Pros and Cons of TRT

TRT has the potential to improve life quality and even save your life. But for all its benefits, what are the cons of TRT we need to watch out for?

As most of you know there is an increased popularity of testosterone replacement therapy (TRT) in the past two decades. However, a lot of men still have some concerns about the side effects of TRT.

They have a lot of questions. Does TRT cause infertility? Heart attack? Prostate cancer? For all these horrible ideas, we all know that TRT is benficial to those who are in need of it medically.

IfIn this article we gather all the information you need to know about the safety profile and the possible side effects of testosterone replacement therapy while also looking at the Pros as well.

Key Takeaways

  • Prior to the start of TRT, Hypogonadal men need to undergo testicular examination and have full hormonal profile.
  • TRT has been linked to reducing the risk of cardiovascular disease and depression in men
  • TRT does have side effects, such as potentially causing infertiliy
  • To make sure you manage the sides, work through a trusted and well known TRT Clinic

Why men need Testosterone

The male hormone testosterone plays an important role in the development and maintenance of typical masculine physical characteristics, such as muscle mass and strength, and growth of facial and body hair. [12]

The levels of testosterone are regulated by the hypothalamus and the pituitary gland at the level of the hypothalamic-pituitary-gonadal axis. [12]

The normal levels of serum testosterone in young healthy men (20 – 30 years old) ranges between 300 and 800 ng/dL. [12]

After the third decade of life, serum testosterone levels decline gradually at an approximate rate of 1-2% per year. [12]

What classifies as Low Testosterone

The 2010 Endocrine Society Guidelines define androgen deficiency as signs and symptoms of low testosterone in the setting of unequivocally low morning serum testosterone levels of less than 300 ng/dl on two separate occasions. [13]

TRT Side Effects
As men age, we see a corrosponding decline in Testosterone production

Symptoms and signs of low testosterone include [13]:

  • Anemia
  • Depressed mood
  • Erectile dysfunction
  • Impaired sexual function, decreased libido and sexual desire, fewer spontaneous erections
  • Reduced muscle mass and strength
  • Reduced bone mass and osteoporosis
  • Insomnia and a reduced sense of general well-being
  • Forgetfulness and difficulty in concentration, and loss of memory

Testosterone Replacement Therapy (TRT)

The U.S. Food and Drug Administration (FDA) cautions that prescription testosterone products are approved only for men who have low testosterone levels caused by certain medical conditions. [14]

Over the last 10 years, testosterone deficiency in men has been under the spotlight due to the increased awareness by medical providers, increased direct-to-consumer advertising in the media, and the longer life expectancy of male population. [13]

Testosterone replacement therapy (TRT) has been used by millions of men allover the world to treat symptoms of low testosterone levels such as diminished libido and erectile dysfunction, and to improve muscle strength and physical function. [13]

In the United States, between 2001 and 2011, testosterone therapy prescription among men 40 years of age or older increased from 0.81% in 2001 to 2.91% in 2011. [13]

TRT has been shown to increase serum testosterone to physiologic levels and improve testosterone deficiency related symptoms. [13]

Low Testosterone has been linked to several health complications, including cardiovascular disease

Several TRT formulations such as topical gels and patches, intramuscular testosterone injections, subcutaneous pellets, and oral/buccal formulations are available and provide clinicians and patients the opportunity to personalize replacement therapy according to the clinical and economic status of each patient. [13]

Pros of TRT

There are plenty of reasons why someone suffering from hypogonadism would consider TRT, as long as they do it through a medical facility.

Improvement of Cardiovascular Health

As we know, low Test levels are linked to various health conditions, such as heart disease, stroke, and higher blood lipids [13].

While studies and medical professionals are not all in agreement about this, there is some evidence to show that raising Test levels to normal levels will decrease the risk of cardiovascular disease.

More Muscle Mass and Less Fat

Testosterone is an androgen after all, and lower Testosterone levels have been linked to lower muscle mass. Lower muscle mass will lead to a poorer quality of life, and an increased risk of injury.

Low Testosterone can also lead to fat gain, increasing the risk of diabetes. Fat gain is predominantly around the abdomen, which has been linked to various health diseases [13].

Improved Mood and Sexual Function

It will come as no surprise that low Testosterone has been linked to depression and erectile dysfunction. TRT has been shown to increase mood, libido, sexual function, and decrease the risk of anxiety and depression.

