10 TRT Myths, Debunked By Doctors Who Prescribe It

If you’ve asked your doctor about TRT, there’s a 75 percent chance you walked in believing something that wasn’t true. In a January 2026 survey Hone asked more than 200 of its doctors to estimate what share of their patients arrive with a major misconception about low testosterone or TRT. The most common answer: three in four. 

Much of the confusion around testosterone comes from outdated medical advice, oversimplified online content, and the tendency to conflate medically prescribed TRT with anabolic steroids, says Jim Staheli, D.O., Medical Director at Hone Health. 

“Men tend to trust the stories they hear from friends instead of getting information from their doctor,” adds Staheli.

Nearly 40 percent of men over 45 experience symptoms of low testosterone such as fatigue, lower sex drive, muscle loss, and low mood. Research also links healthy testosterone levels to a lower risk of chronic disease, depressive symptoms, and metabolic syndrome, a cluster of conditions that doubles risk of stroke and triples the risk for a heart attack.^{1 2 3}

Here are the top 10 testosterone myths Hone physicians say they dispel most often — and what they want men to know instead.

About the Experts

Dr. James R. Staheli is the Medical Director for Broad Health, Hone Health’s affiliated medical practice and a family medicine doctor in Atlanta, Georgia.

Myth #1: TRT Increases Heart Attack and Cardiovascular Risk

Fact: TRT does not increase the risk of heart attack or stroke when it’s medically supervised and intended to restore hormone levels.

Large modern studies support TRT’s cardiovascular safety. In the landmark 2023 TRAVERSE trial, men with low testosterone levels — including many already at risk for heart disease — did not see higher rates of heart attack, stroke, or cardiovascular death while using TRT.⁴ In light of this evidence, in February 2025 the U.S. Food and Drug Administration (FDA) removed its black-box warning regarding the risk of heart attacks and strokes from prescription testosterone products.⁵

In fact, the danger runs the other way. Men with untreated low testosterone (hypogonadism) may have more calcified coronary arteries — a key marker of heart disease —  and a higher risk of heart attack, stroke, and early death.^{6 7} In a study of more than 40,000 men over 40 with low testosterone, men treated with TRT were 33 percent less likely to experience a cardiovascular event over three years than those who weren’t treated.⁸

Myth #2: TRT Causes Permanent Infertility

Fact: About two-thirds of men recover normal fertility within six months of stopping TRT, and around 90 percent recover within a year.⁹ Recovery may be slower or incomplete in men who had pre-existing fertility problems, such as low sperm counts or other disorders affecting sperm production.

“For most men, this effect is temporary and reversible,” Staheli says. “When testosterone therapy is stopped, brain–testicle signaling usually restarts, and sperm production recovers over several months.” Staheli says.

TRT can affect fertility because when you introduce testosterone from an outside source, the brain detects the higher levels and scales back its own production. Specifically, it suppresses two hormones — luteinizing hormone (LH) and follicle-stimulating hormone (FSH) — that tell the testes to produce both testosterone and sperm. Sperm counts often temporarily decline as a result. 

Men who want to maintain their fertility while improving their testosterone levels can consider prescription medications like clomiphene citrate and enclomiphene. When testosterone is metabolized, some of it converts to estrogen — and rising estrogen signals the brain to suppress LH and FSH. These medications block that signal, keeping LH and FSH elevated so the testes continue producing testosterone and sperm.

Myth #3: TRT Causes Aggression

Fact: Testosterone replacement therapy has been shown to reduce anger and irritability when it’s physician-led, not increase it.¹⁰

When testosterone declines, men often experience low mood, depression, and irritability.¹¹ TRT, which uses low doses to bring testosterone back into a normal healthy range, can lessen these effects.

Men can also experience aggression from taking testosterone if their dose is too high. This is where the “roid rage” association comes from: Anabolic steroid use involves doses far higher what any doctor would prescribe, and those supraphysiologic levels are what drive aggression. These issues are uncommon in medically supervised TRT. Additionally, men with certain mood or psychiatric conditions may also experience a bump in aggression on TRT, Staheli says.

Myth #4: TRT Makes You Good in Bed 

Fact: TRT is not guaranteed to improve your sexual performance or treat conditions like erectile dysfunction because these conditions are not always tied to improvements in sexual desire and arousal.

Erections depend on more than hormones. “Erectile performance relies on multiple components — blood flow, nerve health, hormones, medication side effects, and psychological factors,” Staheli, says. “If those aren’t addressed, TRT alone may not deliver the result a patient expects.”

Taking testosterone doesn’t address blood flow problems, which are one of the most common drivers of erectile dysfunction. That’s why a comprehensive medical evaluation before starting TRT is important — it can identify other factors affecting sexual function and help guide the right treatment plan.

Myth #5: Once You Start TRT, You Have to Take It Forever

Fact: If men with low testosterone they stop taking the medication, their testosterone levels can return to baseline levels within a few weeks or months.^{12 13} However, the benefits of TRT for conditions like weight, sleep, stress, or medical conditions also might end if someone stops taking the medication, Staheli says.

In one study, 147 men who paused their TRT after taking it for 11 years on average saw their testosterone return to their previous levels.¹⁴ So even after more than a decade on the medication, their natural testosterone-producing processes still worked as before.

That said, for men with clinically low testosterone, returning to baseline means returning to the levels that caused problems in the first place. “Their bodies don’t reliably produce enough testosterone on their own, and they feel significantly better on treatment,” Staheli says. In this way, continuing TRT is not unlike wearing glasses or taking blood pressure medication.

