Testosterone Replacement Treatment (TRT)

What is testosterone?

Testosterone is a hormone produced by the testicles. It can be given to men as replacement therapy when the body’s natural testosterone levels fall too low. The aim of treatment is to restore testosterone levels to the normal state without any adverse effects.

How to take or use testosterone

A doctor has decided that testosterone replacement therapy may be of benefit to you. Before you start this treatment;

  • Please read the manufacturer’s printed information leaflet from inside your pack. The leaflet gives information about the specific brand of testosterone you have been given.
  • Take or use the testosterone exactly as your doctor has directed (your dose will be printed on the label of your medication pack to remind you).

If you are using Testim®, Testogel® or Tostran® gels: apply the gel at about the same time each day, to a clean, dry area of your skin. The manufacturer’s information leaflet will explain which areas of your skin your gel can be applied to – please read this carefully before you use the gel.

If you are having injections: these are usually given by the practice nurse on a regular basis, so please make sure you know when your next treatment is due and book an appointment for this.

Please note: if you are using a gel, testosterone can be transferred to other people through close skin contact. This may cause side-effects in the other person. To prevent this from happening, cover the treated area with clothes or wait for at least four hours after applying the gel before you have close contact. It is very important that pregnant women avoid contact with any areas of your skin which have been treated with testosterone gel.

Getting the most from your testosterone treatment

It is important to have regular monitoring of your treatment, especially in the first year.

  • You will need a blood test followed by an appointment with your GP at 3, 6 and 12 months after treatment commences (and annually thereafter).
  • It is very important that you book an appointment with the phlebotomist at the surgery for a blood test at these time intervals.
  • After the blood tests, book an appointment with your GP to review the results and check your blood pressure, weight and the effectiveness of treatment.

Can testosterone cause problems?

Along with beneficial effects, many medicines can have unwanted side-effects although not everyone experiences them. Testosterone therapy can cause skin reactions. For example, if you are receiving the testosterone via an intra-muscular injection, skin redness, bruising or swelling may occur at the injection site. Other potential side effects will be listed in the manufacturer’s leaflet. Please report any problems to your pharmacist or GP.

Why are regular blood tests needed?

  • Whichever type of testosterone replacement therapy you use, you need to have your blood levels of testosterone measured to check that you are getting the right amount of hormone.
  • In patients over the age of 40, the prostate gland should be checked regularly by a blood test (the PSA – further information is available on the surgery’s website) and by physical examination (which includes a ‘digital rectal examination’ to examine the prostate gland. This is when a doctor inserts a gloved finger through the back passage to feel the back of the prostate gland). These tests are needed because testosterone can stimulate growth of the prostate and it is important to ensure the gland remains healthy while you are on treatment. Men with a history of prostate cancer should not take testosterone.
  • It is also important to have regular checks of your ‘full blood count’ because on testosterone treatment, the blood can sometimes become too thick.

Is there anything I can do to improve the effectiveness of my treatment?

Absolutely! Even mild changes to your lifestyle can improve testosterone levels.

  • In some patients, a reduction of 10% in bodyweight was associated with increased levels of testosterone in the blood. Weight loss can be achieved through dietary changes.
  • Exercise has long been associated with an increase in male testosterone levels and recent studies have shown that regular aerobic exercise in overweight individuals produces a significant rise in testosterone levels.
  • The illicit use of drugs such as marijuana and opiates is associated with reduced testosterone production in males and should be avoided.
  • Alcohol consumption needs to be moderated to avoid liver disease, which is also associated with testosterone deficiency. The Chief Medical Officers’ (CMO) guidelines for men states that it is safest not to drink more than 14 units of alcohol per week on a regular basis. If you regularly drink as much as 14 units per week, it’s best to spread your drinking evenly over three or more days and have several alcohol-free days in the week.