What Is Testosterone Replacement Therapy?

Testosterone replacement therapy is a type of hormone therapy designed to increase reductions in male testosterone levels, also called low testosterone. During middle age, low testosterone is very common, and is sometimes called male menopause or andropause.

Low testosterone (also often referred to as Low-T) can cause the following symptoms:

• Fatigue
• Muscle loss
• Weight gain
• Insomnia
• Decreased sperm count
• Cognitive issues like short-term memory recall
• Decreased libido, including erectile dysfunction

TRT is a method of supplementing the body’s levels of testosterone to alleviate the symptoms caused by low testosterone.

Why Is Testosterone Important?

Testosterone is the main sexual hormone produced by men and is necessary for a healthy and balanced life. It’s needed to regulate your sex drive, muscle and bone mass, physical strength, memory, and stable mood patterns.

Testosterone is also known to improve mathematical and spatial reasoning skills as well, plus playing the huge role of regulating sexual virility by determining sperm count in semen.

Why Does Testosterone Decrease?

Testosterone levels often decrease because the testicles don’t produce enough of it. The condition is known as hypogonadism and has several possible causes. Largely, genetic predisposition to the condition is exacerbated by external factors.

A few of these are:

• Injury to the testicles
• Testicle infection
• Cancer
• Radiation or chemotherapy
• Diet
• Exercise level

You’ll notice that the last two are controllable. It’s a known fact that exercise increases testosterone, mainly in the short term. Regular exercise can slightly increase and help maintain testosterone levels. Foods like red meat and peanut butter can increase muscle gains, which also affect testosterone levels.

Unfortunately, there’s also genetic predisposition to consider as well. Even if you eat well and exercise regularly, it’s still possible to suffer low T if your family has a history of it.

Can Testosterone Increase Penis Size?

It’s a commonly held belief that testosterone affects libido, aggression, and even penis size. This is a misconception, however:

While testosterone levels during puberty make an impact on the growth of the penis, there’s no substantial evidence that adult men supplementing with testosterone can increase the size of their penises in any major way.

Does Testosterone Increase Male Performance?

Testosterone does increase male performance: it improves the ability to get and maintain an erection, increases libido, and improves mood. With the three together, testosterone increases penis size and performance.

Testosterone can dramatically improve a previously diminished or dead sex life, particularly if sex drive was to blame.

There isn’t much research available on whether testosterone can actually affect male sexual performance in any measurable way.

Do Changes In Testosterone Affect Penis Size?

During puberty, testosterone levels are known to affect the growth and development of the penis. As an adult, low testosterone levels can decrease libido, which can make wilting erections seem like the size is physically smaller. As a result, low testosterone can affect how full erections become.

Testosterone Injections vs. Gels, Creams, Patches, and Pills & Pellets

If you’re interested in testosterone, you may have noticed there are several methods available to actually get it in your system. There are testosterone injections, creams, gels, patches, and pills, just to name a few. Each of these has its pros and cons but ultimately does the same job within the body.

Injections

Testosterone shots, or T shots, are generally considered the best way to administer testosterone. This is because when injected into the muscles, the hormone pools within the muscle tissue and is steadily released into the bloodstream. Also, injection is the best method to ensure precise doses because other methods are much less efficient.

Testosterone shots can be a bit painful because it’s a viscous liquid. So, the needles used to inject it are usually wider-bored than other injectable drugs – 21 or 22-gauge are most common. Using smaller needles can make injections more difficult and painful.

Gels/Creams

Gels and creams are a popular method of boosting testosterone and provide decent and time-released doses of the hormone. The main issue with testosterone gels and creams is that they can rub off onto other people. This is especially a problem with partners and children. Your skin type may also affect how well your body absorbs testosterone.

Oral

Testosterone pills are fairly effective, but still don’t produce effects as dramatic as an injection. They’re an effective way for someone to increase testosterone levels long-term without wanting the hassle of self-injection.

Patches

Patches are theoretically an easy and convenient way to get testosterone, but they’re pretty inefficient. Depending on your skin and how well it adheres, more or less of the drug may be delivered each time.

Pellets

Testosterone pellets are a convenient way to boost testosterone levels without needing regular self-administration like pills or injections. Rather, a pellet of the drug is implanted into the body, where it slowly releases the drug to your bloodstream.

