{"id":4429,"date":"2021-11-26T08:00:00","date_gmt":"2021-11-26T01:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=4429"},"modified":"2026-08-29T04:55:24","modified_gmt":"2026-08-28T21:55:24","slug":"%e1%9e%8f%e1%9f%81%e1%9e%9f%e1%9f%92%e1%9e%8f%e1%9e%bc%e1%9e%9f%e1%9f%92%e1%9e%8f%e1%9f%81%e1%9e%9a%e1%9f%89%e1%9e%bc%e1%9e%93-%e1%9e%80%e1%9e%b6%e1%9e%9a%e1%9e%96%e1%9f%92%e1%9e%99%e1%9e%b6","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/km\/2021\/11\/26\/testosterone-replacement-therapy\/","title":{"rendered":"Testosterone Replacement Therapy: The Honest Balance of Benefits and Risks"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=800%2C800&#038;ssl=1\" alt=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" class=\"wp-image-7037\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?w=800&amp;ssl=1 800w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=300%2C300&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?resize=150%2C150&amp;ssl=1 150w, 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Urologist<\/a><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok hospital Headquarter, Bangkok<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"tel:+66880221445\" target=\"_blank\" rel=\"noreferrer noopener\">Samitivej Sriracha Hospital \u2014 Urology department: <strong>088-022-1445<\/strong><\/a><\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-outline is-style-outline--1\"><a class=\"wp-block-button__link has-background-background-color has-text-color has-background has-link-color has-small-font-size has-custom-font-size wp-element-button\" href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" style=\"color:#1b4965\" target=\"_blank\" rel=\"noreferrer noopener\">Book a 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12 12 12 12-5.372 12-12S18.628 0 12 0zM7.369 4.378c.525 0 .947.431.947.947 0 .525-.422.947-.947.947-.525 0-.946-.422-.946-.947 0-.525.421-.947.946-.947zm-.722 3.038h1.444v10.041H6.647V7.416zm3.562 0h3.9c3.712 0 5.344 2.653 5.344 5.025 0 2.578-2.016 5.025-5.325 5.025h-3.919V7.416zm1.444 1.303v7.444h2.297c3.272 0 4.022-2.484 4.022-3.722 0-2.016-1.284-3.722-4.097-3.722h-2.222z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/scholar.google.com\/citations?user=lTgsRMUAAAAJ&#038;hl=en\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"Google Scholar\"\n     aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 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It is also, at the same time, one of the most oversold treatments in men\u2019s health. Both things are true, and a man deciding whether to start deserves to hear them together rather than one at a time. Levels peak in early adulthood and drift down slowly from around age thirty \u2014 but a number that falls with age is not by itself a disease, and that distinction is where most of the confusion in this subject begins.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4444\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/2021\/11\/26\/testosterone-replacement-therapy\/man-stress-out-and-cover-his-face-by-his-hands\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Stress-man.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;8&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;Canon EOS 5D Mark III&quot;,&quot;caption&quot;:&quot;man stress out and cover his face by his hands&quot;,&quot;created_timestamp&quot;:&quot;1600878353&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;105&quot;,&quot;iso&quot;:&quot;160&quot;,&quot;shutter_speed&quot;:&quot;0.00625&quot;,&quot;title&quot;:&quot;man stress out and cover his face by his hands&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Decreasing in sexual desire and depressed mood can be found in Testosterone deficiency syndrome.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Decreasing in sexual desire and depressed mood can be found in Testosterone deficiency syndrome.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Stress-man.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Stress-man.jpg?resize=800%2C533&#038;ssl=1\" alt=\"A tired man sitting with his head lowered \u2014 fatigue, low mood and reduced libido are common symptoms of testosterone deficiency\" class=\"wp-image-4444\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Stress-man.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Stress-man.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Stress-man.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Stress-man.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Stress-man.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Fatigue, low mood and reduced sexual desire are the usual presentation \u2014 but they have many other causes too.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">First: Is It Actually Testosterone?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Testosterone therapy is for men who have <strong>both<\/strong> a low level, confirmed on two separate early-morning blood tests, <strong>and<\/strong> symptoms that fit. Symptoms alone are not enough, because tiredness, low mood, poor concentration and reduced libido are produced far more often by sleep debt, untreated sleep apnoea, depression, alcohol, thyroid disease, medication or simply being overweight. Treating a normal man with testosterone does not fix any of those \u2014 it just adds a hormone he did not need. If your level is normal and you still feel drained, the answer is elsewhere; I have written about that in <a href=\"https:\/\/drsoaraweeurology.com\/2026\/04\/21\/testosterone-barometer-mens-health\/\">why testosterone is a barometer of overall health<\/a>.