Real-World TRT Experiences: What 345 Men Reveal About Testosterone Replacement Therapy
Curated By Nelson Vergel | ExcelMale.com | Updated January 2026
IntroductionCurated By Nelson Vergel | ExcelMale.com | Updated January 2026
What do men actually experience when they start testosterone replacement therapy? While clinical trials provide valuable data on efficacy and safety, they often fail to capture the nuances of real-world TRT use—the practical challenges, personal preferences, and day-to-day realities that shape treatment outcomes. To bridge this gap, ExcelMale.com conducted a comprehensive survey of 345 men with TRT experience, gathering insights that reveal what the clinical literature often misses.
This survey, collected by Nelson Vergel, provides an unprecedented look into the demographics, treatment preferences, and challenges faced by men using testosterone therapy. The findings offer valuable guidance for men considering TRT, those optimizing their current protocols, and healthcare providers seeking to understand patient perspectives. From delivery method preferences to reasons for discontinuation, this data illuminates the real-world landscape of testosterone replacement therapy.
The survey results align remarkably well with peer-reviewed research on TRT satisfaction while providing unique community-driven insights that clinical studies rarely capture. Recent research published in the International Journal of Impotence Research found that approximately 63% of patients were satisfied with their TRT regimen, while a 2025 UK study of over 900 men found 85% rated TRT as effective or very effective. Our survey data supports these satisfaction rates while revealing the specific factors that drive treatment success and failure.
Survey Demographics: Who Are TRT Users?
The survey captured responses from 345 men across various age groups, providing a representative cross-section of the TRT patient population. Understanding who uses TRT helps contextualize the survey findings and highlights that testosterone deficiency affects men across a broad age spectrum.
Age Distribution
The survey respondents skewed toward middle-aged men, with the largest cohort (43.77%, n=151) falling in the 46-55 age range. This was followed by men aged 56-65 (29.86%, n=103) and 36-45 (16.23%, n=56). Younger men aged 26-35 represented only 3.77% (n=13), while those over 65 accounted for 5.80% (n=20). The youngest group (16-25) was minimal at 0.58% (n=2).
This age distribution reflects the natural decline in testosterone that accelerates in men over 40, though it also underscores the reality that a significant minority of younger men also require TRT. Clinical guidelines from the American Urological Association and the Endocrine Society recognize that testosterone deficiency can occur at any age, whether due to primary hypogonadism (testicular failure), secondary hypogonadism (pituitary or hypothalamic dysfunction), or other underlying conditions.
Age Group | Percentage | Number of Respondents |
16-25 | 0.58% | 2 |
26-35 | 3.77% | 13 |
36-45 | 16.23% | 56 |
46-55 | 43.77% | 151 |
56-65 | 29.86% | 103 |
Older than 65 | 5.80% | 20 |
Diagnosis Confirmation
A striking 86.34% of respondents (n=297) reported being told by their doctor that they had low testosterone levels. Only 13.37% (n=46) stated they had not received such a diagnosis, and a mere 0.29% (n=1) had not yet been tested. This high rate of medical diagnosis indicates that the vast majority of survey respondents are using TRT under appropriate medical supervision with confirmed testosterone deficiency, lending credibility to their reported experiences.
TRT Usage Patterns: Current vs. Former Users
The survey revealed that 83.67% of respondents (n=287) were currently using TRT at the time of the survey. An additional 12.54% (n=43) had used TRT in the past but discontinued, while only 4.08% (n=14) had never used testosterone therapy. This distribution indicates high treatment persistence among TRT users, consistent with research showing that hypogonadism typically requires lifelong therapy.
The high continuation rate observed in our survey aligns with clinical understanding that testosterone deficiency, once established, rarely resolves spontaneously. A 2016 study published in Aging Male found that TRT interruption resulted in rapid return of hypogonadal symptoms and worsening of obesity parameters, underscoring why most men who start TRT continue long-term.
Why Men Stop TRT: Understanding Discontinuation
Among the 49 men who had discontinued TRT, the survey identified several key reasons for stopping treatment. Understanding these factors is crucial for both patients and clinicians seeking to optimize treatment adherence and outcomes.
