Testosterone Replacement

This page explains how testicular cancer can affect testosterone levels and how  levels can be tested. It gives guidance on different testosterone replacement therapies and potential side effects.

What is Testosterone?

Testosterone is the male sex hormone. It is responsible for male sexual characteristics such as:

  • deep voice
  • muscle tone
  • bone strength
  • hair pattern (and balding)
  • sex drive
  • achieving and maintaining erections
  • general sense of male well-being

You can read more about testosterone here.

Testosterone and Orchidectomy


Around 90% of testosterone is produced by the testicles. Having one testicle removed should not the production of testosterone unless the remaining testicle is not functioning properly. However, further treatment with chemotherapy can sometimes affect testosterone production. Usually this is not permanent but it may take quite a while after treatment for levels to recover.

Men who have had had both testicles removed, will no longer be able to produce sperm and will only produce a very small amount of testosterone in the adrenal glands. In this situation, they will need to start testosterone replacement therapy.

How Will I Know if I Have Low Testosterone?

If testosterone levels fall, men may feel tired, low in mood and develop hot flushes or sweats. They might also gain weight and lose muscle strength.

Testosterone levels have a major impact on sexual drive and performance. If  levels are low, men may find it difficult to achieve normal erections or find it difficult to maintain an erection strong enough for sexual intercourse.

If testosterone levels are low for a prolonged time, men may experience breast swelling (gynaecomastia) and thinning of the bones (osteoporosis). They can also become more at risk of cardiovascular disease.

How Do I Get My Levels Checked?

Treatment for testicular cancer is intense and occurs in a fairly short space of time. Unfortunately, it can bring with it both physical and mental stress. This makes it difficult to work out what is causing symptoms like low mood and low sex drive.

Although low mood and sometimes depression can occur after testicular cancer treatment, men should consider asking their specialist cancer team or   GP to check for low testosterone levels. This can be done by a simple blood test.

Measuring Testosterone Levels

A blood test is used to measure testosterone levels.

The test needs to be done in the morning. Testosterone levels are at their highest early in the morning, and this is when the blood test can be performed accurately. The results are usually ready in a few days.

Types of Testosterone Replacement

Gels (Testim®, Testogel®, Tostran®)

These are gels that are applied in a thin layer to a clean, dry and healthy area of skin like the shoulders, chest or back once a day.
These are usually applied daily after a shower or bath. You need to wait at least five minutes before dressing afterwards.

It is very important that you wash your hands before and afterwards to avoid any transfer to your wife or female partner. If someone else applies it for you, they need to wear gloves to stop the testosterone being absorbed into their system.
Injections (Nebido®, Sustanon 250®, Virormone®)

Sustanon or Virormone are given as an injection into the muscle of the buttocks (or the thickest part of the leg) every two or three weeks.

Nebido is an injection which will release testosterone into the body over a certain length of time and is called a depot injection. It is given deep into the muscle of the buttocks every 10-14 weeks. The injection is oilier and a little deeper so can be more uncomfortable.

Testosterone injections are usually given by GP practice nurses.
The injections themselves can be painful whichever form you are on but are better if the vial is warmed up for a few minutes before the injection is given.

Possible skin injection or soreness can happen around the site of the injections.

Nebido tends to give very steady levels of testosterone.

Other testosterone injections lead to a rapid rise for the first week as the testosterone kicks in. After this, the levels usually fall off and symptoms may return before the next injection is due.
Patches (Andropatch®, Intrinsa®)

These are patches that can be applied to clean dry skin like a nicotine patch.
These can cause skin irritation or reactions.

Not currently available in the UK.
Capsules (Restadol®/TestocapsTM)

Three or four capsules are usually taken daily for the first 2-3 weeks, reduced to 1-3 capsules daily. They should be taken with a meal and swallowed not chewed.
These can provide much lower levels of testosterone than other preparations so may not be recommended.
Mucoadhesive Buccal tablets (StriantTMSR)

These are tablets that are placed on the gum above the front teeth and dissolve gradually.
Buccal tablets can become dislodged from the gum.

Not currently available in the UK.

How Will I Know if the Treatment is Working?

When men start testosterone replacement therapy, testosterone levels will need to be checked on a regular basis. Most people start to feel better within a few weeks of treatment, but it may take at least three months to obtain or  feel the full effects of treatment.

If replacement therapy works, it can be continued indefinitely. If one testicle has been removed testosterone levels may eventually return to normal and testosterone replacement therapy can be discontinued.

Some men may also find that it will take a little while to find the best treatment for them and may need to try different types of replacement therapy.

Are There Any Side Effects?

Testosterone is commonly thought to cause aggression and hostility but it is more involved in helping the male body adapt to challenging and stressful events.

However, like all medications, testosterone replacement therapy may cause some side effects and it is important to read the information supplied with any medication. Common side effects are oily skin and spots. Less often, people complain of headaches, nausea, excess sweating, tiredness and mood changes.

In the ong term, doctors will need to monitor levels to make sure they remain in the normal range and also check that the additional testosterone has not affected your liver or blood.

As men get older there is a an increased risk of prostate cancer developing. Testosterone does not cause prostate cancer but can  cause the prostate gland to enlarge. If men have a strong family history of prostate cancer or are over the age of 50 the medical team may monitor them more closely or discuss the risk of prostate cancer with them as prostate cancer progression depends on testosterone.

It is extremely important that men do not take testosterone supplements. Too much testosterone can cause other medical problems.

Men should  not stop testosterone treatment without consulting their GP or specialist team.

Other Ways to Boost Your Testosterone

  • Physical exercise is good for improving energy levels, reducing anxiety and low moods and promoting well-being. A few seconds of sprinting can increase testosterone levels and graduated exercise such as brisk walking or supervised cardiovascular training may also help.
  • A good night’s sleep is a natural way to increase testosterone levels.
  • Avoid stressful situations. Practice relaxation techniques such as deep breathing and meditation to reduce stress levels. Stress lowers testosterone levels.
  • Avoid excessive alcohol intake. Alcohol can lower testosterone levels.
  • Try to eat a healthy mixed diet and keep to a healthy weight. Being overweight leads to a fall in testosterone.

Find out more about Testosterone Replacement Therapy in our video:

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Download a copy of our Testicular Cancer Booklet

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