In short
Testosterone replacement therapy (TRT) is a prescription treatment for men with symptoms of testosterone deficiency and a low morning testosterone level confirmed on at least two separate days. Testosterone gel is usually the first choice. In the TRAVERSE trial of 5,204 men, testosterone did not increase heart attacks, strokes or cardiovascular deaths over an average of 33 months, while atrial fibrillation, pulmonary embolism and fractures were more common. In Dubai, TRT requires a prescription from a licensed doctor.
Treatment Overview
What is testosterone replacement therapy?
Testosterone replacement therapy (TRT) is a prescription treatment that raises a low testosterone level into the normal range for adult men. TRT treats a confirmed deficiency caused by disease of the testes (primary hypogonadism) or of the pituitary gland or hypothalamus in the brain (secondary hypogonadism). The target is the middle of the normal range, not a level above it.
Testosterone replacement therapy does not relieve tiredness or low mood in men whose testosterone is already normal. Testosterone levels above the normal range (supraphysiological levels) add risk without proven benefit.
Who qualifies for testosterone replacement therapy?
Men qualify for testosterone replacement therapy when symptoms of testosterone deficiency and a clearly low morning fasting testosterone, measured on two to three separate days, occur together, according to the Endocrine Society clinical practice guideline. The more specific signs are low libido, fewer morning erections, loss of body hair, breast enlargement (gynaecomastia), small testes and low bone density. Tiredness, low mood, anaemia, weaker muscles and more body fat are less specific, because many other conditions cause them.
A single low reading is not a diagnosis. The blood tests, the sampling time between 8 and 10 in the morning and the role of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are explained on the TRT consultation page. Dr. Felix Lucian Happich decides after the examination and the blood results.
Testosterone is not prescribed as a trial to see whether symptoms improve. The result of such a trial cannot be interpreted, and stopping afterwards means months of low testosterone while the body restarts its own production.
Men over 60 with a low testosterone and no disease of the testes or pituitary gland are covered on the andropause page, and treatment for this group on TRT for men over 50. Other causes of low energy and low libido are covered under male hormonal fatigue.
Which testosterone preparations are used for TRT?
Testosterone gel is usually the first choice, because gels give normal and relatively stable testosterone levels and most men prefer them. Injections, a nasal gel and newer oral capsules are alternatives. The table compares the five main forms by dosing interval and practical limits.
| Preparation | How often | What to know |
|---|---|---|
| Gel or skin solution | Once daily | Stable levels over 24 hours. Skin contact can transfer testosterone to a partner or child, so the site is covered and hands are washed. |
| Testosterone enanthate or cypionate injection | Every 1 to 2 weeks into the muscle, or weekly under the skin | Levels peak 1 to 2 days after an intramuscular injection and fall before the next one. Many men notice swings in energy, mood and libido. |
| Testosterone undecanoate long-acting injection | Every 10 to 14 weeks after a loading dose | Fewer injections, about 4 to 5 a year. Rarely, oil reaches the lungs (about 1 in 7,000 injections) or an allergic reaction occurs (about 1 in 25,000), so a doctor gives the injection in the clinic. |
| Nasal gel | Three times daily | Short-acting. Minor nasal side effects affect about 6 to 10 percent of users. |
| Oral testosterone undecanoate capsules | Twice daily with food | Used when other forms do not suit. Carries a warning about higher blood pressure. |
Men with low testosterone from the pituitary gland who want children receive hCG therapy instead of testosterone, because hCG makes the testes produce their own testosterone and sperm.
Older oral tablets such as methyltestosterone are avoided because of liver side effects. Testosterone pellets implanted under the skin are not used, because insertion needs a minor procedure and data on testosterone levels during pellet treatment are limited.
What does testosterone replacement therapy improve?
Testosterone replacement therapy improves sexual desire, sexual activity, muscle strength, lean body mass and bone density in men with a confirmed deficiency. Symptoms that persist once testosterone is in the normal range point to another cause.
