Testosterone Replacement Therapy
For men in New York with signs or symptoms of low testosterone, associated with low testosterone on blood work, TRT or testosterone replacement therapy, is an evidence-based medical intervention that restores serum testosterone into the appropriate range and often improves disruptive clinical concerns.
What are symptoms of low or inadequate testosterone in men?
- Low libido or sex drive
- Reduces sexual function and performance
- Low muscle mass and strength (when paired with resistance exercise) or inability to gain muscle with resistance work
- Reduced bone density
- Low mood, increased irritability, or depression
- Fatigue or brain fog
- Difficulty with focus and decision making
- Weight gain or weight loss resistance
Who should consider using Testosterone Replacement Therapy?
✓ When both symptoms and confirmatory laboratory results are present, TRT is an effective, evidence based intervention for men who wish to incorporate this into their wellness regimen and who meet criteria for using this treatment.
✓ When used appropriately and with proper monitoring, many men experience measurable, meaningful improvements in energy, sexual health, and body composition.
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What are the risks of Testosterone Replacement Therapy (TRT)?
Cardiovascular Risks: TRT can elevate red blood cell counts, theoretically increasing the risk of blood clots, heart attacks, and stroke. While some studies suggest no increased risk, others found a higher incidence of cardiovascular events, and FDA warnings remain in place due to these conflicting results.
Prostate and Cancer Risks: TRT may worsen benign prostatic hyperplasia (BPH), and, while it does not directly cause prostate cancer, it is contraindicated in patients with known or high-risk prostate or breast cancer. In older men, monitoring is crucial. See below for more details.
Fertility and Reproductive Risks: TRT suppresses endogenous testosterone production and can lower sperm count, potentially leading to infertility—especially concerning for younger men wishing to preserve fertility. Testicular shrinkage and enlarged breasts can also occur.
Metabolic and Other Risks:
- Increases the risk of acne and oily skin, as well as hair loss, which may affect psychological well-being.
- May worsen sleep apnea and peripheral edema; men with existing sleep disorders should be monitored.
- Overproduction of red blood cells (polycythemia), raising clot risk.
Therefore TRT requires baseline evaluation and ongoing regular follow-up. Annual prostate exam assessment are required.
Does TRT increase prostate cancer risk?
- Testosterone replacement therapy (TRT) does not appear to increase the risk of developing prostate cancer in men with documented low testosterone levels and low baseline prostate-specific antigen (PSA), based on large randomized trial and population-level data from recent years.
- Evidence from Clinical Trials: A 2023 review including nearly 150,000 men demonstrated no increased risk for aggressive prostate cancer among those treated with TRT, reinforcing the findings of controlled trials. Several meta-analyses and cohort studies have shown no increased odds of prostate cancer with TRT compared to placebo; this safety profile appears to extend even to men previously treated for prostate cancer and those on active surveillance.
What about for men at higher risk for prostate cancer?
- Most data apply to men screened for low-risk prostate cancer (normal baseline PSA and no high-risk genetic predisposition).
- The effect of TRT in men with a history of high-risk prostate cancer, those on long-term or supraphysiologic doses, or those with elevated PSA remains less certain and requires specialist oversight.
- PSA monitoring remains recommended during TRT, as elevations can signal underlying disease, and shared decision-making about biopsy or urology referral is advised if significant changes occur.
What is the Recommended PSA Monitoring Schedule?
- Baseline PSA and digital rectal examination (DRE) before starting TRT for men over 40 years old or those at risk.
- Repeat PSA and DRE at 6 months after starting TRT, then at 12 months, and annually thereafter if results are stable.
When to refer to a Urologist?
If any of the following occur:
- PSA rises by more than 1.4 ng/mL above baseline within 12 months of starting TRT.
- PSA exceeds 4.0 ng/mL at any time (or 3.0 ng/mL in high-risk populations).
- A prostate nodule or induration is detected on DRE.
- Significant worsening of lower urinary tract symptoms occurs.
What are the benefits I should expect to receive from TRT?
