By Mike Kocsis | 7 minutes read | Last updated: February 5, 2026
Medically Reviewed by Dr. George Touliatos
Testosterone is prescribed to millions of men annually and is considered safe in general. But whether testosterone replacement therapy (TRT) is truly safe depends on:
- Who uses it
- How it is prescribed
- How closely it is monitored
Read on to fully understand TRT safety and learn what the latest research says about it.
Is Testosterone Therapy Safe?
For decades, testosterone’s safety has been a hot topic of debate among men’s health experts. It is because some older observational studies raised cardiovascular disease and prostate cancer concerns among men on TRT. But the latest research provides some comfort around these risks.
According to modern studies, testosterone therapy does not increase heart attack or stroke risk when monitored well. Interestingly, low testosterone concentrations may contribute to cardiovascular risk and mortality, notes another study.
Modern research also indicates that in appropriately selected and monitored low T men, TRT does not raise prostate cancer risk over several years of treatment. This is also what the modern saturation model of biology says: once androgen receptors are saturated, additional testosterone does not stimulate cancer growth.
More on the Latest TRT Research
The TRAVERSE trial 2023 is one of the largest clinical studies ever done on TRT in men with hypogonadism.
It studied some of the TRT risks in more than 5200 men who had a preexisting or a high risk of cardiovascular disease. Half of the participants received 1.62% testosterone gel while the other half received a placebo gel for about 22 months. They were followed for outcomes for about 33 months.
The study concludes that the number of cardiovascular events was almost identical in the placebo group and the testosterone group. And there was no higher incidence of prostate cancer in men receiving testosterone compared with placebo.
But there were some safety concerns in the study, like participants from the testosterone group had a higher rate of clots in the leg compared to the placebo group. That’s why it was suggested that men with high clot risk not take testosterone. Testosterone also caused an expected rise in prostate-specific antigens (PSA), which is why PSA monitoring is a crucial part of TRT monitoring.
Watch our video to learn more about TRT and heart health:
Who is Testosterone Therapy Safe for?
There is no one-size-fits-all answer to this question. In general, testosterone replacement therapy is a safe treatment for men with:
A proven low testosterone diagnosis and hypogonadism symptoms, such as poor energy levels, muscle mass loss, reduced bone density, and low sex drive. However, each low T case is different. So, doctors weigh treatment pros and cons for each patient before deciding whether they are the ideal TRT candidate.
Is TRT Safe for Older Men?
TRT is an effective treatment for late-onset hypogonadism that affects older men. However, it should only be prescribed when necessary and should not be considered an anti-ageing magic remedy.
Is TRT Safe for Women?
TRT is not FDA-approved for women, but in rare cases, it is prescribed off-label mainly to improve libido and sexual function in menopausal women. Some studies show that low doses of testosterone can be beneficial for sex drive in women, but long-term safety has not yet been established.
Is TRT Safe Long-Term?
When monitored closely, testosterone hormone replacement therapy is mostly safe long-term. But currently, there is a lack of comprehensive long-term TRT safety evidence. Hence, a man on testosterone should be thoroughly monitored by a healthcare provider to mitigate risks like infertility and prostate health concerns.
Is Low-Dose TRT Safe?
Generally speaking, low-dose testosterone is safe for most individuals. It causes fewer side effects than larger testosterone doses, improves patient compliance and leads to more consistent/stable testosterone levels. However, its effects can vary from patient to patient, that’s why close monitoring and analysis by a doctor is advised.
Who Should Not Have Testosterone Therapy?
Doctors usually tell the following patients to steer clear of TRT:
- Men with untreated obstructive sleep apnoea.
- Men with active prostate cancer or male breast cancer.
- Men with high red blood cell count.
- Men with severe heart failure.
- Men with liver cancer or kidney failure.
- Men who want to preserve fertility or have children, as TRT can suppress sperm production and render about 90% of the men infertile.
Benefits of TRT
Various studies, reviews and clinical trials show that TRT offers multiple health benefits to low T men. A 2025 cross-sectional survey of the effects of TRT in UK men states that “TRT users reported notable improvements in overall quality of life (75%), mental wellbeing (71%), self-esteem and self-confidence (69%) and appearance (61%).”
In addition to these effects, some of the most-documented TRT benefits include improvement in:
- Most aspects of sexual dysfunction, including erectile dysfunction, low libido and sexual satisfaction
- Bone density, bone structure, bone strength and overall bone health
- Fatigue and vitality
- Muscle mass and strength
- Reduced fat mass
- An overall sense of well-being
- Insulin sensitivity
These benefits usually take time, with noticeable changes coming in weeks or months.
Dangers of TRT Therapy
Regardless of whether you are young or older, TRT does have treatment risks and side effects. This is no different from any other treatment or therapy on the market.
One thing that is important to know is that these symptoms may be at increased risk or worsened in severity when used in men who are not considered to be good and natural candidates for TRT. To put yourself at a lower risk, ensure you meet the profile of a suitable candidate for TRT.
