Testosterone Replacement Therapy—Should You Do It?

Kristin Hall, FNP
Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 7/12/2020

Erectile dysfunction is a surprisingly common condition that many men prefer not to think about. Though there are a number of risk factors that can contribute to erectile issues, low testosterone is frequently a contributing factor. Testosterone is the male sex hormone produced in the testicles, and it affects everything from a man’s physical appearance to his sexual development and function. Testosterone Replacement Therapy is a leading and preferred way for men of all ages to overcome that low testosterone count and come back into the bedroom swinging.

According to the American Urological Association, about 1 in 5 men over the age of 60 have low testosterone (low-T) levels. That number jumps to one in three men over the age of seventy. It probably doesn’t surprise you to learn that erectile dysfunction is a common consequence of aging in men. What you may not know, however, is that it can affect younger men as well. In fact, research even suggests that one in four men over the age of 30 have low testosterone.

Low testosterone can significantly impact your libido and sexual function (We have stuff for that, by the way), but solving the problem isn’t quite so simple as just replacing the missing hormone. Testosterone Replacement Therapy (TRT) comes with some serious risks, and it is only recommended in very specific situations. Keep reading to learn more about what Testosterone Replacement Therapy is and whether you should consider it.

What is Low Testosterone?

The normal range for testosterone levels in men is between 300 and 1,000 nanograms per deciliter (ng/dL). Low testosterone is clinically defined as 300ng/dL of total testosterone, as well as free testosterone levels below 5ng/dL. When testosterone levels drop below these values, it is likely to produce symptoms such as the following:

  • Reduced sex drive (low libido)
  • Difficulty achieving and/or maintaining an erection
  • Decreased semen volume during ejaculation
  • Hair loss, particularly on the head
  • Fatigue and low energy
  • Reduction in muscle mass (not necessarily strength)
  • Increased body fat percentage
  • Osteoporosis or decreased bone mass
  • Changes in mood or mental capacity

As you can see, erectile dysfunction is not the only consequence of low testosterone. In addition to changes to your sexual function and physical appearance, declining testosterone levels can also impact your sleep and emotions. In many cases, these symptoms overlap with the symptoms of chronic diseases like diabetes or cancer which can sometimes make low-T a tricky condition to diagnose. Fortunately, a blood serum testosterone test is a quick and easy way to determine testosterone levels.

What Does Testosterone Replacement Therapy Entail?

Low testosterone is fairly common but, in many men, it does not produce obvious symptoms. In cases where symptoms are present, fatigue and sexual dysfunction are the most common. Depending on how severe these and other symptoms are, you and your doctor will decide whether treatment is warranted or not. If it is, a treatment called Testosterone Replacement Therapy is an option to consider.

Simply put, Testosterone Replacement Therapy involves supplementing the body’s natural hormone production to bring testosterone levels back into the healthy range. Supplemental hormones can be delivered in one of several ways including the following:

  • Skin patches
  • Topical gels
  • Tablets
  • Implants
  • Injections

Skin patches are a form of transdermal TRT, and all you have to do is apply a new patch to the arm or upper body once every 24 hours. A similar option comes in the form of gels like Testim® and AndroGel®, which can be applied directly to the skin once a day. Similar to oral medication, mouth patches or tablets are two other options. The tablet is inserted into the mouth, applied to the upper gums above the incisor twice a day for the continuous release of testosterone into the bloodstream. The last two options involve implanting a hormone-delivering pellet under the skin or injecting testosterone directly into the muscle itself.

What Are the Risks and Rewards?

Though Testosterone Replacement Therapy sounds like an obvious solution for low-T, that isn’t necessarily the case. Testosterone Replacement Therapy side effects abound, and there is no way to accurately predict how your body is going to respond to testosterone replacement. In some cases, the risks do not outweigh the rewards.

It is very common, for example, to develop itching or irritation at the application site (depending which delivery method you choose). If you don’t wash your hands after applying a patch or gel, you risk developing a reaction on other parts of the body as well. More than that, Testosterone Replacement Therapy could have a negative effect on your long-term health and wellness.

Of course, potential Testosterone Replacement Therapy results are alluring many.

The primary potential benefit of TRT is, of course, normalized testosterone levels and relief from symptoms of low-T. For many men, this means an improvement in libido as well as sexual function, and it could also lead to improved mood and energy levels.

For the most part, there are no large-scale clinical trials that have tested the long-term effects of testosterone therapy. There is evidence to suggest, however, that TRT may increase your risk of heart disease, heart attack or stroke. Testosterone therapy can also contribute to sleep disturbances, skin reactions, reduced sperm production, testicle shrinkage and enlarged breasts. It could also stimulate the growth of prostate cancer cells and increase the risk of blood clots.

Things to Think About Before You Decide

If you decide that TRT is the best treatment for you, you should know that it won’t be an immediate improvement. It may take as long as four to six weeks for symptoms of low-T to abate. You should also know that once you start taking supplemental testosterone, your body’s natural production of the hormone will slow down.

Testosterone production is regulated by the hypothalamus in the brain and the pituitary gland. When testosterone levels drop below the optimal level, the hypothalamus and the pituitary gland detect the change and send chemical signals that trigger the natural production of testosterone. In a man who has low-T, it is normally the case that either the body is unable to properly send those chemical signals to produce sufficient testosterone, or the body’s ability to respond to those signals becomes impaired. In either case, if you start Testosterone Replacement Therapy and your testosterone levels return to normal, natural production will slow down or stop. If you stop taking testosterone supplements, your body will go back to its inadequate baseline production.

Depending on the underlying cause for low testosterone levels, TRT may be a long-term therapy. Though you may experience relief from symptoms after a month or so, they will return if you stop the therapy. This can be problematic for a number of reasons, not the least of which is the fact that long-term use of Testosterone Replacement Therapy can cause some nasty side effects.

Because Testosterone Replacement Therapy comes with some serious risks for side effects, you should think carefully before agreeing to this kind of therapy. Talk to your doctor about all of the options available to you in order to determine which is the best course of treatment. If together you decide that TRT is not the best option, rest easy knowing that there are some alternatives. Here are some natural ways to boost your testosterone levels:

  • Start exercising more regularly and include strength training in your routine.
  • Moderate your calorie intake and eat a balance of protein, fats and carbs.
  • Manage your stress to reduce cortisol levels and the resulting inflammation.
  • Boost your Vitamin D intake with natural sunlight and/or dietary supplements.
  • Make an effort to get seven to eight hours of high-quality sleep every night.
  • Avoid excessive exposure to estrogen-like compounds such as soy products.

Declining testosterone levels is natural, to a certain degree, but if it starts to seriously impact your life, you may want to talk to your doctor about treatment. Before you assume that Testosterone Replacement Therapy is the best option, make sure you take the time to learn everything you can about it so you can make an informed decision.

Want to know more about low-T, erectile dysfunction or the science of sex? Head on over to our blog.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.