As with any medical treatment, including testosterone therapy, there are potential side effects. These side effects are uncommon during testosterone therapy and, certainly, as good physicians we want to minimize any negatives while enhancing the positive benefits.
Every patient is different so it is important to individualize the low testosterone treatment. This requires the guidance of a license physician.
Positive Side Effects of Testosterone Therapy in Men
The technical term for low testosterone is hypogonadism. This means the testicles, for whatever reason, are producing too little testosterone and you are at risk for other health problems. Low testosterone causes your body to deliver less oxygen to your cells, increased risks of strokes and heart attacks (the heart is a muscle), bone loss, muscle loss, and, in many patients but not all, erectile dysfunction.
“Male hypogonadism is characterised by androgen deficiency and infertility. Hypogonadism can be caused by disorders at the hypothalamic or pituitary level (hypogonadotropic forms) or by testicular dysfunction (hypergonadotropic forms). Testosterone substitution is necessary in all hypogonadal patients, because androgen deficiency causes slight anemia, changes in coagulation parameters, decreased bone density, muscle atrophy, regression of sexual function and alterations in mood and cognitive abilities.” – Citation 1
Here is a brief list of the well-known benefits of testosterone therapy that most men experience in our treatment program:2
• Improved sexual desire, function and performance
• Improved bone density
• Increased muscle mass and strength
• Decreased body fat
• Better mood and quality of life
• More energy and better sleep
• Improve brain function and reduced risk of Alzheimer’s
• Better blood sugar regulation and decreased risk of diabetes
• More nitric oxide production and more oxygen delivered to cells
“Restoring testosterone levels to within the normal range by using testosterone replacement therapy can improve many of the effects of hypogonadism. Most importantly, these include beneficial effects on mood, energy levels and patients’ sense of well-being, sexual function, lean body mass and muscle strength, erythropoiesis and bone mineral density (BMD), cognition and some benefits on cardiovascular risk factors.” – Citation 2
“Testosterone is well known to help in libido, bone density, muscle mass, body composition, mood, erythropoiesis, and cognition. All these benefits made testosterone replacement therapy in the United States increase substantially over the past several years, with an increase of more than 500% in prescription sales of testosterone products since 1993.” – Citation 2
There are many more potential benefits such as increased confidence, improved work performance, and women finding you more attractive. Testosterone therapy can also help improve growth hormone levels and decrease bad cholesterol levels.
While testosterone therapy is not a “cure-all”, in our opinion, the benefits of testosterone therapy when done correctly greatly outweigh any potential risks. If side effects do occur, which is very rare, we are available to help you address them so you can continue to receive the benefits of optimal testosterone levels. The seattle testosterone replacement therapy doctors at Innovative Men’s Clinic are experts at balancing optimal T levels.
Potential Negative Side Effects That We Help You Prevent & Treat
There is a myth that testosterone causes breast enlargement, prostate problems, and mood swings. This is false. Estrogen, in excess, causes breast enlargement, prostate problems, and mood swings.
The side effects of excess estrogen can be treated and prevented. Testosterone can convert to estrogen and this is normal. As we age, testosterone declines and estrogen production increases. This is also considered normal. However, it is far from healthy unless you want to get in touch with your feminine side and have your chest muscles turn to fat and your prostate swell. In addition, “grumpy old man syndrome” is low testosterone and increased estrogen.
Elevated estrogen levels are also highly correlated with erection problems. Most guys will notice an insidious decline in their penis size as they get older. This is from less testosterone and too much estrogen. This can be very severe in men with diabetes who tend to convert very high amounts of their testosterone to estrogen.
Testosterone Converts to Estrogen and then feeds back to the brain to reduce Testosterone Production
By measuring your estrogen levels and using the proper doses of anti-estrogen medications we can prevent and treat any symptoms related to excess estrogen and this is relatively easy to do. In the past, inexperienced physicians would “freak out” if the patient reported breast enlargement (gynecomastia) and discontinue testosterone therapy despite the fact that estrogen is easy to reduce.
“Gynecomastia is an unusual side effect associated with testosterone replacement therapy (TRT) that has been traditionally treated with surgery, radiation, or discontinuation of testosterone supplementation. We report here our experience with two cases of gynecomastia in men undergoing TRT who were successfully treated with the aromatase inhibitor anastrozole.” – Citation 1
Another potential side effect of testosterone therapy is testicular shrinkage. This happens when your body sees that you have enough testosterone due to testosterone therapy and begins to make less which causes the testicles to get smaller. This can easily be treated with HCG or clomid because these medications increase your natural production. HCG and clomiphene stimulate your body to produce more testosterone.
