Few hormones are as important as testosterone for our general health and wellbeing.
When “T” levels are high, we feel strong, vital, and virile, and when they drop, just about every part of us droops with them.
This explains the surging interest in testosterone replacement therapy (TRT). Just wear a patch, take a pill, or get an injection of testosterone, and you’ll restore much of the vim and vigor of your younger years with few to no side effects.
Is TRT therapy the pharmaceutical fountain of youth it’s made out to be, though?
And are TRT side effects as rare and mild as proponents claim?
In this article, you’ll learn everything you need to know about TRT, including what TRT is, why people take TRT, the benefits, drawbacks, and risks of TRT treatment, how much TRT costs and how to get it, plus answers to all the most common questions about TRT.
Table of Contents
TRT stands for “testosterone replacement therapy” and is a form of hormone therapy that’s most commonly used to restore a man’s testosterone (T) level to a normal range when it drops too low.
The “normal” range of testosterone levels is typically defined as somewhere between 300 nanograms per deciliter (ng/dL) and 1,000 ng/dL, with blood levels below this range considered “low,” and levels above this range considered indicative of steroid use.
Medical professionals can administer TRT treatment in several ways depending on your specific needs and the protocols of the TRT clinic. The most common methods include:
- TRT injection
- TRT cream
- TRT patches
- TRT pills
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Hypogonadism is a condition in which a man’s testes produce little or no testosterone.
(Hypogonadism can also affect women and involves reduced levels of female sex hormones, but the term is usually applied to men, especially when discussing TRT therapy.)
It can affect men at any age and causes symptoms such as:
- Reduced libido
- Erectile dysfunction
- Reduced muscle mass and strength
- Increased adiposity (fat gain)
- Osteoporosis or low bone mass
Typically, doctors prescribe TRT therapy to men suffering from hypogonadism because it improves many of the symptoms associated with low T.
This isn’t the only reason people use TRT, though.
In recent years, TRT use has become more popular among men who don’t suffer from “classic hypogonadism,” but who want to fight the gradual age-associated decline in testosterone levels that begins in men in their mid-30s and continues at an average rate of 1.6% per year thereafter (also known as “age-related hypogonadism”).
Basically, instead of accepting this natural, subtle drift toward lower testosterone levels, some men use TRT to keep their levels as high as they were in their late teens and twenties for decades on end.
Bear in mind, however, that the only FDA-approved way to get TRT is to be diagnosed with classic hypogonadism, not age-related hypogonadism. Thus, any man that takes TRT to treat age-related hypogonadism has either given their doctor reason to believe they also have classic hypogonadism, or they’ve acquired it illegally.
Research shows that testosterone deficiency is on the rise in the US.
One recent study conducted by scientists at Riga Stradins University estimated that nearly 80% of men with obesity, type 2 diabetes, metabolic syndrome, dyslipidemia, arterial hypertension, and/or chronic obstructive pulmonary disease also have low T.
Since two out of three men in the United States have one (or more) of these conditions, the overall percentage of men with low T is staggeringly high.
If you suspect you have low T, the only way to get a confirmed diagnosis is to take a testosterone level test.
Even then, you may have to take several tests before you’re sure that your T levels are low since T levels fluctuate depending on factors such as diet, sleep habits, body composition, and the time of day that you take the test.
(If you do have verifiably low testosterone levels, though, this doesn’t necessarily mean you have to start TRT therapy. There are a number of things you can do to raise your testosterone levels naturally, and you can learn all about them in my fitness books for men: Bigger Leaner Stronger, Muscle for Life, and Beyond Bigger Leaner Stronger.)
When it comes to TRT, most online resources look at TRT therapy through rose-colored glasses.
It’s common to hear mention of “TRT muscle gain” and “TRT fat loss,” but there’s far less chatter about TRT side effects. Speak with many avid TRT users, and you’ll probably walk away with a similar impression: TRT is all gain and no pain.
You’d be wise to take these reports with a grain of salt, though.
Many websites make money by promoting TRT-related products, and thus have an incentive to paper over the downsides.
Moreover, many TRT users whitewash the risks as a way to rationalize their choice to take testosterone or simply haven’t been taking it long enough to experience long-term side effects.
Let’s see what science says about TRT’s pros and cons, so you get the whole picture.
Regardless of whether your T is waning because of a medical condition like hypogonadism or the sands of time, research shows that TRT is likely to reduce many of your symptoms.
The best evidence for this comes from a series of seven placebo-controlled, double-blind studies published in the journal Clinical Trials around the mid-2010s known as “The Testosterone Trials.”
After studying the effects of TRT in 788 men aged 65 and older, The Testosterone Trials showed that TRT can . . .
- Improve overall sexual activity, sexual desire, and erectile function
- Increase muscle mass, strength, and power, and self-reported mobility
- Increase bone strength
- Reduce fat mass
In other words, almost (but not all) all of the physical symptoms of low T are alleviated by TRT therapy.
Not every man with low T experiences symptoms of low T.
