Can a simple pill help men with low testosterone? Yes, it’s possible…at least for some men. Read on to learn more.

What is testosterone?

One of the most important hormones for men is testosterone. It’s the reason men grow facial hair, have deeper voices, and produce sperm cells. It contributes to their muscle mass and bone health. And it’s essential for their sexual health: both libido and erections are driven by testosterone.

Testosterone production is triggered by the pituitary gland in the brain, which “tells” the testes (glands located near the penis in a sac called the scrotum) to start making the hormone.

What happens when a man’s body doesn’t make enough testosterone?

Sometimes, there is a problem with the testosterone production process.

The problem might be something a man is born with (congenital). Some examples are Klinefelter syndrome (when a male child has an extra X chromosome) or intersex conditions (when a child is born with both male and female sex organs).

Injuries, illnesses, and cancer treatment can affect testosterone production, too. For example, if a man has a pituitary gland disorder, if he has had trauma to his testes from an accident, or if he has had radiation treatment to his genital area, his body might make less testosterone. Obesity, diabetes, liver disease, kidney disease, metabolic syndrome, HIV, or AIDS are other factors.

In addition, men’s bodies naturally make less testosterone as they get older. This is a normal part of aging, and the change is gradual—about 1% a year once a man is in his thirties.

Doctors refer to this overall situation as low testosterone, low T, or hypogonadism. These words mean that the body is not making enough testosterone.

What are the symptoms of low testosterone?

As a result, men might feel weaker, depressed, grumpy, or fatigued. They might lose interest in having sex or experience erectile dysfunction (an inability to get an erection firm enough for sexual activity). Some men with low testosterone lose muscle mass and body hair, and some grow breasts.

It’s important to note that these symptoms can be related to other health conditions or medications as well. For example, erectile dysfunction is a common problem for men with diabetes. Men with depression might lose interest in sex. So it’s important to see a doctor if you have any of these symptoms.

What is testosterone deficiency?

When a man has low testosterone levels and accompanying symptoms, doctors use the term testosterone deficiency (TD). To diagnose TD, doctors take a complete medical history, ask questions about medications used, and conduct a thorough medical exam, including blood tests to check the levels of testosterone and other hormones involved with its production, like luteinizing hormone (LH) and prolactin. (Learn more about TD diagnosis.)

What happens next? Doctors treat the root cause of the TD. If a man has diabetes, they will suggest ways to keep his blood sugar under control. If he has kidney disease, that will be addressed. Proper diet and exercise may be recommended for men with obesity.

Another option is testosterone replacement therapy (TRT). With TRT, a man receives medicine to raise his testosterone levels back to a normal range. Many men find that symptoms like low sex drive and moodiness improve with TRT.

When a man has low testosterone levels and accompanying symptoms, doctors use the term testosterone deficiency (TD).

How is testosterone replacement therapy given?

Nowadays, men have a few options for receiving testosterone:

• Transdermal or topical treatments. These treatments are applied to the skin and usually come as gels, creams, and patches. They’re easy to use, but there are some disadvantages. Some men get rashes or itchiness when they use transdermal treatments. It’s also critical that other members of the household, especially women and children, not get any of the product on their own skin.
• Injections into a muscle. Your doctor might offer regular testosterone injections at their office. You can also learn to do your own injections at home. Depending on the injection schedule, this might be more convenient. But injections aren’t for everyone; if you feel squeamish about needles, they might not be for you.
• Intranasal (through the nose). Testosterone is administered (usually three times a day) through the nostril using a special pump. This method isn’t invasive, but some men have side effects like nasal congestion and changes in smell.
• Pellets. Your doctor places small pellets of testosterone under the skin of your buttocks, thigh, or abdominal wall. Over the next three to six months, the pellets dissolve. Then, the process is repeated. Some men like this method because it can be done every three to six months. But they still need to travel to the doctor’s office, and some have pain, swelling, and bruising.
• Oral route. Oral medications are capsules that you take by mouth. In the rest of this article, we’ll go over the details.

What is oral testosterone?

Oral testosterone is a capsule that you swallow. It is absorbed by your intestinal lymphatic system and the testosterone is carried through your bloodstream.

Currently, doctors prescribe a product called testosterone undecanoate, which was approved by the U.S. Food and Drug Administration in 2019. Testosterone undecanoate is marketed under several brand names, including Jatenzo, Kyzatrex, Tlando, and Undecatrex.