Top Reasons for Discontinuation
Lack of perceived benefit was the leading reason for discontinuation, cited by 22.45% of former users. This finding highlights the importance of proper dosing, delivery method selection, and realistic expectation setting. Many men who fail to experience benefits may have suboptimal protocols, inadequate monitoring, or underlying conditions that TRT alone cannot address.
Elevated hematocrit or hemoglobin and moodiness were tied as the second most common reasons, each cited by 20.41% of discontinuers. Polycythemia (elevated red blood cell count) is indeed the most common side effect of TRT, requiring regular monitoring and management. Mood changes, while less commonly discussed in clinical literature, represent a significant concern that clinicians should proactively address.
Cost and the perception that the gel was too messy were each cited by 12.24% of discontinuers. Doctor's recommendation to stop was also noted by 12.24%. These practical factors—affordability and convenience—often determine treatment success as much as clinical efficacy. The messiness complaint specifically applies to topical preparations and reflects why many men eventually transition to injectable testosterone.
Other reasons included acne (10.20%), prostate concerns (8.16%), gynecomastia (8.16%), insurance loss (8.16%), forgetting to use it (6.12%), gel odor (4.08%), and high blood pressure (2.04%). This diverse range of discontinuation factors underscores the need for individualized treatment approaches and regular monitoring.
Reason for Discontinuation | Percentage |
Did not gain any benefits | 22.45% |
Hemoglobin or hematocrit increased | 20.41% |
Moodiness | 20.41% |
Cost | 12.24% |
Gel was too messy | 12.24% |
Doctor thought it was bad | 12.24% |
Acne | 10.20% |
Prostate concerns (size or PSA) | 8.16% |
Tender/enlarged breast tissue | 8.16% |
Lost insurance or coverage | 8.16% |
Just kept forgetting to use it | 6.12% |
Gel had a smell | 4.08% |
High blood pressure | 2.04% |
Testosterone Delivery Methods: What Men Use and Prefer
One of the most valuable aspects of this survey is its exploration of delivery method preferences. Understanding what methods men actually use—and what they would prefer if given the choice—provides crucial insights for treatment optimization.
Current and Past Delivery Methods Used
Among the 331 respondents who answered this question, injectable testosterone and testosterone gels were tied as the most commonly used methods, each at 63.14% (n=209). This reflects the clinical reality that these two delivery methods dominate the TRT landscape. Injectable testosterone (cypionate, enanthate, or undecanoate) offers cost-effectiveness and reliable delivery, while gels provide convenience and steady hormone levels.
The testosterone patch had been used by 14.80% of respondents (n=49), though patches have largely fallen out of favor due to skin irritation issues and inconsistent absorption. Compounded testosterone gels were used by 7.25% (n=24), offering an alternative for men who prefer customized formulations or find commercial gels too expensive.
Less common methods included testosterone-boosting supplements (3.93%, n=13), oral testosterone undecanoate (2.42%, n=8), testosterone pellets (2.11%, n=7), and the Striant buccal strip (0.30%, n=1). The low utilization of pellets and oral formulations likely reflects historical limitations in availability and physician familiarity, though newer oral products like Kyzatrex and Jatenzo are gaining acceptance.
Preferred Delivery Methods
When asked what delivery method they would prefer if all options were available, the responses revealed interesting patterns that diverge somewhat from current usage. The daily gel was the top preference at 27.49% (n=91), reflecting the appeal of a non-invasive, easy-to-use option that provides steady hormone levels without injections.
Weekly or biweekly injections were preferred by 25.38% (n=84), showing that a substantial portion of men are comfortable with self-injection and appreciate the cost-effectiveness and reliability of injectable testosterone. An additional 5.44% (n=18) preferred twice-weekly injections, which can provide more stable hormone levels and reduce side effects for some men.
Notably, sublingual (under-the-tongue) products were preferred by 17.52% (n=58), indicating significant interest in this delivery method despite its limited current availability. Sublingual testosterone offers rapid absorption and avoids first-pass liver metabolism, making it an attractive option for men seeking alternatives to injections and gels.