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4445\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/2021\/11\/26\/testosterone-replacement-therapy\/tiny-male-with-huge-check-mark-and-cross-icons-make-decision-at-notebook-with-pros-or-cons-list-in-separated-column\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Pros-and-Cons.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;Tiny Male Characters with Huge Check Mark and Cross Icons Make Decision at Notebook with Pros or Cons List in Separated Column, Men Count Advantages, Disadvantages of Deal. Cartoon Vector Illustration&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;Tiny Male with Huge Check Mark and Cross Icons Make Decision at Notebook with Pros or Cons List in Separated Column&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Since everything always has Pros and Cons, that&amp;#8217;s why we must know all effects of Testosterone replacement therapy use first.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Since everything always has Pros and Cons, that&amp;#8217;s why we must know all effects of Testosterone replacement therapy use first.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Pros-and-Cons.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Pros-and-Cons.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Scales weighing pros against cons \u2014 balancing the benefits and risks of testosterone replacement therapy before starting\" class=\"wp-image-4445\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Pros-and-Cons.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Pros-and-Cons.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Pros-and-Cons.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Pros-and-Cons.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Pros-and-Cons.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">The decision to start is a balance, and it should be made with both sides visible.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">What It Reliably Improves<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In men with a confirmed deficiency:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Sexual desire<\/strong> \u2014 the most consistent benefit, and usually the first to move, within weeks<\/li>\n\n\n<li><strong>Mood, energy and sense of well-being<\/strong> \u2014 often within weeks to a few months<\/li>\n\n\n<li><strong>Muscle mass and body fat<\/strong> \u2014 real, but measured over many months, and much smaller without exercise<\/li>\n\n\n<li><strong>Bone mineral density<\/strong> \u2014 improves over a year or more <em>on a scan<\/em>. Read the next section before treating that as a benefit: the fracture trial went the other way.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">And what it does not reliably do<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Erections.<\/strong> Desire and erection are not the same thing. Testosterone raises desire dependably; it corrects erectile dysfunction far less often, because most erectile dysfunction is vascular rather than hormonal. A man whose main complaint is getting or keeping an erection needs the <a href=\"https:\/\/drsoaraweeurology.com\/2020\/07\/31\/erectile-dysfunction-ed\/\">cause of that<\/a> established rather than assumed to be his testosterone.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Metabolic disease and diabetes.<\/strong> Low testosterone travels with obesity, diabetes and metabolic syndrome, and treatment can improve some measures \u2014 but the direction of that relationship runs both ways. The prespecified TRAVERSE diabetes substudy found no significant effect on progression from prediabetes to diabetes, and the American Diabetes Association does not recommend testosterone for that purpose. It is not a treatment for diabetes or a substitute for weight loss.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Bones.<\/strong> This deserves stating plainly rather than leaving as an absence of evidence. Testosterone improves bone mineral density on a scan, and it was long assumed that fewer fractures would follow. <strong>The TRAVERSE fracture subtrial found a statistically significant increase of roughly 43% in clinical fractures on testosterone<\/strong> \u2014 around 3.5% of men versus 2.5% on placebo, with the curves separating within the first few months. Bone density and broken bones turned out not to be the same endpoint. Testosterone should not be prescribed to protect bone, and a man with osteoporosis needs treatment aimed at bone specifically.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Memory and dementia.<\/strong> An earlier version of this article listed dementia prevention among the benefits, on the basis that men with higher testosterone levels have lower rates of Alzheimer\u2019s disease. That is an association, not a demonstrated effect of treatment, and the cognitive substudy of the large TRAVERSE trial did not show a cognitive benefit. That claim has been removed, and it should not appear on a page like this again.