TRT Overview
Testosterone replacement therapy can be life-changing when you actually need it. Here's an honest guide — who it's for, how it works, and what the trade-offs are.
TRT replaces testosterone in men whose bodies don't produce enough. It's not for optimising already-normal levels — it's for treating genuine hypogonadism. When used appropriately under medical supervision, it reliably improves energy, libido, body composition, and mood.
This guide is for you if: You've been diagnosed with low testosterone or suspect it, have tried lifestyle and supplement approaches without improvement, or want to understand TRT before discussing it with your doctor.
See the evidenceWho actually needs TRT?
TRT is appropriate when you have both low testosterone on bloodwork and symptoms consistent with hypogonadism:
- Total testosterone consistently below 300 ng/dL (or free T below the lab reference range) on two separate morning tests
- Symptoms: persistent fatigue, low libido, erectile dysfunction, loss of muscle mass, increased body fat, depression, brain fog
- Other causes ruled out: thyroid dysfunction, sleep apnoea, medication side effects, chronic illness
If your total testosterone is 450 ng/dL and you feel fine, you don't need TRT. If your total T is 250 ng/dL with classic symptoms despite lifestyle optimisation, TRT is a legitimate medical treatment — not "steroid use."
Delivery methods available in India
| Method | Frequency | Pros | Cons |
|---|---|---|---|
| Testosterone cypionate/enanthate | Weekly injection | Stable levels, most studied, cheap | Requires self-injection |
| Testosterone undecanoate (Nebido) | Every 10–14 weeks | Infrequent dosing, steady levels | Expensive, large injection volume |
| Testosterone gel | Daily application | No injections, easy | Transfer risk, variable absorption, expensive |
| HCG (adjunct) | 2–3x per week | Preserves testicular size and fertility | Additional injections, cost |
In India, testosterone cypionate or enanthate injections are the most cost-effective and widely used approach. Self-injection (subcutaneous or intramuscular) once or twice weekly provides the most stable blood levels.
What to monitor on TRT
Regular bloodwork is essential — typically every 3 months for the first year, then every 6 months:
- Total & free testosterone — aim for mid-to-upper reference range (500–800 ng/dL)
- Estradiol (E2) — can rise with TRT; too high causes water retention, mood issues
- Haematocrit/haemoglobin — TRT increases red blood cells; haematocrit above 54% requires dose adjustment
- PSA — prostate marker; monitored annually
- Lipid panel — TRT can affect HDL cholesterol
- LH & FSH — will be suppressed on TRT (this is expected)
Monitor your TRT with confidence
eterni tracks your testosterone, E2, haematocrit, and PSA over time — so you and your doctor can see the full picture.
Get early accessFrequently Asked Questions
Is TRT safe long-term?
When properly monitored, TRT has a strong safety profile for men with genuine hypogonadism. Long-term data (10+ years) from European registries shows improvements in cardiovascular markers, body composition, and quality of life. The key is regular monitoring of haematocrit, PSA, and estradiol. Risks increase with supraphysiological doses or inadequate monitoring.
Does TRT cause infertility?
TRT suppresses LH and FSH, which suppresses sperm production. If fertility is a concern, HCG (human chorionic gonadotropin) can be used alongside TRT to maintain testicular function and sperm production. Alternatively, clomiphene citrate can be used as a fertility-preserving alternative to TRT. Discuss this with your doctor before starting.
Will I need TRT forever?
It depends on the cause of your low testosterone. If it's primary hypogonadism (testicular), you'll likely need TRT long-term. If it was caused by lifestyle factors (obesity, stress, sleep deprivation), addressing those may allow you to stop. However, TRT suppresses natural production, so stopping requires a careful PCT (post-cycle therapy) protocol.
How much does TRT cost in India?
Testosterone cypionate/enanthate is remarkably affordable in India — roughly ₹200–500 per month for the medication itself. Nebido (undecanoate) is more expensive at ₹3,000–5,000 per injection (every 10–14 weeks). Gels cost ₹1,500–3,000 per month. The main cost is the regular bloodwork for monitoring.
The endocrinology of TRT
Testosterone is produced primarily in the Leydig cells of the testes, stimulated by LH from the pituitary. When you take exogenous testosterone, the HPG axis detects the elevated levels and shuts down LH production (negative feedback). This is why TRT causes testicular atrophy and suppresses sperm production — your testes are no longer being stimulated.
Estradiol management: Testosterone is converted to estradiol by the aromatase enzyme, primarily in adipose tissue. Men with higher body fat aromatise more. On TRT, estradiol can rise, causing water retention, nipple sensitivity, and mood changes. Routine AI (aromatase inhibitor) use is discouraged — most men do fine with proper TRT dosing. Anastrozole should only be used if symptomatic with confirmed elevated E2.
Haematocrit: Testosterone stimulates erythropoiesis (red blood cell production). While a moderate increase is expected, haematocrit above 54% increases blood viscosity and thrombotic risk. This is the most important safety parameter to monitor. If it rises too high, options include dose reduction, more frequent (smaller) injections, or therapeutic phlebotomy.
Know what's working. Know what's not.
eterni connects your lab results, supplements, and retests — so you can see the trajectory, not just a snapshot.
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