“If patients with hypogonadotropic hypogonadism wish to father a child, spermatogenesis can be initiated and maintained by gonadotropin therapy (conventionally in the form of human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) or, more recently, purified or recombinant follicle stimulating hormone (FSH)).” Citation 2
“No adverse effect was identified after treatment. We conclude that hCG injection may be considered as a treatment for PADAM [partial androgen deficiency].” – Citation 3
Testosterone Cypionate Injections
This medication is used in men who make too little of a natural substance called testosterone. In males, testosterone is important for maintaining normal body functions, such as genitals, muscles, and bones. Testosterone belongs to a group of hormones known as androgens.
How to use testosterone cypionate IM
Watch the video: how to inject testosterone intramuscularly
Testosterone can be taken as an injection, a topical cream, as a tab under the tongue, or can be improved by increasing natural production with medications such as HCG. Testosterone cypionate is given by injection into the buttock or thigh muscle as directed by your doctor, usually once to twice weekly. Do not inject this medication into a vein (pulling back on the plunger before injecting to make sure no blood comes into the syringe will help prevent this). Your dosage is based on your medical condition, testosterone blood levels, and response to therapy.
If you are giving this medication to yourself at home, we will review proper use in the clinic and if you have any questions or concerns it is important to contact us as soon as possible. Always check the vial of testosterone for particles or color change before each use. If particles or color changes occur, do not use and contact us. All needles should be disposed of in a “sharps” container that can be purchased at and returned to most pharmacies (ie Rite Aid). Unused medication should be disposed of properly (contact us for instructions).
Use this medication regularly in order to get the most benefit from it. To help you remember, use a calendar to mark the days you will receive an injection. We always give a dosing schedule to each patient but if you have any questions be sure to contact us.
If you wish to discontinue testosterone therapy we will help you do it safely. It is important to avoid abrupt discontinuation. In such cases, it may take time for your body to begin producing adequate testosterone again, and withdrawal reactions (such as tiredness, weakness, depression) may occur. To prevent withdrawal reactions, your doctor may reduce your dose gradually and use other medications to stimulate your natural production. Consult your doctor for more details, and report any withdrawal reactions immediately.
Testosterone is classified as a controlled substance because some men (ie body builders) may abuse it in an unsafe way. Always ask us before increasing your dose or using it more frequently. Excessive (abuse) use of testosterone may increase serious side effects (such as increased risk for heart disease, stroke, liver disease, ruptured tendons/ligaments). Bodybuilders who abuse testosterone use levels 10x higher than we would ever prescribe for therapeutic benefits.
Possible Side Effects of Testosterone Therapy
WebMD lists a number of possible side effects from testosterone cypionate injections. The majority of these side effects are very rare when testosterone is used properly and estrogen levels are being addressed. In our effort to deliver the highest quality to you, we ask you to review the possible side effects and ask us any questions so we can ensure you understand how we are addressing these issues for you.
Some side effects that we have NEVER seen but are theoretically possible include:
• Nausea and/or vomiting
• Skin color changes (this may happen if you have liver problems)
We commonly see this side effect:
• Increased sexual interest (libido)
We rarely see these side effects and have ways to address them:
• Decreased sexual interest
• Oily skin
• Hair loss
• Pain and redness at the injection site may also occur
If any of these effects occur please tell your doctor at Innovative Men’s Clinic promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is much greater than the risk of side effects and has created a plan to reduce any possible side effects and will help you address any side effects that may occur. Most people using this medication are free of side effects when it is used at normal doses as prescribed by your doctor.
Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as anxiety, depression, increased anger), trouble sleeping/snoring, signs of serious liver disease (such as persistent abdominal pain/nausea, unusual tiredness, yellowing eyes/skin, dark urine). Most men using testosterone therapy notice a slight increase in their aggressiveness but because these side effects were found in men taking oral testosterone (causes liver problems which leads to skin color changes) or abusing testosterone, it is unlikely these will be an issue for you.
Tell your doctor immediately if any of these unlikely but serious side effects occur: trouble urinating, breast swelling/tenderness (too much estrogen), too frequent/prolonged erections.
Rarely, males may have a prolonged erection lasting 4 or more hours that can cause discomfort. If this occurs, call us at (425) 455-1700 or seek immediate medical attention, or permanent problems could occur.
