Side effects of testosterone replacement therapy

How is testosterone affecting your body, side effects you should look out for


Test your knowledge on testosterone

Testosterone is a sex hormone naturally produced in the body. It is not only produced in men but also women, however, there is a higher level of testosterone present in men. Testerone is produced in the testicles and has many beneficial effects on the body. It not only drives sexual function but also enhances male libido. Testosterone increases bone density and strength, has a protective effect on the heart, increases muscle strength and maintains adequate levels of red blood cells in the body. Testosterone also plays a very important role in producing male sexual characteristics. Testosterone levels in the body decrease with age. A study has shown that diminished functional activity of the testicles (male gonads), where testosterone is produced, is seen in 20% of men over 60, 30% of men over the age of 70 and 50% of the men over the age of 80. 

Hypogonadism (reduced activity of the gonads) is a condition resulting in reduced production of testosterone. Fortunately, it can be easily treated. Testosterone replacement therapy is offered to treat low testosterone. 

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Why you might be feeling low

The decline of testosterone production starts around the age of 30 and continues as you age. Causes of decreased testosterone include the following:

  1. Chemotherapy or radiation treatment for cancer
  2. Genetic conditions (Kleinfelter’s Syndrome where there is an extra X chromosome present in men)
  3. Hemochromatosis (a condition where there is too much iron present in the body)
  4. Trauma, infection or loss of one or both testicles
  5. Some medications (hormones prescribed to treat prostate cancer or steroids)
  6. Chronic Kidney Disease 
  7. Stress 
  8. Increased Alcohol Consumption 
  9. Obesity 
  10. Inflammatory conditions such as sarcoidosis or rheumatoid arthritis.


Low testosterone signs and symptoms

Low testosterone can cause low libido, problems with erectile function,  depression and trouble concentrating. There are also physical changes that can manifest due to inadequate levels of testosterone including:

  1. Reduction in muscle mass and an increase in body fat
  2. A decrease in red blood that can lead to mild anemia (low levels of iron in the blood)
  3. Decreased bone strength (Osteoporosis)
  4. Reduction in body hair 
  5. Changes in cholesterol and lipid levels 

If you notice any of these, make sure to visit your doctor and get your testosterone levels checked. Your doctor will order a blood test, which is the only way to measure testosterone. You may have to get multiple blood tests, as testosterone levels fluctuate throughout the day and are normally highest in the morning.

Testosterone replacement therapy is offered in different forms: Injections, patches, gel, pellets, and tablets

Testosterone replacement therapy is generally safe but it has many side effects that you should be aware of including:

  1. Acne or oily skin
  2. Fluid retention which can lead to ankle swelling
  3. An increased risks of developing prostate disease
  4. Breast Enlargement 
  5. Sleep apnea (a disorder that is characterized by daytime sleepiness, snoring, and frequent episodes of waking up at night)
  6. Decreased testicle size
  7. Mood swings and heightened aggression 
  8. Increased risk of heart attack and stroke 
  9. Reduction in sperm production that can lead to infertility 

Pursuing testosterone replacement therapy is a big decision.  Alternatives which may increase testosternoe levels include:

  1. Maintaining a healthy lifestyle as obesity can lead to a reduction of testosterone. 
  2. Keep active. When you’re idle, your body doesn't need as much testosterone. So keep moving and lift some weights. Weightlifting works your muscles and stimulates testosterone production. 
  3. Ensure you have a good sleep cycle. Lack of sleep affects hormone production in the body. Get your 7-8 hours a day. 
  4. Take Vitamin D supplements. A study has shown that 3,300 IUs of Vitamin D promotes increased production of testosterone.
  5. Snack away on nuts. Nuts contain high levels of D-aspartic acid which helps increase testosterone production.

Regular follow up appointments are important when taking testosterone replacement therapy. Make sure to follow the directions given by the doctor when administering testosterone. Don’t be shy and make sure to get your doctor to answer any questions you may have regarding replacement therapy. 



  1. Ramasamy, R, E Osterberg, & A Bernie, "Risks of testosterone replacement therapy in men.". in Indian Journal of Urology, 30, 2014, 2.

  2. Harman, S, E Metter, J Tobin, J Pearson, & M Blackman, "Longitudinal Effects of Aging on Serum Total and Free Testosterone Levels in Healthy Men.". in The Journal of Clinical Endocrinology & Metabolism, 86, 2001, 724-731.

  3. Cold, F, E Health, H Disease, L Disease, P Management, & S Conditions et al., "Erectile Dysfunction and Testosterone Replacement Therapy.". in WebMD, , 2019, <> [accessed 26 September 2019].

  4. "Options to Increase Your Testosterone". in , , 2019, <> [accessed 26 September 2019].

  5. Fernández-Balsells, M, M Murad, M Lane, J Lampropulos, F Albuquerque, & R Mullan et al., "Adverse Effects of Testosterone Therapy in Adult Men: A Systematic Review and Meta-Analysis.". in The Journal of Clinical Endocrinology & Metabolism, 95, 2010, 2560-2575.

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