Testosterone Replacement Therapy (TRT)  What To Know? Testosterone Replacement Therapy (TRT)  What To Know?

Testosterone Replacement Therapy (TRT): What To Know

 

Testosterone is an important hormone essential for various body functions in males, such as maintaining muscle and bone health, enhancing cognition, producing red blood cells, forming sperm, and promoting sexual and reproductive function.

Stress, age, trauma, and infections can all contribute to a decrease in testosterone levels.

What Is Testosterone Replacement Therapy?

Men with hypogonadism, a condition characterised by testosterone deficiency, may be prescribed androgen replacement therapy (ART), also known as TRT, to alleviate the symptoms associated with the condition.

Replenishing the body's testosterone levels through prescription medications can lead to increased alertness, improved sexual activity, increased energy, improved mood, and an overall feeling of well-being. Low testosterone symptoms, such as fatigue and low libido, can be reversed when testosterone levels are restored.

Who Is Testosterone Replacement Therapy For, And How Does It Work?

Testosterone Replacement Therapy (TRT) is a treatment option for males with hypogonadism, a condition in which the body does not produce enough testosterone. A blood test is required to determine testosterone levels to make a definitive diagnosis. A level below 300 nanograms per deciliter (ng/dl) indicates low testosterone. In addition to low testosterone levels, an individual with hypogonadism may experience other symptoms, such as fatigue, breast growth, and sexual dysfunction.

TRT, or testosterone replacement therapy, is not typically the first step taken when a male patient presents with symptoms of low testosterone levels. Doctors usually try to identify and treat the underlying cause that has led to the drop in testosterone levels, such as a medical condition or medication, before opting for TRT.

Benefits Of TRT

A study published in 2019 suggested that Testosterone Replacement Therapy (TRT) can improve sexual function, including:

  • Libido

  • Symptoms of erectile dysfunction

  • Sexual satisfaction

Testosterone replacement therapy (TRT) could help maintain bone density. A study in 2022 also revealed that TRT might boost cognitive performance and enhance attention span.

Despite the potential benefits of testosterone replacement therapy (TRT), the effects were relatively minimal. Furthermore, when the TRT was discontinued, the majority of participants still had poor bone mineral density, with some in the range of osteopenia or osteoporosis.

How To Get TRT

A doctor will only provide a prescription for TRT after assessing a person's medical history, conducting physical exams, and performing laboratory tests if the individual presents with symptoms indicative of low testosterone levels.

Doctors generally take two blood samples before noon to accurately determine the cause of low testosterone levels. Additionally, they may recommend imaging studies or tests for luteinising and follicle stimulation hormones to investigate the issue further. Depending on activity levels, diet, and time of day, hormone levels may vary, so it is essential to measure them accurately.

Types Of Testosterone Treatments

Testosterone can be administered in various forms, including;

Injectable

Testosterone replacement therapy (TRT) is often administered through an injectable form. This treatment is relatively affordable and can be tailored to the individual. Short-term TRT involves a shot every 1 or 2 weeks, while long-term TRT requires a second shot four weeks after the initial one and ten weeks apart for all subsequent injections. The dosage and frequency can be adjusted depending on the person's needs.

The administration of testosterone replacement therapy (TRT) can take place through the injection of short-acting or long-acting testosterone. Short-acting testosterone is administered either under the skin or in the muscle, while long-acting shots go into the gluteal muscles. This treatment can cause fluctuations in testosterone levels, which can affect energy, libido, and overall mood, as well as the presence of specific side effects such as breast tenderness.

Topical (Transdermal)

Daily, people often use creams and gels. The gradual absorption of these products helps to maintain a steady level of testosterone in the bloodstream. However, it is essential to be cautious when using topical treatments and avoid skin-to-skin contact with other people for at least 6 hours after application. This is because transferring the medication onto the skin of pregnant people and children can potentially be hazardous.

Topical patches are a medication that is adhered to the skin and remains in place for a full day. These patches usually contain between 2 to 5 mg of a particular drug. Although effective, topical patches can be unsightly and may lead to skin irritations. Additionally, topical patches may be less damaging to the liver than oral medications.

Usually, topical gel dosages are between 40 and 100 mg daily and should be increased gradually if necessary. The amount may vary depending on the product.

Cheek Or Buccal Patches

A buccal patch containing 30 mg of testosterone is placed above the upper teeth and functions for 12 hours. It is recommended that the patch be used twice daily, with a 12-hour interval between applications. Potential side effects include headaches, gum, and mouth irritation.

