What is TRT (Testosterone Replacement Therapy)?
TRT is an acronym for testosterone replacement therapy, which is also called androgen replacement therapy.
TRT is a hormone replacement therapy used to treat low testosterone levels in men. It does so by adding external/exogenous testosterone to raise low serum testosterone levels.
How Does TRT Work?
In TRT, your doctor prescribes a specific testosterone dosage based on your current testosterone level.
The therapy is administered regularly to ensure your low serum testosterone levels increase and stay within the healthy range.
Testosterone can be taken in any form, such as injection, cream, gel, patch, pellet, pill, etc. Your doctor determines the most suitable form based on your individual needs.
Your testosterone levels are monitored regularly to ensure they remain within the normal range.
How is TRT Delivered?
There are several different ways to administer testosterone. The most common forms of TRT include:
Testosterone Topical Cream/Gel
Gels are applied to the skin surface daily. These are convenient and can be done at home, but it’s important not to expose your skin portion, where you applied the gel, to anyone else for the next few hours after application to prevent testosterone transfer.
While the gel application is convenient, the fact that you cannot come into contact with anyone for hours afterwards is not.
Testosterone Patches
Patches are one of the easiest types of treatment to apply and are highly effective. They are applied once a day on the abdomen, upper thighs or arms. You can apply them on your own at home.
Buccal Patches
Testosterone buccal patches are applied to the upper gum twice each day. However, they can cause gum irritation in some patients. Use them with caution with the guidance of a medical professional.
Testosterone Injections
Injections are perhaps the most popular way to administer TRT. Injections are typically given every 1 to 4 weeks.
Compared to the other TRT treatments, injections are very affordable, and they provide a controlled dose.
However, the drawback to injections is that your testosterone levels can peak soon after injection and then gradually drop before the next dose. Thus, you have to stay on a consistent schedule to achieve best results.
Subcutaneous Pellets
Testosterone pellets are inserted beneath the skin every 3 to 6 months. They provide more even distribution and are also very convenient once they are in.
However, you will have to undergo a minor surgical procedure for each of these pellets, which is expensive, time-consuming, and taxing on the body.
Testosterone Pills
Oral testosterone forms are also available for patients not interested in injections or topical testosterone replacement.
However, they are less preferred compared to other TRT types because of their liver toxicity risk and lower bioavailability.
How to Determine if You Have Low Testosterone?
The only way to determine whether you have low T is through a testosterone blood test. It will show your current level of testosterone and compare it against normal levels.
A testosterone test normally measures free testosterone levels (the form of testosterone that’s available for use) as well as total testosterone levels (free testosterone plus bound testosterone).
For adult males, the normal testosterone range is approximately 6-27 nmol/L. Levels below this range indicate low testosterone. Levels near the lower end of the range may also be associated with symptoms of low T in some men.
Blood sample for this test is mostly taken between 7 AM to 10 AM because testosterone levels are higher during this time.
TRT Medical Uses
TRT is a treatment that has traditionally been used to treat male hypogonadism – a condition in which testicles don’t produce enough testosterone for the body. Hypogonadism has two types:
Primary Hypogonadism – In which low testosterone occurs due to a problem with testicles. They receive signals from the brain to create testosterone but are unable to do so.
Secondary Hypogonadism or Central Hypogonadism – It occurs due to a problem with either hypothalamus or pituitary gland, which sends signals to testicles to initiate testosterone production.
TRT is effective in optimising testosterone levels regardless of what hypogonadism type you have.
Men who have low T due to the following conditions often report improvement with TRT:
- Testicular injury
- Sex organ surgery
- Radiation therapy
- Cancer treatment
- Undescended testicles
- Genetic disorders
- Autoimmune disorders
- Brain trauma
- Pituitary tumours
- Delayed puberty
- Age-related decline
Testosterone Replacement Therapy for Women
TRT is mainly a male treatment but it is sometimes prescribed to women as well.
