Low testosterone levels can significantly affect your well-being. In this article, you will learn about the different types of testosterone therapy, their benefits and risks, and how to find the right doctor. Discover how targeted treatment can sustainably improve your quality of life.
A healthy testosterone level is crucial for a man's physical and mental health. Testosterone influences muscle mass, bone density, libido, and overall energy levels (Nassar & Leslie, 2023). However, testosterone levels can drop with age or due to certain medical conditions—a condition known as hypogonadism. This often leads to symptoms such as fatigue, lack of motivation, weight gain, declining sex drive, and even depression (Snyder, 2022). You can find out more about hormonal fluctuations in men in this blog post.
But what happens when the body no longer produces enough testosterone? This is where testosterone (replacement) therapy (TRT) comes in. It addresses a deficiency and can significantly improve physical and mental well-being (Hijazi & Cunningham, 2004).
Our goal is to provide you with a comprehensive overview so that you can make informed decisions about your health. Let's find out together how testosterone therapy can positively change your life. Note: This article is for informational purposes only and does not replace medical advice. Always consult a doctor about any health concerns.
What is testosterone therapy?
The testosterone therapy, also known as testosterone replacement therapy (TRT), is a medical treatment aimed at addressing a testosterone deficiency (hypogonadism). When the body no longer produces enough testosterone, health problems may occur. A testosterone deficiency often occurs with age, but can also be caused by certain medical conditions, medications, or lifestyle factors such as stress, poor diet, and lack of exercise (Braga et al., 2020).
Goals of testosterone therapy
TRT is used to alleviate the symptoms of testosterone deficiency and improve the affected person's quality of life. The most common complaints that can be alleviated by testosterone therapy are:
Physical symptoms:
- Loss of muscle mass and strength (Yuki et al., 2013)
- Increase in belly fat and weight (Allan et al., 2007)
- Declining bone density (osteoporosis) (Shigehara et al., 2021)
Sexual symptoms:
- Reduced libido (sexual desire) (Hintikka et al., 2009)
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Erection problems (erectile dysfunction) (Wang et al., 2000)
You can find out more about sexual health in our articles "Erectile Dysfunction: A State of Mind or a Health Warning Sign?" and "Potency, Libido, Testosterone: How to Keep Your Sexual Health Stable"
Mental symptoms:
- Chronic fatigue and exhaustion (Straftis & Gray, 2019)
- Depressive mood and irritability (Hintikka et al., 2009)
- Concentration and memory problems (Jäger et al., 2013)
How does testosterone therapy work?
In testosterone therapy, synthetic testosterone is administered to the body to bring the hormone level back to a healthy level. It can be administered in various ways, including injections, gels, patches, tablets, or implants (Sizar et al., 2023).
The therapy is tailored to the individual and monitored by a doctor. Regular blood tests are conducted to control the dosage and detect possible side effects early.
Important note: Testosterone therapy should only be carried out under medical supervision. Improper use can lead to serious side effects such as cardiovascular problems, liver strain, or overstimulation of the prostate. Comprehensive medical advice and regular check-ups are essential to ensure safe and effective treatment.
Who needs testosterone replacement therapy?
TRT is recommended when a clinical testosterone deficiency is proven by blood tests and is associated with significant symptoms. In such cases, treatment is carried out according to clear medical guidelines (EAU Guidelines on Sexual and Reproductive Health - UROWeb, n.d.). Certain diagnoses and life circumstances make testosterone therapy particularly advisable:
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Age-related testosterone deficiency:
Men over 40 often experience a decline in testosterone levels, which can lead to symptoms such as loss of energy, muscle loss, and reduced libido. Find out more in the article "Proactive Strategies Against Age-Related Testosterone Decline: A Holistic Approach". -
Medical causes:
Conditions such as diabetes, obesity, hormonal disorders, or medications such as corticosteroids (MacADAMS et al., 1986) can cause a testosterone deficiency. In such cases, TRT is often used as a complementary treatment. -
Surgical procedures:
After the removal of the testicles or certain tumor treatments, testosterone production is often permanently impaired, so lifelong TRT may be required.
