TRT Side Effects You Should Be Aware Of

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Testosterone Replacement Therapy(TRT) has significantly surged over the last few years, highlighting the need to raise awareness about its side effects among TRT candidates. TRT offers a plethora of benefits for individuals with testosterone deficiency, but, like any other medical procedure, it also has a range of potential side effects.

Fortunately, most people can mitigate these side effects with effective management strategies and regular medical check-ups. However, remember that choosing the right TRT doctor is the key. They can tailor an ideal TRT plan and help make lifestyle adjustments to optimise TRT results.

In this article, we have discussed Testosterone Replacement Therapy side effects to help you decide whether this treatment is proper for you and, if you opt for it, what to expect. Additionally, we have explained some side effects management strategies so you can make the most of this treatment.

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What is Testosterone Replacement Therapy(TRT)?

Testosterone Replacement Therapy (TRT) is a form of hormone replacement therapy designed to treat individuals with low testosterone levels to bring T-levels to a normal range. Low testosterone levels are most prevalent in men (male hypogonadism) but women can experience it too. This condition is diagnosed through a blood test that measures the amount of bioavailable testosterone in the bloodstream. TRT aims to restore testosterone to optimal levels using bioidentical testosterone, improving symptoms such as fatigue, decreased libido, and loss of muscle mass. By supplementing the body’s natural hormone production, TRT helps to balance and maintain healthy testosterone levels and improve physical, cognitive, psychological and sexual function.

TRT helps with several issues related to low testosterone levels. Here are the primary benefits:

– Increased Muscle Mass and Strength: Enhance muscle size and strength, making physical activities easier.

– Improved Mood and Mental Health: Helps to alleviate symptoms of depression, anxiety, and irritability.

– Enhanced Libido and Sexual Function: Boost sexual desire and improve erectile function.

– Increased Bone Density: Prevents osteoporosis by strengthening bones.

– Higher Energy Levels: Reduces fatigue and increases overall vitality.

– Better Cognitive Function: Aids in improving memory and concentration.

– Reduced Body Fat: Decreases body fat and improving body composition.

Side effects in men and women 

Acne

Acne is a prevalent side effect experienced by men and women on testosterone replacement therapy. It occurs mainly due to two reasons. 

Firstly, testosterone over-stimulates the sebaceous glands, leading to increased sebum (oil) production. An excess of sebum creates an environment favourable to acne breakouts, as it can clog pores and provide a breeding ground for bacteria. 

Secondly, studies suggest that TRT can disrupt hormonal balance, further contributing to acne. A 2019 study on transgender men undergoing TRT confirms this, showing that TRT leads to increased sebum production and a higher incidence of acne.

Increased red blood cell production

Testosterone can stimulate the bone marrow to enhance red blood cell (RBC) production. These cells carry oxygen throughout the body. Hence, their increased level helps with oxygen transportation, but, on the other hand, it makes the blood thicker. 

Thicker blood is hard to push. That is why it can cause blood clot formation, high blood pressure, stroke, and heart attack.

People on Testosterone Replacement Therapy should regularly undergo Complete Blood Count (CBC) tests. These tests enable physicians to monitor RBC levels and manage any associated risks on time.

Worsening sleep apnea

Testosterone may disturb respiratory control mechanisms, aggravating obstructive sleep apnea symptoms in those who are already suffering from the condition.

Untreated sleep apnea can increase cardiovascular risk and deep vein thrombosis/pulmonary embolism. Usually, men prescribed higher testosterone doses experience this side effect.

If you experience sleep apnea and are considering testosterone treatment, you must first discuss associated risks with the physician to ensure the treatment does not exacerbate your sleep disorder.

Mood swings

Testosterone Replacement Therapy can cause irritability, aggression, and mood instability in cases. It can happen for multiple reasons, including fluctuations in neurotransmitter levels, particularly serotonin and dopamine.

These chemicals control mood and emotional stability. By disturbing their synthesis, TRT can impact emotional states, leading to changes in mood and motivation.

These effects of TRT not only impact a person alone but also may disturb people around you.