The Testosterone Trials gave 788 men over 65 with low testosterone either testosterone gel or placebo gel for one year. Testosterone moderately improved sexual activity and sexual desire, erectile function to a lesser degree, and mood and depressive symptoms slightly. Energy and memory did not improve in the trials designed to measure them. The meaning of these results for older men is explained under what the Testosterone Trials showed.
Testosterone replacement therapy did not improve blood sugar or prevent progression from prediabetes to type 2 diabetes in a substudy of the TRAVERSE trial. Erectile dysfunction usually has causes other than testosterone, covered on the erectile dysfunction page.
How long does TRT take to work?
Testosterone replacement therapy changes energy, sexual function and lean body mass within 3 to 6 months, while bone density needs about 24 months for the full effect. A three-year study of 18 previously untreated men with hypogonadism on testosterone applied to the skin showed this pattern. Red blood cell production and prostate volume also rose in the first 3 to 6 months.
Symptoms that have not changed after testosterone has reached the normal range suggest a different cause. The plan then changes, rather than the dose rising above the normal range.
What are the risks of testosterone replacement therapy?
The main risks of testosterone replacement therapy are a raised red blood cell count, atrial fibrillation, pulmonary embolism and, in one large trial, more fractures. Heart attacks, strokes and cardiovascular deaths did not increase in the TRAVERSE trial. TRAVERSE followed 5,204 men with low testosterone and heart disease or a high heart risk, typically aged 63. Half used testosterone gel and half a placebo gel, for almost three years on average (33 months). The table lists the safety results.
| Outcome | Result |
|---|---|
| Heart attack, stroke or cardiovascular death | Similar in both groups |
| Atrial fibrillation and other non-fatal heart rhythm problems | More common with testosterone |
| Pulmonary embolism | 24 events with testosterone, 12 with placebo |
| All clinical fractures (fracture analysis) | 3.50 percent with testosterone, 2.46 percent with placebo, mostly ankle, wrist and rib |
| Prostate cancer | 12 men with testosterone, 11 with placebo; men at high risk were excluded |
Erythrocytosis, meaning a haematocrit above 54 percent or haemoglobin above 17.5 g/dL, is the most common abnormal blood result on testosterone. Erythrocytosis is more frequent with injected testosterone esters at high doses and rare when the dose keeps testosterone inside the normal range. A raised haematocrit increases the risk of blood clots.
Other side effects of testosterone include acne, skin irritation from gels and slight fluid retention.
When is testosterone not used?
Testosterone is not started in men with prostate cancer, breast cancer, a haematocrit above 50 percent, severe untreated urinary symptoms, severe untreated sleep apnoea or uncontrolled heart failure, according to the Endocrine Society clinical practice guideline. Each condition is handled as follows:
- Prostate cancer: a history of prostate cancer usually excludes testosterone. Men over 50, or over 40 with African ancestry or a father or brother with prostate cancer, have a prostate examination and a prostate-specific antigen (PSA) blood test first. A nodule or a PSA above 4 ng/mL, or above 3 ng/mL at high risk, leads to a urology referral before any decision.
- Breast cancer: the body converts part of the testosterone to oestradiol, so testosterone is not used.
- Urinary symptoms: moderate to severe symptoms from an enlarged prostate (benign prostatic hyperplasia) are treated first.
- Raised haematocrit: the cause is found and treated first.
- Sleep apnoea: severe untreated obstructive sleep apnoea is treated first. Men with sleep apnoea well controlled by continuous positive airway pressure (CPAP), the breathing mask worn at night, can take testosterone.
- Heart failure: uncontrolled heart failure is stabilised first, because testosterone retains some salt and water.
Does TRT affect fertility?
Yes, testosterone replacement therapy suppresses sperm production and reduces testicular size. Testosterone from outside the body switches off luteinizing hormone (LH), the pituitary signal that drives sperm production in the testes. Men who want children now or later discuss this before treatment starts, as described on the TRT and fertility page. Men with secondary hypogonadism can receive human chorionic gonadotropin (hCG) injections instead, which stimulate both testosterone and sperm production in the testes.
