Testosterone Therapy

The U.S. Food and Drug Administration (FDA) approved testosterone therapy for men who want to address hypogonadism and low testosterone. Hypogonadism is when the body does not produce enough testosterone, and it occurs in 19% of men in their 60s. The rates increase for men in their 70s (28%) and 80s (49%).

The popularity of testosterone therapy rose from 2000 to 2013, when a multitude of the hormone products came to market. More than 2 million Americans took testosterone products, including older men using it to improve libido.

The FDA later warned men about the dangerous side effects of these products, including cardiac events. Although testosterone therapy remains popular, concerns about side effects may ultimately reduce demand.

How Does Hormone Therapy Work?

Your body has androgen receptors in tissues throughout your body that help your body use hormones for different important functions. These receptors in tissues from reproductive organs to the brain all respond to increased testosterone taken orally, through injections or through the skin in patches, gels and creams.

When you start testosterone therapy, the hormone produces increased muscle mass, more body hair and increased sex drive. Some effects of TRT can be felt within weeks, while others build over the course of months.

Testosterone, as a Schedule III drug, is available only with a prescription. Although there are many supplements claiming to boost testosterone, these over-the-counter products do not contain testosterone and lack any peer reviewed evidence of effectiveness.

Gels (Androgel and Testim)

Testosterone gel is a prescription medication applied directly to a man’s skin. It can be applied to the shoulders, upper arms and abdomen, depending on the brand.

Testosterone gel can unintentionally transfer from your body to another’s with skin to skin contact. This can potentially lead to serious health reactions for the other person.

To avoid this type of gel transfer, apply it to clean, dry and intact skin that clothing can cover. Wash your hands right away with soap and water after applying. Once the gel has dried, cover the area with clothing and keep it covered until you have washed it well or showered.

Injections (Depo-Testosterone)

First approved in 1979, Depo-testosterone is one of the older drugs of its kind on the market. It’s a liquid designed for injection deep into the gluteal muscle.

The active ingredient, testosterone cypionate, is a powder mixed with other ingredients to make a solution. The drug is available in two strengths, 100 mg and 200 mg.

Patches (Androderm)

Testosterone transdermal patches, including Androderm, come as patches to apply to the skin. Patches work best when applied around the same time each night and are left in place for 24 hours. Testosterone patches are worn at all times until replaced with new patches.

Androderm patches should be changed every 24 hours. The old patch should be removed before applying the new one. You should apply the patches to different spots each night and wait at least seven days before re-using a spot.

Capsules (Methyltestosterone and Android)

Combined estrogen-methyltestosterone capsules have been discontinued. They were used to treat delayed puberty in men and boys and breast cancer in women.

Methyltestosterone, an artificial form of testosterone, alone is still available – in capsule and tablet form. It can affect bone growth in boys who are treated for delayed puberty.

Boosters (Testofen)

Testosterone boosters are not testosterone therapeutics. These are supplements with very little evidence to support their use.

Despite insufficient scientific data to support claims, manufacturers have suggested their products increase muscle mass, strength and sex drive in men. Among the most popular testosterone boosters are products containing Tribulus terrestris, DHEA, zinc and d-aspartic acid.

These ingredients have been associated with several side effects, including aggressiveness, breast enlargement, cholesterol changes, prostate problems and an increased risk of cardiovascular disease.

Men opt for testosterone replacement therapy to counteract a condition of low testosterone, often referred to as “Low T.” For many men, levels of this hormone decrease with age, leading to erectile dysfunction, low libido, loss of body mass and muscle, anemia and depressive moods.

Men turn to testosterone therapy to increase muscle tone, sexual desire and sexual performance, resulting increased confidence as they grow older.

Treating Low T

The FDA approved testosterone as replacement therapy only for men who have low testosterone levels from disorders that cause hypogonadism. Testosterone levels in men usually decline after age 30.

Other causes of Low T include an injury to the testicles, cancer treatments, chronic diseases and stress. Lack of this key sex hormone can also cause health issues, including osteoporosis, loss of muscle mass and strength (sarcopenia) and psychological symptoms. Doctors prescribe testosterone drugs to treat these symptoms.

Remedying Erectile Dysfunction

As men age, erectile dysfunction (ED), the inability to get or maintain an erection, is common. Before Pfizer released Viagra in 1998 as a medication for ED, doctors often turned to testosterone as a treatment.

