There can be a lot of confusion when it comes to hormone therapy. For example, withtestosterone replacement therapy, there are a lot of important questions to answer. When is it necessary? Is it safe? What are the risks, and perhaps more importantly, can the benefits outweigh the potential side effects?
There are a variety of reasons why testosterone replacement therapy might be implemented on a patient. However, this hormone therapy isn’t for everyone.
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What Is Testosterone?
Testosteroneis considered a male sex hormone, and it is primarily produced in the testicles (although a very small amount comes from the adrenal glands). Women also have testosterone in their bodies but at much lower levels than men.
Testosterone is responsible for the development of primary sexual characteristics: male genitalia. It is also responsible for secondary sexual characteristics including muscle bulk, deep voice, and hair pattern.
Testosterone helps regulate other physical factors that impact mood and energy levels and protect heart health. It is also responsible for maintaining a normal sex drive. Testosterone helps to influence or provides:
Conditions That Cause Low Testosterone
There are a number of conditions that could causelow testosterone levels, which include:
Testosterone Replacement Therapy (TRT)
Testosterone replacement therapy is the process of replacing the testosterone that is lost as a result of an injury, a condition that is present at birth, or a disease that causes low testosterone levels. It can also be given to replace testosterone levels that have fallen as a result of anorchiectomy(removal of one or both testicles).
Treatment
There are various options for the administration of TRT.
Patches (Transdermal)
The body is able to absorb testosterone through patches, which are easy to use. However, they may cause skin irritation and must be applied multiple times each day. Furthermore, not all patients absorb this medication well.
Topical Gels
These are convenient to apply, but precautions must be taken to make sure that the skin that has been exposed to the TRT gel does not inadvertently rub off on other body parts. Women and children should not be exposed to these gels. Dependent on the type, these gels can be applied to the armpits, biceps, groin, and other body parts.
Buccal Patch
This type of patch, which is not commonly used, is placed on the gums two times per day. It is convenient to use but may cause gum irritation.
Injections
Intramuscular injections are given anywhere from twice a week to every other week. Sometimes the dose may be even less frequent. Dose and frequency are tailored to the patient subjective symptoms and objective lab values. There are also long acting injections (Aveed) that only require an injection five times a year.
Subcutaneous
This method involves pellets that are placed under the skin every three to six months. Once they are administered, the pellets require the least amount of maintenance and a high level of continuous steady dosing. However, they do require minor surgery each time a new dosage is due. Further, pellets can extrude, and as with any procedure there is inconvenience and small risk of infection.
Oral
Newer oral formulations include Kyzatrex,Jatenzo, and Tlando (testosterone undecanoate). Capsules are convenient and, unlike some previous oral testosterone formulations, not thought to cause liver damage.
Nasal
Natestois the first FDA-approved intranasal testosterone therapy. Typically, it is administered three times a day per nostril.
It is important for men interested in future fertility not to receive standard testostosterone replacement therapy since this can lead to low or no sperm count and infertility issues. If a man with low testosterone is interested in future fertility, he should seek counseling with a urologist focusing on male reproduction for alternative options. There are numerous ways to boost your testosterone without affecting your fertility.
What Is Hypogonadism?
Symptoms
Symptoms of hypogonadism in adult males may include:
TRT for Hypogonadism
Testosterone replacement therapy is a common treatment option for men with low testosterone levels and symptoms of hypogonadism. TRT can produce very positive results and even cause a person to regain masculine qualities that were lost due to low testosterone production.
Use of TRT for those with hypogonadism has been shown to be effective and generally safe, but additional clinical research data is needed to fully establish long-term safety.
Contraindications
TRT may not be recommended when a person has conditions such as:
Testosterone and Aging
Testosterone levels naturally decrease as a man ages, starting at around age 30, and continue to decline throughout life.
Although TRT has become a popular treatment, many experts do not recommend TRT for age-related symptoms of low testosterone.
A primary reason is due to the many side effects of long-term testosterone replacement therapy, including a controversial increased risk ofheart disease. While some studies support this, more have shown that there may not be detrimental effects of TRT on heart health.
Another factor that poses a controversial issue in prescribing TRT to aging healthy men is that once a person begins to take it, the body will stop making testosterone. This makes a person dependent on taking the hormone replacement long-term.
Symptoms of Age-Related Low Testosterone
Due to aging, testosterone levels naturally decrease. There are several normal changes that may occur, includinginsomnia(or other sleep disturbances), low sex drive, an increase in body fat, a reduction in muscle mass, a decrease in motivation, and a low level of self-confidence.
Side Effects of TRT
Short term side effects of testosterone replacement therapy may include:
Long term TRT side effects are known to be more problematic, including the possible risk of:
Important Tests
There are some important recommendations that those receiving TRT should follow as precautionary measures. One should have baseline bone density testing (DEXA) and regular bone density tests (to rule out osteoepenia orosteoporosis). Regularlab tests to check testosterone levels, PSA (marker of prostate health/cancer), hematocrit, and sometimes liver enzymes are also important and should be done routinely while taking TRT.
