Important things to know about Testosterone Replacement Therapy

Testosterone replacement therapy is used in men with TDS which has been confirmed by blood tests and clinical symptoms. It aims to help you feel better, but as with any medication, it can cause some side effects and is not suitable for everyone. Testosterone replacement therapy is not to be used in patients with prostate or breast cancer, as these conditions are aggravated by hormones, or in cases of allergy to constituents of the medication.

The most common side effects are skin reactions in the area where the treatment is applied or injected. However, there are other potential side effects of testosterone replacement therapy 43.

  • Aggravates existing (but only existing) carcinoma of the prostate.
  • Sperm production is suppressed to some extent, therefore fertility needs to be discussed in appropriate patients
  • The haematocrit (red blood cell count) is increased, so men with polycythaemia should be treated with caution.
  • There may be some oedema (fluid accumulation) and weight gain, which could be problematic in patients with heart problems.

Rare side effects include:

  • Frequent or sustained painful erections. In this situation, please see your doctor urgently, who will review your treatment.
  • Sleep apnoea (sudden obstruction to the airway while sleeping, which interrupts breathing). This occasionally affects men who are obese or have chronic lung disease. This usually resolves as treatment continues, but your doctor may want to review your treatment if this occurs.
  • Behavioural changes, possibly leading to aggression. This is more common if you have never had a normal testosterone level.

You may never experience any of these effects. But if you have any concerns, don’t hesitate to discuss them with your doctor or nurse.

Monitoring testosterone replacement therapy

Your testosterone level and symptoms will be monitored a few weeks after you begin therapy to check that you are getting the right treatment. After that, you will be monitored usually every six months to a year.

A rise in your red blood cell count or prostate-specific antigen (PSA) levels is expected in the first few months. Regular monitoring of the prostate gland (rectal examination and blood tests to check PSA) is therefore required according to clinical guidelines. Your doctor will also continue to monitor the red blood cell count and review your treatment if required.

Over time, you should find that your mood, sex drive and muscles are improved. Growth of body hair will also show that your treatment is working. However, several months of treatment may be required before changes are obvious, so don’t count on any rapid improvements.