Is testosterone therapy safe? Take a deep breath before taking the plunge

Understand the potential risks and consider alternatives before increasing your hormones indefinitely.

Millions of American men use a prescription testosterone injection or gel as a form of testosterone replacement therapy (often called TRT therapy) to restore normal levels of the male hormone. The ongoing pharmaceutical marketing blitz promises that low testosterone treatment can make men feel more alert, energetic, mentally sharp, and sexually functional. However, legitimate safety concerns remain. For example, some older men receiving testosterone replacement therapy may be at higher cardiac risk.

“Because of marketing, men have been inundated with information about the potential benefits of fixing low testosterone, but not the potential costs,” says Dr. Carl Pallais, endocrinologist and assistant professor of medicine at Harvard Medical School. “Men should pay much more attention to the possible long-term complications.”

The Low-T Boom

A loophole in FDA regulations allows pharmaceutical marketers to urge men to talk to their doctors if they have certain "possible signs" that suggest they may need treatment for low testosterone. “Virtually everyone asks about it because direct marketing is so aggressive,” says Dr. Michael O’Leary, a urologist at Harvard-affiliated Brigham and Women’s Hospital. "Tons of men who would never have asked me before started asking me when they saw ads saying 'Do you feel tired?'

Simply being tired is not enough to seek testosterone replacement therapy. “General fatigue and malaise are pretty low on my list,” says Dr. O'Leary. "But if they have significant symptoms, they need to undergo a laboratory test. For most men, testosterone levels are normal."
If a man's testosterone is below the normal range, there is a good chance that he will be on TRT hormone supplements - often indefinitely. “There is a kind of testosterone trap,” says Dr. Pallais. "Men start testosterone replacement and feel better, but then it's hard to come off it. During treatment, the body stops producing testosterone. Men can often feel a big difference when they stop therapy because their body's testosterone production has not yet recovered."

This wouldn't be so important if we were sure that long-term hormone therapy was safe, but some experts worry that low-T therapy exposes men to small risks that could add up to harm over time.

What are the risks of testosterone therapy?

A relatively small number of men experience immediate side effects of testosterone treatment, such as: B. Acne, difficulty breathing when sleeping, swelling or tenderness of the breasts, or swelling in the ankles. Doctors also watch for high red blood cell counts, which could increase the risk of clots.

Men who use long-term forms of testosterone therapy appear to be at higher risk of cardiovascular problems such as heart attacks, strokes and death from heart disease. For example, in 2010, researchers stopped studying testosterone in older men when initial results showed that men who received testosterone replacement therapy had noticeably more heart problems. “Theoretical cardiac side effects occur somewhat more immediately in older men,” says Dr. Pallais.

Some doctors also have ongoing concerns that testosterone therapy could stimulate the growth of prostate cancer cells. As with the hypothetical cardiac risks, the evidence is mixed. But because prostate cancer is so common, doctors tend to prescribe testosterone to men who might be at risk.

For male patients with low blood testosterone levels, the benefits of male hormone replacement therapy typically outweigh the potential risks. However, for most other men, it is a joint decision with your doctor. It offers men who feel lousy a chance to feel better, but this quick fix could divert attention from unknown long-term dangers. "I can't tell you for sure whether or not this increases your personal risk of heart problems and prostate cancer," says Dr. Pallais.

So keep risks in mind when considering testosterone therapy or other therapies. “I often advise against it, especially if the man has borderline values,” says Dr. Pallais.

Proceed with caution

A large, definitive study of hormone treatment for men is still pending. Until then, here's how to approach testosterone therapy carefully.

First, take stock of your health

• Have you considered other reasons why you may be experiencing fatigue, low sex drive, and other symptoms attributed to low testosterone? For example, do you eat a balanced and nutritious diet? Do you exercise regularly? Are you sleeping well? Address these factors before turning to hormone replacement therapy for men.

• If your sex life isn't what it used to be, have you ruled out relationship or psychological issues that could be contributing?

• If erectile dysfunction has led you to suspect "low T" as the culprit, remember that cardiovascular disease can also cause erectile dysfunction.

Get an accurate assessment

• Inaccurate or misinterpreted test results can either misdiagnose or miss a case of testosterone deficiency. Your testosterone levels should be measured between 7:00 a.m. and 10:00 a.m. when they are at their highest. Confirm a low reading with a second test on another day. It may require multiple measurements and careful interpretation to determine bioavailable testosterone, or the amount of the hormone that may have effects on the body. Consider getting a second opinion from an endocrinologist.

• After starting therapy, see your doctor regularly for testosterone checks and other laboratory tests to ensure that therapy is not causing problems with your prostate or your blood chemistry.

Be aware of unknown risks of testosterone replacement therapy

• Approach testosterone therapy with caution if you are at high risk for prostate cancer; have severe urinary problems due to prostate enlargement; or have diagnosed heart disease, a previous heart attack, or multiple risk factors for heart problems.

• Bitten Sie Ihren Arzt, Ihnen die verschiedenen Nebenwirkungen der verschiedenen Testosteron-Formulierungen zu erklären. Die verschiedenen Behandlungen umfassen Testosteron-Injektionen, Gele und Pflaster. Wissen, worauf zu achten ist, wenn etwas schief geht.

Have realistic expectations

Testosterone therapy is not a fountain of youth. There is no evidence that it will return you to the level of physical fitness or sexual function of your youth, make you live longer, prevent heart disease or prostate cancer, or improve your memory or mental acuity. Do not seek TRT therapy with these expectations in mind.

If erectile function was a problem, testosterone therapy may not fix it. In fact, it can increase your sex drive, but you can't act on it. You may also need medication or other therapy if you have difficulty getting or maintaining erections.

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