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Checking testosterone levels is as easy as having a blood test. Because prostate cancer is so common, doctors tend to be leery of prescribing testosterone to men who may be at higher than average risk of having undiagnosed prostate cancer. Testosterone therapy does not appear to increase the risk of prostate cancer, but it can stimulate the growth of prostate cancer cells.
One reason lab conversations around TRT become confusing is that testosterone values are not independent of timing. This means women's TRT targets should not be "as high as possible while feeling good." The better standard is "the lowest effective exposure that stays within the female physiologic range and supports the specific symptom target under monitoring." It is to stay within the physiologic range for women while assessing whether the symptom that justified therapy is actually improving. Testosterone therapy in women has a much narrower evidence-based indication, with the strongest support in postmenopausal women with hypoactive sexual desire disorder (Davis et al., Journal of Sexual Medicine, 2019; Parish et al., Climacteric, 2021). The question of women's TRT target levels is even more delicate. In younger men, some authors have argued that a one-size-fits-all cutoff may miss clinically relevant low values when symptoms are present.
After age 30, notes Dr. Nasir, there's a steady decline in testosterone levels, about 1%-2% per year. "It can even be considered a risk factor for heart disease." But there are many reasons for a man to care about a decline in his testosterone levels. Testosterone is a metabolic hormone with far-reaching effects, including on your heart. After around age 40, testosterone levels begin to decline slowly but steadily.
In men with prostate cancer, testosterone therapy is clearly contra-indicated and lower levels of testosterone are beneficial. Furthermore, testosterone levels decline with age as the prevalence of prostate carcinoma rises—could it be normal and physiological levels of testosterone that are in fact protective against the development of prostate cancer? However, over the last decade, epidemiological and clinical investigations have failed to demonstrate any association between underlying testosterone levels and the risk of developing prostate cancer. However, the effect of testosterone replacement therapy on mortality and patient outcome will need to be subject to large, prospective and randomized controlled trials. Malkin et al.66 advanced this hypothesis by performing a similar, blinded, placebo-controlled and crossover study of testosterone therapy in men with angina, but only recruited men with significant hypogonadism. In men with angiographically-proven coronary disease, 12 weeks of trans-dermal testosterone therapy significantly increased time to ischaemia at exercise testing.
Testosterone is an essential part of reproductive health. AIS prevents male genitals from developing as they should and almost always results in infertility (it’s difficult or impossible to father children) during adulthood. It affects male fetuses as they develop in the uterus, as well as teenage sexual development during puberty. Late-onset hypogonadism affects about 2% of men over the age of 40. This condition is very common — up to 15% of females of reproductive age have it. Excess testosterone affects your body differently depending on your sex and age.
TRT can be very important for helping teenage males with hypogonadism experience typical masculine development. A good first step is increasing activity levels and maintaining a healthy diet in order to reduce body fat. Hypogonadism in males happens when the testicles don’t produce enough testosterone. Between 19 and 39 percent of older men may have low levels of testosterone. He called the small number of patients and limited follow-up in the four studies, in some cases just weeks to months, "insufficient to identify potential risks."
This means that you’ll need the medication to continue having a normal level of testosterone in your body. This can help improve the symptoms of low testosterone, like low libido and lack of energy. With TRT, you take a manufactured form of testosterone to regulate your levels. Before starting TRT, your healthcare provider will make sure low testosterone is an accurate diagnosis. As of 2025, it’s not yet approved for males who naturally experience a decline in testosterone as they age. TRT has certain risks and benefits, so your healthcare provider will carefully evaluate if it’s safe and right for you.
There are no large long-term, placebo-controlled, randomized clinical trials to provide definitive conclusions about TRT and CV risk.