Before You Take Testosterone

Testosterone is actually a pretty universal hormone. It’s often associated with being the culprit for the symptoms of teenage boys going through puberty or what makes men gather in a sports bar during the Super Bowl. But testosterone plays a role in all bodies. Testosterone is a naturally occurring hormone that is present as early as 6 to 7 weeks into fetal development. Throughout the lifespan of humans, it contributes to physical growth, muscle development, libido, fertility, and more.

Around the 6 week mark in utero, embryos with a Y chromosome will trigger a series of events that leads to the development of the testes and subsequent production of testosterone. The testosterone then aids in the development of the rest of the male reproductive organs. On the other hand, fetuses without a Y chromosome will move forward with the development of ovaries and female reproductive organs. And the role of testosterone doesn’t just end there.

Although testicles produce the most amount of testosterone, ovaries, adrenal glands, and peripheral tissues (i.e. skin and fat cells) make testosterone as well. However, ovaries produce a fraction of the amount of testosterone that testicles do. The majority of the testosterone produced by the ovaries is converted into estrogen through a process called aromatization. The levels and aromatization process of these hormones are key players in the differences we see between people assigned male and female at birth. 

Testosterone Replacement Therapy

Before diving in, while we are experts in good and safe sex, we aren’t medical professionals. If you have questions or concerns about your testosterone levels, chat with your healthcare provider. Similarly to how testosterone plays a role in all bodies, there are many reasons why someone might need to supplement their testosterone levels through Testosterone Replacement Therapy (TRT). People across the biological sex and gender spectrum have use cases for TRT. No matter the reason or person, all TRT is considered gender-affirming care. Supplemental testosterone requires a prescription and consultation with a healthcare provider. Blood tests are usually done to check testosterone levels, along with assessing your symptoms or reasons for pursuing TRT.

One use case for TRT is men who have low testosterone levels. Testosterone does decline with age, but TRT is not currently FDA approved for low testosterone levels due to aging alone. Instead, TRT is used to treat low testosterone in men that have an underlying condition. Some symptoms of low testosterone can include a lower sex drive, mood swings, depleted energy, or erectile dysfunction (ED). 

Transgender men may also choose to do TRT as part of their medical transition. Taking testosterone to support a gender transition can cause more significant changes due to there being a lower baseline of testosterone to begin with. People might notice physical changes like an increase in muscle mass, redistribution of body fat, the clitoris becoming larger, an increase in body hair growth, thickening of the vocal chords which can lead to a deeper voice, and their face becoming more angular. Other changes can be in mood, menstruation, libido, and orgasms. Not every transgender person will decide to go through hormone replacement therapy, but it can often be an affirming step that is easier to access and lower risk than other medical procedures. Some of the physical changes are permanent, so consult your doctor with any questions. 

Recently, there’s been more research around women taking low doses of testosterone during menopause or to increase libido. Testosterone naturally decreases in all people as we age. Although TRT isn’t formally FDA approved as a treatment for low libido in women or during menopause either, there are a few FDA approved testosterone treatments for women with generalized low testosterone levels. 

Side Effects of TRT

As with any medical intervention, side effects can occur. It’s important to note that side effects are not necessarily negative; they are simply effects that fall outside of the original purpose for treatment. There are millions of different experiences and not every person who takes testosterone will experience all or any of these side effects. However, it's important to consider these factors when deciding if TRT is right for you. We’ll focus on the more common experiences, but, as always, be sure to discuss your medical history and keep an open line of communication with your doctor regarding any changes you experience while taking testosterone. It can feel awkward to tell your doctor about changes in your sex drive, erections, orgasms, and overall hormonal state, but it really is crucial to making sure you’re on the right treatment and dose.

Physical Side Effects

1. Oil Production: Testosterone can increase the level of oil produced in your skin. Often this presents itself through an uptick in acne. Some people decide to use a topical acne medication or face washes with benzoyl peroxide if they find it bothersome. As always, chat with your doctor about options.
2. Swelling: Since testosterone is a naturally occurring steroid, some swelling may occur throughout the body. This is usually in part to an increase in water retention. People report swelling in their chest or breast tissue, ankles, hands, legs, and feet.
3. Red Blood Cells: Some people experience an increase in red blood cell production. Your doctor will usually monitor your levels while you take testosterone. Keeping the red blood cell count in a normal range is important to prevent excess blood clots. Initial research showed that this could increase the risk of cardiovascular events, but newer research has been debunking those theories.
4. Testicular Atrophy: Testicles can shrink as you age, but they can when taking supplemental testosterone as well. This is incredibly normal and isn’t a cause for concern if it happens to you. The shrinkage is caused by a decrease in the production of hCG (Human chorionic gonadotropin). Some medical providers will prescribe taking an hCG supplement while on TRT to help re-balance levels. 

Emotional Side Effects

1. Irritability: Testosterone activates the amygdala and other parts of the brain that produce aggression. Taking additional testosterone can increase some of those “puberty” emotions such as irritability, anger, depression, or anxiety.
2. Energy: Because of the increase in muscle mass and an increase in metabolism with testosterone, there’s usually an increase in energy that goes along with that. You may notice this especially in the gym or during more physical activities.

Sexual Side Effects

1. Fertility: Taking additional testosterone can decrease sperm count. If you’re in the process of family planning, your doctor may recommend stopping testosterone. There can be some long-term effects, but because sperm production is ongoing, typically stopping testosterone can help rebalance fertility levels.
2. Libido: Testosterone is a primary sex hormone that is linked to arousal. That usually means the more testosterone, the more arousal. If you’re partnered, it’s important to make sure you’re checking in about both of your desire levels. If you find yourself needing more release than what works for your partner, grabbing some lube and masturbating is never a bad idea. 
3. Erections: Because TRT is often used to treat ED, it can also result in more frequent or sustained erections. This can mean an increase in the ability to get an erection or the length of time you can maintain one. But even without taking testosterone, there are some ways you can increase how long you last. Check out our blog post on it for more tips.

Too Much of a Good Thing

Unfortunately, having excess testosterone won’t make you superhuman in the gym or the bedroom. It can actually cause similar issues to having low testosterone, which is why it’s crucial to only take testosterone with a prescription and with the prescribed amount. Typically, dosing is slowly increased or decreased until you get to the ideal level. This helps avoid an intense spike in hormones. But, if you notice bothersome side effects or a worsening of symptoms, your testosterone dose may not be right, so consult with a doctor.

Some of these issues can arise from the relationship between testosterone and estrogen. In all bodies, a percentage of testosterone is converted into estrogen. So, the more testosterone there is, the more estrogen there will be. If testosterone and estrogen levels are too high, it can cause erectile dysfunction, depression, and fatigue. Even in people with ovaries, excess testosterone can cause Polycystic ovary syndrome (PCOS). Symptoms of PCOS usually include cysts on the ovaries, irregular and extremely painful periods, increased body hair growth, and weight gain. 

Sometimes switching the method of TRT can be helpful with too much or too little testosterone absorption. Methods like injections, pills, patches, implants, gels, and nasal sprays can all be discussed as options. Each one has varied effectiveness and a different life span, with some being short-acting and some long-acting. You and your doctor will decide what method works best for you and your lifestyle. However, it's important to consider these factors when deciding if TRT is right for you.