Subcutaneous pellets were preferred by 11.48% (n=38), reflecting the appeal of a "set it and forget it" approach that provides consistent testosterone levels for 3-4 months. Monthly (or longer) injections were preferred by 8.76% (n=29), likely referring to longer-acting formulations like testosterone undecanoate (Aveed/Nebido). The daily skin patch was the least preferred option at only 3.02% (n=10), reflecting the well-known issues with skin irritation and adhesion.
Pre-Treatment Evaluation: What Doctors Test
Proper baseline evaluation before initiating TRT is essential for safe and effective treatment. The survey asked respondents about the tests their doctors performed before starting testosterone therapy, revealing both areas of adequate screening and potential gaps in care.
Total and free testosterone testing was performed for 91.07% of respondents (n=51 of 56 who answered), appropriately representing the foundational diagnostic test for hypogonadism. The Endocrine Society guidelines recommend at least two morning testosterone measurements before initiating therapy.
PSA testing was performed for 69.64% (n=39), reflecting appropriate prostate cancer screening before TRT, though current guidelines no longer consider testosterone therapy to increase prostate cancer risk in men without known disease.
Thyroid hormones were checked in 62.50% (n=35), important for ruling out thyroid dysfunction as a cause of low-T symptoms.
Estradiol was measured in 51.79% (n=29), an important but often overlooked parameter that influences both symptom response and side effect management. Prolactin was tested in 33.93% (n=19), which helps rule out pituitary tumors as a cause of secondary hypogonadism.
Digital rectal exam was performed in 32.14% (n=18) and DHEA was measured in 32.14% (n=18). Only 8.93% (n=5) reported not remembering what tests were performed. These results suggest that while most physicians perform adequate baseline testing, there is room for improvement in comprehensive hormone panel evaluation, particularly for estradiol and other ancillary hormones.
HCG Use: Preserving Fertility and Testicular Function
Human chorionic gonadotropin (HCG) is commonly used alongside TRT to prevent testicular atrophy and preserve fertility. The survey explored HCG usage patterns among TRT users, revealing both high satisfaction among users and significant barriers to access.
Among the 46 respondents who answered this question, 47.83% (n=22) currently use HCG and are satisfied with it. This high satisfaction rate aligns with research showing that HCG effectively maintains intratesticular testosterone levels and prevents the testicular shrinkage that commonly occurs with TRT monotherapy.
However, a substantial 34.78% (n=16) reported that their doctor does not agree to prescribe HCG, despite their desire to use it. This represents a significant gap between patient needs and provider practices. Many physicians remain unfamiliar with HCG's benefits in TRT protocols, and some are hesitant due to regulatory concerns or lack of experience with the medication.
An additional 15.22% (n=7) had stopped HCG for reasons unrelated to efficacy (such as cost or availability), while only 2.17% (n=1) stopped because it did not work. Research supports using 500-1,500 IU of HCG two to three times weekly to maintain testicular function, with higher doses potentially needed for fertility preservation.
Testosterone Injection Protocols: Real-World Dosing
For the 35 respondents using injectable testosterone, the survey captured specific dosing protocols that provide insight into real-world TRT practices.
100 mg weekly was the most common protocol at 34.29% (n=12), representing a moderate dose that aligns with clinical guidelines recommending 75-100 mg weekly as a starting point. 50-100 mg twice weekly was used by 28.57% (n=10), reflecting the growing recognition that more frequent, smaller doses can provide more stable hormone levels and potentially fewer side effects.
200 mg weekly was used by 20% (n=7), a higher dose that may be appropriate for some men but often produces supraphysiologic testosterone levels. Research by Bhasin and colleagues found that 125 mg weekly represents an optimal balance between efficacy and side effects for most men.
Less common protocols included 200 mg every two weeks (5.71%, n=2) and more than 300 mg weekly (5.71%, n=2). The biweekly 200 mg protocol, while still prescribed by some physicians, is now generally considered suboptimal due to significant peak-to-trough fluctuations that can cause mood swings, energy crashes, and other symptoms as levels decline before the next injection.
Clinical Implications and Recommendations
This survey data, combined with current clinical evidence, suggests several key takeaways for men on TRT and their healthcare providers:
Individualized treatment is essential. The diversity of delivery method preferences and the various reasons for discontinuation highlight that there is no one-size-fits-all approach to TRT. What works well for one man may be intolerable for another. Clinicians should discuss all available options and be willing to adjust protocols based on patient response and preferences.
