We investigate the risks and uncertainties of using TRT vs natural testosterone supplements in our latest evidence-based research
With rising concerns on cardiovascular, fertility, hormonal and psychological health, is TRT the safer option compared to natural testosterone supplements?
This article goes in deep into investigating the use and safety of HRT, its side effects and whether natural testosterone supplements such as Tongkat Ali are safe and effective alternatives to HRT / TRT.
The use of Testosterone Replacement Therapy (TRT), or known as HRT vs natural testosterone supplements sparks debates amongst healthcare professionals and users. Some Reddit users claimed that natural supplements such as Tongkat Ali perform better as a testosterone and libido booster without permanent side effects.
Doctors in testosterone clinics are now advertising TRT to healthy adults and the rise of Over-The-Counter (OTC) HRT gels, patches and TRT injections without explaining the long-term risks to consumers.
Marketed as an anti-aging remedy, testosterone men clinics such as Biostation in the US are offering men the chance to regain that virility. But in reality, whether you are using TRT as a sports performance booster, some men ended with infertility and other health risks as reported by WSJ’s Rofle Winkler in a recent podcast.
As the cost of TRT is covered by insurance coverage in the US, many opt for a quick-fix solution to boost T-levels without considering its implications. Of course, you may think why not – even if you don’t need it.
On the first treatment, patients reported that TRT works miraculously well to restore energy, bringing back the natural youth and some reported a strong boost of libido. Well, at least for the next 72 hours. The effect will eventually wear off or it may last you for a week or so if you are lucky.
The worst part, as the testosterone feel-good effect fades away, you may be hooked for another round of TRT injection that will burn your wallet. And when your body is reliant on synthetic TRT drugs to produce testosterone or keep your mood or energy up, that is when you have to start to worry.
For first-time TRT users and general consumers who are keen to compare between these two remedies to boost your testosterone, here is a quick overview of the risks that you need to know.
Evidence-based comparative analysis across cardiovascular, hormonal, psychological, regulatory, and long-term domains. Use the tabs to explore each risk category in depth.
| Risk domain | TRT level | Natural supp. | Evidence | Notes |
|---|---|---|---|---|
| Erythrocytosis | High | Very low | Strong RCT | 3–18% on TRT |
| HDL suppression | High | Very low | Strong RCT | 5–20% reduction |
| MI / cardiac events | Moderate | Low | Debated | TRAVERSE 2023 |
| HPG suppression | Severe | Minimal | Strong RCT | Near-universal on TRT |
| Infertility risk | Very high | Very low | Strong | Azoospermia in months |
| Aromatisation (E2↑) | High | Low | Strong | Gynaecomastia risk |
| Testicular atrophy | Very high | None | Strong | Predictable with TRT |
| Mood / aggression | Moderate | Low | Moderate | Dose-dependent |
| Dependency / withdrawal | High | Low | Clinical evidence | Lifelong commitment |
| Sleep apnoea | Moderate | Low | Moderate | Ashwagandha may help |
| Acne & hair loss | High | Very low | Strong | DHT-mediated |
| Prostate cancer | Uncertain | Very low | Weak long-term | Saturation model debated |
| Contaminants / purity | Low–mod | High | Testing data | No pre-market regulation |
| Drug interactions | Moderate | Uncertain | Weak human data | CYP450 pathways |
| Zinc / copper imbalance | None | Moderate | Mechanistic | High-dose zinc only |
| Long-term unknowns | High | High | Very weak | Both lack >10-yr data |
There are several risks associated with long-term and short-term use of TRT which are less discussed by patients, but often present significant health risks or complications to those who have underlying medical conditions – or even if you are a healthy.
According to Dr. Abraham Morgentaler from Harvard Medical School, testosterone therapy can be overprescribed and lead to cardiovascular issues in certain men.
“There are significant concerns about the long-term cardiovascular risks of testosterone injections, particularly in older men with heart disease.” Said Dr. Michael Lauer, a board-certified cardiologist, at the National Heart, Lung, and Blood Institute.
As more testosterone clinics in the US prescribing TRT injections to healthy men, this could bring further risks of side effects such as infertility as the body stops producing testosterone naturally once you stop taking testosterone injections.
Disrupting our natural hormonal balance that occurs in our endocrine system through synthetic TRT injections are far more worrying. Endocrinologist Dr. Shalender Bhasin from Brigham and Women’s Hospital in Boston warned users on the severe side effects of TRT.
“Testosterone therapy may have limited benefits for men without clear clinical signs of hypogonadism and can increase the risk of heart attack, stroke, and other conditions.” he said.
Natural hormonal supplements such as Tongkat Ali and Ashwagandha are often seen as a long-term, sustainable and safe alternative to TRT or HRT, mainly due to the natural-plant-based diet that offers the same effects without the side effects – provided it is consumed within the recommended daily dosage.
Hailed for its wide range of hormonal-inducing benefits, Tongkat Ali works through a complex mechanism of actions that optimizes the endocrine system – mainly by stimulating FSH and LH through the pituitary glands to produce more testosterone.
