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June 24, 2025

Testosterone Replacement Therapy: Risks, Benefits, and Informed Consent

Explore the full risks and benefits of testosterone replacement therapy, including side effects, alternatives, dosing options, and what to expect with ongoing care.

Testosterone Replacement Therapy: Risks, Benefits, and Informed Consent

Informed Consent for Testosterone Replacement Therapy (TRT)

Testosterone Replacement Therapy (TRT) is a medical treatment used to restore healthy testosterone levels in men experiencing symptoms of testosterone deficiency. These may include fatigue, low libido, difficulty building or maintaining muscle, weight gain, mood changes, brain fog, or decreased motivation.

While TRT can offer substantial benefits, it is not without risks. The purpose of this article is to clearly communicate the potential benefits and side effects of TRT, the available treatment options, and what to expect throughout your therapy. If you decide to proceed with TRT, we will continue to monitor you closely and adjust your care plan to maximize benefits and minimize risks.

Benefits of Testosterone Replacement Therapy

Many men report the following improvements while on TRT:

  • Increased libido and sexual function

  • Improved energy and motivation

  • Enhanced mood and reduced irritability

  • Improved cognitive clarity and memory

  • Increased lean muscle mass and strength

  • Reduced fat mass, especially abdominal fat

  • Better insulin sensitivity and metabolic markers

  • Stronger bones and improved bone density

These benefits are most consistently observed when testosterone levels are optimized and monitored under physician supervision.

Risks and Considerations of TRT

1. Increased Estradiol Levels

Testosterone can convert into estradiol (a form of estrogen) through the aromatase enzyme. In some men, this can result in:

  • Gynecomastia (breast tissue enlargement)

  • Water retention

  • Mood changes or emotional lability

  • Decreased libido despite high testosterone levels

We monitor estradiol levels regularly and may prescribe aromatase inhibitors when appropriate to maintain balance.

2. Suppression of Endogenous Testosterone

When exogenous testosterone is administered, the body may reduce or stop its own production. This is expected and usually reversible if TRT is discontinued. However, natural recovery can vary by individual.

3. Testicular Atrophy

As a result of decreased natural testosterone production, the testes may shrink in size due to reduced stimulation. This is a cosmetic change and does not typically impact function, though fertility may be reduced.

4. Secondary Polycythemia (Elevated Red Blood Cell Count)

TRT can increase erythropoiesis (red blood cell production), potentially raising hematocrit and hemoglobin levels. This may increase the risk of:

  • Blood thickening

  • High blood pressure

  • Headaches

  • Risk of blood clots (rare)

We monitor your CBC (complete blood count) regularly. If hematocrit becomes elevated, we may recommend therapeutic phlebotomy or dose adjustments.

5. Infertility

TRT can reduce sperm production, sometimes significantly. For men desiring fertility preservation, concurrent medications such as HCG or Clomid may be used to support testicular function.

Alternatives to Testosterone Replacement Therapy

In cases where patients are interested in supporting their testosterone production naturally—or in maintaining fertility—there are effective alternatives to exogenous testosterone:

  • HCG (Human Chorionic Gonadotropin) – stimulates testicular function

  • Kisspeptin – promotes GnRH secretion and supports natural testosterone rhythm

  • Clomid (Clomiphene Citrate) – blocks estrogen receptors in the brain to increase LH and FSH

  • Enclomiphene – an isolated isomer of Clomid with fewer estrogenic side effects

  • Gonadorelin – a synthetic GnRH that can stimulate pituitary hormone release

These alternatives may be used alone or in combination under physician supervision to support healthy testosterone levels while preserving fertility.

Discontinuing TRT: Can I Come Off Testosterone?

Yes. If you choose to stop TRT in the future, we offer a structured protocol to support your body in restarting natural testosterone production. This may include medications such as HCG and/or Clomid, nutritional support, and close monitoring. While many men successfully transition off TRT, outcomes can vary depending on how long you’ve been on therapy and your underlying physiology.

Methods of Testosterone Replacement: Pros and Cons

1. Injections (Intramuscular or Subcutaneous)

  • Pros: Inexpensive, easy to adjust dose, usually once per week, reliable lab tracking

  • Cons: Requires regular self-injection or office visits; some men report fluctuations in their levels

2. Pellets (Subdermal Implants)

  • Pros: Long-lasting (placed every 4–5 months), minimal daily maintenance, steady hormone release

  • Cons: Most expensive, minor procedure for insertion, dose adjustment is slower

3. Topical Creams or Gels

  • Pros: Easy to apply, non-invasive

  • Cons: Must be applied daily, risk of transfer to others, blood levels can be harder to interpret

4. Troches, Drops, Nasal Sprays, or Alternate Topical Forms

  • Pros: Good for men who cannot tolerate other forms

  • Cons: Dosing consistency can vary; absorption is less predictable

Supplementation During TRT: Prostate Health Support

We recommend that all patients on testosterone therapy (male or female) take our supplement Prostate Health, which is formulated to:

  • Support healthy testosterone metabolism

  • Reduce conversion to estradiol and DHT

  • Promote prostate and reproductive tissue wellness

  • Support urinary and hormonal balance

This supplement is an important part of our comprehensive approach to ensure that TRT is safe and effective long term.

Ongoing Monitoring

Once on TRT, you will be monitored with regular lab work to evaluate:

  • Total testosterone

  • Estradiol

  • CBC (for hematocrit)

  • PSA (prostate-specific antigen)

  • Lipids and metabolic markers

We adjust treatment based on symptoms and lab findings. The goal is symptom relief with minimal side effects.

Final Notes and Informed Consent

TRT can be life-changing for many men. However, it is a medical commitment that involves consistent monitoring, responsible use, and long-term decision-making.

By beginning therapy, you acknowledge that:

  • You understand the risks and benefits of TRT

  • You are willing to undergo regular lab testing

  • You will communicate openly with your provider about symptoms or concerns

  • You understand that cessation of TRT requires a protocol for best outcomes

If you have additional questions, we are happy to discuss them with you.

To begin testosterone therapy, please speak with your provider to determine if you are an appropriate candidate and to review baseline labs and treatment preferences.