The cons of pellets are that they’re imprecise as far as a constant, steady amount of drug in your bloodstream. Incorrect dosages can be a huge hassle because you’d have to go back to the doctor and get it removed and corrected.

Risks of Testosterone Injections

A testosterone injection may be the best way to administer the drug, but it isn’t without its risks and side effects. Generally, any positive or negative effect from the injection is more extreme than using patches or creams.

Testosterone side effects include:

• Headache
• Increased facial and body hair growth
• Increased confidence, libido, and possibly aggression
• Raised cholesterol levels
• Heightened blood pressure
• Skin rash
• Increased urination
• Acne
• Changes in the voice

How Long Do Testosterone Injections Take to Work?

As with any medication, with testosterone, you want to know how long it takes to get the desired effects.

Testosterone therapy is generally a more gradual course of medication, and it’ll usually yield results at around 3-6 weeks after starting treatment. Increases in energy, libido, and muscle growth will be incremental rather than an immediately noticeable difference.

Before significant effects can be seen or felt, testosterone has to balance out within the body and regulate where it goes and what it affects. Your body’s systems will have to get used to the increase in testosterone and all the other chemicals it helps produce – a big one is a dopamine boost in the brain that improves and stabilizes your mood.

Other hormones in the body that change, can cause thicker hair and increased hair growth, as well as a deepening of the voice. Oily skin and acne are also common.

How long improvement takes to occur also depends on the patient’s specific circumstances. Some of these may depend on what they’re looking for from TRT, as someone with low T cuasing libido issues probably won’t notice a change in muscle mass.

Another factor that greatly affects how soon results occur is whether you do things to help the therapy work.

Things that improve how TRT works include:

• Getting enough sleep
• Drinking enough water
• Eating a balanced diet with enough protein

The longer you take testosterone shots, the more dramatic effects you’ll experience. Your mood will improve and stabilize, hair growth increases, and finally, energy levels and libido usually rise as well.

How Do Testosterone Injections Work?

Testosterone is most commonly injected into the deltoid muscles of the shoulders or in the glutes, or butt cheeks. The injection is made directly into these muscles, where testosterone pools and slowly releases into the bloodstream at a steady pace.

Regular testosterone injections will enhance the initial effects as chemicals begin to adjust to the presence of so much testosterone in your system and enhance bodily functions.

How To Inject Testosterone

Proper injection technique is vital to the success of any drug. Without proper injection procedures, you may experience painful or reduced side effects. The first and most crucial part of injection is preparing the medication within the syringe.

Preparation

The following steps are how to prepare testosterone injections:

1. Thoroughly wash your hands with soap and warm water.
2. Uncap the syringe.
3. Draw enough air into the syringe to match your dose.
4. Insert the syringe into the medication bottle.
5. Push the air into the bottle by depressing the plunger.
6. Turn the bottle upside-down.
7. Draw 5 ml (0.16 fl oz) past your dose into the syringe.
8. Slowly press the plunger by 1 or 2 ml (0.03-0.06 fl oz) at a time toward your precise dose.
9. Remove the syringe from the bottle.
10. Inspect the syringe for air bubbles, gently tapping the syringe to remove them.
11. Cap the syringe and put it away.

Injection

The next step is to actually prepare the injection site and make the injection. The injection is commonly made into the deltoid or glute muscles for optimal distribution of the drug.

Follow these steps to inject testosterone:

1. Uncap the syringe.
2. Gently tap the side of the syringe to remove air bubbles.
3. Depress the syringe a tiny bit until you see a tiny bit of medication squirt out.
4. Rub alcohol on the injection site to kill bacteria and prevent infection.
5. Holding the syringe like a dart at a 90-degree angle, plunge it into the site.
6. Pull back on the syringe a tiny bit; if blood appears, you’ve hit a vein by accident.
7. Press the plunger down and inject the medication.
8. Pull the syringe out and immediately apply pressure to the site with a sterile cotton pad.
9. Apply a bandage if desired to further staunch bleeding.

Precautions

Only take medication that has been prescribed to you by a doctor, and always store it in a cool, dark place. You should also pay attention to the expiration date, as expired medication rapidly loses potency. Most importantly, you should only take the recommended dose as determined by your doctor; greater and lesser doses may produce undesirable effects.

