Patient Education
Information on Testosterone Replacement Therapy (TRT)
Please read this document carefully before submitting the medical questionnaire. It contains important information about your planned treatment.
What is testosterone deficiency?
Testosterone deficiency (hypogonadism) occurs when the body does not produce enough testosterone. The diagnosis is confirmed by at least two blood tests on different days (fasting in the morning, before 11 am) showing a low total testosterone level.
Typical symptoms include fatigue, lack of drive, decreased libido, mood swings, muscle loss, increase in body fat, and concentration problems.
What is testosterone replacement therapy?
Testosterone replacement therapy (TRT) compensates for a confirmed testosterone deficiency by supplying body-identical testosterone. The goal is to bring hormone levels into the physiological normal range.
Common application methods:
- Intramuscular injection — e.g. testosterone undecanoate (Nebido®) or testosterone enanthate
- Transdermal gel — e.g. Testogel®, Androgel® (daily application to the skin)
The choice of application method is made individually in consultation with the treating doctor and depends on personal preferences, lifestyle, and medical factors.
Expected Benefits
With a confirmed testosterone deficiency, TRT can bring about the following improvements. Results are individual and typically appear over several months:
- Increase in energy and drive
- Improvement in libido and sexual function
- Improvement in mood and reduction in irritability
- Increase in muscle mass and strength
- Reduction of body fat percentage
- Improvement of bone density (long-term)
- Better concentration and cognitive performance
Note: A response to the therapy is not guaranteed. The individual effect depends on numerous factors. Fine-tuning the dose can take 3–12 months.
Possible Risks and Side Effects
As with any medical treatment, TRT involves risks. Most side effects are manageable through regular monitoring.
Common side effects
- Acne and oily skin — especially in the first few months
- Water retention — mild edema possible
- Mood changes — irritability, increased emotionality (especially with fluctuations)
- Increased body hair
- Reactions at the application site — redness, pain with injection; skin irritation with gel
Medically relevant risks
- Hematocrit elevation (polycythemia) — TRT can increase red blood cell production. A hematocrit above 54% increases the risk of thrombosis and stroke. Checked with a blood count at every follow-up.
- PSA elevation / Prostate — TRT can increase the PSA level. For men over 40 or with risk factors, PSA is checked regularly. TRT is contraindicated in existing prostate cancer.
- Cardiovascular risk — Changes in the lipid profile (decrease in HDL, increase in LDL) possible. Individual cardiovascular risk is evaluated before therapy begins.
- Reduced fertility — TRT suppresses the body's own testosterone and sperm production. This can lead to temporary or permanent infertility. If you have an active desire for children, this must be discussed before starting therapy.
- Liver damage — mainly with oral testosterone preparations (rarely used in Switzerland). Liver values are checked as part of the monitoring.
- Sleep apnea — TRT can worsen existing obstructive sleep apnea.
Other possible effects
- Estrogen elevation — Testosterone can be partially converted to estrogen (aromatization), which can lead to breast tenderness
- Hair loss — Acceleration of hereditary alopecia possible
- Testicular shrinkage — through suppression of the body's own production
- Deepening of the voice — usually minimal at physiological dosages
Contraindications
TRT must not be performed if you have:
- Known or suspected prostate cancer
- Breast cancer in men
- Severe uncontrolled heart failure
- Hematocrit > 54% before starting therapy (without prior assessment)
- Untreated severe obstructive sleep apnea
- Active, untreated desire to have children (relative contraindication — must be discussed)
The treating doctor will check for contraindications before starting therapy. Please inform us fully about your pre-existing conditions.
Alternatives to TRT
The following alternatives may be considered:
- No treatment / Watchful waiting — Symptoms may worsen, but the condition is not immediately life-threatening
- Lifestyle measures — Regular exercise, weight reduction, adequate sleep, and stress reduction can positively influence testosterone levels
- Clomiphene (off-label) — Stimulates the body's own testosterone production. Can be considered for secondary hypogonadism, especially if trying to conceive
- HCG (Human Chorionic Gonadotropin) — Can support the body's own production and is sometimes used as a supplement
The choice of therapy is discussed individually with the specialist. You always have the right to decide against treatment.
Monitoring and Follow-up
Regular blood tests are medically essential and a prerequisite for continuing therapy:
- Year 1–2: Every 3 months (Testosterone, Hematocrit, PSA, estradiol if applicable)
- From Year 3: Every 6 months (if values are stable)
- Annually: Complete blood count, lipid profile, liver values, HbA1c
Important: Without up-to-date blood values, no follow-up prescription can be issued. You bear the costs of the laboratory tests yourself.
A video consultation takes place during each follow-up to discuss the results and make adjustments.
Special Features of Telemedicine
Your care is provided via telemedicine (video consultation). This offers advantages such as flexibility and time savings, but also has special features:
- Limitations of remote treatment — A physical examination cannot be performed telemedically. If necessary, you will be referred to a local doctor.
- Duty to cooperate — You are obliged to provide truthful and complete information and submit your lab results on time.
- IT Security — We use encrypted communication. However, there are fundamental residual risks in digital communication that we cannot rule out completely.
- No emergency service — Swiss TRT does not provide emergency care. In the event of acute medical emergencies, please call the ambulance (144) immediately or visit an emergency room.
Costs and Insurance
Swiss TRT services are not billed through mandatory health insurance (KVG). All costs are to be borne by the patient:
- Initial Consultation: CHF 200
- Start of Therapy: CHF 500
- Follow-up (per interval): CHF 100
In addition, there are costs for lab tests (CHF 40–160) and medications (CHF 30–80/month), which are not charged by Swiss TRT.
Your Consent
By submitting the medical history questionnaire you confirm that:
- You have read and understood this patient information document completely
- You were informed about risks, side effects and alternatives
- You had the opportunity to ask questions (these can also be clarified during the consultation)
- You consent to the collection and processing of health data necessary for the treatment
- Your answers in the medical history questionnaire are true and complete
- You understand that this consent can be revoked at any time
Note: The final decision on treatment is only made after the medical consultation. Submitting the medical questionnaire does not obligate you to receive treatment.
Have you read this patient information document? Then you may now proceed to fill out the medical history questionnaire.
Start Questionnaire →This educational form serves to provide information and does not replace the personal consultation with the treating doctor. The risks and side effects mentioned here are not exhaustive. Individual risks will be discussed during the medical consultation.
Sources: Endocrine Society Clinical Practice Guideline (2018), European Association of Urology (2024), American Urological Association (2024), FMH Code of Conduct, Swiss Medical Professions Act (MedBG).