Overview
Testosterone Replacement Therapy (TRT) is prescription testosterone for men with symptoms plus repeatedly low morning testosterone, after you have looked for reversible causes (sleep apnea, opioids, obesity, pituitary disease). Longevity menus often skip that step and treat a single afternoon lab as “low T.” Female testosterone for desire is a separate, usually off-label, much lower-dose practice—not the same as a men’s cypionate protocol.
How it is given
Intramuscular or subcutaneous cypionate/enanthate, daily gel, patches, or compounded pellets. Oral testosterone undecanoate exists in labeled products; it is not the old methyltestosterone story. hCG or SERMs are fertility-preserving strategies, not automatic add-ons.
Evidence and limits
Guideline-directed TRT can improve sexual function, anemia of hypogonadism, and some body-composition measures. The TRAVERSE trial found testosterone gel was not inferior to placebo for major cardiac events in a selected higher-risk hypogonadal population—not a license to run hematocrit to 54% in a cash-pay mill. TRT does not treat depression as a first-line drug, does not replace resistance training, and will usually impair spermatogenesis while you are on it. Prostate monitoring is individualized; untreated prostate cancer is a contraindication in standard labeling.
Benefits
Can improve libido and sexual function when hypogonadism is real
May help energy, mood, and lean mass as an adjunct to training
Several adjustable routes (gel, injection) before considering pellets
Generic injectable testosterone is inexpensive compared with clinic memberships
Effects reverse after stopping—unlike a pellet you cannot pull out easily
The Procedure
1
Confirm the diagnosis
2
Fertility conversation
3
Start and monitor
4
Hold or phlebotomize if hematocrit climbs
Preparation
Morning labs, medication list (especially opioids and glucocorticoids), fertility plans, and recent PSA/hematocrit if you have them. Disclose prostate history.
Recovery & Aftercare
Injection-site soreness is common. Gels need dry-skin transfer precautions around partners and children.
Risks & Considerations
Erythrocytosis, infertility/azoospermia while treated, acne, gynecomastia, edema, worsening sleep apnea, possible prostate stimulation of existing cancer, gel transfer, and pellet extrusion or supraphysiologic peaks.
Frequently Asked Questions
References
[1]
Bhasin S. et al. Testosterone therapy in men with hypogonadism: Endocrine Society clinical practice guideline (J Clin Endocrinol Metab, 2018).
https://doi.org/10.1210/jc.2018-00229[2]
Lincoff A.M. et al. Cardiovascular safety of testosterone-replacement therapy (TRAVERSE) (N Engl J Med, 2023).
https://doi.org/10.1056/NEJMoa2215025[3]
FDA. Testosterone products: caution about use for low testosterone due to aging (safety communication).
https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-cautions-about-using-testosterone-products-low-testosterone-due[4]
NAMS 2022 hormone therapy position statement (context for female androgen use limits).
https://doi.org/10.1097/GME.0000000000002028
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