Stillpoint Integrative Men’s Health
Testosterone Therapy Side Effects: What to Expect and How to Manage Them
What are the side effects of testosterone therapy?
Most men tolerate testosterone replacement therapy (TRT) well. Possible side effects include mild acne, oily skin, water retention, or temporary infertility—all of which are rare, manageable, and reversible under proper medical supervision. Routine lab monitoring helps ensure safe and balanced treatment.
Understanding Testosterone Therapy
Like any medical treatment, testosterone replacement therapy (TRT)—or as we call it, testosterone optimization therapy (TOT)—can have side effects.
Fortunately, these effects are usually rare, mild, and easily managed when treatment is supervised by an experienced provider and guided by routine lab monitoring.
At Stillpoint Integrative Psychiatry & Wellness, our goal is not just to replace testosterone—it’s to optimize your overall well-being by restoring balance, minimizing side effects, and tracking your progress through every phase of care.
How Side Effects Happen
When a man begins TRT, he’s introducing exogenous testosterone (testosterone from outside the body).
Because levels are often low before treatment, the body may take time to adjust to its new hormonal environment—especially if levels rise too quickly.
Testosterone is metabolized into two key hormones:
- Dihydrotestosterone (DHT) — a stronger androgen
- Estradiol (E2) — a form of estrogen
Most side effects occur when one of these pathways becomes overactive—either too much DHT or too much E2.
DHT-Related Side Effects
When DHT levels are elevated, men may notice:
- Mild acne or oily skin
- Benign prostate growth (not cancerous)
- Thinning hair or male-pattern balding (in genetically predisposed men)
These effects are uncommon and easily managed by:
- Adjusting the testosterone dosage
- Switching to a different delivery method
- Supporting the body with diet and skin care
(For reference, these are the same hormonal effects seen in teenage boys during puberty—typically short-lived and manageable.)
Estradiol (E2)–Related Side Effects
When estradiol levels rise too high, symptoms may include:
- Mood swings or irritability
- Breast tissue sensitivity or puffiness
- Water retention or bloating
- Lower libido or erectile issues
This happens because excess testosterone can convert into estrogen.
At Stillpoint, we monitor and balance estrogen levels throughout your treatment to prevent these issues. Adjustments can include small dose changes or, if needed, adding medications or supplements that help regulate estrogen naturally.
Prostate Health and Testosterone
Many men worry that testosterone therapy may cause prostate cancer.
While testosterone can slightly enlarge the prostate in some men, this is typically benign and not associated with cancer.
In fact, multiple studies show that low testosterone may actually increase prostate cancer risk.
To ensure safety, we monitor your prostate-specific antigen (PSA) levels before starting therapy and during treatment at regular intervals.
Fertility Considerations
One important (and reversible) effect of TRT is temporary infertility.
When external testosterone is introduced, the brain reduces its production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH)—the signals that tell the testes to make sperm.
This can lower sperm count during treatment.
For men who wish to preserve fertility, we can add human chorionic gonadotropin (hCG) to the regimen, which keeps the natural testosterone and sperm production pathways active.
Elevated Hematocrit (Erythrocytosis)
Testosterone can increase red blood cell production, which may thicken the blood (a condition called erythrocytosis).
We regularly check your hematocrit levels. If they exceed 54%, we typically recommend blood donation every 3 months to keep levels in a safe range.
Other Possible Changes
Occasionally, men experience:
- A mild decrease in HDL (“good”) cholesterol
- Increased body hair
- A deeper voice
- Enhanced libido and energy (which most men consider a positive effect!)
Each of these is monitored during routine labs and can be adjusted if necessary.
The Bottom Line
Adverse effects from testosterone therapy are rare, predictable, and manageable.
With the right dosing, regular lab work, and individualized care, most men experience significant improvements in energy, mood, muscle tone, and vitality—without complications.
At Stillpoint Integrative, our approach to testosterone therapy
emphasizes safety, optimization, and balance.
If you’re ready to explore whether TRT is right for you, schedule a consultation today and experience what true hormonal balance can do for your life.
Explore the full Testosterone Optimization Therapy guide to learn how Stillpoint customizes treatment plans, monitors safety, and optimizes hormonal balance for lasting results.
Frequently Asked Questions About Testosterone Therapy Side Effects
What are the most common side effects of testosterone therapy?
Most men tolerate TRT well. When side effects occur, they’re usually mild—acne/oily skin, water retention, breast tissue sensitivity, mood shifts, or a temporary rise in hematocrit. These are typically dose- or metabolite-related and are manageable with careful monitoring.
How do you manage high estradiol (E2) on TRT?
We start with dose timing/adjustment and assess lifestyle contributors. If needed, we consider supportive measures or targeted medication to optimize estrogen balance—always using the lowest effective intervention to maintain symptom relief and safety.
Will TRT affect my fertility?
TRT can temporarily lower sperm count by suppressing LH/FSH signals. If you wish to preserve fertility, we can add hCG to help maintain testicular function and sperm production during therapy.
What if my hematocrit goes up (erythrocytosis)?
We monitor hematocrit routinely. If it exceeds safe thresholds (e.g., 54%), we adjust your regimen and often recommend periodic blood donation. Most men normalize with these simple steps.