That is, some men who meet the medical criteria for low T feel healthy and strong, have high energy levels, sleep well, and don’t suffer anxiety.
If this is the case for you, there’s no reason to start taking TRT because it won’t improve your quality of life, and the risks likely outweigh the benefits.
What’s more, The Testosterone Trials showed that TRT isn’t effective at treating all of the symptoms associated with low T. Specifically, they found that TRT . . .
- Doesn’t improve vitality (how much energy you have) to a significant degree
- Has only a very modest positive effect on mood (it may alleviate depressive symptoms to a small degree)
- Doesn’t improve cognitive function
Thus, if you have low T but only experience symptoms such as low energy, poor mood, and decreased cognitive function, then TRT is unlikely to help.
It’s also worth noting that all of the subjects in The Testosterone Trials started with clinically low testosterone levels (below 275 ng/dL), and thus you shouldn’t expect similar benefits if your testosterone levels are in the lower end of the normal range.
For example, if your testosterone levels are currently 400 ng/dL, doubling them to 800 ng/dL isn’t going to significantly improve muscle mass, strength gain, energy, mood, sexual health, or much of anything. To notice significant benefits, you’d likely have to take enough TRT to boost your testosterone levels above the upper end of the “normal” range—to use them like steroids, basically.
One of the main concerns people have about TRT is that it can affect your cardiovascular health, but it’s not clear how legitimate this fear is.
For instance, research conducted by scientists at the University of Pennsylvania as part of The Testosterone Trials showed that taking TRT may increase “noncalcified coronary artery plaque volume,” which could be dangerous because it means that TRT may make the lumen (the passageway inside of arteries that blood flows through) smaller.
However, several studies show that testosterone therapies have no adverse effect on cardiovascular health, which is probably why the researchers from the University of Pennsylvania concluded that TRT doesn’t increase your risk of experiencing cardiovascular problems.
That said, other risks associated with TRT use include:
- Increased risk of prostate cancer (there are many studies that refute this and it remains unclear how the two are connected).
- Increased risk of benign prostatic hyperplasia (enlarged prostate)
- Increased risk of male breast cancer
- Increased risk of polycythemia—an abnormally increased concentration of hemoglobin in the blood, which may lead to an higher risk of vascular problems, including stroke, heart attack, and deep vein thrombosis
- Exacerbated sleep apnea
- Decreased sperm quality
- Skin conditions such as acne, redness, and itchiness
- Gynecomastia and/or breast pain
Another consequence of TRT therapy that many people don’t consider is contamination. This isn’t an issue if you receive TRT through injections or pills, but if you get testosterone from patches, gels, or creams, as many men do, you have to be very careful to make sure it doesn’t come into contact with others.
For instance, if your wife or child touches the area of your skin where you applied testosterone cream, or you touch them without washing your hands, this can boost their testosterone levels and cause serious side effects. The same thing can happen if others touch clothes that have absorbed some of the cream or gel.
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The only FDA-approved way to get TRT is to be diagnosed with classic hypogonadism, not age-related hypogonadism.
That is, the FDA only classifies TRT as an approved treatment for hypogonadism or testosterone deficiency associated with hypogonadism, not testosterone deficiency due to aging.
The reason for this, they say, is the benefit and safety of TRT has not been established for the treatment of low T levels due to aging and may increase the risk of cardiovascular issues and strokes. Plus, they don’t want bodybuilders cadging TRT from doctors as a legal way to get steroids.
- Are retrospective and observational (and thus constitute weak evidence)
- Use higher doses of TRT than people use in practice
- Misreport results
- Don’t recognize issues with the studies’ designs
- Prove the opposite is true (one meta-analysis shows similar risk for cardiovascular issues and mortality between TRT and placebo)
What’s more, critics often point out that low T levels may contribute to mortality and coronary artery disease and that most studies show reduced mortality and reduced risk of heart attack and stroke with long-term testosterone treatments.
All the same, if you aren’t diagnosed with hypogonadism, a (legitimate) doctor won’t prescribe you TRT.
The cost of TRT treatment varies depending on several factors, including:
- Where you live
- Which TRT clinic you use
- The type and quantity of TRT therapy you need
- How the TRT clinic administers your TRT treatment
- Whether you have health insurance
That said, most people can expect to pay at least $150 per month for TRT.
(Also, bear in mind that TRT doesn’t treat the underlying cause of low T, which means you may need TRT treatment for the rest of your life.)
Provided you’re comfortable with the risks, taking TRT is an effective way to alleviate many of the unwanted symptoms of low T that accompany medical conditions such as hypogonadism.
However, if you . . .
- Don’t have low T
- Have low T but have no symptoms of low T
- Have low T but your only symptoms are low energy, poor mood, or decreased cognitive function
- Are concerned about the risks
- Have low-ish T that’s still within the normal, healthy range
. . . then TRT probably isn’t for you.
