30). Adverse Cardiovascular Events Reported in Testosterone Trial in Older Men. Retrieved from https://www.nih.gov/news-events/news-releases/adverse-cardiovascular-events-reported-testosterone-trial-older-men

  • Testosterone replacement therapy has been shown to improve the symptoms of angina pectoris and peripheral vascular disease. A spectrum of recent studies has also shown that testosterone replacement therapy does not increase the risk of cardiovascular disease.
  • Several meta-analyses have shown that testosterone replacement therapy does not increase the risk of cardiovascular disease. The analysis of the FDA in response to a petition to place a black box on testosterone products also concluded that there is no solid evidence that testosterone replacement therapy increases the risk of cardiovascular disease.

Prostate Cancer?

Aside from these, experts express concern regarding the link between testosterone replacement therapy and increased risk of prostate cancer. [14]Lesser, M. A., Vose, S. N., & Dixey, G. M. (1955). Effect of testosterone propionate on the prostate gland of patients over 45. Journal of Clinical Endocrinology and Metabolism, 15(3):297-300. DOI: 10.1210/jcem-15-3-297 Other scientists think that the association is simply coincidental, though, with studies revealing the other side of the argument and those are:

  • There is no link in low testosterone to a reduction in the risk of prostate cancer.
  • With age, testosterone declines while the risk of prostate cancer increases.

Although the experts are split on this issue, it is best to stay away from testosterone replacement therapy until there is a link.

Tips Before You Go Through The Therapy

Considering the side effects, there are various ways you could minimize the risk associated with this treatment option. Before you consider TRT, here are some of the things you need to remember.

Establish the need for testosterone. TRT is not for everyone. Before you consider this treatment, make sure there is an apparent need to boost your T levels. At the same time, get a thorough checkup to rule out any possible chronic conditions such as heart disease and prostate cancer.

Make sure to trytechniques to increase testosterone naturally first. If you can avoid TRT altogether by getting your body to produce more testosterone, this should be a preference over administering testosterone exogenously. Follow instructions. Just like any other medication, follow your doctor’s orders on how to take or use the supplements to minimize possible complications.

Don’t go for the pills. You need to digest pills, which requires the liver to function before going through your bloodstream. This could affect your liver in a negative way. Spare the liver and consider other methods such as gels and injection since it goes directly into the bloodstream.

stay away from the pills

Take it easy. You might get excited to try testosterone supplements after knowing its benefits. However, take it easy. Exposing yourself in any form of testosterone supplements at high dosages for a prolonged period could lead to negative effects.

Make follow-up checkups a habit. This is to check if your T levels are on its normal physiological range. At the same time, this could be a good opportunity to discuss any side effects and address any issue before it gets worse.

Alternatives To Testosterone Replacement Therapy

Is there a way you can evade testosterone replacement therapy? The answer is yes. Still, keep in mind that TRT is not all bad. In fact, you could benefit from it as long as you are a good candidate and you follow the recommended dosage.

In case you prefer to increase testosterone naturally, here are some of the things you could do.

  • Exercise regularly.
  • Eat healthily.
  • Get supplements like Zinc and tongkat ali.
  • Maintain a healthy weight.
  • Get an adequate amount of sleep.

Testosterone replacement therapy is not the fountain of youth. Yes, it helps you feel younger and bring back your lost vitality but make sure to keep your expectations realistic. More importantly, consult your doctor to establish the need for such a treatment option.

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Fran Sanchez, BSc MSc

About Fran Sanchez, BSc MSc

Fran Sanchez, the founder of Herbolab, graduated from Uppsala University (Sweden) with a master in molecular biology and Karolinska University (Sweden) with a degree in medical sciences and business. He then moved to Singapore to run e-commerce operations in a pharmaceutical company, until eventually, he could fulfill his dream of creating a brand dedicated to help men reach their peak performance. Drawing on his experience as a lifelong multi-sport athlete and cutting edge medical and scientific research, Fran launched herbolab tongkat ali as flagship supplement in April of 2014. Fran now spend most of his time weight lifting and creating content dedicated to improve people’s lives.

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