MEN'S HEALTH

TRT side effects

Understand the possible side effects of testosterone replacement therapy (TRT), potential management options, and what to expect when starting treatment under medical supervision.

What is TRT?

Testosterone replacement therapy is used to restore hormone levels in men when the body is not producing enough on its own. Low testosterone can cause fatigue, reduced sex drive, weight gain, and erection problems.¹

Treatment helps bring levels back into a healthy range. TRT dose formats may include injections, gels, patches, or capsules, depending on what your provider has access to and your clinical needs. The aim is not to raise testosterone beyond normal levels but to correct an imbalance so you can feel more like yourself again.²

Common TRT side effects

The side effects men are most likely to notice when starting TRT are listed below.³ For a complete list of side effects, please refer to the patient information leaflet found in the packaging your medication comes in.

Acne	Injection site reactions	Increased red blood cell count
Increased haematocrit (a blood marker)	Thicker blood	Increased appetite
Weight gain	Hot flushes	Increased prostate-specific antigen (prostate marker)

Uncommon side effects of TRT

Some side effects from TRT are considered uncommon, meaning they affect between 1 in 100 and 1 in 1,000 people.³

Uncommon side effects of TRT include:³

Allergic reactions
Increased appetite
High cholesterol
Irritability
Headaches

If you experience any of these, it's important to let your healthcare provider know so they can monitor and support you.

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Rare side effects of TRT

There are also some rare side effects associated with certain forms of TRT. Rare means they affect between 1 in 1,000 and 1 in 10,000 people. One example is something called pulmonary oil microembolism.³

This happens when a tiny amount of the oily solution used for injections enters the bloodstream and reaches the lungs. It can cause sudden symptoms like cough, chest pain, dizziness, or shortness of breath during or just after the injection. If that happens, treat it as urgent and get medical help straight away rather than waiting to see whether it passes.⁴

Other rare side effects of TRT include:

Liver damage
Priapism
Sleep apnoea

How to deal with TRT side effects

Not everyone who takes TRT will experience side effects, and many are mild or temporary. Some symptoms, like acne or mild nausea, are self-limiting and often settle on their own as your body adjusts to treatment.

If side effects persist, your clinician may recommend adjusting your dose. This can help balance the benefits of TRT while minimising unwanted effects. In some cases, you might be advised to switch to a different formulation, such as moving from injections to gels or patches, to see if that suits you better.

Rarely, if side effects are more severe or cannot be managed safely, your clinician may recommend stopping TRT altogether. Any decision about changes to your treatment will always be guided by your healthcare provider, who will monitor your response with regular check-ins and blood tests.

Chest pain, breathlessness, or swelling and pain in a leg are not symptoms to sit on, because they can point to a clot. Call 999 or go to A&E if you get any of them, and mention that you're on testosterone. Everything else is worth raising with your clinician, and the sooner the better. If you notice any new or concerning symptoms, let them know right away so you can work together on the best way forward.

How to access TRT safely

The safest way to start TRT is through a regulated clinic, either in person or online, where treatment follows strict medical guidelines and national safety limits.

Avoid black market products or offers from unlicensed vendors, such as people in gyms or online forums. These are not only illegal but also risky, as the medicines may be counterfeit, unsafe, or dosed incorrectly. A credible healthcare provider will run proper blood tests, assess your symptoms, and create a plan that treats you as an individual, with ongoing monitoring to make sure the therapy is both safe and effective.

Do TRT side effects differ across treatments?

The side effects that come with TRT are often formulation-dependent. Below are the main differences in side effects between different TRT formulations.

Regular injections

These can cause hormone level “peaks and troughs,” which may lead to mood changes, tiredness, or fluctuations in symptoms. Injection site pain and, in rare cases, blood clots have also been reported.⁵

3-monthly injections

Most common side effects are acne and pain at the injection site. Rarely, a reaction called pulmonary oil microembolism can occur during or just after the injection, causing short-lived chest symptoms.⁶

Gels

Gels often cause skin irritation, redness, or acne at the application site. Care is needed to avoid accidental transfer of the medication to partners or children through skin contact.⁷

Capsules

Capsules are convenient but can raise blood pressure, alter cholesterol, and sometimes worsen sleep apnoea. They may also cause water retention, leading to swelling in the ankles or legs.⁸

Regular injections

3-monthly injections

Gels

Gels often cause skin irritation, redness, or acne at the application site. Care is needed to avoid accidental transfer of the medication to partners or children through skin contact.⁷

Capsules

Capsules are convenient but can raise blood pressure, alter cholesterol, and sometimes worsen sleep apnoea. They may also cause water retention, leading to swelling in the ankles or legs.⁸

Meet the team

Our men’s health team brings together years of experience from both the NHS and private practice. Having worked across leading healthcare organisations in the UK and internationally, they combine clinical expertise with the latest research to deliver evidence-based treatments. At Numan, they apply this knowledge to men’s health, tailoring care to each individual’s needs with the same commitment to excellence.

Dr Dimitris Schizas

Numan Doctor

MBBS MRCGP MSC BSSM

Dr Michael Lacey

Numan Doctor

MBChB BSc (Hons) MRCGP

Dr Tom Anderson

Clinical Product Lead

MBBS MRCGP

Abby Watts

Senior Nurse Prescriber

BSc Adult Nursing, IP

Dr Dimitris Schizas

Numan Doctor

MBBS MRCGP MSC BSSM

Dr Michael Lacey

Numan Doctor

MBChB BSc (Hons) MRCGP

Dr Tom Anderson

Clinical Product Lead

MBBS MRCGP

Abby Watts

Senior Nurse Prescriber

BSc Adult Nursing, IP

numan patient

Real people. Real impact.

As everyone is unique, we offer a range of ways to get you back to your best, from lifestyle changes and symptom relief to testosterone replacement therapy.

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References

^{1. Sizar O, Leslie SW, Schwartz J. Male hypogonadism. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.}

^{2. Barbonetti A, D’Andrea S, Francavilla S. Testosterone replacement therapy. Andrology. 2020;8(6):1551–66.}

^3.^{Testosterone replacement therapy : (TRT). Nhs.uk. [accessed 17 Feb 2026] Available from:}^{https://www.ncic.nhs.uk/patients-visitors/patient-information-leaflets/Testosterone-replacement-therapy}

^{4. Meyer RJ, Mann M. Pulmonary oil micro-embolism (POME) syndrome: a review and summary of a large case series. Curr Med Res Opin. 2015;31(4):837–41.}

^{5. DEPO®-TESTOSTERONE (testosterone cypionate) Description. Pfizermedical.com. [accessed 25 Sept 2025] Available from: https://www.pfizermedical.com/depo-testosterone/description}

^{6. Nebido 1000 mg/4 ml solution for injection. Org.uk. [accessed 25 Sept 2025] Available from: https://www.medicines.org.uk/emc/product/14631/smpc}

^{7. TESTOGEL 50 mg, transdermal gel in sachet. Org.uk. [accessed 25 Sept 2025] Available from: https://www.medicines.org.uk/emc/product/6808/smpc}

^{8. Oral Testosterone Replacement - KYZATREX® (testosterone undecanoate). Kyzatrex. 2024. [accessed 25 Sept 2025] Available from: https://www.kyzatrex.com/}

Updated: 20/08/2026