Testosterone replacement therapy: Pros and Cons

Last updated: May 18, 2026

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There are lots of patients who suffering from testosterone deficiency syndrome (TDS) whom need testosterone replacement therapy at my andrology office. Testosterone level peaks at age 30 then gradually declines by 1% per year. Testosterone plays a main role in erectile function, sexual desire, and mood stabilization in men.

Pros of Testosterone replacement therapy

1. Improves sexual desire and erectile dysfunction – testosterone directly relates to libido and erectile function.
2. Increases mineral bone density
3. Increases muscle mass and decreases fat mass
4. Stabilizes mood, improves well-being and reduces fatigue
5. May help prevent dementia – higher testosterone levels are associated with lower Alzheimer’s disease risk
6. Improves insulin resistance and reduces metabolic syndrome risk

Cons of Testosterone replacement therapy

1. May worsen benign prostate hyperplasia (BPH) symptoms
2. Contraindicated in prostate cancer – TRT can accelerate prostate cancer aggressiveness. Prostate cancer screening is mandatory before starting therapy.
3. Risk of polycythemia (high red blood cell concentration) – requires regular blood monitoring during therapy
4. Excessive libido and aggressiveness (rare)
5. Gynecomastia (female-like breast development) with long-term use
6. Testicular size reduction and compromised fertility – occurs around 10 weeks after starting, reverses after stopping therapy for 18 months

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Frequently Asked Questions

Q1: What are the main benefits of testosterone replacement therapy?

Testosterone replacement therapy (TRT) offers multiple benefits for men with confirmed testosterone deficiency. These include improved sexual desire and erectile function, increased bone mineral density, greater muscle mass with reduced fat mass, improved mood and energy levels, reduced fatigue, and potential benefits for insulin resistance and metabolic health. Some research also suggests higher testosterone levels may be associated with lower Alzheimer’s disease risk.

Q2: What are the risks and side effects of testosterone replacement therapy?

Known risks of TRT include worsening of benign prostatic hyperplasia (BPH) symptoms, polycythemia (excessively high red blood cell concentration requiring regular monitoring), gynecomastia (breast tissue development) with long-term use, testicular size reduction, and temporarily compromised fertility. Excessive libido or aggressiveness can occur but is rare. Prostate cancer is an absolute contraindication, as TRT can accelerate tumor growth.

Q3: Who should NOT take testosterone replacement therapy?

TRT is contraindicated in men with active prostate cancer, as testosterone stimulates cancer cell growth. It should also be avoided in men with severe untreated BPH, polycythemia, severe sleep apnea, or those actively planning to have children, as TRT suppresses sperm production. A thorough medical evaluation including PSA testing and prostate assessment is mandatory before starting any TRT program.

Q4: Will testosterone therapy affect my fertility?

Yes. Testosterone replacement therapy suppresses the body’s natural sperm production by reducing FSH and LH hormone signals to the testes. This typically becomes apparent around 10 weeks after starting therapy. Importantly, fertility can recover after stopping TRT, usually within 18 months, though recovery is not guaranteed for all men. If fertility preservation is a concern, alternatives such as hCG monotherapy should be discussed with your urologist.

Q5: How do I know if I need testosterone replacement therapy?

TRT is indicated only for men with clinically confirmed testosterone deficiency, which requires both symptoms (reduced libido, fatigue, mood changes, erectile dysfunction) AND low serum testosterone levels confirmed on at least two morning blood tests. Self-diagnosis or starting TRT based on symptoms alone is not appropriate. A qualified urologist or andrologist will assess your hormone profile, medical history, and overall health before recommending treatment.

If you are experiencing symptoms of testosterone deficiency and would like a comprehensive evaluation, Dr. Soarawee Weerasopone offers specialist men’s health consultations at Bangkok Hospital Headquarters. Book a Consultation.

Disclaimer: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any medical treatment.