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Off-label treatment for testosterone deficiency
In certain cases, an off-label treatment may be considered if testosterone levels are in the lower normal range, but significant symptoms such as lack of motivation, fatigue, or loss of libido persist. Although the levels are still formally within the normal range, an individually tailored testosterone therapy may be medically advisable.
Requirement:
The treating doctor must carefully weigh the benefits of the treatment, inform the patient, and obtain their written consent. Regular blood tests and comprehensive monitoring ensure the therapy and minimize risks.
Forms of testosterone therapy
Testosterone therapy can be carried out in different ways, depending on the patient's individual life situation, health status, and preference. The right form of therapy is chosen by the treating doctor after a careful medical assessment. Here is an overview of the most important methods:
1. Injections (shots)
How does it work?
Testosterone injections are administered directly into the muscle (intramuscularly). Depending on the preparation, the active ingredient is released quickly or over a longer period. There are short-acting injections, which are given every 1-3 weeks, and long-acting depots, which are only needed every 10-14 weeks.
Active ingredients and preparations:
Testosterone enanthate (e.g., Testoviron®):
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- Duration of effect: Short to medium-term (1-2 weeks)
- Application: Intramuscularly every 1-2 weeks
- Special feature: Rapid onset of action, ideal for quickly addressing a deficiency.
Testosterone cypionate: (not approved in Europe)
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- Duration of effect: Similar to enanthate
- Special feature: More commonly used in the USA, as it has a similar structure to enanthate.
Testosterone undecanoate (e.g., Nebido®):
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- Duration of effect: Long-acting preparation (up to 12-14 weeks)
- Application: Intramuscularly every 10-14 weeks
- Special feature: Very stable testosterone levels due to slow and even release. Suitable for long-term testosterone replacement therapy with only 4 injections per year.
Benefits:
Fast action:
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- Testosterone enanthate: The active ingredient becomes effective in the body within a few days after the injection, which can quickly provide relief in cases of acute testosterone deficiency.
- Nebido® (testosterone undecanoate): The effect sets in more slowly (after a few weeks), but the level remains stable for several months.
Long-term supply:
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- Nebido®: Due to the extended duration of effect of 10 to 14 weeks, four injections per year are sufficient, making the treatment convenient and time-efficient.
Well monitored:
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Medical supervision: Regular blood tests and doctor visits ensure an exact dosage, level monitoring, and treatment safety.
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Risks:
Hormone fluctuations:
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- Testosterone enanthate: Since it is injected every 1-2 weeks, level fluctuations can occur. Immediately after the injection, the level is high, but drops again by the next dose, which can lead to a "hormone wave" effect.
Pain at the injection site:
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- Possible reactions: Redness, hardening, or swelling can occur, especially with frequent injections or improper administration.
Regular doctor visits:
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Dependence on medical professionals: If the injections cannot be carried out independently at home, regular practice visits are required. Especially with Nebido® injections, which must be administered slowly and professionally due to their volume (4 ml), a doctor's visit is essential.
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Conclusion:
Testosterone injections such as enanthate and Nebido® are effective treatment options, but with different efficacy profiles and application requirements. While enanthate provides rapid results, Nebido® is ideal for patients who prefer its long-lasting effect and a lower injection frequency. However, in both cases, regular monitoring and proper application are essential.
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2. Testosterone Gels
How does it work?
The gel is applied daily to clean, dry areas of skin, such as the shoulders, upper arms, or underarms. It is absorbed through the skin and enters the bloodstream to ensure a steady testosterone level.
Active Ingredients and Preparations:
Testosterone Gels: (e.g., Testogel®, Androgel®, Testavan®)
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- Duration of Effect: Daily application required
- Application: 2-4 pumps daily (depending on the prescription)
- Special Feature: Precise dosing, individually adjustable.
