What are the potential side effects on Testosterone Replacement Therapy?

February 13, 2023
- Androgenic alopecia. Potential exacerbation of pre-existing male pattern hairloss, or potentially earlier onset. Can be managed through topical and oral DHT blockers
- Testicular atrophy. This is due to shutdown of Hypothalamic-Pituitary-Testicular Axis. Does not usually affect volume of ejaculate or orgasms.
- 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.
- Lowering of HDL-cholestrol. This can be addressed by modifying the T regimen, and supplementation of omega-3 to reduce CV risk factors.
- 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.
- 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.