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Is TRT Right for You? A Comprehensive Guide

Testosterone Replacement Therapy (TRT), also called androgen replacement therapy, is a treatment designed to address hypogonadism. This condition occurs when the gonads do not produce enough testosterone in males assigned at birth (MAAB). TRT helps increase testosterone to normal levels, helping to relieve the symptoms of low testosterone caused by numerous factors, such as age or health conditions negatively impacting hormone production.

As you research TRT, you may also have heard about Hormone Replacement Therapy (HRT). Although testosterone is a hormone, TRT refers explicitly to treatments for MAAB people with below-normal testosterone levels. HRT primarily contains estrogen to treat low levels of female hormones in people assigned female at birth (AFAB).

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Understanding Low Testosterone and Testosterone Deficiency

The normal range for testosterone levels in MAAB people is 300-1,000 ng/dL. Low testosterone symptoms and their severity can vary on a case-by-case basis. Some may not notice symptoms until after their T-levels have dropped below 100 ng/dL. Others may experience symptoms at levels technically within a normal range but lower than their bodies typically produce at peak health.

Signs of testosterone deficiency include:

  • Hair loss (both body and facial hair)
  • Decreased lean muscle mass
  • Depression
  • Difficulty concentrating
  • Erectile dysfunction
  • Fatigue/low energy levels
  • Increased body fat
  • Irritability/mood changes
  • Low libido (sex drive)
worried bald man

Testosterone supplements have become a booming industry. However, research does not indicate that they effectively help raise testosterone levels.1 Only some supplements could produce accurate data to support their claims, and more than 1 in 10 boosters included in recent studies contained ingredients shown to impact testosterone levels negatively.

Additionally, supplements often contain doses of vitamins that significantly exceed the recommended daily intake, which can lead to vitamin overload. Excessive amounts of vitamins in these supplements are because T-boosters are not FDA-regulated, meaning they are not subject to the thorough testing process required for prescription treatments.

Despite the research, some people still insist testosterone supplements can help those looking for a slight increase in testosterone production. A healthy diet and a physically active lifestyle are vital to testosterone levels. Anyone not practicing healthy lifestyle habits will find it highly unlikely that testosterone supplements will help you increase production. Always consult your doctor before starting any supplement, so they can ensure the supplement is safe and guide you toward reputable providers.

As previously mentioned, testosterone levels naturally decrease with age in a process called andropause. This process typically begins around age 30-40, with the decline averaging roughly 1% lost yearly. While not all MAABs will experience andropause, it is one of the primary causes of testosterone deficiency.

TRT is a treatment option for andropause. However, you may need to maintain testosterone therapy indefinitely, as testosterone production is unlikely to increase with age naturally.

The Benefits and Risks of TRT

The primary benefit of TRT for MAABs is that it helps relieve symptoms of low testosterone outlined above.

The direct benefits of TRT include:2

  • Increased bone mineral density
  • Improved cognitive function
  • Improved sexual desire and increased libido
  • Help build lean muscle mass and promote fat loss

Elevated testosterone ratios can also help improve spatial memory, increase cognitive processing speed and verbal memory, and reduce the risk of developing Alzheimer’s disease.

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Like any treatment, TRT is not without risks. The most common mild to moderate side effects include:

  • Mood swings
  • Testicle shrinkage
  • Enlarged breasts
  • Worsening or development of sleep apnea
  • Lower sperm count (which can lead to infertility)
  • Higher risk of blood clots
  • Back and joint pain

These symptoms are typically mild and often subside as treatments continue.
TRT also has more severe side effects that may require immediate medical attention.

Significant risks of TRT include:

  • Significant changes in urination, such as the sudden and urgent need to urinate, difficulty urinating, or urinating more frequently
  • Intense mood swings, including depression, anxiety, or suicidal ideation
  • Yellowing skin or eyes (jaundice)
  • Redness, swelling, warmth, or pain in the extremities, especially the lower legs.

Though there have previously been concerns that TRT increases the risk of heart attack or stroke, a recent study by the Cleveland Clinic did not show TRT presented an increased risk. That said, TRT can cause unpleasant long-term and short-term side effects and may also lead to infertility. Your doctor can help you weigh the potential benefits and risks to determine if TRT is the proper treatment.

The Practical Considerations of TRT

As with any medical treatment, price is always a factor. TRT cost varies depending on several factors, such as insurance coverage, dosage, how it is administered, medication type, and additional charges such as doctor’s visits and laboratory fees.

Insurance coverage of testosterone therapy can vary greatly – you should contact your insurance provider to determine what parts of treatment that may or may not be covered. TRT-related expenses can range from $1,650 to $3,200 per year.

TRT dosage is typically determined on a case-by-case basis, with amounts taken depending on individual factors and the type of TRT you take. Age, the severity of your hypogonadism, other medical conditions, current medications, and how your body reacts to the first dose will impact dosage.

