Hormone Replacement Therapy HRT for men, more accurately called Testosterone Replacement Therapy (TRT), is a treatment used to address low testosterone levels, a condition known as hypogonadism. As men age, testosterone production naturally declines, but some experience a more significant drop that can lead to physical, emotional, and cognitive symptoms.

What Is Testosterone and Why Is It Important?

Testosterone is the primary male sex hormone responsible for:

  • Muscle mass and strength
  • Bone density
  • Libido (sex drive)
  • Sperm production
  • Mood and energy levels
  • Fat distribution

Low levels can affect many aspects of health and quality of life.

Symptoms of Low Testosterone

Common signs include:

  • Fatigue
  • Decreased sex drive
  • Erectile dysfunction
  • Depression or irritability
  • Loss of muscle mass
  • Weight gain, especially around the abdomen
  • Difficulty concentrating

Causes of Low Testosterone

  • Aging (natural decline starts around age 30)
  • Chronic illnesses (diabetes, obesity)
  • Injury to the testicles
  • Chemotherapy or radiation
  • Pituitary gland disorders
  • Certain medications

What Is TRT?

TRT is the administration of synthetic testosterone to restore normal levels. It can be delivered in several forms:

  • Injections (intramuscular or subcutaneous) – weekly or biweekly
  • Gels or creams – applied daily to the skin
  • Patches – worn on the skin, changed daily
  • Implants or pellets – inserted under the skin every few months
  • Oral formulations – newer options, though not as commonly used

Benefits of TRT

  • Improved energy and mood
  • Enhanced libido and sexual function
  • Increased muscle mass and bone density
  • Better cognitive function
  • Improved sleep in some cases

Risks and Side Effects

TRT is generally safe for well-screened candidates, but it can carry risks:

  • Increased red blood cell count (polycythemia)
  • Acne or oily skin
  • Breast enlargement
  • Testicular shrinkage
  • Fertility issues
  • Worsening of sleep apnea
  • Potential cardiovascular risk (still debated)
  • Prostate health concerns (routine screening advised)

Is TRT Right for You?

TRT should only be initiated after thorough testing, including:

  • Multiple blood tests confirming low testosterone (usually <300 ng/dL)
  • Evaluation of underlying causes
  • A clear discussion of risks and benefits with a healthcare provider

Monitoring While on TRT

Once on TRT, regular monitoring is essential:

  • Testosterone levels
  • Hematocrit/hemoglobin (for blood thickness)
  • Prostate-specific antigen (PSA)
  • Liver function tests
  • Symptom tracking