Can testosterone treatments cause swollen feet? This is a common concern for men undergoing testosterone replacement therapy (TRT) in the UK. Peripheral oedema—fluid accumulation in the lower extremities—is a recognised adverse effect of testosterone preparations, though it does not affect all patients. The swelling occurs due to testosterone's influence on sodium and water retention, with fluid accumulating in the feet and ankles, particularly after prolonged standing. Whilst mild oedema may be manageable with lifestyle modifications, significant swelling warrants medical review, especially in patients with pre-existing cardiac, renal, or hepatic conditions. Understanding when foot swelling represents a minor side effect versus a more serious complication is essential for safe testosterone treatment.

Can Testosterone Treatments Cause Swollen Feet?

Yes, testosterone treatments can cause swollen feet as a recognised adverse effect, though this does not occur in all patients. Peripheral oedema—the medical term for fluid accumulation in the lower extremities—is listed as a known side effect of testosterone replacement therapy (TRT) in the Summary of Product Characteristics (SmPC) for various testosterone preparations available in the UK.

The mechanism behind this swelling appears to be related to testosterone's effect on fluid and electrolyte balance. Testosterone may promote sodium and water retention in the body, though the precise mechanism is not fully established. When the body retains excess sodium, water follows, leading to increased fluid volume in the bloodstream and tissues. Gravity causes this fluid to accumulate in the feet and ankles, particularly after prolonged standing or sitting.

The incidence of peripheral oedema varies depending on the testosterone formulation, dosage, and individual patient factors. Patients with pre-existing conditions such as heart failure, kidney disease, or liver problems face higher risk, as their bodies already struggle to manage fluid balance effectively. Older patients and those receiving higher doses of testosterone may also be more susceptible to this adverse effect.

It is important to note that whilst swollen feet can occur with testosterone treatment, they may also indicate other medical conditions requiring investigation. According to product information, significant oedema should prompt dose reduction or temporary cessation of TRT, especially in patients with cardiac, renal or hepatic impairment. Regular monitoring, including haemoglobin and haematocrit checks (at baseline, 3-6 months, then annually), is recommended during testosterone treatment.

Recognising Swelling and When to Seek Medical Advice

Recognising the characteristics of swelling is essential for determining whether it represents a minor side effect or a more serious concern. Mild peripheral oedema typically presents as slight puffiness around the ankles that may worsen throughout the day and improve with leg elevation overnight. You might notice sock marks remaining on your skin for longer than usual, or shoes feeling tighter by evening. This swelling is usually symmetrical, affecting both feet equally, and the skin typically returns to normal when pressed (known as pitting oedema).

You should contact your GP or prescribing clinician promptly if you experience:

• Sudden or rapidly worsening swelling in your feet, ankles, or legs

• Swelling that extends above the knees

• Swelling accompanied by shortness of breath, chest pain, or difficulty breathing when lying flat

• Painful unilateral swelling (affecting only one leg), especially with warmth or redness, which could indicate a blood clot requiring same-day assessment

• Swelling associated with weight gain of more than 2–3 kg in a few days

• Skin changes such as redness, warmth, tenderness, or skin breakdown

• Reduced urine output or changes in urine colour

Seek immediate medical attention (call 999 or attend A&E) if swelling occurs alongside severe breathlessness, chest pain, confusion, or collapse. These symptoms may indicate serious complications such as heart failure or pulmonary embolism, which require urgent assessment.

According to NICE guidance on chronic heart failure, new or worsening peripheral oedema in patients on medications affecting fluid balance warrants clinical review. Your healthcare provider may measure natriuretic peptide levels (BNP/NT-proBNP) and arrange further investigations such as echocardiography if heart failure is suspected. Keeping a symptom diary noting when swelling occurs, its severity, and any associated symptoms can help your clinician make an accurate assessment.

Managing Foot Swelling During Testosterone Treatment

Management of testosterone-related foot swelling involves both lifestyle modifications and potential treatment adjustments under medical supervision. Your prescribing clinician may initially recommend conservative measures before considering changes to your testosterone regimen, as mild oedema often improves with simple interventions.

Lifestyle and self-care measures that may help reduce swelling include:

• Elevating your legs above heart level for 20–30 minutes several times daily, particularly in the evening

• Reducing salt intake to less than 6g per day (approximately one teaspoon of salt), as recommended by the NHS

• Wearing compression stockings (class 1 or 2), which can be purchased from pharmacies or prescribed if appropriate—these should be professionally fitted and are not suitable if you have certain conditions including suspected DVT, severe peripheral arterial disease, or acute cellulitis

• Regular physical activity, particularly walking and ankle exercises, to promote venous return

• Avoiding prolonged standing or sitting without movement

• Maintaining a healthy weight, as excess body weight increases pressure on the lower limbs

• Fluid intake should be discussed with your healthcare provider, particularly if you have heart or kidney problems

Medical management may involve dose adjustment or formulation changes. If significant oedema occurs, your clinician might reduce your testosterone dose or temporarily stop treatment, as recommended in product information. They might also consider switching between different preparations (such as from intramuscular injections to transdermal gels) to achieve more stable hormone levels. In some cases, diuretic medication may be prescribed to help eliminate excess fluid, though this requires careful monitoring of electrolyte levels and kidney function.

Regular monitoring of haematocrit levels is important, as testosterone can increase red blood cell production, potentially contributing to circulatory issues. Action may be needed if your haematocrit exceeds 54%. Do not stop or alter testosterone without medical advice; your clinician may need to reduce, pause or switch your treatment while assessing the swelling.

If you experience side effects from testosterone treatment, you can report them through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

Alternative Causes of Swollen Feet to Consider

Whilst testosterone treatment may contribute to foot swelling, numerous other conditions can cause similar symptoms, and it is essential not to automatically attribute oedema to hormone therapy without proper investigation. Your healthcare provider will consider differential diagnoses to ensure appropriate management.

Cardiovascular causes represent important considerations. Chronic heart failure occurs when the heart cannot pump blood effectively, leading to fluid accumulation in the lower extremities. According to NICE guidelines, heart failure should be suspected in patients with breathlessness, fatigue, and ankle swelling, particularly those with risk factors such as hypertension, coronary artery disease, or previous myocardial infarction. Venous insufficiency, where damaged valves in leg veins impair blood return to the heart, typically causes bilateral ankle oedema that may be asymmetric, often with skin changes including discolouration and varicose veins.

Renal and hepatic conditions significantly affect fluid balance. Chronic kidney disease reduces the kidneys' ability to excrete sodium and water, whilst nephrotic syndrome causes protein loss in urine, reducing oncotic pressure and promoting oedema. Liver cirrhosis impairs albumin production and increases portal pressure, leading to fluid retention. These conditions typically present with additional symptoms such as changes in urine output, abdominal swelling, or jaundice.

Medication-related oedema extends beyond testosterone. Calcium channel blockers (commonly prescribed for hypertension), non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and thiazolidinediones (such as pioglitazone for diabetes) can all cause fluid retention. Lymphoedema, resulting from impaired lymphatic drainage due to surgery, radiotherapy, or infection, may be pitting in early stages and non-pitting later. It can affect one or both limbs.

Other considerations include deep vein thrombosis (requiring same-day assessment via GP, urgent clinic or NHS 111), hypothyroidism, prolonged immobility, and nutritional deficiencies. A thorough clinical assessment including medical history, physical examination, and appropriate investigations (such as blood tests, urinalysis, or imaging) will help identify the underlying cause and guide treatment decisions.

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