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"4446\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/2021\/11\/26\/testosterone-replacement-therapy\/happy-young-couple-embracing-laughing-on-date\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Sexual-drive.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;1.4&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;Canon EOS 5D Mark III&quot;,&quot;caption&quot;:&quot;Happy young couple embracing laughing on date. People kiss happiness fun concept.&quot;,&quot;created_timestamp&quot;:&quot;1476032373&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;35&quot;,&quot;iso&quot;:&quot;125&quot;,&quot;shutter_speed&quot;:&quot;0.0008&quot;,&quot;title&quot;:&quot;Happy young couple embracing laughing on date&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Absolutely improving sexual desire and erection function can be encountered during Testosterone replacement therapy.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Absolutely improving sexual desire and erection function can be encountered during Testosterone replacement therapy. &lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Sexual-drive.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Sexual-drive.jpg?resize=800%2C533&#038;ssl=1\" alt=\"A couple embracing \u2014 sexual desire is the domain that responds most consistently to testosterone treatment\" class=\"wp-image-4446\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Sexual-drive.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Sexual-drive.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Sexual-drive.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Sexual-drive.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Sexual-drive.jpg?resize=18%2C12&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Desire responds most consistently; erectile function is a separate question with separate causes.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">What It Costs You<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Fertility \u2014 raise this before the first dose.<\/strong> Testosterone from outside switches off the brain signals driving the testicles, and sperm production commonly falls to zero, usually within a few months of starting. The testicles also shrink. It is usually reversible after stopping, and most men recover over the following months to a couple of years \u2014 but recovery is not guaranteed in every man, and it is slower after long-acting preparations. If you may want children now or later, say so before you start: <strong>clomiphene citrate, hCG and an aromatase inhibitor<\/strong> raise your own testosterone instead, and a semen analysis beforehand is worth having.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Thickened blood.<\/strong> Testosterone stimulates red cell production, and a rising haematocrit is the single finding that most often forces a dose reduction, a change of route or a pause. <strong>This was also the clearest and most statistically robust adverse effect in the TRAVERSE trial<\/strong> \u2014 several times more frequent on testosterone than on placebo, a difference of a completely different order from the signals discussed below. You cannot feel it. That is why the blood tests are part of the treatment rather than an optional extra.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Prostate.<\/strong> Testosterone does not cause benign enlargement, but urinary symptoms should be assessed before starting and followed afterwards. PSA and a prostate assessment are checked before starting and monitored during treatment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Sleep apnoea<\/strong> can worsen \u2014 and if you snore heavily or wake unrefreshed, treating the apnoea may improve the very symptoms that sent you looking for testosterone. <strong>Other effects:<\/strong> acne and oily skin, breast tenderness or enlargement, fluid retention, mood changes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">And the framing that matters throughout: <strong>higher is not better.<\/strong> The aim is a level in the normal range with symptoms improved \u2014 not the highest number achievable. Testosterone bought from an unregulated source, where neither the dose nor the contents can be relied upon and nobody is checking your blood, is a different and worse proposition from prescribed treatment.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Prostate Cancer: A Correction to What This Page Used to Say<\/h2>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"437\" data-attachment-id=\"4447\" data-permalink=\"https:\/\/drsoaraweeurology.com\/km\/2021\/11\/26\/testosterone-replacement-therapy\/diagram-of-prostate-cancer-2\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Prostate-cancer.jpg?fit=1200%2C655&amp;ssl=1\" data-orig-size=\"1200,655\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;Diagram of prostate cancer illustration&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;Diagram of prostate cancer&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Prostate cancer condition is contraindicated for Testosterone replacement therapy.\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Prostate cancer condition is contraindicated for Testosterone replacement therapy.