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
What Is TRT?
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
Why Do People Take TRT?
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
- Depression
- Fatigue
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.
By short-circuiting their body’s natural physiology, they feel more vital and virile and can build muscle, gain strength, and lose fat more easily.
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.
How to Know if You Have Low Testosterone
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.)
TRT: Pros and Cons
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.
TRT Benefits
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.
TRT Downsides
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.
TRT: Risks
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.
How to Get TRT
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.
If you dig around online, you’ll find that the FDA’s position is fervently disputed, with critics saying that the studies used to bolster their argument . . .
- 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.
How Much Does TRT Cost?
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.)
Conclusion
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.
FAQ #1: Is TRT for men only, or is TRT for women, too?
TRT isn’t just for men—you can get TRT for women, too.
That said, there is no well-defined clinical syndrome caused by testosterone deficiency in women, so doctors only tend to prescribe TRT for women as a treatment for low libido.
FAQ #2: What’s the optimal TRT dosage?
It depends.
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.
FAQ #3: How much is TRT and can you buy TRT online?
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.
FAQ #4: Are the “TRT results” and “TRT before and after pictures” you see online realistic?
Maybe.
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.
FAQ #5: Once you start TRT can you stop?
Yes.
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.
FAQ #6: Is TRT steroids?
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.)
FAQ #7: Does TRT make you infertile?
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.
FAQ #8: Does TRT cause hair loss?
Not necessarily.
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.
FAQ #9: Is TRT safe?
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
FAQ #10: Can you buy TRT supplements?
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.
+ Scientific References
- Mulhall, J. P., Trost, L. W., Brannigan, R. E., Kurtz, E. G., Redmon, J. B., Chiles, K. A., Lightner, D. J., Miner, M. M., Murad, M. H., Nelson, C. J., Platz, E. A., Ramanathan, L. V., & Lewis, R. W. (2018). Evaluation and Management of Testosterone Deficiency: AUA Guideline. The Journal of Urology, 200(2), 423–432. https://doi.org/10.1016/J.JURO.2018.03.115
- Kumar, P., Kumar, N., Thakur, D. S., & Patidar, A. (2010). Male hypogonadism: Symptoms and treatment. Journal of Advanced Pharmaceutical Technology & Research, 1(3), 297. https://doi.org/10.4103/0110-5558.72420
- Cox, L., & Liu, J. H. (2014). Primary ovarian insufficiency: an update. International Journal of Women’s Health, 6(1), 235. https://doi.org/10.2147/IJWH.S37636
- Dandona, P., & Rosenberg, M. T. (2010). A practical guide to male hypogonadism in the primary care setting. International Journal of Clinical Practice, 64(6), 682. https://doi.org/10.1111/J.1742-1241.2010.02355.X
- Wang, C., Nieschlag, E., Swerdloff, R. S., Behre, H., Hellstrom, W. J., Gooren, L. J., Kaufman, J. M., Legros, J. J., Lunenfeld, B., Morales, A., Morley, J. E., Schulman, C., Thompson, I. M., Weidner, W., & Wu, F. C. W. (2009). ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males. The Aging Male : The Official Journal of the International Society for the Study of the Aging Male, 12(1), 5–12. https://doi.org/10.1080/13685530802389628
