Testosterone Replacement Therapy (TRT)


The symptoms of low testosterone (T) may include low sex drive, low energy, moodiness, memory changes, exercise intolerance and erectile dysfunction. These symptoms may be variable among men. There may also be other medical conditions that may cause similar symptoms, including issues related to anemia, thyroid, B12, kidney or liver disease. The medical word for low T is “hypogonadism”. T levels decrease with age, and low T is seen in approximately 2 out of 10 men over age 60 years, and 3 out of 10 men over age 70 years.

The diagnosis of low T is always confirmed with a second lab check. T is highest between 8 and 10 AM. If you are having symptoms of low T, and it is confirmed with a blood check, you may be a candidate for replacement, Testosterone Replacement Therapy or TRT.

Options for replacement include:

  • Daily skin gel
  • Weekly home injections
  • Injections in the clinic every 10 weeks (Aveed)
  • Pellets placed under the skin that release testosterone over 3-4 months (Testopel)

Men on TRT should be aware of a few things. If they choose to come off of replacement, their T levels will drop.

TRT may be associated with certain medical risks, including: acne, breast enlargement, mood swings, sleep apnea, fluid retention, prostate enlargement, prostate cancer, breast cancer, urinary blockages and changes in cholesterol. TRT may also cause an increase in the number of red blood cells, which may clump together, increasing a man’s risk of blood clots, heart attack or stroke. Because of this, men on TRT should have blood checked regularly for cholesterol levels, red blood cell levels, PSA levels, liver function enzymes, and other hormone levels. It is important to know that TRT will decrease sperm production and counts, and may result in a decrease in testicular size.

There are certain groups of men who should not take TRT, including those with untreated heart problems, elevated red blood cell counts, prostate or breast cancer, or men planning on having children. The association between TRT and cardiac events and prostate cancer are areas of active research.