Swelling in hands and feet

Hand and foot swelling, also called oedema, may occur due to high testosterone levels. It commonly happens due to fluid retention. The salt and water balance gets disturbed, leading to fluid accumulation in the extremities.

It is not serious unless accompanied by other symptoms like shortness of breath. It usually goes away on its own. But if it persists, you are advised to consult your physician.  

Skin reactions

Testosterone Replacement Therapy may also cause an increased risk of skin reactions depending on the type of testosterone delivery method you use. This effect appears mainly in those who use gels, patches, or intramuscular injections for administration.

Testosterone gel can cause skin redness and itchiness, particularly if it is applied in the same place over and over again. 

Similarly, skin patches can cause reactions because of the adhesives or testosterone. It commonly occurs in men and women with sensitive skin.

Testosterone injections can cause swelling, pain, redness and bruising. These reactions are typically a result of the injection technique or the body’s response to the injected solution.

You should discuss these effects with your healthcare provider if you experience them. They may suggest a different TRT method or prescribe skin care products.

Side effects in men 

Increase in breast size (Gynecomastia)

Sometimes, Testosterone Replacement Therapy(TRT) can cause an increased risk of gynecomastia due to hormonal imbalance. This occurs when excess testosterone converts into oestrogen, the hormone responsible for breast tissue growth.

Gynecomastia may also lead to breast swelling and tenderness, which can cause discomfort and dissatisfaction with one’s body image.

Men experiencing this issue should talk with their TRT doctors. They may adjust their dose, prescribe aromatase inhibitors, or explore alternative treatments to resolve this issue effectively.

Testicular problems

Testosterone Replacement Therapy(TRT) can cause various testicular problems, including testicular atrophy, in which the size of the testicles is reduced.

This occurs because the introduction of external testosterone suppresses the body’s natural testosterone production, leading to testicular shrinkage.

When a person starts taking exogenous testosterone, their body’s natural testosterone production decreases. It happens because their brain does not stimulate the testicles enough times, which causes testicular shrinkage. This size reduction can also result in a low sperm count and, potentially, infertility.

You must discuss your infertility-related concerns with your physician before starting the treatment. This will help in developing a treatment plan that preserves fertility while still providing the benefits of testosterone supplementation.

Hair loss

Hair loss is another notable side effect of Testosterone replacement therapy. It occurs when testosterone converts into dihydrotestosterone (DHT), a hormone associated with male pattern baldness. High DHT levels cause shrinkage of hair follicles, leading to hair thinning and loss of facial and body hair.

To prevent this problem, doctors may prescribe medicines that inhibit DHT formation.

Risk of prostate cancer

Testosterone therapy has in the past been associated with both male breast cancer and prostate cancer. The prostate gland is sensitive to androgens, particularly testosterone. So, when your testosterone levels increase, the prostate gland responds by growing in size which presents a risk of prostate cancer. 

This side effect is more common in men with pre-existing prostate conditions such as benign prostatic hyperplasia (BPH).

Prostate growth can further cause many other health effects. Hence, doctors carefully examine prostate health from time to time in men undergoing TRT to ensure they maintain their prostate health. There is ongoing research regarding TRT’s risk of causing prostate cancer. 

Testosterone replacement therapy stimulates prostate cell growth, leading to worsening of existing prostate cancer. However, recent studies suggest that this treatment does not necessarily increase prostate cancer risk in healthy men.

Still, if you opt for TRT, it is better to stay on the safer side and have prostate screening every now and then to check your health and detect any risk of prostate cancer early.

Increase in prostate-specific antigen (PSA)

The prostate gland produces PSA protein. Doctors study its levels to screen for prostate issues, including prostate cancer, inflammation, and enlargement.

Testosterone therapy can lead to an increase in prostate-specific antigen production. While a moderate increase in PSA levels is normal for TRT patients, a significant rise can be alarming and requires immediate monitoring.

TRT patients often have PSA tests regularly so they can detect any risk of elevated prostate specific antigen and prostate cancer quickly and take suitable steps.

Lower urinary tract symptoms (LUTS)

Testosterone therapy can worsen LUTS, including frequent urination and trouble starting or stopping urination. It is thought to be because of the effect of testosterone on prostate size.

