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Testosterone Therapy for Men in India: Tests, Routes and Risks
In short: Testosterone replacement therapy (TRT) gives testosterone to a man whose body does not make enough. Society guidance says low testosterone should be diagnosed only when symptoms and signs fit and repeat morning blood tests are clearly and consistently low. Some men are screened out first. Treatment needs regular blood monitoring, and it reduces sperm production. A doctor weighs all of this with you.
What is testosterone therapy? (Testosterone therapy kya hai?)
Testosterone therapy is medical treatment that replaces testosterone in men with a confirmed deficiency. The aim is to bring blood levels into the normal range, not above it.
The medical name for the deficiency is male hypogonadism. It means the testes are not making enough testosterone, or the brain's signals to the testes are not working properly.
Bioidentical testosterone has the same molecular structure as the testosterone your body makes. Our bioidentical hormone guide explains that term in full.
What does testosterone do in a man's body?
Testosterone is the main male sex hormone, made mainly by the testes. It drives male characteristics at puberty and helps maintain them in adult life. It also has a central role in sperm production, and it acts on tissues such as muscle, bone and the bone marrow, which makes red blood cells.
The normal role of a hormone does not tell you what giving more of it will do. This guide explains the assessment and the risks. It does not promise any result from treatment.
How is low testosterone confirmed?
Low testosterone is confirmed by symptoms and signs that fit, plus repeat morning blood tests that are clearly and consistently low. One result is not enough. The Endocrine Society, a major international hormone society, advises these steps:
A fasting morning test. Total testosterone is measured in the morning, after fasting, by an accurate and reliable laboratory method. Levels peak in the early morning. A 2023 Indian expert opinion notes that they can be up to 60 percent lower in the evening.
A repeat test. A second fasting morning test confirms the result.
Free testosterone, when needed. Most circulating testosterone is bound to proteins, principally sex hormone-binding globulin (SHBG) and albumin; a small proportion is unbound. If the total is near the lower limit, or SHBG may be altered, free (unbound) testosterone is measured or calculated.
A search for the cause. LH and FSH, the brain's signals to the testes, help show where the problem lies.
The timing of the test matters. The guideline advises against testing during a short illness or short-term use of medicines that suppress testosterone, such as opioids.
There is no single cut-off. Diagnosis requires compatible symptoms and repeatedly low morning results. The American Urological Association (AUA) uses below 300 ng/dL as a reasonable threshold. The Endocrine Society's 2018 guideline gives 264 ng/dL for appropriately standardised assays (laboratory tests); laboratory methods matter. The 2023 Indian expert opinion notes that India has no standardised national guideline on this condition, so doctors here draw on international guidance and Indian expert opinion.
Symptoms alone do not prove it. Tiredness, low mood, poor sleep and changes in sexual health are common and have many causes. Thyroid problems, low iron, depression, sleep apnoea and medicines can all look similar.
Who does a doctor screen out before testosterone therapy?
A doctor must rule out several conditions first. The Endocrine Society recommends against starting testosterone in men who:
are planning to father a child in the near term
have breast or prostate cancer
have a lump or hard area felt in the prostate on examination
have a raised PSA (a prostate blood test) above 4 ng/mL, or above 3 ng/mL if at higher risk of prostate cancer, without further urological evaluation
have a high haematocrit (the share of the blood made up of red cells)
have untreated severe obstructive sleep apnoea (breathing pauses in sleep)
have severe urinary symptoms
have uncontrolled heart failure
have had a heart attack or stroke in the last 6 months
have thrombophilia (a tendency for blood to clot)
The Indian expert opinion uses a similar list, and gives a haematocrit above 50 percent as a reason not to treat.
This list is for your doctor's screening, not for self-diagnosis. Tell your doctor about every medicine and supplement you take, including anything bought for the gym.
How is testosterone given?
Testosterone can be given by several routes, and the choice depends on your needs, preference and how the body handles each form.
Injections into muscle. Shorter-acting forms are given every few weeks, and levels can swing widely between doses. A longer-acting form is given about every 10 to 14 weeks. Pain at the injection site is possible.
Gels on the skin. These are applied daily. Testosterone can transfer to another person through close skin contact.
Skin patches. These are applied daily and can irritate the skin.
Capsules. Oral forms need several doses a day with meals, and absorption varies.
Pellets under the skin. These need a small surgical procedure and can sometimes work their way out.
Not every form is available everywhere. Your doctor's aim, under the Endocrine Society guideline, is a level in the mid-normal range.
How is testosterone therapy monitored?
Testosterone therapy needs a standard monitoring plan, not one prescription and no follow-up. Under the Endocrine Society guideline:
Symptoms and side effects are reviewed, along with whether you are able to keep to treatment.
Testosterone and haematocrit are measured at the start, at 3 to 6 months depending on the form used, at 12 months, and then yearly.
Prostate risk is evaluated according to your age and risk, after an informed discussion with your doctor. For men aged 55 to 69 who choose monitoring, this is done before starting and again 3 to 12 months later.
If haematocrit rises above 54 percent, the guideline says to stop treatment until it falls to a safe level, assess for low oxygen and sleep apnoea, then restart at a lower dose.
