Testosterone deficiency? Let's learn everything about TRT treatment in simple terms (Testosterone Replacement Therapy - TRT)

Have you been feeling very tired, uninterested in anything, and lacking the energy you used to have lately ? Sometimes we think of these as normal signs of aging, but a decrease in testosterone, one of the main hormones in a man's body, can also be a reason for this. So today, let's talk about testosterone replacement therapy, or TRT (Testosterone Replacement Therapy), which is a treatment given when testosterone levels are low. Let's simply understand what it is, who needs it, and what are the pros and cons.

What is TRT? Let's understand it simply.

Simply put, TRT is a treatment that restores testosterone levels in men who have low testosterone levels due to medical reasons. It's like giving our bodies something they're lacking from the outside.

Think of it this way, just like when you have low iron levels, we take iron pills. But this should only be done under the supervision of a doctor. Because this treatment can have benefits as well as some risks. Therefore, you and your doctor will decide together whether this is right for you or not.

Who really needs this treatment?

This is a very important question. TRT is not a treatment that can be given to everyone. Even institutions like the Food and Drug Administration (FDA) in the United States have approved this treatment only for those who have low testosterone levels due to a medically confirmed medical condition . We call this condition `(Male Hypogonadism)`.

What are the causes of `(Hypogonadism)`?

There are three main organs involved in the process of testosterone production. Any damage or dysfunction in any of these can lead to low hormone levels.

• Testicles: The main site of testosterone production.
• Pituitary gland: This gland in the brain signals the testicles to produce hormones.
• Hypothalamus: Another part of the brain that controls the activity of the pituitary gland.

Imagine, these organs can be damaged by chemotherapy or radiation therapy given to a cancer patient. Or this problem can also occur due to a genetic condition.

What do you need to know before starting TRT?

Before starting TRT, your doctor will make sure that you really have low testosterone levels and that this treatment is safe for you. They will do the following:

1. Talk about your medical history: Ask about other illnesses you have, medications you take, and family medical history.

2. Performs a physical examination: Performs a full body examination.

3. Order several blood tests: These are very important.

• Two morning testosterone tests: Testosterone levels are highest in the morning, so two blood samples are taken in the morning to get the most accurate reading.
• Hemoglobin and Hematocrit: See the number of red blood cells in the blood.
• Liver function tests: Check if the liver is healthy.
• Luteinizing hormone test: Get an idea of ​​the functioning of the pituitary gland.
• PSA (prostate-specific antigen) test: Learn about prostate health.
• Prolactin hormone test.

After considering all of this, the doctor will make the final decision as to whether TRT is right for you or not.

How does this treatment work?

TRT treatment involves administering synthetic testosterone to your body to regulate hormone levels. This can help improve symptoms of testosterone deficiency (such as decreased sexual desire and loss of energy).

But here's something important to understand. TRT doesn't cure the underlying cause of your low hormones. What it really does is, by giving you hormones from outside, your testicles think, "Oh, we don't need to make hormones anymore," and they stop producing them naturally. That means you have to keep taking the medication to maintain normal hormone levels. If you stop taking the medication, it will take some time for your body to learn to make testosterone again.

What are the different methods of TRT?

Fortunately, there's more than one way to get TRT. You can choose a method that suits your lifestyle and convenience by talking to your doctor.

After you start treatment, your doctor will regularly check your hormone levels and other blood tests to see if the treatment is causing any other health problems.

What are the benefits of TRT?

If administered correctly and to the right person, TRT can be very effective. It can help to alleviate the symptoms of testosterone deficiency to a great extent.

• Increased sexual activity and interest: This is a major benefit for many people.
• Increase in muscle mass: Helps the body become toned and strong.
• Increased bone mineral density: Bones become stronger and less likely to break.
• Improved mental state: The previous anxiety and irritability have decreased, and you may feel refreshed.
• Increases energy and stamina: Helps you stay active throughout the day.
• Feeling good overall.

Should we also be aware of side effects?

Like any medication, TRT can have side effects. Not everyone gets them, but it's important to be aware of them.

• Acne or oily skin.
• Swelling in the ankle area (due to slight fluid retention in the body).
• Difficulty urinating due to prostate stimulation.
• Enlarged or painful breasts (Gynecomastia).
• Worsening of sleep apnea.
• Small testicles.
• If you use skin cosmetics, you may develop skin allergies.
• Decreased sperm count and therefore reduced fertility. This is very important. If you are planning to have children, you should think twice and talk to your doctor about this before starting TRT.

In addition, there are several changes that can be seen in blood tests:

• Rising PSA levels.
• An increase in the number of red blood cells. This can thicken the blood and increase the risk of blood clots.

How long does it take to see results?

This varies from person to person. Some people start to feel changes in their body and mind within a few weeks. Doctors usually check testosterone levels again about a month after starting treatment to see the full effect.

If your symptoms have not improved after 3 to 6 months, your doctor may recommend stopping treatment. This is because your symptoms may not be due to low testosterone.

Who should not use TRT?

For people with certain medical conditions, using TRT can make those conditions worse. Therefore, TRT is not suitable for those with these conditions.

• Untreated severe heart failure.
• Untreated obstructive sleep apnea.
• If you have had a heart attack or stroke within the last 6 months.
• High levels of red blood cells in the blood.
• Having prostate cancer.
• Having an unexamined lump in the prostate.
• Male breast cancer.

Is TRT really safe? Let's talk about the risks.

This is a problem for many people. As mentioned earlier, TRT is generally considered safe for people who do not have conditions like prostate cancer or heart disease, as long as they are taken under the supervision of a doctor.

However, there is still a lack of large-scale research on what happens when TRT is taken for long periods of time, such as decades. The results of some of the studies that do exist are conflicting.

For example, some studies suggest that TRT reduces the risk of heart disease over time. Others suggest that it increases the risk. For example, a large study in 2024 found that long-term use of testosterone gel does not increase the risk of heart disease. There are also conflicting opinions about the risk of blood clots in the veins (venous thromboembolism).

For all of these reasons, your doctor will carefully study your personal health condition and decide whether TRT is safe for you.

When do you need to see your doctor?

After starting TRT, you will need to see your doctor at regular intervals and have blood tests. Your doctor will give you a schedule. In addition, see your doctor at these times as well.

• If your symptoms do not improve despite treatment.
• If the side effects bother you.
• If you want to try a different TRT method.
• If you are thinking of stopping TRT.
• Taking TRT can be dangerous if you have a new medical condition.

If the symptoms of low testosterone are affecting your life, it's not something you can just put up with. TRT may be a good option for you. But the decision should be made by you and your doctor, weighing all the pros and cons. Don't hesitate to talk to your doctor about any questions or concerns you may have.