However, only about 5% of men experience ED because of Low T. Low testosterone levels can contribute to ED but are more likely to reduce sexual desire than cause the condition.

Enhancing Physical Performance

Testosterone therapy can enhance athletic and physical performance. Athletes use it to boost strength and stamina, but it can also help men with chronic fatigue syndrome or fibromyalgia.

The National Football League (NFL) in 2011 banned players’ use of testosterone except for extraordinary health circumstances because of its ability to increase strength and muscle mass.

For many men, the biggest benefit of testosterone therapy is an improved sex drive. But there are other benefits related to muscle growth and body mass, which high-performance athletes and physical trainers acknowledge.

While some men report experiencing benefits shortly after beginning treatment, most studies indicate results take weeks or months.

Because it involves a potent hormone, testosterone therapy carries a handful of risk factors. Some are common while others are rare. Not all are serious, but anyone who undergoes therapy should be aware of the potential life-changing side effects.

Recent studies had mixed findings about links between testosterone replacement therapy and increased risks of obesity, diabetes and metabolic syndrome. Research linking it to an increased risk of cardiac events is still a source of debate, and studies continue to examine long-term cardiovascular risks.

Common testosterone side effects are often hormonal or psychological. Acne, changes to sexual desire and breast tenderness commonly occur. Mood swings, depression and anxiety are also possible. If you choose to pursue testosterone replacement therapy, it’s important to understand the common side effects you may experience.

Some people taking testosterone therapy experience irritation at the injection or application site. This can manifest as burn-like blisters, bleeding, redness, hardness, pain, itching or a burning sensation.

Patients experiencing any pain in the abdominal region after taking testosterone medication should report it to a health care provider immediately, as this may indicate liver damage.

Serious side effects of testosterone may include blood clots and infertility. Though the evidence is conflicting, serious side effects may also include cardiac issues and increased risk of prostate cancer. While not life-threatening, some patients may view hair loss, breast size changes and an irreversibly deeper voice as severe negative side effects. Various testosterone supplement manufacturers have faced significant lawsuits due to adverse side effects.

However, more recent research appears to contradict heart risks. A 2017 study published in the Methodist DeBakey Cardiovascular Journal found a correlation between testosterone replacement therapy and improved cardiovascular conditions.

If you are concerned about your heart health, talk to your doctor before beginning any form of testosterone replacement therapy.

Prostate Cancer Risk

While an increased risk of prostate cancer steered some patients away from testosterone replacement therapy in the early 2000s, a 2022 study in the journal Uro found that the conclusions of prior studies may have overestimated these harmful effects. According to this newer research, testosterone replacement therapy may instead counteract several metabolic problems.

Another 2016 literature review in Urological Oncology also found no significant correlation between testosterone levels and the chance of developing prostate cancer.

However, warnings related to prostate cancer risk are still on many testosterone replacement therapy product labels. Researchers may need to perform further studies to determine the level of risk.

Minor side effects, such as rash and acne, may clear up on their own. They may also be treatable with over-the-counter solutions such as acne treatments or soothing lotions. More severe symptoms like fever and vomiting may indicate something more serious, such as a cardiac condition. If you experience severe symptoms while on testosterone, talk to your prescribing health care provider to ensure they aren’t a sign of a serious health concern.

General life-style changes, such as getting adequate sleep, vitamin D, zinc and exercise, may help increase testosterone levels.

Additionally, there is some evidence that human chorionic gonadotropin (hCG) may stimulate the production of testosterone in the testes. While hCG is commonly used as a fertility aid in women, a study published in Cureus in 2022 showed subjective increases in libido and sexual function among men taking hCG.

If you respond poorly to testosterone replacement therapy and would like to explore other options, be sure to consult your doctor before beginning or ending any sort of hormone therapy treatment.

The FDA approved testosterone products only for men with low testosterone levels. Children should never be exposed to testosterone products because they can cause premature puberty and health problems such as liver damage.

Women can inadvertently and dangerously raise their testosterone through skin to skin contact with a man undergoing treatment. Most exposures happen with the gel and cream forms of TRT. When women are exposed to testosterone they may also experience increased hair growth on her face and body, a deeper voice and increased muscle mass.