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 symptoms 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 (muscle building) hormone, produced by men from the testes. It plays a vital role in many biological processes, affecting health and longevity.  

A decline in testosterone production is common as men age, at a rate of about 2% per year over the age of 30. Low testosterone levels do not always require treatment. Therefore, TRT isn’t recommended to men who have low levels but are without symptoms.

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 fall 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, increased body fat (and weight gain which sometimes involves the breasts). 
• Emotional well-being: fatigue, difficulty concentrating, increased irritabiity and low mood.  

What does testosterone replacement therapy involve? 

If you are experiencing these symptoms and suspect the cause to be low testosterone levels, you should see your GP (or if you prefer a hormone specialist). They will assess your case and take bloods if necessary to measure testosterone levels. 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 different ways. Common methods include topical gels or injections. No pill is offered, as oral consumption of testosterone can damage the liver. The aforementioned methods are absorbed directly into the bloodstream with benefits often seen within a few weeks.

Who is testosterone replacement therapy suitable for? 

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. If treatment is advised, monitoring of your full blood count, prostate enzyme level and testosterone will be arranged.  

Does testosterone replacement therapy carry any risks? 

Taking testosterone as a performance enhancing drug is not recommended due the risk of adverse side effects. However, in TRT, safe replacement doses of testosterone are prescribed. 

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

• Oily skin, causing acne
• Pain at injection sites
• Skin irritation from gels
• A rise in blood counts

Prescription doses require adjustment to optimise treatment and minimise side effects.