Testosterone Replacement Therapy (TRT): What to Know

October 24, 2023

Testosterone performs essential functions in the body, such as supporting muscle and bone health, cognition, red blood cell and sperm production, and male sexual and reproductive function.

There are multiple factors that can contribute to a decline in testosterone levels, including stress, aging, trauma, and infections.

This article delves deeper into the topic of Testosterone Replacement Therapy (TRT), providing detailed information on its target audience, different types, mechanisms of action, ways to obtain it, expected outcomes, and additional relevant insights. Explore this informative resource to gain a comprehensive understanding of TRT and its implications.

What is testosterone replacement therapy?

Testosterone Replacement Therapy, also known as TRT or Androgen Replacement Therapy (ART), is a medical treatment provided to males with testosterone deficiency who exhibit symptoms of hypogonadism.

By administering prescribed testosterone, this therapy aims to restore hormone levels in the bloodstream, effectively reversing the symptoms of low testosterone. Individuals undergoing TRT may experience enhancements in alertness, sexual function, energy levels, mood, and overall well-being.

Who can benefit from testosterone replacement therapy, and how does it work?

TRT is recommended by doctors for males diagnosed with hypogonadism. A definitive diagnosis requires blood tests that reveal low testosterone levels, typically defined as below 300 nanograms per deciliter (ng/dl) by the American Urological Association. Additionally, accompanying symptoms such as fatigue, breast growth, and sexual dysfunction are considered.

It is important to note that TRT is not usually the first-line treatment for low testosterone levels, even in individuals displaying symptoms.

In cases where other underlying conditions or medications contribute to the decrease in testosterone levels, doctors typically address the root cause before considering TRT.

Benefits of Testosterone Replacement Therapy (TRT)

According to a comprehensive study conducted in 2019, TRT has shown significant improvements in sexual function, encompassing factors such as libido, symptoms of erectile dysfunction, and sexual satisfaction. Additionally, recent research from 2022 indicates that TRTs may also have a positive impact on bone density, cognitive function, and attention span.

However, it is important to note that while these benefits exist, they are relatively modest and may diminish upon discontinuation of TRT. In fact, in the 2019 study, approximately half of the participants still exhibited bone mineral density within the range of osteopenia or osteoporosis while on TRT.

How to get TRT

To obtain TRT, a prescription from a qualified healthcare professional is required. In order to determine if a person is a suitable candidate for TRT, the doctor will conduct a comprehensive medical history review, physical examination, and laboratory tests. As hormone levels can fluctuate throughout the day, doctors typically collect two blood samples before noon. In some cases, additional diagnostic tests, such as luteinizing hormone and follicle stimulation hormone tests, as well as imaging studies, may be ordered to identify the underlying cause of low testosterone levels.

Experience the benefits of Testosterone Replacement Therapy and improve your quality of life today. Speak to a medical professional to explore the suitability of TRT in addressing your needs.

Types of Testosterone Treatments

There are multiple methods available for administering testosterone, each with its own benefits and considerations:

Injectable Testosterone:

Injectable testosterone is a widely-used and cost-effective form of testosterone replacement therapy (TRT). It can be administered through two approaches:

Short-Acting Treatment: This involves receiving a shot every 1 or 2 weeks. Doctors typically inject short-acting testosterone under the skin or into the muscle.
Long-Acting Treatment: This approach requires the second shot to be administered 4 weeks after the first, with subsequent shots given 10 weeks apart. Long-acting shots are usually administered into the gluteal muscles.

It’s important to note that the dosage and frequency of the treatment may vary based on an individual’s specific needs.

Testosterone replacement therapy (TRT) has the potential to cause fluctuations in testosterone levels, which can impact energy levels, libido, mood, and the presence of certain symptoms, such as breast tenderness.

By considering the different types of testosterone treatments, individuals can work closely with their healthcare professionals to determine the most suitable approach for their specific situation.

Topical (transdermal)

Topical (transdermal) treatments, such as gels, creams, and patches, are commonly used to maintain stable testosterone levels in the bloodstream. These options offer convenience, but it’s crucial to ensure proper application and avoid contact with others, particularly pregnant individuals and children.

