• Hormone Replacement Therapy

What is HRT For Men? Your Guide to Hormone Replacement Therapy

Medically reviewed and edited by Dr. Danielle Weiss

Since the 1950s, testosterone replacement therapy has been used in the U.S. by men with hypogonadism (a condition where the body is unable to produce enough testosterone).

The FDA has only approved testosterone for treating certain types of hypogonadism and has not approved it for treating low testosterone due to aging.

However, with a doctor’s prescription, testosterone can be used to treat, among other things, low testosterone levels that occur during the aging process.

In this article, we'll go into detail about hormone replacement therapy for men, its risks and benefits, and how to tell whether you might need it.

What is HRT for Men?

Hormone replacement therapy (HRT), also known as testosterone replacement therapy (TRT), is chiefly used to treat the disease known as hypogonadism — a condition that occurs when the testes do not produce enough testosterone or there is a problem with signaling the testes to make testosterone.

Some men are born with hypogonadism, but the condition may also develop later in life. HRT helps raise the testosterone levels (sometimes called T levels) of men who have a testosterone deficiency because they cannot produce enough of this hormone.

As men age, their total testosterone levels drop by around 1.6% per year. Even though the FDA has not approved testosterone replacement therapy for use in aging men with low T levels, doctors may prescribe it to decrease the side effects of low testosterone.

What are the different types of HRT?

There are several ways testosterone may be given, including via:

• Injections

• Patches

• Creams

• Gels

• Pills

• Implants

• Buccal

Why Would I Need Hormone Replacement Therapy?

Testosterone deficiency can cause various problems in men, including low libido and sperm count, decreased strength, erectile dysfunction, osteoporosis, and infertility. Testosterone replacement therapy can be used to address some of the side effects.

Low testosterone levels

Men with hypogonadism can restore their testosterone levels with hormone replacement therapy. This is the only FDA-approved use of testosterone replacement therapy.

As men age, their testosterone production decreases. This is called andropause, otherwise known as 'male menopause.'

Some doctors may prescribe hormone therapy to men experiencing andropause to relieve some of the unpleasant symptoms, such as feelings of anxiety, irritability, and fatigue. Rebalancing testosterone levels will help improve overall health and wellbeing.

Masculinizing hormone therapy

Masculinizing hormone therapy is sometimes prescribed as a treatment option for those with gender dysphoria.

Gender dysphoria describes the anxiety or distress someone experiences when their gender identity does not correspond with their biological sex. In other words, when a biological male identifies as a woman, or a biological female identifies as a man.

Testosterone therapy may be prescribed to bring about secondary sex characteristics so that someone’s body more closely matches their gender identity. This is sometimes also called gender-affirming hormone therapy.

There are many risks of undergoing masculinizing hormone therapy, including:

• Male-pattern baldness

• Acne and weight gain

• Sleep disorders

• Hypertension

• Infertility

• Pelvic and clitoral pain

• Type 2 diabetes

Not everyone is a candidate for masculinizing hormone therapy. Those considering it will need to undergo physical health and behavioral evaluations before they can move forward with the treatment.

Masculinizing hormone therapy may or may not be supplemented with masculinizing surgery. Not all transgender men decide to get masculizing hormone therapy — but those who do may experience many benefits, as well as side effects.

What are secondary sex characteristics?

The changes that happen during puberty are called secondary sex characteristics.

These changes are not directly related to the reproductive system, such as the primary internal and external sex organs that are present from birth.

In men, secondary sex characteristics include:

• Increased muscle mass

• Growth of chest and facial hair

• Adam’s apple formation

• Deepening voice

What are Some Signs of Low Testosterone Levels?

Low testosterone can have some really unpleasant symptoms.

If you experience one or more of the following symptoms and suspect you may be suffering from low T levels, get in touch with your healthcare provider to explore treatment options.

Keep in mind that some symptoms of low testosterone, such as erectile dysfunction and low sex drive, may be caused by other factors such as stress, anxiety, or depression.

Some symptoms of low testosterone levels include:

• Low sex drive: Also known as low libido, a low sex drive is characterized by a lack of interest in sexual activity.

• Erectile dysfunction: Not being able to get or maintain an erection.

• Hair loss: Although hair thinning is a natural part of the aging process, low testosterone levels can result in body and facial hair loss, too.

• Decreased energy: Feeling tired after sleeping and/or having no motivation to exercise.

• Low muscle mass: Because testosterone helps build muscle, low T levels can cause decreased muscle mass.

• Breast enlargement or increased body fat: Low testosterone can affect breast tissue in males, which may lead to a condition known as gynecomastia or enlarged male breasts.

• Mood swings: Low testosterone levels may affect your general mood and contribute to feelings of anxiety, irritability, depression, sadness, and decreased confidence and motivation.

• Poor concentration: The ability to concentrate and remember information may be affected by testosterone levels.

• Decreased mental and physical well-being.

What are Some Underlying Causes of Low Testosterone Levels?

