Your treatment plan will be tailored to your unique needs, but those needs can change over time. The attending physician observes the changes the patient undergoes and rarely fails to be fascinated by the multitude of functions testosterone appears to have in the process of masculinization in the broadest sense." Sexual thoughts and fantasy rose considerably by week three and remained at levels approximately double initial scores thereafter. The number of spontaneous and total erections, as well as the number of ejaculations, increased to stable levels between weeks 12 to 21. It is important to note that this study only evaluated patients at three-week intervals, so any symptomatic change occurring before that point could not be documented. Additionally, several psychosocial parameters were measured looking for changes such as levels of agitation, aggression, depression, listlessness (avoidance of activity), sociability, and activation.
Testosterone levels are measured and reported as nanograms per deciliter (ng/dL). Testosterone is a hormone responsible for male sex characteristics, sperm creation, and fertility. Many providers that offer gender affirming care on an informed-consent model — like FOLX, Plume, and Planned Parenthood — have a robust library of articles designed to answer the most frequently asked questions. These are all signs that your testosterone dosage is too high. "So, fertility preservation options should be discussed with your provider."
By restoring testosterone levels to normal through TRT, the need for pain management medications may decrease. In fact, it seems returning testosterone levels to normal may be good for your heart. We know now that prostate cancer has many more risk factors than your PSA levels. While there is concern that TRT might cause existing prostate cancer to worsen (the studies show mixed data), properly monitored administration of supplementary testosterone does not appear to cause prostate cancer in otherwise healthy men.
Hormones are your body’s communication network, and excess estrogen (in proportion to testosterone) signals the body to develop more female characteristics, which may include the development of breast tissue in men. Research indicates that gynecomastia is usually caused by a hormone imbalance between male hormones (testosterone) and female hormones (estrogen or estradiol), with the ratio between the two as the determining factor. The simple answer is, "Too much estrogen," but it’s not just the simple amount of female hormones present in your system that leads to gynecomastia. Very few studies (if any) have found that Testosterone Replacement Therapy for people with legitimately low testosterone is dangerous or harmful, either to the heart, to cholesterol levels, or to any other bodily function.
With an injection, it’s relatively easy to increase or decrease your maintenance dose by 10 mg or 20 mg. With injections, your levels will elevate and plateau at about 48 hours, and then gradually decline over the coming days. The compound dissolves into the bloodstream over the course of several days. Lab results, symptomatic response, and careful clinical medical decision making must all be considered to achieve the results you’re looking for. It depends largely on the symptoms you feel and will hinge on your commitment to consistency. Anyone embarking on TRT should realize that response to treatment manifests in different ways in different individuals.
They are inexpensive compared to other treatments. A nasal gel is now available that eliminates the risk of exposure to others. Otherwise they could get testosterone in their system.
That does not mean every man on TRT should target the same exact point in that range. Reference-range work helps place this in context. But that is a diagnostic threshold, not a universal treatment target. The AUA guideline is often cited because it uses a total testosterone below 300 ng/dL as a reasonable diagnostic cutoff for testosterone deficiency. A man using injections measured at trough will not necessarily show the same lab value as a man using transdermal therapy measured under a different protocol. That distinction matters even more when men and women are discussed in the same article.
There aren’t a lot of guarantees, but reasonable measures can be taken to lessen the negative impact that exogenous testosterone and TRT has on fertility. If having a family in the traditional manner is still a goal for you, holding off on treatment for a period of time is one option. However, for men who do not want to risk not being able to father a child, banking sperm before starting TRT makes sense. Studies have shown that sperm count often returns to normal several months after stopping Testosterone Replacement Therapy. If you and your partner are hoping to expand your family in the near future, it may be necessary to look at other possible avenues of Low T treatment that will maintain sperm production. On the other hand, there is a risk that TRT will adversely affect fertility. In other words, we interrupt the process of sperm production by introducing additional testosterone into the biochemical equation.

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