"I don't want hormones thrown at me."
Neither do we.
Testosterone therapy can be a wonderful tool for the right person, and I've seen what it can do. I've also seen people who started on high doses, felt great at first, and three to five years later weren't feeling so great anymore.
So let's talk honestly about what it can do, what it can't do, and what you should expect.
Quick summary: what you need to know
- It's for people with symptoms and a full evaluation behind them. It isn't a quick fix or a performance shortcut.
- It may help with desire, energy, mood, and motivation. Everyone responds differently.
- It has real risks. These include lower sperm count, higher red blood cell counts, and worsened sleep apnea.
- It affects fertility. If you may want children, tell your clinician before you start.
- It takes follow-up. The right dose and form usually take time to dial in.
What are the benefits of testosterone therapy?
The possible benefits of testosterone therapy include more desire, better energy, better mood and motivation, and support for muscle and bone. Men often tell me they feel like themselves again. They want to go to the gym, they're more patient at home, and they're more interested in their life.
Those results aren't guaranteed. Testosterone also doesn't build muscle by itself. Muscle comes from lifting and eating enough protein. In my experience, testosterone can help by giving you the energy and motivation to do the work. And when you do the work, your muscle and bone benefit.
What are the risks of testosterone therapy?
The risks of testosterone therapy include side effects such as acne, breast enlargement, smaller testicles, lower sperm count, worsened sleep apnea, and higher red blood cell counts. Mood swings and irritability can also happen.
Those are reasons to be careful, and they're why follow-up matters. Here's what I want you to know about the big questions.
Heart health. A large trial called TRAVERSE studied more than 5,200 men with symptoms, low testosterone, and heart disease or a high risk of it. Testosterone gel didn't raise the overall risk of major heart problems compared with placebo. The testosterone group did have more atrial fibrillation, sudden kidney injury, and blood clots in the lungs. So the news is reassuring, and it doesn't mean there's no risk.
Fertility. Testosterone therapy can sharply lower sperm production, and it can drop sperm to very low levels or to none. For most men this reverses after stopping, though it can take six to 12 months or longer. If you may want children, say so before you start.
Your own production. Testosterone therapy doesn't fix the reason your level is low. If you stop, you'll have to wait for your own production to recover, so please make that decision with your provider.
Who shouldn't take testosterone?
Testosterone may not be right for you if you have a history of prostate cancer or breast cancer, an untreated prostate lump, an enlarged prostate, high blood pressure that isn't well controlled, a recent heart attack or stroke, heart failure that isn't managed, untreated sleep apnea, or a history of blood clots. It also matters if you may want children.
These don't rule testosterone out, and they do call for a careful conversation with you and your other doctors. Sometimes the first step is getting a condition managed, and then we look at testosterone together. At AgeWell, no single condition or lab makes this decision for you. We look at the whole picture.
What should I expect when starting testosterone?
Expect a process. At AgeWell, a physician-led midlife medicine practice for men and women in Amarillo, Texas, we start with a full evaluation. We listen to your symptoms and goals, review your history and labs, and talk through your options. Then we start conservatively and test closely.
We check labs at about six weeks, then adjust the dose, the form, or the timing. This may not be as fast as your friend's. We're planning for year five, not just month one.
How is testosterone therapy monitored?
Testosterone therapy is monitored with follow-up visits and lab work. We follow total and free testosterone, SHBG, estradiol, DHEA, and your hemoglobin and hematocrit, plus PSA for men and FSH for women. How you're feeling counts just as much.
If you've tried testosterone and it didn't work, that doesn't mean you failed. It may just mean it wasn't dialed in yet.
Can women take testosterone?
Yes. Women make testosterone too. No testosterone product is FDA-approved for women in the United States, so it's prescribed off-label, a common and accepted practice in medicine. Women use much lower doses. Women tell us they notice more desire, more energy, better mood, and more motivation, though not all of these have been studied. Every woman responds differently, and we watch side effects closely.
How do I decide?
Start with the question, "What am I hoping this will do?" Then look at what else may be going on. Read about low testosterone symptoms, what your number means, and how we approach testosterone therapy.
The decision is yours. We keep you safe, and you keep your say. If you want to talk it through, start with a free conversation.
Frequently asked questions
How long does testosterone therapy take to work?
It varies, and we don't promise a timeline. We follow your symptoms and labs and adjust as we go.
Do I have to stay on testosterone forever?
Not necessarily. Stopping means your level will likely go back down, and your own production may take time to recover. Make that plan with your provider.
Does testosterone cause prostate cancer?
This is a common worry and a good question for your clinician. If you've had prostate cancer or a prostate lump, testosterone may not be right for you, and it calls for a careful conversation with you and your other doctors. We follow PSA in men on testosterone.
Will testosterone make me angry?
Mood swings and irritability can be side effects. Many people find their mood improves. If yours gets worse, tell your provider.
Is testosterone therapy safe?
For the right person with good monitoring, it can be a reasonable choice. It has real risks, and we talk through them with you.
See if AgeWell is right for you
This article is for education and isn't a substitute for personalized medical advice. Talk with your clinician about your own situation. If you have severe or urgent symptoms, seek emergency care.
Sources
- Lincoff AM, et al. Cardiovascular Safety of Testosterone-Replacement Therapy. New England Journal of Medicine. 2023. Summary: American College of Cardiology
- Cleveland Clinic: Testosterone Replacement Therapy
- Cleveland Clinic: Can Drugs Lower Your Sperm Count?
- Cleveland Clinic: Low Testosterone
