TRT, The Pros and Cons
🧬 TRT for Men 35+: Pros and Cons
Testosterone Replacement Therapy (TRT) is a common topic for men in their mid-30s and older. Here’s an, evidence-informed look at the potential upside and the potential downsides. There is a lot of misinformation and misunderstanding around this subject, the below should simplify your thought process…
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✅ The Pros:
1) Better energy and mood
- Many men report increased energy, improved motivation, and better overall mood when they have clinically low testosterone.
2) Lean mass and strength
- TRT can support muscle mass gains and strength, especially in those with documented testosterone deficiency.
3) Bone density and metabolic health
- Potential improvements in bone mineral density and favourable shifts in body composition for some men.
4) Libido and sexual function
- Libido, sexual satisfaction, and erectile function can improve in men with low testosterone.
5) Quality of life
- Some men experience better stamina, confidence, and overall well-being when symptoms of hypogonadism are relieved.
❌ The Cons
1) Not a universal fix
- Benefits depend on having low testosterone plus symptoms; men with normal levels often see little to no improvement.
2) Prostate considerations
- Can affect the prostate ( PSA changes). Not recommended for men with untreated or suspected prostate cancer. Regular monitoring required.
3) Blood health changes
- Can cause raised hematocrits, if not monitored.
5) Fertility impact
- TRT suppresses natural testosterone production and sperm production, which can reduce fertility. Fertility planning should be discussed if you want children. There are measures which can be put in place to maintain testicular function, but its worth considering the implications.
6) Skin and other side effects
- Acne, fluid retention, gynecomastia (very rare with TRT), and mood fluctuations in some users.
7) Logistical and cost considerations
- Requires ongoing monitoring, self administration and regular blood tests.
🧭 Who Should Consider TRT
- Reduced testosterone levels are common in males from around 35 years onwards, an initial hormone test should be done before TRT is considered.
- Consider if you have any existing indications of low testosterone; poor sleep, poor mood, reduced muscle mass, higher fat mass, reduced sexual desire or erectile dysfunction are a few key examples
- Goal alignment. Are you trying to combat a specific symptom, which could be resolved with an alternative?
- Age alone isn’t enough to start TRT. It’s about symptoms plus lab-confirmed deficiency and overall health.
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💉 How to start the TRT process
- Initially you would need a hormone blood test, this can be done through the NHS or Private Doctors.
- Once your test results are ready you can consider whether TRT is appropriate and the different methods of administration.
- TRT is commonly administered by intramuscular if subQ injection, athlough patches and nasal form are available in some cases.
- The choice depends on preferences, lifestyle, cost, and medical history. A clinician will tailor dosing and form.
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🧪 Safety & Monitoring
- Baseline tests: morning total testosterone, free testosterone, SHBG, LH/FSH, hematocrit, PSA, lipid panel, liver enzymes if indicated.
- Follow-up tests: recheck testosterone levels after starting, monitor hematocrit, PSA, and lipid profile. Often tested every 6+ months.
- Red flags to watch: sudden mood changes, worsening sleep apnea, signs of prostate issues, severe headaches, or signs of high blood pressure.
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TRT, The Pros and Cons
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