Testosterone Implants Or Pellets

Doctors may implant small plastic pellets under a person's skin in the upper hip or buttock. Over time, these pellets will dissolve and provide testosterone replacement therapy (TRT) for up to six months. The dosage for each individual should be determined in consultation with their doctor before the first implantation.

A doctor performs a minor inpatient surgical procedure to insert implants. A small incision is made in the fatty tissue beneath the skin to insert the pellets. Local anaesthesia is used to numb the area during the procedure.

Oral Testosterone

Testosterone replacement therapy (TRT) can come in a variety of forms, with oral testosterone being less common. This type of TRT is more costly and less practical, and its prolonged use may result in liver damage.

Since tablets have warnings regarding hypertension and stroke, people typically opt for other forms of testosterone replacement therapy (TRT). However, when other forms of TRT are not suitable, a physician may suggest taking oral testosterone tablets twice a day, with a dosage range of 225–396 mg.

Intranasal

It is recommended to use nasal testosterone gel three times per day, with intervals of 6-8 hours between applications. The dosage for each application is 11 mg, administered across both nostrils. This amounts to a total daily intake of 33 mg. However, some people may experience side effects such as headaches, nosebleeds, a runny nose, and nasal discomfort.

What To Expect

TRT is designed to bring a person’s testosterone levels back to a normal range. After a week of treatment, individuals may notice increased blood testosterone levels. However, it could take more time for the full benefits of the treatment to be felt.

These benefits are due to the increased muscle mass and bone density that come with strength training and the increased energy levels that come with increased physical activity.

People with medical illnesses that require testosterone replacement therapy (TRT) should have an ongoing relationship with their doctor. Regular checkups are essential to ensure effective treatment and prevent potential side effects. It is recommended that individuals on TRT visit their doctor at least every 6–12 months to review their blood testosterone levels.

A doctor should be consulted three months after the initial treatment to assess any changes in symptoms or side effects. After that, a follow-up appointment should be scheduled annually to review the treatment progress.

Approximate Costs

TRT costs per year depending on various factors, including:

  • Type Of Medication

  • Insurance Coverage

  • Dosage

  • Doctor And Laboratory Fees

  • Mode Of Administration

Is It Safe?

The Endocrine SocietyTrusted Source does not recommend that people with the following conditions use TRT, as it may cause health risks in addition to the short-term side effects:

  • Hematocrit levels are elevated

  • Prostate-specific antigen levels are high

  • Cardiovascular congestive failure

  • Sleep apnea that is untreated and severe

  • Symptoms of severe lower urinary tract infection

  • Cancer of the breast or prostate

  • Nodules or induration in the prostate

  • Stroke or heart attack within the past year

  • Thrombophilia

Males who wish to conceive soon should not receive this treatment. Additionally, those aged 40 or over, preadolescents, and those with migraine or epilepsy should be carefully considered before beginning treatment.

Who Should Avoid TRT?

TRT should not be initiated for those who have the following conditions, according to the :

Obstructive Sleep Apnoea

When prescribing testosterone replacement therapy (TRT) to people with severe obstructive sleep apnoea, clinicians should take extreme caution, as suggested by research.

Regular use of TRT can lead to neuromuscular modifications in the respiratory system and changes to the body's metabolic processes. This can reduce oxygen levels in body tissues, known as hypoxia. Symptoms of hypoxia include confusion, restlessness, difficulty with breathing, an accelerated heartbeat, and a bluish skin tone.

High carbon dioxide levels in the blood can be caused by TRT, leading to a condition called hypercapnia. Respiratory acidosis can result, which can cause fatigue, drowsiness, and an intense urge to sleep.

Severe Lower Urinary Tract Symptoms

BPH is a condition that affects many men as they age and can cause an increase in the frequency of urination, a sudden urge to urinate, and difficulty urinating. It can also cause difficulty starting or stopping the flow of urine and a weak or interrupted flow of urine. Treatment for BPH may involve medications or surgery.

Studies conducted in the past have found that testosterone replacement therapy (TRT) may be associated with lower urinary tract symptoms (LUTS) in men with hypogonadism. However, recent trials have revealed that although it may help reduce prostate inflammation, it may worsen LUTS in the long run. This is particularly true for ageing men who developed hypogonadism late in their life.

Elevated Hematocrit Levels And Thrombophilia

TRT should be avoided by those with a high red blood cell count and thrombophilia, as it can increase red blood cell count, thus increasing the thickness of the blood. This can increase the risk of blood clots forming, leading to stroke or ischemia.

The research study on trans men who utilised long-term testosterone replacement therapy (TRT) determined that this treatment increased red blood cell count. Red blood cell numbers were measured annually, and the data showed a 10% increase after the first year and a 38% increase after the 10th year.

