How To Avoid Hair Loss on TRT: Side Effects of Testosterone Replacement Therapy


Written by Elite HRT on June 28, 2021

Medically reviewed by

Camille Freking, Regulatory Affairs Specialist, MEDICAL ADVISOR

Testosterone therapy can seem like a drastic measure of treatment. Negative stories of hair loss, testicular atrophy, and even the development of breasts plague the name of testosterone therapy. 

While these events can certainly occur, oftentimes people experience these symptoms due to misguided use and a lack of specialized knowledge on the part of the prescribing health care professional. 

The simple fact is that low testosterone therapy should rarely be given with testosterone replacement alone, which is why you’ll see supplements, vitamins, or over-the-counter/prescription hair regrowth products like minoxidil (aka Rogaine) highly encouraged if not outright prescribed. 

Testosterone is an androgen that plays many roles within the body and is readily converted into other signaling molecules that can cause side effects. Because of the complex nature of thism ale sex hormone within the human body, it is important to ensure a more holistic approach is taken. 

Elite HRT has highly specialized practitioners in the field of hormone replacement therapy. With this highly specific skill set, Elite HRT is able to offer highly tailored and specialized treatment plans for patients that reduce the chances of adverse side effects while aiming to provide the most therapeutic benefit. 

Below is a look at four common side effects of testosterone replacement therapy as well as medications and ways that can help alleviate them. 

Seeking help for your hormone deficiencies is hard enough and you shouldn’t need to worry that you are receiving suboptimal care. This article will hopefully give you a better understanding of everything that should go into a TRT treatment and better prepare you for what to look out for when embarking on your HRT journey. 

Hair Loss

Hair loss is a common condition that men across the globe experience. Like many conditions, hair loss is caused by an interplay of your specific genetics and your environment. While little can be done on the side of your inherited genes, there are factors within your environment that can be altered or changed to limit the chance of balding. 

Testosterone therapy is a great option for men looking to regain some of their youthfulness through the power of hormones. While testosterone can be effective in improving your overall well being, it can also be an accelerating agent to hair loss, receding hairline, or hair thinning. 

How TRT Can Contribute to Hair Loss

When you think about testosterone and hair, you would most likely think that the two are positively associated. During adolescence, testosterone peaks, and during this time new hair growth is experienced. While testosterone can increase the growth of body hair, it can have a drastically different effect on the hair follicles of the scalp. 

The main reason that testosterone can cause hair loss is due to the natural conversion of testosterone into dihydrotestosterone (DHT). DHT has been found in elevated levels in the scalps of men who are experiencing androgenetic alopecia, also known as male pattern baldness. 

When undergoing testosterone replacement therapy, testosterone levels are elevated which can lead to more conversion of testosterone into DHT. 


The simplest solution would be to cease TRT, but in most cases, men still want to have the benefits that TRT has to offer. Luckily cessation is not the only option for reducing hair loss during TRT. Thanks to a drug known as finasteride, the rate of DHT production can be slowed and allow men to decrease the chance of hair loss. 

Testicular Atrophy

Testicular atrophy is the condition in which the testicles experience a diminished level of function. Much like any other form of atrophy like muscle atrophy, testicular atrophy can come as a result of prolonged disuse. 

Unlike muscle atrophy, testicular atrophy can occur without you even knowing it’s occurring as it is not immediately noticeable. Due to the cryptic nature of testicular atrophy, it is important to ensure your care team includes aspects of your care that ensures you retain the function of these important hormone-producing organs. 

How TRT Can Contribute to Testicular Atrophy

Testosterone replacement therapy works by supplementing pure testosterone into the bloodstream. This results in a quick and near-immediate elevation of testosterone which can be just what is needed to establish better baseline testosterone levels. 

Through the injection of testosterone, you essentially circumvent the body’s natural testosterone-producing mechanism which involves the testicles. 

Because testosterone levels are within a healthy range, your body naturally reduces its own production of testosterone. As a result, over time the testicles can decrease in their effectiveness in producing testosterone. 

While not immediately noticeable, when you decide to get off TRT, it can become extremely apparent that your endogenous testosterone levels are even lower than when you started. 


The first solution is to avoid prolonged usage of TRT. By doing this it can limit the chance that your body experiences prolonged disuse and subsequent atrophy. While this is an option, it typically isn’t the most practical as TRT works the best over time to see results and get the most out of your treatment. 

Another option is to add Human Chorionic Gonadotropin (HCG) to a TRT plan. HCG is a molecule that signals the testicles to produce testosterone. Taking HCG with testosterone is a great method of avoiding testicular atrophy because it essentially forces your body to continue producing endogenous testosterone even when additional testosterone is being supplemented. 

Breast Enlargement

Testosterone is often thought of as a manly hormone. With a title like that, it can be difficult to imagine how the manly hormone can contribute to the development and enlargement of breasts which is a womanly trait. 

The reality is that testosterone is closely linked with many other hormones within the body and this includes estrogen. Understanding the relationship between testosterone levels and estrogen levels is important in gaining a better understanding of how TRT can cause breast enlargement as a side effect. 

How TRT Can Contribute to Breast Enlargement

When you look at the chemical composition and structure of testosterone and estrogen, it is easy to see that the two molecules are very similar. Both consist of four interconnected rings and both have a similar mode of transport within the body. 

An interesting aspect of testosterone is that it is naturally converted into estrogen through molecules known as aromatase. Aromatase is an enzyme that initiates the aromatization of testosterone which results in the formation of estrogen. 

TRT comes into play with this because the therapy directly increases the amount of circulating testosterone. With more testosterone, aromatase is able to increase estrogen through the aromatization of testosterone. 


The solution to this problem is to give an aromatase inhibitor in addition to testosterone therapy. Aromatase inhibitors, also known as estrogen blockers, prevent the conversion of testosterone into estrogen. 

While decreasing the chances of estrogen-associated symptoms like breast enlargement, aromatase inhibitors can allow TRT to be more effective. A decreased conversion of testosterone means that there is more circulating testosterone available thereby increasing TRT effectiveness. 


Acne can be another side effect of testosterone replacement therapy, but unlike the other side effects, it is directly caused by the testosterone molecule. Hormonal acne is caused by the overproduction in the exocrine glands on the surface of the skin. These hyperactive glands are more prone to clogging which is what causes blemishes. 

How TRT Can Contribute to Acne

The mechanism for how testosterone increases sebaceous gland activity is not entirely understood but there are some interesting correlations between the two. 

One study found that those suffering from hormonal acne have elevated levels of testosterone and DHT in the skin. With this finding, it would make sense that elevating testosterone levels through TRT could inadvertently cause acne. 


There is no real clear-cut solution to testosterone therapy associated with acne. The best method is to manage your skin health by following a good skin care regimen. Additional topical medications can be prescribed to help manage the hormonally induced blemishes that are unresolved with a good skincare routine. 

Another solution would be to dial back on the amount of testosterone given through TRT. While this will most likely not provide you with glowing skin, it could help to reduce the severity of acne. 


In summary, TRT like any other treatment comes with its fair share of side effects. The potential for hair loss, testicular atrophy, breast enlargement, and acne are all present when undergoing TRT. 

Having an experienced healthcare team that is familiar with these pitfalls and the ways to avoid them is why Elite HRT is a leader in testosterone replacement therapy

By providing testosterone in addition to HCG, estrogen blockers, or finasteride allows patients to get more therapeutic value out of their treatment and not have to worry about adverse effects of their treatment. 


Cause of Androgenic Alopecia: Crux of the Matter

Finasteride: a review of its use in male pattern hair loss

An update on the role of the sebaceous gland in the pathogenesis of acne