If you’re a man over 30, you’ve likely noticed some unwelcome changes: low energy, diminished sex drive, decreased muscle mass, and mood changes. This could be caused by low testosterone, a condition affecting 4 to 5 million men in the United States.
Testosterone levels begin decreasing after age 30. While there are prescription testosterone replacements available, research on their long-term safety is still on-going. At Physician’s Rejuvenation Centers, we take a cautious, personalized approach to testosterone replacement therapy (TRT) to ensure optimal treatment with minimal risk.
What is Testosterone Therapy?
Overview, Purpose, and Types
Testosterone therapy is a treatment aimed at relieving symptoms associated with low testosterone levels in men. Testosterone is a key male sex hormone that plays vital roles in sexual and reproductive function, muscle mass, bone density, red blood cell production, and more.
TRT aims to restore normal testosterone levels in order to alleviate symptoms such as diminished sex drive, erectile dysfunction, decreased energy and mood changes. It can be used to treat primary hypogonadism from testicular failure, or secondary hypogonadism from pituitary gland problems.
There are different types of testosterone therapy:
| Type | Details |
| Injectable testosterone | The most common injectable testosterone medications used in testosterone replacement therapy (TRT) are testosterone cypionate and testosterone enanthate. These are typically injected every 7 days at a dose of 200 mg to maintain testosterone levels. |
| Topical testosterone gels | Topical testosterone gels are applied daily at starting doses of 50-100 mg. Testosterone levels should be monitored 14 days after initiation of gel therapy and the dose adjusted accordingly based on the results. |
| Testosterone patches | Testosterone patches containing 4-6 mg of testosterone are applied daily. Like gels, testosterone levels should be checked 14 days after starting patches and the dose adjusted to between 2-6 mg per day based on the test results. |
| Testosterone pellets | Testosterone pellets containing 150-450 mg of testosterone are implanted subdermally every 3-6 months to provide steady testosterone release over time. |
| Oral testosterone capsules | Oral testosterone capsules are rarely used nowadays due to the risk of liver toxicity. |
Testosterone therapy should only be given to men with clinically low testosterone levels with symptoms. It requires ongoing medical monitoring for long-term safety.
Is Testosterone Therapy Safe?
TRT is generally considered safe for most men when prescribed appropriately under medical supervision. While some early studies linked TRT to increased cardiovascular risks, larger recent studies found no increased risk of heart attacks or strokes among men receiving TRT.
However, the long-term safety of TRT is still unclear as large, long-term studies are still lacking. For this reason, TRT should only be administered to men with clinically low testosterone levels, under regular monitoring by a physician.
Benefits and Risks of TRT
When appropriately prescribed, testosterone replacement therapy can provide several benefits for men with low testosterone levels, including:
- Increased libido and improved sexual function
- Increased muscle mass and strength
- Improved mood, mental focus and emotional wellbeing
- Increased bone mineral density
- More energy and endurance
However, TRT does come with some potential side effects and risks:
- Swelling or tenderness of the breasts
- Acne outbreaks
- Sleep apnea
- Fluid retention
- Prostate enlargement
- Elevated red blood cell count
How to Ensure the Safety of Testosterone Therapy
If considering TRT, comprehensive screening and ongoing monitoring are critical for safe administration. Key safety practices include:
- Confirm clinically low testosterone before initiating TRT, based on symptoms and blood tests.
- Monitor TRT patients for side effects and conduct regular blood work to ensure optimal testosterone levels.
- Use the minimum effective dose of TRT needed to relieve symptoms.
- Routine prostate exams to screen for enlargement or cancer.
- Have patients keep a symptom journal to assess treatment effectiveness.
- Enter patient data into an adverse event reporting database to identify safety issues.
With careful screening and monitoring, physicians can maximize the benefits of TRT while minimizing health risks that may emerge with long-term use.
What Are the Safest Testosterone Therapies?
