Testosterone Replacement Therapy TRT: What to Know

When Should Men Consider Testosterone Replacement Therapy?

They will need to do this three times a day at intervals of 6–8 hours, preferably at the same times every day. The dosage is usually 11 mg per application across both nostrils, resulting in a total dosage of 33 mg daily. However, people using topical treatments must be careful to avoid skin-on-skin contact with other people for at least 6 hours after application. It is important to prevent the risk of transferring the medication onto other people’s skin because it may be dangerous for pregnant people and children. If you stop TRT, you’ll return to your normal level of testosterone. Your body will take some time to restart production of testosterone naturally.

A detailed profile of the therapeutic agents discussed in this guideline can be found in Appendix B (in the Appendix B section in the left menu). The original guideline search strategy was updated and used to systematically search PubMed for new evidence published between the previous search end date and February 2022. This search covered the topic areas of all Key Questions listed previously.

Doctors will then repeat these tests annually if the results prove to be stable. A 2021 study suggests that long-term TRT improves liver function and reduces cardiovascular risks. However, further studies are needed to assess the long-term effects. However, doctors do not usually recommend TRT as the first course of action for low testosterone levels, even for males who show such symptoms. Also, some research shows that testosterone therapy can increase your risk of heart disease. Hormone therapy is often used alone for people who have a recurrence of prostate cancer after earlier treatment with radiation or surgery.

Previously, interest in testosterone therapy rarely came up in appointments, she said. While the treatment may have an impact on muscle strength and how people feel, LaPook said there is limited evidence on the extent of potential benefits and potential dangers. Testosterone replacement therapy, which involves taking manufactured forms of testosterone, has surged in popularity. Prescriptions for the treatment rose from 7.3 million in 2019 to more than 11 million last year. “Injections of hCG are sometimes used as an alternative to testosterone products in men for low testosterone and to help improve fertility.”

If you stop taking testosterone, your levels will return to baseline. It may take a few weeks before you start noticing differences in your body and mood once starting TRT. To allow the therapy to take full effect, healthcare providers typically wait 30 days after you start TRT to check your testosterone levels. As you age, your testosterone level gradually declines — typically about 1% a year after age 30 or 40. For older men, it’s important to determine if a low testosterone level is due to normal aging or if it is due to a disease (hypogonadism). Hormone therapy is sometimes used alone for palliation or prevention of local symptoms in men with localized prostate cancer who are not candidates for surgery or radiation therapy (11). Such men include those with a limited life expectancy, those with locally advanced tumors, and/or those with other serious health conditions.

Shifren, who has been involved in clinical trials looking at testosterone therapy in women, said that the benefits for women with low libido aren’t terribly impressive. Typically, testosterone levels in men are around 15 times higher than in women. One important aspect of study design is the specific endpoints and objective measures used to identify outcomes.

I think that testosterone replacement therapy for [patients with] prostate cancer has to be individualized. It has to be based on numerous factors such as comorbid conditions, life expectancy, Gleason score, pathology, and severity of symptoms. It is important that everyone understands the potential risks and benefits prior to starting [patients] on therapy. It is important to discuss the AUA guidelines, particularly since the risk-benefit ratio is still unknown, and we need more studies.

Excess estrogen can also cause sleep apnea, edema (swelling), and acne. Testosterone is FDA-approved as replacement therapy in men with low testosterone levels and those with symptoms of hypogonadism. Symptoms highly suggestive of hypogonadism include fewer or diminished spontaneous erections, decreased nocturnal penile tumescence, low libido, sparse beard growth, and shrinking testes. In males, the normal range for early morning testosterone is between 300 ng/dL to 1000 ng/dL but may vary from laboratory to laboratory. Clinicians must distinguish between primary (testicular) and secondary (pituitary-hypothalamic) hypogonadism.

If you don’t have a medical condition that’s contributing to your decline in testosterone levels, your doctor might suggest natural ways to boost testosterone, such as losing weight and increasing muscle mass through resistance exercise. Although the addition of ADT to radiation therapy has been shown to increase survival for men with high-risk prostate cancer, it worsens some adverse effects of radiotherapy, particularly sexual side effects and vitality (14). The risk of side effects increases the longer a person is on hormone therapy (13). Testosterone levels naturally rise in response to sexual arousal and activity. Men with higher levels of testosterone and zinc usually have greater sexual activity.