Low Testosterone Therapy: Risks and Benefits
The link, though, makes sense to Morgentaler. "On testosterone, we see that fat mass goes down while muscle mass goes up," he says. "We know that that is good for overall health."
Morgentaler also says that treating low T can strengthen a man's bones and help prevent osteoporosis. Some evidence also suggests that treatment can also aid blood sugar control, which is important for the prevention and control of diabetes.
Testosterone is also tied to heart health, says Eisenberg, who discloses that he has received a grant from Endo Pharmaceuticals to study the association between testosterone and health.
"Lower testosterone levels have been linked to higher risk of cardiovascular problems," Eisenberg says. Again, it's not clear if low testosterone levels actually cause heart problems.
Both Eisenberg and Morgentaler say that testosterone therapy can dramatically affect a man's quality of life. Besides its sexual benefits, TRT can improve a man's mood and energy level while reducing irritability and anger.
What Are the Risks?
There are some cautions men should know about.
Testosterone therapy can raise a man's risk for blood clots and stroke. Eisenberg says that men can offset that risk by occasionally donating blood.
Uncommon side effects include sleep apnea, acne, and breast enlargement. All such side effects go away if treatment is stopped.
Men who use a testosterone gel should wash their hands thoroughly after applying a dose and make sure that no one else touches the spots where they medicate. If a woman or child comes into contact with testosterone gels, it can cause side effects in them, including hair growth and premature puberty.
"Although all testosterone creams or gels have the potential to be transferred to women or children, in practice this is exceedingly rare. I've never seen a case," Morgentaler says.
Still, as a precaution, he advises men to avoid skin-to-skin contact with women or children for the first two to four hours after applying medication. A nasal gel is now available that eliminates the risk of exposure to others.
To continue to benefit, a man with low testosterone must remain on it. However, says Eisenberg, we don’t know a lot about its long-term safety.
Finally, there's the question of prostate cancer risk. Research over the past few decades has shown little evidence of a link between testosterone replacement therapy and prostate cancer. However, the question has not been entirely laid to rest. Eisenberg recommends that his testosterone replacement therapy patients get a PSA test once or twice a year to check for possible signs of concern.
For Morgentaler, the benefits far outweigh the risks for men who are otherwise healthy yet have low testosterone levels, and he says the results of treatment are rewarding for him as well as for his patients.
"This is one of the very few areas of medicine where a male patient will come to you and say, 'You made me feel like myself again,'" Morgentaler says. "I hear from their wives, too, who say, 'You gave me my husband back.'"