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Prostate-cancer.jpg?fit=800%2C437&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Prostate-cancer.jpg?resize=800%2C437&#038;ssl=1\" alt=\"Prostate examination illustration \u2014 prostate assessment and PSA testing are required before and during testosterone therapy\" class=\"wp-image-4447\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Prostate-cancer.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Prostate-cancer.jpg?resize=300%2C164&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Prostate-cancer.jpg?resize=1024%2C559&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Prostate-cancer.jpg?resize=768%2C419&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/11\/Prostate-cancer.jpg?resize=18%2C10&amp;ssl=1 18w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Prostate assessment before starting, and monitoring during treatment, are not negotiable \u2014 but the old blanket prohibition has changed.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This article previously stated flatly that testosterone therapy is contraindicated in prostate cancer because it accelerates the disease. That reflected a belief held for sixty years on the strength of very thin evidence, and it is no longer where the field stands.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What is accurate today: <strong>testosterone is not started in a man with known untreated prostate cancer<\/strong>, and an undiagnosed prostate cancer is a reason to assess before treating rather than after \u2014 which is why the pre-treatment prostate check exists. But for men who have been <strong>treated<\/strong> for prostate cancer, a blanket prohibition is no longer supported. It has become a carefully selected, shared decision made with the treating urologist, in full knowledge that the data remain limited. The reasoning behind that shift is set out in <a href=\"https:\/\/drsoaraweeurology.com\/2026\/05\/19\/testosterone-prostate-cancer-saturation-model\/\">the saturation model explained<\/a>, and I discuss the practical cases in <a href=\"https:\/\/drsoaraweeurology.com\/2026\/06\/23\/testosterone-therapy-today-fertility-prostate-cancer-heart-health-explained\/\">testosterone therapy today<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is worth being plain about how thin the evidence still is: the two largest testosterone safety trials, TRAVERSE and the T-Trials, both <em>excluded<\/em> men with a prostate cancer history altogether, which is precisely why the question keeps being answered from opinion rather than data. I was a co-author on a 2026 study in <em>The Journal of Sexual Medicine<\/em> reporting real-world outcomes in a single-centre cohort of 46 men aged 80 and over on testosterone, <strong>39% of whom had a prostate cancer history, with no biopsy-confirmed recurrence during follow-up<\/strong> (<a href=\"https:\/\/doi.org\/10.1093\/jsxmed\/qdag258\" target=\"_blank\" rel=\"noreferrer noopener\">DOI 10.1093\/jsxmed\/qdag258<\/a>). The limits matter as much as the finding, and an earlier version of this paragraph overstated one of them: the median follow-up was around 21 months rather than the full three years, only about a third of the men reached 36 months, and there was no untreated comparison group, so the study cannot measure relative risk. It is a contribution to that evidence rather than an answer to it.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">And the Heart: What TRAVERSE Actually Found<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The other fear that shadowed testosterone therapy for years was cardiovascular. TRAVERSE randomised 5,246 men aged 45 to 80 with confirmed deficiency who already had cardiovascular disease or multiple risk factors, and followed them for a mean of 33 months. It found <strong>no increase in heart attack, stroke or cardiovascular death<\/strong>, meeting the criterion for non-inferiority, and no increase in prostate cancer or prostate enlargement.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It also produced findings on the other side, and they need separating by how strong they are \u2014 because an earlier version of this page did not separate them.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Statistically significant:<\/strong> erythrocytosis, described above, and \u2014 in the fracture subtrial \u2014 a roughly 43% increase in clinical fractures.<\/li>\n\n\n<li><strong>Numerically higher but not statistically significant:<\/strong> atrial fibrillation, pulmonary embolism and acute kidney injury. An earlier version of this page said the trial found more of each without that qualification, which reads as though they were established harms. They are not.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">That distinction is not pedantry. Describing a difference the trial could not separate from chance as a demonstrated risk misleads a man into refusing treatment he needs \u2014 and it is the same mistake, pointed the other way, as the version of this page that called a significant rise in fractures merely undemonstrated. Neither is dismissal: these are serious events, the numbers moved the same way, and a previous clot, a clotting disorder or a known arrhythmia is still worth mentioning before starting so it can be weighed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">And there is a further point about what a safety trial is: it demonstrated the <em>absence of the harm that was feared<\/em>, not a cardiovascular benefit. Testosterone remains a treatment for confirmed deficiency, not