TRT: what clinical guidelines say about testosterone therapy

What is TRT?

TRT stands for testosterone replacement therapy. It is intended for men with hypogonadism, meaning their bodies do not produce enough testosterone. The cause may lie in the testes (primary hypogonadism) or in the hypothalamic-pituitary axis (secondary hypogonadism).

A diagnosis with two conditions

The 2018 Endocrine Society guideline sets two conditions for the diagnosis:

• Symptoms or signs consistent with testosterone deficiency.
• Unequivocally and consistently low testosterone, confirmed by repeated early-morning, fasting measurements in a reliable laboratory.

It advises against routine screening of the general population and recommends looking for the cause of the deficiency before any treatment.

Monitoring and when TRT is not advised

Treatment is prescribed and aims for testosterone in the mid-normal range. It comes with medical monitoring, including haematocrit and, depending on age and profile, prostate risk assessment.

The same guideline advises against starting TRT in several situations, for example: plans to father a child soon, prostate or breast cancer, elevated haematocrit, or a recent cardiovascular event.

Fertility and cardiovascular safety

Testosterone taken from an outside source suppresses the pituitary hormones LH and FSH, which drive sperm production. A WHO study published in 1990 even explored this effect as a male contraceptive method. TRT is therefore not a fertility treatment, and can instead cause infertility.

On cardiovascular safety, the TRAVERSE trial (NEJM 2023) enrolled hypogonadal men at high cardiovascular risk. TRT did not increase major cardiovascular events compared with placebo. Atrial fibrillation, acute kidney injury and pulmonary embolism were, however, more frequent.

Where Velia Labs stands

Testosterone medicines are prescription-only in France and the European Union, and testosterone is among the anabolic agents prohibited by the World Anti-Doping Agency. Velia Labs does not sell testosterone, and its research peptides are not an alternative to TRT. This article is not medical advice: hormone results should be interpreted with a doctor.

For laboratory reagent documentation, see research peptides: definition and documentation.

Sources

• Bhasin et al., Endocrine Society 2018: testosterone therapy in hypogonadism
• Lincoff et al., NEJM 2023: the TRAVERSE trial
• WHO, Lancet 1990: testosterone-induced azoospermia
• WADA: the Prohibited List