A recent surge of ‘Low T” advertisements have led to an increase in men seeking Testosterone Replacement Therapy (TRT) to a level of 3 percent of men over 40, as well as a industry of men’s clinics that has flowered to meet this interest. Because of this marketing blitz, millions of men and their partners are increasingly made to believe that the application of testosterone is akin to the garden of youth, especially as an antidote to erectile dysfunction and sexual problems. Low testosterone (hypogonadism) can impact a man’s sex drive, sexual performance, including erectile dysfunction, energy, and motivation. Under appropriate conditions, TRT can return testosterone levels to the normal range, and renew a man’s performance and quality of life.
In prescription form, as a gel, patch, or injection, Testosterone, a hormone produced primarily in the testicles, helps maintain a man’s bone density, strengthening a man’s bones and help prevent osteoporosis, and decreasing fat distribution, supporting weight loss and waist size reduction while increasing muscle strength and mass. Testosterone can improve a man’s mood and energy level while reducing irritability and anger, and TRT can increase a man’s libido, his sex drive, as well as his ability to maintain an erection, and consequently, his self-esteem.
In general, hormone replacement therapy is safe. However, possible side effects include:
• Cause acne, oily skin, or other skin reactions
• Mild fluid retention.
• Breast enlargement (increase estrogen production).
• Worsening sleep apnea.
• Decreased testicular size.
• Liver toxicity correlated with oral testosterone.
• Changes in cholesterol and lipid levels.
• Decrease in sperm production, leading to problems with fertility (especially in younger men).
• Increase the risk of a heart attack, stroke, or blood clots, and death from heart disease, especially in men with existing cardiovascular problems over 65 years of age.
• Increased red blood cell production (Polycythemia) that can be ameliorated with blood donations.
• Increase noncancerous growth of the prostate (benign prostatic hyperplasia) and growth of existing prostate cancer. Stimulation of prostate tissue may increase urination problems such as a decreased stream or frequency, and possibly increased PSA levels.
There are however conflicting results with studies of TRT, with some studies showing a lower cardiac risk with testosterone therapy, increase in blood sugar control, and no apparent effect on prostate cancer. However, there needs to be caution around hormone replacement therapies, as the history of other therapies, such as estrogen replacement therapy, resulted in serious risks for women that came to light only after many years of usage. A man on testosterone will have to remain on the therapy for a lifetime, as disuse will lead to the return of symptoms. Therefore, long-term safety is still unknown. It is therefore recommended that men should take a cautious approach and get a full evaluation of their likely candidacy for TRT.
First, men should talk to their doctors about the costs and benefits of this therapy, as there may be many other reasons for symptoms that are attributed to low testosterone, like fatigue, low libido, and erectile dysfunction. The problem may really be the coincidence of other chronic disease, medications, poor self care, alcohol and drug use, depression, or relationship issues.
Seeking medical advice from a doctor or urologist is important to get accurate measure of testosterone and be clinically diagnosed with testosterone deficiency. Men with “low T” symptoms should undergo blood tests prior to starting testosterone replacement therapy. The blood test should be taken in the morning (between 7 am and 10 am), when testosterone is at its peak, and confirmed with a second test on a different day. Normal levels of testosterone range from about 300 to 900 nanograms per deciliter (ng/dL), and men whose levels fall within that range would not benefit from therapy. An aware patient should also ask for a determination of “free” testosterone, which is the amount of the testosterone that is active in the bloodstream. A man with total testosterone in the normal range may still be deficient in testosterone if his free testosterone level is below effective dose at any given time.
Men at high risk, which includes men with prostate cancer, those with urinary problems from prostate enlargement, men with heart disease and heart attack survivors, and men with diabetes, should approach testosterone therapy with extra caution. Getting a second opinion from an endocrinologist should also be considered.
Moshe Rozdzial,LPC, is a Psychotherapist and Certified Sex Therapist in private practice in Denver, Colorado, at Glow Counseling, www.glowcounseling.com.
