What are the side Effects of TRT?

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There are sadly many physicians out there that take advantage of (younger) men who don’t feel well by prescribing them testosterone replacement therapy (TRT) as a quick-fix for low testosterone that can ultimately have long-term, irreversible side effects. Ideally, you won’t have to deal with the side effects of testosterone because you won’t jump on the TRT bandwagon without a good medical reason.

In my case, TRT was a no-brainer because I had pituitary dysfunction that was preventing my body from producing a sufficient amount of testosterone and thyroid hormone. I was basically a type-I diabetic in the world of low testosterone; instead of having to inject insulin, I have to inject testosterone.

But the vast majority of men don’t require testosterone treatment to live a healthy and fulfilling life, and these are the men who are generally at a higher risk of TRT side effects. So, let’s take a look at what the side effects of testosterone are and what makes steroid abuse so dangerous.

What are the Side Effects of Testosterone (TRT)?

Since testosterone is a highly potent anabolic androgenic steroid (AAS), TRT can cause a range of side effects, some of which are manageable and others that are more serious (possibly even irrevocable). Making the decision to begin TRT in haste can have permanent consequences if you’re not careful.

Thankfully, a good chunk of men only experience superficial side effects on TRT, such as shrunken testicles, oily skin, night sweats, and acne. However, there are men who experience harsher side effects of TRT, notably gynecomastia (“man boobs”), prostate hypertrophy leading to trouble urinating, infertility, erectile dysfunction, and excessive body hair growth.

If you’re on TRT, it’s crucial to work closely with your physician so they can adjust your testosterone dose (or possibly form) to help mitigate the side effects of testosterone. As your body adjusts to having healthy levels of testosterone (again), these side effects may or may not subside.

Unfortunately, the one side effect of testosterone that basically never goes away is shrunken testicles.

Why Does Testosterone Cause Testicles to Shrink?

A major misconception among the general public is that anabolic steroids cause a man’s penis to shrink. The reality is that testosterone (and other AAS) cause a man’s testicles – not his penis – to shrink.

The penis is first and foremost a reproductive sex organ; it doesn’t secrete testosterone into the bloodstream as the testicles do. Hence, the testicles are an endocrine organ as well as a reproductive organ.

When a man takes testosterone, his body effectively flips the “off switch” in the hypothalamus, leading to a significant reduction of the requisite gonadotropin-releasing hormone necessary for eventual testosterone production via the testicles.

Shrunken testicles are generally indefinite on TRT since testosterone injections/patches/creams suppress the body’s natural testosterone production.

Essentially, your body no longer needs the testicles to produce testosterone since you’re getting it from an outside (exogenous) source.  This is called a negative feedback loop, and the neuroendocrine system has several of them to keep your hormones in balance.

About the only option to remedy shrunken testicles is to take human chorionic gonadotropin (HCG) in conjunction with testosterone, but this complicates the process of balancing testosterone and estrogen in the body. It also significantly increases the cost of treatment and HCG has to be injected multiple times per week for it to be effective.

In addition, most doctors won’t go out of their way to prescribe HCG as part of TRT since it’s not essential but more so a luxury. They may prescribe it intermittently to restore fertility in men on TRT, but not for ongoing use.

Side Effects of Testosterone Abuse

Now that you have a better grasp of the comparatively “mild” side effects of testosterone, let’s take a look at what testosterone starts to do in higher doses (e.g. when used for “performance enhancement”).

First off, testosterone is a controlled substance in the United States (and many other countries) for a reason: it can cause irreversible and morbid consequences when abused. For reference, a typical TRT dose of injectable testosterone is 100 mg per week; athletes, bodybuilders, and gym-goers will take doses 5-10 times larger than that.

This takes their testosterone levels well beyond the normal/healthy physiological range. In other words, they are abusing testosterone.

Naturally, these individuals are at a much greater risk of life-threatening ramifications, which commonly include:

  • Cardiac hypertrophy (enlarged heart)
  • Hypertension
  • Elevated hematocrit
  • Elevated blood triglycerides
  • Non-alcoholic fatty liver disease
  • Enlarged prostate


All of these are significant risk factors for heart attack, liver failure, embolism, stroke, atherosclerosis, prostate cancer, and ultimately, death.

In fact, an autopsy case study of two young adult Australian footballers who died of sudden cardiac arrest during workouts found that anabolic steroid abuse contributed to sizeable increases in their hearts.[1] These athletes were considered “fit and healthy,”  illustrating the deceptively dangerous nature of steroid abuse, especially in younger men.

A recent retrospective study also found that AAS users had a mortality rate three times higher than nonusers.[2] It’s not uncommon for men to feel perfectly fine despite abusing these drugs, only to drop dead the next morning.

Granted, it’s extremely unlikely for proper TRT to cause sudden fatal events. Ultimately, TRT can be quite healthy – and lifechanging – for the men who truly need it.

The catch is that the vast majority of men don’t medically require TRT, and the long-term effects of taking testosterone when your body can otherwise produce enough on its own are unclear.

But the question is, why would you want to take testosterone unless you absolutely need it?

It’s likely that many men feel they stand to benefit from TRT even though they have a completely normal level of testosterone, or they are on the lower end of the healthy range.

But there is no good reason to presume that. If anything, you’re committing to a lifetime of dependency on medication and unnecessary side effects. The wiser approach is to see what you can do naturally to boost your testosterone levels, first.

Consider this Before Taking TRT

TRT is not a panacea for men, nor is it without drawbacks. Take it from someone who has been on it for almost a decade, I would much rather not have to inject testosterone every week or deal with the way it’s made my skin more prone to acne outbreaks.

Trust me, it gets annoying.

Not to mention, you have to put up with societal stigma and medical expenses, both of which are frustrating. But yes, in my case, the side effects of TRT are worth it and I do what I can to manage them.

Most men, however, wouldn’t see it the same way. There are supplements that you can take for low testosterone and the prudent option is to implement lifestyle habits that are conducive to healthy testosterone levels, such as getting enough sleep, exercising regularly, eating properly, and managing stress.

Why not read more about low testosterone and its causes and watch out for our upcoming post about Lifestyle Habits that Impact Testosterone.

Documentation

[1] Kennedy, M. C., & Lawrence, C. (1993). Anabolic steroid abuse and cardiac deathMedical Journal of Australia158(5), 346-348.

[2] Horwitz, H., Andersen, J. T., & Dalhoff, K. P. (2019). Health consequences of androgenic anabolic steroid useJournal of internal medicine285(3), 333-340.

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