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 does not only drive 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 as a result of reduced production levels of testosterone. Hypogodamisn is simply low testosterone. Worry not, as scary as this might seem, 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. 

  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 whereby there too much iron present in the body
  4. Trauma, infection or loss of a/both testicles
  5. Some medications (hormones prescribed to treat prostate cancer or steroid drugs)
  6. Chronic Kidney Disease 
  7. Stress 
  8. Increased Alcohol Consumption 
  9. Obesity 
  10. Inflammatory conditions such as sarcoidosis (an inflammatory condition affecting the lungs) 


Low testosterone symptoms and signs

Low testosterone can cause men to lose their sex drive, have problems with erectile dysfunction, experience depression, have trouble concentrating and may not feel like themselves. There are also physical changes that can manifest due to inadequate levels of testosterone.  

  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. Weak bones due to decreased bone strength (Osteoporosis)
  4. Reduction in body hair 
  5. Changes in cholesterol and lipid levels in the body

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 as that’s the only way to measure testosterone in the blood. You may have to get multiple blood tests as testosterone levels fluctuate throughout the day. It is usually done in the morning when testosterone levels are the highest. 

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

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

  1. May cause acne or oily skin
  2. Fluid retention in the body (may lead to ankle swelling)
  3. Higher risks of developing abnormalities in the prostate
  4. Breast Enlargement 
  5. Sleep apnea (a disorder that is characterized by daytime sleepiness and frequent episodes of waking up at night)
  6. A decrease in the size of the testicles
  7. Mood swings and heightened aggression 
  8. Increased risk of heart attack and stroke 
  9. Reduction in sperm production that can lead to infertility 

Step back and take a breath before making this big decision. There are other alternatives available:

  1. Maintain a healthy lifestyle as obesity can lead to a reduction of testosterone. 
  2. Get off your bum and keep active. When you’re idle, your body doesn't need as much testosterone. So keep moving and lift those 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. So make sure to 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 queries you may have regarding the 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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