As a capsule, oral testosterone is a convenient, easy-to-take option.

Like other forms of TRT, the goals of oral testosterone therapy are to bring low testosterone levels back up to a normal level (generally above 300 ng/dL) and to relieve symptoms.

How has oral testosterone changed over the years?

At one time, an oral testosterone product called methyltestosterone was the common form prescribed. However, scientists were concerned about side effects, such as jaundice, liver disease, and liver damage. These problems occurred because the medicine was absorbed by the body’s portal system; it was going from the digestive system to the liver.

Methyltestosterone is not typically used nowadays. Scientists developed testosterone undecanoate, the current form, which is not processed through the liver, making it a safer option in this regard.

Is oral testosterone better than other forms, like gels, pellets, or injections?

All types of testosterone are effective, so often men choose their method depending on their preferences. As a capsule, oral testosterone is a convenient, easy-to-take option. Some men find gels and creams to be messy, and there is the risk of transferring the medicine to people in the household. Others are uncomfortable with the idea of injections or pellets under the skin.

Side effects may also play a role. For example, men who have skin irritation from injections or creams may decide that the oral route is a better fit.

If one method isn’t ideal for you, ask your doctor about trying another method.

Is oral testosterone OK everyone?

Before prescribing oral testosterone, your doctor will take your complete medical history and conduct tests. They’ll also need to know what other medications you currently take (both prescription and over-the-counter) as well as any vitamins or supplements. If you have allergies, be sure to let them know that, too.

Men should also let their doctor know if they have any of the following conditions:

• Diabetes
• Prostate cancer
• High blood pressure
• High cholesterol
• Heart disease or a history of heart attack
• Sleep apnea
• Liver disease
• Lung disease
• Blood disorders
• Problems with blood clotting
• An enlarged prostate
• Breast cancer
• Obesity
• A history of drug dependence
• High levels of calcium in the blood

It’s critical to be open and honest about your health history and medications. Some drugs, like bupropion (an antidepressant), insulin (for diabetes), and warfarin (a blood thinner used to reduce the formation of blood clots) can interact with oral testosterone. Your health information will help your doctor determine whether the oral route is best for you or if any adjustments need to be made.

Also note that testosterone undecanoate has been FDA-approved only for men who have low testosterone caused by medical conditions. It has not been approved for men who have low testosterone caused by aging.

Women should not take oral testosterone.

How should I take oral testosterone?

Like all medications, oral testosterone should be taken exactly as a doctor prescribes. Your dose will be based on your personal needs, depending on your testosterone levels and symptoms. Over time, your doctor will follow up and monitor your progress. If necessary, your dose can be adjusted.

Some men take oral testosterone once a day; others take it twice a day. It should be taken with food. You might decide to take it with breakfast or dinner.

What risks of oral testosterone should I be aware of?

One concern is high blood pressure, which can raise your risk for a stroke or heart attack. If you’ve already had a stroke or heart attack before taking oral testosterone, your risk might be even higher.

Some men measure their blood pressure at home while taking oral testosterone. If your blood pressure increases, you may need to take medicine to control it. Or you might need to stop taking oral testosterone altogether.

Other potential risks include the following:

• Higher levels of red blood cells, which could increase your risk for blood clots, heart attack, and stroke
• Worsened enlarged prostate symptoms, like trouble urinating
• Blood clots
• Lower sperm count and fertility issues
• Liver issues
• Sleep apnea
• Swelling of ankles, feet, or body
• Mood changes, irritability, depression, or suicidal thoughts
• Higher levels of calcium, cholesterol, and fats in the blood
• Breast swelling or pain
• Increased risk for heart or blood vessel problems

Currently, the U.S. Food and Drug Administration (FDA) warns that men taking testosterone could be at a higher risk for prostate cancer. However, guidelines issued by the American Urological Association (AUA) in 2024 state that “there is accumulating evidence against a link between testosterone therapy and prostate cancer development.”

For some men, oral testosterone is habit forming and they might start to abuse it.

What are some common side effects of oral testosterone?

Some men experience:

• Diarrhea
• Nausea
• Gas
• Burping
• Heartburn
• Indigestion
• Sore throat
• Upset stomach
• Runny nose
• Nasal congestion
• Headache
• Higher levels of the hormone prolactin
• Weight gain
• Muscle or bone pain
• Upper respiratory tract infection

Often, these side effects go away as your body gets used to the medicine. If they trouble you, talk to your doctor. It may help to adjust the dose, but any changes should be made under a doctor’s care.

