What Are the Side Effects of Testosterone Therapy?

October 4, 2023

TRT and Side Effects: The Pro's and Con's to Testosterone Therapy

As men age and start to feel the effects of diminishing hormone levels, the option of beginning testosterone replacement therapy (TRT) may sound pretty beneficial to some men. Hormone replacement therapy is a very popular option and has gained much traction recently, yet it is not a new medical treatment. Hormone replacement therapy, or HRT has been around for quite a long time. Testosterone was first isolated and synthesized in 1935 by European doctors Ernst Laqueur, Adolf Butenandt and Leopold Ruzicka. Soon after, its discovery, it was approved for medical usage just four years later in 1939 and its utilization has increased steadily since then. It's important to note that testosterone levels naturally decline with age, and some men may experience symptoms of low testosterone (hypogonadism) as a result. In such cases, testosterone replacement therapy (TRT) may be recommended by a healthcare provider to restore normal testosterone levels and alleviate associated symptoms.

Just what IS testosterone?

Testosterone is a hormone primarily produced in the testes in males, although smaller amounts are also produced in the adrenal glands. Where females also produce testosterone, they do so in significantly lower amounts so testosterone is widely viewed as a male hormone. It plays a crucial role in the male body, with a wide range of functions, including:

Development of Male Sexual Characteristics:

Testosterone is responsible for the development of male secondary sexual characteristics, controlling things like facial and body hair, having a deep voice, and increased lean muscle mass. It also plays a role in a males sex drive, sexual performance and studies have even found men with higher testosterone levels appear more attractive to females.

Sperm Production

It stimulates the production of sperm in the testes, which is essential for male fertility by releasing hormones LH and FSH from the pituitary. These travel to the testes which in turn produce more sperm and testosterone.

Bone Density

It helps maintain bone density and strength.

Muscle Mass

Testosterone promotes muscle growth and strength.
Fat Distribution

It can affect fat distribution, leading to a more muscular and lean body composition.

Mood and Energy

Testosterone levels can influence mood, energy levels, and overall well-being. It’s been shown to increase motivation as well, leading to behavioral changes like increased exercise thus causing a beneficial feedback loop, where positive self-esteem causes a male to work out more. The improvements from working out improves perceived self-worth and the cycle continues.

Cognitive Function

Some studies suggest that testosterone may play a role in cognitive functions, including memory and cognitive abilities. There are several studies that reflect this however more research needs to be done.

Red Blood Cell Production

Testosterone stimulates the production of red blood cells, which help transport oxygen throughout the body as well as remove carbon dioxide.

Regulation of Other Hormones

Testosterone interacts with other hormones in the body, such as insulin and cortisol, and may have an impact on overall hormone balance. It also can increase estrogen levels as well, which is normal and typically beneficial as there is a direct correlation between estrogen levels and testosterone levels in men.

It should be noted that despite all of the benefits, TRT should only be used when prescribed and monitored by an experienced sand licensed medical professional, as the improper use of testosterone or any medications for that matter, could have adverse effects. A doctor with knowledge of this particular field of medicine knows what to look for and how to minimize risks associated with treatment.

Testosterone replacement therapy (TRT) can have various side effects, which may vary from person to person since no 2 individuals are alike. Some of the more common side effects of testosterone therapy could possibly include:

Side Effects of Testosterone Therapy

1. Acne.  TRT can increase your body's sebum production, which may clog pores in the skin and lead to acne, with however, with proper planning and care, testosterone-related acne is treatable and preventable.2. Increased red blood cell count. (elevated hematocrit)  In a research article published in October of 2013 in the Journals of Gerontology, researchers found that “Testosterone-induced increase in hemoglobin and hematocrit is associated with stimulation of EPO and reduced ferritin and hepcidin concentrations. We propose that testosterone stimulates erythropoiesis by stimulating EPO and recalibrating the set point of EPO in relation to hemoglobin and by increasing iron utilization for erythropoiesis.” This is known as Polycythemia and usually levels out after 6 months. Fortunately, this can be managed by your doctor. It’s important for a physician to regularly monitor hematocrit and hemoglobin levels to determine what should be done and takes necessary steps if its determined that levels are elevated too high.  