a tonic for ageing. The full account is in <a href=\"https:\/\/drsoaraweeurology.com\/2026\/09\/23\/testosterone-therapy-heart-safety-traverse\/\">testosterone and the heart<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Get Help the Same Day If Any of These Happen<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Chest pain, or breathlessness on less exertion than usual<\/strong><\/li>\n\n\n<li><strong>Pain, swelling or warmth in one calf<\/strong>, or sudden breathlessness with chest pain on breathing in<\/li>\n\n\n<li><strong>Sudden severe headache, one-sided weakness or numbness, or difficulty speaking<\/strong>, even if it passes<\/li>\n\n\n<li><strong>Complete inability to pass urine<\/strong> with a painfully full bladder<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Attend an emergency department or call <strong>1669<\/strong> in Thailand. These are symptoms anyone should act on regardless of what medication they take; listing them here is prudence rather than a claim that testosterone caused them. Do not stop a prescribed medicine on your own because of something you have read here \u2014 tell the doctor who prescribed it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Weighing all of this properly needs confirmed blood results and a monitoring plan rather than a trial-and-error prescription. The <a href=\"https:\/\/drsoaraweeurology.com\/services\/testosterone-replacement-therapy\/\">testosterone replacement therapy service page<\/a> covers diagnosis, treatment selection and long-term monitoring.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">What does testosterone therapy reliably improve?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">In men with a confirmed deficiency: sexual desire most consistently and soonest, then mood, energy and sense of well-being, then muscle mass and body fat over many months. It improves erectile function far less reliably than desire, because most erectile dysfunction is vascular rather than hormonal. It is not a treatment for diabetes, not a substitute for weight loss, there is no demonstrated cognitive or dementia benefit, and although it raises bone density on a scan the fracture trial found more fractures rather than fewer.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What are the risks of testosterone replacement therapy?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Suppression of sperm production, commonly to zero, with testicular shrinkage; a rising haematocrit, which produces no symptoms you could notice and most often forces a change; worsening of sleep apnoea; acne, breast tenderness or enlargement, fluid retention and mood changes. Prostate assessment and PSA are monitored throughout. In the TRAVERSE trial, erythrocytosis and clinical fractures rose significantly, while atrial fibrillation, pulmonary embolism and acute kidney injury were numerically higher but did not reach statistical significance.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Which TRAVERSE findings were statistically significant?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Two. Erythrocytosis, a rise in red cell count, was by far the clearest, which is why haematocrit is monitored throughout treatment. Clinical fractures rose by roughly 43% in the fracture subtrial. Atrial fibrillation, pulmonary embolism and acute kidney injury were each numerically higher on testosterone but did not reach statistical significance, and should not be described as established harms. An earlier version of this page did not make that distinction.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Is testosterone therapy contraindicated if I have had prostate cancer?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Not as an absolute rule any longer, though this page used to say so. Testosterone is not started in a man with known untreated prostate cancer, and prostate assessment before treatment exists precisely to avoid treating an undiagnosed cancer unknowingly. But in men who have been treated for prostate cancer, the old blanket prohibition is no longer supported: it is a carefully selected, shared decision made with the treating urologist, with the limits of the data stated openly.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Will testosterone therapy affect my fertility?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes, and this is the most important thing to settle before the first dose. Testosterone suppresses the brain signals driving the testicles, and sperm production commonly falls to zero, usually within a few months. Most men recover after stopping, over months to a couple of years, but recovery is not guaranteed and is slower after long-acting preparations. If you may want children, fertility-sparing options such as clomiphene citrate, hCG or an aromatase inhibitor raise your own testosterone instead, and a semen analysis beforehand is worth having.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Who should not start testosterone therapy?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Men actively trying to conceive, in whom fertility-sparing alternatives are used instead; men with untreated prostate cancer; and men with untreated erythrocytosis or untreated severe sleep apnoea, in whom those are addressed first. Men whose testosterone is normal should also not be treated, however tired they feel \u2014 the cause lies elsewhere and testosterone will not find it.