- Elliot Reimers, M. S. (C). C. C. (n.d.). Is it Low T? The Truth about Testosterone Replacement Therapy (TRT) – Transparent Labs. Retrieved March 18, 2022, from https://www.transparentlabs.com/blogs/all/guide-to-testosterone-replacement-therapy-trt
- Erenpreiss, J., Fodina, V., Pozarska, R., Zubkova, K., Dudorova, A., & Pozarskis, A. (2020). Prevalence of testosterone deficiency among aging men with and without morbidities. The Aging Male : The Official Journal of the International Society for the Study of the Aging Male, 23(5), 901–905. https://doi.org/10.1080/13685538.2019.1621832
- Gurka, M. J., Filipp, S. L., & Deboer, M. D. (2018). Geographical variation in the prevalence of obesity, metabolic syndrome, and diabetes among US adults. Nutrition & Diabetes, 8(1). https://doi.org/10.1038/S41387-018-0024-2
- Whittaker, J., & Wu, K. (2021). Low-fat diets and testosterone in men: Systematic review and meta-analysis of intervention studies. The Journal of Steroid Biochemistry and Molecular Biology, 210. https://doi.org/10.1016/J.JSBMB.2021.105878
- Leproult, R., & Van Cauter, E. (2011). Effect of 1 Week of Sleep Restriction on Testosterone Levels in Young Healthy MenFREE. JAMA, 305(21), 2173. https://doi.org/10.1001/JAMA.2011.710
- Rohrmann, S., Shiels, M. S., Lopez, D. S., Rifai, N., Nelson, W. G., Kanarek, N., Guallar, E., Menke, A., Joshu, C. E., Feinleib, M., Sutcliffe, S., & Platz, E. A. (2011). Body fatness and sex steroid hormone concentrations in US men: results from NHANES III. Cancer Causes & Control : CCC, 22(8), 1141–1151. https://doi.org/10.1007/S10552-011-9790-Z
- Brambilla, D. J., Matsumoto, A. M., Araujo, A. B., & McKinlay, J. B. (2009). The Effect of Diurnal Variation on Clinical Measurement of Serum Testosterone and Other Sex Hormone Levels in Men. The Journal of Clinical Endocrinology and Metabolism, 94(3), 907. https://doi.org/10.1210/JC.2008-1902
- Snyder, P. J., Ellenberg, S. S., Cunningham, G. R., Matsumoto, A. M., Bhasin, S., Barrett-Connor, E., Gill, T. M., Farrar, J. T., Cella, D., Rosen, R. C., Resnick, S. M., Swerdloff, R. S., Cauley, J. A., Cifelli, D., Fluharty, L., Pahor, M., Ensrud, K. E., Lewis, C. E., Molitch, M. E., … Hadley, E. (2014). The Testosterone Trials: Seven coordinated trials of testosterone treatment in elderly men. Clinical Trials (London, England), 11(3), 362–375. https://doi.org/10.1177/1740774514524032
- Brock, G., Heiselman, D., Maggi, M., Kim, S. W., Rodríguez Vallejo, J. M., Behre, H. M., McGettigan, J., Dowsett, S. A., Hayes, R. P., Knorr, J., Ni, X., & Kinchen, K. (2016). Effect of Testosterone Solution 2% on Testosterone Concentration, Sex Drive and Energy in Hypogonadal Men: Results of a Placebo Controlled Study. Journal of Urology, 195(3), 699–705. https://doi.org/10.1016/J.JURO.2015.10.083
- Bhasin, S., Ellenberg, S. S., Storer, T. W., Basaria, S., Pahor, M., Stephens-Shields, A. J., Cauley, J. A., Ensrud, K. E., Farrar, J. T., Cella, D., Matsumoto, A. M., Cunningham, G. R., Swerdloff, R. S., Wang, C., Lewis, C. E., Molitch, M. E., Barrett-Connor, E., Crandall, J. P., Hou, X., … Gill, T. M. (2018). Effect of testosterone replacement on measures of mobility in older men with mobility limitation and low testosterone concentrations: secondary analyses of the Testosterone Trials. The Lancet Diabetes & Endocrinology, 6(11), 879–890. https://doi.org/10.1016/S2213-8587(18)30171-2
- Storer, T. W., Basaria, S., Traustadottir, T., Harman, S. M., Pencina, K., Li, Z., Travison, T. G., Miciek, R., Tsitouras, P., Hally, K., Huang, G., & Bhasin, S. (2017). Effects of Testosterone Supplementation for 3 Years on Muscle Performance and Physical Function in Older Men. The Journal of Clinical Endocrinology and Metabolism, 102(2), 583–593. https://doi.org/10.1210/JC.2016-2771
