TRT risks, side effects and monitoring

TRT is generally well tolerated when properly prescribed and monitored — but "lifelong" means the monitoring matters as much as the start. This page summarises the risks and the monitoring schedule that good clinics follow.

The risks that monitoring exists for

• Haematocrit rise (thicker blood). Testosterone stimulates red-cell production; high haematocrit raises clot risk. Monitored by blood test; dose reduction or donation manages it.
• PSA/prostate. TRT does not cause prostate cancer, but it is contraindicated with active prostate cancer — baseline PSA plus examination before starting, then periodic PSA per monitoring schedule.
• Cardiovascular debate. Large trials (TRAVERSE, 2023) found TRT non-inferior for major cardiac events versus placebo, with higher AF and PE signals noted. Men with existing heart disease should discuss specifics with their doctor.
• Fertility suppression. TRT switches off sperm production — irreversible in some men after long use. The hCG/enclomiphene trade-offs are in TRT and fertility.
• Oestrogen rise, acne, hair changes, sleep apnoea worsening. All manageable; all reasons the follow-ups exist.

The monitoring schedule good clinics publish

• Baseline: two morning total-T tests, LH, SHBG, prolactin, PSA, haematocrit, lipids.
• 6–12 weeks: mid-titration bloods (total T aiming mid-normal range, haematocrit, oestrogen where symptomatic).
• Quarterly in year one, then 6-monthly once stable: total T, haematocrit, PSA.
• Symptom review every blood cycle — dose changes are driven by symptoms plus levels.

Red flags in a clinic's practice

• No PSA check before starting.
• Bloods "optional" after the first test.
• No named doctor responsible for your care.
• Selling without prescription (illegal in the UK for testosterone POMs).

The press scrutiny is real

UK coverage (BBC, Sky News, the Pharmaceutical Journal) has questioned some private clinics' diagnostic thresholds and marketing. The honest response is the checklist: two tests, named doctors, published monitoring, CQC registration. See choosing a clinic.

Medical content summarised from BSSM-aligned sources and clinic published pages; this directory is not medical advice.

Information directory — medically reviewed sources cited per page · Source-checked 2026-10-09 · Independent information directory — not medical advice.