Testosterone Replacement Therapy (TRT): The Science, Myths & Facts
Testosterone replacement therapy is now a popular treatment for men with low sex hormone levels. Here’s everything you need to know about combating hypogonadism with TRT…
- What is testosterone?
- Why is testosterone important?
- Symptoms of low testosterone
- What is testosterone therapy?
- Forms of TRT
- What are the benefits and risks?
- Final Word: Should I do it?
What is testosterone?
Testosterone is a naturally occurring hormone made by the Leydig cells inside your testes. It is quite literally what makes you a man in the physical sense.
As an anabolic-androgenic hormone, testosterone causes your masculine sexual traits to develop. This is especially true during puberty where men see the most dramatic changes in their body.
Why is testosterone important?
Testosterone plays a key role all the way into adulthood. Healthy levels of T help you stay strong and masculine, leading to a better quality of life. It triggers, manages and maintains many ‘manly’ traits such as:
- Increased bone and muscle mass
- Sex drive, libido, and sexual performance
- Voice deepening and hair growth
- A broadened and muscular physique structure
- Increased red blood cell production – something directly related to energy, endurance and stamina
- Heightened absolute strength
- Lower body fat
Average males typically have total testosterone levels between 300-1,000 ng.dL. Men with less than this amount could be considered to have low testosterone.
Symptoms of low testosterone
As men reach age 30 the amount of testosterone, natural production starts to decline around 1-2% every year. However, regardless of age, men can still suffer from low T.
The medical diagnosis for low levels of testosterone is hypogonadism. There isn’t one definitive cause of the issue – however medical problems, lifestyle, and age can all influence it. Men suffering from symptoms of low testosterone should see their doctor for a professional diagnosis.
Symptoms of low testosterone include:
- Loss of sex drive, libido and/or sexual performance
- Reduced muscle mass
- Decreased strength
- Development of man boobs (gynecomastia)
- Tanked mood – feelings of depression, anxiety, and deflation
- Low energy – less vigor
- Weakened bones
It should be noted that TRT has not been approved for low-testosterone because of aging. This is because testosterone production naturally slows down with age and is not a medical complication.
What is testosterone therapy?
If a man is suffering from hypogonadism his doctor might prescribe testosterone therapy. Also known as TRT, testosterone therapy is the use of a synthetic version of the hormone to raise total levels inside the body.
TRT should not be confused with the naturally occurring hormone itself. Rather than produced by the testicles, the version of testosterone used in TRT is created in a lab, and then prescribed by a doctor.
There are many forms of testosterone replacement therapy available – each suit the individual patient. While most men think instantly of testosterone injections, other options might be advised differently, dependent on age, lifestyle, or even medical insurance.
Response to TRT also differs from man to man. There are no guarantees that it will work right away, and there’s even a risk that it won’t work at all. As everyone is unique there’s no way of immediately telling how you’d react.
Yet, when prescribed to the right patient, TRT can considerably improve quality of life. Not only are there physical benefits to enjoy like an increase in lean body mass, but mental bonuses too.
Loss of sex drive, reduced muscle mass, and a deflated mood can leave men feeling depressed and emasculated. In turn, this can put a strain on relationships, marriages, and even careers.
While testosterone therapy can’t cure what causes low testosterone, it can be used to manage the symptoms. Therefore, TRT can help balance out and reinvigorate a man’s overarching quality of life.
Forms of Testosterone Replacement Therapy
Testosterone replacement therapy can come in many forms. Each one improves total testosterone levels and should be prescribed by a doctor.
Forms of TRT:
- Transdermal skin patches – Testosterone secreting patches are applied to the upper body once a day
- Mouth patches – Tablets are stuck to the upper gums and release testosterone continually into the blood. Application is carried out twice daily above the incisor
- Gels – Once the gel is directly applied testosterone is absorbed through the skin. Application is typically carried out once a day
- Injections – Testosterone is injected directly into the buttocks or thigh via needle and syringe
- Implants – Implanted pellets sit inside soft tissues and slowly release Testosterone into the bloodstream
It’s possible to find testosterone replacement therapy in pill form. However, this method is shunned by many experts due to possible negative effects on the liver. None of the forms above must be broken down by organs so are deemed much safer.
What are the benefits & risks?
Undergoing testosterone replacement therapy isn’t to be taken lightly. Some changes to the patient’s body might be small, while others can be big and unpleasant. Before anybody takes on TRT they should be absolutely sure they understand both the risks and rewards.
Benefits of TRT
As mentioned, testosterone replacement therapy can help men re-find their masculinity. For many hypogonadism patients, it can be the answer to reinvigorating both their mental and physical health.
Strength, fitness, and possible fat loss
Testosterone is directly related to muscle mass as it triggers the androgen receptors located inside muscle tissue. This, in turn, stimulates powerful muscle growth, meaning TRT can make a man fitter and stronger.
