TRT Australia: Testosterone Replacement Therapy Guide & Tracker
Everything an Australian man needs to understand and track TRT - from diagnosis and blood tests, to testosterone levels by age, cypionate vs enanthate half-life, haematocrit management and PSA monitoring. Upload your pathology results and BloodTrack monitors every TRT marker automatically.
Testosterone levels by age (Australian reference)
Total testosterone declines gradually in healthy men at roughly 1-2% per year after age 30. The table below shows representative reference ranges used by Australian RCPA-accredited pathology labs (4Cyte, Laverty, Sullivan Nicolaides, Australian Clinical Labs, Dorevitch). Reference ranges vary slightly between labs - always interpret results against your own lab's printed range.
| Age group | Low end (nmol/L) | Mid-range (nmol/L) | High end (nmol/L) |
|---|---|---|---|
| 18-29 | 8.6 | 15.3 | 29.0 |
| 30-39 | 8.0 | 14.2 | 27.8 |
| 40-49 | 7.4 | 13.1 | 25.6 |
| 50-59 | 6.8 | 12.0 | 23.5 |
| 60-69 | 6.2 | 10.8 | 21.1 |
| 70-79 | 5.5 | 9.6 | 19.0 |
| 80+ | 4.9 | 8.3 | 17.0 |
Conversions: 1 nmol/L ~= 28.8 ng/dL. Most Australian men on TRT target trough total testosterone of 15-25 nmol/L (432-720 ng/dL).
Andropause: age range, symptoms and diagnosis in Australia
Andropause - also called late-onset hypogonadism or age-related testosterone decline - typically begins around age 30 and becomes clinically relevant for many men after 45-50. Unlike female menopause, andropause is gradual and does not affect every man. By age 70, around 20-30% of Australian men have total testosterone below the young-adult reference range, and symptoms become more prevalent in men with metabolic syndrome, obesity, poor sleep or chronic illness.
Common andropause symptoms
- Persistent fatigue and low energy that doesn't improve with rest
- Reduced libido and fewer spontaneous morning erections
- Erectile dysfunction
- Loss of muscle mass and increase in visceral fat
- Low mood, irritability, reduced motivation
- Poor concentration and brain fog
- Reduced exercise tolerance and recovery
How it's diagnosed in Australia
The Endocrine Society of Australia recommends diagnosis based on two early-morning fasting blood tests showing total testosterone below the age-specific reference range, plus consistent clinical symptoms. LH and FSH are measured to determine whether the problem originates in the testes (primary) or pituitary/hypothalamus (secondary). Additional tests include SHBG, prolactin, full blood count and iron studies.
Blood tests to monitor on TRT
A complete TRT panel in Australia covers hormones, red-cell parameters, cardiovascular markers and prostate safety. Upload your pathology PDFs to BloodTrack and every one of these is tracked over time automatically.
Total Testosterone
Trough sample on day 7 (weekly ester). Target 15-25 nmol/L.
SHBG
Low SHBG -> more free T. Often low in insulin resistance.
Oestradiol (E2)
Aim for the mid-normal range; too low = joint pain, too high = gynaecomastia.
LH & FSH
Suppressed on exogenous T. Distinguishes primary vs secondary hypogonadism at baseline.
Haematocrit
Keep below 0.52. Most common reason to adjust dose.
Ferritin
Often falls on TRT due to blood donation - monitor for iron deficiency.
PSA (men 40+)
Baseline, 3-6 months, then annually.
HbA1c
TRT typically improves insulin sensitivity.
ALT & AST
Baseline liver safety, especially with oral formulations.
Testosterone ester half-life and dosing frequency
The ester attached to testosterone determines how quickly it is released into the blood. Longer esters mean less frequent injections but higher peak-to-trough swings. Cypionate and enanthate are functionally interchangeable at the weekly timescale; Reandron (undecanoate) is the PBS-subsidised long-acting option in Australia.
| Ester | Half-life | Typical TRT frequency |
|---|---|---|
| Testosterone Cypionate | ~8 days | Weekly or twice-weekly IM/SC |
| Testosterone Enanthate | ~7 days | Weekly or twice-weekly IM/SC |
| Testosterone Propionate | ~2 days | Every 2-3 days IM/SC |
| Testosterone Undecanoate (Reandron) | ~21 days | Every 10-14 weeks IM (Australia: PBS-listed) |
Subcutaneous (SC) injection is now widely used in Australia as an alternative to intramuscular (IM). It produces smoother levels with smaller needles.
Haematocrit and donating blood on TRT
Testosterone stimulates red blood cell production. Haematocrit (HCT) and haemoglobin rise in most men starting TRT, usually plateauing at 3-6 months. The Endocrine Society recommends dose adjustment or venesection if haematocrit exceeds 0.52 (52%), which is also the cut-off Australian Lifeblood uses for therapeutic donations. Many Australian men on TRT book regular whole-blood donations at Lifeblood (every 12 weeks) to keep HCT in range. If you donate, also monitor ferritin - repeated donations deplete iron stores.