Proper monitoring prevents discontinuation. The high rates of discontinuation due to hematocrit elevation and moodiness underscore the importance of regular lab monitoring and proactive side effect management. Hematocrit should be checked at each visit, and if it exceeds 52%, dose reduction or more frequent injections may help.
HCG access remains a barrier. With over one-third of respondents unable to access HCG despite wanting it, patient advocacy and physician education are needed to improve access to this important adjunctive therapy. For men concerned about testicular atrophy or fertility preservation, HCG should be considered as part of the treatment protocol.
More frequent injections may improve outcomes. The significant proportion of men using twice-weekly injections reflects the growing consensus that smaller, more frequent doses provide more stable hormone levels. This approach can reduce side effects, improve symptom control, and potentially lower hematocrit compared to larger, less frequent doses.
Baseline testing should be comprehensive. While testosterone levels are appropriately measured in most cases, estradiol, prolactin, and other hormones deserve more attention in pre-treatment evaluation. Comprehensive testing helps identify underlying causes of hypogonadism and establishes benchmarks for monitoring treatment response.
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Conclusion
This survey of 345 men provides valuable real-world insights into the TRT patient experience. The findings reveal a patient population that is largely satisfied with treatment but faces meaningful challenges including side effect management, access to adjunctive therapies like HCG, and the need for individualized protocols. As TRT continues to grow in prevalence, understanding patient perspectives becomes increasingly important for optimizing treatment outcomes.
The data also highlights the value of patient communities like ExcelMale.com, where men can share experiences, learn from each other, and gain insights that complement—but do not replace—professional medical guidance. For men considering TRT or seeking to optimize their current protocols, engaging with both knowledgeable healthcare providers and informed patient communities offers the best path to treatment success.
Key References
1. Loeb C, et al. Testosterone replacement therapy is associated with high satisfaction rates: results of a survey study. Int J Impot Res. 2024;36(4):394-398. https://doi.org/10.1038/s41443-023-00724-2
2. El-Osta A, et al. A cross-sectional survey of experiences and outcomes of using testosterone replacement therapy in UK men. Transl Androl Urol. 2025;14(5):1295-1307. https://doi.org/10.21037/tau-2024-738
3. Kovac JR, et al. Patient satisfaction with testosterone replacement therapies: the reasons behind the choices. J Sex Med. 2014;11(2):553-562. https://pubmed.ncbi.nlm.nih.gov/24344902/
4. Bhasin S, et al. Testosterone therapy in men with hypogonadism: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744.
5. Mulhall JP, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423-432.
6. Lee JA, Ramasamy R. Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men. Transl Androl Urol. 2018;7(Suppl 3):S348-S352. https://pmc.ncbi.nlm.nih.gov/articles/PMC6087849/
7. Hudson J, et al. Symptomatic benefits of testosterone treatment in patient subgroups: a systematic review, individual participant data meta-analysis, and aggregate data meta-analysis. Lancet Healthy Longev. 2023;4(11):e561-e572.
8. Haider A, et al. Effects of testosterone replacement therapy withdrawal and re-treatment in hypogonadal elderly men upon obesity, voiding function and prostate safety parameters. Aging Male. 2016;19(1):64-69.
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Testosterone replacement therapy should only be initiated and monitored by qualified healthcare providers. Individual responses to TRT vary significantly, and treatment decisions should be based on comprehensive evaluation including symptoms, laboratory values, and individual health considerations. Always consult with your healthcare provider before starting, stopping, or modifying any hormone therapy.
About ExcelMale
ExcelMale.com is a men's health forum with over 24,000 members and more than 20 years of accumulated knowledge on testosterone replacement therapy, male hormone optimization, and related health topics. The forum provides a supportive community where men can share experiences, ask questions, and learn from both peers and experts.
Founded by Nelson Vergel, ExcelMale builds on his decades of experience as a patient advocate and author. Nelson's books, Testosterone: A Man's Guide and Beyond Testosterone, provide comprehensive guidance for men navigating hormone health. Visit ExcelMale.com to join the community and access additional resources.
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