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Starting Testosterone Therapy: What to Expect

starting testosterone therapy

Beginning testosterone replacement therapy, also called TRT or hormone replacement therapy, is a big step that inevitably brings many questions and some uncertainties. Testosterone is an essential male hormone that impacts several body functions and systems. When levels are low, due to conditions like hypogonadism or andropause, supplementing with exogenous testosterone can provide significant benefits. However, it also comes with potential side effects and requires close medical monitoring.

If you are considering starting testosterone therapy, it is helpful to understand the key steps in the process, what effects emerge at different stages, and how treatment is managed for the long run. Working closely with knowledgeable healthcare professionals and tracking your personal response to therapy is vital for a successful outcome. Read on to learn what to expect when embarking on testosterone replacement.

Understanding Testosterone Therapy

Before diving into the hormone therapy process, let’s review some fundamentals about what this treatment entails.

What is testosterone replacement therapy?

Testosterone replacement therapy involves taking manufactured testosterone medication to increase levels of this vital male hormone in the body. Reasons for starting testosterone supplementation include:

  • Treating clinically low testosterone levels known as hypogonadism or “low T.” This may be caused by disorders of the testes, pituitary gland, or hypothalamus.
  • Supporting gender transition for transgender men – regulating fat redistribution, increasing muscle mass, and inducing other masculinizing effects.

Forms of testosterone therapy and hormone supplementation

There are several delivery methods for introducing additional testosterone into the system, including testosterone injections, testosterone patches, and testosterone supplements.

Effects of testosterone therapy

When circulating testosterone levels are brought into a normal range with supplementation, you can expect to see both mental and physical effects. These may include:

  • Increased muscle mass and strength
  • Decreased body fat, change in fat distribution
  • Facial and body hair growth
  • Deepened voice
  • Increased bone density and strength
  • Boosted sex drive and erections
  • Elevated mood, energy, motivation and cognitive function
  • Increased red blood cell production

The degree and timing of these testosterone therapy effects will depend on your individual hormones, genetics, dosage, lifestyle and more. Monitoring your experience closely is important.

Deciding if Testosterone Therapy is Right for You

The choice to begin hormone replacement is a significant one that you should make in careful consultation with medical providers. Here are some key steps to take when considering testosterone therapy:

Discuss low testosterone symptoms with your doctor

If you are experiencing potential low testosterone symptoms – fatigue, low sex drive, difficulty building muscle mass, irritability, depressive moods – have an open conversation with your healthcare provider. Together you can investigate possible causes and decide if testing your testosterone levels is warranted.

Get baseline lab tests

Bloodwork is needed to determine if you truly have clinically low testosterone. A diagnosis of hypogonadism is made when total testosterone blood serum levels are below 300 ng/dL. Checking other related hormones provides additional insights.

Weigh pros and cons

In discussion with your doctor, carefully consider possible benefits you hope to gain against short and long-term side effects and health risks that may arise. Different treatment forms have various pros/cons.

Define your goals

Be clear on the specific changes you aim to achieve, and ensure your provider agrees they are realistic expectations. Setting goals helps monitor progress.

Assess contributing lifestyle factors

Look at lifestyle habits like exercise, diet, sleep, and stress management. Optimizing these areas first may boost natural testosterone.

Working thoughtfully through these steps helps ensure you make an informed decision and have a successful testosterone replacement experience.

Starting Testosterone Replacement Therapy

Once the decision is made to begin treatment, your doctor will work with you to pinpoint the ideal form, dosage and monitoring plan. Here’s an overview of how this process typically goes:

Determine best form of testosterone

Choose the delivery method that is most convenient, effective and safe based on your individual health profile. Those seeking maximum results may prefer injections.

Establish proper dosage

Starting dosage is often 50-100 mg injected weekly. This is adjusted over time based on bloodwork and how your body responds. Finding the optimal dose may take months.

Schedule monitoring and lab tests

You’ll need periodic bloodwork to check testosterone levels and watch for potential side effects. Follow your provider’s advice for testing frequency.

Discuss side effect risks

Have an open discussion about possible side effects like polycythemia, weight gain, fluid retention, enlarged prostate, etc. Consider underlying risk factors.

Address emotional expectations

Explore your hopes and expectations around the emotional impact of starting therapy. Understanding changes takes time and careful tracking of moods is needed.

With your medical team’s guidance, you can start testosterone replacement therapy equipped with the key information and tools to optimize success. Now let’s look at what to expect in the first weeks and months.

What to Expect in the First Month

The early stages of testosterone therapy bring both physical changes and emotional responses. It takes time to adjust to this new phase, so be patient with yourself and your body. Have realistic expectations, stay in touch with your feelings, and report any significant effects to your provider.

Here’s an overview of what you may experience within the first 1-2 months:

Increased energy and motivation

Many notice a difference in energy, motivation, and alertness within the first few weeks. The degree varies, but most feel some uplift.

