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What are the side effects of testosterone replacement therapy? The side effects of testosterone replacement therapy include: or oily skin Swelling in the ankles caused by mild fluid retention Stimulation of the prostate, which can cause urination symptoms such as difficulty urinating Breast enlargement or tenderness Worsening of sleep apnea (a sleep disorder that results in frequent nighttime awakenings and daytime sleepiness) Smaller testicles Skin irritation (in patients receiving topical testosterone replacement) Laboratory abnormalities that can occur with testosterone replacement include: Increase in prostate-specific antigen (PSA) Increase in red blood cell count Decrease in sperm count, producing infertility (inability to have children), which is especially important in younger men who desire fertility, tribulus testosterone benefits. If you are taking hormone replacement therapy, regular follow-up appointments with your physician are important. 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