A drop in testosterone levels can significantly impact well-being. This article explains 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, with increasing age or due to certain medical conditions, testosterone levels can decline—a condition known as hypogonadism. This often leads to symptoms such as fatigue, lack of motivation, weight gain, decreased sex drive, and even depression ( Snyder, 2022 ). You can find more information 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 compensates for 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 you can make informed decisions about your health. Let's explore together how testosterone therapy can positively transform your life. Note: This article is for informational purposes only and does not replace medical advice. Always consult a doctor with any health concerns.
What is testosterone therapy?
Testosterone therapy , also known as testosterone replacement therapy (TRT) , is a medical treatment aimed at correcting a testosterone deficiency (hypogonadism) . When the body no longer produces sufficient testosterone, it can lead to health problems. Testosterone deficiency often occurs with increasing age, but can also be caused by certain diseases, medications, or lifestyle factors such as stress, poor diet, and lack of exercise ( Braga et al., 2020 ).
Goals of testosterone therapy
Testosterone replacement therapy (TRT) is used to alleviate the symptoms of testosterone deficiency and improve the quality of life of those affected. The most common symptoms that can be reduced by testosterone therapy are:
Physical symptoms:
- Loss of muscle mass and muscle strength ( Yuki et al., 2013 )
- Increase in abdominal fat and weight ( Allan et al., 2007 )
- Decreased bone density (osteoporosis) ( Shigehara et al., 2021 )
Sexual symptoms:
- Reduced libido (sexual desire) ( Hintikka et al., 2009 )
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Erectile dysfunction ( Wang et al., 2000 )
You can find more information on sexual health in our articles "Erectile Dysfunction: All in Your Head 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 moods and irritability ( Hintikka et al., 2009 )
- Concentration and memory problems ( Jäger et al., 2013 )
How does testosterone therapy work?
Testosterone therapy involves administering synthetic testosterone to the body to restore hormone levels to a healthy range. Administration can take various forms, including injections , gels , patches , tablets , or implants ( Sizar et al., 2023 ).
The therapy is individually tailored and monitored by a doctor. Regular blood tests are performed to check the dosage and detect any potential 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 prostate overstimulation. Comprehensive medical consultation and regular check-ups are essential to ensure safe and effective treatment.
Who needs testosterone replacement therapy?
Testosterone replacement therapy (TRT) is recommended when clinical testosterone deficiency is confirmed by blood tests and is associated with significant symptoms . In such cases, treatment follows clear medical guidelines ( EAU Guidelines on Sexual and Reproductive Health - UROWeb , n.d. ). Certain diagnoses and life circumstances make testosterone therapy particularly beneficial:
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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 fatigue, muscle loss, and decreased libido. Learn 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 like corticosteroids ( MacADAMS et al., 1986 ) can cause testosterone deficiency. In such cases, TRT is often used as an adjunct treatment. -
Surgical procedures:
After removal of the testicles or certain tumor treatments, testosterone production is often permanently disrupted, so lifelong TRT may be necessary.
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Off-label treatment for testosterone deficiency
In certain cases, 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 are present. Even though the levels are still formally within the normal range , individually tailored testosterone therapy may be medically beneficial.
Requirement:
The treating physician must carefully weigh the benefits of the treatment , inform the patient , and obtain their written consent . Regular blood tests and comprehensive monitoring ensure the success of the therapy and minimize risks.
Forms of testosterone therapy
Testosterone therapy can be administered in various ways, depending on the individual's life circumstances , health status , and preferences . The treating physician will select the appropriate therapy after a thorough medical evaluation. Here is an overview of the most important methods:
1. Injections (syringes)
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-term injections , administered every 1-3 weeks, and long-term depot injections , 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 compensating for a deficiency.
Testosterone cypionate: (not approved in Europe)
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- Duration of action: Similar to enanthate
- Special feature: More commonly used in the USA because 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.
Advantages:
Fast effect:
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- Testosterone enanthate: The active ingredient becomes effective in the body within a few days after 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 care:
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- Nebido®: Due to its extended duration of action of 10-14 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 accurate dosage , level monitoring , and treatment safety .
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Risks:
Hormonal fluctuations:
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- Testosterone enanthate: Because it is injected every 1-2 weeks, fluctuations in hormone levels can occur. Levels are high immediately after injection but drop again until the next dose , which can lead to a "hormone ripple" effect .
Pain at the injection site:
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- Possible reactions: Redness, hardening or swelling may occur, especially with frequent injections or improper administration .
Regular doctor's visits:
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Dependence on medical personnel: If the injections cannot be administered independently at home, regular visits to the doctor 's office are necessary. A doctor's visit is particularly essential for Nebido® injections , which, due to their volume (4 ml) , must be administered slowly and correctly.
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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 delivers rapid results, Nebido®, with its long-lasting effect, is ideal for patients who prefer less frequent injections . However, regular monitoring and proper administration are essential in both cases.
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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 stable testosterone level.
Active ingredients and preparations:
Testosterone gels: (e.g. Testogel®, Androgel®, Testavan®)
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- Duration of effect: Daily application necessary.
- Directions: 2-4 pumps daily (depending on prescription)
- Special feature: Precise dosing, individually adjustable.
Advantages:
- Consistent hormone supply: Stable levels through daily use.
- Easy to use: Can be used independently at home.
- Flexible dosage: Adjustable as needed.
Risks:
- Skin irritation: Itching, redness or dryness at the application site is possible.
- Risk of transmission: Avoid contact with partners or children to prevent accidental hormone transmission.
- Daily use is required: Discipline and regularity are crucial.
