What Is Hormone Replacement Therapy for Men, and How Does It Work?

You’ve probably heard of hormone replacement therapy (HRT) for women dealing with symptoms of menopause, but hormone treatment can be beneficial for men, too—using testosterone instead of estrogen. 

As men age, testosterone levels naturally decline, which commonly leads to symptoms like fatigue, reduced muscle mass, low libido, erection issues, and mood changes that can affect quality of life. 

For some guys, making lifestyle adjustments is enough to get things back on track, but for others, HRT may be warranted.

Below, explore how HRT works, its benefits and risks, and what you need to know before considering it.

Testosterone is sort of like your body’s internal motivational speaker. It keeps your energy up, muscles strong, and libido ready to go. 

But as time marches on, testosterone levels tend to dip. And that’s where HRT comes in. 

HRT is a general term for medical treatments that supplement hormones in your body. In men, HRT is aimed to restore testosterone levels to a healthy range when your body isn’t producing enough on its own, which is why it is often called testosterone replacement therapy, or TRT.

Testosterone isn’t just about feeling macho—it’s a critical player in a lot of behind-the-scenes action, like building muscle, keeping bones strong, regulating mood, and maintaining sexual health. If your testosterone’s low, you may start feeling like a dialed-down version of your former self. 

Here’s how it works: Testosterone replacement therapy uses synthetic (manufactured) or bioidentical testosterone to supplement what your body is no longer making.  

The goal of TRT isn’t to turn you into a gym bro but to bring your levels back into the normal range—enough to feel good but not so much that you start sprouting hair in weird places.

There are a few ways to get testosterone into your system, depending on your preferences, including: 

• Injections (the most common form of TRT)

• Gels to apply topically

• Patches to wear on your skin

• Pellets, which are tiny implants a doctor inserts under your skin that gradually release testosterone 

Once you start TRT, the effects aren’t immediate, but you’ll typically notice improvements in energy, mood, and other symptoms over the course of a few weeks to months. It’s a process of recalibration. 

Along the way, your healthcare provider will monitor your testosterone levels to make sure you’re not overdoing it. When it comes to testosterone, it’s good to be within a normal range. Going above and beyond isn’t better, and too much even comes with health risks. 

So TRT is available for men who could use a hormone boost to get back to normal—but how do you know if you need one?

Low testosterone, often called "low T," or hypogonadism, can show up in ways that might surprise you. If you're experiencing any of the following symptoms, it might be worth talking to your healthcare provider about getting your T levels checked: 

• Fatigue and low energy. Feeling constantly drained, even after a good night's sleep.

• Decreased libido. A noticeable drop in sexual desire or interest.

• Erectile dysfunction. Difficulty achieving or maintaining an erection.

• Mood changes. Increased irritability, feelings of sadness, or even signs of depression.

• Loss of muscle mass and strength. Struggling with physical activities that used to be easy.

• Increased body fat. Especially around the belly, called visceral fat, often paired with reduced muscle definition.

• Weakened bones. A higher risk of fractures due to lower bone density.

• Mental changes. Trouble concentrating, memory issues, or general "brain fog."

• Reduced endurance. Difficulty keeping up with physical activities or exercise routines that you’ve been used to.

• Thinning hair. A loss of facial, scalp, pubic or body hair that seems unusual for your age.

• Low motivation or drive. Feeling unmotivated or less ambitious than usual.

Symptoms of low T can vary in severity and might not all appear at once. While they’re not exclusive to low testosterone, if they’re affecting your daily life, it’s a good idea to get your hormone levels tested.

While it’s not a quick fix, HRT can help you feel more like yourself again. Here are some of the potential perks.

• Increased energy. Say goodbye to that constant exhaustion. With balanced testosterone levels, you may find yourself powering through your day with renewed vigor.

• Improved mood. Low testosterone can contribute to irritability, sadness, or even mild depression. HRT may help stabilize your mood, leaving you feeling more positive and emotionally balanced.

• Stronger sex drive and sexual function. One of the most talked-about benefits is sexual: a resurgence in sexual desire and improved performance, addressing one of the more frustrating effects of low testosterone.

• Increased muscle mass and strength. Testosterone plays a key role in muscle growth. With HRT, you may notice an easier time building and maintaining lean muscle, making those workouts more effective.

