Vad är Testosterone Replacement Therapy?
Testosterone Replacement Therapy (TRT) refers to the medical treatment of male hypogonadism — a clinical condition characterised by the failure of the testes to produce adequate testosterone, resulting in symptoms that significantly affect quality of life. TRT is approved by the Europeiska läkemedelsmyndigheten (EMA) for the treatment of hypogonadism in adult men when testosterone deficiency has been confirmed by both clinical symptoms and repeated laboratory testing.
TRT involves supplementing the body’s testosterone levels with exogenous (externally produced) testosterone in a variety of EMA-approved formulations. It is not a treatment for age-related testosterone decline in otherwise healthy men without confirmed hypogonadism.
Hur fungerar Testosterone work in the body?
Testosterone is the primary male sex hormone (androgen), produced predominantly in the Leydig cells of the testes under the regulation of luteinising hormone (LH) from the pituitary gland. It plays essential roles throughout the body:
- Sexual function: Maintains libido, supports erectile function, and drives sexual development during puberty
- Muscle and bone: Promotes muscle protein synthesis and bone mineral density maintenance
- Red blood cell production: Stimulates erythropoietin production in the kidneys, supporting red blood cell formation
- Energy and mood: Influences energy levels, mood, cognitive function, and overall sense of well-being
- Body composition: Influences the distribution of fat and lean muscle mass
- Spermatogenesis: Supports (but does not solely drive) sperm production — this is also regulated by FSH and intratesticular testosterone levels
In hypogonadism, inadequate testosterone production leads to a characteristic cluster of symptoms. TRT replaces the deficit, restoring physiological testosterone levels and alleviating symptoms.
Vem är TRT for?
TRT is indicated for adult men with documented hypogonadism, defined as:
- Clinical symptoms consistent with low testosterone: reduced libido, erectile dysfunction, fatigue, decreased muscle mass, increased body fat, mood disturbance, poor concentration, reduced body/facial hair, or reduced bone density, AND
- Biochemically confirmed low testosterone: Two separate morning serum total testosterone measurements below the laboratory reference range (typically <12 nmol/L or <300 ng/dL, but reference ranges vary by laboratory and assay)
Types of hypogonadism:
- Primary hypogonadism (testicular failure): Caused by conditions such as Klinefelter syndrome, testicular injury, mumps orchitis, chemotherapy
- Secondary hypogonadism (hypothalamic-pituitary failure): Caused by conditions such as pituitary tumours, haemochromatosis, hyperprolactinaemia, or Kallmann syndrome
TRT is not indicated for:
- Age-related decline in testosterone without confirmed hypogonadism
- Men with prostate cancer or breast cancer
- Men with polycythaemia (significantly elevated red blood cell count)
- Men with severe untreated obstructive sleep apnoea
- Men who wish to father children in the near term (without specialist co-management)
TRT Formulations and Dosering
| Formulation | Examples | Frequency | Dose |
|---|---|---|---|
| Transdermal gel | Testogel, Testim, AndroGel | Daily | 25–75 mg/day |
| Long-acting injection | Nebido (testosterone undecanoate) | Every 10–14 weeks | 1000 mg |
| Short-acting injection | Testosterone enanthate / cypionate | Every 2–4 weeks | 100–250 mg |
| Buccal tablet | Striant | Twice daily | 30 mg |
The prescribing doctor will select the most appropriate formulation based on patient preference, lifestyle, compliance, and clinical considerations.
Transdermal gels: Applied daily to clean, dry skin (shoulders, upper arms, or abdomen — not the genitals). Allow to dry before dressing. Wash hands after application. Avoid skin-to-skin contact with the application site with women, children, or pregnant women until the gel has dried.
Nebido (long-acting injection): Given by a healthcare professional as an intramuscular injection every 10–14 weeks. Provides stable testosterone levels without daily application.
Biverkningar
Vanliga biverkningar
- Acne or oily skin
- Increased red blood cell count (polycythaemia) — monitored via regular blood tests
- Fluid retention (mild oedema)
- Prostate-specific antigen (PSA) increase — monitoring required
- Increased libido (particularly early in treatment)
- Mood changes
Mindre vanliga side effects
- Sleep apnoea (may worsen pre-existing sleep apnoea)
- Gynaecomastia (breast tissue development — related to testosterone aromatisation to oestradiol)
- Male pattern hair loss (in genetically predisposed men)
- Testicular atrophy (due to suppression of natural testosterone production and LH)
- Skin reactions at the application site (gels) or injection site
Serious concerns requiring monitoring
- Cardiovascular risk: The relationship between TRT and cardiovascular events is complex and remains an area of ongoing research. Men with pre-existing cardiovascular disease should discuss the risk-benefit profile with their doctor.
- Polycythaemia: Excess red blood cell production increases thrombosis risk — haematocrit must be monitored
- Prostate health: TRT may stimulate prostate tissue growth; PSA must be monitored. TRT is contraindicated in men with prostate cancer.
Monitoring during TRT
Regular medical monitoring is essential throughout TRT. A doctor will typically assess:
| Parameter | Frequency |
|---|---|
| Serum testosterone | 3 months, then annually |
| Full blood count (haematocrit) | 3 months, then annually |
| PSA (prostate-specific antigen) | Annually (or more frequently in older men) |
| Liver function | Annually |
| Lipid profile | Annually |
| Digital rectal examination | As clinically indicated |
Hur får man tillgång till TRT online i Europa
Testosterone is a receptbelagt läkemedel (POM) and a controlled substance in most EU-medlemsländer. It cannot legally be dispensed without a valid prescription from a licensed medical professional.
