What is TRT? Testosterone Replacement Therapy

Aging affects more than just your looks. It also has a direct on your hormones, influencing your ability to build mass. Your testosterone levels reach their peak around age 17 and remain high for another 20 or 30 years. 

As you age, testosterone production declines by about 1% per year. This process typically starts after age 30 or 40. Some men may experience these changes earlier in life due to kidney or liver disease, diabetes, pituitary gland problems, and other illnesses. 

Many guys turn to testosterone replacement therapy, or TRT, to bring their T levels back to normal. While this form of treatment has its perks, it’s often abused or misused. 

According to the Military Health System, TRT prescriptions have tripled over the past years. About 25% of patients don’t even have their T levels checked before starting the treatment. Approximately one-third of those who undergo TRT have no clinical symptoms of hypogonadism or low testosterone. 

What you may not know is that TRT carries serious health risks, like strokes, heart attacks, and premature death. There are safer ways to boost our testosterone levels and feel like yourself again. 

Today we’ll get an in-depth look at TRT, what it does to your body, and when it’s recommended. We’re also going to discuss its side effects to help you make an informed decision. Let’s dive in! 

The Role of Testosterone 

If you’re a regular reader of our blog, you know that testosterone plays a key role in hypertrophy and overall health. Let’s do a quick recap. 

Testosterone, the male sex hormone, affects your mood, body composition, bone density, and physical performance. It also regulates libido, sperm production, and reproductive function. 

Elevated T levels are associated with stronger bones, improved muscle function, reduced catabolism, and enhanced cognition. The female body produces this hormone too but in smaller amounts. 

Free testosterone in healthy men accounts for about 2% of total testosterone and has stronger biochemical effects than SHBG- and albumin-bound testosterone, according to the journal Reviews in Urology. 

As mentioned earlier, testosterone levels decline with age. But aging is just one of the many factors that affect hormone production. The University of Rochester states that age-related testosterone decline isn’t considered hypogonadism and doesn’t require TRT. 

What Are Normal Testosterone Levels in Men? 

Testosterone levels depend on your age and overall health. The American Urology Association defines low testosterone as less than 300 nanograms per deciliter (ng/dL). 

The University of Rochester, on the other hand, says that testosterone levels between 280 and 1,100 ng/dL are considered normal. According to Mayo Clinic Laboratories, T levels in healthy men should be around 240 to 950 ng/dL. 

These numbers vary among health organizations, so it’s not surprising that millions of men get TRT without actually needing it. On top of that, men with certain conditions tend to have higher or lower T levels. 

Bodybuilders, for example, often have higher testosterone levels than the average person. Obese and overweight men produce less testosterone than those with a lean figure. 

Generally, you should talk with your doctor if you experience the following symptoms: 

Anemia, high cholesterol, sexual dysfunction, and diminished penile sensation are all common symptoms of hypogonadism reports a 2010 review published in the Journal of Advanced Pharmaceutical Technology and Research. If left unaddressed, this condition may lead to osteoporosis, cardiac events, and mental disorders.

MDedge Family Medicine recommends testing your serum testosterone levels twice (at least one month apart) before starting TRT. The organization states that physicians should only prescribe this therapy when both clinical and lab tests confirm suspected hypogonadism. 

Also, healthcare providers are required to disclose the potential benefits and risks of TRT to their patients, especially those over 65.

What Is Testosterone Replacement Therapy? 

In the 1930s, doctors prescribed testosterone to aging men suffering from erectile problems, fatigue, mood swings, and other symptoms known collectively as the male climacteric. Back then, there was no way to measure testosterone levels in the blood. 

Even today it’s hard to tell whether someone needs TRT or could benefit from a different approach. A 2012 review featured in the Journal of Andrology states that testosterone prescriptions increased more than 15-fold between 1992 and 2002. 

The rising demand for TRT doesn’t necessarily mean that more men are being diagnosed with hypogonadism or that they actually need the treatment. Clinical evidence doesn’t support the use of TRT as a preventive measure for older adults. 

But what is TRT and how does it work? 

Also known as androgen replacement therapy, this treatment method involves the administration of testosterone through patches, creams, gels, or injections. Nasal sprays and subcutaneous pellets can be used too. 

• Topical products are effective for about four days, according to the American Urology Association. 
• Testosterone shots have longer-lasting effects and should be administered weekly, biweekly, or monthly. 
• The effects of oral patches last 12 hours or so. 
• Subcutaneous pellets ensure a steady release of testosterone over three to six months.
• Intranasal products must be used at least three times a day. 

The role of treatment is to make up for T that isn’t being produced by your body. 

This form of therapy can help offset hypogonadism symptoms and bring your hormones back into balance. However, it’s often used for completely different purposes, like weight loss, hypertrophy, sexual performance, or increased energy. 

Unfortunately, the benefits of TRT come at a price. The risks are even higher for those who misuse or abuse testosterone products. 

What’s Wrong With TRT? 

The American Urology Association warns that TRT is often administered to men who don’t necessarily need it. Many patients are not even tested. As the scientists point out, there are safer ways to increase testosterone levels. 

Up to 2.9% of American men are using testosterone products, reports the Military Health System. Back in 2015, more than 85,000 veterans received TRT despite having normal testosterone levels. 

