Testosterone replacement therapy (TRT) has gained significant attention in recent years. More men are exploring treatment options for low testosterone, often called “Low T,” due to its association with symptoms like low energy, decreased muscle mass, and reduced libido.Â
The increasing demand for TRT has been driven by aggressive marketing, direct-to-consumer telemedicine platforms, and the perception that it can reverse aging. However, TRT is not a one-size-fits-all solution. It has benefits, but it also carries risks.
This article explores what testosterone therapy does, who qualifies for it, and what research says about its safety and effectiveness.
Why Testosterone Levels Decline
Testosterone naturally decreases as men age. Men over 65 experience a noticeable decline, and up to 15 percent of men in this age group have testosterone levels below 250 ng/dL. This decline can result in symptoms such as fatigue, depression, and decreased muscle strength.
Body weight also plays a role. Studies show that excess body fat lowers testosterone by increasing estrogen conversion and suppressing the brain’s signal to produce the hormone. Lifestyle factors such as poor sleep, stress, and chronic illnesses can further contribute to lower levels.
Who Qualifies for Testosterone Replacement Therapy?
TRT is a medical treatment, not a lifestyle drug. Doctors prescribe it to men who meet specific criteria. To qualify, a patient typically needs:
- Clinically low testosterone levels: Most guidelines define this as two separate morning blood tests showing testosterone below 300 ng/dL.
- Symptoms of testosterone deficiency: This may include low libido, erectile dysfunction, fatigue, depression, and reduced muscle mass.
- An evaluation ruling out other causes: Doctors check for conditions like sleep apnea, diabetes, or thyroid disorders, which can mimic low testosterone symptoms.
Insurance coverage varies. Many plans cover TRT when patients meet strict medical criteria. However, men seeking TRT for general aging concerns or athletic performance typically pay out of pocket.
How TRT Works
Testosterone therapy comes in several forms, each with its own benefits and drawbacks. Doctors monitor patients regularly to adjust dosage and watch for side effects.
- Topical gels: Applied daily to the skin, these absorb into the bloodstream gradually. However, accidental transfer to others is a concern.
- Injections: Administered weekly or biweekly, injections provide a steady supply of testosterone but may cause mood swings as levels peak and drop.
- Patches: Worn daily, these offer consistent hormone release but can cause skin irritation.
- Pellets: Implanted under the skin every few months, these provide long-term benefits without frequent application.
Does Testosterone Therapy Improve Sexual Function?
One of the most common reasons men seek TRT is to improve their libido and sexual performance. Research from The Testosterone Trials, a coordinated set of seven studies, found that TRT significantly increases sexual desire and activity in men with low testosterone. However, its impact on erectile function is limited. The study noted that while testosterone improved erections, it was only about half as effective as phosphodiesterase inhibitors like Viagra.
The Effect of TRT on Physical Strength and Energy
Testosterone plays a major role in muscle mass and endurance. The Testosterone Trials found that men who received TRT saw modest improvements in walking distance, with 20 percent of them increasing their six-minute walk by at least 50 meters. However, men who were already frail did not experience significant gains.
Muscle strength can improve with TRT, but results depend on the dose. In a study published in the New England Journal of Medicine, Lincoff et al. (2023) noted that moderate TRT doses had only a small effect on muscle mass. Higher doses, often used in bodybuilding, increase strength, but they go beyond therapeutic use.
Potential Risks and Side Effects of TRT
Like any medical treatment, TRT comes with risks. The TRAVERSE Study, the largest trial on TRT’s cardiovascular safety, found no significant increase in heart attacks or strokes. However, some risks require monitoring:
- Fertility suppression: TRT reduces sperm production, which can take months or years to recover after stopping treatment.
- Elevated red blood cell count: This may increase the risk of blood clots, particularly in older men.
- Fluid retention and swelling: Some men experience mild swelling in the lower legs.
- Prostate concerns: While TRT does not directly cause prostate cancer, it can increase PSA levels, leading to more prostate biopsies.
Testosterone and Diabetes Prevention
A lesser-known benefit of TRT is its potential to reduce the risk of type 2 diabetes. The TRAVERSE Study found that TRT improved insulin sensitivity and helped men with low testosterone control their blood sugar more effectively.
This suggests that testosterone may play a role in metabolism beyond muscle and libido. However, TRT should not replace traditional diabetes management strategies such as weight loss and exercise.
Overprescription and Marketing Hype
Many men seek TRT without meeting medical guidelines, often influenced by aggressive marketing. The Center for Science in the Public Interest highlights the rise of online telemedicine platforms that prescribe testosterone to men with normal levels. These companies often position TRT as an anti-aging solution despite a lack of evidence supporting benefits for men with normal testosterone.
A concerning trend is the lack of informed consent. Some clinics fail to mention TRT’s effect on fertility. A urologist with a normal testosterone level of 675 ng/dL applied for TRT at seven telemedicine clinics. Despite not meeting medical criteria, six approved treatment without proper evaluation. Half of them failed to mention fertility risks, highlighting concerns about overprescription, lack of oversight, and misleading marketing in online TRT services. This highlights the need for stricter regulations and responsible prescribing practices.
Testosterone therapy is an effective treatment for men with diagnosed testosterone deficiency. It can improve sexual function, mood, and body composition when used correctly. However, it is not a magic bullet for aging. Men considering TRT should consult with a qualified healthcare provider to assess risks, benefits, and alternative treatments.
Looking for Expert Guidance? Contact Us Today
At Zeam Health & Wellness, we specialize in hormone replacement therapy and testosterone optimization. Our primary care team evaluates each patient individually, ensuring that treatment is safe, effective, and medically appropriate.
If you are experiencing symptoms of low testosterone, schedule a consultation with us today. We are here to provide expert guidance and personalized care tailored to your health needs.