Men who want to stop TRT should do so under a doctor’s guidance. Gradually tapering treatment can help reduce temporary symptoms like fatigue, headaches, or sleep disruption.¹⁵

Myth #6: Testosterone Increases Your Risk of Prostate Cancer

Fact: The 2023 TRAVERSE trial, the largest randomized study of TRT to date, found men taking testosterone did not experience higher rates of prostate cancer than those taking placebo. In another study published in 2025, men already being monitored for prostate cancer did not see increases in prostate-specific antigen (PSA) levels while on TRT.¹⁶ And men who received testosterone after prostate cancer did not have higher recurrence rates than their counterparts who didn’t take TRT.¹⁷

In fact, emerging evidence suggests men with low testosterone and low PSA may develop more aggressive prostate cancers.¹⁸ A 2026 study suggests that low testosterone may be associated with a 60 percent higher likelihood of cancer progression and increased cancer mortality.¹⁹ Researchers don’t have the full picture yet, but leading theories behind this dynamic are: Low testosterone suppresses PSA, so cancer hides longer before detection, and normal testosterone levels may actually help keep certain cancer-promoting genes “switched off.” The old assumption that high testosterone is the danger — and low testosterone is safe — is increasingly being turned on its head.

Doctors still monitor PSA levels during TRT because prostate cancer risk naturally rises with age, Staheli explains, not because testosterone therapy causes or fuels the disease.

Myth #7: Testosterone Causes Baldness

Fact: TRT doesn’t cause baldness, but it may speed up hair loss in men who are already genetically predisposed to it.

Here’s why: an enzyme called 5-alpha reductase converts a small percentage of testosterone into dihydrotestosterone (DHT). In men whose hair follicles are genetically sensitive to DHT, it causes those follicles to shrink — making hair progressively thinner until it stops growing altogether.²⁰ Because TRT raises testosterone levels, it can slightly increase DHT as well.

“If a patient is genetically prone to male pattern hair loss, DHT can cause miniaturization of hair follicles,” Staheli says, referring to the shrinking and thinning effects that lead to hair loss. “If a patient is not genetically prone, TRT won’t cause one to go bald.”

Risk for baldness is most pronounced when testosterone levels climb above the normal therapeutic range — which is why proper dosing and regular monitoring matter. Men whose levels stay within a normal physiological range are less likely to see an effect on their hair. 

Myth #8: Annual Bloodwork Will Show If Your Testosterone Is Low

Fact: Most routine wellness blood panels don’t include a testosterone test. If you’re experiencing symptoms of low testosterone — like fatigue, low libido, or reduced muscle mass — you may need to ask your doctor to test for it specifically.

A proper evaluation should measure both total testosterone and free testosterone. Total testosterone reflects the overall amount of the hormone circulating in your body, while free testosterone represents the portion your tissues can actually use. In some men, total testosterone can appear normal while free testosterone is low, meaning symptoms may still occur.

Doctors may also look at other testosterone-related biomarkers to determine why levels are low and what might be affecting hormone balance:

• Luteinizing hormone (LH): Tells the testes to produce testosterone. Measuring LH helps doctors determine whether low testosterone is coming from the testes themselves (primary hypogonadism) or from the brain’s signaling system (secondary hypogonadism).

• Sex hormone–binding globulin (SHBG): A protein that binds testosterone in the bloodstream. Higher SHBG levels can reduce the amount of free testosterone available to the body even when total testosterone appears normal.

• Albumin: Another protein that binds testosterone and helps transport it in the blood. Along with SHBG, it helps doctors calculate how much testosterone is biologically available.

• Estradiol: A form of estrogen produced from testosterone. Elevated estradiol levels can sometimes contribute to hormone imbalance or symptoms, so doctors may measure it to better understand the overall testosterone–estrogen balance.

To confirm a diagnosis, testosterone levels are typically measured in the morning on two separate days, when levels are naturally highest.²¹

Myth #9: TRT Is a Shortcut or “Magic Bullet” That Fixes Everything Instantly

Fact: Health issues like erectile dysfunction, fatigue, or weight gain can have multiple causes. TRT helps restore hormone levels, which can improve symptoms like energy, libido, mood, muscle mass, and body composition. But if issues are caused by poor sleep, impaired circulation (due to disrupted blood flow in the veins and arteries, often from plaque buildup), thyroid disorders, or lifestyle factors, TRT alone won’t solve them.

“TRT is not a cure-all,” Staheli says. “It addresses one piece of the puzzle — your hormones — but other systems like metabolism, circulation, and sleep still have to be optimized.”

TRT results also take time. Some low testosterone symptoms like libido, mood, and energy may begin improving within 2–4 weeks, while changes in muscle mass and body composition often take 3–6 months.²²

Myth #10: It’s Not Safe to Order Testosterone Online

Fact: Getting testosterone online is not only safe — it’s regulated. 

• When prescribed by a licensed physician, online testosterone therapy involves the same safeguards used in traditional clinics. 
• Telemedicine is now governed by state medical boards, the same bodies that oversee in-person practice. 
• Physicians practicing via telehealth must be licensed in the state where the patient is located

The real concern with testosterone isn’t telemedicine — it’s unregulated online pharmacies and “wellness” sites that sell hormones without a prescription or proper medical evaluation. Legitimate telehealth providers operate under the same medical standards as in-person clinics, including lab testing, physician consultations, and ongoing monitoring of treatment. 

What matters isn’t whether care happens online or in an office — it’s whether testosterone therapy is prescribed and managed by a licensed physician using evidence-based protocols.

At Hone, a licensed physician (M.D. or D.O.) prescribes and manages your testosterone therapy, monitoring your symptoms and biomarkers over time to ensure the treatment is safe and effective. 

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About the reviewer

Marilyn Lajoie, M.D., is an internist who specializes in hormone therapy for men and women. She holds degrees in integrative medicine from Saba University School of Medicine and chiropractic medicine from Northeast College of Health Sciences.