Is TRT safe? Risks, benefits, & how to access safely

Testosterone replacement therapy (TRT) is one of the most talked-about treatments in men’s health. Some see it as a way to restore energy and improve sexual health, while others worry about risks to the heart or prostate. But in reality, it’s a little more nuanced. TRT can be safe and effective when prescribed for the right reasons and monitored carefully, but it’s not for everyone.¹

What is TRT?

Testosterone replacement therapy is a medical treatment designed to bring testosterone levels back into a healthy range. It’s usually prescribed for men with hypogonadism, a condition where the body produces too little testosterone.¹ This can happen because of damage to the testicles or brain centres that control hormones, or it can develop later in life due to ageing and related health conditions such as obesity and diabetes.¹

Treatment comes in different forms, including gels, injections, patches, or capsules. The choice depends on lifestyle, preferences, and how the body responds. While it’s sometimes portrayed as a lifestyle booster, TRT isn’t meant for men who simply want to increase their hormone levels. It’s a treatment for a diagnosed medical condition.

Is TRT safe?

The question “is TRT safe?” has been debated for years. Much of the concern comes from older studies that raised questions about heart attacks and strokes in men on TRT. 

Large studies involving tens of thousands of men have shown that when treatment is prescribed properly and monitored, TRT doesn’t increase the risk of cardiovascular problems. In fact, low testosterone itself has been linked to poorer heart health.¹

The same is true for prostate cancer. For decades, it was feared that raising testosterone would fuel prostate cancer growth. Modern research shows no evidence of this. The “saturation hypothesis” suggests that once the prostate has enough testosterone to function, adding more doesn’t make it grow further. Clinical trials confirm that while TRT may cause small rises in PSA levels, it doesn’t raise prostate cancer risk when men are monitored.¹

Is TRT safe for older men?

Older men with clear symptoms and confirmed low testosterone can benefit from TRT. The large T Trials in the United States found that men over 65 saw improvements in sexual function, energy, and mood without added safety concerns.² The key is careful diagnosis and ongoing checks.

Is TRT safe for younger men?

Younger men can also develop hypogonadism, often due to injury, genetic conditions, or pituitary disorders. In these cases, TRT can be a safe and effective treatment. However, men in their 20s or 30s who want to father children should avoid it, since testosterone therapy can reduce sperm production and fertility.³

Is TRT safe for women?

TRT is rarely prescribed to women, but in certain cases very low doses may be used, such as for women with hypoactive sexual desire disorder.⁴ This should only ever be managed by a specialist, since the risks and benefits differ from men.

TRT risks

TRT is not risk-free, but the risks are well understood and manageable with medical supervision. Men on therapy may develop a higher red blood cell count, which can increase the risk of blood clots if not monitored. PSA levels can rise, which is why prostate checks remain important. Some men notice acne, oily skin, or mood changes, and fertility can be reduced during treatment.⁵

The biggest risks come when TRT is used without proper diagnosis, at excessive doses, or obtained from unregulated sources.⁶ Under medical supervision, with regular blood tests, the risks are significantly reduced.

TRT benefits

The benefits of TRT are often the reason men seek treatment in the first place. Sexual health is where the strongest evidence lies. Studies show TRT improves desire, erectile function, and satisfaction in men with low testosterone. It can also reduce fatigue, improve mood, and help restore a sense of wellbeing.⁷

Physical benefits are also important. Men on TRT often see increased lean muscle, reduced fat mass, and stronger bones. Some studies suggest improvements in insulin sensitivity, which may support men with type 2 diabetes or metabolic problems.⁸ For many, these changes lead to more energy and greater confidence in daily life.

How to take TRT safely

The safest way to access TRT is through a healthcare professional who specialises in men’s health. Proper diagnosis is the first step. Blood tests should confirm low testosterone, ideally taken in the morning, and symptoms such as low sex drive or tiredness should also be present.

If TRT is prescribed, the form of treatment (gel, patch, injection, or capsule) will be chosen by the clinician based on the outcomes of a consultation with their patient.  Regular monitoring is essential. This means blood tests to check testosterone levels, red blood cell counts, and prostate health, alongside reviews of symptoms and any side effects.

Lifestyle changes remain important too. Exercise, diet, and weight management can improve testosterone naturally and support the benefits of therapy. TRT works best when combined with healthy habits.

The numan take

So, is TRT safe? The evidence shows that TRT is safe when used correctly, for men with genuine testosterone deficiency, and with proper monitoring. It’s not a shortcut for ageing or a replacement for healthy living, but it can be life-changing for those struggling with true hypogonadism. For men who meet those criteria, TRT can restore balance and improve both health and quality of life.

References

1. ^{Corona G, Sforza A, Maggi M. Testosterone replacement therapy: Long-term safety and efficacy. World J Mens Health. 2017;35(2):65–76.}

2. ^{Yeap BB, Tran C, Douglass CM, McNeil JJ. Testosterone therapy in older men: Present and future considerations. Drugs Aging. 2025;42(6):501–12.}

3. ^{Bassil N, Alkaade S, Morley JE. The benefits and risks of testosterone replacement therapy: a review. Ther Clin Risk Manag. 2009;5(3):427–48.}

4. ^{Reis SLB, Abdo CHN. Benefits and risks of testosterone treatment for hypoactive sexual desire disorder in women: a critical review of studies published in the decades preceding and succeeding the advent of phosphodiesterase type 5 inhibitors. Clinics (Sao Paulo). 2014;69(4):294–303.}

5. ^{Osterberg EC, Bernie AM, Ramasamy R. Risks of testosterone replacement therapy in men. Indian J Urol. 2014;30(1):2–7.}

6. ^{Handelsman DJ. Testosterone: use, misuse and abuse. Med J Aust. 2006;185(8):436–9.} 

7. ^{Rizk PJ, Kohn TP, Pastuszak AW, Khera M. Testosterone therapy improves erectile function and libido in hypogonadal men. Curr Opin Urol. 2017;27(6):511–5.} 

8. ^{Traish AM. Testosterone and weight loss: the evidence: The evidence. Curr Opin Endocrinol Diabetes Obes. 2014;21(5):313–22.}