- Snyder, P. J., Kopperdahl, D. L., Stephens-Shields, A. J., Ellenberg, S. S., Cauley, J. A., Ensrud, K. E., Lewis, C. E., Barrett-Connor, E., Schwartz, A. V., Lee, D. C., Bhasin, S., Cunningham, G. R., Gill, T. M., Matsumoto, A. M., Swerdloff, R. S., Basaria, S., Diem, S. J., Wan, C., Hou, X., … Keaveny, T. M. (2017). Effect of Testosterone Treatment on Volumetric Bone Density and Strength in Older Men With Low Testosterone: A Controlled Clinical Trial. JAMA Internal Medicine, 177(4), 471–479. https://doi.org/10.1001/JAMAINTERNMED.2016.9539
- Snyder, P. J., Bhasin, S., Cunningham, G. R., Matsumoto, A. M., Stephens-Shields, A. J., Cauley, J. A., Gill, T. M., Barrett-Connor, E., Swerdloff, R. S., Wang, C., Ensrud, K. E., Lewis, C. E., Farrar, J. T., Cella, D., Rosen, R. C., Pahor, M., Crandall, J. P., Molitch, M. E., Resnick, S. M., … Ellenberg, S. S. (2018). Lessons From the Testosterone Trials. Endocrine Reviews, 39(3), 369–386. https://doi.org/10.1210/ER.2017-00234
- Budoff, M. J., Ellenberg, S. S., Lewis, C. E., Mohler, E. R., Wenger, N. K., Bhasin, S., Barrett-Connor, E., Swerdloff, R. S., Stephens-Shields, A., Cauley, J. A., Crandall, J. P., Cunningham, G. R., Ensrud, K. E., Gill, T. M., Matsumoto, A. M., Molitch, M. E., Nakanishi, R., Nezarat, N., Matsumoto, S., … Snyder, P. J. (2017). Testosterone Treatment and Coronary Artery Plaque Volume in Older Men With Low Testosterone. JAMA, 317(7), 708. https://doi.org/10.1001/JAMA.2016.21043
- Basaria, S., Harman, S. M., Travison, T. G., Hodis, H., Tsitouras, P., Budoff, M., Pencina, K. M., Vita, J., Dzekov, C., Mazer, N. A., Coviello, A. D., Knapp, P. E., Hally, K., Pinjic, E., Yan, M., Storer, T. W., & Bhasin, S. (2015). Effects of Testosterone Administration for 3 Years on Subclinical Atherosclerosis Progression in Older Men With Low or Low-Normal Testosterone Levels: A Randomized Clinical Trial. JAMA, 314(6), 570–581. https://doi.org/10.1001/JAMA.2015.8881
- Srinivas-Shankar, U., Roberts, S. A., Connolly, M. J., O’Connell, M. D. L., Adams, J. E., Oldham, J. A., & Wu, F. C. W. (2010). Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. The Journal of Clinical Endocrinology and Metabolism, 95(2), 639–650. https://doi.org/10.1210/JC.2009-1251
- Onasanya, O., Iyer, G., Lucas, E., Lin, D., Singh, S., & Alexander, G. C. (2016). Association between exogenous testosterone and cardiovascular events: an overview of systematic reviews. The Lancet. Diabetes & Endocrinology, 4(11), 943–956. https://doi.org/10.1016/S2213-8587(16)30215-7
- Huggins, C., & Hodges, C. V. (1972). Studies on prostatic cancer. I. The effect of castration, of estrogen and androgen injection on serum phosphatases in metastatic carcinoma of the prostate. CA: A Cancer Journal for Clinicians, 22(4), 293–297. https://doi.org/10.3322/CANJCLIN.22.4.232
- Morgentaler, A. (2006). Testosterone therapy for men at risk for or with history of prostate cancer. Current Treatment Options in Oncology, 7(5), 363–369. https://doi.org/10.1007/S11864-006-0004-Y
- Ramasamy, R., Fisher, E. S., & Schlegel, P. N. (2012). Testosterone replacement and prostate cancer. Indian Journal of Urology : IJU : Journal of the Urological Society of India, 28(2), 123. https://doi.org/10.4103/0970-1591.98449
- Bell, M. A., Campbell, J. D., Joice, G., Sopko, N. A., & Burnett, A. L. (2018). Shifting the Paradigm of Testosterone Replacement Therapy in Prostate Cancer. The World Journal of Men’s Health, 36(2), 103. https://doi.org/10.5534/WJMH.170007
- Polchert, M., Voznesensky, I., Soubra, A., & Hellstrom, W. J. G. (2021). Updated Review of Testosterone Replacement Therapy in the Setting of Prostate Cancer. Https://Home.Liebertpub.Com/Andro, 2(1), 36–45. https://doi.org/10.1089/ANDRO.2020.0013
- Natale, C., Carlos, C., Hong, J., Khera, M., Baum, N., & Raheem, O. A. (2021). Testosterone Therapy After Prostate Cancer Treatment: A Review of Literature. Sexual Medicine Reviews, 9(3), 393–405. https://doi.org/10.1016/J.SXMR.2020.12.003
