Understanding Testosterone Replacement Therapy

Testosterone replacement therapy (TRT) increases the amount of the hormone in your bloodstream and is administered in one of several ways:   

  • Testosterone skin patch – A patch containing the hormone is applied either to the scrotum or the body and delivers a consistent level of testosterone for 24 hours. The patch is changed daily. 

    • Side effects: The patch may cause skin irritation at the site of application.


  • Testosterone gel – The gel is applied daily to either the shoulders, upper arms, thighs, underarm or intranasal area and provides a consistent dose of testosterone over a period of 24 hours. 

    • Side effects: Transfer of the gel to other people through physical contact is possible and could pose a risk. Contact with children and women (especially pregnant women) should be avoided.

  •  Intramuscular injection – A short-acting dose of testosterone is injected every one to two weeks. A long acting dose of the hormone requires injection every 10 weeks.

    • Side effects: Intramuscular injections produce fluctuation in hormone concentrations, which may also cause a swing in symptoms.


 Other treatment options 

  • Insertion of sub-dermal testosterone pellets – Small pellets containing the hormone testosterone are inserted beneath the skin, providing a slow-release of testosterone into the body over time.  This is performed in a 10-minute office procedure under local anesthesia every four to six months.
    • Side effects:  Localized pain and/or bleeding at insertion site;     Infection (although not common).


Although not common, other side effects of hormone replacement therapy may include:

  • Stimulation of prostate tissue growth, which can lead to urinary symptoms
  • Breast enlargement
  • Decreased testicle size
  • Fluid retention
  • Decreased sperm production
  • Increased Red Blood Cells (Polycythemia) which may predispose to clotting issues
  • Possible increased risk of heart attacks and strokes

Is testosterone replacement therapy right for me?

In general, hormone replacement therapy is safe under the supervision of a physician. Because testosterone replacement therapy may stimulate prostate growth, men who have been diagnosed with prostate cancer or are at increased risk of developing prostate cancer, should be thoroughly evaluated by a urologist to determine whether TRT is recommended. Before beginning TRT, your urologist may perform a prostate exam and give you a PSA test to ensure you are not at risk for prostate cancer.

Every man reacts differently to testosterone replacement therapy, and symptom management and improvement varies. Your urologist will work with you to monitor the benefits versus the side effects and risks of TRT to ensure your overall good health.