Testosterone Replacement Therapy (TRT)

What is testosterone replacement therapy (TRT)?

Testosterone replacement therapy (TRT) is a medical treatment designed to increase testosterone levels in individuals who have low or deficient levels of this hormone. It involves the administration of exogenous (external) testosterone to help alleviate symptoms associated with low testosterone and improve overall well being.

Who might benefit from TRT?

TRT is typically considered for men who have clinically diagnosed low testosterone levels (hypogonadism), which can lead to symptoms such as fatigue, reduced libido, erectile dysfunction, muscle loss, mood changes, and decreased bone density. The normal levels of testosterone are considered to be above 300-350 ng/dl.

How is TRT administered?

TRT can be administered through various methods including injections, gels or creams applied to the skin, patches, tablets, and implants placed under the skin.

Are there any risks or side effects associated with TRT?

While TRT can be beneficial for many individuals, it is not without potential risks and side effects. These can include acne, fluid retention, increased red blood cell count, sleep apnea, breast enlargement, and potential cardiovascular risks. Additionally, TRT can cause urinary symptoms from an enlarged prostate to become worse, and is contraindicated in most patients with active prostate cancer. It is believed that TRT is safe for men who have a history of prostate cancer that has been cured. Regular monitoring and adjustments by a healthcare provider are essential to manage these risks.

Does TRT affect fertility?

Receiving exogenous testosterone shuts down the body’s endogenous testosterone production, and in turn affects fertility. Fortunately there are a few options for men who desire to maintain their fertility and be treated with TRT. These include the agents clomiphene and anastrozole. Clomiphene helps the body produce more endogenous testosterone while anastrozole blocks the conversion of testosterone into estrogen. Patients on these medications require continued monitoring, just as with other TRT agents.