What You Need to Know While on Testosterone Replacement Treatment

On: December 22, 2017
testosterone levels, Testosterone Therapy, trt

Facts About Hormone Replacement Therapy for Men

If you’re on hormone replacement therapy for men, you need to read this article on checkups you need to schedule to monitor your health.

1 in 4 men over 30 have low testosterone while 1 in 20 experience the clinical symptoms of the deficiency. Hormone replacement therapy for men with low testosterone is one of the best ways to combat those symptoms.

If you’re reading this, you’ve likely been through this gauntlet before. Poor sex drive, weak erections, unexplained weight gain, lethargy, and depression can all point to a low testosterone level. The hormone also plays a part in bone density and most secondary sex characteristics.

But unfortunately, unlike medicating other sicknesses, testosterone replacement therapy (TRT) isn’t as straightforward as popping a pill. TRT requires multiple follow-ups, blood tests, and yes, even prostate exams.

Keeping your appointments makes sure the therapy works and that you’re not experiencing unmanageable side effects. It also catches any potentially harmful side effects early.

But what are those checkups specifically? Read on for a list of each checkup you should attend while on hormone replacement therapy for men, and when you should schedule them.


This isn’t a one shot and you’re done situation, fellas. Most reputable health clinics will recommend a follow-up within 2-3 months of your first visit. This is to check how your body is taking to the therapy.

From there many clinics will want you back either quarterly or yearly.

Regular follow-ups are crucial to ensure that the hormone replacement therapy is working. They also help make sure your health isn’t being adversely affected by the treatment.

Hormone replacement therapy for men can have a number of side effects, including:

  • Acne
  • Breast tenderness
  • Low sperm count
  • High red blood cell count
  • Fluid retention in the feet or ankles
  • Sleep apnea
  • Cardiovascular disease (though this is in contention)
  • Trouble urinating
  • Prostate growth

Maintaining your follow-up appointments ensures that any minor side effects can be managed. It also means serious side effects can be caught before doing permanent harm.

Testosterone Levels

While many health clinics don’t opt for monitoring the level of testosterone itself, a study conducted by The Endocrine Society recommended that treatment should aim to get testosterone levels to a mid-normal range.

Most clinics that do test the testosterone levels throughout treatment recommend checks at 3 months, 6 months, and then annually.

Digital Rectal Exam (DRE)

Hormone replacement therapy for men can stimulate the cells of the prostate to grow. This can cause a condition known as benign prostate hyperplasia or enlarged prostate.

An enlarged prostate typically presents with urinary problems. These can include:

  • A slow or weak urinary stream
  • A feeling of incomplete bladder emptying
  • Difficulty starting urination
  • Frequent urination
  • Urgency to urinate
  • Getting up frequently at night to urinate
  • An inconsistent urinary stream
  • Straining to urinate
  • Dribbling of urine after emptying
  • Returning to urinate again minutes after finishing.

Most of these symptoms start to present as men get older. As they age, their prostate enlarges until it begins to impact on the urethra. This, in turn, causes the bladder to contract more forcefully to push urine through the narrowed opening.

Over time the muscles of the bladder can become larger and more sensitive. It begins to contract the moment it contains even a small amount of urine, causing frequent urination.

If the prostate impacts on the urethra too much, the bladder often can’t compensate for the block. When this happens, urine can remain in the bladder and cause the perpetual feeling of needing to urinate.

If left unchecked this can lead to Urinary Tract Infections (UTIs), bladder stones, blood in the urine, or acute urinary retention.

The American Association of Clinical Endocrinologists recommends prostate exams every 6-12 months for the duration of the hormone therapy. This ensures any prostate enlargement is caught early before it starts to impact too heavily on your health.

Prostate-Specific Antigen (PSA) Test

Recent studies show that men undergoing TRT aren’t at a higher risk of prostate cancer. Most health clinics will recommend regular prostate-specific antigen (PSA) tests as a precaution anyway.

The European Association of Eurology recommends PSA tests at 3 months, 6 months, and thereafter annually.


TRT can cause an increase in red blood cells in patients. In fact, it’s the most common adverse effect experienced by people on hormone replacement therapy for men.

This condition, called Polycythemia, can cause a number of health complications. This is because as the red blood cells increase, your blood becomes thicker. This, in turn, can increase the risk of thrombosis (the formation of blood clots inside blood vessels) that could affect the heart, lungs, or brain.

Symptoms of polycythemia include:

  • Bruising easily
  • Easily bleeding
  • Blood clot formation
  • Bone and joint pain
  • Abdominal pain
  • Headaches
  • Itching
  • Fatigue
  • Dizziness

The Endocrine Society recommends determining the baseline hematocrit when beginning the hormone therapy. Clinics should then check levels again at 3 to 6 months, and thereafter annually.

Bone Mineral Density (BMD) Checks

The most common cause of male osteoporosis is testosterone deficiency. As such, TRT is often a recommended treatment for male osteoporosis.

That said, experts agree that hormone therapy is not suitable for men with the symptoms of low testosterone but normal levels of the hormone. Testosterone fails to increase bone density in such cases.

Because TRT has a proven effect on the bones, it’s recommended patients receive regular BMD checks throughout the therapy. The American Association of Clinical Endocrinologists recommends BMD checks every 1 to 2 years. The European Association of Urology recommends the same.

Keep Your Appointments While On Hormone Replacement Therapy for Men

Once you start to feel your own self again, it can be all too easy to put off or skip your follow-up appointments. But it’s very important you stick to the schedule your health clinic outlines for you.

Periodic blood tests not only make sure the therapy is working as expected, they can also flag potentially serious health concerns before they blow up. Same goes for regular prostate exams and bone mineral density checks.

By staying on top of your appointments, you also stay on top of your health.

Unsure if your testosterone levels are where they should be? Check out how a testosterone test checks if your levels are right.


Latest Blog Posts

Take a look at our latest blog posts

The Benefits of Testosterone Therapy for Men’s Health and Wellness

Read our latest blog post which covers an amazing topic around The Benefits of Testosterone Therapy for Men’s Health and Wellness written by staff at Mantality Health

Making Dad Time Special

Read our latest blog post which covers an amazing topic around Making Dad Time Special written by staff at Mantality Health

4 Ways To Get Motivated Right Now

Read our latest blog post which covers an amazing topic around 4 Ways To Get Motivated Right Now written by staff at Mantality Health
Mantality Health Testosterone Replacement Therapy Logo

Choose your location for access to the patient portal