In fact, natural TRT supplements are used by runners, sprinters and natural bodybuilders in actual competitions without issues of failing drug tests.
Trusted natural testosterone supplements in the US & UK such as AKARALI are used widely by marathon runners, sprinters and bodybuilding, making it the most potent and safe supplement you could buy without doctor’s prescription.
Natural bodybuilders replacing TRT with natural supplements (eg: Tongkat Ali) reported similar energy boosts, improved libido and greater strength. When consumed at the appropriate dosage of 200mg to 600mg, it may increase testosterone production by up to 50%-120%. Combining natural supplements with multivitamins such as Vitamin C, zinc, magnesium Vitamin K, Vitamin D3 and Gingko may boost testosterone production by up to 580%.
The effects of testosterone from natural herbs may not be surprising to many. In a research paper published a decade ago, South African medical bioscientist Ralf R. Henkel suggests that Tongkat Ali is a safe alternative to TRT, and its benefits extend beyond improved libido.
As this natural herb can be incorporated into any plant-based or keto-diet, this makes it popular amongst aging and healthy men, and used mainly for optimal energy boost, libido and overall hormonal balance.
Most common testosterone injections or TRT contains synthetic testosterone cypionate, testosterone enanthate, testosterone propionate, estosterone undecanoate, and methyltestosterone – which are well tolerated when administered if you have low androgen.
However, studies showed increased harm from using HRT / TRT as your body stop producing testosterone naturally. Some of the common HRT / TRT side effects may include:
According to Reddit users, TRT offers many advantages if you are into weight lifting or weight training. But often bodybuilders are experiencing peak and valleys with TRT, whilst some expressed concerns of the low-T levels when pushing really hard at the gym.
Experienced powerlifters and bodybuilders often experience low testosterone (similar to endurance marathon runners) – most of it can be circumvented through TRT whilst some opt for a safer approach of taking natural supplements such as Tongkat Ali.
Natural bodybuilders on the other hand stick to natural supplements (Tongkat Ali in particular) for optimal muscle growth and strength as evidenced in various bodybuilding competitions around the world. For example, a Australian-based YNF bodybuilding is amongst the first event organizers that allow participants to use Tongkat Ali with positive feedback.
“TRT is synthetic hence most bodybuilders are switching to Tongkat Ali with zinc, magnesium, D3, B complex, creatine and protein powder to boost muscle growth and retain optimal metabolic health without risks of cardiovascular disease”, said Andric, Business Manager of YNF Ausralia.
Bioidentical natural hormone supplements are plant-based HRT which are administered to patients who prefer natural / organic remedy. Other natural supplement that works at par with HRT (but with gradual improvements) includes Tongkat Ali (Eurycoma Longifolia)
Bioidentical Hormone Replacement Therapy (BHRT) using natural supplements are most frequently used to ease symptoms of perimenopause and menopause for women, or to boost energy and libido for men – with gradual improvements over a prolonged use.
BHRT or HRT / TRT natural supplements are getting more popular in the US rather than TRT injections or patches as consumers are increasingly aware of the infertility risks from long term use.
Tongkat Ali pure root extract and Ashwagandha may be classified as a natural form of BHRT that is safe, often taken daily with a monthly cycle and up to 15 years without side effects.
Here is a summary of HRT (TRT) vs. Natural Supplements, outlining the pros and cons.
| HRT / TRT
| Natural Supplements |
Type | Synthetic Testosterone | Plant-based natural testosterone |
Price | Injectables $288 -$1400 per month
Pills: $130 – $240 per month
| Capsules $30-60 per month |
Response Time | Fast (24-72 hours) | Moderate – Fast (24 hours – 96 hours) |
Improvements | Noticeable | Noticeable |
Risk of Cancer | Medium – High | Low |
Risk of Infertility | Medium – High | Low |
Risk of Cardiovascular Disease | Medium – High | Low |
Libido Boost | High | Moderate – High |
Testosterone Improvements | High | Moderate – High |
Risk of Long Term Use | High | Low |
Our Analysis
Natural supplements such as Tongkat Ali or Ashwagandha may be a safer option to increase your testosterone as it is seen as a natural way for your body to produce more testosterone compared to TRT injections (i.e derived from synthetic drugs). However, TRT may offer an immediate boost of energy and libido, although it may be a pricer option. This makes it more popular as the go-to solution for men with insurance coverage without knowing the long term cardiovascular and infertility risks.
For a man on the go, just drop into a random man’s clinic in Florida or New York, and off you go feeling manly, recharged, and super energized. On the other spectrum, Dr. Andrew Huberman is amongst the few Americans who felt strongly that natural supplementation is a better TRT alternative due to growing research studies.
Growing popularity supported by clinical studies showed that Tongkat Ali is amongst the best natural testosterone supplements for men as it helps to restore overall hormonal balance; notably increasing total and free testosterone, dopamine, reducing cortisol and regulating other key hormones.
For women above 40, Tongkat Ali supplement presents a promising alternative to HRT, when taken daily over a period of 24 to 52 weeks. Do you even need a TRT injection if you can source it naturally from plant-based herb such as Tongkat Ali?
