By Mike Kocsis | 7 minutes read | Last updated: May 3, 2025 Categories: Hormone imbalance Testosterone
Medically Reviewed by Dr. George Touliatos
Guys have 101 questions about TRT before they start. How long for testosterone to kick in? How to take testosterone? Will testosterone make me bald? And so many more.
However, there is usually a core of basic questions that are asked over and over.
In this article, we answer frequently asked questions (FAQs) about testosterone replacement therapy (TRT) – backed by science and clinical insights.
Do you need hCG with TRT?
When you take exogenous testosterone (testosterone from an external source), your body detects this and stops producing its own testosterone.
The production of testosterone is key to sperm production. Therefore, if you want to father children and remain fertile on testosterone replacement therapy, you must take hCG.
hCG or human chorionic gonadotropin is a hormone that mimics the behaviour of luteinising hormone (LH) in the body. This sends a signal to the testes to produce testosterone, which stimulates sperm production.
A typical dose of hCG alongside testosterone to maintain fertility varies from patient to patient. But generally it would be 1000 -1500 IU weekly.
Do you cycle testosterone?
The whole concept of ‘cycling’ comes from bodybuilding. Athletes and bodybuilders typically take supraphysiologic doses (levels that are much higher than natural hormone levels) of testosterone and other anabolics to put on bulk muscles or lose fat (cutting) fast.
Doing this for prolonged periods can be extremely detrimental to health. That’s why bodybuilders tend to cycle these drugs.
However, when you come off testosterone, it might take your body weeks to recover and resume its own natural production of testosterone and bring it back to the normal range.
This transition is challenging and can pose serious risks to overall health.
TRT is a totally different mode of testosterone use. It is about administering therapeutic doses of testosterone, e.g. 200-250mg weekly to maintain testosterone levels within the healthy range. This is beneficial to health and avoids the negative side effects at higher doses.
If you cycle TRT, this means you lose the benefits of it each time you come off it.
Do you need to take an aromatase inhibitor (AI) with TRT?
The use of an AI (aromatase inhibitor) has become a hot topic in recent times.
An AI works by blocking the action of the aromatase enzyme, which is responsible for the conversion of testosterone into oestrogen.
Increased levels of testosterone through TRT will normally raise oestrogen levels. And this is not necessarily a bad thing.
However, too much oestrogen can have unwanted side effects such as gynaecomastia (increase in breast size, often called ‘man boobs’), water retention, and nipple swelling.
Some doctors say you need an AI to effectively mitigate negative estrogenic side effects. Some say AIs are detrimental to your health.
Ultimately, if the patient has a clinical need, and aromatase inhibitors are used in a sensible way, they are quite safe.
Is testosterone really safe?
Yes, testosterone therapy for low testosterone is considered safe when administered and monitored under the supervision of healthcare professionals.
Recent research has challenged old concerns about testosterone replacement therapy increasing the potential risk of prostate cancer and cardiovascular disease.
A 2022 article published in The Journal of Clinical Endocrinology and Metabolism states that “normalization of physiological T reduces myocardial infarction, stroke, and deaths compared with men whose testosterone levels failed to normalize. “
Still, like any other treatment, TRT is not completely risk-free. It has its own side effects, including breast enlargement, increased red blood cell production and mood changes. That is why you should undergo proper lab testing and ongoing monitoring during treatment.
Millions of men worldwide safely use TRT under clinical care and have reported improvements in low T signs. These include improved sex drive, healthy testosterone levels, improved sexual function, and increased energy levels, muscle mass and muscle growth.
Can you trial TRT?
When you are diagnosed with testosterone deficiency, the idea is for you to trial it for several months to see if it relieves your symptoms.
These symptoms can be low energy levels, reduced sexual desire, decreased bone density, brain fog, trouble concentrating, low muscle mass, erectile dysfunction and more.
Doctors may consider long-term treatment if it offers benefits.
But if you are still experiencing symptoms and blood work shows a male sex hormone imbalance, then you are under no obligation to continue.
In most cases, no improvement mostly occurs due to issues like an incorrect dosage, delivery method, or another underlying health issue.
Testosterone is rarely if EVER the real issue when treatment doesn’t work.
How is TRT administered?
There are several different ways in which TRT can be delivered, though oral tablets are generally not the preferred option.
It is possible to get oral testosterone but there are concerns that it can cause liver toxicity.
Therefore, there is a focus on alternative delivery methods which bypass the liver and allow testosterone to get straight into the bloodstream.
Popular types of TRT based on the testosterone administration method include:
Transdermal testosterone (skin patch)
Testosterone patches are typically applied once per day to the arm or upper body. They deliver testosterone steadily through the skin into the bloodstream.
Testosterone gel
Testosterone can be absorbed through the skin when a testosterone gel is applied. It is also possible to get a pump that ensures that the correct prescribed dosage is delivered.
Testosterone mouth patch
It is possible to get testosterone as a mouth patch which sticks to the upper gums in the mouth and releases it into the blood throughout the day. These are usually applied twice per day.
Testosterone injections and implants
Testosterone can be injected under the skin directly into muscles via intramuscular injection. You can also use testosterone pellets, which are inserted into the soft tissues of the body and slowly release testosterone.
What are the risks associated with TRT?