Topical patches provide a continuous release of testosterone for 24 hours, while gels offer a dosage range of 40–100 mg per day. It’s advisable to start with the lowest recommended dose and adjust gradually if needed. However, it’s worth noting that patches may cause minor skin irritations and are less aesthetically appealing compared to other forms.

Cheek or buccal patches

For those seeking an alternative, cheek or buccal patches are available, which deliver testosterone over a 12-hour period. These patches, usually containing 30 mg, are administered twice daily, with approximately 12 hours between applications. Potential side effects may include headaches, gum discomfort, and mouth irritation.

By carefully considering these options and following the recommended guidelines, individuals can effectively utilize topical treatments to maintain hormonal balance and well-being.

Testosterone Implants or Pellets

Testosterone pellets, also known as testosterone implants, are small plastic pellets surgically implanted under the skin. Typically inserted in the upper hip or buttock, these pellets slowly dissolve, providing testosterone replacement therapy (TRT) for a period of 3 to 6 months. The specific dosage varies for each individual and should be discussed with a healthcare professional before the first implantation.

The implantation procedure involves making a small incision in the subcutaneous fatty tissue, and it is performed as a minor inpatient surgical procedure under local anesthesia.

Oral Testosterone

While less commonly used, oral testosterone is another form of TRT that is more expensive and less practical. Prolonged usage of oral testosterone can potentially lead to liver damage.

It’s worth noting that oral testosterone tablets often carry warnings regarding hypertension and stroke risks. Consequently, individuals who cannot utilize other TRT methods may resort to oral testosterone administration.

Typically, a healthcare professional will recommend a daily dosage of oral testosterone ranging from 225 to 396 mg, divided into two doses.

Intranasal

For intranasal testosterone gel, a person applies the gel inside the nose three times a day at intervals of 6 to 8 hours, preferably at consistent times. The usual dosage is around 11 mg per application across both nostrils, resulting in a total daily dosage of 33 mg.

Common side effects of this treatment include headaches, nosebleeds, a runny nose, and nasal discomfort. Please note that it is always crucial to consult with a healthcare professional for personalized advice and guidance on TRT options.

What to Expect from Testosterone Replacement Therapy (TRT)

The main goal of TRT is to restore testosterone levels to normal. Within a week, individuals can expect improvements in their blood testosterone levels, while symptom relief may take longer.

Along with restoring testosterone levels, TRT offers other benefits, such as increased bone density, lean body mass, overall well-being, energy, and libido. It’s important to note that positive changes may appear anywhere between 4 weeks to several months.

TRT is typically a lifelong treatment, unless caused by medical illness. Doctors monitor patients’ response to treatment and conduct routine checkups every 6-12 months to assess blood testosterone levels.

During the initial treatment, doctors keep a close eye on symptoms and side effects, followed by check-ins at 3 and 6 months, and then annually.

Approximate Costs of TRT

The cost of TRT can range between $1,650* and $3,200* per year, depending on various factors such as medication type, dosage, method of administration, insurance coverage, and fees associated with doctors and clinics.

Please note that the provided costs are estimates and may vary. Contact us for updated information tailored to your specific needs. Our team is dedicated to providing you with exceptional TRT options that are both effective and cost-efficient.

Is TRT Safe?

Besides possible short-term side effects, TRT poses health risks. Following the guidelines of the Endocrine Society, TRT is not recommended for individuals with conditions such as breast or prostate cancer, prostate nodules, high prostate-specific antigen levels, elevated hematocrit levels, untreated sleep apnea, severe lower urinary tract symptoms, congestive heart failure, recent stroke or heart attack, and thrombophilia. It may also not be suitable for males who plan to conceive soon.

Special Considerations

Individuals aged 40 and older, preadolescent individuals, and those with migraine or epilepsy may require special considerations during TRT.

Please note that the information provided should not replace medical advice, and it’s essential to consult with a healthcare professional before starting any treatment.

Who should avoid TRT?

Certain individuals should refrain from using TRT, according to recommendations from The Endocrine SocietyTrusted Source.