With his new muscle, he will be much better equipped to handle physical activity. Everything from day-to-day tasks to hitting the gym becomes easier – giving him a better chance of rebuilding his masculine physique.
Plus, as lean muscle increases, so does basal metabolic rate. This means you’ll burn more calories at rest as your body uses energy to support new mass. For many men, a rise in BMR can also result in fat loss – helping support testosterone production even more.
A key benefit of TRT is a better mood. As physical and mental barriers begin to be removed, men report they feel better about life and happier overall.
One study published in The Aging Male even announced that 12 months of testosterone therapy was also successful in helping fight depression. Out of all the men tested with moderately severe to severe depression, symptoms dropped from 17% to 2%. 
Another factor to consider is how reclaimed fitness and motivation can affect mood. As TRT users become fitter and inspired to ‘get up and go’, their actions are likely to positively influence their outlook on life. This is especially true if their sex life improves.
Improved sex life
Many users claim that reigniting their sex life as one of the best benefits of TRT.
By replacing testosterone, androgen receptors in the brain that control sexual desire are switched back on. Libido is then increased, giving men a greater urge to have sex, which sometimes makes erections stronger.
Again, a reclaimed libido can give men a sense of re-harnessing their masculinity and youthfulness. For men in a relationship or looking for a partner, this can be particularly important.
Energy levels are reignited
Fatigue and low energy levels are both common side effects of low testosterone. Many men suffering from hypogonadism report feeling lethargic, demotivated, and even suffering ‘brain fog’.
While scientists aren’t quite sure why, one theory suggests that testosterone flicks the switch on dormant mitochondria. These are energy producing cells that are turned back on by TRT, re-energizing users in the process.
Again, as energy levels rise men are more likely to be productive. In turn, this triggers positive reward responses in the brain helping to improve mental wellbeing and feeling of purpose.
Risks of TRT
While there are undeniably positive, life-changing benefits of TRT the risks cannot be ignored. Initially, these may only be small annoyances – yet there is evidence to suggest life-threatening reactions.
Users must be completely clear that they understand the risks before commencing any testosterone replacement therapy. These should be discussed beforehand with a trained medical professional.
Acne and oily skin
As a hormone testosterone may raise oil production. This can be ideal for skin health; however, a buildup of oil can result in breakouts. If the user has a history of acne this becomes even more likely.
Itching and irritation
Itching and irritation around the TRT application site is one of the most common complaints from users. While it may not be fatal – it could be too annoying for some men.
Unfortunately, testicle size reduction is a common risk associated with TRT.
When the pituitary gland senses testosterone levels are low, it sends luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to the testicles. LH tells your testicles to start producing more testosterone, whereas FSH encourages them to create extra sperm.
However, once synthetic testosterone is introduced to the bloodstream, the pituitary gland detects this. It then stops sending out LH and FSH messages altogether – ultimately telling the testicles to become dormant.
Because the majority of the testicle is dedicated to producing sperm, once they’re told to stop making it, they become smaller. And while this might not be an issue for some men it definitely plays a role in fertility. Therefore, if you’re looking to start a family now or in the future TRT is not advised.
Heart attack, strokes, and blood clots
Just like other anabolic steroids, there’s an undeniable link between TRT and life-threatening side effects. Two of these are the increased risk of heart attacks, strokes, and blood clots.
One study carried out on over 50,000 men found that TRT users above the age of 65 doubled their chances of a heart attack. While the evidence isn’t conclusive as to why this is, some scientists suggest it’s because testosterone binds androgen receptors together, which signals the bone marrow to produces greater amounts of red blood cells, therefore thickening the blood.
Another study also suggests that testosterone replacement therapy may also increase the risk of a stroke by 30% too. Again, this is due to testosterone causing the blood to thicken.
Finally, testosterone replacement treatments are required by the FDA to warn users of the risk of blood clots. This is because, if a clot occurs, it could raise the risk of deep vein thrombosis and pulmonary embolism.
Final Word – Should I do it?
Not only does testosterone help men maintain their masculine physique but it plays a role in their mental wellbeing too. Therefore, low levels can seriously impact the way men feel both physically and emotionally.
Therefore, if you feel like low-testosterone is negatively impacting your life, TRT could be a way of managing the symptoms. Users report elevated energy, increased libido, and finding their lust for life as some of the many benefits which cannot be ignored.
Yet, before deciding to undergo testosterone replacement therapy you must understand the risks. Look at what your insurance can cover and weigh up the pros and cons with your doctor.
It should also be noted that there are currently no long-term studies backing testosterone therapy. Consequently, there’s no guarantee how your future health might be impacted. If you have a history of heart, lung, prostate or blood thickening problems – it would be safer to seek another option.