Skin changes and acne

Hormonal shifts may trigger acne along the hairline, back or chest. Your skin may also feel oilier. These effects often stabilize over time.

Sex drive changes

You may find your libido and sexual responsiveness increase within the first month or two. Sensations may feel different as well.

Emotional adjustments

Moods, emotions and anger may feel closer to the surface. Making a conscious effort to manage feelings can help.

Sleep pattern shifts

Some report restless sleep and changes in sleep architecture in the first weeks. Tracking sleep quality is advised.

Bottom growth

For transgender men, clitoral enlargement is often one of the first effects noticed, within weeks.

Cessation of periods

For transgender men, menstruation or menstrual periods usually stop within the first 1-3 months of hormone therapy. Monitor your cycle and report any changes to your endocrinologist.

Subtle muscle changes

You may start sensing slight muscle growth and strength gains around 6-8 weeks in as testosterone impacts muscle development. Weight training helps maximize the effects of hormone therapy on physical strength and body composition.

Monitoring moods and behaviors

Keep notes tracking moods, sleep, appetite, exercise tolerance, and any behavior changes. Discuss with your provider.

The timing and degree of effects varies widely. The key is paying close attention and reporting all outcomes to your doctor. With close monitoring, the early weeks of therapy lay the foundation for success.

Ongoing Monitoring and Adjustments

While the first months involve some trial and error, testosterone therapy is meant to be an ongoing process. You and your medical providers will regularly assess progress, make dosage adjustments, and manage side effects for ideal outcomes.

Here’s what to expect with long-term management:

Monitor testosterone levels

Have regular bloodwork to confirm your circulating testosterone stays in the normal male range, with ideal levels around 500-700 ng/dL.

Watch for polycythemia

Increased red blood cells cause thicker blood. Symptoms like high blood pressure may indicate an adjustment is needed in regulating hormone levels and balancing the hormone therapy.

Track body composition

Note changes in weight, muscle gain and body fat percentage. Avoid significant weight gain.

Communicate about side effects

Report any concerning symptoms so your provider can adjust treatment accordingly.

Have ongoing discussions

Check in regularly with your doctor to ensure therapy is aligned with your transition goals and improving quality of life.

Consider emotional health

Your emotional state is critical. Seek counseling if needed to support mental health amidst changes.

Adjust dose and form if needed

Your provider may modify the dose, administration frequency or form to optimize results and minimize side effects.

Obtain preventative care

Stay up to date with health screenings to minimize risks that may be associated with long-term testosterone therapy.

Here is the continuation of the article:

With close medical collaboration, you can tailor testosterone therapy over time to keep your hormones balanced and maximize benefits while minimizing risks.

Maintaining Long-Term Therapy

Many individuals find they require lifelong testosterone therapy to maintain healthy hormone levels, especially if hypogonadism is caused by permanent testicular damage or other irreversible factors. Therapy may continue for years or decades based on your circumstances.

Here are some key points to be aware of when considering testosterone replacement as an ongoing, long-term treatment:

There is no pre-set duration

Testosterone therapy is not like a short course of medication with a defined endpoint. Your doctor will advise you based on evaluating your hormonal bloodwork and symptom response.

Effects may plateau

Results often plateau around the 12-month mark as your physiology adjusts to the new hormone levels. However, benefits may continue over years.

Modifications may be needed

Changing life circumstances like aging, changes in weight or medical conditions can necessitate dosage adjustments over time.

Continued monitoring is critical

Have regular bloodwork, medical check-ins, and screenings to protect against potential cardiac, prostate and other health risks.

Lifestyle factors play a role

Support testosterone’s benefits through nutrition, exercise, stress reduction, and other healthy lifestyle practices.

Work as a team with your providers

Maintain open, honest communication with your doctor to ensure therapy continues meeting your needs safely.

Assess your emotional health

Periodically evaluate your mental health, mood stability and emotional responses to therapy. Seek support if needed.

Approaching testosterone replacement as an ongoing process requiring self-care, lifestyle management and close medical collaboration can help you maximize benefits over the long run.


Starting testosterone therapy is a process – from making the initial decision, through the adjustments of the first months, to maintaining treatment for years to come. Learning what to realistically expect at each stage and working closely with your medical team sets the stage for the best possible outcome.

Key takeaways to remember:

  • Understand your specific goals, risks and benefits before embarking on treatment
  • The first weeks and months require tracking of physical and emotional changes
  • Dosage adjustments happen gradually and require periodic lab testing
  • Therapy must be monitored long-term to balance results and health risks
  • Maintaining an open dialogue with your doctor is essential
  • Supporting your body through healthy lifestyle habits optimizes testosterone’s benefits

By learning all you can about the process, you can approach testosterone replacement therapy with realistic expectations and the knowledge to have the most positive experience possible.