Prostate Cancer

The National Cancer Research Institute has found that men who have higher levels of testosterone in their bloodstream are more likely to be diagnosed with prostate cancer. This is because prostate cancer requires testosterone to grow, and testosterone replacement therapy (TRT) can stimulate the growth of cancer cells.

High Prostate-Specific Antigen Levels

In a clinical trial, men aged 65 or over were given TRT for 12 months. The research revealed that 5% of the men had an increase of 4.0 ng/mL in antigen levels by the end of the trial. This indicates a relation between TRT and increased antigen levels in elderly men.

Ischemic Stroke

A clinical trial involving 15,401 men aged 45 and over who had low testosterone levels was conducted. Those receiving testosterone replacement therapy (TRT) had a 21% increased risk of cardiovascular conditions such as heart attack and stroke compared to those who did not receive TRT.

Side Effects And Warnings

The effects of testosterone replacement therapy (TRT) on low testosterone levels caused by ageing are uncertain. Therefore, testosterone products come with warnings that they may be associated with an increased risk of stroke and heart disease.

A review suggested that men taking testosterone replacement therapy (TRT) may have a higher risk of cardiovascular events like stroke, but further research is needed to confirm this.

Testosterone can also cause the following side effects:

  • Bladder irritability

  • Anxiety

  • Increase in prostate size

  • Worsening of prostate cancer

  • Decreased sperm production

  • High red blood cell count, which may lead to blood clots

  • Liver dysfunction

  • Anger and aggressive behaviour

  • Male pattern baldness

  • Shrinkage of the testes

  • Breast soreness or enlargement (gynecomastia)

  • Rashes, itching, and acne

  • Deep vein thrombosis

  • High blood pressure

  • Priapism

  • Hair loss or excessive hair growth

Research has indicated that Testosterone Replacement Therapy (TRT) may improve total cholesterol levels despite a potential side effect of high cholesterol. Additionally, while TRT may worsen existing breast and prostate cancer cases, it may offer benefits to those with early-stage prostate cancer without stimulating the recurrence or progression of the cancer.

Alternatives To TRT

The level of testosterone can be improved without medical intervention. There are several ways to do this, including:

  • Avoiding drugs and alcohol

  • Reducing stress

  • Eating a balanced diet

  • Taking vitamins and minerals, such as vitamin D and magnesium

  • Getting enough sleep

  • Losing weight

  • Getting enough exercise

It is essential for anyone who is taking medications that may lower testosterone levels to consult with their doctor.

Frequently Asked Questions About TRT

TRT is commonly asked about the following topics.

Does Insurance Cover TRT?

Some insurance companies may cover the costs of Testosterone Replacement Therapy (TRT). However, contacting your insurer to confirm this coverage and ensure no unexpected expenses is essential.

Is Testosterone Replacement Therapy Safe?

Despite the potential benefits of TRT for people with low testosterone, it can also lead to a range of short-term side effects.

An investigation conducted concluded that sustained use of testosterone replacement therapy (TRT) improves liver health and lowers the risk of cardiovascular issues. Nevertheless, additional research is required to gauge its long-term consequences. To this end, an ongoing study evaluates TRT's long-term cardiovascular effects.

How Long Should I Stay On Testosterone Replacement Therapy?

The length of TRT treatment will continue until the root cause of the low levels has been addressed, or the low levels are no longer present.

What Does TRT Do To Your Body?

TRT can potentially increase muscle mass and bone density and lead to a reduction in body weight.

Does Insurance Cover TRT?

People with a health condition that requires TRT (Testosterone Replacement Therapy) as a treatment should have their medical insurance cover the cost.

How Do I Take Testosterone Therapy?

TRT can be administered orally, through intramuscular injections or implants, transdermal patches, mouth patches, topical creams or gels, intranasal gels or pellets. The frequency of administration can vary from daily to weekly or monthly, up to every three months.

Before starting any treatment, individuals should consult their healthcare provider to determine which option suits their medical needs and lifestyle.

How Will Doctors Monitor My TRT?

People undergoing testosterone replacement therapy will have their treatment monitored regularly. This involves taking blood tests to measure total serum testosterone, complete blood count (hematocrit), and prostate-specific antigens (PSA). At the start of the treatment, these tests will be conducted and repeated three to six months later. If the results remain stable, annual blood tests will only be required.

After beginning testosterone replacement therapy (TRT), individuals who have had osteoporosis or suffered a low-trauma fracture should have a bone density scan done within one to two years.

Summary

For those with low testosterone levels, testosterone replacement therapy (TRT) is an option, but it is not suitable for everyone. Before beginning TRT, a prescription and guidance from a medical doctor or qualified healthcare provider is required.

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