TRT Safety
Based on the extensive clinical evidence from multiple high-quality studies, TRT demonstrates an overall favorable safety profile when properly administered and monitored, though several important risks require ongoing attention. Compared to other long-term drug classes, its risk–benefit profile is superior for the right patient.
Large, long-term RCT data (TRAVERSE) show TRT is just as safe as a placebo treatment when it comes to major heart problems in men with low testosterone who already have a high risk of heart issues. However, it might slightly raise the chances of irregular heartbeats, sudden kidney problems, or blood clots in the lungs, so doctors need to keep a close eye on patients. Prostate health seems fine as long as regular blood tests (like PSA checks) are done.
The most common and expected side effect is an increase in red blood cells (called erythrocytosis), which depends on the dose and type of testosterone used. This can sometimes raise blood pressure or the risk of blood clots, so regular blood tests are needed to monitor it—treatment should pause if levels get too high (above 54% hematocrit).
Compared with other chronic therapies (GLP-1/GIP agents, antihypertensives/statins, antidepressants), benefit–risk is class-specific: GLP-1/GIP agents and statins reduce hard outcomes but have their own adverse-effect profiles; TRT risks are largely predictable and monitorable, particularly erythrocytosis—patient-specific judgment remains essential.