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There are several ways TRT can be administered, including:

  • Injection – Injectable testosterone can be given on a short or long-term basis. Short-term TRT usually consists of a single shot every 1-2 weeks. Long-acting treatments typically involve two shots four weeks apart, followed by one shot every ten weeks.
  • Oral testosterone – This treatment is less common, comes with a higher cost, is less practical, and presents a higher risk of side effects such as hypertension or stroke. Long-term use can lead to liver damage. The typical dosage is 225-396 mg, taken twice per day.
  • Cheek or buccal patches – These patches are placed inside the mouth, either on the cheek or above the upper teeth. They usually contain 30 mg of testosterone, released over 12 hours, and may be applied twice daily. Known side effects include irritation of the mouth and gums, as well as headaches.
  • Topical – Also known as transdermal TRT, these treatments typically involve gels or creams applied to the skin daily, which can lead to more stable testosterone levels in the blood. However, it is essential to note that skin-to-skin contact with other people within 6 hours of application can cause dangerous side effects in others, especially pregnant people and children.
  • Testosterone pellets or implants – Pellets or implants are implanted into the upper hip or buttock and are designed to dissolve slowly over 3-6 months. As with injections, the dosage is determined on a case-by-case basis.
  • Intranasal – Intranasal gels are applied to the inside of the nose three times per day, with each application typically containing 11 mg of testosterone. Side effects of this treatment include nasal discomfort, runny nose, nosebleeds, and headaches.

What Are Some Alternatives to TRT?

It’s important to note that a healthy lifestyle is vital to testosterone production.

Natural ways to increase testosterone include:

  • Staying Active – increased physical activity can help boost natural testosterone production. Weight training and other types of resistance training have proven to be the most beneficial for short-term boosts in testosterone levels.
  • Practice Healthy Sleep Habits – Getting enough sleep has been linked to higher testosterone levels, and being sleep deprived has been shown to reduce testosterone levels by up to 10-15%.
  • Healthy Diet – Proteins, healthy fats, and carbs help support healthy testosterone levels.
  • Limit Alcohol Intake – Excess alcohol consumption can reduce testosterone levels, and alcohol abuse can impact testicular function.
  • Manage Stress – Sharp increases in cortisol, a stress hormone, can cause testosterone levels to drop. Cortisol can also negatively affect other body systems and impact testosterone production.

TRT is most effective when paired with a healthy lifestyle. If you are unsure about beginning TRT, you can effectively incorporate healthier habits into your lifestyle first to determine any positive impacts on your testosterone levels before starting TRT.
TRT isn’t suitable for everyone.

Those who have the following conditions should discuss TRT alternatives with their doctor:

Dynamic running uphill male athlete runner in background of sea and sky.
  • Prostate cancer or who are at risk of prostate cancer – While TRT does not cause prostate cancer, it can make it easier for cancer to grow
  • Sleep Apnea – Untreated sleep apnea can worsen with TRT and cause serious health issues
  • Polycythemia – A condition in which your body overproduces red blood cells. Testosterone can worsen this condition as it stimulates red blood cell production.
  • Being seriously overweight – Despite popular belief, testosterone is unlikely to aid weight loss attempts without healthy lifestyle changes.
  • Trying to have children – TRT can lower sperm count and decrease fertility, which can become permanent with long-term TRT.

Consulting a Healthcare Professional

TRT is a prescription treatment and should only be obtained through a licensed and trained doctor with experience in testosterone therapy. The guidance of a trusted medical professional is crucial to ensuring that TRT is the right therapy for you. Symptoms of low testosterone can also be signs of other health conditions, meaning that testosterone therapy may not help address your health concerns.

A TRT consultation can ensure that TRT addresses your health concerns and is a safe treatment. When meeting with a doctor, they can conduct a health screening to learn your health history, medications, and why you are interested in TRT treatment. They may also perform a blood test to determine if you meet TRT guidelines. Your doctor may require multiple blood tests taken at different times of day as testosterone levels fluctuate.

If your doctor suspects another health condition may be causing your symptoms, they may recommend further testing to rule out more possibilities. Finally, if your doctor determines that TRT is an appropriate treatment, they will examine your lifestyle and preferences regarding TRT options to determine which is most effective for your needs.

Last Words

TRT can be a valuable therapy for those experiencing symptoms of hypogonadism. It can help increase libido and lean muscle mass, improve mood, and enhance cognitive function. Unlike testosterone supplements, TRT efficacy is supported by research and is safer as a prescription treatment than unregulated supplements and thus not subject to rigorous testing and safety standards.

TRT also has the advantage of availability through multiple forms, including injections, topical gels, and implants, so you can find the option that best fits your lifestyle and needs. However, TRT has side effects like any treatment and may not be appropriate for everyone.

Symptoms of low testosterone may also be related to another health condition, so it is crucial to have a thorough TRT consultation to ensure TRT is the best option to address your concerns. It is vital to consult with a healthcare professional who can help determine whether TRT is the right choice for you.

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[1] 'Testosterone Boosting' Supplements Composition and Claims Are not Supported by the Academic Literature. Clemesha CG.

[2] The benefits and risks of testosterone replacement therapy: a review. Bassil N.

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