• Reduced body fat. By improving muscle-to-fat ratio, testosterone therapy can help with weight management, particularly if you’ve noticed stubborn fat accumulation around your midsection.

• Better bone health. Testosterone supports bone density, which means HRT can reduce your risk of fractures and osteoporosis as you age.

• Better overall quality of life. By addressing the symptoms of low testosterone, HRT can help you feel more confident, capable, and in control of your body and mind.

While hormone replacement therapy can offer significant benefits, it’s not without potential risks and side effects. Understanding these is important for making an informed decision about whether HRT is right for you: 

• Cardiovascular risks. Some studies suggest that HRT could increase the risk of heart-related issues, such as high blood pressure, blood clots, or heart attack, especially in men with pre-existing conditions. However, the risk appears to be higher with long-term HRT use. Regular cholesterol screening and other heart health monitoring is a good idea regardless. The FDA has recently removed the cardiovascular risk warning from testosterone labels based on recent studies showing no increased risk of major cardiac events. However, the FDA requires a note that it may raise blood pressure.

• Prostate health concerns. There is ongoing debate about whether testosterone therapy could accelerate the growth of existing prostate cancer. While it’s not believed to cause cancer, it’s important to discuss your prostate health history with your doctor.

• Fertility issues. Testosterone therapy can suppress natural testosterone production and sperm production, potentially leading to infertility in the long run. This is particularly important for men planning to have children.

• Sleep apnea. Testosterone can worsen sleep apnea or cause it in men who don’t already have the condition. If you’re already a snorer, this is worth monitoring.

• Gynecomastia. The hormonal shifts that occur when you’re on HRT can sometimes cause enlarged breast tissue, which may be uncomfortable or undesirable for some men.

• Mood swings. While many men experience improved mood, some may notice increased irritability or emotional instability, particularly if testosterone levels are too high.

• Skin reactions. Some forms of testosterone, like gels or patches, can cause skin irritation at the application site. Acne or oily skin may also occur as testosterone levels rise.

• Excess red blood cells. HRT can increase red blood cell production and mass (called erythrocytosis), which may thicken the blood and elevate the risk of blood clots. Regular blood tests are vital to catch this early.

• Fluid retention. Some men experience swelling or water retention, particularly in the ankles or feet, though this side effect is usually temporary.

• Testicular shrinkage. As the body adjusts to receiving testosterone externally, the testicles may shrink in size due to reduced natural production. This is also called testicular atrophy.

Starting HRT isn’t as simple as just picking up a prescription and going along on your merry way. It’s an involved process designed to ensure your treatment is safe, effective, and tailored to your needs. 

Here are the basic steps you can expect from the time you suspect low testosterone to starting treatment. 

1. Recognizing the Symptoms of Low Testosterone

Before anything else, identify if you’re experiencing symptoms of low testosterone, such as fatigue, low libido, mood swings, or muscle loss. If these symptoms are affecting your quality of life, it’s time to take the next step. Keep in mind that symptoms of low testosterone—fatigue, low libido, and mood changes—can mimic conditions like thyroid disorders or depression, so getting them checked out is a good idea either way.

2. Consulting a Healthcare Provider

Make an appointment with a qualified healthcare provider, such as a primary care doctor, endocrinologist, or urologist. Be prepared to discuss your symptoms, medical history, lifestyle, and goals for treatment.

3. Testing Testosterone Levels

A simple blood test is used to measure your testosterone levels. Typically, this test is done in the morning when testosterone levels are at their highest. Your doctor may also check other markers, like red blood cell counts, prostate-specific antigen (PSA), and liver function, to rule out any underlying health issues.

4. Discussing Treatment Options

If your blood test confirms your testosterone levels are low, your doctor will explain your treatment options. These include:

• Injections, delivered into your muscle (often your glutes or thighs) every 1 to 2 weeks

• Gels or creams applied daily to your skin for consistent absorption

• Patches worn on your skin and changed daily

• Pellets, which a doctor implants under your skin every few months for long-term release

Your provider will help you choose the best method based on your preferences, lifestyle, and budget.

5. Starting the Therapy

Once you begin HRT, it’s important to follow the prescribed dosage and method closely. Testosterone isn’t a “more is better” situation—too much can lead to side effects and complications.