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">How do I know whether I actually need it?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Both a low level confirmed on two separate early-morning blood tests and symptoms that fit. One without the other is not testosterone deficiency. Self-diagnosis on symptoms alone is unreliable, because fatigue, low mood, poor concentration and reduced libido are produced far more often by sleep debt, sleep apnoea, depression, alcohol, thyroid disease, medication or excess weight.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Book an Appointment<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Dr. Soarawee Weerasopone sees men\u2019s health and testosterone patients at <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok Hospital Headquarters<\/a> and at Samitivej Sriracha Hospital, Chonburi \u2014 Urology department <a href=\"tel:0880221445\">088-022-1445<\/a>. Questions about cost are answered by the hospital rather than by Dr. Soarawee \u2014 for Bangkok Hospital, by email to <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients \u2014 arrange it in advance by email to the Urology department at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. Because the diagnosis requires two early-morning blood tests, laboratory testing and examination still need an in-person visit. Samitivej Sriracha is in-person only.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">References<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular safety of testosterone-replacement therapy. <em>N Engl J Med<\/em>. 2023;389(2):107\u2013117.<\/li>\n\n\n<li>Snyder PJ, Bauer DC, Ellenberg SS, et al. Testosterone treatment and fractures in men with hypogonadism. <em>N Engl J Med<\/em>. 2024;390(3):203\u2013211.<\/li>\n\n\n<li>Bhasin S, Lincoff AM, Nissen SE, et al. Effect of testosterone on progression from prediabetes to diabetes in men with hypogonadism: a substudy of the TRAVERSE randomized clinical trial. <em>JAMA Intern Med<\/em>. 2024;184(4):353\u2013362.<\/li>\n\n\n<li>Coady PJ, Walia A, Oppenheimer A, Hernandez BS, Chidananda R, Hinojosa-Gonzalez DE, Weerasopone S, Kohn T, Khera M. Testosterone replacement therapy in male octogenarians: clinical outcomes and adverse event rates. <em>J Sex Med<\/em>. 2026;23(9):qdag258.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This article is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is educational only, is not medical advice, and does not create a doctor\u2013patient relationship. It gives no doses: those are set by the prescribing doctor, and testosterone therapy requires ongoing monitoring. Do not start, stop or change a prescribed treatment on your own. No diagnosis, prescription or individual medical advice is given through personal messaging channels or social media, and Dr. Soarawee operates no public social media account \u2014 any account offering private consultation in his name is fraudulent. Always consult a qualified healthcare professional before starting any medical treatment.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/11\/26\/testosterone-replacement-therapy\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2021\/11\/26\/testosterone-replacement-therapy\/\",\n      \"name\": \"Testosterone Replacement Therapy: The Honest Balance of Benefits and Risks\",\n      \"description\": \"What testosterone replacement therapy reliably improves in men with confirmed deficiency, what it does not, its effect on fertility and haematocrit, the modern position on prostate cancer, and which of the TRAVERSE findings reached statistical significance.\",\n      \"inLanguage\": \"en\",\n      \"datePublished\": \"2021-11-26\",\n      \"dateModified\": \"2026-08-29\",\n      \"lastReviewed\": \"2026-08-29\",\n      \"specialty\": \"https:\/\/schema.org\/Urologic\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#website\" },\n      \"author\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"reviewedBy\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"publisher\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"audience\": { \"@type\": \"MedicalAudience\", \"audienceType\": \"Patient\" },\n      \"about\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/11\/26\/testosterone-replacement-therapy\/#trt\" },\n      \"citation\": [\n        { \"@type\": \"ScholarlyArticle\", \"name\": \"Cardiovascular safety of testosterone-replacement therapy\", \"isPartOf\": { \"@type\": \"Periodical\", \"name\": \"The New England Journal of Medicine\" }, \"datePublished\": \"2023\", \"identifier\": \"10.1056\/NEJMoa2215025\" },\n        { \"@type\": \"ScholarlyArticle\", \"name\": \"Testosterone treatment and fractures in men with hypogonadism\", \"isPartOf\": { \"@type\": \"Periodical\", \"name\": \"The New England Journal of Medicine\" }, \"datePublished\": \"2024\", \"identifier\": \"10.1056\/NEJMoa2308836\" },\n        { \"@type\": \"ScholarlyArticle\", \"name\": \"Testosterone replacement therapy in male octogenarians: clinical outcomes and adverse event rates\", \"isPartOf\": { \"@type\": \"Periodical\", \"name\": \"The Journal of Sexual Medicine\" }, \"datePublished\": \"2026\", \"identifier\": \"10.1093\/jsxmed\/qdag258\" }\n      ],\n      \"disambiguatingDescription\": \"Corrected August 2026. An earlier version listed dementia prevention as a benefit and described