Written By : Rohit Dwivedi, M.D. (Last Updated on April 11, 2024)
In recent years, testosterone replacement therapy has grown in popularity.
There has been a fourfold increase in the use of testosterone therapy since 2014 in the US alone.
However, there have been controversies surrounding the use of testosterone replacement therapy (TRT).
The FDA has approved the use of TRT only for the treatment of clinical male hypogonadism.
However, TRT is often prescribed on the assumption of low testosterone for muscle mass, mood, strength, bone density, and cognitive function.
All the same, research shows that testosterone replacement therapy improves sexual and general health in men diagnosed with low T levels.
But, is testosterone therapy safe?
Let’s see the misconceptions, benefits, and risks associated with TRT.
Testosterone Replacement Therapy For Male Hypogonadism
Male hypogonadism is a condition where the testes do not produce enough testosterone.
This condition is associated with reduced sex drive, loss of bone density, hair loss, erectile dysfunction, loss of muscle mass, fatigue, irritability, gynecomastia, insomnia, and infertility.
Treatment includes testosterone therapy inform of gels, pellets, injections, and patches.
Is It Ideal For Healthy Men?
With increasing age, men may experience the same symptoms as low testosterone; however, these changes are due to the normal aging process.
They may experience weight gain, changes in mood, sleep disturbances, and loss of lean mass muscle.
Research shows that testosterone therapy yields positive results in men suffering hypogonadism, but these results are ambiguous in healthy men with normal T-levels and those with similar signs of aging.
Misconceptions Surrounding TRT
There are a few misconceptions surrounding testosterone replacement therapy.
For instance, some people say that TRT is not ideal for older men.
However, there is no age limit when it comes to TRT.
Also, some say that testosterone therapy causes cardiovascular issues.
The dangers of using this therapy happen in individuals who use it for the wrong reasons, such as build muscles and increase sports performance.
TRT should be used to treat clinically-diagnosed low testosterone.
When used right, testosterone therapy can restore normal T-levels and improve general health.
TRT Benefits
The main reason for testosterone therapy is to restore healthy T-levels and deal with problems caused by low levels.
Increases muscle mass and bone density
Low testosterone is linked to loss of bone density, fat gain, and reduced lean muscle mass.
Several studies 1 support that testosterone therapy boosts bone density in the hip and spine in older men and only at the lumbar spine among middle-aged men.
Additionally, there were improvements in muscle growth and fat loss following TRT.
Controls blood sugar levels
Testosterone therapy also helps to control blood sugar levels, thus reducing the risk of diabetes.
This also improves the quality of life among many individuals.
Improves erectile function and libido
Reduced sexual desire is one of the causes of male hypogonadism.
In a review of several studies 2, testosterone replacement therapy improved libido in both young and older men.
It also helped men maintain an erection; however, there were mixed reactions to erectile dysfunction.
Some studies showed that testosterone therapy improved erectile dysfunction in young and older men who had male hypogonadism.
However some studies showed that there were no improvements.
All the same, the positive results were rather small; hence, testosterone replacement therapy should not be among first-line treatments for erectile dysfunction.
The American Urological Association states that testosterone therapy should only be administered to individuals with low testosterone to improve erectile dysfunction.
Improves energy, and mood
Low testosterone is often linked to irritability, anger, and fatigue.
Testosterone therapy improves your mood, increases energy levels, and keeps your motivation high.
Additionally, it reduces depressive symptoms that are common among individuals with low T levels.
Are There Risks?
Unfortunately, testosterone replacement therapy is associated with an increased risk 3 of prostate cancer, obstructive sleep apnea, male breast cancer, polycythemia, cardiovascular issues including stroke and blood clots and deteriorating benign prostatic hyperplasia.
Increased risk of prostate cancer
It has been hypothesized that increased testosterone levels in the blood increase the risk of prostate cancer.
This is supported by the fact that androgen deprivation therapy is a significant treatment for progressed prostate cancer.
Thus, testosterone replacement therapy is contradicted in men with prostate cancer and high-risk patients – those with close relatives with prostate cancer.
But, there are contradicting study results on the correlation between increased risk of prostate cancer and TRT.
Some studies showed that there is no relation between prostate cancer occurrence or progression and testosterone therapy.
However, some studies indicate an increased risk of metastatic prostate cancer in older men who were using TRT.
Despite the controversies, caution should be exercised.
Increased risk of obstructive sleep apnea
Research suggests that men who were undergoing TRT developed obstructive sleep apnea, which faded away once treatment stopped.
More research is, however, needed to support this contradiction.
Increased risk of cardiovascular issues
Older men on testosterone replacement therapy have a heightened risk of cardiovascular problems such as blood clots, strokes, heart attacks and death from cardiac diseases.
Increased risk of male breast cancer
There is no direct association of TRT and breast cancer; however, research shows that high levels of testosterone may trigger aromatization- conversion of testosterone to estrogen.
This may boost breast tissue receptors increasing the possibility of male breast cancer.
More research needs to be done to support this correlation.
Other risks include
- Acne.
- Enlarged breasts.
- Reduced sperm production.
- Shrinkage of the testes.
- High red blood cell count.
- Adverse lower urinary tract symptoms.
Men are advised to wash their hands and avoid skin to skin contact with children, pets, and women two to four hours following application of testosterone gel or cream.
This is because these creams and gel have the potential to cause side effects to women and children, such as premature puberty, and hair growth.
However, this is very rare.
How About Natural Options?
Men who do not have hypogonadism but are facing signs of low testosterone due to increasing age can try natural alternatives to boost their testosterone.
These natural ways will improve their sex drive, increase energy levels, improve muscle growth, enhance mood, and increase motivation without using TRT.
Get enough sleep
Getting plenty of quality sleep increases T-levels and lowers cortisol hormone, which negatively affects testosterone.
Increase zinc enriched foods
Lack of enough zinc in the body is associated with male hypogonadism.
Eat more zinc-rich foods to kick start your testosterone levels.
Maintain a healthy weight
Too much fat will lower your testosterone levels.
A 2014 study 4 shows that obese men had eight times lower testosterone compared to healthy men.
Many fat cells increase aromatases-enzymes that convert testosterone into estrogen, thus lowering testosterone levels.
Try natural T-boosters
Natural testosterone boosters such as Testogen, Prime Male, TestoFuel have proven to be among the best in the market.
Supplement Vitamin D
Scientists show that supplementing Vitamin D 5 boosts testosterone levels.
Additionally, get some sun for 30 minutes daily to get natural Vitamin D.
Stay active
Exercising regularly, primarily through weight lifting and high-intensity cardio training, will boost your testosterone levels.
Bottom Line
The benefits of TRT prevail over the risks for healthy individuals with clinical male hypogonadism.
However, more research needs to be done to prove the effectiveness of testosterone therapy in older men with symptoms of low testosterone due to increasing age and those with normal T-levels, who want to boost sex drive and muscle growth.
There is a lot of controversy surrounding TRT benefits and risks; hence, more research is needed to ascertain its safety in the long term use.
Men on testosterone therapy need to have regular checks to ascertain that their health is okay, and hormone levels are within the acceptable limit.
Read next: How To Increase Testosterone, With These 6 Best Testosterone Boosting Foods
