We get asked more and more about testosterone replacement therapy as many men buy this independent of doctors and administer it themselves.

The main reasons our patients are on testosterone are:

1. Gender identity changes.

2. Hypogonadism: where the testosterone is low because it is not being produced by the testicles or because the messenger signals from the brain are not being sent to the testicles to say “produce testosterone.”

We generally see everyone for a physical: to examine the testicles and ensure there are no other conditions that could be causing the hypogonadism.

Testosterone production can dip low when we are under stress or have a viral illness at the time the blood is taken, so we do need at least two early morning levels 8 weeks apart to ensure the reading is true.

A referral to a hormone( endocrine doctor) is always needed to confirm hypogonadism.

For Gender dysphoria, and change again the hormone prescription is initiated by a specialist in that field.

Risks of being on TRT

• In younger patients with low testosterone related to hypogonadism the risk of heart disease was similar to someone not on TRT and so considered safe.

• For middle-aged men who have a low side of normal Testosterone- but not hypogonadism-the main concern is the possible increased risk of heart attacks and stroke. 

There are mixed results from studies but some studies were stopped due to high rates of adverse events.