What are the potential side effects on Testosterone Replacement Therapy?

What are the potential side effects on Testosterone Replacement Therapy?
February 13, 2023
  1. Androgenic alopecia. Potential exacerbation of pre-existing male pattern hairloss, or potentially earlier onset. Can be managed through topical and oral DHT blockers
  2. Testicular atrophy. This is due to shutdown of Hypothalamic-Pituitary-Testicular Axis. Does not usually affect volume of ejaculate or orgasms.
  3. Gynaecomastia. This is due to aromatization of exogenous bioidentical testosterone in fat tissue, which may be higher in patients who have higher body fat %. Can be managed through reducing body fat, lowering T dose or Aromatase Inhibitors.
  4. Lowering of HDL-cholestrol. This can be addressed by modifying the T regimen, and supplementation of omega-3 to reduce CV risk factors.
  5. Hemoglobin and Hematocrit. There is an increased risk of polycythemia while on testosterone therapy and if hematocrit exceeds 50%, testosterone treatment should be withheld or dose reduced.
  6. Acne. This is due to increase activity of sebaecous glands in the skin due to T administration. However this is generally uncommon and can be managed with conventional anti-acne treatment, and/or optimizing therapeutic T levels.