How soon will I start feeling better?

This answer is different for each man, but many men start seeing improvements in their symptoms—such as better sexual function and mood—within a few weeks.

What kind of follow-up will I have when taking oral testosterone?

Your doctor will want to see you regularly for follow-up visits. At these appointments, they’ll likely do further blood and urine testing to see how well the medicine is working. They will also check your blood pressure and red blood cell count.

Can oral testosterone affect my fertility?

For some men, oral testosterone reduces sperm count, making it more difficult to conceive a child. If you are planning to have a child, tell your doctor before you start taking oral testosterone.

Does oral testosterone have to be prescribed by a doctor? Can I use the over-the-counter versions I see online and in stores?

All forms of testosterone should always be prescribed by a doctor and taken with a doctor’s guidance. Over-the-counter products and supplements are not regulated by the U.S. Food and Drug Administration and may contain ingredients that are harmful for you.

Be sure to tell your doctor about any other medications, vitamins, or supplements you take. They should also know about any allergies you have.

Summary: Key points about oral testosterone

• Testosterone deficiency means that a man’s body does not produce adequate amounts of testosterone. It is accompanied by symptoms like low libido, poor erections, moodiness, and weakness.
• Testosterone replacement therapy (TRT) is one way to treat testosterone deficiency. The goal of TRT is to raise testosterone levels to a normal range and alleviate symptoms. Many men see improvements in their sexual function, mood, and overall quality of life when they undergo TRT.
• There are several ways to administer testosterone replacement therapy. They include transdermal (through the skin), injections, nasal sprays, and oral formulations.
• A previous formulation of oral testosterone, methyltestosterone, had side effects, such as jaundice, liver disease, and liver damage. Scientists have since developed a safer version called testosterone undecanoate, which is the type used today.
• Testosterone undecanoate is a capsule taken by mouth. It is marketed under brand names like Jatenzo, Tlando, Kyzatrex, and Undecatrex.
• Men may find that oral testosterone is more convenient than other formulations, like injections, gels, and creams.
• Oral testosterone dosage depends on a man’s personal situation.
• Oral testosterone does have some risks and side effects. High blood pressure is a particular concern. Men should have a thorough medical exam before starting therapy.
• Regular checkups with a doctor are essential for men taking oral testosterone.
• Oral testosterone is available by prescription only. Over-the-counter products are not the same and could be harmful. It’s important to follow your doctor’s guidance.

Resources

American Urological Association

Azad, Babak K., MD and Faysal A. Yafi, MD, FRCSC.
“Oral Testosterone Replacement Therapy: What’s Available and What Took so Long?”
(September 19, 2023)
https://auanews.net/issues/articles/2023/september-extra-2023/oral-testosterone-replacement-therapy-whats-available-and-what-took-so-long

Mulhall, J.P., et al.
“Evaluation and Management of Testosterone Deficiency (2024).”
(2024)
https://www.auanet.org/guidelines-and-quality/guidelines/testosterone-deficiency-guideline

Cureus

Ahmad, Syed W., et al.
“Is Oral Testosterone the New Frontier of Testosterone Replacement Therapy?”
(August 8, 2022)
doi: 10.7759/cureus.27796
https://www.cureus.com/articles/26237-is-oral-testosterone-the-new-frontier-of-testosterone-replacement-therapy

Drugs.com

“Undecatrex: Package Insert / Prescribing Info”
(Last updated September 25, 2024)
https://www.drugs.com/pro/undecatrex.html

The Endocrine Society

“Study finds oral testosterone therapy undecanoate is effective, with no liver toxicity”
(Press release. March 20, 2021)
https://www.endocrine.org/news-and-advocacy/news-room/featured-science-from-endo-2021/study-finds-oral-testosterone-therapy-undecanoate-is-effective-with-no-liver-toxicity

Jatenzo.com

“Important Safety Information”
https://jatenzo.com/oral-testosterone-safe-effective/

Kyzatrex.com

“Medication Guide”
https://www.kyzatrex.com/medication-guide/

Mayo Clinic

“Testosterone (oral route).”
Drug information provided by: Merative, Micromedex®.
(Portions last updated February 01, 2025)
https://www.mayoclinic.org/drugs-supplements/testosterone-oral-route/description/drg-20461351

