What are the main side effects of TRT?

Testosterone replacement therapy (TRT) can offer many benefits, but it can also come with some side effects, especially for people who use it for a long time or at high doses. These side effects include skin problems, hair loss, sleep apnea, cardiovascular problems, and more. A good understanding of these potential side effects can help you start TRT better and plan your response in advance.

Skin problem

TRT may increase the activity of the sebaceous glands, leading to excessive production of oil in the skin, which in turn leads to acne (pimples). This side effect is more common in young people or men with more sensitive skin.

For men using topical testosterone gels or patches, skin irritation, redness, or itching may occur in the area applied topically. The condition is usually mild, but may cause ongoing discomfort for some people.

Alopecia

TRT may exacerbate androgenic alopecia (male pattern baldness) in some men, especially those who genetically predisposed to hair loss. This is because testosterone convert into dihydrotestosterone (DHT) in the body, and DHT is one of the main hormones that causes hair follicles to shrink.

Conversely, some men may experience increased body hair, especially on the face, chest, and back.

Cardiovascular problems

Studies have shown that long-term use of TRT may be associated with an increased risk of cardiovascular problems, such as heart disease, heart attack, or stroke, especially in men who already have cardiovascular disease or risk factors. Therefore, men with heart disease or poor cardiovascular health need to be extra cautious when considering TRT and to monitor their heart health regularly.

TRT may increase the red blood cell count, which can lead to increased blood viscosity, which increases the risk of blood clots (venous thromboembolism or pulmonary embolism), especially at high doses or with long-term use. This is especially important when using injectable testosterone.

Sleep apnea

TRT can sometimes aggravate or induce sleep apnea, especially in men who already have it. Sleep apnea is a condition in which breathing is temporarily halted during sleep at night, which can lead to poor sleep quality and increased health risks such as high blood pressure and heart disease.

This is because TRT may exacerbate the problem by enhancing airway muscle relaxation, or increasing upper airway resistance. If a man has a history of sleep apnea, the risk should be carefully evaluated with his doctor before receiving TRT.

Prostate problems

Testosterone may stimulate the growth of the prostate, leading to prostate hyperplasia, which can cause problems such as frequent urination, urgent urination, and difficulty urinating. Although TRT has not been definitively  cause prostate cancer, it may accelerate the progression of prostate cancer, so men with prostate problems or a family history of the disease should be especially cautious.

TRT may raise levels of prostate-specific antigen (PSA), a marker use to detect prostate health, so need to monitor PSA levels regularly.

Testis atrophy and sterility

Because exogenous testosterone inhibits the production of natural testosterone in the body, long-term use of TRT may cause the testicles to atrophy and the size of the testicles to decrease. This is because TRT makes the function of the testicles no longer necessary, which causes them to atrophy.

TRT inhibits the production of gonadotropins (LH and FSH), which are important for sperm production. Therefore, long-term use of TRT may lead to a decrease in sperm count, which can affect fertility. In men who are planning to have a family, TRT may not be the ideal option unless there are other fertility support treatments available at the same time.

Mood swings and anxiety

TRT may sometimes cause mood swings, such as anxiety, irritability, or may cause mood instability in the early stages of treatment. This may be related to rapid changes in testosterone levels, especially when using injectable TRT.

Some men report greater emotional stability after using TRT, but some may experience the opposite effect, which needs to be adjusted during treatment.

Increased red blood cell count (polycythemia)

TRT increases red blood cell production, which increases hemoglobin and hematocrit levels. While this can improve oxygen transport capacity, if red blood cells increased too much, it can cause the blood to be too viscous, increasing the risk of blood clots and stroke. Therefore, blood indicators need to checked regularly during the TRT process to avoid potential blood problems.

Liver Health (oral testosterone)

While the injectable and topical forms of TRT have less impact on the liver, some types of oral testosterone (such as methyltestosterone) can be stressful to the liver, and long-term use can lead to impaired liver function or liver disease.

Breast enlargement (male breast hyperplasia)

TRT may cause breast enlargement in men (i.e., male mammary hyperplasia) because a portion of testosterone in the body is convert into estrogen (such as estradiol), which may lead to the growth of breast tissue. This side effect, while uncommon, may occur in certain sensitive individuals. During TRT, estrogen levels in the body should monitored and anti-estrogen should be use if necessary.

These side effects are not experience by everyone, and the kind of side effects we experience are relate to the individual’s constitution, as well as the dose of testosterone or testosterone derivatives in TRT. Long-term use of TRT requires close monitoring of health and adjustment of dosage according to individual circumstances.