In addition, it is important to get a physical exam every three to six months to evaluate blood pressure and check for other symptoms or side effects, such as insomnia.
When to Seek Care
Emergency medical attention is needed right away when serious side effects occur, and these include symptoms of a cardiovascular event.
Signs You Should Seek Medical CareYou are experiencing chest pain.You have shortness of breath or difficulty breathing.You feel weakness on one side of the body.Your speech is slurred.
Signs You Should Seek Medical Care
You are experiencing chest pain.You have shortness of breath or difficulty breathing.You feel weakness on one side of the body.Your speech is slurred.
The Effectiveness of TRT
The many possible side effects of TRT should be strongly considered before you begin taking testosterone. Unfortunately, there is limited research on the long-term safety of TRT. Some studies have discovered serious risks that were linked with TRT — particularly with long-term use.
Some significant findings from studies on TRT include the following:
These research findings do need to be taken in moderation, however, due to the fact that more research needs to be done to definitively prove the long-term side effects of TRT.
5 Science-Backed Ways to Increase Testosterone Naturally
Conclusion
There are many positive benefits of TRT that may enhance the overall quality of life for those with low testosterone levels. Before taking TRT, it’s important to examine all the pros and cons of its safe and effective use. In some instances, the benefits of TRT may outweigh the risks. Keep in mind that although TRT has been linked with BPH (prostate gland enlargement), polycythemia, andsleep apnea, the evidence is not substantial enough to fully back up many of the potential risks
Having an in-depth conversation with your healthcare provider before deciding on TRT is an important first step.
Men are encouraged to seek medical advice and ask their doctors for advice on the effectiveness o testosterone replacement therapy in their particular situation.
1 SourceVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Urological Society.Evaluation and Management of Testosterone Deficiency (2018).Additional ReadingBarbonetti A, D’Andrea S, Francavilla S.Testosterone replacement therapy.Andrology. 2020;8(6):1551-1566. doi:10.1111/andr.12774Jia H, Sullivan CT, McCoy SC, Yarrow JF, Morrow M, Borst SE.Review of health risks of low testosterone and testosterone administration. World J Clin Cases. 2015 Apr 16;3(4):338-44. doi: 10.12998/wjcc.v3.i4.338.Osterberg EC, Bernie AM, Ramasamy R.Risks of testosterone replacement therapy in men. Indian J Urol. 2014 Jan;30(1):2-7. doi: 10.4103/0970-1591.124197.
1 Source
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Urological Society.Evaluation and Management of Testosterone Deficiency (2018).Additional ReadingBarbonetti A, D’Andrea S, Francavilla S.Testosterone replacement therapy.Andrology. 2020;8(6):1551-1566. doi:10.1111/andr.12774Jia H, Sullivan CT, McCoy SC, Yarrow JF, Morrow M, Borst SE.Review of health risks of low testosterone and testosterone administration. World J Clin Cases. 2015 Apr 16;3(4):338-44. doi: 10.12998/wjcc.v3.i4.338.Osterberg EC, Bernie AM, Ramasamy R.Risks of testosterone replacement therapy in men. Indian J Urol. 2014 Jan;30(1):2-7. doi: 10.4103/0970-1591.124197.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Urological Society.Evaluation and Management of Testosterone Deficiency (2018).
Barbonetti A, D’Andrea S, Francavilla S.Testosterone replacement therapy.Andrology. 2020;8(6):1551-1566. doi:10.1111/andr.12774Jia H, Sullivan CT, McCoy SC, Yarrow JF, Morrow M, Borst SE.Review of health risks of low testosterone and testosterone administration. World J Clin Cases. 2015 Apr 16;3(4):338-44. doi: 10.12998/wjcc.v3.i4.338.Osterberg EC, Bernie AM, Ramasamy R.Risks of testosterone replacement therapy in men. Indian J Urol. 2014 Jan;30(1):2-7. doi: 10.4103/0970-1591.124197.
Barbonetti A, D’Andrea S, Francavilla S.Testosterone replacement therapy.Andrology. 2020;8(6):1551-1566. doi:10.1111/andr.12774
Jia H, Sullivan CT, McCoy SC, Yarrow JF, Morrow M, Borst SE.Review of health risks of low testosterone and testosterone administration. World J Clin Cases. 2015 Apr 16;3(4):338-44. doi: 10.12998/wjcc.v3.i4.338.
Osterberg EC, Bernie AM, Ramasamy R.Risks of testosterone replacement therapy in men. Indian J Urol. 2014 Jan;30(1):2-7. doi: 10.4103/0970-1591.124197.
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