Testosterone Replacement Therapy (TRT)

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Understanding low testosterone (Low-T) symptoms, diagnosis, and treatment options


Testosterone, commonly known as the primary male hormone, is essential for supporting many aspects of men’s health. Identifying the signs of low testosterone and exploring replacement options can be key to restoring energy and overall well-being. This can happen any age from birth through adulthood.


Low-T symptoms:

  • Reduced Sex Drive: A decline in testosterone can lead to a noticeable drop in libido, affecting both desire and performance.
  • Decreased Erectile Function: Testosterone plays a key role in erectile function, and lower levels can cause difficulties in achieving or maintaining erections.
  • Reduced Body Hair and Beard Growth: Low testosterone may result in less body hair and slower beard growth.
  • Loss of Lean Muscle Mass: As testosterone is crucial for muscle development, reduced levels can lead to a decrease in lean muscle mass.
  • Chronic Fatigue: Persistent tiredness, even with sufficient rest, can be a result of low testosterone.
  • Weight Gain and Obesity: Low testosterone is associated with weight gain and can contribute to obesity, making it difficult to break the cycle.
  • Depressive Symptoms: Hormonal imbalances may affect mood, potentially leading to symptoms of depression.

Diagnosis:


If you’re experiencing symptoms of low testosterone, your healthcare provider will conduct a physical exam and ask about your medical history, current medications, smoking habits, and any symptoms you’re noticing. Blood tests may also be performed. To make a diagnosis, your provider will take into account your symptoms, physical findings, and blood test results.

The following tests can help confirm low testosterone and identify the underlying cause:


Total Testosterone Blood Test:

This test typically requires two samples taken between 8 a.m. and 10 a.m., when testosterone levels are at their peak. If you’re currently or recently ill, inform your provider, as acute illness can cause falsely low results.

Luteinizing Hormone (LH) Blood Test:

This test helps determine if low testosterone is due to a pituitary gland issue.

Prolactin Blood Test:

Elevated prolactin levels can indicate problems with the pituitary gland or the presence of tumors.

Treatment options: 

Healthcare providers treat low testosterone (male hypogonadism) with testosterone replacement therapy, which comes in several forms:

Testosterone Skin Gels:

Applied daily to clean, dry skin as directed. Be careful to avoid transferring the gel to others through skin contact. This is one of the most common forms of treatment in the U.S.

Intramuscular Testosterone Injections:

Administered either by you or a healthcare provider into a muscle every 1 to 2 weeks. Long-acting injections are available every 10 weeks, and there are subcutaneous injection options as well.

Testosterone Patches:

Applied daily to the skin, with the location rotated to prevent skin irritation.


Testosterone Pellets:

Implanted under the skin by a specialist every 3 to 6 months, providing consistent, long-term testosterone release.

Buccal Testosterone Tablets:

Sticky pills applied to the gums twice daily, allowing testosterone to quickly enter the bloodstream.

Testosterone Nasal Gel:

A gel applied in each nostril three times a day.

Oral Testosterone:

An oral form of testosterone, undecanoate, is available for specific medical conditions like Klinefelter syndrome or pituitary damage.


You may not be eligible for testosterone replacement therapy if you have a history of:

  • Prostate cancer.
  • An undiagnosed lump on the prostate (prostate screening is required before therapy).
  • Breast cancer.
  • Uncontrolled heart failure.
  • Untreated obstructive sleep apnea.

The side effects of testosterone replacement therapy may include:

  • Acne or oily skin.
  • Swelling in the ankles due to mild fluid retention.
  • Prostate stimulation, potentially leading to urinary issues like difficulty urinating.
  • Breast enlargement or tenderness.
  • Worsening of sleep apnea.
  • Shrinking of the testicles.
  • Skin irritation (for those using topical testosterone).

Laboratory abnormalities associated with testosterone replacement therapy include:

  • Increased prostate-specific antigen (PSA) levels.
  • Elevated red blood cell count.
  • Reduced sperm count, potentially causing infertility, which is especially important for younger individuals looking to have biological children.

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