Testosterone Replacement Therapy Side Effects

Testosterone Replacement Therapy Side Effects

Testosterone replacement therapy (TRT) is seen as a quick and easy option to restore natural testosterone.

However, there are associated risks, not too dissimilar from someone using steroids for aesthetic reasons. Because, essentially, it is the same. Just on prescription.

Author: Nicola Joyce has competed in amateur and natural bodybuilding competitions at an international level gaining two titles.

Nicola has also swam the English Channel twice, competed in power lifting while writing for many well established fitness publications.

This article is supported by references that are found at the bottom of the page.

LAST UPDATED: March 2019 by Ben

Therapy for low testosterone (TRT)

If your natural testosterone levels are on the low side, you’ll already know what a negative impact it can have on all areas of your life, from sex drive and energy levels to gym performance and even your ability to get and stay lean.

Low test has even been linked to depression and mental health issues.

It’s no wonder that guys with low test seek out hormone therapy treatments and testosterone therapy.

But before you go down that road, it’s worth looking at the risks and side effects so you can make an informed decision.

What Are Normal Levels Of Testosterone?

There’s a large range for normal test, but if yours falls below 300 ng/dL then you could be a candidate for testosterone replacement therapy (TRT) or another form of hormone therapy. [1]

However, this isn’t the only measure to look at.

You might also want to address low test levels if your free testosterone levels (the amount in your blood stream at any given time) are low, even if your total test falls in the normal range.

Do You Have Low Testosterone?

It can be quite difficult to realize that you may have low testosterone levels. 

There simply isn’t an alarm, and it is not something that is tested on a regular basis.

And some areas, you cannot really check yourself.

So, what are the signs to look out for, that may trigger you to find out more?

Well, we must tread slightly carefully here.

Many people may just put these things down to ageing. We all know that as we get older we can find it more difficult to have the energy to regularly hit the gym.

As a result, we may carry extra body fat.

However, that is a sign of low testosterone, and, naturally as we age we produce less.

These little differences can contribute to one big change over time.


Here are some signs to look out for:

  • – Feeling ‘low’
  • – Always feeling tired with a lack of energy
  • – Confidence levels low and lacking self esteem
  • – Losing focus
  • – Difficulty sleeping
  • – Muscle atrophy and bone density reductions
  • – More fat tissue
  • – Lower sex drive
  • – Difficulty sustaining erections

Why Seek Testosterone Replacement Therapy?

man with low testosterone receives TRT injection

That bullet pint list above is scary enough, so if you are agreeing to some of those symptoms you may wish to understand more.

However, if you think your test levels are low, you will need an official medical check up to look at the numbers rather than just self diagnose.

Addressing low test though therapeutic intervention can help with the common effects of low testosterone, boosting your sex drive and renewing libido, giving you more energy and strength in the gym,

This can help you to feel more energized, and even making it easier to lose fat and retain muscle.

But it’s about more than your sex life and aesthetics. 

Invisible Effects

Bringing testosterone up to normal levels can have a big impact on important health issues like metabolic syndrome, obesity, and type 2 diabetes.

There have even been links between low test levels and early mortality rates.

While at present it is difficult to establish whether low testosterone does actually increase the risk of health or whether chronic diseases are causing low testosterone, the two present close links. [2]

Addressing low test levels can have a dramatic impact on your physical and mental health.

So what can you do about it – and what are the risks you should be wary of?

What Are the Risks Of Testosterone Replacement Therapy Treatment?

Like any medical intervention, testosterone therapy or replacement treatment does not come without risks and side effects.

Here are the most commonly reported ones.

1. Testosterone therapy can increase your risk of blood clots and even stroke (through increased red blood cell counts).

2. You could experience skin issues including acne

3. Your sleep may be affected (sleep apnea is a commonly reported side effect)

4. TRT can lead to enlargement of male breast tissue.

5. The links to increase prostate cancer risk are thought to be very low, but more research is needed in this area. If you go on TRT, get regular checks.

And it’s addictive, too.

In fact, the main risk of being on being on testosterone therapy is that it is hard to come off it once you start.

Once you are on it, your body will stop making its own testosterone all the while that you are taking TRT.

Going on hormone therapy is a serious and long term decision.

Do it with the support of your Doctor, and get regular checks for red blood cell count, prostate health, and heart health.

medical waiting room

What Do The T Trials Say?

The TTrials were a group of seven clinical trials conducted by the Perelman School of Medicine at the University of Pennsylvania and 12 medical centers, in partnership with the National Institute on Aging.

The TTrials looked at the effects and risks of testosterone treatment, and found plenty of benefits but did also warn of the risks.

These include greater levels of coronary artery plaque buildup, suggesting that testosterone treatment may pose a risk to heart health. [3]

Types Of Testosterone Replacement Therapy

There are three main forms of TRT which you can discuss with your Doctor: topical (via creams, patches or gels), injections, or testosterone boosters.

But before you do, check that your existing lifestyle is optimized for healthy hormone levels without intervention.


Before you turn to TRT, you might like to take stock of your diet and lifestyle.

What other reasons might contribute to your fatigue, low sex drive, and body fat changes?

Could you improve your diet, sleep, stress levels, and activity habits?

You should then get accurate tests for your hormone levels from a medical professional that is experienced in this area.

Make sure your test levels are measured in the morning (at their peak), and take at least two readings for comparative purposes.

A good Doctor should advise you to think very carefully about TRT if you have elevated risk of prostate cancer or heart disease, or have family history of heart disease, heart attacks, strokes, or diabetes.

Sometimes a borderline level of low testosterone does not warrant the risks of using a synthetic testosterone product. [4]


[1] Prevalence, Diagnosis and Treatment of Hypogonadism in Primary Care Practice by Culley C. Carson III, MD

[2] Testosterone Deficiency, Weakness, and Multimorbidity in Men. Peterson MD, Belakovskiy A, McGrath R, Yarrow JF. Sci Rep. 2018 Apr 12;8(1):5897. doi: 10.1038/s41598-018-24347-6. PMID: 29651127

[3] https://www.pennmedicine.org/news/news-releases/2016/february/researchers-find-testosterone

[4] https://www.health.harvard.edu/mens-health/is-testosterone-therapy-safe-take-a-breath-before-you-take-the-plunge

Article by:

Nicola Joyce (aka “the fit writer”) is a fitness industry copywriter who has been writing for and about sport and fitness since 2004. Nicola is a competitive drug-free bodybuilder (with two World titles at amateur level) and has also competed in powerlifting and a couple of strongman comps. Prior to her strength training days, Nicola was an endurance athlete and has even swum the English Channel twice. She can be found on all social media at: thefitwriter.



Testosterone Replacement Therapy Risks
Article Name
Testosterone Replacement Therapy Risks
If you feel you may be low on testosterone, the first port of call for many is TRT. We look at the risks.

Ben BA(Hons), PGCert

Ben established this site to be a free resource in 2015. Since then it has gained over half a million visits. He has always been interested in sport and he started playing rugby at the age of 6 represented his town, county and school. Ben also enjoys cycling, has started skiing and is in the Army Reserve representing his Regiment as part of the 150 Regimental Shooting Team. He holds a bachelor's and postgraduate degree in sport exercise & nutrition.

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