Testosterone is a vital hormone for males that helps with muscle and bone growth, cognition, red blood cell production, and sexual and reproductive function. Testosterone levels can decline for many reasons, including stress, illness, and aging. TRT Therapy, also known as androgen replacement therapy, is a treatment used by doctors to restore testosterone to healthy levels in males who have low or no naturally occurring testosterone. Some men use anabolic steroids to increase testosterone levels and improve performance in sports or for body-building. The difference between TRT and anabolic steroids is that the doses of testosterone used by athletes are usually 10 to 100 times higher than what is prescribed medically for TRT. The steroids are also often combined “stacked” with other substances like stimulants and pain relievers to enhance their effectiveness.

In 2017, approximately 4.7 per 1,000 active component service men received TRT prescriptions. Over half of these were without an indication for TRT based on 2018 American Urological Association clinical practice guidelines. These men could experience side effects like obstructive sleep apnea, worsening urinary tract symptoms and edema which negatively affects deployability and medical readiness.

While TRT can be helpful for some patients, it is important to recognize its limitations. The American College of Physicians released a statement in 2020 that indicated TRT only offers small improvements in some symptoms linked to low testosterone, such as fatigue and erectile dysfunction. The report noted that there is not enough data to determine whether TRT reduces the risk of heart disease or osteoporosis.

Men on TRT should be closely monitored for prostate cancer with regular PSA testing. This is because testosterone can encourage the growth of prostate cancer cells. If a man on TRT experiences a significant rise in his PSA level, it may indicate the presence of prostate cancer and warrants immediate cessation of TRT.

Another concern of TRT is that it may increase the risk of breast cancer in men with certain preexisting health conditions. However, the role of testosterone in a man’s breast cancer risk is unclear because many existing health conditions have to do with hormones. Future prospective studies with longer follow-up will be needed to evaluate these relationships.

TRT may also increase the risk of liver problems in some patients, especially those taking orally-administered alkylated forms of TRT. However, topical delivery systems avoid first-pass hepatic metabolism and have been shown to be safe in patients with chronic liver disease.

The cost of TRT varies depending on the type and how it’s administered, but most insurance companies cover it. Men without insurance can get it for a discounted price at some pharmacies, and there are organizations that provide TRT at no cost. The best way to find out more about TRT is to talk to your doctor. They can tell you more about the benefits, risks and how to manage any side effects of TRT. They can also help you decide if your low testosterone is related to an illness or simply because of aging and whether or not you require TRT.