Benefits:
- Steady Hormone Supply: Stable levels through daily application.
- Easy to Use: Self-administration at home.
- Flexible Dosing: Adjustable as needed.
Risks:
- Skin Irritation: Itching, redness, or dryness at the application site is possible.
- Risk of Transfer: Avoid contact with partners or children to prevent accidental hormone transfer.
- Daily Application Required: Discipline and consistency are crucial.
3. Testosterone Patches
How does it work?
The patches are applied daily to clean, oil-free areas of skin (abdomen, back, or thigh). They release testosterone continuously through the skin and ensure a stable level. However, they are considered an inferior form of therapy, as they more frequently cause skin irritation and adhesion problems.
Active Ingredients and Preparations:
Transdermal Patches: (e.g., Testoderm®, Androderm®)
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- Duration of Effect: 24 hours
- Dosage: Daily replacement required
Benefits:
- Stable Testosterone Levels: Steady delivery throughout the day.
- Easy to Use: Similar to a regular medical patch.
Risks:
- Skin Irritation: Skin reactions such as redness or itching are common.
- Adhesion Problems: Patches may come loose due to sweating or water.
- Daily Replacement Required: Constant replacement is necessary.
4. Oral Intake (Tablets/Capsules)
How does it work?
The capsules are taken orally and delivered directly into the bloodstream through the lymphatic system, bypassing the liver. Tablets for oral intake are considered less effective. Because they must pass through the liver, their bioavailability may be severely limited. This increases the risk of liver damage and often leads to uneven hormone supply.
Active Ingredients and Preparations:
Testosterone Undecanoate (e.g., Andriol®):
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- Duration of Effect: Short (several times daily)
- Dosage: 2-4 capsules daily (depending on the doctor's instructions)
- Special Feature: The only oral testosterone preparation with a specific formulation that bypasses the liver.
Benefits:
- Discreet Application: No injections or topical application required.
- Convenient Intake: Easy to integrate into everyday life.
Risks:
- Regular Intake: Dosing several times daily is required.
- Fluctuations: Irregular intake leads to unstable levels.
- Lower Bioavailability: Hormone levels can be influenced by diet and digestion.
5. Implants (Testosterone Implants)
How does it work?
Testosterone implants are surgically placed under the skin (usually in the abdominal or buttock area) and release testosterone continuously for several months. They are not available in Germany.
Active Ingredients and Preparations:
Subcutaneous Implants: (e.g., Testopel®) (not available in Germany)
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- Duration of Effect: 3-6 months
- Dosage: Implantation under the skin every 3-6 months
Benefits:
- Long-Term Hormone Supply: Stable levels without daily dosing.
- Low Maintenance: Only needs replacement every 6 months.
Risks:
- Surgical Procedure: Implantation is performed under local anesthesia.
- Risk of Infection: Infections and irritation at the implantation site are possible.
- Removal Due to Side Effects: Implants must be surgically removed if adverse effects occur.
Risks and Side Effects of Testosterone Therapy
Testosterone therapy (TRT) can offer significant health benefits, but it is not without risks. Depending on the dosage, duration of use, and individual body response, various side effects may occur (Grech et al., 2014). Careful medical supervision and regular blood tests are essential to ensure the safety and effectiveness of the therapy.
Skin Problems: Acne and Oily Skin
Elevated testosterone levels stimulate the sebaceous glands, which can lead to oily skin and acne. Young men and patients on high doses are particularly affected.
Prevention: Use mild skincare products. Regular skin cleansing and, if necessary, dosage adjustment by the doctor.
Enlarged Prostate (in Older Men)
Testosterone stimulates prostate growth. This can exacerbate benign prostatic enlargement (benign prostatic hyperplasia). Although testosterone does not cause prostate cancer, it can accelerate the growth of pre-existing prostate cancer (Zitzmann et al., 2003).