3. Mood swings. With testosterone less is not more and more is not less.  Research has shown that high levels of testosterone to be related to increased rates of depression and potential mood swings as well as hypomania. Conversely low levels of testosterone has been related to depressive disorders in some subpopulations of male patients. Everyone is unique and finding a doctor to help find the right balance is important. Most men on TRT though do show improvements in mood and as long as they take a therapeutic dose, don’t seem to have issues regarding their mood regulation

4. Sleep disturbances. Once again we find that Low levels of testosterone in men may cause insomnia, nighttime awakenings and sleep disordered breathing problems and nocturia, however HIGH levels may cause the same issues as well as the development of sleep apnea, or worsening of sleep apnea for patients who have already been diagnosed. Ironically, sleep apnea and insomnia may also cause a decrease in testosterone levels worsening the cycle.
5. Breast enlargement. (gynecomastia) Gynecomastia is an atypical, yet possible side effect associated with testosterone therapy that has in the past been treated with either surgery, radiation, or discontinuation of testosterone therapy. However most cases of gynecomastia in men undergoing TRT are due to elevated estrogen levels and can be successfully treated with an aromatase inhibitor such as anastrozole.
6. Testicular shrinkage. One side effect of TRT, or taking exogenous testosterone is testicular atrophy, also called “shrinkage”. For those men who experience testicular atrophy, there’s are ways to potentially treat this condition with medications like HCG which can be prescribed and work extremely well.

7. Changes in cholesterol levels In a research article published by
Arthi Thirumalai
, Katya B Rubinow and Stephanie T Page studying the risks of cardiovascular health and men on TRT, it was determine that TRT can lower HDL cholesterol however is associated with the lowering of LDL as well. For patients with preexisting heart conditions or a history of heart disease its advisable to speak to a cardiologist prior to starting testosterone therapy.

It's important to note that TRT should only be used under the supervision of an experienced and licensed healthcare provider, as the risks and benefits of TRT need to be carefully considered based on an individual's specific medical history and needs. Regular monitoring through physician consultation and blood work as well as potential adjustments to the treatment plan may be needed to minimize side effects and optimize results. To schedule a consultation to speak with a doctor visit www.NovaGenix.org to learn whether medical treatment would be right for you.


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Blood Work Request Form

This subsequent lab panel is necessary for males undergoing Testosterone Replacement Therapy (TRT) through NovaGenix Health and Wellness. It allows physicians to assess the patient's response to prescribed medications, covering sex hormone levels, thyroid function, adrenal health, hematocrit, and liver and kidney function. The panel includes tests such as:

  • Complete Blood Count
  • Comprehensive Metabolic Panel
  • Testosterone (Free and Total)
  • Estradiol Sensitive
  • Thyroid Stimulating Hormone
  • Prostate Specific Antigen

Each test serves a specific purpose in monitoring overall health and treatment effectiveness. When required, Dr Mackey may require LH and FSH (Luteinizing hormone, follicle stimulating hormone) SHBG (Sex hormone binding globulin) or any other tests which may be important for your health and optimizing your hormones.

The Comprehensive Hormone and Wellness Panel for Women offers a foundational assessment of sex hormones, thyroid function, adrenal health, metabolic activity, and overall well-being. This panel serves as a diagnostic tool for identifying testosterone and estrogen deficiencies, assessing health risks, and detecting potential thyroid issues before considering hormone replacement therapy. Additionally, it includes insights into hematocrit (red blood cell volume), as well as liver and kidney function. The panel encompasses various tests such as:

  • Complete Blood Count (CBC)
  • Complete Metabolic Panel
  • Testosterone (free and total)
  • Estradiol
  • Thyroid Stimulating Hormone (TSH)
  • Progesterone

When indicated, Dr. Mackey may require additional tests such as Follicle Stimulating Hormone (FSH), and IGF-1 and Cortisol.

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