3. Testosterone patches
How does it work?
The patches are applied daily to clean, grease-free areas of skin (abdomen, back, or thighs). They continuously release testosterone through the skin, ensuring a stable level . However, they are considered an inferior form of therapy because they more frequently lead to 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 change necessary
Advantages:
- Stable testosterone levels: Consistent release throughout the day.
- Easy to use: Similar to a normal medical plaster.
Risks:
- Skin irritation: Skin reactions such as redness or itching are common.
- Adhesion problems: Plasters can come loose due to sweating or water.
- Daily replacement required: Constant replacement necessary.
4. Oral administration (tablets/capsules)
How does it work?
The capsules are taken orally and transported directly into the bloodstream via the lymphatic system to relieve the burden on the liver. Tablets for oral administration are considered less effective. Because they have to pass through the liver, their bioavailability can be severely limited. This increases the risk of liver damage and often leads to an imbalance in hormone levels.
Active ingredients and preparations:
Testosterone undecanoate (e.g. Andriol®):
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- Duration of effect: Short (several times a day)
- Dosage: 2-4 capsules daily (depending on doctor's instructions)
- Special feature: The only oral testosterone preparation with a specific form of action that bypasses the liver.
Advantages:
- Discreet application: No spraying or application required.
- Convenient to take: Easy to integrate into everyday life.
Risks:
- Regular intake: Multiple doses daily are 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 inserted under the skin (usually in the abdomen or buttocks) 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 every 3-6 months under the skin
Advantages:
- Long-term hormone supply: Stable levels without daily dosing.
- Minimal effort: Renew only every 6 months.
Risks:
- Surgical procedure: Implantation is performed under local anesthesia.
- Risk of infection: Infections and irritations at the implantation site are possible.
- Removal in case of side effects: Implants must be surgically removed if unwanted effects occur.
Risks and side effects of testosterone therapy
Testosterone replacement therapy (TRT) can offer significant health benefits, but it is not without risks. Depending on the dosage, duration of use, and individual response, various side effects can occur ( Grech et al., 2014 ). Careful medical monitoring 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 taking high doses are particularly affected.
Prevention: Use mild skincare products. Cleanse your skin regularly and, if necessary, have the dosage adjusted by your doctor.
Enlarged prostate gland (in older men)
Testosterone stimulates prostate growth. This can exacerbate benign prostatic hyperplasia (BPH). Although testosterone does not cause prostate cancer, it can accelerate the growth of an existing prostate carcinoma ( Zitzmann et al., 2003 ).
Prevention: Regular PSA (prostate-specific antigen) tests. 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, resulting in swollen legs and weight gain. Hormonal fluctuations or excessive dosages intensify these effects ( Chahla et al., 2011 ).
Prevention: Dosage adjustment by the doctor. Low-salt and low-water diet, regular exercise, and controlled fluid intake.
Inhibition of the body's own testosterone production
External testosterone administration can temporarily inhibit the hypothalamic-pituitary axis, which can reduce the body's own testosterone production. In some cases, this can lead to a temporary decrease in testicular function and reduced sperm production ( Khodamoradi et al., 2020 ).
These effects are usually reversible, especially if the therapy is professionally monitored and gradually discontinued. In certain cases, additional treatment with hCG (human chorionic gonadotropin) can help stimulate the body's own hormone production ( Lee & Ramasamy, 2018 ). Close medical monitoring ensures that any potential side effects are recognized 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 therapy.
Liver strain (when taken orally)
Oral testosterone preparations can put a strain on the liver because they are absorbed directly through the gastrointestinal tract and must be processed by the liver. This can lead to hepatitis, elevated liver enzymes, and liver dysfunction (Johnsen, 1978 ).
Prevention: Prefer alternatives such as gels, patches, or injections. Regular liver function tests are recommended during oral therapy.
Mood changes and psychological effects
Excess testosterone can lead to mood swings, irritability, aggression, or depressive moods. Sleep disturbances 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 costs of testosterone replacement therapy depend on the type of administration, the dosage, and the duration of therapy. Additionally, doctor's visits, blood tests, and laboratory checks should be factored in, which may not be covered by health insurance.
Monthly costs depending on the type of treatment
Injections (e.g. testosterone enanthate):
Testosterone enanthate is relatively inexpensive. Monthly costs range between €20 and €30, depending on the dosage and injection frequency (usually every 1-2 weeks).
Testosterone gels:
Testosterone gels cost 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 manufacturer. They usually need to be changed daily.
Oral administration (tablets/capsules):
The monthly cost for 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 are effective for 3 to 6 months.
Additional costs
Medical consultation:
Initial consultations and follow-up appointments to monitor therapy incur additional costs, especially for self-paying patients and those with private insurance. A doctor's consultation appointment can generally cost between €60 and €100, depending on its duration and complexity.
Laboratory tests and blood tests:
Regular blood tests to check testosterone levels, PSA levels, and blood clotting are necessary. These lab costs may not be fully reimbursed depending on your insurance policy. Depending on the number of different biomarkers tested, you can expect costs between €60 and €90. Test your hormone levels now.
Our conclusion, your knowledge
Testosterone therapy can significantly improve quality of life when administered correctly and tailored to the individual . It offers the possibility of effectively treating symptoms such as lack of motivation, fatigue, and reduced libido.
Before deciding on a therapy, it's important to be well-informed . Talk to your doctor , have your hormone levels checked, and find out which treatment option is best for you. Carefully weigh the benefits and potential risks to make the right decision for your health.
With the right therapy, you can regain new energy , vitality and life force , and improve your quality of life in the long term .