This treatment method carries significant risks, including:

• Heart disease
• Respiratory problems
• Reproductive issues
• Suppressed sperm production
• Fluid retention
• Allergic reactions
• Blood clots under the skin (hematoma)

According to the American Urology Association, men who are planning to have children should not use TRT because it can affect sperm production and cause fertility issues. Additionally, topical testosterone may transfer to women and children, putting them at risk for hormonal imbalances. 

The American Academy of Family Physicians states that there’s little evidence to confirm the safety and effectiveness of TRT for age-related testosterone decline. 

This form of treatment should only be used for men with low T levels AND clinical symptoms of hypogonadism. Patients need to be monitored regularly for potential side effects. 

The FDA says that prescribing TRT for age-related testosterone decline is considered off-label use. Testosterone products may increase the risk of strokes and heart attacks and should be used with caution. 

Health Risks Associated with TRT 

While there is plenty of information about the benefits of TRT, few are aware of its risks and adverse effects. 

Let’s start with a recent study published in the American Journal of Medicine. The cohort included over 15,000 men who received TRT for low testosterone. 

Researchers who conducted the study concluded that TRT may raise the odds of developing cardiovascular problems, particularly in the first two years of treatment. TRT products were associated with a higher risk of stroke, cardiac arrest, and transient ischemic attacks. 

These findings contradict the results of a 2015 study conducted at the Intermountain Medical Center Heart Institute. 

After analyzing the effects of TRT on 1,472 men in their 50s and 60s, scientists have found no evidence that testosterone products may lead to strokes, heart attacks, or premature death. 

Another study showed no association between TRT and venous thromboembolism (blood clots) in 30,573 men. These findings were published in Mayo Clinic Proceedings in 2015. 

A different study suggests that blood clots may develop in men who undergo TRT as soon as three weeks after starting the treatment. None of the study participants had thrombotic events before receiving testosterone shots. 

Furthermore, TRT doesn’t appear to increase the risk of prostate cancer as it was once thought. Yet, a 2015 review featured in the World Journal of Men’s Health notes that some studies confirm a potential association between TRT and prostate cancer. 

All in all, the long-term risks of TRT are not known. This treatment method has been said to both increase and decrease the risk of heart disease, blood clots, cancer, and premature death.

TRT Side Effects: What Does the Research Say? 

Based on the current evidence, it’s hard to confirm the safety of TRT in the long run. What we do know is that it has immediate side effects. 

For example, TRT may trigger or worsen sleep apnea, a disorder that causes repeated pauses in breathing during sleep. Over time, this condition may lead to cardiac ischemia and other cardiovascular issues. 

In a clinical trial, high doses of short-term testosterone worsened sleep apnea in obese men. Another study has found that TRT may increase the risk of developing this condition through several mechanisms. 

TRT may also cause oily skin, acne, breast enlargement, and reduced sperm count, warns WebMD. Additionally, it may worsen congestive heart failure and lower urinary tract symptoms. 

Other potential side effects include: 

• Edema 
• Shortness of breath
• Liver problems
• Numbness and tingling
• Male-pattern baldness
• Anxiety
• Headaches
• Changes in bowel habits 

Testosterone cypionate (depo-testosterone), a drug used in sports and TRT, can affect liver function, blood lipids, and sex drive. It has also been linked to depression, water retention, and gynecomastia.

Are There Any Alternatives to TRT?

The benefits of TRT are due to its ability to replace the testosterone your body is no longer producing. These may include faster gains in lean mass and strength, fat loss, increased energy, higher libido, and more. But are you willing to risk your health?

If you’re on the heavier side, take the steps needed to lose excess fat and build lean mass. Evidence shows that weight loss may improve the body’s ability to produce this hormone. Other lifestyle changes, such as cutting back on sugar and lifting heavier in the gym, can further raise your T levels.

Know that TRT isn’t your only option. From changing your diet and losing weight to quitting smoking, there are ways to boost your T levels naturally. 

For example, certain foods may help increase testosterone production and prevent age-related testosterone decline. Oysters, pomegranate, leafy greens, eggs, and fatty fish are all a great choice. 

Another option is to use a natural testosterone booster, like Old School Labs’ Vintage Boost. Our formula works with your body, not against it. Instead of pumping hormones into your system — as TRT does, it increases the body’s testosterone production.  

Vintage Boost contains no synthetic hormones or artificial substances. Like all of our products, it’s manufactured in FDA-certified facilities and has all-natural ingredients, such as maca root, Tribulus terrestris, zinc, and B-complex vitamins. 

Is TRT Worth the Risk? 

Unless your testosterone levels are borderline low, you probably don’t need TRT. Its risks often outweigh any potential benefits. 

We’re not saying that TRT should be avoided at all costs. This form of treatment can be a viable option for men with hypogonadism. However, if you’re young and healthy, you should be able to boost your T levels throughout lifestyle changes. 

Focus on building lean mass and clean up your diet. Go heavy in the gym and prioritize compound movements, like squats, deadlifts, and bench presses. Cut back on alcohol, trans fats, sugary treats, and ultra-processed foods. 

Do you know anyone who has tried TRT? What happened? Share your experience in the comments below!