Does testosterone replacement therapy (TRT) increase hunger?

Testosterone Replacement Therapy and Hunger

Testosterone replacement therapy (TRT) does not increase hunger and may actually prevent increases in appetite during energy deficits. 1

Effects of Testosterone on Appetite Regulation

• Testosterone therapy prevents deficit-induced increases in circulating ghrelin (an orexigenic hormone) without affecting concomitant increases in appetite during severe energy deficits 1
• Acute consumption of either protein or glucose results in decreases in plasma testosterone levels in males, suggesting a complex relationship between testosterone and nutritional intake 2
• There is no evidence supporting testosterone's role in acute regulation of food intake, as studies have found no associations between testosterone levels and appetite or food intake 2

Testosterone and Body Composition

• Testosterone therapy in men with low testosterone levels:

  • Decreases subcutaneous fat on the abdomen and lower extremities 3
  • Increases lean body mass and decreases total fat mass 3, 4
  • Prevents visceral fat accumulation without changing total body or abdominal subcutaneous fat mass 4
  • Increases total body fat-free mass and skeletal muscle mass 4

• These body composition changes occur without evidence of increased hunger or appetite:

  • Testosterone replacement selectively reduces visceral adiposity without increasing hunger 4
  • Decreases in adiponectin levels during testosterone therapy may influence metabolic parameters but have not been associated with increased appetite 3

Clinical Considerations for Testosterone Replacement

• HIV-positive patients with testosterone deficiency should receive testosterone substitution to restore muscle mass 5
• Randomized placebo-controlled trials in patients with wasting and low testosterone showed positive effects of testosterone substitution on fat-free mass, muscle mass, and quality of life 5
• In women with HIV wasting who have low testosterone, supplementation shows some positive effects on muscle mass strength but no significant weight gain 6
• Testosterone therapy should aim to achieve total testosterone levels in the middle tertile of the normal reference range (450-600 ng/dL) 5

Monitoring and Safety

• Testosterone levels should be tested 2-3 months after treatment initiation and after any dose change 5
• Patients should be counseled that the current scientific literature does not definitively demonstrate that testosterone therapy increases cardiovascular risk 5
• Lifestyle modifications such as weight loss and increased physical activity should be recommended alongside testosterone therapy 5
• Transdermal testosterone preparations (gel, patch) are often preferred for convenience and more stable testosterone levels compared to injections 5

Caveats and Considerations

• The FDA has required labeling changes regarding possible increased risk of heart attack and stroke with testosterone use for age-related hypogonadism 5
• Some evidence suggests testosterone injections may be associated with greater cardiovascular risk than gels, possibly due to fluctuating testosterone levels 5
• Testosterone therapy is not currently licensed for use in HIV wasting in women in Europe 6
• Long-term follow-up is needed for patients on testosterone therapy to monitor for potential adverse effects 5