We've had nearly zero men report this as an issue on standard therapeutic doses of TRT. This is more prevalent at higher doses, say something a bodybuilder might use from an UGL combined with steroids, than at what we treat. Often times it is not the testosterone in these situations leading to it but rather things related to thyroid or cortisol. If we had a patient with this issue we would check those first to make sure something else isn't off. In those cases it would be best to remove whatever extra substance is causing those levels to change, reducing the dose, or looking for something else going on.

Moon face seems to be more prevalent in supraphysiologic levels (>1200 total T). We don’t see much of it on traditional TRT doses.

Moon face is a combination of edema (fluid retention), hypertrophy of facial musculature, and venous congestion that comes with high hematocrit. Again these are more prevalent with above normal T levels.

Other than dose adjustment, they can be managed with natural diuretics like dandelion root and keeping hematocrit in check with donations and/or naringen supplements.