The potential risks of testosterone replacement therapy include:
- Worsened sleep apnoea and other sleep disorders
- Increased acne and skin reactions
- Growth of the prostate or an increase in prostate specific agent (PSA)
- Enlarged breast tissue, swollen or tender breasts
- Low sperm production or infertility
- Testicular shrinkage
- Increased red blood cell production
- Increased risk for blood clots
- Fluid retention which may also cause temporary weight gain
Though many of these risks and side effects are rare, they are still something that you should be aware of if you want to get a full picture of what is possible during TRT.
Tips for Using TRT Safely
Many men take synthetic testosterone to reverse unwanted low T signs and feel better mentally and physically. To get the best treatment outcome, it is important to use testosterone carefully.
Before starting TRT, make sure you have ruled out other causes of your symptoms. For example, if you are fatigued, ask yourself if anything in your lifestyle, like sleep, diet, or similar factors, could be causing it.
Get your blood work done for a correct low T diagnosis. A simple blood test, preferably done in the morning, will measure your serum testosterone levels. Confirm a low testosterone result with a second test done on another day. Check luteinizing hormone, sex hormone binding globulin, bioavailable testosterone, and follicle-stimulating hormone levels as well to find the underlying cause of low testosterone levels.
Work with a registered provider like Balance My Hormones to make sure everything from treatment protocols to monitoring processes meets high safety standards.
Discuss all TRT options, including testosterone injections, gels, creams, patches, and pills, with your doctor to fully understand their pros and cons. Use the prescribed testosterone according to your doctor’s instructions.
Don’t change your testosterone dose without consulting your doctor. Carefully monitor how your body responds to testosterone and discuss the effects during the follow-up appointment.
Start a nutritious diet, exercise regularly, get quality sleep and manage your stress. All these healthy lifestyle habits can help maximise your TRT results.
FAQs about How Safe is TRT
Should I Take Testosterone?
Only a qualified doctor can answer this question after a thorough medical examination and diagnosis. Exogenous testosterone may be prescribed if you have male hypogonadism and exhibit associated symptoms.
Is TRT for Life?
TRT may or may not be for life, depending on its underlying cause. For instance, if a temporary problem causes it, a short-term treatment will likely be sufficient. But if there is a permanent underlying cause, you may require lifelong treatment for testosterone deficiency.
Are Testosterone Boosters Safe?
A wide variety of over-the-counter testosterone supplements is available today, but they are largely unregulated and lack evidence. Their unmonitored use can result in many side effects, such as reduced natural testosterone production, infertility, liver injury and more. If you are truly testosterone-deficient, get yourself checked by an experienced physician to find the most suitable, proven solution.
Is Oral TRT Safe?
Oral testosterone is known for its liver toxicity and similar risks. However, now there are some oral testosterone therapy formulations (such as testosterone undecanoate – Kyzatrex) available with improved chemistry that helps minimise these risks effectively.
TRT Safety with Balance My Hormones
All factors considered, TRT is generally thought of as a safe and effective treatment. It has a high success rate and is helpful for men with low testosterone.
Balance My Hormones has helped several men and women improve their hormonal health. Our doctor-led TRT clinic follows strict guidelines and the latest TRT protocols to ensure effective and safe testosterone treatment.
Speak with our team today to clear up any TRT questions and get a bespoke treatment plan.
References
Cruickshank, M., Hudson, J., Hernández, R., Aceves-Martins, M., Quinton, R., Gillies, K., Aucott, L.S., Kennedy, C., Manson, P., Oliver, N. and Wu, F., 2024. The effects and safety of testosterone replacement therapy for men with hypogonadism: the TestES evidence synthesis and economic evaluation. Health Technology Assessment (Winchester, England), 28(43), p.1.
Walia, A., Coady, P., Sofia‐Hernandez, B., Gudlavalleti, H., El‐Achkar, A., Dunnam, S.E., Madhusoodanan, V., Kohn, T. and Khera, M., 2025. Testosterone Replacement, Where Are We in 2025?. Trends in Urology & Men’s Health, 16(6), p.e70016.
Lincoff, A.M., Bhasin, S., Flevaris, P., Mitchell, L.M., Basaria, S., Boden, W.E., Cunningham, G.R., Granger, C.B., Khera, M., Thompson Jr, I.M. and Wang, Q., 2023. Cardiovascular safety of testosterone-replacement therapy. New England Journal of Medicine, 389(2), pp.107-117.
Deng, L. and Shi, Q., 2023. Testosterone treatment: who will benefit the most?. The Lancet Healthy Longevity, 4(10), pp.e524-e525.
Evidence Based Research
This article has been researched and written based on scientific evidence and fact sheets that have then been crossed checked by our team of doctors and subject matter experts.
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 25 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 with his first-hand experience he has helped thousands of people suffering from low testosterone recover and regain control of their lives. You can follow him on LinkedIn and on the Balance My Hormones YouTube Channel.
Last update: February 5th, 2026
