Everything You Need to Know About Testosterone Replacement Therapy

August 16, 2021

5 mins

As the primary sex hormone for men, testosterone plays a role in several bodily functions. For men, having low levels of testosterone (or  T) can result in an assortment of issues – some of the more common of which include a decrease in sex drive and erectile dysfunction.

But these are far from the only issues that can arise when testosterone is too low. Fortunately testosterone replacement therapy (TRT) is commonly used to treat a variety of medical conditions.

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Why Does Testosterone Matter? 

Testosterone helps to support some of the most important male health aspects – and traditionally male traits.

In terms of sexual function, testosterone is essential for libido (sex drive) and erectile function. It stimulates the production of sperm in the testes, which is crucial for fertility. 

Beyond sexual health, testosterone contributes significantly to bone and muscle health. It promotes the development and maintenance of lean muscle mass, which is vital for strength, physical performance, and overall mobility. 

Testosterone even helps regulate bone density by stimulating bone growth and inhibiting bone resorption, which reduces the risk of osteoporosis and fractures.

In addition to its physical effects, testosterone influences various aspects of mental health and cognitive function. It plays a role in mood regulation, with low testosterone levels often associated with symptoms of depression, irritability, and decreased motivation. 

Testosterone also contributes to cognitive function, including memory, attention, and spatial abilities. Maintaining optimal testosterone levels is crucial for sustaining energy levels, vitality, and overall sense of well-being.

How Can You Tell If You Have Low Testosterone? 

As men age, our testosterone levels decline naturally. The overall effects attributed to low testosterone might be difficult to notice; however, some of the most common symptoms of low testosterone include:

• Concentration problems

• Depression

• Difficulty sleeping

• Erectile dysfunction

• Fatigue

• Irritability

• Less spontaneous erections

• Hair loss

• Loss of muscle and bone density

• Low self esteem or confidence

• Reduced sex drive

If you're experiencing any of these symptoms, talk with a healthcare provider about a testosterone test. This simple blood test will measure the amount of testosterone in your blood, described in nanograms per milliliter (ng/mL), which can be benchmarked against your prior tests and levels expected for most men your age.

Since testosterone levels can fluctuate based on diet, fitness level, medications, and the time of the day that the test is performed, it may require a few tests to get an accurate view. If you've been diagnosed with low testosterone, you might consider asking about testosterone replacement therapy as a potential treatment. 

What is Testosterone Replacement Therapy? 

Testosterone replacement therapy is primarily used to treat men that have low levels of testosterone – or hypogonadism. This may be caused by a number of factors, including age, injury, or a medical condition. 

TRT works by introducing exogenous testosterone into the body. This means that the testosterone is sourced outside of the body, such as from medication. (Endogenous testosterone means it’s produced naturally in the body.) 

Once administered, the exogenous testosterone enters the bloodstream and reaches the testes.

In the testes, the testosterone signals to the Leydig cells – which are responsible for testosterone production – to reduce natural testosterone production.

This decrease in testosterone production is due to a negative feedback loop — the body senses the increased levels of testosterone and reduces its own production to maintain hormonal balance.

As a result of TRT, circulating testosterone levels rise, reaching levels within the normal range and help alleviate the symptoms associated with low testosterone levels. 

It's important to note that TRT does not permanently cure hypogonadism but rather provides ongoing maintenance of testosterone levels.

While studies are somewhat mixed regarding the potential risks of TRT, overall the scientific community is supportive that testosterone replacement therapy can greatly enhance the overall quality of life of most patients. 

It’s important to note that while testosterone replacement therapy can help to improve overall levels of testosterone, it is not a permanent cure. Testosterone replacement therapy can be a lifelong treatment in the event that there is no addressable underlying condition for your low testosterone. 

Is TRT a Steroid?

It’s not uncommon to think that taking TRT is the same as taking steroids. But, it’s not true. Testosterone replacement therapy and taking steroids are not the same – they’re actually quite different. 

Anabolic-androgenic steroids are the synthetic hormones we think of when we see a bodybuilder or a super athlete. They’re taken (often in extremely high doses) to increase muscle building (anabolic) and to enhance male characteristics (androgenic).

Testosterone medications for TRT use ingredients involving bioidentical testosterone. This means that chemicals are created that are identical to the naturally occurring testosterone hormone. 

While both testosterone replacement therapies and steroids raise T levels in the body, they are typically used for very different reasons. Men opting for TRT are aiming to get their testosterone levels within the normal range to alleviate symptoms of hypogonadism. 

Men looking to bulk up and build muscle quickly for athletic or aesthetic purposes are more likely to take steroids. 

How is Testosterone Replacement Therapy Administered? 

There are a few factors that go into determining the most effective treatment option and delivery method of testosterone replacement therapy, including the medical need and lifestyle of the patient. Some options have to be administered daily while others might last for a few months. 

These are the most common delivery methods for testosterone replacement therapy:

Injections 

Testosterone injections are typically administered intramuscularly and can provide a sustained release of testosterone over a period of time. 

Depending on the exact formula being administered the injection could last for a week or several months. This administration may cause some pain and irritation from the needle.

There are a few medications on the market for testosterone injections including cypionate, enanthate, undecanoate, and propionate. Your healthcare provider will determine which one is most suitable for your needs depending on XYZ.

Topical gels and patches 

Topical gels and patches require applying the treatment directly.

Gels are typically rubbed into the skin once or twice daily, and the patch is usually placed on the upper body or arm once a day. The testosterone is absorbed through the skin in either case.

The most popular testosterone replacement gel is called Androgel. 

Transdermal patches are also a viable option, the most common brand sold being Androderm.

