Understanding Testosterone Replacement Therapy (TRT): A Comprehensive Guide

man exercising after taking TRT online

The human body operates like a finely tuned machine, where every component contributes to the overall functionality. Among these contributors is your hormones. In men, testosterone often takes center stage, influencing everything from muscle mass and bone density to mood and energy levels as well as the production of red blood cells and sperm.

In other words, it’s pretty important. 

For those individuals who struggle to maintain optimal testosterone levels—which can happen for a variety of reasons—they may struggle with a myriad of health issues. That’s why so many consider testosterone replacement therapy, or TRT therapy

Whether you are considering TRT for yourself or seeking a better understanding for someone you know, this guide will serve as a valuable resource on the path to hormonal harmony.

What is Testosterone Replacement Therapy (TRT)?

Testosterone Replacement Therapy (TRT) is a medical intervention designed to address and rectify low testosterone levels in the body. 

Testosterone, a crucial hormone primarily produced in the testicles in men and, to a lesser extent, in the ovaries in women, plays a vital role in regulating various physiological functions. When levels in the body are low, TRT therapy can help to replenish those numbers. 

Most often administered via intramuscular injections, it can also be administered transdermally with patches and gels, with small pellet implants, or less commonly  orally. 

Who Needs Testosterone Replacement Therapy?

Anyone with low serum testosterone and symptoms of hypogonadism can be considered for testosterone replacement therapy. Normal range for serum testosterone is 300 to 1,000 ng/dl.

Symptoms of hypogonadism that may lead to someone seeking TRT therapy include: 

  • Sexual dysfunction such as ED and reduced libido
  • Reduced energy levels
  • Depressed moods
  • Increased irritability
  • Cognitive issues
  • Changes in cholesterol levels

While this is typically due to age-related testosterone decline—with testosterone levels beginning to decline at age 30—medical conditions that affect the testicles or pituitary gland can also lead to low testosterone production. Conditions that can impact testosterone levels include:

Before TRT therapy can be administered, there is a comprehensive diagnosis process that must be completed. It’s important to understand the underlying causes of low testosterone before treating. 

Diagnosis is typically completed via blood tests that measure total and free testosterone levels. Your physician may also discuss medical history, symptoms, and conduct a physical examination before determining if testosterone hormone replacement therapy is right for you. 

How Does Testosterone Replacement Therapy Work?

Testosterone replacement therapy (TRT) is a targeted therapy designed to restore and maintain optimal testosterone levels. This prescription testosterone replacement works to bring an individual’s testosterone levels back within a normal range for their age and gender. 

TRT offers several modes of testosterone administration, each catering to different preferences and medical considerations. The common methods include:

Intramuscular injections: Administered intramuscularly, testosterone injections are the most common TRT therapy. Since the hormone is released more slowly with this administration, it requires less frequent doses. In addition to the convenience, this method is considered to have higher efficacy.

Transdermal administration: Testosterone can also be administered transdermally with topical gels and patches. This method delivers testosterone through the skin, allowing for steady absorption in a non-invasive way. 

Implantable pellets: This is a  longer-lasting approach that is administered by subcutaneously implanting small pellets. The testosterone is released gradually over time. It requires less frequent administration but is a more invasive option. 

Oral administration: While not common, TRT therapy can also be administered through oral medications. Androgens have poor bioavailability, making oral medication difficult. This is only available as testosterone undecanoate and would need to be administered more frequently. 

Regardless of the chosen method, your healthcare professionals will need to carefully monitor and adjust dosage to achieve the right balance. Regular blood tests and follow-up appointments with healthcare providers are also crucial. 

Types of Testosterone Replacement Therapy

In addition to the different testosterone administrations associated with testosterone hormone replacement therapy, there are different types of testosterone. 

There is synthetic testosterone and bioidentical hormone replacement. 

Synthetic Testosterone

Synthetic testosterone refers to hormones that are chemically similar but not identical to the testosterone naturally produced by the body. They are created in a lab and mimic the structure and chemical composition of the naturally occurring hormone. 

Bioidentical Hormone Replacement

Bioidentical hormones are molecularly identical to the hormones produced by the body. These are not created in a lab and are instead derived from “natural” sources such as plants and animals. 

Surprisingly, synthetic testosterone is more commonly used in TRT therapy. It is actually considered the “traditional” treatment for low testosterone and hypogonadism. 

If the traditional TRT therapy isn’t suitable, then the bioidentical therapy may be considered. However, they are not FDA-approved and there is minimal clinical testing and research completed to prove the efficacy and risks related to the use of bioidentical testosterone. 

When determining which testosterone administration and which type of testosterone to use, there are several factors to consider:

  • Individual health conditions, such as cardiovascular health, prostate health
  • Personal preferences, such as the convenience of administration, frequency of treatment, and potential side effects
  • How your body responds to TRT
  • Your long-term goals, including fertility preservation or other concerns

Benefits and Risks of Testosterone Replacement Therapy

Before beginning any treatment, it is important to understand the benefits as well as the risks. 

Benefits of TRT Therapy

In addition to restoring the testosterone levels in the body to a normal range, TRT can have a significant positive impact on:

  • Mood
  • Energy levels
  • Sexual function
  • Lean body mass and muscle strength
  • Bone mineral density (BMD)
  • Overall cognition
  • Cardiovascular health

Risks of TRT – Is Testosterone Replacement Therapy Safe?

No treatment is without its risks and TRT is no different. It is, however, considered generally safe when monitored by a healthcare professional. Risks of testosterone hormone replacement therapy include:

  • Increased risk of prostate cancer
  • Increased risk of male breast cancer
  • Worsening benign prostatic hyperplasia (BPH), which is the enlargement of the prostate
  • Polycythemia (an increase in the absolute red blood cell (RBC) mass in the body)
  • Obstructive sleep apnea (OPA)

There are also some cardiovascular risks and fertility concerns to consider. 

Choosing the Right TRT Provider

Low testosterone levels are not something to take lightly but deciding to undergo testosterone replacement therapy is still a big decision. A decision that requires the guidance of a qualified healthcare professional. 

TRT requires more than the initial diagnosis and assessment. There will be follow-ups and continued conversations with your chosen provider, so it is important that you choose the right TRT provider for you. 

Make sure that you are comfortable with the provider you choose and that they are qualified to provide the care you need. 

Questions to Ask When Choosing a TRT Provider:

Credentials and Specialization:

  • Are you a board-certified endocrinologist? 
  • Do you have expertise in hormonal therapies?
  • How long have you been practicing in the field of hormone replacement therapy, specifically TRT?

Individualized Treatment Approach:

  • Will the treatment plan be customized based on my specific health needs and goals?
  • What monitoring processes do you have in place to track the effectiveness of TRT?
  • How often will follow-up appointments be scheduled, and what parameters will be assessed during these visits?

Treatment Options and Preferences:

  • What TRT methods do you offer, and how do we decide on the most suitable option for me?
  • What are the expected costs associated with TRT, including consultations, tests, and medications?


Get Started with TRT

Whether you’re considering TRT or helping a loved one make medical decisions, the key is informed decision-making. Your hormonal well-being is a unique journey, and by arming yourself with knowledge—and the right provider—you can confidently navigate the path to better health.

Find a TRT provider near you through Heally and start raising your testosterone levels!


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