How is TRT monitored?
Testosterone replacement therapy is monitored with blood tests 2 to 3 months after starting and after every dose change, then every 6 to 12 months, according to the Endocrine Society clinical practice guideline. The table lists each check, its timing and its purpose.
| Check | When | Why |
|---|---|---|
| Serum testosterone | 2 to 3 months after starting or a dose change, then every 6 to 12 months | Confirms a level inside the normal range |
| Haematocrit | 3 to 6 months after starting, then yearly | Detects erythrocytosis early |
| Symptoms and side effects | Every review | Shows whether treatment helps, which the level alone does not |
| Prostate examination and PSA | At 3 and 12 months in men over 50, or over 40 at higher risk | Follows prostate changes |
| Bone density | After 2 years if low at the start | Measures the full bone effect |
The timing of the testosterone blood sample depends on the preparation. With enanthate or cypionate injections, the sample is taken midway between injections, and the target is the middle of the normal range, about 400 to 700 ng/dL (13.9 to 24.3 nmol/L). With a gel, testosterone varies from day to day without a predictable pattern, so two samples are taken before a dose change.
A haematocrit above the upper normal limit leads to a lower dose or a pause, with a repeat blood count after 2 months. Treatment stops at a haematocrit of 54 percent or more.
Testosterone replacement therapy in Dubai and the UAE
Is testosterone legal in the UAE?
Testosterone is legal in the UAE only with a prescription from a licensed doctor, dispensed by a licensed pharmacy. The UAE Ministry of Health and Prevention (MOHAP) has stated that these hormones may only be prescribed by the treating physician for a clear medical reason, and that hormone injections need medical tests beforehand (Khaleej Times, 2019). Testosterone preparations such as Sustanon injections and Andriol capsules appear on the UAE list of controlled medicines published by UAE embassies (UAE Embassy in Sweden).
Dr Felix treats within the scope of his Dubai Health Authority licence. When a case needs a specialist view, for example a wish for children, an abnormal prostate finding, a possible pituitary cause or a high red blood cell count, the treatment decision is made together with an endocrinologist, urologist or fertility specialist.
Hormones sold in gyms or by online sellers sit outside this system. The action of UAE authorities against these sellers is summarised on the TRT after steroid use page.
Can testosterone be brought into the UAE?
Testosterone can be brought into the UAE with a MOHAP permit issued before travel, according to the Gulf News summary of the MOHAP rules from August 2025. The application is free, and the certificate arrives by SMS or email. The application needs three things:
- Prescription: issued within the last 3 months, with the patient name, medicine, dose, form, treatment duration and prescribing doctor.
- Medical report: issued within the last 12 months, with diagnosis, treatment plan and the stamp of the healthcare facility.
- Quantity: no more than 3 months of treatment.
How should testosterone gel be stored in Dubai heat?
Testosterone gel is stored at normal room temperature, 20 to 25 °C, and may briefly be between 15 and 30 °C, according to the US prescribing information for AndroGel 1.62%. Dubai summer temperatures outdoors and inside a parked car exceed 30 °C, so the gel stays indoors and not in a car. Alcohol-based testosterone gels are flammable until dry, so fire, flames and smoking are avoided until the gel has dried.
Who Is a Good Candidate?
- Men with symptoms of androgen deficiency and low morning fasting testosterone confirmed on separate days.
- Men whose low testosterone comes from a problem of the testes or the pituitary gland, established by LH and FSH.
- Men already on testosterone elsewhere who want the diagnosis, the dose and the monitoring reviewed properly.
- Men who want an honest comparison of what treatment does and does not deliver before starting.
- Prostate cancer or breast cancer: testosterone is not prescribed.
- Trying for a child now or in the near future: testosterone suppresses sperm production, so another route is needed.
- Haematocrit above 50 percent, severe untreated sleep apnoea, severe urinary symptoms or uncontrolled heart failure: these are treated first.
