The pros and cons of TRT: 5 benefits and 5 drawbacks

Testosterone replacement therapy (TRT) is a widely recognised and extensively researched treatment for low testosterone levels. Medical experts and numerous clinical studies have documented the benefits, as well as the potential risks.

Let’s take a look at the benefits and drawbacks.

The benefits of TRT

1. Revitalised energy levels

One of the most notable benefits of TRT is bringing back your zest for life. In a year-long study, men receiving TRT experienced a marked reduction in fatigue compared to those who did not receive the therapy.¹

2. Enhanced libido and sexual performance

Low testosterone levels are often associated with decreased sex drive and erectile dysfunction (ED). TRT can improve both issues in men with low testosterone levels, especially those with mild symptoms.² In some cases, additional treatments like sildenafil or tadalafil, or psychological therapy might be needed.

3. Improved muscle mass and bone density

Testosterone plays a critical role in maintaining muscle mass and bone density. Men with low testosterone are at a higher risk of osteoporosis and muscle loss. Studies found that TRT significantly increases and maintains both bone mineral density and muscle mass, even in older patients.^3,4

4. Cardiovascular health

TRT has potential benefits for cardiovascular health. A study of over 6,300 patients showed that TRT had a mild protective effect on the heart, reducing the risk of heart attacks.⁵ However, be cautious about this. Its effects can vary depending on individual health conditions. Careful monitoring and consultation with a healthcare provider are crucial for older men and those with pre-existing heart issues.⁶

5. Better mood and outlook

Low testosterone can lead to irritability, anxiety, and depression. TRT has been linked to improved mood, with participants reporting better emotional wellbeing and reduced depressive symptoms.⁷ There’s no conclusive evidence that taking testosterone leads to aggression.

The drawbacks of TRT

1. Impact on fertility

For men looking to start a family, TRT should be carefully considered. While TRT can improve sexual health, it can negatively impact fertility by significantly lowering sperm counts.⁸ In most cases, this effect is reversible once treatment is stopped.

2. Prostate health concerns

Despite a growing number of studies demonstrating no increase in prostate cancer among men on TRT,⁹ it’s still crucial to assess the prostate before starting. Once the therapy begins, regular monitoring for prostate issues is important.¹⁰ An early increase in PSA levels after starting testosterone therapy might reveal a hidden prostate cancer that wasn’t detected at the start.

3. Increased risk of blood clots

TRT can increase the number of red blood cells, thickening the blood and raising the risk of blood clots. This can lead to serious conditions like deep vein thrombosis or pulmonary embolism. Regular blood monitoring is advised to mitigate this risk.

4. Testicular shrinkage and skin conditions

When external testosterone is introduced into the body, natural testosterone production can decrease in the testicles, leading to shrinkage. Additionally, TRT can cause skin issues like acne due to increased oil production in the sebaceous glands.¹¹

5. Long-term commitment

TRT is typically a long-term, if not lifelong, treatment. Once you start, your body may reduce or cease its natural testosterone production, making it difficult to stop therapy without experiencing low testosterone symptoms again. If you're on TRT and want to stop, speak to your clinician who will help you find ways of coming off it safely and reducing the risk of symptoms returning.

The numan take

TRT can significantly enhance your quality of life, but it’s important to approach it with a thorough understanding of the advantages and potential risks. Since TRT is often a lifelong commitment, speaking to a medical professional to discuss all available treatment options is essential. By carefully weighing the pros and cons, you can make an informed decision that best supports your health.

References

^{1 de Almeida Ferreira, M., & Mendonça, J. A. (2022). Long-term testosterone replacement therapy reduces fatigue in men with hypogonadism. Drugs in Context, 11, 2021-8-12. https://doi.org/10.7573/dic.2021-8-12}

^{2 Rizk, P. J., Kohn, T. P., Pastuszak, A. W., & Khera, M. (2017). Testosterone therapy improves erectile function and libido in hypogonadal men. Current Opinion in Urology, 27(6), 511–515. https://pmc.ncbi.nlm.nih.gov/articles/PMC5649360/}

^{3 Behre, H. M., Kliesch, S., Leifke, E., Link, T. M., & Nieschlag, E. (1997). Long-term effect of testosterone therapy on bone mineral density in hypogonadal men. The Journal of Clinical Endocrinology & Metabolism, 82(8), 2386–2390. https://academic.oup.com/jcem/article/82/8/2386/2877617}

^{4 Neto, W. K., Gama, E. F., Rocha, L. Y., Ramos, C. C., Taets, W., Scapini, K. B., Ferreira, J. B., Rodrigues, B., & Caperuto, É. (2015). Effects of testosterone on lean mass gain in elderly men: Systematic review with meta-analysis of controlled and randomized studies. Age, 37(1), 9742. https://doi.org/10.1007/s11357-014-9742-0}

^{5 Baillargeon, J., Urban, R. J., Kuo, Y.-F., Ottenbacher, K. J., Raji, M. A., Du, F., Lin, Y.-L., & Goodwin, J. S. (2014). Risk of myocardial infarction in older men receiving testosterone therapy. Annals of Pharmacotherapy, 48(9), 1138–1144. https://doi.org/10.1177/1060028014539918}

^{6 Vigen, R., O'Donnell, C. I., Barón, A. E., et al. (2013). Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA, 310(17), 1836–1843. https://doi.org/10.1001/jama.2013.280386}

^{7 Snyder, P. J., Bhasin, S., Cunningham, G. R., et al. (2016). Effects of testosterone treatment in older men. The New England Journal of Medicine, 374(7), 611–624. https://doi.org/10.1056/NEJMoa1506119}

^{8 Crosnoe, L. E., Grober, E., Ohl, D., & Kim, E. D. (2013). Exogenous testosterone: A preventable cause of male infertility. Translational Andrology and Urology, 2(2), 106–113. https://tau.amegroups.org/article/view/2249/html}

^{9 Michaud, J. E., Billups, K. L., & Partin, A. W. (2015). Testosterone and prostate cancer: An evidence-based review of pathogenesis and oncologic risk. Therapeutic Advances in Urology, 7(6), 378–387. https://doi.org/10.1177/1756287215597633}

^{10 Hackett, G., Kirby, M., Rees, R. W., Jones, T. H., Muneer, A., Livingston, M., et al. (2023). The British Society for Sexual Medicine guidelines on male adult testosterone deficiency, with statements for practice. The World Journal of Men's Health, 41(3), 508–537. https://doi.org/10.5534/wjmh.221027}

^{11 Abou Chawareb, E., Campos, L., Savio, L., Hartman-Kenzler, J., Mahdi, M., Hammad, M. A. M., & Yafi, F. A. (2026). Dermatological adverse effects of testosterone replacement therapy: A scoping review of the literature. Sexual Medicine Reviews, 14(1), qeaf061. https://doi.org/10.1093/sxmrev/qeaf061}