TRT Side Effects: What's Normal and What Isn't

Blood pressure changes. Testosterone can increase blood pressure in some men. In 2025, the FDA required blood-pressure warnings across testosterone products after ambulatory blood-pressure studies demonstrated increases with testosterone treatment. If you are receiving TRT through telehealth, your provider may recommend monitoring your blood pressure at home or having it checked periodically as part of your routine medical care.

What Needs Immediate Medical Attention

Some symptoms should not be assumed to be a normal effect of TRT.

Seek prompt medical evaluation for symptoms such as new or severe shortness of breath, significant one-sided leg swelling or pain, or difficulty urinating. Symptoms that could indicate a medical emergency—including chest pain, sudden severe shortness of breath, sudden weakness or numbness on one side of the body, difficulty speaking, or signs of a severe allergic reaction—require immediate emergency care.

These symptoms can have many causes and do not necessarily mean TRT is responsible. What matters is that potentially serious symptoms are evaluated rather than attributed to a normal adjustment to treatment.

Do not change your dose or treatment schedule on your own because of a side effect. Contact your provider so the symptom and your treatment can be evaluated appropriately.

What About Cardiovascular Risk?

Questions about cardiovascular risk have surrounded testosterone therapy for years.

The 2023 TRAVERSE trial studied more than 5,000 men with hypogonadism who had preexisting cardiovascular disease or were at increased cardiovascular risk. Testosterone therapy was not associated with an increased incidence of the study's primary endpoint of major adverse cardiovascular events—cardiovascular death, nonfatal heart attack, or nonfatal stroke—compared with placebo.

However, the study also found a higher incidence of atrial fibrillation, acute kidney injury, and pulmonary embolism in the testosterone group. These findings are part of the broader risk-benefit discussion clinicians consider when prescribing and monitoring testosterone therapy.

Following its review of TRAVERSE and other required studies, the FDA removed the boxed warning regarding increased cardiovascular risk from testosterone product labeling in 2025. At the same time, the agency required warnings about increased blood pressure for testosterone products.

Your individual cardiovascular history and risk factors still matter and should be discussed with your provider before and during treatment.

How Side Effects Are Managed on TRT

Managing TRT involves more than checking a testosterone number.

Your provider evaluates how you are feeling alongside your laboratory results and other relevant health information. Monitoring commonly includes testosterone and hematocrit, while PSA and other testing may be appropriate depending on your age, medical history, symptoms, and individual risk factors.

If a side effect develops, the answer is not automatically to stop treatment or add another medication. Your provider may first look at your dose, dosing frequency, testosterone level, other laboratory findings, medical conditions, medications, and other possible causes of the symptom.

The goal is to use the information together to determine whether treatment should stay the same or whether something needs to change.

Frequently Asked Questions

What are some common side effects of TRT?

Possible side effects include acne or oily skin, fluid retention, injection-site reactions with injectable testosterone, changes in red blood cell production, and suppression of sperm production. Not everyone experiences the same effects, and some are specific to the type of testosterone being used.

Why is hematocrit monitored on TRT?

Testosterone can increase red blood cell production and raise hematocrit. Because a substantial increase may require a change in treatment, hematocrit is measured before TRT and periodically after treatment begins.

Does TRT increase the risk of a heart attack or stroke?

The large TRAVERSE trial found that testosterone therapy did not increase the incidence of major adverse cardiovascular events compared with placebo in men with hypogonadism who had preexisting cardiovascular disease or were at increased cardiovascular risk. However, pulmonary embolism, atrial fibrillation, and acute kidney injury occurred more frequently in the testosterone group, so individual risks still matter.

When should I call my provider instead of waiting for my next appointment?

Contact your provider if you develop a new or persistent side effect, significant swelling, breast tenderness or enlargement, worsening sleep symptoms, urinary problems, or other symptoms that concern you. Seek emergency medical care for symptoms such as chest pain, sudden severe shortness of breath, sudden one-sided weakness or numbness, difficulty speaking, or signs of a severe allergic reaction.

This article is for educational purposes only and is not medical advice. Testosterone therapy is available by prescription following clinical evaluation. Always consult a licensed clinician about your individual symptoms and treatment.

ADD