Tlando.com

“Important Safety Information”
https://www.tlando.com/introducing-tlando

Up to Date

Snyder, Peter J., MD.
“Testosterone treatment of male hypogonadism.”
(Topic last updated October 21, 2022)
https://www.uptodate.com/contents/testosterone-treatment-of-male-hypogonadism

Testosterone is the reason males develop characteristics like facial hair and a deeper voice. It drives a man’s libido and helps with erections. It’s also involved with sperm production, muscle strength, and bone health. Produced by the testicles, testosterone is what’s known as an androgen—a hormone responsible for masculine traits. (Note: While women’s bodies produce testosterone in smaller amounts, it is usually considered a male hormone.)

Sometimes, men don’t produce enough testosterone (this is called hypogonadism or “low testosterone”)

Sometimes, men don’t produce enough testosterone (this is called hypogonadism or “low testosterone”). This may happen due to a congenital condition (something a man is born with), an injury, cancer treatment, or other reasons. In addition, men’s testosterone levels decline as they get older.

When low testosterone is accompanied by other symptoms, like low sex drive, fatigue, and moodiness, urologists make a diagnosis of testosterone deficiency (TD).

The Urology Care Foundation estimates that 2% of men have TD. It is more frequent in older men, overweight men, and men with diabetes.

What are the symptoms of testosterone deficiency?

The typical symptoms of TD include the following:

Less interest in sex
Erectile dysfunction
Fatigue
Moodiness, depression, or irritability
Loss of muscle mass
Weaker bones
Less body or facial hair
Development of breasts (gynecomastia)

TD symptoms are similar to symptoms of other conditions. For example, trouble with erections can be a sign of diabetes or heart disease. Low sex drive could be linked to depression or be a side effect of medication. For these reasons, it’s a good idea to call your doctor if you have any of these symptoms so you can have a thorough medical exam.

What causes testosterone deficiency?

Congenital conditions

These are medical conditions that you’re born with. On example is Klinefelter syndrome, when a genetically male child is born with an extra X chromosome. Children with Klinefelter syndrome may have smaller testicles that produce less testosterone.

Children with intersex conditions (development of both male and female reproductive organs) may also have trouble with testosterone production.

Pituitary gland disorders

The pituitary gland is a tiny gland found in the brain. It produces, or stimulates the production of, many hormones. In men, it “tells” the testicles to make testosterone. If there is a problem with the pituitary gland, the testicles might not get the “message” to produce.

Trauma

Testicles that have been injured in an accident or through pelvic trauma may not function properly.

Cancer treatment

If a man has one or both testicles surgically removed, his body will produce less testosterone. Chemotherapy and radiation can affect testosterone production, too.

Obesity

Testosterone deficiency is more common in men who are overweight or obese. That’s because fat cells convert testosterone to estrogen, another type of hormone. In addition, obese men may have lower levels of sex hormone binding globulin (SHBG), a substance that carries testosterone through the bloodstream. Weight loss might help restore testosterone levels.

Age

When men reach their thirties, their bodies start producing less testosterone. The decline is gradual—about 1% each year—and might not be noticeable at all. Some people call this change andropause or male menopause, comparing the testosterone decline to the drops in estrogen production in women’s bodies during menopause. However, this comparison is not accurate. Men’s testosterone levels decline gradually, while women’s estrogen levels fall more quickly over time.

Here are some other issues that can contribute to TD:

• Autoimmune disorders
• Infections
• Medications (such as antidepressants, opioids, and narcotics)
• Liver disease
• Kidney disease
• Diabetes
• Metabolic syndrome (high blood pressure, high blood sugar, unhealthy cholesterol levels, excess belly fat)
• HIV and AIDS

How is testosterone deficiency diagnosed?

When diagnosing TD, several factors are considered:

Blood tests

Several substances are checked during blood tests.

Total testosterone

Testosterone circulates in the bloodstream, and it is classified in two different ways. Attached testosterone attaches to proteins in the blood. Free testosterone circulates on its own, not attached to another substance. Most testosterone is attached.

For the purpose of diagnosing TD, doctors assess total testosterone (both attached and free), which is measured in nanograms per deciliter (ng/dL). For context, think of a typical paper clip, which weighs about a gram. A nanogram weighs one-billionth of a gram. A deciliter represents one-tenth of a liter. (To visualize a liter, think of a liter of soda.)