- Holmäng, S., Mårin, P., Lindstedt, G., & Hedelin, H. (1993). Effect of long-term oral testosterone undecanoate treatment on prostate volume and serum prostate-specific antigen concentration in eugonadal middle-aged men. The Prostate, 23(2), 99–106. https://doi.org/10.1002/PROS.2990230203
- Thomas, S. R., Evans, P. J., Holland, P. A., & Biswas, M. (2008). Invasive breast cancer after initiation of testosterone replacement therapy in a man--a warning to endocrinologists. Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 14(2), 201–203. https://doi.org/10.4158/EP.14.2.201
- Medras, M., Filus, A., Jozkow, P., Winowski, J., & Sicinska-Werner, T. (2006). Breast cancer and long-term hormonal treatment of male hypogonadism. Breast Cancer Research and Treatment, 96(3), 263–265. https://doi.org/10.1007/S10549-005-9074-Y
- Drinka, P. J., Jochen, A. L., Cuisinier, M., Bloom, R., Rudman, I., & Rudman, D. (1995). Polycythemia as a complication of testosterone replacement therapy in nursing home men with low testosterone levels. Journal of the American Geriatrics Society, 43(8), 899–901. https://doi.org/10.1111/J.1532-5415.1995.TB05534.X
- Calof, O. M., Singh, A. B., Lee, M. L., Kenny, A. M., Urban, R. J., Tenover, J. L., & Bhasin, S. (2005). Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 60(11), 1451–1457. https://doi.org/10.1093/GERONA/60.11.1451
- Kim, S. D., & Cho, K. S. (2019). Obstructive Sleep Apnea and Testosterone Deficiency. The World Journal of Men’s Health, 37(1), 12. https://doi.org/10.5534/WJMH.180017
- Mauras, N., Hayes, V., Welch, S., Rini, A., Helgeson, K., Dokler, M., Veldhuis, J. D., & Urban, R. J. (1998). Testosterone deficiency in young men: marked alterations in whole body protein kinetics, strength, and adiposity. The Journal of Clinical Endocrinology and Metabolism, 83(6), 1886–1892. https://doi.org/10.1210/JCEM.83.6.4892
- Rhoden, E. L., & Morgentaler, A. (2004). Risks of testosterone-replacement therapy and recommendations for monitoring. The New England Journal of Medicine, 350(5), 482–492. https://doi.org/10.1056/NEJMRA022251
- Kurokawa, I., Danby, F. W., Ju, Q., Wang, X., Xiang, L. F., Xia, L., Chen, W. C., Nagy, I., Picardo, M., Suh, D. H., Ganceviciene, R., Schagen, S., Tsatsou, F., & Zouboulis, C. C. (2009). New developments in our understanding of acne pathogenesis and treatment. Experimental Dermatology, 18(10), 821–832. https://doi.org/10.1111/J.1600-0625.2009.00890.X
- Eckman, A., & Dobs, A. (2008). Drug-induced gynecomastia. Expert Opinion on Drug Safety, 7(6), 691–702. https://doi.org/10.1517/14740330802442382
- Morgentaler, A., & Traish, A. (2020). The History of Testosterone and the Evolution of its Therapeutic Potential. Sexual Medicine Reviews, 8(2), 286–296. https://doi.org/10.1016/J.SXMR.2018.03.002
- Miner, M., Morgentaler, A., Khera, M., & Traish, A. M. (2018). The state of testosterone therapy since the FDA’s 2015 labelling changes: Indications and cardiovascular risk. Clinical Endocrinology, 89(1), 3–10. https://doi.org/10.1111/CEN.13589
- Haddad, R. M., Kennedy, C. C., Caples, S. M., Tracz, M. J., Boloña, E. R., Sideras, K., Uraga, M. V., Erwin, P. J., & Montori, V. M. (2007). Testosterone and cardiovascular risk in men: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clinic Proceedings, 82(1), 29–39. https://doi.org/10.4065/82.1.29
- Basaria, S., Coviello, A. D., Travison, T. G., Storer, T. W., Farwell, W. R., Jette, A. M., Eder, R., Tennstedt, S., Ulloor, J., Zhang, A., Choong, K., Lakshman, K. M., Mazer, N. A., Miciek, R., Krasnoff, J., Elmi, A., Knapp, P. E., Brooks, B., Appleman, E., … Bhasin, S. (2010). Adverse events associated with testosterone administration. The New England Journal of Medicine, 363(2), 109–122. https://doi.org/10.1056/NEJMOA1000485
