When To Start Testosterone Replacement Therapy

Testosterone replacement therapy (TRT) remains a controversial treatment. However, many people who suffer from conditions such as hypogonadism and hemochromatosis all attest to its benefits and how it has improved their quality of life. Despite all the success stories, however, not everyone is eligible to receive it as a treatment option, and many underlying factors constitute its eligibility for it to be useful. So if you’re wondering when to start testosterone replacement therapy, read below.

What is the current verdict on TRT?

There is no actual age on when to start testosterone replacement therapy, and its use can either be medical or non-medical depending on the prognosis. According to the law, persons seeking TRT need to be eighteen years and above before getting a TRT prescription. However, some medical cases of low testosterone can result in the treatment age being lower.


Researchers and medical professionals agree that sufficient evidence needs to be present before prescribing TRT as a treatment. Presently, four organizations conduct research and state the guidelines on the use of TRT as a treatment:

  • American Urological Association (AUA)
  • The International Society for the Study of the Aging Male (ISSAM)
  • Endocrine Society
  • The International Society for Sexual Medicine (ISSM)

As more research continues into the use of testosterone supplements, there are clear guidelines that determine when to start testosterone replacement therapy. The qualifying conditions may vary depending on the diagnosis.

Advice from the experts

If you’re looking at getting testosterone replacement therapy, here is what the experts advise:

Seek counsel from your physician

Testosterone replacement therapy is known to cause complications with certain conditions. Therefore, it’s necessary to get advice from your doctor on whether being on the treatment will pose any risk to your current health. Individuals with conditions such as obstructive sleep apnea or congestive heart failure are not eligible for TRT.

Similarly, testosterone is responsible for developing male characteristics and causes changes to your body to this effect. Patients with enlarged prostates are not eligible as the supplemental testosterone may lead to it becoming even larger. Other conditions that disqualify TRT are high red blood cell counts and male breast cancer.

Take into account the risks associated with TRT

As with any treatment, there are risks associated with testosterone replacement therapy. These may not all apply to a single patient, but you must understand what to expect. Some of the risks that researchers identify include:


There is evidence stating that testosterone replacement therapy can interfere with the normal production of sperm, particularly in pubescent males. A 2018 study by the Endocrine Society shows evidence that some formulations of synthetic testosterone can effectively lower sperm count. They identify dimethandrolone undecanoate as the formulation with the most adverse effect.

Skin allergies and irritations

TRT formulations are available in different forms. Skin conditions such as acne and rashes are a known side effect of TRT, mainly when using testosterone patches, gels, and injectables.

Mood alterations

Studies show that there is an effect on a person’s mood when using TRT as a treatment. Long-term use can lead to more aggressive behavior, which may affect a person’s interactions with others. The side effect applies to both men and women. Therefore, it’s advisable to work with a psychologist to help manage the changes in emotions.


There’s a potential risk of dependency and abuse when on TRT. The effect is common in people who over-medicate or do not receive the right guidance in the dosage amounts. Endocrinologists recommend that individuals should always start with lower doses and attend regular testing to determine the appropriate levels to scale up.

It can be costly

Testosterone replacement therapy can be a lifelong commitment for certain users. Individuals suffering from conditions such as Klinefelter syndrome – males with an extra X chromosome – need to be on the regimen throughout their life. Depending on the administration method and formulation prescription, patients can incur hundreds of dollars per dosage.


Despite the jury still being out on TRT’s efficacy as a treatment, the number of people opting for it continues to grow. Both the government and medical organizations are continually introducing policies and legislation to regulate its use to ensure patients’ safety. Therefore, it’s vital to do your due diligence before opting for testosterone replacement therapy.