As a physician, one of the most common concerns I hear from my male patients—especially those over 40—is about changes in energy, mood, sexual wellness, and muscle strength. Many ask, "Could it be low testosterone?" And often, it’s a valid question.
In recent years there has been a proliferation of testosterone replacement clinics that promise men a fountain of youth. Men who go there often think that they are talking to a physician who specializes in hormone replacement. That is rarely the case. These clinics are usually run by mid-level providers who are not physicians. I find that they commonly misinform their patients, don’t explain the risk vs. benefits of testosterone replacement therapy (TRT), and prescribe dangerously high doses of testosterone.
Let’s talk openly about testosterone replacement therapy (TRT), what it is, when it's appropriate, and what you should know before starting it.
Testosterone is the primary male sex hormone. It plays a vital role in maintaining:
- Muscle mass and strength
- Bone density
- Sexual Wellness
- Mood and cognitive function
- Red blood cell production
As men age, testosterone levels naturally decline. For some, this decline is subtle. For others, it can significantly affect daily life. Those affected by low testosterone may experience low energy, declining sexual wellness, loss of muscle mass, and mood swings.
However, these symptoms can overlap with many other conditions, which is why testing and a full medical evaluation are crucial.
Testosterone replacement therapy is not a fountain of youth. It’s a medical treatment intended for men with clinically diagnosed low testosterone—confirmed by blood tests taken in the morning on at least two separate occasions.
I recommend TRT only when:
- You have persistent symptoms that affect your quality of life.
- Lab tests confirm significantly low testosterone levels.
- We’ve ruled out or treated other possible causes (e.g., thyroid disorders, sleep apnea, depression, vitamin D deficiency, and obesity)
It is important to have a good understanding of the risks vs. benefits of TRT. All treatments have potential side effects, and TRT is no exception.
Potential benefits of TRT (when prescribed appropriately) include:
- Increased energy and mood stability
- Improved sexual wellness
- Better muscle mass and strength
- Greater mental focus
It is important to understand that replacing testosterone is intended to make a man feel better. It does not prolong life, and for older men who feel fine but have low levels on blood tests, there is no need to replace. It is a personal choice based on the individual’s preferences.
There are risks to consider and these include:
- Increased red blood cell count (which can raise the risk of blood clots)
- Breast enlargement or tenderness
- Prostate enlargement and stimulation of cancer. TRT doesn’t cause prostate cancer but may stimulate growth in existing cancer.
- Fertility suppression (TRT can reduce sperm production)
- Increased risk of heart attack and stroke
- Long-term dependence on TRT. When you start taking testosterone, it suppresses your body’s natural ability to make it. When you stop taking testosterone you will recover to some extent ,but you might not recover fully.
For those who choose TRT, regular monitoring and follow-up is essential. Hormone levels, red blood cell count, and PSA should all be checked regularly. Open communication about side effects or new symptoms is also important.
TRT can be life-changing for men who truly need it—but it’s not a cure-all. It should never be started based on symptoms alone or pursued for athletic enhancement or anti-aging.
If you’re experiencing symptoms of low testosterone, let’s talk. Together, we can look at the full picture—your lifestyle, lab results, and health goals—and determine the best path forward.
Your health is about more than a number. It’s about how you feel, function, and live.