- Vigen, R., O’Donnell, C. I., Barón, A. E., Grunwald, G. K., Maddox, T. M., Bradley, S. M., Barqawi, A., Woning, G., Wierman, M. E., Plomondon, M. E., Rumsfeld, J. S., & Ho, P. M. (2013). Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA, 310(17), 1829–1836. https://doi.org/10.1001/JAMA.2013.280386
- Finkle WD, Greenland S, Ridgeway GK, Adams JL, & Frasco MA. (n.d.). Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men | Healthy Male. Retrieved March 18, 2022, from https://www.healthymale.org.au/research-reviews/increased-risk-non-fatal-myocardial-infarction-following-testosterone-therapy
- Corona, G., Maseroli, E., Rastrelli, G., Isidori, A. M., Sforza, A., Mannucci, E., & Maggi, M. (2014). Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Expert Opinion on Drug Safety, 13(10), 1327–1351. https://doi.org/10.1517/14740338.2014.950653
- Morgentaler, A., Miner, M. M., Caliber, M., Guay, A. T., Khera, M., & Traish, A. M. (2015). Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clinic Proceedings, 90(2), 224–251. https://doi.org/10.1016/J.MAYOCP.2014.10.011
- Wallis, C. J. D., Lo, K., Lee, Y., Krakowsky, Y., Garbens, A., Satkunasivam, R., Herschorn, S., Kodama, R. T., Cheung, P., Narod, S. A., & Nam, R. K. (2016). Survival and cardiovascular events in men treated with testosterone replacement therapy: an intention-to-treat observational cohort study. The Lancet. Diabetes & Endocrinology, 4(6), 498–506. https://doi.org/10.1016/S2213-8587(16)00112-1
- Sharma, R., Oni, O. A., Gupta, K., Chen, G., Sharma, M., Dawn, B., Sharma, R., Parashara, D., Savin, V. J., Ambrose, J. A., & Barua, R. S. (2015). Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. European Heart Journal, 36(40), 2706–2715. https://doi.org/10.1093/EURHEARTJ/EHV346
- Tyagi, V., Scordo, M., Yoon, R. S., Liporace, F. A., & Greene, L. W. (2017). Revisiting the role of testosterone: Are we missing something? Reviews in Urology, 19(1), 16. https://doi.org/10.3909/RIU0716
- Islam, R. M., Bell, R. J., Green, S., & Davis, S. R. (2019). Effects of testosterone therapy for women: a systematic review and meta-analysis protocol. Systematic Reviews, 8(1). https://doi.org/10.1186/S13643-019-0941-8
- Kohn, T. P., Louis, M. R., Pickett, S. M., Lindgren, M. C., Kohn, J. R., Pastuszak, A. W., & Lipshultz, L. I. (2017). Age and Duration of Testosterone Therapy Predict Time to Return of Sperm Count after hCG Therapy. Fertility and Sterility, 107(2), 351. https://doi.org/10.1016/J.FERTNSTERT.2016.10.004
- Urysiak-Czubatka, I., Kmieć, M. L., & Broniarczyk-Dyła, G. (2014). Assessment of the usefulness of dihydrotestosterone in the diagnostics of patients with androgenetic alopecia. Advances in Dermatology and Allergology/Postȩpy Dermatologii i Alergologii, 31(4), 207. https://doi.org/10.5114/PDIA.2014.40925
- Ustuner, E. T. (2013). Cause of Androgenic Alopecia: Crux of the Matter. Plastic and Reconstructive Surgery Global Open, 1(7). https://doi.org/10.1097/GOX.0000000000000005
- Vaamonde, D., Da Silva-Grigoletto, M. E., García-Manso, J. M., Barrera, N., & Vaamonde-Lemos, R. (2012). Physically active men show better semen parameters and hormone values than sedentary men. European Journal of Applied Physiology, 112(9), 3267–3273. https://doi.org/10.1007/S00421-011-2304-6
- Ari, Z., Kutlu, N., Uyanik, B. S., Taneli, F., Buyukyazi, G., & Tavli, T. (2004). Serum testosterone, growth hormone, and insulin-like growth factor-1 levels, mental reaction time, and maximal aerobic exercise in sedentary and long-term physically trained elderly males. The International Journal of Neuroscience, 114(5), 623–637. https://doi.org/10.1080/00207450490430499
- Kumagai, H., Zempo-Miyaki, A., Yoshikawa, T., Tsujimoto, T., Tanaka, K., & Maeda, S. (2016). Increased physical activity has a greater effect than reduced energy intake on lifestyle modification-induced increases in testosterone. Journal of Clinical Biochemistry and Nutrition, 58(1), 84–89. https://doi.org/10.3164/JCBN.15-48
