The Risks and Benefits of Testosterone Replacement Therapy

Testosterone replacement therapy (TRT) is a treatment for males with testosterone deficiency or hypogonadism. It is also called androgen replacement therapy.

While there are clear benefits of TRT for hypogonadal males, there is still a lot of uncertainty about its long term health risks.

In this article, we discuss the risks and benefits of testosterone replacement therapy for men who have been diagnosed with testosterone deficiency and those with normal levels of testosterone.

Who Needs Testosterone Replacement Therapy?

TRT is recommended for males with diagnosed testosterone deficiency (adult onset hypogonadism).

Experiencing fatigue, low sex drive and other symptoms commonly associated with low testosterone is not enough reason to get TRT without first getting a test. That’s because these issues are common with age and don’t always mean you have hypogonadism.

A testosterone test will confirm that these symptoms are caused by testosterone deficiency.

TRT should only be prescribed by a doctor after at least two early morning blood tests. Testosterone tests are done in the morning because that’s when testosterone levels are the highest.

Your doctor will prescribe TRT based on the level of your testosterone as well as your symptoms.

Normally, testosterone levels range between 300 and 1,000 nanograms per deciliter (ng/dL) in men. Sustained testosterone levels below 300 ng/dL are considered low. If they are accompanied by symptoms of low testosterone, then TRT may be prescribed.

Some experts recommend TRT only for testosterone levels below 230 ng/dL. Ultimately, your doctor is the best person to help you decide if you need testosterone therapy.

Benefits of Testosterone Replacement Therapy

It’s important for anyone planning to get TRT to manage their expectations.

A lot of men expect to get a lot stronger, become more energetic and improve their sexual function beyond what’s normal for their age. That’s not what happens with TRT.

Testosterone therapy raises testosterone levels back to normal levels. It does not make you any more energetic or virile than you would be at your age. In other words, it won’t turn back the years and make you feel younger.

What TRT does is reverse or reduce the effects of low testosterone.

Some of the benefits of TRT include less fatigue, improved moods, higher libido, better overall sexual function (including quality of erections), higher bone density and better sleep.

Because low testosterone affects so many aspects of one’s health, getting testosterone replacement therapy significantly improves one’s life quality.

You’ll find that it’s easier to work out, you gain muscle more easily, you feel happier and have an easier time doing mental tasks that involve concentration and learning.

A lot of men report feeling more confident, enjoying better relationships with their partners, and feeling better about life in general.

Keep in mind these benefits are for men suffering from testosterone deficiency. According to Mayo Clinic, there is currently no evidence that testosterone replacement offers any benefits for healthy men.

Risks and Side Effects of Testosterone Replacement Therapy

Some men experience side effects when they undergo TRT treatment. These include sleep apnea, prolonged erections, acne and growth of breast tissue. Report any of these side effects to your doctor if they continue for some time.

What many medical experts are most worried about are the long term risks of testosterone replacement therapy.

Currently, researchers are not sure exactly how taking TRT affects one’s health in the long term. There are some proposed health risks, but there isn’t strong evidence for any of them.

This uncertainty is why doctors are increasingly advising caution about TRT, particularly for men who have not been diagnosed with hypogonadism.

Possible long term health risks of TRT include:

Heart disease

Some studies indicate that TRT increases the risk of cardiovascular disease, but others find that TRT doesn't make it more likely that you will have a heart attack and stroke.

The current recommendation is that men who have cardiovascular disease risk factors like diabetes, hypertension and family history should discuss their options with their doctor before taking TRT.

Prostate Cancer

This is another health issue where the impact of testosterone replacement therapy is not clear.

Prostate cancer cells require androgens (male hormones) like testosterone to grow. The concern with TRT is that adding more testosterone into the body can cause or worsen prostate cancer.

But studies on this are mixed. Older studies found that testosterone therapy can increase the risk of prostate cancer, but newer ones find no increased risk.

Most current research points to minimal long term risk of prostate cancer among men taking testosterone therapy. But this is not conclusive, so caution is advised especially if you do not have testosterone deficiency. The risk is not worth it.

You should also be careful if you’ve been diagnosed or have recovered from prostate cancer. TRT can, in some cases, worsen prostate cancer or cause it to recur. Discuss with your doctor before starting TRT.

Fertility

Despite TRT having positive effects on sexual function in men with hypogonadism, it lowers male fertility.

That’s because taking supplemental testosterone sends a signal to the brain, which stops the production of three crucial hormones: gonadotropin-releasing hormone (GnRH), follicle stimulating hormone (FSH) and luteinizing hormone (LH).

These three hormones are important in stimulating sertoli cells in the testicles to produce sperm.

Men planning to start a family soon should not take TRT as it significantly reduces the chances of achieving pregnancy.

If you are already on TRT, you should stop. It can take up to two years for sperm production to recover.

Takeaways

Testosterone replacement therapy is an effective treatment for men diagnosed with low testosterone.
Do not take off the shelf testosterone treatments. Get tested first to confirm hypogonadism then ask your doctor for a prescription.
There are possible long term risks of TRT, but most of them are unproven. Because of the uncertainty surrounding long term use of testosterone therapy, doctors recommend caution.