Does Testosterone Make You Gain Weight?
The hormone can help pounds peel off, but there’s a catch.
30-Second Takeaway
- For most men, testosterone replacement therapy (TRT) is associated with significant weight loss.
- Some men note a small weight gain on TRT due to mild fluid retention early in testosterone therapy.
- If you gain more than a few pounds or your weight continues to rise, talk to your doctor about other factors that might be contributing to weight gain.
You started testosterone replacement therapy (TRT) expecting more energy, a higher libido, and easier weight loss. A month in, you’re starting to feel the first two, but instead of “leaning out,” you’re gaining weight. Is the uptick on the scale a side effect of testosterone, or is something else at play?
Weight gain from taking testosterone might happen because:
- If you’re gaining muscle, it can increase the number on the scale
- Initially, starting TRT can cause water retention
Here’s how testosterone affects your weight—and what you can do to stay on track.
About the Experts
Justin Dubin, M.D., is a urologist and men’s health specialist in South Florida.
Thomas Masterson, M.D., is an assistant professor of urology at the Desai Sethi Urology Institute in the Miller School of Medicine at the University of Miami.
Amy Pearlman M.D., is a board-certified urologist and men’s health specialist in Coral Gables, Florida.
TRT and Weight Gain
When you start TRT, you can gain a small amount of weight rather than lose it. But before you panic, know this: Your body is adjusting to increased testosterone levels, which can affect other hormones and body composition in unexpected ways.1
According to urologist Amy Pearlman, M.D., your “weight gain” might not be fat gain at all. You could have gained lean muscle or have water weight gain.
Muscle mass
Increased muscle mass from TRT might show up as weight gain on the scale, even as your waist circumference shrinks. Muscle is denser than fat and weighs 15-20 percent more by volume, so while your clothes may be looser, your weight on TRT might stay the same or even increase by a few pounds.
TRT helps you build muscle because testosterone ignites protein synthesis, strengthening muscle fibers and increasing lean mass.2
A systematic review found that obese men treated with TRT gained an average of 4.4 pounds of muscle over six months.3 Pairing TRT with strength training and a high-protein, low-carb diet is the best way to accelerate muscle growth and body recomposition.4
“Testosterone by itself isn’t a silver bullet. You still have to exercise and consider your diet to meet weight loss and muscle gain goals,” says urologist Thomas Masterson, M.D.
Water retention
One side effect of taking testosterone is mild water retention, which can be mistaken for weight gain from fat. A 2015 study in the Journal of Obesity revealed that water retention tends to increase within the first three to six months of starting TRT.5 This weight gain typically resolves on its own without treatment.
Hunger
Research has also explored whether testosterone indirectly influences hunger through its interaction with ghrelin; however, the evidence does not support a connection between the two.
In one controlled trial, when men were put on a strict diet, their bodies naturally increased ghrelin levels, a hormone that usually makes people feel hungrier. Men who received testosterone supplements didn’t experience this increase in ghrelin, and it also didn’t impact their levels of hunger or how much food they ate.6
Besides ghrelin, research in animals and humans suggests that testosterone interacts with several systems and hormones to affect hunger, including:
- Leptin: This hormone is made by fat cells and tells your brain when you’re full. Research suggests that increased leptin may reduce testosterone production.7 When testosterone levels rise with TRT, leptin often drops, weakening fullness signals and potentially increasing hunger.
- Orexins: Animal studies have found that these brain chemicals, which control hunger and energy, may also suppress testosterone.8 So when TRT boosts testosterone, it could disrupt orexin signaling, potentially increasing hunger and contributing to early weight gain.
Testosterone also affects hunger by increasing lean muscle mass,9 which increases your resting metabolic rate.10 Muscle requires more calories to maintain than fat, so as your body composition shifts, your calorie needs may rise, and your body may respond by signaling increased hunger.
“When my patients gain weight on TRT, it’s usually due to water retention, increased muscle mass, and sometimes increased hunger, leading to increased food intake,” says Pearlman.
What if Weight Gain Continues to Increase on TRT?
