HRT Safety, Side Effects & Monitoring Explained | Total Health Pros WV

Introduction

Hormone replacement therapy can be life‑changing for men and women experiencing hormone deficiencies. When used appropriately, it restores vitality, mood, muscle mass and sexual function. However, like any medical therapy, HRT carries potential risks. Understanding side effects, contraindications and monitoring requirements is critical to maximise benefits and minimise harm. This article focuses on testosterone replacement therapy (TRT) but many principles apply to other hormones.

Overview of TRT and bioidentical hormones

TRT involves taking manufactured testosterone to raise low levels. Forms include skin gels, intramuscular injections, subcutaneous injections, patches, pellets and oral capsules. Bioidentical hormones are compounds chemically identical to those produced by the body, whereas synthetic hormones may differ in structure. At Total Health Pros, we prefer bioidentical formulations when possible and customise dosing based on lab results and symptoms.

Who should avoid HRT?

Testosterone therapy isn’t for everyone. According to Cleveland Clinic, TRT can be dangerous for men with untreated heart failure, obstructive sleep apnea, recent heart attack or stroke, elevated red blood cell counts, prostate cancer, an unexplained prostate lump or male breast cancer. Men planning to have biological children should avoid TRT because it can drastically reduce sperm production. Women should avoid estrogen therapy if they have a history of certain cancers, blood clots or liver disease. Always discuss your full medical history with your provider.

Common side effects and management

• Skin irritation (gels and patches): Rotating application sites and using hypoallergenic products can reduce rashes or itching.
  

• Acne or oily skin: Often resolves with dose adjustment or improved skincare routines.
  

• Fluid retention and swelling: Limiting sodium intake and adjusting dosage may help; diuretics are rarely needed.
  

• Breast enlargement (gynecomastia) or tenderness: May occur if testosterone is converted to estrogen. Aromatase inhibitors or lower doses can mitigate this.
  

• Sleep apnea and snoring: TRT can worsen sleep apnea. Treat underlying sleep apnea with continuous positive airway pressure (CPAP) and evaluate whether dose reduction is necessary.
  

• Mood changes: Some men experience irritability or increased aggression at high doses. Adjusting therapy usually resolves this.

Rare but serious risks

• Polycythemia: TRT stimulates red blood cell production; high hematocrit can increase blood viscosity and risk of clotting. Monitoring hemoglobin and hematocrit is crucial. Therapeutic phlebotomy or dose adjustment may be required.
  

• Prostate issues: Testosterone can stimulate prostate growth. Men should have PSA tests and prostate exams regularly. There is no clear evidence that TRT increases prostate cancer risk, but caution is warranted. If PSA rises rapidly, therapy may be paused and further evaluation performed.
  

• Cardiovascular risk: Early studies suggested TRT might raise risk of heart attack or stroke, but later research is mixed. In 2024 a large randomized trial found no increased risk with testosterone gel. Men with pre‑existing heart disease should discuss risks with their cardiologist.

Monitoring schedule

Cleveland Clinic advises that after starting TRT, you should have follow‑up testing to ensure treatment isn’t harming your health. Mayo Clinic recommends medical checkups and blood tests several times during the first year and yearly thereafter. A typical monitoring schedule includes:

• Baseline: Total and free testosterone, SHBG, LH, FSH, hemoglobin, hematocrit, liver function, lipid panel, PSA and prostate exam. For women, baseline includes estradiol, progesterone and mammogram if appropriate.
  

• 3 months after initiation: Recheck testosterone, hemoglobin, hematocrit, liver function, PSA and symptoms. Adjust dosage accordingly.
  

• 6 months: Repeat labs and evaluate side effects. Consider adding estradiol and SHBG to ensure proper balance.
  

• 12 months and annually thereafter: Continue to monitor labs, PSA and physical exam. Discuss any changes in health or new medications.

How Total Health Pros ensures safety

At Total Health Pros, we prioritise safety. We begin with comprehensive diagnostic testing, including FoodAlign sensitivity panels and 3D body scans, to identify metabolic or inflammatory issues that could affect hormone therapy. We prescribe the lowest effective dose and titrate slowly. Our clinicians educate patients on injection techniques and proper gel application to avoid accidental transfer. We provide a secure app for scheduling, lab reminders and symptom tracking. Because we are local to Hurricane, WV, patients can come in quickly if issues arise. Our team collaborates with urologists and cardiologists when necessary to ensure holistic care.

Conclusion

Hormone replacement therapy can transform lives, but only when used responsibly. Understand the potential side effects, know whether you’re a good candidate and commit to regular monitoring. At Total Health Pros, we support patients through every step—from initial evaluation to ongoing follow‑up. If you’re considering TRT or other hormonal therapies, schedule a consultation to discuss safety and develop a personalised monitoring plan.