Testosterone Replacement Therapy (TRT) in Singapore

Am I a Candidate for TRT?

You might be suitable for TRT if you have both of the following:

• Real symptoms that are affecting your life — reduced libido, erectile difficulties, persistent fatigue, low mood, loss of muscle or strength, or poor concentration
• Low testosterone confirmed on a blood test — a morning sample, interpreted against relevant reference ranges

A low number alone isn't enough, and symptoms alone aren't enough. Both need to be there.

TRT is used in three main situations:

• Primary hypogonadism — the testes can't produce enough testosterone (e.g. after chemotherapy, testicular injury, or genetic conditions like Klinefelter syndrome)
• Secondary hypogonadism — the pituitary or hypothalamus isn't signalling the testes properly (e.g. pituitary disorders, long-term opioid use, chronic illness)
• Late-onset hypogonadism — age-related decline with clear symptoms. In this group, lifestyle changes come first — weight loss, better sleep, cutting back on alcohol, and reviewing medications can often bring testosterone back up over a few months

If you're not sure whether TRT is right for you, start with a testosterone test and a conversation. Dr Joel will look at the full picture — your symptoms, your blood results, and any lifestyle factors — before recommending treatment.

How Does TRT Work?

TRT adds testosterone from outside the body — through an injection or a gel — to bring your blood levels back into the healthy range. Once your levels are restored, the knock-on effects follow: better libido and mood, more energy, stronger muscles, and healthier bones.

One thing to know: once you start TRT, your body's own production usually slows down because it senses there's enough testosterone already. That's why TRT tends to be a long-term commitment — especially in primary hypogonadism, where the testes can't produce testosterone on their own anyway.

What to Expect on TRT

In men with confirmed low testosterone, TRT is generally safe and effective — provided it's prescribed and monitored properly. Here's what most men ask about before starting.

Benefits you can expect

• Improved libido and sexual function
• Reduced fatigue, better energy and mood
• More muscle mass and strength
• Reduction in body fat, particularly around the waist
• Stronger bones (better bone mineral density)
• Correction of low red blood cell count (anaemia) when it's caused by low testosterone

Libido and mood often improve within 3–6 weeks. Body composition and bone density changes are seen over several months — so give it time, and track how you feel at each follow-up.

Risks and side effects to know about

Like any prescription treatment, TRT has side effects. Most are manageable with regular blood tests and dose adjustments — but a few warrant closer attention.

• Thickened blood (polycythaemia) — the most common reason for dose changes. Monitored with routine blood tests
• Blood clots (DVT, pulmonary embolism) — a small increased risk. Seek urgent help for unexplained leg swelling, chest pain or sudden breathlessness
• Irregular heart rhythm (atrial fibrillation) — small increase seen in the TRAVERSE trial
• Fracture risk — a small increase, largely trauma-related, seen in a TRAVERSE fracture subtrial
• Worsening sleep apnoea in men who already have it
• Acne, oily skin, or fluid retention
• Breast tenderness or enlargement (gynaecomastia)
• Reduced sperm count — TRT should not be used if you're trying to conceive or wish to preserve future fertility
• Benign prostate growth — TRT hasn't been shown to cause prostate cancer, but it can accelerate an existing one, so PSA is monitored in men aged 40 and above

On cardiovascular safety: the TRAVERSE trial (2023) confirmed that TRT does not increase heart attack or stroke in men with hypogonadism — though the small increases in atrial fibrillation, pulmonary embolism and fractures mean individualised assessment still matters, especially after a recent cardiovascular event.

When TRT isn't the right fit

TRT isn't started — or is postponed — for men with any of the following, until the underlying issue is sorted:

• Known prostate or male breast cancer, or an unevaluated prostate nodule / raised PSA
• Baseline haematocrit above 48%, or known polycythaemia (on treatment, a haematocrit above 54% usually triggers dose reduction or a temporary pause)
• A history of unexplained blood clots, or a known clotting disorder
• Untreated severe sleep apnoea, uncontrolled heart failure, or a recent heart attack / stroke (within 3–6 months)
• Plans to father children in the near future
• Severe, uncontrolled urinary symptoms from an enlarged prostate

Dr Joel will check for all of these as part of your assessment before prescribing.

Monitoring and red flags

Once you start TRT, regular check-ins matter as much as the prescription itself. Expect blood tests for testosterone, haematocrit, PSA (in men 40 and above) and a lipid panel — more frequently in the first year, then less often once stable. A baseline bone density (DEXA) scan may be added if there's concern about osteoporosis.

If you take warfarin, diabetes medication (insulin or oral pills) or corticosteroids, let Dr Joel know — TRT can change how these work and doses may need to be adjusted.

Stop TRT and seek urgent medical care if you notice: unexplained leg swelling or pain, sudden chest pain or breathlessness, sudden severe headache or weakness on one side, a persistent irregular heartbeat, severe difficulty passing urine or blood in your urine, or a new lump in the breast.