Other Pros of TRT

  • Increased Bone Density and Strength
  • Improved Cognition and Memory
  • Fat loss
  • Reduced risk of injury
A 2017 study found that bone density and strength increased when older men were treated with Testosterone

Cons of TRT

Despite the benefits of testosterone administration in management of low testosterone, TRT as a hormone treatment comes with several potential side effects that patients need to be aware of before starting the treatment.

Cardiovascular Adverse Events

The use of testosterone injection is associated with a greater risk of myocardial infarction and stroke, but not venous thromboembolism, compared with testosterone gel use. [1] However, more recent studies have shown that TRT is not associated with an increased risk of cardiovascular disease. [1]

Data regarding the cardiovascular safety of TRT have been conflicting and inconclusive.


Erythrocytosis is an increase in the number of erythrocytes and is defined as a hemoglobin level above 185 g/L and hematocrit percentage over 49% in men. [2] Interestingly, exogenous testosterone was initially used as a treatment for anemia. [2]

Additionally, testosterone increases erythropoiesis by increasing iron availability via reduced hepcidin levels, a hormone responsible for iron sequestration. [2] However, estradiol seems to also play a role.

Venous Thromboembolism

The known association between TRT and erythrocytosis and a report that demonstrated an increased risk of venous thromboembolism in men receiving TRT, especially in those with underlying thrombophilia, have led the FDA to require adding a general warning to testosterone products about the potential risk for venous blood clots. [1]

Prostate Cancer Risk

Among the various side effects of TRT, prostate safety is one of the major concerns. Hence, urologists are interested and play an important role in the diagnosis of testosterone deficiency and TRT. [1]

The 2008 guidelines on late-onset hypogonadism (LOH) state โ€œThere is no conclusive evidence that testosterone therapy increases the risk of prostate cancer or BPH. There is also no evidence that testosterone treatment will convert subclinical prostate cancer to clinically detectable prostate cancer. However, there is unequivocal evidence that testosterone can stimulate growth and aggravate symptoms in men with locally advanced and metastatic prostate cancerโ€. [4]

Other Cons of TRT

  • Infertility (potentially)
  • Lower Urinary Tract Symptoms
  • Obstructive Sleep Apnea

How to Start TRT?

You need to get in contact with a good doctor or TRT clinic such as Evolve TRT. They will help you on your journey and supply you with a prescription for TRT and send you the medication as well.

TRT or HRT with Evolve is safe, legal, and easy to get

You will have a discussion with a medical professional who will ask you about the symptoms you are experiencing. Then, once your blood tests reflect what needs to be prescribed, the doctor will prescribe the correct treatment, and it will be shipped to your door.

Alternatives to TRT

Instead of exogenous T, alternative therapies, including selective estrogen receptor modulators (SERMs), human chorionic gonadotropin (hCG), and aromatase inhibitors, are commonly used to promote the production of endogenous testosterone. [1]

Can you get TRT prescribed online?

TRT is usually prescribed at real-life clinics, you know, waiting rooms, stuffy walls, etc. Online TRT Treatment Centers aim to replace this unnecessary trip to the doctor, and provide treatment from the comfort of your own home. You simply get into contact with one of the Clinics on this list, you follow the respective steps, and you can get your TRT Prescribed Online.

What is the best TRT treatment?

The term “best” does not exist in science, as there is no unit of measure to determine “bestness”. Therefore, it really comes down to which is best for you. If you suffer from Low T due to factors other than Steroid use, then restarting your own Endogenous Testosterone production will probably be best – since you can eventually stop treatment.

For men who suffer due to Steroid use, just taking Exogenous Testosterone might be best. The reason being is that your Leydig cells will be harder to activate if they are completely inactive, which is the case more often with Steroid users.

How much does it cost to get on TRT therapy?

Taking care of your health is extremely important, but taking care of your wallet is just as important. TRT can range anything from $100 – $500 per month, depending on your provider and therapy type.

Does TRT shorten your life?

This is a real tricky one to answer. We know that TRT has a great number of benefits, including massive improvements in Cardiovascular health [8]. That being said, we also know that hormone levels that are left unchecked (even with quality products used) can be detrimental to health. TRT in an of itself does not shorten life, according to most research [10].

However, if you fail to have your blood markers checked regularly with a medical professional, you might be missing issues with your Cholesterol, Blood Pressure, or Estrogen. Best go for a blood test.

Can you get TRT at 30?

You will only be prescribed TRT if your Testosterone is low, regardless of age.

Is it hard to get TRT?

Illegally? Yes. From one of the clinics we have discussed? Not at all. TRT is essential to men’s health, and accessible to most.

What is the cheapest form of Testosterone Replacement Therapy?