- A single borderline reading, or a request for a prescription without examination and blood tests: not offered.
- Doses aimed at levels above the normal range, for training or physique: not offered.
What Happens During the Consultation
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1
Symptoms and history
Dr. Felix reviews what has changed and since when, plus sleep, weight, alcohol, medicines such as opioids or steroids, chronic illness, previous blood clots and plans for children.
-
2
Examination and blood tests
The examination includes testes and breast tissue. Blood tests cover morning fasting testosterone on separate days, LH and FSH, haematocrit, PSA where age-appropriate and other hormones where needed.
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3
Diagnosis before prescription
The results give one of three answers: deficiency of the testes, deficiency of the pituitary gland, or another cause that needs different treatment. Pituitary causes can need imaging.
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4
Treatment plan and review dates
When TRT is indicated, the plan sets the preparation, the dose, the documented fertility discussion and the date of the first blood test at 2 to 3 months.
Program Structure & Follow-Up
What does the first year of TRT look like?
The first year of testosterone replacement therapy follows fixed reviews at 2 to 3 months, 3 to 6 months and 12 months. The reviews cover these points:
- 2 to 3 months: testosterone level, symptoms, side effects and a dose adjustment where needed.
- 3 to 6 months: haematocrit, plus prostate examination and PSA at 3 months in men over 50.
- 12 months: haematocrit, prostate examination and PSA, symptoms and the plan for the second year.
Between appointments, patients reach the practice through the membership programmes.
When is the testosterone dose changed?
The testosterone dose changes when the measured level lies outside the target range or the haematocrit rises, not because a symptom improves slowly. A dose raised to chase symptoms pushes testosterone above the normal range, where erythrocytosis becomes more common.
What happens after stopping TRT?
After stopping testosterone replacement therapy, the original symptoms return and testosterone stays low for months while the pituitary gland and testes recover. A planned stop is therefore scheduled with blood tests rather than done abruptly.
Benefits, Limits & Safety
What are the common side effects of TRT?
The common side effects of testosterone replacement therapy are a rising red blood cell count, acne and, with gels, skin irritation at the application site. Skin irritation from the alcohol in testosterone gels causes itching, burning or redness, but is uncommon.
Can testosterone gel transfer to other people?
Testosterone gel can transfer to a partner or child through skin contact. This is rare but serious. The US Food and Drug Administration (FDA) received 8 reports of young children, aged 9 months to 5 years, with early genital growth and pubic hair. That compares with about 1.8 million prescriptions. After these reports, the FDA added a boxed warning, its strongest label warning. Four steps from the package instructions keep the risk minimal:
- Wash hands thoroughly after applying the gel.
- Prevent transfer: keep the application area covered after drying. Before expected direct skin contact, wash the area with soap and water.
- Cover the application site with clothing once dry.
- Follow the exact product instructions for application sites and the minimum time before showering or swimming; this differs between gels.
When is urgent medical help needed on testosterone?
Signs of a blood clot or an irregular heartbeat during testosterone treatment need urgent medical help:
- Sudden breathlessness or chest pain, a possible sign of pulmonary embolism.
- Pain, swelling, redness or warmth in one calf, a possible sign of a clot in a leg vein.
- A racing or irregular heartbeat that does not settle.
- Sudden weakness on one side or difficulty speaking, a possible sign of stroke.
In the UAE, 998 is the number for an ambulance.
Which testosterone treatments are not offered?
Dr. Felix does not offer testosterone without examination and blood tests, doses aimed above the normal range, or a trial of testosterone. Products bought from gyms, online sellers or social media accounts are not continued unchanged. The review establishes what was used and plans a safe route, which sometimes means stopping.
Testosterone products can raise blood pressure. Blood pressure is checked before and during treatment, alongside the other monitoring appropriate to the product and your medical history.
What the evidence shows
Better sexual desire and activity, more muscle strength and lean mass, denser bone and slightly better mood. No improvement in memory, and no reduction in heart attacks or strokes.
