Pros and Cons of TRT

TRT has the potential to improve life quality and even save your life. But for all its benefits, what are the cons of TRT we need to watch out for?

As most of you know there is an increased popularity of testosterone replacement therapy (TRT) in the past two decades. However, a lot of men still have some concerns about the side effects of TRT.

They have a lot of questions. Does TRT cause infertility? Heart attack? Prostate cancer? For all these horrible ideas, we all know that TRT is benficial to those who are in need of it medically.

IfIn this article we gather all the information you need to know about the safety profile and the possible side effects of testosterone replacement therapy while also looking at the Pros as well.

Key Takeaways

  • Prior to the start of TRT, Hypogonadal men need to undergo testicular examination and have full hormonal profile.
  • TRT has been linked to reducing the risk of cardiovascular disease and depression in men
  • TRT does have side effects, such as potentially causing infertiliy
  • To make sure you manage the sides, work through a trusted and well known TRT Clinic

Why men need Testosterone

The male hormone testosterone plays an important role in the development and maintenance of typical masculine physical characteristics, such as muscle mass and strength, and growth of facial and body hair. [12]

The levels of testosterone are regulated by the hypothalamus and the pituitary gland at the level of the hypothalamic-pituitary-gonadal axis. [12]

The normal levels of serum testosterone in young healthy men (20 – 30 years old) ranges between 300 and 800 ng/dL. [12]

After the third decade of life, serum testosterone levels decline gradually at an approximate rate of 1-2% per year. [12]

What classifies as Low Testosterone

The 2010 Endocrine Society Guidelines define androgen deficiency as signs and symptoms of low testosterone in the setting of unequivocally low morning serum testosterone levels of less than 300 ng/dl on two separate occasions. [13]

TRT Side Effects
As men age, we see a corrosponding decline in Testosterone production

Symptoms and signs of low testosterone include [13]:

  • Anemia
  • Depressed mood
  • Erectile dysfunction
  • Impaired sexual function, decreased libido and sexual desire, fewer spontaneous erections
  • Reduced muscle mass and strength
  • Reduced bone mass and osteoporosis
  • Insomnia and a reduced sense of general well-being
  • Forgetfulness and difficulty in concentration, and loss of memory

Testosterone Replacement Therapy (TRT)

The U.S. Food and Drug Administration (FDA) cautions that prescription testosterone products are approved only for men who have low testosterone levels caused by certain medical conditions. [14]

Over the last 10 years, testosterone deficiency in men has been under the spotlight due to the increased awareness by medical providers, increased direct-to-consumer advertising in the media, and the longer life expectancy of male population. [13]

Testosterone replacement therapy (TRT) has been used by millions of men allover the world to treat symptoms of low testosterone levels such as diminished libido and erectile dysfunction, and to improve muscle strength and physical function. [13]

In the United States, between 2001 and 2011, testosterone therapy prescription among men 40 years of age or older increased from 0.81% in 2001 to 2.91% in 2011. [13]

TRT has been shown to increase serum testosterone to physiologic levels and improve testosterone deficiency related symptoms. [13]

Pros and Cons of TRT
Low Testosterone has been linked to several health complications, including cardiovascular disease

Several TRT formulations such as topical gels and patches, intramuscular testosterone injections, subcutaneous pellets, and oral/buccal formulations are available and provide clinicians and patients the opportunity to personalize replacement therapy according to the clinical and economic status of each patient. [13]

Pros of TRT

There are plenty of reasons why someone suffering from hypogonadism would consider TRT, as long as they do it through a medical facility.

Improvement of Cardiovascular Health

As we know, low Test levels are linked to various health conditions, such as heart disease, stroke, and higher blood lipids [13].

While studies and medical professionals are not all in agreement about this, there is some evidence to show that raising Test levels to normal levels will decrease the risk of cardiovascular disease.

More Muscle Mass and Less Fat

Testosterone is an androgen after all, and lower Testosterone levels have been linked to lower muscle mass. Lower muscle mass will lead to a poorer quality of life, and an increased risk of injury.

Low Testosterone can also lead to fat gain, increasing the risk of diabetes. Fat gain is predominantly around the abdomen, which has been linked to various health diseases [13].

Improved Mood and Sexual Function

It will come as no surprise that low Testosterone has been linked to depression and erectile dysfunction. TRT has been shown to increase mood, libido, sexual function, and decrease the risk of anxiety and depression.

Other Pros of TRT

  • Increased Bone Density and Strength
  • Improved Cognition and Memory
  • Fat loss
  • Reduced risk of injury
Pros and Cons of TRT
A 2017 study found that bone density and strength increased when older men were treated with Testosterone

Cons of TRT

Despite the benefits of testosterone administration in management of low testosterone, TRT as a hormone treatment comes with several potential side effects that patients need to be aware of before starting the treatment.

Cardiovascular Adverse Events

The use of testosterone injection is associated with a greater risk of myocardial infarction and stroke, but not venous thromboembolism, compared with testosterone gel use. [1] However, more recent studies have shown that TRT is not associated with an increased risk of cardiovascular disease. [1]

Data regarding the cardiovascular safety of TRT have been conflicting and inconclusive.

