The Pros and Cons of Testosterone Therapy

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The number of men who take testosterone has dropped dramatically in the past few years, in part because of growing awareness of the risks that may accompany it. Should you avoid it?

Testosterone, a hormone, helps men maintain muscle, bone health, libido, and the ability to perform in the bedroom. But beginning in their mid-30s, men lose an average of just under 2% per year. Eventually, that drop could lead to hypogonadism, or low testosterone. This happens to 1 in 5 men in their 60s, and the likelihood rises as men get older. Testosterone replacement treatment (TRT) aims to boost those low levels back up.

But TRT has had its ups and downs in the past 2 decades. From 2001 to 2013, prescriptions rose by 300% following marketing efforts that proclaimed it could restore energy, alertness, mental focus, and sexual function. Then, over the next 3 years, the number of men taking it dropped by half as studies revealed potential risks, particularly to heart health.

“I do see some men who are more hesitant to take testosterone supplementation,” says Michael Eisenberg, MD, director of the Stanford Male Reproductive Medicine and Surgery Program at Stanford Health Care in Palo Alto, CA. “We talk about the risks, as that’s what we’ve gotten more information on in recent years.”

In 2014, the FDA ordered that a warning label must accompany TRT prescriptions, alerting men to the possibility that TRT increases the chances of heart attack and stroke. More recently, a study linked TRT to higher chances of venous thromboembolism, a potentially fatal type of blood clot.

And there are other concerns. Does TRT improve symptoms linked to low testosterone? In January of this year, the American College of Physicians released new practice guidelines that outlined the limited benefits men are likely to get from TRT. The doctors’ group found that TRT offered slight improvements to sexual and erectile function; they found no other benefits.

Eisenberg says that studies of TRT’s benefits and risks have had mixed results and provide limited answers. Does it improve fatigue, for example? It’s unclear. “We counsel men that it’s not clear whether TRT will help,” Eisenberg says.

However, Eisenberg stresses that men with very low testosterone have a higher chance of developing heart disease, osteoporosis, and other problems if they go untreated.

“There are health implications for very low levels,” he says. “It’s very important to have an open discussion about the benefits and the risks of HRT.”

 

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Ask Your Doctor

Could something other than low testosterone explain my symptoms?

Yes. Low libido and erectile dysfunction, for example, have many contributing factors to rule out, including heart disease and psychological issues.

If I do start TRT, how long until I know it’s helping?

Your doctor should confirm within 6 months or so whether TRT has improved your symptoms. If it hasn’t, discuss ending treatment.

Will TRT affect my ability to father children?

Yes. TRT decreases sperm production. Stop therapy, and fertility likely will return. In a small number of men, infertility is permanent.

Can I do anything to elevate my testosterone naturally? 

If you are overweight or obese, weight loss and, perhaps especially, exercise may help boost your levels without medication.

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WebMD Feature Reviewed by Michael W. Smith, MD on February 04, 2020

Sources

SOURCES:

Michael Eisenberg, MD, director, Stanford Male Reproductive Medicine and Surgery Program, Stanford Health Care, Palo Alto, CA.

American College of Physicians: “ACP issues guideline for testosterone treatment in adult men with age-related low testosterone.”

American Society for Reproductive Medicine: “Testosterone Use And Male Infertility.”

American Urological Association: “Evaluation and Management of Testosterone Deficiency.”

FDA: “FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use.”

Endocrine Journal: “Lifestyle modification increases serum testosterone level and decrease central blood pressure in overweight and obese men.”

Journal of Clinical Biochemistry and Nutrition: “Increased physical activity has a greater effect than reduced energy intake on lifestyle modification-induced increases in testosterone.”

JAMA Internal Medicine: “Association of Testosterone Therapy With Risk of Venous Thromboembolism Among Men With and Without Hypogonadism.”

 

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