In women, testosterone is given during menopause to improve symptoms like low sex drive, mood changes and low energy. It is often prescribed when estrogenic therapy alone is not enough.
Elective TRT Applications
Some men take testosterone for non-medical purposes even when their testosterone levels are within the normal range. Mostly, they do it to increase endurance, muscle mass and athletic performance.
Increasing testosterone levels beyond what’s considered normal can lead to various health risks, such as cardiovascular disease, liver damage and hormonal imbalances. In some cases, it can also cause mood swings, aggression, and even infertility.
Many countries have banned the purchase of testosterone supplements without a valid prescription.
For those in a professional sports league, taking testosterone is considered “doping”, which has been outlawed in virtually every professional sport. If caught using testosterone to increase performance, many athletic organisations can ban the person from the league.
Benefits of Testosterone Replacement Therapy
TRT is a beneficial treatment for low T men as it helps them subside unwanted symptoms. Studies report various benefits of TRT, including:
- Enhanced sexual function and desire
- Increased bone mineral density
- Improved muscle mass and strength
- Better mood and energy levels
- Improved cognitive function
- Improved body composition
TRT Associated Risks
Testosterone treatment is effective for hypogonadal men but it requires close monitoring because of its side effects. Here are some reported side effects of testosterone therapy:
- Acne
- Water retention
- Breast tenderness
- Worsening sleep apnoea
- Blood clot formation risk
- Irritability
- Increase in blood pressure
- Stroke
- Mood swings
- Prolonged erection
Long-term safety data on TRT is lacking, and potential risks should be discussed with a healthcare provider.
Pros and Cons of Testosterone Replacement Therapy
Pros of TRT | Cons of TRT |
Increases sexual health and may also improve erectile function | Health risks with long-term use |
Improves muscle mass | Reduces sperm production |
Better bone density | Long-term treatment |
Enhances cognitive function | Requires ongoing monitoring |
Improves energy levels and motivation | Suppresses the body’s natural testosterone production |
| Available in multiple forms, such as injections, gels, patches, etc. | Can be expensive |
Does TRT Cause Hair Loss?
TRT does not directly cause hair loss. However, it can accelerate hair loss or baldness, especially if you have genetic sensitivity to the hormone DHT.
Dihydrotestosterone (DHT) is a testosterone byproduct. High testosterone levels can lead to higher DHT levels, which can cause hair thinning and hair loss.
Can TRT Cause High BP?
TRT can cause high blood pressure in some individuals, especially if they are taking high testosterone doses and the treatment is not well-monitored.
This can occur because testosterone stimulates red blood cell production, which thickens the blood, leading to increased viscosity. Thicker blood can make it harder for the heart to pump blood through the vessels, which may raise BP.
Does TRT Cause Infertility?
Yes, TRT causes infertility by suppressing natural testosterone production which is required for sperm formation. However, this effect of testosterone supplementation can be reversed with the discontinuation of TRT and in some cases, with the use of medications like human chorionic gonadotropin (hCG).
Can TRT Boost Energy
Many men with testosterone deficiency report feeling fatigued and low energy. So, boosting your testosterone levels with TRT is something that could help to bring up energy levels and give you an energy boost throughout your day.
Another thing to watch out for when using TRT is the drop in body fat. With more testosterone and less body fat, the effects on your energy could be compounded and even further improved.
Is TRT Used to Treat Erectile Dysfunction?
You may notice an improvement in erectile dysfunction (ED) if you have it due to low T in the first place.
However, it’s important to note that ED can have many potential causes. If you are experiencing this problem due to factors unrelated to low T, increasing testosterone levels with TRT may not be effective in curing ED.
Is TRT the Same as Steroids?
No, TRT and steroids are not the same at all. The following table explains TRT vs steroids well:
| TRT | Steroids |
Done to restore natural testosterone levels | Done to enhance athletic performance and physical appearance |
| Administered under medical supervision | Often taken without medical supervision |
Brings testosterone levels within the healthy range | Usually increases testosterone levels beyond what’s considered healthy |
| Dosage is determined based on patient’s needs | Very high testosterone dosage |
Regularly monitored | Rarely monitored |
| Legal with a medical prescription | Illegal without a prescription. Banned in various sports. |
How Long Does It Take Testosterone Replacement Therapy to Work?