A randomized clinical trial showed Tongkat Ali supplementation reduced hot flushes and improved hormone and lipid profiles in healthy peri-menopausal and menopausal women. The supplement enhanced hot flush symptoms in women by 65% after 12 weeks and by 73% after 24 weeks reducing menopausal symptoms in women.
Along with various research and clinical trials, Tongkat Ali is poised as one of the best alternative natural herbs to TRT. More so if you are seeking a gradual but sustainable solution to improve men’s health and fertility.
Hormone Replace Therapy (HRT) is relatively safe if you are taking the right type of HRT (eg: combined HRT, oestrogen-only HRT, testosterone gel, etc) and administered with the right dosage. However, Havard medical experts pointed out the long term risks associated with cardiovascular health, blood clotting and prostate cancer.
In reality, most of these severe side effects and health risks are visible few years down the road after TRT or HRT, and most men suffer with long-term downsides due to the inability of the body to produce testosterone naturally, posing further damage to the hormonal glands.
A study in 2002 by the Women’s Health Initiative found a link between HRT and an increased risk of blood clots, ovarian and breast cancer – which are largely ignored by men’s clinics, wellness centers and online TRT telemedics.
According to Professor Jane Green from the University of Oxford, the general consensus by medical professionals is that HRT should not be used to prevent long term disease, but used short-term to relieve menopausal symptoms (at least for women).
Meanwhile, many functional health coaches in the US and UK are not recommending HRT or TRT to their clients. UK functional health coach, AJ Brookes, who specializes in bloodwork analysis and bespoke health protocols reported that many of his clients were prescribed HRT hastily by doctors without knowing other underlying medical conditions.
Health coaches have had their fair share of close encounters with HRT patients. AJ Brookes added that he experienced many family friends and clients whose health has deteriorated due to HRT.
Amongst the largest concerns is doctors prescribing HRT to patients without knowing their health condition, or other underlying conditions that contribute to more health risks and damaging side effects.
In other parts of the world such as in the US, there are unreported HRT patients struggling to live with long-term side effects of HRT such as unwanted weight gain, unexpected vaginal bleeding, erratic mood changes, depression, gradual hair loss and nausea.
Related Article: Long Term Safety of Testosterone Replacement Therapy (TRT)
Our functional health coach AJ Brookes specializes in analyzing bloodwork and optimizing health using proprietary SuperHuman Health Protocol (SHP).
There are risks of breast and ovarian cancer by taking combined HRT based on several studies reported by scientists and research studies. In addition, HRT carries higher risks of cancer if you decide to take HRT long term, or regularly at high dosages:
Breast cancer: combined HRT increases the risk of breast cancer as reported by several studies. Prolonged use of HRT increases the risks of breast cancer.
Ovarian cancer: combined HRT increases the risk of ovarian cancer in menopausal women. Prolonged use of HRT increases the risks of ovarian cancer.
Those wanting to reduce cancer risks of HRT may opt for natural supplements, or natural endocrine supplements to restore overall hormonal balance.
Natural testosterone supplements may have lower health risks of cancer compared to TRT injections. Natural hormone supplements such as Tongkat Ali (Eurycoma Longifolia) contain anti-cancer properties against lung cancer, breast cancer, cervical cancer, colon and rectum cancers.
Whilst various Tongkat Ali studies showed promising results, more research and clinical studies are required on herbs such as Ashwagandha, Panax Ginseng, Primrose Oil and others.
Yes, you may take Tongkat Ali in small doses of 100mg to 200mg three times a week if you are on HRT treatment, but it is not recommended unless it is absolutely necessary. You should not take Tongkat Ali after 24 or 72 hours of your first TRT to avoid any hormonal complications.
You may lower your Tongkat Ali dosage to 100mg-200mg daily 2 weeks after your TRT treatment, before increasing your dose if you are actively training in the gym or gearing up for sports competition.
Should you need to take Tongkat Ali during or after your TRT, please observe any adverse or acute side effects ranging from frequent headaches, nausea, vomiting or diarrhea.
Related Article: Tongkat Ali Dosage Guide
Naressa Khan contributes regularly on AKARALI. As a researcher and investigative journalist, Naressa is all about creating, deconstructing, and reassembling meaningful content through words and facts. With this approach always in mind, she eagerly explores the nuances in life via the aspects of lifestyle, culture, travel, health, and wellness in Malaysia .
Our articles are third party reviewed by our panel of experts and medical advisors to ensure the facts are accurate and credible. These are validated against multiple source references which include but not limited to research studies, peer-reviewed journals, pre-clinical studies, clinical tests and other credible publications.
Our panel of medical advisors and experts are highly experienced in their individual fields. However, they do not provide any medical advice or recommendations arising from content published in this article.
Disclaimer:
The use of TRT, HRT or testosterone supplements should be consulted and administered by qualified medical professionals. The content published on this webpage is for educational purposes and should not be viewed, read, or seen as a prescription or constitute any form of medical advice. We recommend you consult your nearest GP or doctors before consuming Tongkat Ali or any products which contain Tongkat Ali. For further information, kindly refer to our Frequently Asked Questions (FAQ) for more information.