TRT monitoring schedule (Australian guidelines)
- Baseline: total T (x2 morning fasting), free T, SHBG, LH, FSH, E2, PSA (men 40+), FBC, HbA1c, lipids, LFTs, iron studies, prolactin.
- 6-12 weeks: total T (trough), SHBG, E2, haematocrit. Adjust dose if needed.
- 3 months: full panel minus baseline exclusion tests. Confirm haematocrit stable and PSA unchanged.
- 6 months: full panel. Reassess symptoms.
- Every 6-12 months thereafter: maintenance monitoring once stable.
PSA and prostate safety on TRT
The landmark 2023 TRAVERSE trial found no increase in high-grade prostate cancer with TRT over 3.8 years versus placebo in hypogonadal men. That said, prostate safety monitoring remains standard: baseline PSA and digital rectal exam before starting TRT, PSA rechecked at 3-6 months and annually thereafter. A PSA rise of more than 1.4 ng/mL in any 12-month period, or a total PSA above 4 ng/mL, warrants urology referral. Active or untreated prostate cancer is a contraindication to TRT.
Frequently asked questions about TRT in Australia
Is TRT legal and available in Australia?▾
Yes. Testosterone replacement therapy is legal and subsidised under the PBS in Australia when prescribed for clinically confirmed androgen deficiency. Diagnosis requires two morning (before 10 am) fasting total testosterone results below the reference range, with LH and FSH measured to distinguish primary from secondary hypogonadism. The Androgen Study Group of the Endocrine Society of Australia publishes the clinical criteria. Off-label prescribing for age-related testosterone decline alone is generally not PBS-subsidised.
What blood tests do I need on TRT in Australia?▾
The standard TRT monitoring panel includes total testosterone, free testosterone, SHBG, oestradiol (E2), LH, FSH, PSA (men over 40), full blood count (especially haematocrit), lipids, HbA1c and liver function. Baseline bloods are taken before starting TRT, then rechecked at 3 months, 6 months, and every 6-12 months once stable. Samples for testosterone should be trough (just before the next dose) to assess the lowest point.
What is a normal testosterone level by age in Australia?▾
Australian labs typically report total testosterone in nmol/L. The adult reference range is roughly 8-29 nmol/L, but levels decline with age. Men in their 20s typically sit at 15-20 nmol/L, while men in their 70s may be 8-12 nmol/L. Androgen deficiency in Australia is generally diagnosed when total testosterone is persistently below 8 nmol/L on two morning fasting samples, or below 12 nmol/L with clinical symptoms and low SHBG.
What is andropause and at what age does it start?▾
Andropause (also called late-onset hypogonadism or age-related testosterone decline) refers to the gradual fall in testosterone that begins in most men around age 30, at roughly 1-2% per year. It is not a universal or sharp decline like female menopause. By age 70, around 20-30% of Australian men have total testosterone below the young-adult reference range. Symptoms include fatigue, low libido, erectile dysfunction, mood changes, loss of muscle mass and reduced morning erections.
How often should I get blood work on TRT?▾
Australian endocrinology guidelines recommend baseline bloods before starting, follow-up at 6-12 weeks to confirm dose, then every 3-6 months for the first year, and every 6-12 months thereafter once stable. Haematocrit and oestradiol should be monitored more frequently in the first 6 months because they are the most common parameters to drift out of range.
What is the half-life of testosterone cypionate vs enanthate?▾
Testosterone cypionate has a half-life of approximately 8 days, while testosterone enanthate is approximately 7 days. In practice, the two are almost interchangeable - both are dosed weekly or twice-weekly in TRT. Testosterone undecanoate (Reandron, available on the PBS in Australia) is much longer-acting at ~21 days and is dosed every 10-14 weeks intramuscularly.
Why does TRT raise haematocrit and what is the threshold for donating blood?▾
Testosterone stimulates erythropoiesis (red blood cell production), so haematocrit commonly rises on TRT. The Endocrine Society and the Australian Lifeblood service flag a haematocrit above 0.52 (52%) as an indication to reduce dose, switch to a shorter ester with more frequent smaller doses, or undergo therapeutic venesection (blood donation). Many Australian men on TRT donate at Lifeblood every 12 weeks to keep haematocrit in range.
Does TRT cause prostate cancer?▾
Current evidence does not show that TRT causes prostate cancer in men without pre-existing disease. The 2023 TRAVERSE trial (N=5,246 middle-aged/older men with hypogonadism) found no increase in high-grade prostate cancer over 3.8 years versus placebo. However, men over 40 should have a PSA and digital rectal exam before starting TRT, and PSA should be rechecked at 3-6 months and annually thereafter. Active prostate cancer remains a contraindication.
What is a trough testosterone level?▾
The trough is the lowest testosterone level in a dosing cycle - measured just before the next injection or application. It is the recommended sample timing for monitoring TRT because it shows whether the dose is maintaining levels above the lower reference limit for the full interval. For weekly cypionate or enanthate, the trough sample is taken on day 7. For twice-weekly dosing, on the morning before the next dose.
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