prostate cancer as an absolute contraindication; both were revised. Revised again 29 August 2026: the page previously stated that TRAVERSE found more atrial fibrillation, pulmonary embolism and acute kidney injury without noting that none of those differences reached statistical significance, and treated the bone question as merely undemonstrated when the fracture subtrial found a statistically significant increase of approximately 43%. Erythrocytosis is identified as the clearest significant adverse finding. The octogenarian cohort cited here is a co-authored single-centre study of 46 men with a median follow-up of approximately 21 months, not three years as previously stated. Testosterone replacement at Bangkok Hospital Headquarters is provided as a transdermal gel or an injection; pellets, nasal gel and oral capsules are not offered. No doses are given on this page.\"\n    },\n    {\n      \"@type\": \"MedicalTherapy\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/11\/26\/testosterone-replacement-therapy\/#trt\",\n      \"name\": \"Testosterone replacement therapy\",\n      \"description\": \"Replacement of testosterone in men with a deficiency confirmed on two separate early-morning blood tests together with symptoms. Most consistent benefit is in sexual desire, followed by mood and energy, then body composition. Erectile function responds less reliably because most erectile dysfunction is vascular rather than hormonal. Bone mineral density improves on imaging but the TRAVERSE fracture subtrial found significantly more clinical fractures, so it is not indicated for bone protection.\",\n      \"indication\": {\n        \"@type\": \"MedicalIndication\",\n        \"description\": \"Symptomatic testosterone deficiency confirmed biochemically on two early-morning measurements. Not indicated for men with normal testosterone, not a treatment for diabetes or obesity, not indicated for fracture prevention, and not a tonic for ageing.\"\n      },\n      \"contraindication\": {\n        \"@type\": \"MedicalContraindication\",\n        \"description\": \"Men actively seeking to conceive, in whom clomiphene citrate, hCG or an aromatase inhibitor are used instead. Known untreated prostate cancer. Untreated erythrocytosis and untreated severe obstructive sleep apnoea require management first. Previously treated prostate cancer is no longer an absolute contraindication but a selected, shared decision with the treating urologist.\"\n      },\n      \"seriousAdverseOutcome\": [\n        { \"@type\": \"MedicalEntity\", \"name\": \"Erythrocytosis\", \"description\": \"The clearest and most statistically robust adverse effect in the TRAVERSE trial. Asymptomatic and detected only on blood testing; the commonest reason for dose reduction, change of route or a pause.\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Clinical fracture\", \"description\": \"Statistically significant increase of approximately 43% in the TRAVERSE fracture subtrial, around 3.5% versus 2.5%, despite improvement in bone mineral density on imaging.\" }\n      ],\n      \"adverseOutcome\": [\n        { \"@type\": \"MedicalEntity\", \"name\": \"Suppression of sperm production, commonly to azoospermia, with testicular atrophy; usually reversible over months to a couple of years but not guaranteed\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Worsening of obstructive sleep apnoea\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Gynaecomastia, acne, oily skin, fluid retention, mood changes\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Atrial fibrillation (numerically higher in TRAVERSE but NOT statistically significant)\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Pulmonary embolism (numerically higher in TRAVERSE but NOT statistically significant)\" },\n        { \"@type\": \"MedicalEntity\", \"name\": \"Acute kidney injury (numerically higher in TRAVERSE but NOT statistically significant)\" }\n      ],\n      \"followup\": \"Haematocrit, testosterone level, PSA and prostate assessment before starting and at intervals during treatment. Target is a level within the normal range with symptoms improved rather than the highest achievable level. Same-day emergency assessment for chest pain, breathlessness on reduced exertion, unilateral calf pain or swelling, stroke symptoms, or complete inability to pass urine. In Thailand the emergency number is 1669.\"\n    },\n    {\n      \"@type\": \"FAQPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/11\/26\/testosterone-replacement-therapy\/#faq\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/11\/26\/testosterone-replacement-therapy\/#webpage\" },\n      \"mainEntity\": [\n        {\n          \"@type\": \"Question\",\n          \"name\": \"What does testosterone therapy reliably improve?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"In men with a confirmed deficiency: sexual desire most consistently and soonest, then mood, energy and well-being, then muscle mass and body fat over many months. It improves erectile function far less reliably than desire, because most erectile dysfunction is vascular rather than hormonal. It is not a treatment for diabetes, not a substitute for weight loss, there is no demonstrated cognitive or dementia benefit, and although it raises bone density on a scan the fracture trial found more fractures rather than fewer.