Another vital tip is to never suddenly discontinue injections without talking to your doctor first so they can supervise your cessation.

How Much Do Testosterone Injections Cost?

For the first few weeks as you and your doctor dial in on your ideal dose, the prescription cost may vary significantly. Once you have a perfect dose, testosterone injections are generally the cheapest form of TRT. Depending on your dose and injection schedule, injections are between $40 to as high as $400 for a month of doses.

Does Insurance Cover Testosterone?

Most insurance providers do cover testosterone replacement therapy, as long as you demonstrate a legitimate medical need for it. The exact requirements vary widely, and many men end up paying out of pocket for testosterone that isn’t deemed medically necessary, such as for accumulating muscle.

Can You Get Testosterone Without a Prescription?

Testosterone can’t be purchased over the counter, at least not in the United States, where it’s a controlled substance. Therefore, it must be prescribed by a doctor to address certain medical needs.

This is because testosterone is considered an anabolic steroid, often used to cheat in athletic activities by enhancing performance and muscle gains. Another illicit use of testosterone is as a mood enhancer and performance booster for exercise – it’s commonly seen as a ‘shortcut’ to increase muscle gains in a shorter period of time.

Testosterone abuse is prevalent in some circles, such as fitness or weightlifter groups where it’s often sold and shared for performance-boosting effects. Testosterone abuse is heavily discouraged because it can lead to very unpleasant results as the doses aren’t planned by a doctor.

Effects of testosterone abuse include:

• Testicles can shrink, possibly permanently if abuse is heavy enough.
• Hormonal disturbances, which can cause an array of effects including fluctuations in mood, libido, hair growth, and much more.
• Mood swings include episodes of severe depression and aggression.
• Risk of cardiovascular conditions like strokes and heart attacks, especially if high doses are taken without a medical need.
• Risk of stunted growth if used by teenagers going through puberty.

Can You Stop Taking Testosterone After You Start Taking It?

Testosterone is generally a lifelong treatment in that effects of the therapy may be reversible if you stop taking the drug. When you stop taking it, your testosterone levels will naturally go down. The reduction is also affected by other factors like diet and exercise habits.

How long the effects last depends primarily on the length of the therapy. Taking testosterone for 10 years will produce more permanent effects than stopping treatment after just 2 years. For the most part, though, the body will revert to its state before you took testosterone.

Some possible side effects of stopping TRT are:

• Fatigue and decreased energy levels
• Muscle weakness
• Muscle loss
• Weight gain
• Thinning hair growth
• Decreased libido
• Decreased confidence
• Decreased spontaneous erections

It’s important to not stop taking testosterone without consulting your doctor. Changes in something as important and life-altering as hormones should be discussed with a doctor, who will decide if it’s safe for you to stop taking testosterone, and how to go about it safely.

Do You Get Withdrawals From Testosterone?

You can expect withdrawal-type effects when you stop TRT. Once you’ve been taking testosterone for a month or longer, you can develop a dependence on the drug. If you suddenly stop taking it after a much longer time, the withdrawal effects may be more severe and dramatic.

These symptoms include:

• Anxiety
• Mild depression
• Fatigue and reduced energy levels
• Headaches
• Mood swings
• Reduced libido
• Reduced sexual appetite
• Erectile dysfunction
• Shrinking of the scrotum and testicles
• Muscle loss and weakness

Typically after long-term testosterone use, you would slowly taper your dose down over time to naturally get your body used to lower levels. Dramatic changes in dosage are far more likely to cause severe effects, and doctors are quick to caution against them.

When To Not Take Testosterone

Under some circumstances, you may not be able to safely take testosterone replacement therapy. This is mostly due to various health conditions or medications that contraindicate with testosterone. Don’t take testosterone if you suffer from any of the following medical conditions:

• Prostate cancer
• Diabetes
• Obese body weight
• Very high cholesterol
• Decreased liver or kidney function
• Past strokes or heart attacks
• History of blood clots
• Enlarged prostate
• High red blood cell levels

You should report all medications you’re taking to your doctor, as some can interact with testosterone. Notably, blood thinners, insulin, and other steroids can interfere unfavorably with testosterone replacement therapy.

Final Thoughts

Testosterone may not physically increase your penis size, it can increase libido and mood. Improved blood flow, though, can cause firmer erections and provide the illusion of a bigger penis.