While minor fluid retention (e.g., “puffiness”) and weight gain of a few pounds aren’t unusual for the first few months of TRT, significant weight gain or fluid retention should be brought to your provider’s attention. Both can signal serious medical issues, such as undiagnosed sleep apnea, low thyroid hormone levels, or issues with the heart, kidneys, liver, or lungs. They can rule out or diagnose these issues and help you make a plan to get back on track.
Symptoms of Low Testosterone
Men who have low testosterone experience low sex drive, increased anxiety, and fatigue. Dubin notes that men with low testosterone might struggle with these symptoms to the point where it impacts their day-to-day life. “This can make it more difficult to get motivated to exercise regularly and lose weight,” he says. “It’s a cyclical problem.”
Benefits of Testosterone Replacement Therapy
Studies show testosterone replacement therapy can lead to sustainable weight loss, by improving insulin resistance and body composition.11 12 13 And research shows that losing weight can reduce the risk of heart disease, stroke, and type 2 diabetes.14 Other benefits of TRT include increased sex drive, improved mental health, and stronger bone density.15 16 17
The Bottom Line
TRT supports weight loss, but it can also push the number on the scale higher. This “weight gain” is likely due to increased muscle mass or water retention. To ensure that any weight gain is muscle—not fat—pair TRT with a solid nutrition and exercise plan. Strength training, a high-protein diet, and regular movement can help maximize TRT’s benefits while minimizing unwanted weight gain.
Stephens-Shields AJ, et al. (2022). Relation of Testosterone, Dihydrotestosterone, and Estradiol With Changes in Outcomes Measures in the Testosterone Trials
↑Vingren JL, et al. (2010). Testosterone physiology in resistance exercise and training: the up-stream regulatory elements
↑Mangolim AS, Brito LAR, Nunes-Nogueira VDS (2021) Effectiveness of testosterone replacement in men with obesity: a systematic review and meta-analysis
↑Giagulli VA, et al. (2019) The Role of Diet and Weight Loss in Improving Secondary Hypogonadism in Men with Obesity with or without Type 2 Diabetes Mellitus
↑Saad, F., Yassin, A., Doros, G. et al. (2016) Effects of long-term treatment with testosterone on weight and waist size in 411 hypogonadal men with obesity classes I-III: observational data from two registry studies
↑Karl JP, et al. (2020) Effects of Testosterone Supplementation on Ghrelin and Appetite During and After Severe Energy Deficit in Healthy Men
↑Lima TFN, et al. (2020) Association of Leptin with Total and Free Testosterone: Results from the National Health and Nutrition Examination Surveys
↑Sengupta, Pallav, et al (2019) Orexins and male reproduction
↑Corona G, et al (2015) THERAPY OF ENDOCRINE DISEASE: Testosterone supplementation and body composition: results from a meta-analysis study
↑Gitsi, E., et al (2024). The Relationship between Resting Metabolic Rate and Body Composition in People Living with Overweight and Obesity
↑Kelly DM, Jones TH. (2013) Testosterone: a metabolic hormone in health and disease
↑Saad F, et al (2016). Effects of long-term treatment with testosterone on weight and waist size in 411 hypogonadal men with obesity classes I-III: observational data from two registry studies
↑Aversa A, et al. (2010) Effects of testosterone undecanoate on cardiovascular risk factors and atherosclerosis in middle-aged men with late-onset hypogonadism and metabolic
↑Saad F, et al (2016). Effects of long-term treatment with testosterone on weight and waist size in 411 hypogonadal men with obesity classes I-III: observational data from two registry studies
↑Straftis AA, Gray PB. (2019) Sex, Energy, Well-Being and Low Testosterone: An Exploratory Survey of U.S. Men’s Experiences on Prescription Testosterone
↑Johnson JM, et al (2013) The effect of testosterone levels on mood in men: a review
↑Saad F, et al (2011) Onset of effects of testosterone treatment and time span until maximum effects are achieved
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About the author
David Hopper is a freelance writer and editor with over 15 years of experience. He has worked as a reporter and copy editor at several newspapers and online media outlets. In recent years, he has focused on health journalism, primarily writing about men’s health and sexual health topics.
About the reviewer
James R. Staheli, D.O., is the Medical Director for Broad Health, Hone Health’s affiliated medical practice and a family medicine doctor in Atlanta, Georgia.