What are the known risks of testosterone therapy?
The main known risks are lower sperm production, a raised red blood cell level, and some heart, kidney and clotting events seen in a large trial.
Lower sperm production. Testosterone from outside tells the brain to reduce its signals to the testes. The testes then make less of their own testosterone and fewer sperm. Sperm production often slowly returns after stopping, but the speed of recovery varies widely. Tell your doctor if you may want children in the future, before any treatment starts.
More red blood cells. Testosterone can raise haematocrit. This can thicken the blood, and the Indian expert opinion links it to vein clots.
Sleep apnoea. Testosterone may trigger or worsen sleep apnoea, so a doctor asks about it and looks for it if haematocrit rises.
Heart and circulation. The TRAVERSE trial followed 5,246 men aged 45 to 80 who had heart disease or a high risk of it, along with symptoms of low testosterone and two low fasting results. They used a testosterone gel or a placebo gel. Major heart events occurred in 7.0 percent on testosterone and 7.3 percent on placebo, which met the trial's predefined comparison for major cardiovascular events during an average 33-month follow-up; this does not establish safety for every outcome or lifelong use. A higher rate of atrial fibrillation (an irregular heartbeat), acute kidney injury and lung clots was seen in the testosterone group.
Prostate. Prostate risk is the reason for screening and monitoring. Men with prostate cancer are not treated with testosterone.
Seek emergency care for sudden chest pain or sudden breathlessness. Seek urgent assessment for a newly swollen, painful leg. Report new urinary symptoms promptly.
How does a SOMA doctor decide what is right for you?
At SOMA, hormonal optimisation begins with a diagnostic consultation and full hormone panels, covering thyroid, cortisol, insulin and sex hormones. It begins with testing, not treatment.
Any protocol is proportionate to the findings. Lifestyle and nutritional correction form the base. Bioidentical hormones are used where indicated, at physician-set doses, and therapy starts only where there is a documented need. Some situations rule it out.
Repeat tests at physician-set intervals check the response, and doses are adjusted. This is a managed process, as one part of a plan built around you.
SOMA centres in Mumbai and New Delhi
Hormonal optimisation is available at both SOMA centres:
Mumbai: A-507, Kohinoor Square, N.C. Kelkar Marg, Shivaji Park, Dadar West, Mumbai 400028. Phone +91 98671 94033.
New Delhi: E-354, Greater Kailash II, New Delhi 110048, serving Delhi NCR and Gurugram. Phone +91 87969 92001. More about the New Delhi centre.
The New Delhi centre is independently operated under licence from SOMA Longevity Sciences, and its own doctors lead care there. Both centres follow the same SOMA assessment and diagnostic standards. Online consultations are also available. Contact either centre.
Questions people ask
What is testosterone replacement therapy?
Testosterone replacement therapy gives testosterone to men with a confirmed deficiency, by injection, gel, patch, capsule or pellet. Its aim is a level within the normal range. It needs a doctor's assessment first and blood monitoring throughout.
What level of testosterone is considered low?
There is no single cut-off. Diagnosis requires compatible symptoms and repeatedly low morning results. The AUA uses below 300 ng/dL as a reasonable threshold. The Endocrine Society's 2018 guideline gives 264 ng/dL for appropriately standardised assays; laboratory methods matter.
Does testosterone therapy affect sperm production?
Yes. Testosterone therapy reduces the body's own sperm production. Production often slowly returns after stopping, but the speed of recovery varies widely. Men who may want children should tell their doctor before starting.
Do I have to stay on testosterone therapy for life?
There is no fixed length. Your doctor reviews benefits, risks and blood results at regular intervals, and adjusts or stops treatment as your needs change.
What hormone assessment does SOMA offer?
SOMA offers hormonal assessment in Dadar West, Mumbai, and Greater Kailash II, New Delhi. Hormonal care there starts with your history, examination and tests, and any hormone support is decided by your doctor where it is indicated.
Related guides
Sources
Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism 2018;103(5):1715–1744. https://pubmed.ncbi.nlm.nih.gov/29562364/
Kalra S, Jacob J, Unnikrishnan AG, et al. Expert opinion on the diagnosis and management of male hypogonadism in India. International Journal of Endocrinology 2023;2023:4408697. https://pubmed.ncbi.nlm.nih.gov/36876281/
Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular safety of testosterone-replacement therapy. New England Journal of Medicine 2023;389(2):107–117. https://pubmed.ncbi.nlm.nih.gov/37326322/
Naelitz BD, Momtazi-Mar L, Vallabhaneni S, et al. Testosterone replacement therapy and spermatogenesis in reproductive age men. Nature Reviews Urology 2025;22(10):703–719. https://pubmed.ncbi.nlm.nih.gov/40346275/
Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. Journal of Urology 2018;200(2):423–432. https://pubmed.ncbi.nlm.nih.gov/29601923/
Basaria S. Male hypogonadism. The Lancet 2014;383(9924):1250–1263. https://pubmed.ncbi.nlm.nih.gov/24119423/
This article is for education and general information. It is not a substitute for a medical consultation, diagnosis or treatment. Results vary by individual biology.
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