Erythrocytosis

Erythrocytosis is an increase in the number of erythrocytes and is defined as a hemoglobin level above 185 g/L and hematocrit percentage over 49% in men. [2] Interestingly, exogenous testosterone was initially used as a treatment for anemia. [2]

Additionally, testosterone increases erythropoiesis by increasing iron availability via reduced hepcidin levels, a hormone responsible for iron sequestration. [2] However, estradiol seems to also play a role.

Venous Thromboembolism

The known association between TRT and erythrocytosis and a report that demonstrated an increased risk of venous thromboembolism in men receiving TRT, especially in those with underlying thrombophilia, have led the FDA to require adding a general warning to testosterone products about the potential risk for venous blood clots. [1]

Prostate Cancer Risk

Among the various side effects of TRT, prostate safety is one of the major concerns. Hence, urologists are interested and play an important role in the diagnosis of testosterone deficiency and TRT. [1]

The 2008 guidelines on late-onset hypogonadism (LOH) state “There is no conclusive evidence that testosterone therapy increases the risk of prostate cancer or BPH. There is also no evidence that testosterone treatment will convert subclinical prostate cancer to clinically detectable prostate cancer. However, there is unequivocal evidence that testosterone can stimulate growth and aggravate symptoms in men with locally advanced and metastatic prostate cancer”. [4]

Other Cons of TRT

  • Infertility (potentially)
  • Lower Urinary Tract Symptoms
  • Obstructive Sleep Apnea

How to Start TRT?

You need to get in contact with a good doctor or TRT clinic such as Evolve TRT. They will help you on your journey and supply you with a prescription for TRT and send you the medication as well.

Pros and Cons of TRT
TRT or HRT with Evolve is safe, legal, and easy to get

You will have a discussion with a medical professional who will ask you about the symptoms you are experiencing. Then, once your blood tests reflect what needs to be prescribed, the doctor will prescribe the correct treatment, and it will be shipped to your door.

Alternatives to TRT

Instead of exogenous T, alternative therapies, including selective estrogen receptor modulators (SERMs), human chorionic gonadotropin (hCG), and aromatase inhibitors, are commonly used to promote the production of endogenous testosterone. [1]

Park, H. J., Ahn, S. T., & Moon, D. G. (2019). Evolution of Guidelines for Testosterone Replacement Therapy. Journal of clinical medicine, 8(3), 410. https://doi.org/10.3390/jcm8030410

Cervi, A., & Balitsky, A. K. (2017). Testosterone use causing erythrocytosis. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 189(41), E1286–E1288. https://doi.org/10.1503/cmaj.170683

Bhasin, S., Cunningham, G. R., Hayes, F. J., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., Montori, V. M., & Task Force, Endocrine Society (2010). Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. The Journal of clinical endocrinology and metabolism, 95(6), 2536–2559. https://doi.org/10.1210/jc.2009-2354

Nieschlag E. (2015). Current topics in testosterone replacement of hypogonadal men. Best practice & research. Clinical endocrinology & metabolism, 29(1), 77–90. https://doi.org/10.1016/j.beem.2014.09.008

Gagnon, D. R., Zhang, T. J., Brand, F. N., & Kannel, W. B. (1994). Hematocrit and the risk of cardiovascular disease--the Framingham study: a 34-year follow-up. American heart journal, 127(3), 674–682. https://doi.org/10.1016/0002-8703(94)90679-3

Kim, S. D., & Cho, K. S. (2019). Obstructive Sleep Apnea and Testosterone Deficiency. The world journal of men's health, 37(1), 12–18. https://doi.org/10.5534/wjmh.180017

Lee, M. H., Shin, Y. S., & Kam, S. C. (2021). Correlation Between Testosterone Replacement Treatment and Lower Urinary Tract Symptoms. International neurourology journal, 25(1), 12–22. https://doi.org/10.5213/inj.2040234.117

Pearl, J. A., Berhanu, D., François, N., Masson, P., Zargaroff, S., Cashy, J., & McVary, K. T. (2013). Testosterone supplementation does not worsen lower urinary tract symptoms. The Journal of urology, 190(5), 1828–1833. https://doi.org/10.1016/j.juro.2013.05.111

Snyder, Peter J. "Testosterone treatment of male hypogonadism." UpToDate, Matsumoto, AM (Ed), UpToDate, Waltham, MA (2012). https://www.medilib.ir/uptodate/show/7461

Isidori, A. M., Balercia, G., Calogero, A. E., Corona, G., Ferlin, A., Francavilla, S., Santi, D., & Maggi, M. (2015). Outcomes of androgen replacement therapy in adult male hypogonadism: recommendations from the Italian society of endocrinology. Journal of endocrinological investigation, 38(1), 103–112. https://doi.org/10.1007/s40618-014-0155-9

https://www.health.harvard.edu/mens-health/is-testosterone-therapy-safe-take-a-breath-before-you-take-the-plunge

Yabluchanskiy, A., & Tsitouras, P. D. (2019). Is Testosterone Replacement Therapy in Older Men Effective and Safe?. Drugs & aging, 36(11), 981–989. https://doi.org/10.1007/s40266-019-00716-2

Grech, A., Breck, J., & Heidelbaugh, J. (2014). Adverse effects of testosterone replacement therapy: an update on the evidence and controversy. Therapeutic advances in drug safety, 5(5), 190–200. https://doi.org/10.1177/2042098614548680

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 https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-cautions-about-using-testosterone-products-low-testosterone-due

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