The American Urological Association (AUA) defines a “normal physiologic” testosterone range as 450-600 ng/dL.

For a TD diagnosis, the AUA uses a cutoff of 300 ng/dL. In other words, men whose total testosterone levels are below 300 ng/dL could be diagnosed with TD.

Doctors conduct two blood tests on different days. Both tests are done in the early morning because a man’s testosterone levels fluctuate throughout the day. Levels are usually higher in the morning and lower at night. The protocol of testing in the morning keeps measurements consistent.

Luteinizing hormone (LH)

Produced by the pituitary gland, luteinizing hormone spurs testosterone production by the testes. If LH levels are abnormal, there could be a problem with pituitary gland function or a hormone disorder.

Prolactin

Prolactin is another hormone produced by the pituitary gland. High levels might signal an issue with this gland.

Hemoglobin and hemocrit

Red blood cells contain hemoglobin, a substance that brings oxygen from the lungs to other parts of the body. Hemocrit refers to the percentage of red blood cells found in the blood. High levels of hemocrit could signal polycythemia – an increase in red blood cells that can lead to blood clots. Polycythemia can be a side effect of TD treatment, so it is helpful to get baseline values during diagnosis.

Medical history

Doctors will likely ask about the following:

• Any symptoms associated with low testosterone
• Prescribed medications and use of other drugs
• Past illnesses
• Past traumas, accidents, and surgeries
• Illnesses that run in the family
• Development at puberty

Other assessments

During a physical exam, providers usually check the following:

• BMI (body mass index)
• Waist circumference
• Blood pressure
• Cholesterol and triglyceride levels
• Blood sugar
• Hair patterns
• Testicle size
• Prostate size
• Development of breasts (gynecomastia)

Other tests, if necessary.

Estradiol. If a man has shown some breast development, doctors may check his levels of estradiol, a form of estrogen.

PSA (prostate-specific antigen). Men over age 40 may have their PSA levels checked. High PSA could indicate a prostate condition, such as prostate cancer. Because testosterone replacement therapy, a typical treatment for TD, can be risky for men with prostate cancer, it’s important to screen for prostate cancer before any treatment begins.

How is testosterone deficiency treated?

When considering treatments for TD, we first consider the cause.

When considering treatments for TD, we first consider the cause. If we can pinpoint the reason a man’s testosterone levels are low, treating the underlying condition might be the first step toward improvement. For example, if a man has low testosterone due to obesity, we might suggest weight loss, a healthy diet, and exercise.

Testosterone replacement therapy (TRT) is another option. TRT has 2 goals: to boost testosterone levels into a normal range (usually between 450 and 600 ng/dL) and to relieve the symptoms a patient is experiencing due to his testosterone deficiency. Usually, improvement of symptoms occurs within the first 3 months of treatment.

Testosterone preparations are available by prescription; in fact, testosterone prescribed by a healthcare professional is the only safe way to treat TD. It can be administered in several ways, and we’ll talk with you about your personal situation, medication preferences, insurance coverage, and out-of-pocket costs:

Gels, creams, and patches

These are called transdermal or topical treatments: they are applied to the skin. For example, a man might apply a gel to his belly every day or a patch to his shoulder every few days. Specific instructions are provided. Often, the exact dose is pre-measured in a corresponding pump or tube.

Advantage:

• Application is easy and convenient.

Disadvantages:

• Some men develop rashes or itching from topical testosterone treatments.
• Men need to be careful when using topical testosterone and make sure that the product does not transfer to anyone else, especially women or children.

Men are advised to cover the treatment area and keep products in a safe place, out of reach for children and pets.

Men should also wash their hands thoroughly after applying testosterone. Clothing that has come into contact with testosterone should be washed separately.

Why is avoiding testosterone transfer to others so important? Women who come into contact with topical testosterone may develop unusual hair growth or acne. In pregnant women, testosterone exposure may harm the unborn baby. Exposure in children may lead to enlarged genitals, pubic hair growth, increased sexual desire, increased erections, aggressive behavior, and bone growth issues.)

Injections

Some men go to their doctor’s office to receive testosterone injections. Others self-inject their prescribed medicine at home. Frequency can vary from one injection every week to one injection every 10 weeks. (Most men have an injection every 2 weeks.) Shots may be placed just under the skin or directly into a muscle.