Obstructive Sleep apnea

These include people with obstructive sleep apnea, as caution should be exercised when prescribing TRT due to its potential neuromuscular and metabolic effects on the airways. Hypoxia, characterized by low oxygen levels in body tissues, may result, leading to symptoms like confusion, restlessness, difficulty breathing, rapid heart rate, and bluish skin.

Another potential consequence of TRT is hypercapnia, which occurs when carbon dioxide levels in the blood become excessively high. This can lead to respiratory acidosis, with symptoms such as fatigue, drowsiness, or an intense inclination to sleep.

Severe lower urinary tract symptoms

Individuals experiencing severe lower urinary tract symptoms, such as urinary frequency and urgency, which may be indicators of an enlarged prostate or benign prostatic hyperplasia (BPH), should also exercise caution. Research has established a connection between TRT and lower urinary tract symptoms (LUTS), which can be attributed to testosterone’s role in promoting prostate growth. Although TRT may help reduce prostate inflammation, it does not alleviate urinary tract symptoms and may even exacerbate them in the long run, according to recent clinical trials.

Elevated hematocrit levels and thrombophilia

Elevated hematocrit levels and thrombophilia can have significant implications when considering the use of TRT. Individuals with a high red blood cell count and thrombophilia should avoid undergoing TRT due to its potential to further increase red blood cell count and blood viscosity. This, in turn, raises the risk of blood clot formation, stroke, and ischemia.

In a recent 2021 research study focused on trans men using TRT over the long term, it was concluded that TRT led to a significant increase in red blood cell count. The study tracked red blood cell counts on an annual basis and revealed a 10% increase after the first year and a substantial 38% increase after 10 years.

Prostate cancer

Additionally, it’s important to consider the impact of TRT on prostate health. Prostate cancer, which relies on testosterone to grow, may be exacerbated by the use of TRT, potentially accelerating the growth of cancer cells. According to the National Cancer Research Institute, higher levels of testosterone in the bloodstream can increase the likelihood of prostate cancer diagnosis.

High prostate-specific antigen levels

Moreover, there is evidence linking TRT to higher prostate-specific antigen (PSA) levels, particularly in men over the age of 65. A clinical trial involving men in this age group who received TRT for 12 months showed a notable 4.0 ng/mL increase in PSA levels in about 5% of the participants.

Ischemic stroke

Lastly, a study examining 15,401 men aged over 45 years with low testosterone levels found that those who underwent TRT had a 21% higher risk of developing cardiovascular conditions, including ischemic stroke, compared to those who did not undergo TRT. Understanding these risks associated with TRT is crucial when making informed decisions about hormonal therapy.

Side Effects and Warnings of Testosterone Replacement Therapy (TRT)

Testosterone Replacement Therapy (TRT) is a treatment aimed at low testosterone levels often associated with aging. However, it is important to note that the benefits and safety of TRT in this context are still not fully understood, according to the Food and Drug Administration (FDA).

As mandated by the FDA, warnings are required on testosterone products highlighting the potential risks of stroke and heart disease.

Studies have suggested that males undergoing TRT may have an increased risk of cardiovascular events like stroke. However, more research is needed to establish a definitive link.

In addition to these risks, there are other potential side effects associated with TRT. These may include:

Rashes, itching, and acne
Male pattern baldness
Hair loss or excessive hair growth
Anxiety
Bladder irritability
Priapism (prolonged and painful erections)
Deep vein thrombosis
Anger and aggressive behavior
Breast soreness or enlargement (gynecomastia)
High blood pressure
Increase in prostate size
Decreased sperm production
Worsening of prostate cancer
Shrinkage of the testes
High red blood cell count, which may lead to blood clots
Liver dysfunction

It is worth noting that TRT may also impact cholesterol levels. However, a recent study suggests that TRT could have potential benefits in improving total cholesterol levels.

Regarding cancer, current scientific literature suggests that TRT may exacerbate breast and prostate cancer. However, it may be beneficial for individuals with early-stage prostate cancer without stimulating cancer recurrence or progression. This comprehensive information about the side effects and warnings of TRT serves to better inform individuals considering or undergoing this treatment.