While these methods are some of the easiest to administer at home, they do come with a few drawbacks. The gel can accidentally be transferred to others that come into contact with it – by shaking hands after application, for instance – and there may also be an unpleasant odor along with the potential for rash or skin irritation. 

Oral delivery 

A buccal delivery method is designed to stick to the gums and is typically administered twice daily. The testosterone will be directly absorbed into the bloodstream via the gums. Some people may experience irritation in their gums or mouth. 

Pellets 

Pellets containing testosterone can be implanted underneath the skin around the hips and pelvic area. Over the course of three to six months, these pellets slowly release testosterone. 

Outside of visiting a healthcare provider in order to get the implantation, there are few side effects associated with this delivery method. These include: 

• Allergic reaction at site of pellet

• Mood swings, irritability, or hostility

• Increase in blood pressure

• Acne

• Change in sex drive or performance

• Unexpected breast tissue growth

Oral tablets

Twice-daily oral softgel tablets have recently joined the market for testosterone replacement therapy. This alternative to TRT was introduced to offer men an easier approach to their treatment – you just take a pill with your breakfast and again at dinner. 

The brand name for these oral tablets is Jatenzo, and its active ingredient is testosterone undecanoate. 

What Does Testosterone Replacement Therapy Treat? 

Testosterone replacement therapy is used to combat the natural decline of testosterone that is experienced during the aging process as well as clinical medical diagnoses that can lead to low T, 

While men of all ages can experience low levels of testosterone, the risk increases dramatically with age. 

Men reach peak testosterone production sometime during their late 20s or early 30s. After this peak, levels drop by roughly 1.6% every year. As a result, roughly 20% of men will have low testosterone levels in their 60s, and nearly half of men will experience it by the time they reach their 80s. 

There are other reasons that someone may seek out testosterone replacement therapy. These conditions include:

Hypogonadism 

This medical condition is when the body fails to produce the required amount of testosterone. There are two distinct types of hypogonadism:

Primary: Also known as primary testicular failure, this condition derives from problems that directly involve the testicles. It may occur as the result of an injury to the testicles, various treatments for cancer, or a mumps infection. 

Secondary: This is probably the more common of the two and stems from issues relating to the hypothalamus or pituitary gland. These are parts of the brain that are directly responsible for the creation of gonadotropin releasing hormones and luteinizing hormones. A decrease in these hormone levels will result in a decrease in testosterone overall. Secondary hypogonadism can be the result of aging, obesity, the side effects of medications, or symptoms of an inflammatory disease.     

Osteoporosis 

Although more common in women than men, it’s estimated that nearly eight million men in the United State have osteoporosis. 

This bone disease occurs when the body loses too much bone mass, creates too little bone, or a combination of both. One of the main causes of osteoporosis can be low levels of testosterone. 

Male sexual function 

Testosterone replacement therapy being used to increase sex drive and improve erectile function has produced mixed results at best. 

It’s fairly conclusive that this option is not as effective as PDE5 inhibitors such as Viagra®, Cialis®, or Levitra®. However, testosterone replacement therapy may be an effective alternative option to avoid potential side effects associated with those medications. 

Other Reasons

Some people will undergo TRT without low levels of testosterone or a medical condition. The thought is that higher levels of testosterone can enhance sexual performance, achieve higher levels of energy, help with weight loss, increase muscle strength, and cultivate mass for bodybuilding.

Generally testosterone replacement therapy will only help those that are experiencing low testosterone, but the extra testosterone could provide a moderate boost in some of these areas. Medical professionals generally agree that self-diagnosing or self-treating with TRT is unsafe.

What are the Risks Associated With Testosterone Replacement Therapy? 

Reported potential side effects associated with testosterone replacement therapy include: 

• Acne and oily skin

• Blood clots

• Breast enlargement 

• Chest pain

• Deep vein thrombosis

• Difficulty speaking

• Enlarged prostate

• Heart attack

• High red blood cell count

• Lower sperm count

• Pulmonary embolism

• Reduced HDL (or “good”) cholesterol

• Shrunken testicles

• Sleep apnea

• Stroke

• Swelling in hands or feet

• Trouble breathing

The most severe side effects are typically rare, and even mild or moderate side effects are not common. If you are currently experiencing or are at an elevated risk for any of the conditions listed above, you may not want to pursue testosterone replacement therapy. A licensed healthcare provider can help make that determination.

How Much Does TRT Cost?

For TRT, the cost may range from $30 to $1500 depending on the mode of administration. Most insurance companies cover the cost of all forms of TRT, so you’ll only have to pay the copay. Generic options also help lower the overall cost. 

Injections are typically the most affordable option, with monthly therapies between $40 to $100. 

Pellet implants can be around $500 per month, though this may vary depending on the dose.

Gels, creams, and patches tend to be on the more expensive side, reaching up to $700 for a month’s supply. 

How Can You Get TRT?

Testosterone replacement medications can only be obtained with a prescription from a healthcare provider. Talk to your doctor about your symptoms to determine if TRT may be right for you. Your provider will discuss the different options available to you depending on your needs. 

With the Rex MD TestoRx program, you’ll have access to quality care from a team of licensed clinicians and testosterone replacement therapies (if clinically appropriate) or other testosterone solutions that can help you feel like yourself again.

To find out if the program is right for you, just answer some questions about your symptoms and medical history. Your provider will order lab work for you to help determine if you’re eligible for TRT or another testosterone solution available through the program.

Then, you’ll be able to schedule a virtual call with the Rex MD care team to further discuss your results, eligibility, and which treatment option would be most suitable for you, if any.

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