What is testosterone replacement therapy? 

Testosterone replacement therapy, also called TRT, is prescribed to men who produce low levels of the hormone and suffer from uncomfortable symptom as a result. It is one of many hormone treatments that involves replenishing the levels with exogenous (artificial) testosterone.  

Testosterone is the main sex and anabolic hormone, produced by male humans in the testicles. It plays a vital role in many biological processes, affecting health and longevity.  

A decline in testosterone production is common as males age, at a rate of about 2% per year over the age of 30. Low testosterone levels do not inherently require treatment. Therefore, TRT isn’t recommended to men who produce low levels, but are symptomless.  

 

Why is testosterone replacement therapy used?

Although a reduction in testosterone is a natural part of aging, it can also have a negative impact on wellbeing. TRT is prescribed to make up for the decrease in testosterone production and to combat its associated symptoms.  

These symptoms can affect:   

Sex life: lower sex drive, erectile dysfunction, and infertility.  Physical well-being: loss of muscular strength and increased body fat (particularly the breasts).  Emotional well-being: fatigue, difficulty concentrating and remembering, and increased irritability.  

  

What does testosterone replacement therapy involve?

Low testosterone levels are caused when not enough of the hormone is being produced naturally by the body. To combat this, exogenous testosterone is prescribed in order to stabilise levels.  

If you are experiencing the symptoms and suspect the cause to be low testosterone levels, you will first need to visit your GP. They will assess your case and take bloods if necessary to measure levels of testosterone in the blood. If the results show signs of deficiency, you will be referred to a hormone specialist, an endocrinologist, who will prescribe TRT to suitable patients.  

The hormone can be administered in numerous ways. Common methods include injection, implant, skin patches, mouth patches and gels. No pill is offered, as oral consumption of testosterone can damage the liver. The aforementioned methods are absorbed directly into the bloodstream. Treatment does not have an immediate effect; results will be noticeable after 1-2 months of TRT.  

 

How can you prepare for testosterone replacement therapy? 

If you are experiencing symptoms of reduced testosterone levels, the first step is to speak to your doctor. They will organise blood tests to prove that the symptoms experienced are as a result of low testosterone production. 

Doctors may advise against treatment if the patient has prostate or breast cancer, or one of the following conditions:  

Sleep apnoea Lower urinary tract symptoms (associated with large prostate) Congestive heart failure Abnormal red blood cell counts

The risks and benefits will be weighed up and the chance of prostate cancer evaluated. If treatment is advised, frequent prostate monitoring will be arranged.  

  

Does testosterone replacement therapy carry any risks? 

Taking testosterone as a performance enhancing drug has well-known negative effects. In TRT the dosage is much lower. However, the long-term risks and benefits are unknown.  

Regular check-ups with your GP whilst on TRT are important. Side effects of the treatment include: 

Oily skin, causing acne Ankle swelling due to fluid retention Enlargement of breasts Shrinking of testicles Lower sperm count Increased risk of blood clot, heightening risk of heart attack or stroke

Often these side effects fade as the body adjusts to the treatment.