Depending on which treatment you choose, and depending on which gives you the best blood work, the cheapest form of TRT is either Testosterone or Clomid.

Which testosterone is better Cypionate or Enanthate?

Neither. Both these are exactly the same, the only difference is the Ester length attached to the Testosterone. A longer Ester (Cypionate) will mean a longer half-life, and less frequent injections.

What is the best Testosterone to inject?

There is no single “best” version, only the one that is best for your Testosterone Levels. Most people will opt for a longer version like Cypionate, Enanthate, or even Decanoate.

What are the benefits of online TRT clinics compared to traditional in-person clinics?

A: Online TRT clinics offer several advantages, including convenience, accessibility, privacy, and often lower costs. Patients can consult with medical professionals, receive a diagnosis, and obtain treatment from the comfort of their own homes without needing to travel to a clinic.

How do online TRT clinics ensure accurate diagnosis and prescription?

A: Online TRT clinics use detailed patient questionnaires, telemedicine consultations, and lab tests to assess patients’ testosterone levels and determine the appropriate treatment plan. This is essentially the same process done in person, but at a lower cost.

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Park, H. J., Ahn, S. T., & Moon, D. G. (2019). Evolution of Guidelines for Testosterone Replacement Therapy. Journal of clinical medicine, 8(3), 410.

Cervi, A., & Balitsky, A. K. (2017). Testosterone use causing erythrocytosis. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 189(41), E1286โ€“E1288.

Bhasin, S., Cunningham, G. R., Hayes, F. J., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., Montori, V. M., & Task Force, Endocrine Society (2010). Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. The Journal of clinical endocrinology and metabolism, 95(6), 2536โ€“2559.

Nieschlag E. (2015). Current topics in testosterone replacement of hypogonadal men. Best practice & research. Clinical endocrinology & metabolism, 29(1), 77โ€“90.

Gagnon, D. R., Zhang, T. J., Brand, F. N., & Kannel, W. B. (1994). Hematocrit and the risk of cardiovascular disease–the Framingham study: a 34-year follow-up. American heart journal, 127(3), 674โ€“682.

Kim, S. D., & Cho, K. S. (2019). Obstructive Sleep Apnea and Testosterone Deficiency. The world journal of men’s health, 37(1), 12โ€“18.

Lee, M. H., Shin, Y. S., & Kam, S. C. (2021). Correlation Between Testosterone Replacement Treatment and Lower Urinary Tract Symptoms. International neurourology journal, 25(1), 12โ€“22.

Pearl, J. A., Berhanu, D., Franรงois, N., Masson, P., Zargaroff, S., Cashy, J., & McVary, K. T. (2013). Testosterone supplementation does not worsen lower urinary tract symptoms. The Journal of urology, 190(5), 1828โ€“1833.

Snyder, Peter J. “Testosterone treatment of male hypogonadism.” UpToDate, Matsumoto, AM (Ed), UpToDate, Waltham, MA (2012).

Isidori, A. M., Balercia, G., Calogero, A. E., Corona, G., Ferlin, A., Francavilla, S., Santi, D., & Maggi, M. (2015). Outcomes of androgen replacement therapy in adult male hypogonadism: recommendations from the Italian society of endocrinology. Journal of endocrinological investigation, 38(1), 103โ€“112.

Yabluchanskiy, A., & Tsitouras, P. D. (2019). Is Testosterone Replacement Therapy in Older Men Effective and Safe?. Drugs & aging, 36(11), 981โ€“989.

Grech, A., Breck, J., & Heidelbaugh, J. (2014). Adverse effects of testosterone replacement therapy: an update on the evidence and controversy. Therapeutic advances in drug safety, 5(5), 190โ€“200.ย

FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use


Dr. Mohammed Fouda

Dr. Mohammed Fouda | Writer

Dr. Mohammed Fouda is a renowned neurosurgeon with a wealth of experience and expertise. He graduated from Ain Shams University and completed postdoctoral fellowships at Harvard and Johns Hopkins. He has published over 15 peer-reviewed articles and is a medical reviewer for 9 prestigious neurosurgical journals. He serves as an official medical reviewer for our website content. His expertise ensures the accuracy and credibility of the information presented.

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Jasen cameron
Jasen cameron
1 year ago

Hi guyโ€™s just wondering if TRY will help me back in 2010 I had a bad bike crash witch left me with multiple injuries witch lead to a big weight gain Iโ€™m in a lot of pain witch my supposed take a lot of pain killers but I donโ€™t take them so Iโ€™m just wondering if TRT would help me with weight loss an all kind regards jasen cameron

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