- Lane, A. R., Duke, J. W., & Hackney, A. C. (2010). Influence of dietary carbohydrate intake on the free testosterone: cortisol ratio responses to short-term intensive exercise training. European Journal of Applied Physiology, 108(6), 1125–1131. https://doi.org/10.1007/S00421-009-1220-5
- Costa, R. J. S., Jones, G. E., Lamb, K. L., Coleman, R., & Williams, J. H. H. (2005). The effects of a high carbohydrate diet on cortisol and salivary immunoglobulin A (s-IgA) during a period of increase exercise workload amongst Olympic and Ironman triathletes. International Journal of Sports Medicine, 26(10), 880–885. https://doi.org/10.1055/S-2005-837467
- Bishop, D. T., Meikle, A. W., Slattery, M. L., Stringham, J. D., Ford, M. H., & West, D. W. (1988). The effect of nutritional factors on sex hormone levels in male twins. Genetic Epidemiology, 5(1), 43–59. https://doi.org/10.1002/GEPI.1370050105
- Hämäläinen, E., Adlercreutz, H., Puska, P., & Pietinen, P. (1984). Diet and serum sex hormones in healthy men. Journal of Steroid Biochemistry, 20(1), 459–464. https://doi.org/10.1016/0022-4731(84)90254-1
- Wen, B. M. (1998). Stress, adaptation, and disease. Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840, 33–44. https://doi.org/10.1111/J.1749-6632.1998.TB09546.X
- Cumming, D. C., Quigley, M. E., & Yen, S. S. C. (1983). Acute suppression of circulating testosterone levels by cortisol in men. The Journal of Clinical Endocrinology and Metabolism, 57(3), 671–673. https://doi.org/10.1210/JCEM-57-3-671
- Pilz, S., Frisch, S., Koertke, H., Kuhn, J., Dreier, J., Obermayer-Pietsch, B., Wehr, E., & Zittermann, A. (2011). Effect of vitamin D supplementation on testosterone levels in men. Hormone and Metabolic Research = Hormon- Und Stoffwechselforschung = Hormones et Metabolisme, 43(3), 223–225. https://doi.org/10.1055/S-0030-1269854
- Wehr, E., Pilz, S., Boehm, B. O., März, W., & Obermayer-Pietsch, B. (2010). Association of vitamin D status with serum androgen levels in men. Clinical Endocrinology, 73(2), 243–248. https://doi.org/10.1111/J.1365-2265.2009.03777.X
- Wong, W. Y., Merkus, H. M. W. M., Thomas, C. M. G., Menkveld, R., Zielhuis, G. A., & Steegers-Theunissen, R. P. M. (2002). Effects of folic acid and zinc sulfate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Fertility and Sterility, 77(3), 491–498. https://doi.org/10.1016/S0015-0282(01)03229-0
- Akmal, M., Qadri, J. Q., Al-Waili, N. S., Thangal, S., Haq, A., & Saloom, K. Y. (2006). Improvement in human semen quality after oral supplementation of vitamin C. Journal of Medicinal Food, 9(3), 440–442. https://doi.org/10.1089/JMF.2006.9.440
- Umeda, F., Kato, K. ichi, Muta, K., & Ibayashi, H. (1982). Effect of vitamin E on function of pituitary-gonadal axis in male rats and human subjects. Endocrinologia Japonica, 29(3), 287–292. https://doi.org/10.1507/ENDOCRJ1954.29.287
- Liu, T. C., Lin, C. H., Huang, C. Y., Ivy, J. L., & Kuo, C. H. (2013). Effect of acute DHEA administration on free testosterone in middle-aged and young men following high-intensity interval training. European Journal of Applied Physiology, 113(7), 1783–1792. https://doi.org/10.1007/S00421-013-2607-X
- Kenny, A. M., Boxer, R. S., Kleppinger, A., Brindisi, J., Feinn, R., & Burleson, J. A. (2010). Dehydroepiandrosterone combined with exercise improves muscle strength and physical function in frail older women. Journal of the American Geriatrics Society, 58(9), 1707–1714. https://doi.org/10.1111/J.1532-5415.2010.03019.X
- Leproult, R., & Van Cauter, E. (2011). Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA, 305(21), 2173–2174. https://doi.org/10.1001/JAMA.2011.710
- Penev, P. D. (2007). Association between sleep and morning testosterone levels in older men. Sleep, 30(4), 427–432. https://doi.org/10.1093/SLEEP/30.4.427