Prevention: Regular PSA tests (prostate-specific antigen). Urological examinations for early detection. Symptoms such as frequent urination or a weak urine stream should be investigated early.
Water Retention and Weight Gain
Elevated testosterone levels can lead to water retention in the tissues, noticeable through swollen legs and weight gain. Hormonal fluctuations or excessive doses exacerbate these effects (Chahla et al., 2011).
Prevention: Dosage adjustment by the doctor. Low-salt and low-water diet, as well as regular exercise and controlled fluid intake.
Suppression of the Body's Natural Testosterone Production
External testosterone supply can temporarily suppress the hypothalamus-pituitary axis, which can reduce the body's natural testosterone production. In some cases, this can lead to a temporary reduction in testicular function and sperm production (Khodamoradi et al., 2020).
However, these effects are generally reversible, especially if the therapy is properly monitored and tapered off slowly. In certain cases, additional treatment with hCG (human chorionic gonadotropin) can help stimulate the body's natural hormone production again (Lee & Ramasamy, 2018). Close medical supervision ensures that possible effects are detected early and treated accordingly.
Prevention: Therapy breaks or additional treatments with hCG (human chorionic gonadotropin) to maintain testicular function. Thorough explanation by the doctor before starting the therapy.
Liver Strain (with Oral Intake)
Oral testosterone preparations can strain the liver, as they must be absorbed directly through the gastrointestinal tract and processed in the liver. This can lead to liver inflammation, elevated liver enzymes, and liver dysfunction (Johnsen, 1978).
Prevention: Prefer alternatives such as gels, patches, or injections. Regular liver enzyme monitoring during oral therapy.
Mood Changes and Psychological Effects
Excess testosterone can lead to mood swings, irritability, aggression, or depressive moods. Sleep disorders are also possible.
Prevention: Regular medical monitoring of hormone levels. Psychological support if emotional changes occur.
How Much Does Testosterone Replacement Therapy Cost?
The monthly cost of testosterone replacement therapy depends on the method of application, the dosage, and the duration of therapy. In addition, doctor visits, blood tests, and lab monitoring should be factored in, which may not be covered by health insurance.
Monthly Costs by Treatment Method
Injections (e.g., testosterone enanthate):
Testosterone enanthate is relatively affordable. Monthly costs range between €20 and €30, depending on the dosage and injection frequency (usually every 1-2 weeks).
Testosterone Gels:
The cost of testosterone gels is approximately €60 to €70 per month, depending on the brand and prescribed amount. Daily application is required.
Testosterone Patches:
Transdermal patches cost approximately €60 to €150 per month, depending on the dosage and provider. They usually need to be changed daily.
Oral Intake (Tablets/Capsules):
The monthly cost of tablets starts at around €60, but varies depending on the prescribed dosage and frequency of intake.
Implants:
Testosterone implants are not available in Germany. In other countries, they cost up to €600 per implantation and last for 3 to 6 months.
Additional Costs
Doctor's Consultation:
Initial consultations and follow-up appointments to monitor the therapy incur additional costs, especially for self-payers and private patients. A doctor's consultation appointment can roughly be expected to cost €60-100, depending on the duration and effort.
Lab Tests and Blood Examinations:
Regular blood tests to check testosterone levels, PSA levels, and blood clotting are required. These lab costs may not be fully reimbursed depending on the insurance contract. Depending on the number of different biomarkers determined, costs can be expected between €60-90. Test your hormone levels now.
Our Conclusion, Your Knowledge
Testosterone therapy can significantly improve quality of life if it is professionally administered and individually adjusted. It offers the opportunity to effectively treat symptoms such as lack of motivation, fatigue, and reduced libido.
Before you decide on a therapy, it is important to be well informed. Talk to your doctor, have your hormone status checked, and clarify which form of treatment is best suited for you. Carefully weigh the benefits and possible risks to make the right decision for your health.
With the right therapy, you can regain new energy, vitality, and vigor, and improve your quality of life in the long term.