Advantages:

• Injectable testosterone tends to be the most affordable option.
• The dosing schedule may be more convenient.

Disadvantages:

• Testosterone levels can fluctuate. Typically, testosterone levels increase right after the injection, then gradually decrease until the next one. (In some cases, the dosing protocol might be changed to 1 injection once a week to even out the amount of testosterone given over time.)
• Some men might be uncomfortable with the idea of injections.
• Men may still need to travel to a doctor’s office to receive injections.
• Allergic reactions are another potential side effect.

By mouth

This route is also called oral or buccal (buccal is a word that refers to the cheek or mouth cavity and in this case refers to placing a patch between the gum and cheek). Options might include capsules to swallow or patches to place on the gum.

Advantage:

• Taking testosterone by mouth may be less invasive.

Disadvantages:

• Some men experience gum irritation, pain, headache, or a bitter taste in the mouth. Gum disease (gingivitis) is possible as well.

Through the nose (intranasal)

Testosterone in gel form is pumped into the nostril.

Advantage:

• The delivery method is less invasive. One form of intranasal testosterone, Natesto, may have fewer effects on fertility, but more research is needed. See more details below.

Disadvantages:

• Men may need to take their medicine 3 times a day, which could be inconvenient.
• Side effects may include congestion, nasal irritation, scabbing, a runny nose, or changes in smell.

Pellets

Administered by a doctor, pellets are placed under the skin and gradually dissolve. Treatment needs to be repeated every 3 to 6 months.

Advantage:

• The dosing schedule can be convenient. Men do not need to remember to take medication every day or every week.

Disadvantages:

• Testosterone pellets need to be administered at a doctor’s office.
• Administration is more invasive.
• After pellet implantation, some men experience pain, swelling, or bruising.

How often should a man on TRT see his doctor?

About 2 to 4 weeks after starting testosterone therapy, patients need to return for a checkup. At this time, lab results and symptoms are re-assessed. If results are satisfactory, further assessment is recommended every 6 to 12 months.

If necessary, estradiol and PSA levels will also be assessed periodically.

Hematocrit levels may also be monitored. Hematocrit is a measure of the percentage of red blood cells on the blood. As mentioned earlier, polycythemia— excess amounts of red blood cells—is a possible side effect of TRT. Polycythemia can thicken the blood and raise a person’s risk for stroke or blood clots.

If TRT raises testosterone levels but does not improve symptoms, providers may recommend that men stop TRT. It’s possible that the symptoms are not related to TD, and further evaluation could be necessary.

Is it okay to take over-the-counter TRT medications or order them online?

Men should always have TRT under the care of a qualified medical professional.

You might see testosterone supplements at pharmacies, department stores, or online. Are they safe to use?

No, they’re not. And here’s why:

• Supplements are not regulated by the FDA (U.S. Food and Drug Administration). Therefore, the safety of these products cannot be guaranteed.
• Supplements can contain ingredients that interact with other medications you take. This can make you sick.
• Some supplements have ingredients that aren’t listed on the product label, so you might not know exactly what you are getting.

Urologists tailor treatment to a patient’s personal situation, prescribing formulations that are safe and effective for you. We will also monitor your health after you start testosterone therapy, making any adjustments as needed.

Special Concerns

How might testosterone replacement therapy affect a man’s fertility?

Men who wish to father children may wish to consult a reproductive health specialist before starting testosterone replacement therapy.

Testosterone preparations can reduce a man’s levels of follicle-stimulating hormone (FSH), which triggers sperm production. As a result, testosterone therapy could lower sperm count. Men who are hoping to become a father need to carefully consider the risks testosterone replacement therapy may present to fertility.

Depending on the cause of TD, there might be other medications a man can take to raise his testosterone levels. Some examples are aromatase inhibitors (AI), human chorionic gonadotropin (hCG), and selective estrogen receptor modulators (SERM). Sometimes, a combination of these medications is prescribed.

Note: In September 2020, scientists reported that a nasal testosterone preparation called Natesto may have a less negative impact on sperm production. However, more research is needed before this medication can be safely prescribed to men who wish to preserve fertility.

Is TRT linked to prostate cancer?

No, there is no evidence that connects testosterone therapy to prostate cancer. However, a man’s PSA levels might increase during testosterone therapy, so it is important to monitor them.

Is TRT linked to other health risks?