✓ Improved libido and sexual function
✓ Increased lean mass and strength when combined with resistance exercise
✓ Improved bone density
✓ Improved mood, focus and mental energy
How to assess for low testosterone?
- We obtain a fasting morning total and free testosterone blood work (repeated to confirm low values).
- We then perform a symptom assessment, review any associated health conditions such as cardiovascular disease, sleep apnea, desire for future fertility, prostrate cancer risk and — if starting TRT — establish a monitoring plan that includes periodic testosterone levels, hematocrit, and prostate surveillance as indicated.
How do I get started?
- Men who are interested in assessing whether TRT is appropriate for them should contact our office to set up an appointment to create a personalized assessment treatment plan.
What monitoring is required on TRT?
- Patients on testosterone replacement therapy (TRT) require regular monitoring of blood tests and symptoms to ensure safety and effectiveness throughout the course of treatment.
Laboratory Tests we recommend:
- Total and Free Testosterone: Measured to verify that levels are in the physiologic range and to assess clinical response.
- Estradiol (Estrogen): Monitored due to possible aromatization, which can lead to side effects like gynecomastia or mood changes.
- Hematocrit and Hemoglobin: Because TRT can stimulate red blood cell production, these must be checked for polycythemia or hyperviscosity; hematocrit should remain below 54%.
- PSA (Prostate-Specific Antigen): Assessed to screen for prostate issues, especially in men at risk or age 40+.
- Lipid Panel: Evaluates cholesterol changes that might increase cardiovascular risk.
- Liver Function (AST, ALT) and SHBG: Liver enzymes are checked when oral testosterone is used or in patients with liver concerns; SHBG affects free testosterone measurement.
- CBC (Complete Blood Count): Monitors overall red and white cell numbers for early detection of adverse effects.
Who is an appropriate candidate?
- Men with persistent morning low testosterone and symptoms/signs of testosterone deficiency (fatigue, low libido, erectile dysfunction, loss of morning erections, decreased muscle mass, low bone density).
Symptom and Safety Tracking
- Patients should track their Energy, mood, cognition, libido, sleep, and muscle strength.
- Any side effect or new symptoms should prompt additional monitoring and provider evaluation.
How do we monitor progress?
- Before Starting TRT: Baseline panel for all above labs.
- First 6-12 Weeks: Early check to verify response and screen for adverse effects as dose titration occurs.
- Every 6 Months (ongoing): Regular panels for hormone levels, PSA, hematocrit, hemoglobin, and symptom review.
- Annually: Comprehensive metabolic, lipid, and prostate health assessment, plus periodic symptom tracking and review.
Summary Points
★ Monitoring is critical for optimizing efficacy of TRT and minimizing risk.
★ Testing frequency is highest in the initial phase and can be reduced after clinical and lab goals have been attained.
★ Both lab results and symptom tracking are essential for clinical decision-making.
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Testosterone Replacement Therapy Near Me?
Testosterone replacement therapy (TRT) for men is available for Long Island, New York males in Nassau, Suffolk, Westchester, Manhattan, Kings, Bronx, Queens and Brooklyn counties, including Port Washington, Manhasset, Roslyn, Great Neck, Brookville, Cedarhurst, East Meadow, East Rockaway, Elmont, Floral Park, Franklin Square, Freeport, Garden City, Hempstead, Hewlett, Inwood, Lawrence, Levittown, Lynbrook, Merrick, Mineola, New Hyde Park, Valley Stream, Woodmere, Oceanside, Rockville Centre, Roosevelt, Seaford, Uniondale, Albertson, Carle Place, Floral Park, Glenwood, Greenvale, Kings Point, Westbury, Atlantic Beach, Baldwin, Bellerose, Bellmore, Bethpage, Williston Park, Bayville, Bethpage, Farmingdale, Glen Head, Glenwood Landing, Greenvale, Hicksville, Jericho, Locust Valley, Massapequa, Mill Neck, Oyster Bay, Plainview, Sea Cliff, Syosset, Woodbury, Amityville, Babylon, Copiague, Deer Park, Lindenhurst, Cold Spring Harbor, Commack, Northport, Huntington, Melville, and many more fine New York communities.
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