TRT’s effects vary from patient to patient. However, most patients start noticing improvement in sexual performance, mood and energy levels within a month. Improvement in physical changes, such as an increase in muscle mass and bone density, can take 3 to 4 months.
Can You Stop TRT?
Yes, you can stop TRT whenever you want but it is important to do so only under medical supervision. Your doctor will design a proper protocol, involving a gradual reduction in testosterone dosage. This approach helps with TRT withdrawal effects and minimizes potential side effects associated with stopping TRT.
What Happens When You Stop Taking Testosterone?
When you stop taking testosterone, your body returns to its pre-treatment state. This means that your serum testosterone levels become lower again and your low T symptoms also return.
How to Get Testosterone Replacement Therapy?
If you suspect you have low T and might need TRT, then visit an endocrinologist or your healthcare provider for a proper diagnosis.
They will conduct a medical examination and check your serum testosterone levels via a blood test. If the test results confirm you have low T and you meet the necessary criteria, they will likely prescribe TRT.
Where to Get Testosterone Replacement Therapy?
There are two options to get testosterone therapy in the UK: one is via the NHS and the other is through private TRT clinics.
Getting TRT via NHS can be difficult as they have strict criteria and a long waiting time. On the other hand, private clinics help diagnose low T and prescribe testosterone more quickly, but they are more costly than the NHS.
We have a team of qualified doctors and professionals who can assist you in checking your testosterone levels and restoring low T if needed. Contact us now for further details.
Cost of Testosterone Replacement Therapy: How Much is TRT?
The cost of TRT will vary widely based on what type of TRT you are using, how long, and which clinic you are getting it from. It will also depend on what health insurance you have and the reason for getting your TRT.
The cost of TRT can range from £20 to £1000 per month, depending on the following factors:
- Location
- Medication type
- Treatment method
- Generic version
One thing to be aware of is that while TRT can boost your testosterone levels, it does not treat the actual cause of low testosterone. If your underlying low T cause is untreatable, you will likely need lifelong TRT to maintain normal testosterone levels, which means a long-term financial commitment.
What Conditions Disqualify Me from TRT?
Many conditions can prevent you from using TRT, including:
- Sleep apnoea
- Urinary tract symptoms
- Congestive heart failure
- Higher than normal red blood cell counts
- Low cholesterol
- Prostate cancer
- Breast cancer
If you have had prostate cancer in the past, you may be able to use TRT. Additionally, healthy men are assessed for their risk of prostate cancer before starting TRT.
TRT can worsen symptoms of above-mentioned health problems. That’s why it’s not suggested for patients with these conditions.
Monitoring While on TRT
While you are on TRT, your condition and treatment effects must be monitored regularly by your medical team.
In the beginning, doctors generally measure testosterone levels at the 3 and 6-month intervals to ensure they are within the desired range.
If your levels stay healthy and don’t impact your health negatively, your testosterone dosage will likely stay the same. If not, your doctor will adjust your dosing as needed.
During regular TRT monitoring, you will also be tested for red blood cell levels, prostate-specific antigen (PSA) and some other factors to ensure treatment safety.
If at any time during your TRT treatment, you experience these symptoms, you should call emergency services immediately:
- Chest pain
- Shortness of breath
- Trouble breathing
- Slurred speaking
- Body weakness
Conclusion
Low testosterone and its symptoms are something that affects millions of men worldwide.
TRT is one of the most effective methods for treating low testosterone. And while it does not treat the underlying causes of low testosterone, it can help raise testosterone levels and mitigate many of the side effects that come along with low T.
If you’re experiencing signs of low testosterone and need professional assistance, contact our team today for complete guidance!