When the prostate size increases, it puts pressure on the urethra (a tube through which urine leaves the body), leading to these symptoms.

Regular prostate health monitoring and TRT dose adjustment can help mitigate these effects. So, reach out to your healthcare provider if you experience this problem.  

You should discuss these effects with your healthcare provider if you experience them. They may suggest a different TRT method or prescribe skin care products.

Side effects in women

Women also have Testosterone therapy to treat low libido or other hormonal imbalances. They may experience the following side effects due to it:

Deepening of voice

One potential side effect of Testosterone Replacement Therapy(TRT) in women is the deepening of the voice. This occurs because testosterone, a potent androgen, influences the growth and function of the vocal cords. In women, the introduction of excess testosterone can cause the vocal cords to thicken and lengthen, resulting in a deeper, more masculine voice. 

This change can be gradual and, once it occurs, is often irreversible without surgery. The voice deepening happens as testosterone stimulates the larynx, also known as the voice box, to grow larger, similar to the natural changes that occur during male puberty. 

Irregular Periods

Testosterone can disrupt the delicate balance of female hormones when administered at higher-than-normal levels. This disruption can affect the regularity of the menstrual cycle. Normally, a woman’s menstrual cycle is regulated by estrogen and progesterone. Introducing excess testosterone can interfere with the production and regulation of these hormones, leading to irregular or missed periods. This hormonal imbalance occurs because testosterone can suppress the hypothalamic-pituitary-ovarian (HPO) axis, which is responsible for the cyclical nature of menstruation, causing the cycle to become unpredictable.

Hirsutism/Hair Growth

Hirsutism is the excessive growth of dark or coarse hair of facial and body hair. Hirsutism can be a side effect for women undergoing testosterone therapy.

This occurs because Testosterone therapy increases the levels of testosterone in the body, which can stimulate hair follicles to produce more hair. Women naturally have lower levels of testosterone, and the introduction of additional testosterone through TRT can disrupt the hormonal balance, leading to the development of hirsutism. 

The hair growth typically appears on the face, chest, and back, areas where men typically grow hair but women do not. Managing this side effect often requires a careful adjustment of the TRT dosage and, in some cases, the use of additional treatments to counteract the unwanted hair growth.

Enlarged Clitoris (Clitoromegaly)

Increased testosterone can lead to the development of male secondary sexual characteristics when introduced into the female body. As testosterone levels increase, it stimulates the growth of the clitoral tissue, causing it to enlarge. This is similar to the way testosterone affects the growth of the penis in males during puberty. 

While this side effect is usually reversible if TRT is discontinued, prolonged exposure to high levels of testosterone can result in permanent changes. Women considering or undergoing TRT should be aware of this potential side effect and discuss it with their healthcare provider to monitor and manage any changes effectively.

Decreased Breast Size

Typically, women have higher levels of estrogen, which helps maintain breast tissue. When testosterone levels increase, it can lead to a reduction in estrogen, causing the breast tissue to diminish. The hormonal imbalance disrupts the natural maintenance of breast size, leading to a noticeable decrease. Consequently, women on Testosterone therapy may experience this change as their bodies adjust to the increased testosterone levels.

Increased Muscle Mass

Testosterone is a natural anabolic steroid, which means it promotes protein synthesis and muscle mass growth. When women receive testosterone therapy, their bodies experience an increase in the hormone levels that enhance the muscle-building processes. This leads to more efficient muscle repair and growth following physical activity. The result is a noticeable increase in muscle mass, which can be beneficial for some women but may be an unintended side effect for others who do not desire such changes.

How common are Testosterone Therapy side effects?

The prevalence of Testosterone therapy side effects varies depending on several factors. Some of these are testosterone dosage, frequency of testosterone administration, the patient’s health condition, and treatment duration.

However, you should remember that not all men having testosterone treatment experience its side effects. And for many, Testosterone therapy side effects outweigh its potential benefits.

Monitoring and mitigating physical and psychological Testosterone therapy side effects

As mentioned earlier, Testosterone supplementation can produce various side effects that we have already explained above. You can manage them using a multifaceted approach.

