Testosterone is. a vital hormone responsible for many processes in the human body—specifically in men. It regulates everything from red blood cell production and fat distribution to fertility., and it’s also the driving factor behind characteristics like a deep voice and facial hair. Unfortunately, studies show that millions of men suffer from low testosterone, which can result in fatigue, diminished sex , and reduced muscle mass.

“Men produce less testosterone as they get older,” says Ali Gilbert, a men’s health specialist who spoke on Reps, the Muscle & Fitness podcast. This decline often begins as early as age 30. “If you’re overweight or obese, which is a big issue in the U.S., it’s even worse because more body fat means more estrogen and lower T.” 

According to a landmark study published in The Journal of Clinical Endocrinology & Metabolism, the normal reference range for healthy testosterone levels falls between 264 and 916 ng/dL (nanograms per deciliter). Gilbert says that a T level below 300 ng/dL may signify hypogonadism, a condition associated with sexual dysfunction, decreased muscle mass and bone strength, lower fertility, and less energy.

If your T levels are scraping the bottom of the barrel, you’re not alone—but you don’t have to sit there and take it. Testosterone replacement therapy (TRT) is an option that’s becoming increasingly popular for millions of Americans. “In essence, you are replacing a hormone that’s not being produced endogenously anymore,” says Gilbert. Before you take the plunge, here’s what you need to know.

TRT Is Technically Steroids, but Different

“Testosterone is a steroid hormone, so technically, yes, undergoing testosterone replacement therapy means you will be taking steroids,” explains Gilbert. However, it’s important to realize the difference in dosage between replacement therapy and recreational use.

Gilbert says that between 100-200mg per week is the recommended dose. “There is a huge difference between therapeutic dosages for optimization and supraphysiological dosages,” she adds. “Steroid-using bodybuilders might take three of four times a typical TRT dose.”

TRT Comes in Many Forms—It’s Not Just Injectable

If you hate needles, you’ve still got options. “There are creams, pellets, gels, and soon-to-be nasal sprays,” says Gilbert. “However, these methods are not as optimal, and medical professionals can charge a hefty amount for these alternative methods.” 

Before Trying TRT, Vet Your Doctor

Before choosing to undergo testosterone replacement, Gilbert advises asking your doctor certain questions. For example: how long they’ve been managing patients on TRT, their preferred form of therapy—e.g. injections, gels, creams, or pellets—how they determine dosing schedules, and how they maintain fertility throughout treatment.

You can look online for other helpful conversation starters. If your doctor can’t answer the above questions, look for a new one.

TRT Does Not Cause Prostate Cancer

Past literature showed a relationship between TRT and prostate cancer risks, but that research is outdated.

“It is safe to say that the most current data. [including a Journal of Urology study] clearly shows that TRT does not increase the risk of being diagnosed with prostate cancer,” says Gilbert. “And, most importantly, the prior knowledge linking TRT to prostate cancer has been completed upended and rewritten based on real data and science.” 

TRT Does Not Cause Heart Attacks

“TRT is actually quite cardioprotective, and it is one of the safest medications out there,” says Gilbert. In fact, a 2015 American Heart Association study. found that healthy men receiving TRT did not have a higher risk of heart attack, stroke, or death. Gilbert also notes that it’s been shown to improve cognition and memory while fighting inflammation. 

As TRT’s perceived risks decrease, the medical community’s understanding of testosterone’s role in overall health and wellness is beginning to increase. Endocrinology journals in the U.S. and Europe show that low T levels are associated with a greater risk of death among older men. And nobody wants that. So, if you think you may be suffering from low testosterone, talk to your doctor. Sure, those words could be mistaken for those of a late-night drug commercial, but a simple conversation might change your life and protect your health.