As we have already discussed, testosterone is safe and can be highly beneficial. However, like all medications, there can be some risks associated with taking hormone replacement therapy.
Depending on the method of delivery, there may be an increased risk of rash or itching at the site of application, but this is usually temporary and rarely serious.
Additionally, here are the most common side effects of TRT:
- Oily skin
- Acne
- Mood swings
- Fluid retention
- Weight gain
- Breast enlargement
- Reduced sperm production
- Increased blood cell count
- Male pattern baldness
- Prostate enlargement
There are also some conditions that could be exacerbated by testosterone therapy, such as benign prostatic hypertrophy or sleep apnea. Therefore, these patients are often prescribed other treatments.
Can TRT cause prostate cancer?
The debate as to whether TRT causes prostate cancer is still ongoing, but to date there are no studies which have found a link between the two.
There are a number of doctors who suggest that taking TRT can speed up the rate at which prostate cancer tumours grow but so far there is no clear evidence to support this.
Dr. Abraham Morgentaler, Harvard Medical School, notes that “the longstanding belief that TTh is associated with increased prostate cancer (PCa) risk is contradicted by recent evidence, including multiple studies showing that TTh is associated with reduced PCa risk.”
Is taking TRT like taking anabolic steroids?
In a word, no.
The anabolic steroids are used to enhance performance. They include testosterone or a similar chemical, but at much higher levels than would be found naturally in the body.
It is also common for performance steroid treatments to contain other drugs that increase muscle development.
| Feature | TRT | Anabolic steroids (used in bodybuilding) |
| Purpose | Medical therapy for low T | Muscle gain, performance enhancement |
| Dosage | Physiological (100 to 200mg per week) | Supraphysiologic (400mg+ per week) |
| Supervision | Doctor-prescribed and monitored | Often self-administered or underground |
| Health risks | Low with medical supervision | High risk: liver damage, heart disease, congestive heart faliure |
| Legality | Legal with prescription | Illegal or banned in many sports |
What tests will be carried out before you start taking TRT?
Testosterone serum test is conducted to determine whether you have low testosterone levels or not. When test results show you have low T, a few more tests are done to identify the low T cause and to assess your overall health.
These include:
- SHBG (Sex Hormone-Binding Globulin) blood test
- Prolactin levels test
- LH (Luteinizing Hormone) and FSH (Follicle-Stimulating Hormone) tests
- Complete blood count (CBC)
- PSA (Prostate-Specific Antigen) test
- Liver and kidney function tests
- Estradiol levels test
Can you get off TRT?
Yes, you can stop taking testosterone whenever you want. But doing so will make your pre-treatment symptoms return.
Getting off TRT under the supervision of a healthcare provider can help you manage withdrawal symptoms.
Instead of cutting out testosterone completely, they will taper it off gradually. They may also use medications like hCG to support your natural testosterone production.
What happens if testosterone is not injected into the muscles?
If testosterone injection is accidentally injected into fatty tissue or just under the skin, testosterone will be absorbed more slowly.
You may also experience some localised reactions such as redness, swelling, and bump formation. The site will be painful to touch but all these signs will be gone in a few days, one week at most.
Does TRT make you infertile?
When you take exogenous testosterone (from outside the body), your brain senses you have enough testosterone so there is no need to create more. As a result, natural testosterone production declines.
Sperm production requires endogenous testosterone (produced inside the body). So when you do not make enough endogenous testosterone, your sperm count declines, resulting in reduced fertility or infertility.
Medications like HCG can help mitigate this TRT side effect.
How to get a doctor to prescribe testosterone in the UK?
TRT is a controlled treatment in the UK. It means doctors only prescribe it to patients with hypogonadism after thorough clinical evaluation and testosterone testing.
Blood tests are performed to identify whether you have low T or not.
If you are confirmed to be testosterone deficient and present with relevant symptoms, your doctor may consider TRT as a treatment option in the UK, provided no contraindications exist.
Still have questions regarding testosterone treatment? Contact our professionals to get all your queries resolved and find out whether TRT is the right treatment plan for you.
References
Morgentaler, A., Traish, A., Barua, R.S., Dandona, P., Dhindsa, S., Khera, M. and Saad, F., 2022. Recognizing the true value of testosterone therapy in health care. Androgens: Clinical Research and Therapeutics, 3(1), pp.217-223.
Yassin, A., Asaad, O., Kamkoum, H., Alzubaidi, R.T. and Ramadan, A., 2025. Recent Update on Advancements in Testosterone Therapy (Tth). J Urol Ren Dis, 10, p.1413.
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References, sources and studies used alongside our own in-house research have been cited below, most of which contain external clickable links to reviewed scientific paper that contain date stamped evidence.
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About the Author: Mike Kocsis
Mike Kocsis has an MBA with a focus on healthcare administration and is an entrepreneur and medical case manager for Balance My Hormones which offers medical services in the UK and Europe. Mike has over 20 years of experience in the healthcare sector, much of that working with people who have hormone imbalances. Mike has appeared on podcasts and radio and is an expert speaker on the subject of hormone imbalance. He specialises in Testosterone Replacement Therapy and Hormone Replacement Therapy (HRT) and has helped thousands of people suffering from hormone imbalances recover and regain control of their lives. You can follow him on LinkedIn and on the Balance My Hormones YouTube Channel.
Last update: May 3rd, 2025