The safest forms of testosterone replacement therapy appear to be topical gels and injections administered under medical supervision.
Testosterone gels rubbed onto the skin, such as AndroGel or Testim, allow precise dosing and normalize testosterone levels without dramatic peaks and drops. When monitored by a doctor, gels offer effective treatment with minimal side effects.
Injections of testosterone enanthate or cypionate are another safe option when administered once every 1-2 weeks. One study found injections may be safest when combined with a prostate drug like finasteride.
Testosterone pellets implanted under the skin every 3-6 months are also considered relatively safe. Skin patches and oral capsules seem to carry higher risks of side effects.
For optimal safety, TRT should start at conservative doses which are gradually increased only as needed to relieve symptoms.
Starting Minimum Dosages
The table below summarizes the starting minimum dosages for the various testosterone replacement therapies based on a study. These starting doses should be adjusted based on serum testosterone level monitoring and clinical response.
| Therapy | Starting Minimum Dosage |
| Oral Testosterone Undecanoate | 120 mg/day |
| Buccal Testosterone | 30 mg twice daily |
| Nasal Testosterone Gel | 33 mg/day |
| Testosterone Pellet Implants | 450 mg every 3-6 months |
| Transdermal Patches | 4 mg/day |
| Topical Gels (Solutions 1%) | 50 mg/day |
| Topical Gels (Solutions 1.62%) | 40.5 mg/day |
| Topical Gels (Solutions 2%) | 40-60 mg/day |
| Injectable Testosterone Cypionate | 75-100 mg weekly or 150-200 mg every 2 weeks |
| Injectable Testosterone Enanthate | 75-100 mg weekly or 150-200 mg every 2 weeks |
| Injectable Testosterone Undecanoate | 750 mg every 10 weeks |
Is It Safe to Take Testosterone Supplements with Replacement Therapy?
It is not advisable to take additional testosterone supplements outside of what is prescribed for TRT by your physician.
Prescription testosterone replacement therapy aims to return testosterone levels back to a healthy normal range. Taking supplements could lead to excessive testosterone, potentially increasing the risks of side effects like prostate issues, blood clots, heart problems in older men, and others.
While some over-the-counter testosterone boosters claim to be natural and safe, their quality is unregulated and benefits unproven. It’s best to avoid these and stick to your doctor’s prescribed TRT protocol. Your physician will monitor your hormone levels and make dosage adjustments as needed.
The key is working with an experienced hormone therapy specialist who can ensure customized TRT treatment at the minimal effective dose to restore normal testosterone levels safely.
Who Shouldn’t Have Testosterone Replacement Therapy?
Certain groups should generally avoid testosterone replacement therapy due to increased health risks:
- Men with prostate cancer or at high risk of prostate cancer. Testosterone can accelerate prostate tumor growth.
- Men with breast cancer or at high risk of breast cancer. Testosterone may stimulate breast tissue.
- Men over 65 years old with heart disease. TRT may worsen heart disease in older men.
- Those with a history of blood clots or thick blood. TRT increased clotting risk.
- Those with severe liver disease. The liver regulates testosterone.
- Pregnant or breastfeeding women, as testosterone is not intended for them.
- Those allergic to testosterone or its components. Patches or gels may cause rashes.
Is Testosterone Replacement Therapy Right for Me?
If you are over 30 and experiencing low energy, reduced sex drive, depressed mood, and loss of strength and muscle mass, you may be a candidate for TRT. Schedule a consultation with one of our hormone therapy experts at Physician’s Rejuvenation Centers.
Our physicians will carefully evaluate your symptoms, risk factors, and testosterone levels through comprehensive lab testing to determine if TRT is appropriate. We take a personalized approach, using the minimum doses needed to achieve healthy testosterone levels so you can feel your best.
Don’t wait to start feeling like your best self again. Physician’s Rejuvenation Centers offers a comprehensive approach focused on disease prevention, proactive health, and optimal aging. Contact us today to schedule your consultation!