Alternatives to TRT

Enhancing testosterone levels without medical intervention is possible. Here are some effective strategies individuals can consider:

Prioritize Quality Sleep: Make sure to get sufficient and restful sleep to support healthy testosterone levels.
Follow a Balanced Diet: Opt for a nutritious and well-rounded diet that includes foods known to promote testosterone production.
Achieve Healthy Weight: Maintaining a healthy weight range can positively influence testosterone levels.
Stay Active: Engaging in regular physical activity and exercise can help optimize testosterone levels.
Manage Stress: Finding effective stress management techniques can contribute to maintaining optimal testosterone levels.
Incorporate Essential Vitamins and Minerals: Including vitamin D and magnesium-rich foods or supplements can aid in testosterone production.
Avoid Substance Abuse: Refrain from using drugs and excessive alcohol consumption, as they can negatively impact testosterone levels.
Seek Professional Guidance: If an individual suspects any medications may lower testosterone, consulting a doctor is crucial for appropriate guidance and support.

By adopting these non-medical strategies, individuals can naturally promote healthy testosterone levels.

Frequently asked questions about TRT

The following are common questions about TRT.

How much does TRT cost?

Does insurance cover TRT?

Most insurance providers typically offer coverage for various forms of TRT. However, it is important to note that there might be associated out-of-pocket expenses. It is advisable for individuals to verify coverage with their insurance company to prevent any unforeseen financial burdens.

Is testosterone replacement therapy safe?

While TRT can provide benefits for individuals with low testosterone levels, it’s important to be aware of potential short-term side effects. Research indicates that long-term TRT can enhance liver function and mitigate cardiovascular risks. However, additional studies are required to comprehensively evaluate the long-term effects. When TRT is administered by a qualified and knowledgeable healthcare professional, the probability of experiencing side effects is notably diminished.

How long should I stay on testosterone replacement therapy?

The duration of TRT treatment is indefinite, unless the low levels can be attributed to a treatable underlying cause. It is crucial to address potential factors that can be resolved to optimize results and maintain optimal health.

What does TRT do to your body?

Testosterone Replacement Therapy (TRT) can lead to various physical transformations, such as enhanced muscle mass and bone density, as well as reduced body weight. Experience the benefits of TRT for improved overall well-being and vitality.

Is TRT covered by insurance?

If an individual undergoes TRT as a treatment for a health condition, their medical insurance should provide coverage for this expense. Benefit from comprehensive insurance coverage for your TRT treatment, tailored to address your specific health needs.

How do I take testosterone therapy?

There are various administration methods for TRT including oral intake, intramuscular injections, implants, transdermal patches, mouth patches, topical creams or gels, and intranasal gels or pellets. The frequency of administration can vary from daily, weekly, monthly, to every three months, depending on individual medical needs and lifestyle. Before starting treatment, it is crucial for individuals to consult with their healthcare practitioner to discuss these options tailored to their specific requirements.

How will doctors monitor my TRT?

Doctors ensure effective monitoring of TRT treatment by utilizing blood tests, physical examinations, and scans.

The blood tests encompass measurements of total serum testosterone, complete blood count (hematocrit), and prostate-specific antigens (PSA). These vital tests are typically administered at the beginning of the treatment, followed by subsequent evaluations three to six months later. Doctors then undertake annual repeats of these tests to ensure stability and optimal outcomes.

Individuals with a history of low trauma fractures or osteoporosis receive a bone density scan one to two years after the commencement of TRT therapy. This comprehensive approach ensures the thorough assessment and management of patients’ wellbeing.

Conclusion

Testosterone Replacement Therapy (TRT) is a highly prescribed remedy for individuals experiencing low testosterone levels. However, it is essential to note that TRT is not suitable for everyone. Before considering this treatment, it is imperative to obtain a doctor’s prescription and consult with a qualified healthcare professional. This ensures that the treatment aligns with your specific needs, ultimately yielding optimal results.

For those residing in Schertz, TX and neighboring communities, ReUP Men’s Clinic stands as a leading men’s clinic dedicated to advancing men’s health through innovative and ethical practices. Our esteemed team of experts prioritizes your well-being, providing personalized in-person consultations and state-of-the-art treatments tailored to your unique health profile. Experience a renewed sense of vitality and well-being with ReUP Men’s Clinic – your trusted partner in men’s health.