This medication can decrease sperm production, an effect that may lower male fertility. Consult your doctor for more details about how hCG can be used to help maintain your fertility (see additional handout).
This medication can cause your body to hold on to extra body water (edema). Some men experience this with testosterone injections and there are ways to address this as it is due to either too much estrogen or from the cypionate. Generally,switching to topical testosterone will resolve this issue.
Excess water retention can increase your risk of heart failure. Tell your doctor immediately if any of these unlikely but serious signs of water retention or heart failure occur: decreased exercise ability, hands/ankles/feet swelling, unusual tiredness, shortness of breath while lying down.
In reality, research support the use of testosterone therapy in heart failure as it improves heart function:
“Heart failure is a chronic clinical syndrome with very poor prognosis. Despite being on optimal medical therapy, many patients still experience debilitating symptoms and poor quality of life. In recent years, there has been a great interest in anabolic hormone replacement therapy – namely, growth hormone and testosterone – as an adjunctive therapy in patients with advanced heart failure. It has been observed that low levels of growth hormone and testosterone have been associated with increased mortality and morbidity in patients with heart failure. Animal studies and clinical trials have shown promising clinical improvement with hormonal supplementation.”
“Growth hormone has been shown to increase ventricular wall mass, decrease wall stress, increase cardiac contractility, and reduce peripheral vascular resistance, all of which might help to enhance cardiac function, resulting in improvement in clinical symptoms. Likewise, testosterone has been shown to improve hemodynamic parameters via reduction in peripheral vascular resistance and increased coronary blood flow through vasodilation, thereby improving functional and symptomatic status. To date, growth hormone and testosterone therapy have shown some positive benefits, albeit with some concerns over adverse effects. However, large randomized controlled trials are still needed to assess the long-term safety and efficacy.” – Citation 4
Allergic reactions to testosterone cypionate injections are very rare. Our testosterone cypionate is typically in an base of grapeseed oil or sesame oil. Get medical help immediately if you notice any signs of a serious allergic reaction, including: rash,itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your Innovative Men’s Clinic doctor immediately.
Before using testosterone, tell your doctor if you are allergic to it, grapeseed, or sesame seed; or if you have any other allergies. This product may contains inactive ingredients (sesame oil or grapeseed oil), which can cause allergic reactions or other problems in some men.
This medication should not be used if you have prostate or breast cancer.
Before using this medication, tell your doctor your medical history, especially of: heart disease (such as heart failure, chest pain, heart attack), liver problems, kidney problems, other types of cancer, high cholesterol, high blood pressure, enlarged prostate, sleep apnea, or diabetes. This will help your doctor determine the safest approach to balancing your hormones.
If you have diabetes, this product may decrease your blood sugar levels, which is usually a good thing but we want to prevent your blood sugar from decreasing too much. Check your blood sugar levels regularly to make sure your blood sugar is not going too low. Tell your doctor immediately if you have symptoms of low blood sugar, such as increased hunger, dizziness, or unusual sweating. Your diabetes medication may need to be reduced.
If you use coumadin or warfarin to thin your blood, this product may increase the effectiveness of your blood thinner. Check your protime and INR regularly and advise your cardiologist that you may need to reduce your coumadin/warfarin dose. Tell your doctor immediately if you have symptoms of increased bruising.
1. Treatment of testosterone-induced gynecomastia with the aromatase inhibitor, anastrozole. Rhoden EL, Morgentaler A. Int J Impot Res. 2004 Feb;16(1):95-7.
2. Zitzmann M. Hormone substitution in male hypogonadism. Mol Cell Endocrinol. 2000 Mar 30;161(1-2):73-88
3. Nazem Bassil, Saad Alkaade, and John E Morley. The benefits and risks of testosterone replacement therapy: a review. Ther Clin Risk Manag. 2009; 5: 427–448. Published online 2009 June 22. PMCID: PMC2701485
4. Tsujimura A et al. Treatment with human chorionic gonadotropin for PADAM: a preliminary report. Aging Male. 2005 Sep-Dec;8(3-4):175-9.
5. Nguyen CT, Aaronson A, Morrissey RP, Agarwal M, Willix RD, Schwarz ER. Myths and truths of growth hormone and testosterone therapy in heart failure. Expert Rev Cardiovasc Ther. 2011 Jun;9(6):711-20. doi: 10.1586/erc.11.25.