There have been concerns about testosterone therapy and cardiovascular events, like strokes, blood clots, and heart disease. However, it is not definitely known whether TRT raises or lowers risk of cardiovascular problems. Men are encouraged to discuss any heart concerns with their doctor.

The AUA recommends that men who have had a cardiovascular event wait 3 to 6 months before starting TRT.

It should also be noted that low testosterone itself can be a risk factor for cardiovascular disease.

Resources

American Urological Association

Mulhall, J.P., et al.
“Evaluation and Management of Testosterone Deficiency (2018)”
(Published: 2018)
https://www.auanet.org/guidelines/guidelines/testosterone-deficiency-guideline

Videos included with above guidelines:

• What is Testosterone Deficiency: Definition and Diagnosis
• Monitoring and Management the Testosterone Deficient Patient
• Low Testosterone and Cardiovascular Risk
• Fertility Preservation in the Testosterone Deficient Patient
• Testosterone, PSA, and Prostate Cancer

Healthwise

“Nanograms per deciliter (ng/dL)”
(Current as of: June 17, 2021)
https://paleymd.com/patient-education/healthwise/?DOCHWID=stn166036

Hormone Health Network (The Endocrine Society)

“Low Testosterone (Hypogonadism)”
(Last updated: April 2020)
https://www.hormone.org/diseases-and-conditions/low-testosterone

“Pituitary Gland”
(Last updated: January 2019)
https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/glands/pituitary-gland

“Testosterone Treatments”
(Last updated: March 2018)
https://www.hormone.org/your-health-and-hormones/mens-health/testosterone-treatments

“What is Luteinizing Hormone?”
(Last updated: November 2018)
https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/luteinizing-hormone

The Journal for Nurse Practitioners

Luthy, Karlen E., DNP, FNP, et al.
“Comparison of Testosterone Replacement Therapy Medications in the Treatment of Hypogonadism”
(Full-text. Published: 2016)
https://www.npjournal.org/article/S1555-4155(16)30716-4/pdf

The Journal of Sexual Medicine

Lundy, Scott D., MD, PhD, et al.
“Obstructive Sleep Apnea Is Associated With Polycythemia in Hypogonadal Men on Testosterone Replacement Therapy”
(Full-text. Published: April 16, 2020)
https://www.jsm.jsexmed.org/article/S1743-6095(20)30169-7/fulltext

The Journal of Urology

Ramasamy, Ranjith, et al.
“Effect of Natesto on Reproductive Hormones, Semen Parameters and Hypogonadal Symptoms: A Single Center, Open Label, Single Arm Trial”
(Abstract. Published: September 1, 2020)
https://www.auajournals.org/doi/10.1097/JU.0000000000001078

Medical News Today

Johnson, Jon
“Polycythemia: Everything you need to know”
(December 16, 2019)
https://www.medicalnewstoday.com/articles/polycythemia

MedlinePlus.gov

“Hemoglobin Test”
(Page last reviewed: July 31, 2020)
https://medlineplus.gov/lab-tests/hemoglobin-test/

“Klinefelter Syndrome”
(Topic last reviewed: June 5, 2017)
https://medlineplus.gov/klinefeltersyndrome.html

“Prolactin Levels”
(Page last reviewed: December 17, 2020)
https://medlineplus.gov/lab-tests/prolactin-levels/

“Testosterone Levels Test”
(Page last reviewed: December 3, 2020)
https://medlineplus.gov/lab-tests/testosterone-levels-test/

“Testosterone Topical”
(Page last reviewed: December 6, 2021)
https://medlineplus.gov/druginfo/meds/a605020.html

ReproductiveFacts.org (American Society for Reproductive Medicine)

“Testosterone Use And Male Infertility”
(Created: 2015)
https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/testosterone-use-and-male-infertility/

UpToDate

“Patient education: Low testosterone in men (The Basics)”
(Topic retrieved on November 11, 2021)
https://www.uptodate.com/contents/low-testosterone-in-men-the-basics

Urology Care Foundation

“Testosterone Therapy – What You Should Know”
(2020)
https://www.urologyhealth.org/educational-materials/testosterone-therapy

“What is Low Testosterone?”
https://www.urologyhealth.org/urology-a-z/l/low-testosterone

WebMD

Hoffman, Matthew, MD
“Low Testosterone and Your Health”
(Reviewed: February 7, 2021)
https://www.webmd.com/men/what-low-testosterone-can-mean-your-health