6. Regular Monitoring

HRT requires ongoing medical supervision to ensure it’s working effectively and safely. You’ll need follow-up blood tests every few months to monitor testosterone levels, red blood cell counts, and prostate health. These checkups help your provider adjust your treatment if necessary.

7. Adjusting Expectations

It’s important to understand that HRT is not an overnight fix. Improvements in energy, mood, and other symptoms often take weeks to months. Be patient and give your body time to adapt.

8. Maintaining a Healthy Lifestyle

HRT works best when combined with healthy habits. Regular exercise, a balanced diet, adequate sleep, and stress management all play a role in maximizing the benefits of therapy and supporting overall well-being.

Starting HRT is a commitment, but with the right guidance and monitoring, it can make a significant difference in your quality of life. Your healthcare provider is your partner in this journey, so don’t hesitate to ask questions and advocate for your needs.

Your everyday lifestyle habits make a big difference in your overall health and hormone balance. For some men, lifestyle changes alone may not be enough to fully address low testosterone, especially if levels are significantly below normal. 

Consider where you might benefit from making adjustments, which can help support normal T as well as complement hormone replacement therapy. 

Prioritize Strength Training and Physical Activity

Resistance training (like lifting weights) and high-intensity interval training (HIIT) can naturally boost testosterone levels, at least for some time. Studies have shown that exercise can temporarily boost testosterone in men, but levels typically return to baseline within 30-60 minutes.

Staying active overall helps maintain muscle mass, reduce body fat, and support energy levels. (Excess body fat, particularly around the abdomen, is linked to lower testosterone levels and higher risk of testosterone deficiency.) Plus, it just makes you feel better and more confident.

Maintain a Balanced Diet

Nutrition is foundational to every aspect of health, including hormonal balance. The best thing you can do is to focus on eating higher-quality foods that boost testosterone levels, including plenty of healthy fats and lean proteins, like tuna and eggs. Variety and balance are key to ensuring you’re getting plenty of micronutrients.

Get Better Sleep

Your body produces the most testosterone while you’re asleep. Aim for 7 to 9 hours of good rest per night. Not getting enough sleep is associated with conditions like sleep apnea, which can disrupt hormone production and leave you feeling worse.

Manage Stress Levels

Chronic stress leads to elevated levels of the hormone cortisol, which can suppress testosterone production. We can’t always avoid stressors, but we can improve our responses to them. 

For instance, practice stress-management techniques like meditation, deep breathing, yoga, and taking a daily walk to clear your mind.

Limit Alcohol 

Excessive alcohol consumption can lower testosterone levels, especially in heavy drinkers. 

It’s normal to have a lot of questions about any health concern. Before you see your healthcare provider about low testosterone, it can be helpful to make a list of your questions to bring with you to your appointment. This ensures you get all the information you need and don’t forget to ask something. 

Here’s a preliminary list of questions about HRT for men that may be helpful: 

• What are the possible causes of low testosterone levels?

• Is HRT the best option for me, or should I try lifestyle changes first?

• What forms of HRT do you recommend for me and why?

• How soon can I expect to see results?

• What can I do to minimize the risks of side effects?

• How often will I need follow-up appointments or other blood tests?

• How will we know if the treatment is working?

• How long will I need to stay on HRT?

• Will HRT affect my ability to have kids?

• Is HRT covered by my insurance plan, and what will it cost?

• Are there any supplements, medications, or over-the-counter products I should avoid while on HRT?

HRT can be a powerful tool for addressing symptoms of low testosterone and improving quality of life. However, it’s not a decision to take lightly—it requires careful consideration, monitoring, and a personalized approach. Here are some things to keep in mind: 

• HRT can have significant benefits. You can look forward to increased energy, improved mood, enhanced sexual health, and better muscle and bone strength, but it’s most effective when combined with a healthy lifestyle.

• There are potential downsides. HRT can raise concerns around blood pressure, heart disease, fertility, and mood changes—part of why regular monitoring and medical supervision are so important.

• Lifestyle changes are also powerful. Everyday habits may be enough to get your testosterone levels in a healthy range if they’re close to normal levels or complement to HRT. Focus on where you can improve your nutrition, exercise, stress management, and sleep.

If you’re considering HRT, the first step is to consult with a qualified healthcare provider. They can help you evaluate your symptoms, explore your options, and create a plan that’s tailored to your unique needs.