How you are followed
Testosterone at 2 to 3 months and after each dose change, then every 6 to 12 months. Haematocrit at 3 to 6 months, then yearly. Prostate examination and PSA at 3 and 12 months from age 50.
When testosterone is not used
Prostate or breast cancer, haematocrit above 50 percent, severe untreated urinary symptoms, severe untreated sleep apnoea, uncontrolled heart failure, or a current wish for children.
Cost & Program Investment
The cost of testosterone replacement therapy depends on the preparation and the monitoring it needs. Dr. Felix explains the full cost, including blood tests and reviews, before any prescription. Ongoing care runs through the membership programmes.
Frequently Asked Questions
Testosterone replacement therapy is indicated only when symptoms of testosterone deficiency and a clearly low morning fasting testosterone on at least two separate days occur together. Genuine deficiency is uncommon: in the European Male Ageing Study of about 3,000 men aged 40 to 79, only about 2 in 100 had low testosterone together with three sexual symptoms.
Testosterone gel is usually the first choice, because gels give stable levels and most men prefer them. Injections suit men who prefer fewer doses, and long-acting testosterone undecanoate injections are given every 10 to 14 weeks. The preparation can change later.
Testosterone replacement therapy changes energy, libido and lean body mass within 3 to 6 months. Bone density needs about 24 months for the full effect. Symptoms unchanged once testosterone is in the normal range point to another cause.
Testosterone replacement therapy did not increase heart attacks, strokes or cardiovascular deaths in the TRAVERSE trial, which followed 5,204 men with cardiovascular disease or risk factors for an average of 33 months. Atrial fibrillation and pulmonary embolism were more common with testosterone.
Replacement doses of testosterone have not been shown to cause prostate cancer: in the TRAVERSE trial, prostate cancer occurred in 12 men on testosterone and 11 on placebo. Men at high risk were excluded from TRAVERSE, so a prostate examination and PSA test remain part of monitoring from age 50, or 40 at higher risk.
Testosterone replacement therapy suppresses sperm production and reduces testicular size. Men who want children now or later raise this before treatment, because human chorionic gonadotropin (hCG) supports both testosterone and sperm production in men with secondary hypogonadism.
Testosterone is checked 2 to 3 months after starting and after every dose change, then every 6 to 12 months. Haematocrit is checked 3 to 6 months after starting and then yearly. Prostate checks start at age 50, or 40 at higher risk.
Testosterone is legal in the UAE with a prescription from a licensed doctor, dispensed by a licensed pharmacy. Testosterone is a controlled medicine in the UAE, not a supplement, and buying or holding it without a prescription is a legal problem as well as a medical one.
Testosterone enters the UAE with a free MOHAP permit issued before travel. The application needs a prescription from the last 3 months, a stamped medical report from the last 12 months and no more than 3 months of supply. The certificate arrives by SMS or email.
Testosterone replacement therapy can be stopped, but the body's own production takes months to recover and the original symptoms return in the meantime. A planned stop is therefore scheduled with blood tests.
Testosterone for muscle building in men with normal testosterone is not prescribed. Testosterone above the normal range raises the risk of erythrocytosis and suppresses fertility, and testosterone without a prescription is illegal in the UAE.
The cost of testosterone replacement therapy in Dubai depends on the preparation, the dose and the monitoring. Dr. Felix explains the full cost in the consultation before any prescription.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
- Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline
- Cardiovascular Safety of Testosterone-Replacement Therapy (TRAVERSE)
- Testosterone Treatment and Fractures in Men with Hypogonadism
- Effects of Testosterone Treatment in Older Men (The Testosterone Trials)
- Identification of late-onset hypogonadism in middle-aged and elderly men (European Male Ageing Study)
- AndroGel 1.62% (testosterone gel): US prescribing information
- UAE cracks down on gyms promoting, selling steroids
- How to bring prescription or controlled medicines into the UAE legally
- List of Restricted Medication in the UAE
- Steroids can only be prescribed by physicians: Ministry of Health
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.