Prescrivia operates as a technology intermediary: we do not prescribe medicines, employ doctors, or sell medicines. Our platform connects patients with independent EU-registered doctors who can conduct confidential online consultations.
Important note on TRT assessment: Diagnosing hypogonadism requires blood testing to confirm low testosterone levels. An online assessment is a first step — the doctor may refer you for blood tests and will review the results before any prescribing decision is made.
The process:
- Fyll i en hälsobedömning: Describe your symptoms, relevant medical history, and any previous testosterone testing or treatment.
- Läkarbedömning and blood test referral: An independent EU-registered doctor reviews your assessment. If clinically indicated, they will refer you for appropriate blood tests.
- Results review and prescription: If test results confirm hypogonadism and TRT is appropriate, the doctor may issue a prescription.
- Apoteksleverans: The prescription is sent to a licensed EU pharmacy partner for dispensing and direct delivery.
Important: Prescrivia garanterar inte that a prescription will be issued. All prescribing decisions are made independently by qualified medical professionals based on confirmed clinical and biochemical criteria.
Viktig säkerhetsinformation
TRT is contraindicated in men who:
- Have prostate cancer or breast cancer
- Have polycythaemia (significantly raised haematocrit)
- Have severe untreated heart failure
- Have uncontrolled severe sleep apnoea
- Are allergic to testosterone or any excipient in the formulation
Berätta för din läkare if you:
- Are using TRT and experience chest pain, breathlessness, leg swelling, or symptoms of stroke
- Are taking anticoagulants such as warfarin (testosterone can potentiate anticoagulant effect)
- Are taking insulin or other antidiabetic medicines (testosterone may improve insulin sensitivity — blood glucose monitoring may need adjustment)
- Have or have had liver tumours
TRT is not the same as anabolic steroid misuse: TRT restores physiological testosterone levels to within the normal range. It is not the same as supraphysiological doses of testosterone or anabolic steroids used without medical supervision, which carry substantially greater health risks.
Källor
Medical information on this page is based on the following sources:
- Europeiska läkemedelsmyndigheten (EMA). Testogel (testosterone) — Summary of Product Characteristics. Available at: ema.europa.eu
- European Association of Urology (EAU). Guidelines on Male Hypogonadism. 2023. uroweb.org
- Världshälsoorganisationen (WHO). Testosterone — Essential Medicines information. who.int
- Bhasin S, et al. Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism. 2018.
This content is reviewed periodically to reflect updated clinical guidance. It is provided for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for advice relevant to your individual health circumstances.
Frequently asked questions
- Vad är Testosterone Replacement Therapy used for?
- Testosterone Replacement Therapy (TRT) is prescribed for male hypogonadism — a condition where the testes do not produce sufficient testosterone. Symptoms of low testosterone (low T) include reduced libido, erectile dysfunction, fatigue, reduced muscle mass, mood changes, and impaired concentration. TRT is only prescribed after blood tests confirm clinically low testosterone levels alongside appropriate symptoms.
- What are the different types of TRT available?
- Testosterone replacement is available in several formulations approved by the EMA: transdermal gels (applied daily to skin — Testogel, AndroGel, Testim), injectable testosterone (long-acting injections such as Nebido/testosterone undecanoate every 10–14 weeks, or shorter-acting testosterone esters every 2–4 weeks), and buccal tablets (applied to the gum). The appropriate formulation is determined by a doctor based on the patient's preference, lifestyle, and clinical circumstances.
- Can TRT affect fertility?
- Yes. Exogenous testosterone suppresses the body's natural hormonal signals (LH and FSH) that stimulate sperm production. Men who wish to preserve or maintain fertility should discuss this with their doctor before starting TRT. Alternative treatments such as human chorionic gonadotropin (hCG) or selective oestrogen receptor modulators (SERMs) may be considered for men with hypogonadism who wish to maintain fertility.
- Hur snabbt verkar TRT improve symptoms?
- The timeline varies by symptom and individual. Sexual function and libido may improve within a few weeks. Energy, mood, and cognitive function often improve over 3–6 months. Muscle mass and body composition changes may take 6–12 months to become apparent. Bone density improvements require treatment over 1–2 years. Regular monitoring by a doctor is essential throughout treatment.
- Kan jag få TRT online i Europa?
- TRT is a receptbelagt läkemedel in all EU-medlemsländer and requires confirmed diagnosis of hypogonadism via blood testing before a prescription can be issued. You can access TRT evaluation through online intermediary platforms that connect you with independent EU-registered doctors. The doctor will review your symptoms and, if appropriate, refer you for relevant blood tests before any prescribing decision is made.
Prescrivia er kun en formidlingsplattform. Vi leverer ikke medisinske tjenester, forskriver ikke behandlinger og utleverer ikke legemidler. Alle medisinske beslutninger tas av uavhengige EU-registrerte leger. Alle legemidler utleveres av lisensierte EU-apotek. Denne plattformen legger til rette for kontakt mellom pasienter og helsepersonell.