Aside from aging and hypogonadism, there are some other reasons you may be experiencing low T levels.

Some causes of low testosterone levels include:

• Injuries that affect the blood supply to the testes

• Infection of the testes

• Chemotherapy

• Medications such as steroids or opioids, and hormones (i.e. used in cancer treatment)

• Illnesses

• HIV/AIDS

• Extreme weight loss

• Obesity

• An excess of estrogen

• Alcohol abuse

What are the Benefits of Hormone Replacement Therapy?

Men who undergo hormone replacement therapy to treat low testosterone levels — either due to hypogonadism or aging — may experience relief from the unpleasant effects of low T levels.

Some benefits for these men include:

• Improved mood and energy levels

• Better mental and physical wellbeing

• Improved sexual health

• Higher lean body mass

• Improved strength

• Mental alertness

• Improved bone density

For those who've been taking testosterone as part of masculinizing hormone therapy, the benefits may include:

• Experiencing less severe gender dysphoria

• Improved self-esteem

• Better social and psychological functioning

• Less anxiety and distress

What are the Potential Risks of Hormone Replacement Therapy?

The risks and side effects of testosterone therapy differ from person to person, and you may experience different side effects depending on your reasons for taking the drug.

Individuals who are at high risk for developing prostate cancer should proceed with caution when considering hormone replacement therapy, as should those with a risk of heart disease.

Some other risks or side effects include:

• Sleep apnea

• Acne

• Breast tenderness or swelling

• Increased red blood cells, which could lead to heart disease

• Increased risk of premature death

In addition, it is often difficult to stop testosterone therapy. Aging men with low testosterone who start hormone replacement therapy may become dependent on it and have to take testosterone for the rest of their lives.

What is the Link Between Testosterone and Cancer?

While testosterone is vital for growth, sexual health, and to keep the body functioning optimally, in certain cases, testosterone can also lead to health problems.

Testosterone may feed prostate cancer cells, so it’s not typically recommended to men undergoing cancer treatment or who may be at high risk for developing prostate cancer.

However, new evidence suggests that testosterone therapy may be safe for men who have hypogonadism as well as non-high-risk prostate cancer.

How Can I Tell if I Need Hormone Replacement Therapy?

The symptoms associated with low testosterone levels may overlap with other conditions, such as high stress or anxiety. The only way to know for sure if you require hormone replacement therapy, is to do a lab test.

Do an at-home testosterone test or visit the doctor

You can purchase an at-home testosterone kit and use a finger prick to determine your testosterone levels. Alternatively, you can visit the doctor to have a blood test drawn at their office or lab. In both cases, the blood samples should be sent to a CLIA certified or CAP accredited lab for analysis.

Be sure to disclose any medications or herbal remedies you’re taking before you do the test, as this may impact the results.

Irrespective of your choice, it’s advisable to conduct the test on an empty stomach (after fasting) and in the morning as testosterone levels are highest then.

What Happens if Low Testosterone is Not Treated?

If men with testosterone deficiency are not given the required treatment, the symptoms and signs associated with low T will persist and likely worsen.

It is also possible for men to start displaying more symptoms as they grow older and experience a further decline in testosterone.

In addition to the common signs of low testosterone — such as loss of body hair, decrease in muscle mass, and erectile dysfunction — men with low testosterone may also have an increased risk of premature death.

How Can I Increase My Testosterone Levels Naturally?

If you’re not ready to undergo hormone replacement therapy, or you feel it’s not the right option for you, there are alternative ways to boost testosterone levels.

Some things you can do that may naturally increase your testosterone levels include:

• Exercisinging regularly, with a special focus on resistance training

• Eating a balanced diet that includes healthy fats, carbohydrates, and protein

• Reducing stress and getting enough quality sleep

• Ensuring you get enough vitamin D — you can take oral supplements, or get 10-30 minutes of midday sun directly on at least 50-75% of your skin

• Taking multivitamin supplements

• Reducing alcohol and drug use (this refers to drugs prescribed by a doctor and those used for recreational purposes).

When Should I See a Doctor for Hormone Replacement Therapy?

If you’re worried about low testosterone levels, you can purchase an at-home testosterone kit or, preferably, visit your healthcare provider to get tested.

There are several other conditions that may have the same symptoms as low testosterone levels, but your doctor will be able to find the cause and provide the proper treatment.

Where Can I Learn More About Hormone Replacement Therapy for Men?

Are you feeling unusually tired, anxious, or irritable? Is your strength not what it used to be? You may have low testosterone levels. Don’t let the symptoms of testosterone deficiency affect your quality of life. Make a telehealth appointment at LifeMD today, and speak to a board-certified physician or nurse practitioner from the comfort of your home (or anywhere).

Dr. Danielle Weiss

Dr. Weiss earned her MD from NYU School of Medicine, completed her residency at Scripps Mercy San Diego, and an endocrinology fellowship at Stanford University. She’s Board Certified in both Internal Medicine and Endocrinology, Diabetes, and Metabolism.

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