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"What are the risks of testosterone replacement therapy?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Suppression of sperm production, commonly to zero, with testicular shrinkage; a rising haematocrit, which produces no noticeable symptoms and most often forces a change; worsening of sleep apnoea; acne, breast tenderness or enlargement, fluid retention and mood changes. Prostate assessment and PSA are monitored throughout. 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Atrial fibrillation, pulmonary embolism and acute kidney injury were each numerically higher on testosterone but did not reach statistical significance, and should not be described as established harms.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Is testosterone therapy contraindicated after prostate cancer?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Not as an absolute rule any longer. Testosterone is not started in a man with known untreated prostate cancer, and prostate assessment before treatment exists to avoid treating an undiagnosed cancer unknowingly. For men who have been treated for prostate cancer, the old blanket prohibition is no longer supported: it is a carefully selected, shared decision made with the treating urologist, with the limits of the data stated openly.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Will testosterone therapy affect fertility?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Yes, and it should be settled before the first dose. Testosterone suppresses the brain signals driving the testicles and sperm production commonly falls to zero, usually within a few months. Most men recover after stopping, over months to a couple of years, but recovery is not guaranteed and is slower after long-acting preparations. Fertility-sparing options such as clomiphene citrate, hCG or an aromatase inhibitor raise the body's own testosterone instead.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"Who should not start testosterone therapy?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Men actively trying to conceive, in whom fertility-sparing alternatives are used instead; men with untreated prostate cancer; and men with untreated erythrocytosis or untreated severe sleep apnoea, in whom those are addressed first. Men whose testosterone is normal should also not be treated, however tired they feel.\" }\n        },\n        {\n          \"@type\": \"Question\",\n          \"name\": \"How do I know whether I need testosterone therapy?\",\n          \"acceptedAnswer\": { \"@type\": \"Answer\", \"text\": \"Both a low level confirmed on two separate early-morning blood tests and symptoms that fit. One without the other is not testosterone deficiency. Self-diagnosis on symptoms alone is unreliable, because fatigue, low mood, poor concentration and reduced libido are produced far more often by sleep debt, sleep apnoea, depression, alcohol, thyroid disease, medication or excess weight.\" }\n        }\n      ]\n    }\n  ]\n}\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>Testosterone therapy helps some men a great deal and is oversold to many more. Dr. Soarawee Weerasopone sets out what it reliably improves, what it does not, what it costs you in fertility, and what the largest safety trial actually found.<\/p>","protected":false},"author":185281453,"featured_media":10108,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"The real benefits and risks of testosterone replacement therapy, set out by a urologist \u2014 what improves and what does not, the effect on fertility, haematocrit and prostate monitoring, and what the TRAVERSE trial found.","jetpack_seo_html_title":"Testosterone Therapy: The Honest Balance of Benefit and Risk | Dr. Pom","jetpack_seo_noindex":false,"jetpack_seo_schema_type":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_wpcom_ai_launchpad_first_post":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"{title}\n\n{excerpt}\n\n{url}","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false,"jetpack_post_was_ever_published":false},"categories":[1363],"tags":[1532,1563,1564],"class_list":["post-4429","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-mens-health","tag-men-health","tag-testosterone","tag-testosterone-replacement-therapy"],"jetpack_publicize_connections":[],"jetpack_likes_enabled":false,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/pgZdrK-19r","jetpack_featured_media_url":"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2026\/04\/TRT-Pros-and-Cons.jpg?fit=1200%2C630&ssl=1","_links":{"self":[{"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/posts\/4429","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/users\/185281453"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/comments?post=4429"}],"version-history":[{"count":26,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/posts\/4429\/revisions"}],"predecessor-version":[{"id":11776,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/posts\/4429\/revisions\/11776"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/media\/10108"}],"wp:attachment":[{"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/media?parent=4429"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/categories?post=4429"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoaraweeurology.com\/km\/wp-json\/wp\/v2\/tags?post=4429"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}