Testosterone Replacement Therapy Side Effects, Safety & Risk

Since 2014, the FDA has required that all forms of testosterone therapy provide warning labels about the risks of blood clots [2].

And this is not just limited to patients who are dealing with age-related low testosterone levels.

The research suggests that there is a link between hormone replacement therapy and increases in thromboxane.

This is a hormone that can cause blood vessels to constrict, leading to red blood cells clotting.

It’s unclear how much this is linked to the dosage of testosterone supplementation, and that’s why it’s so important to ensure that a doctor fully reviews your medical history and monitors your response to the treatment.

Stroke Risks

Similar to the risk of red blood cells clotting, the FDA has required all types of TRT to have warnings about the increased risk of strokes.

More specifically, research published by the New England Journal of Medicine found this specific link in older men [3].

Because the reasons for this risk are still unclear, doctors assume that it can happen with any form and dosage of testosterone therapy.

It’s also one of the reasons why it’s so important to aim for a normal range when treating low testosterone levels rather than allowing an increase to elevated T levels.

Some initial research in the early 2000s suggested that the increased risk of prostate cancer development was very high.

However, the difficulty was in distinguishing between men who had already developed prostate cancer cells and those who had benign prostatic hyperplasia (a non-cancerous issue).

More recent research from 2015 suggests that while there is a link between treating low testosterone levels and cancer, it’s still very unclear how to assess those risks [4].

And because of that, doctors remain cautious and don’t necessarily recommend TRT for people who have a family history of prostate cancer.

Male Breast Cancer

One of the less common side effects that are also still not fully understood is the link to breast cancer.

The theory is that excessive serum testosterone increases ultimately lead to the hormone being broken down into estrogen.

This, in turn, could then lead to an increased risk of developing cancer cells in the breast, and there is some evidence of this through a meta-analysis of multiple studies [5].

As a personal trainer, I have seen many men who take large amounts of steroids, with the result being gynecomastia or the development of enlarged breast tissue [6].

With that in mind, it seems like there are valid reasons to be concerned about breast cancer.

Obstructive sleep apnea is a condition where the airways completely collapse during sleep [7].

The risk here is not just the disruption to sleep and the health risks that come with it. But in both the short and long term, sleep apnea can be a serious issue.

There is scientific evidence that testosterone therapy can increase the risk of apnea, and if you already have such a diagnosed health condition, then TRT might be too risky [8].

But also keep in mind that excessively low T-levels due to male hypogonadism could lead to the same issue [9].

It’s just another reason not to mess with these treatments without medical support.

Mood Swings

Another thing that is more common with testosterone therapy is the impact it can have on men’s mental health. There is evidence that it’s directly linked to increased risks of depression and mood swings [10].

While low testosterone levels can also lead to depression and anxiety, it’s sudden increases that can be particularly disruptive.

A common term in the fitness industry is “roid-rage,” which is short for “steroid-rage.” It’s something I have witnessed, and it can come with crashing depression as well as mental highs and lows.

It’s why many doctors recommend that their patients keep a journal where they write down how they feel every morning and evening.

More on this shortly.

Another issue that you need to take into consideration with testosterone therapy is how it could impact urinary tract issues [11].

The studies so far have reported that it could be an interaction between the prostate that gets stimulated by an increase in testosterone.

It seems like it’s more common with men who have previously had a UTI, and doctors need to carefully monitor if the chosen treatment, testosterone administration, and dosage make things worse.

“TRT can cause fluctuations in testosterone levels, which can affect energy levels, libido, mood, and the presence of symptoms such as breast tenderness.”

- Megan Soliman, MD

Another thing you have to keep in mind in order to limit the side effects of testosterone replacement therapy is the need to deal with a trusted and licensed medical clinic and doctor.

Here’s why that’s important.

For a long time, there were shady online services offering TRT without the actual involvement of doctors.

It might have even seemed like you were assessed by medical professionals, but it could be all just a front to the illegal sale of restricted drugs.

However, things have changed a lot, and there are now fully licensed and reputable online TRT clinics.

These employ experienced doctors in men’s health issues, and you’ll have to go through blood tests and medical consultations before you get your hands on any testosterone medications.

Only if these doctors determine that you have low testosterone levels and significant health issues relating to it will they get you set up for treatment.

And when it comes to choosing such clinics, you have to be sure that you’re only considering the most reputable and effective options.