Physical side effects like acne, breast enlargement, and changes in sexual function are usually closely monitored by healthcare providers.

For this, they conduct different tests, such as blood tests to track hormone levels, lipid profiles, liver function, and red blood cell count. Additionally, they also check prostate health via regular PSA tests and digital rectal exams. It helps them detect potential problems on time and prevent serious issues. 

Doctors usually adjust testosterone dose and administration frequency or switch to a different testosterone delivery method to mitigate these physical side effects.

Psychological side effects such as mood swings and changes in emotional state are also common. You should discuss them with your doctor without any hesitation. In some cases, counselling or behavioural therapy may help manage these effects.

Lifestyle adjustment to complement Testosterone Therapy

The following lifestyle adjustments can help men undergoing Testosterone therapy get better results and manage their symptoms effectively.

Dietary changes: You should eat foods rich in essential nutrients that support hormonal balance and overall health. 

Take lean protein, whole grains, healthy fats, and vitamins from natural food sources in a balanced amount. Avoid processed foods, as they can disturb your hormones and cause metabolic problems.

Adequate sleep: Quality sleep is essential for hormonal balance. Sleep patterns impact your testosterone levels. That is why you must enjoy 7 to 9 hours of sound sleep every night.

Regular exercise/losing weight: There are numerous healthy effects of exercise that can contribute to hormonal balance. These include improved mood, muscle strength, bone density and heart health. 

So, use a combination of different exercises to maintain a healthy weight and increase the effectiveness of your testosterone treatment.

Stress management: Stress can disturb your hormonal balance. Hence, you should practise different stress management exercises and perform yoga or meditation to promote relaxation.

Reduce the intake of harmful chemicals: Alcohol, smoking and illegal drugs can interfere with the efficacy of Testosterone therapy. Therefore, you should limit alcohol intake and smoking. Minimize drug consumption and get professional help if it seems impossible to do on your own. 

Regular health check-ups: Have health check-ups to see what is happening inside your body. They will help you see how your body responds to the treatment.

Following Testosterone Treatment protocol strictly

Strictly adhere to the testosterone treatment protocol to make the most of this treatment and reduce its side effects.

Do not change the testosterone administration method or dosage on your own without consulting with your doctor. It is because self-adjusting can disturb testosterone levels, potentially worsening side effects.

Discuss problems that you are experiencing with your doctor so they can make necessary adjustments based on the up-to-date information, leading to a safer treatment outcome.

Choosing the right TRT doctor

Selecting the right TRT specialist is crucial in resolving testosterone deficiency and minimising the treatment’s side effects. 

A knowledgeable and experienced doctor will prescribe the correct testosterone dose, treatment frequency, and administration method according to your current health condition, medical history and treatment goals.

Regular monitoring by a skilled physician ensures early detection of side effects, allowing for timely adjustments to the treatment plan. They also provide comprehensive guidance on lifestyle changes to help you reach a normal testosterone level and a have a safe treatment experience.

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Summing it up

TRT is a beneficial procedure that has helped innumerable men improve their testosterone deficiency and the overall quality of their lives. However, it has some side effects that you must discuss with your healthcare provider before starting the procedure to ensure it is safe for you.

Typically, Testosterone therapy side effects are manageable and not severe. Your TRT specialist can adjust your treatment plan according to your body’s response towards it to maximise testosterone’s benefits and minimise side effects.

Since TRT is a long-term commitment, selecting a qualified TRT doctor is essential. The right doctor will create a customised treatment strategy that aligns with your specific goals and will support you throughout your TRT journey. Want to know more about how to start testosterone replacement therapy or how about checking your testosterone levels with a blood test? Get in contact with us by clicking the contact button above!

References/Scientific studies/Further reading/ Bibliography

Grech, A., Breck, J. and Heidelbaugh, J., 2014. Adverse effects of testosterone replacement therapy: an update on the evidence and controversy. Therapeutic advances in drug safety, 5(5), pp.190-200.

Osterberg, E.C., Bernie, A.M. and Ramasamy, R., 2014. Risks of testosterone replacement therapy in men. Indian journal of urology: IJU: journal of the Urological Society of India, 30(1), p.2.

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