Before you jump on the TRT bandwagon, it’s also worth attempting to raise your testosterone levels naturally. Many people with low testosterone levels are making a number of poor lifestyle choices that cumber their natural testosterone production, and simply correcting these mistakes is often enough to get your levels into a normal, healthy range. Check out this article to learn more.
TRT isn’t just for men—you can get TRT for women, too.
The optimal TRT dose is person- and situation-specific, so you’ll need to speak to your doctor to learn what TRT dosage is right for you.
The price of TRT varies depending on factors such as:
- Where you live
- Which TRT clinic you use
- The type and quantity of TRT therapy you need
- How your TRT treatment is administered
- Whether you have health insurance
Thus, it’s difficult to say how much TRT will cost for you. That said, most people can expect to pay at least $150 per month.
Some people who can’t or don’t want to get a prescription for TRT also try to buy it illegally online, but this isn’t something I’d recommend.
Some of the TRT products you can buy online will be made by pharmaceutical companies, but many will be produced in underground labs by amateur chemists, and that means you have to ask yourself: how comfortable are you handing your health over to anonymous criminals?
Remember that many illicit supplements sold online, like SARMs, are frequently contaminated with unsafe or ineffective ingredients, so you’re playing roulette with your health by using them.
Taking TRT makes building muscle and losing fat easier, which means that you can expect to see improvements in your physique if you increase your T levels using TRT and optimize your diet and training regimen to build muscle and lose fat.
In fact, with the right diet and exercise program, you can skip the TRT altogether and still build muscle, lose fat, and get healthy fast, and I explain exactly what this entails in my best-selling fitness book for men, Bigger Leaner Stronger.
If you want to stop taking TRT, you should work with your doctor or TRT clinic to decide the best way to “taper off” (systematically lower the dose) your treatment over the course of a period of weeks or months.
If you stop taking TRT, any symptoms you experienced before starting your treatment will return, unless you make other lifestyle changes to help ameliorate them.
Yes and no.
While testosterone is an anabolic steroid, the amount used in testosterone replacement therapy is meant to be just enough to nudge your levels into a healthy, normal range, whereas you have to take enough to boost your levels well beyond this level to significantly improve your body composition.
(This is also why you should look askance at guys who are suspiciously swole, lean, and strong who claim they’re “just taking TRT,” when in reality they’re taking enough to keep their levels well above what they could ever achieve naturally.)
TRT significantly decreases sperm count, which means you’re unlikely to conceive while taking TRT.
That said, most men’s sperm count increases once they stop taking TRT.
Thus, if you suffer from low T but would like to have biological children in the near future, TRT may not be a suitable treatment for you.
Testosterone doesn’t cause hair loss, but a byproduct of testosterone known as dihydrotestosterone (DHT) might.
Specifically, an enzyme called 5α-reductase converts T into DHT, which can then cause hair follicles to shrink and become less able to support healthy hair if you’re genetically predisposed to baldness.
Thus, taking TRT may hasten the onset of baldness in some men, but this isn’t the case for everyone.
TRT isn’t without risks, though some of the purported side effects of TRT are overblown.
For example, it’s unlikely that TRT increases your risk of cardiovascular issues and prostate cancer.
That said, studies show that taking TRT may . . .
- Increase your risk of benign prostatic hyperplasia (enlarged prostate)
- Increase your risk of male breast cancer
- Increase your risk of polycythemia—an abnormally increased concentration of hemoglobin in the blood, which may lead to an higher risk of vascular problems, including stroke, heart attack, and deep vein thrombosis
- Exacerbate sleep apnea
- Lower sperm quality
- Cause skin conditions such as acne, redness, and itchiness
- Cause gynecomastia and/or breast pain
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You can buy testosterone booster supplements, but I wouldn’t recommend it, mainly because they’re hot garbage.
If you want to increase your T levels but don’t have hypogonadism, here are some natural methods you can try:
- Lift weights: People who exercise regularly have higher testosterone levels. This is even true in elderly and obese people.
- Change your diet: Eat a high-carb diet with plenty of healthy fats. (And if you’d like specific advice about what diet to follow to reach your fitness goals, take the Legion Diet Quiz.)
- Minimize stress: Increased cortisol leads to reduced testosterone.
- Take a multivitamin supplement: Some studies show a link between increased vitamin D and increased testosterone, while other studies show deficiencies in zinc, and vitamins A, C, and E are linked to decreased testosterone. If you want a multivitamin that contains clinically effective doses of vitamin A, C, D, and E and zinc, as well as 26 other ingredients designed to enhance your health and mood and reduce stress, fatigue, and anxiety, try Triumph. (And if you’d like more specific advice about what supplements to take to reach your fitness goals, take the Legion Supplement Finder Quiz.)
- Take a DHEA supplement: Studies show that DHEA increases testosterone production in older men and estrogen production in older women. If you want a wellness supplement that contains a clinically effective dose of DHEA as well as three other ingredients designed to make you feel fitter, livelier, and calmer, try Vitality.
- Get plenty of sleep: Sleep deficiency correlates with low testosterone.
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