Testosterone Replacement Therapy: Benefits and Risks

Gentlemen, are you feeling tired, unmotivated, and noticing some unwanted

loss of muscle tone? How about some loss of libido or a change in mood? Low testosterone could be to blame. Over the last several years, testosterone

replacement therapy (TRT) has increased in popularity with men, but does this

mean TRT is right for you? Here’s what you need to know about TRT before seeking the first men’s health clinic in your Google search.

What is Testosterone?

Testosterone is the male sex hormone responsible for hair growth, deepening of the voice, and muscle growth. Testosterone is highest in the body around age 19 and then decreases with age.

Purpose of TRT and Some Indications?

Some men experience lower-than-normal testosterone levels. This is often called 'low T'. The good news is, it can be managed. Testosterone replacement therapy is used in people with  lower testosterone levels. TRT is indicated for several different reasons, a few of them are:

• Hypogonadism or testosterone deficiency due to medical conditions

• Age-related decline in testosterone

• Clinical symptoms of low testosterone

While these are some reasons for treatment, beginning TRT isn’t for everyone.  Understanding the risks and benefits of treatment is a critical step in deciding if TRT is the right choice.

Symptoms of Low Testosterone

Low testosterone has the potential to cause different side effects.These may include: 

• Decreased sexual desire

• Inability to maintain an erection

• Decreased muscle mass or strength

• Low energy or fatigue

• Mood change

• Decreased bone density

These symptoms are not a complete list, and some can be vague, but it is important to discuss your symptoms with your provider. Your provider may pick up on something that can help them rule in or rule out a diagnosis.

Benefits of TRT

Testosterone therapy can have impressive effects throughout the body. Some of these effects may be noticed quickly, while others may take some time. Benefits include areas of physical, metabolic, sexual health, and cognition. 

Here is a list of possible benefits:

• Increased muscle mass and strength

• Bone density

• Increased sexual drive

• Improvement in erectile dysfunction

• Increased red blood cell production

• Improved insulin sensitivity

• Body fat reduction/body composition

• Better mood/reduction of depression symptoms

• Possible memory/concentration improvement

Proper diet and exercise will help improve and increase the likelihood of muscle mass/strength, bone density, and body composition, too. While medications have benefits, they also have side effects. TRT is no different.

Side Effects of TRT

While TRT can offer benefits, it is important to know the potential side effects. Side effects from TRT can range from minor to major. Major side effects can

lead to death, depending on the severity.

Cardiovascular System

TRT may have an impact on heart health. Some studies suggest it could increase the risk of heart disease or stroke, especially in men with preexisting conditions. It can also raise your blood pressure and throw off cholesterol levels, which are key factors in long-term cardiovascular risk.

Blood and Circulation (Hematologic)

Testosterone therapy can raise your red blood cell count. While this might sound like a good thing, it can thicken the blood and increase the risk of clot formation. This can be life-threatening in the lungs. It's important to have your blood levels monitored regularly if you're on TRT.

Hormonal and Metabolic (Endocrine)

TRT can suppress your body's natural testosterone production. This means your body may become dependent on the therapy over time. In addition, it can reduce sperm production, which may lead to infertility, a key consideration for men who are planning to have children.

Prostate Health

Testosterone can stimulate growth in the prostate, potentially leading to an enlarged prostate. This can affect urinary function. While there’s no confirmed link between TRT and prostate cancer, the risk is still being studied, so regular screening is essential.

Skin and Hair

Some men notice an increase in acne, especially in the early stages of treatment. You might also see more hair growth on the body. On the flip side, TRT can speed up male pattern baldness if you’re genetically predisposed to it.

Mental and Emotional Health

TRT can affect your mood. While many men report improved energy and confidence, others may experience mood swings, irritability, or even aggression. If you have a history of anxiety, depression, or other mental health concerns, it's important to discuss this with your doctor before starting therapy.

As outlined above, there are several potential side effects of TRT. Knowing these

possible side effects are important. They will help you decide if the benefits outweigh the associated risks and what to watch out for along the way.

Considerations Before Starting TRT

Now that you know you have low testosterone, the question remains, “Are you a

good candidate?” Several medical conditions may not be a good fit with TRT or

need to use extreme caution, such as:

• Known or suspected prostate cancer

• Male Breast cancer (yes, breast cancer can be diagnosed in men)

• Elevated hematocrit

• Sleep apnea

• Uncontrolled heart failure

• Elevated PSA without a clear diagnosis

• Infertility concerns (are children still in the plans?)

• Polycythemia vera

This list is not complete, and while several of these conditions are not strictly prohibited for TRT, they should still be approached with caution. There are other considerations to think about, too. TRT needs to be monitored through follow ups and blood work. TRT not only causes physical side effects, but, as mentioned before, can affect your blood counts too. Regular blood work can tell a story to providers. Adjustments may be needed in treatment to maximize the effectiveness, while minimizing potential side effects. That said, TRT isn’t the only path to boosting testosterone, there are other options worth exploring, too.

What are the alternatives?

Alternatives to low testosterone vary depending on the underlying cause and ultimate long-term goals. There are many things you  can do for yourself to correct your testosterone without the use of TRT and potential side effects.

Lifestyle changes

Incorporating regular exercise, such as resistance training and high-intensity interval training (HIIT), can help naturally boost testosterone levels. Prioritizing quality sleep by aiming for the 7 to 9 hours per night is also essential for hormone balance. Maintaining a well-balanced diet supports overall health and optimal hormone production. Additionally, managing stress is crucial, as chronic stress can elevate cortisol levels, which can lower testosterone.

Treating Underlying Conditions

Addressing underlying health issues can significantly impact testosterone levels. Managing obesity through weight loss, treating sleep apnea, improving insulin sensitivity, and correcting thyroid dysfunction are all important steps in optimizing hormonal health.

When it comes to treating underlying conditions, lifestyle changes are the key.

Exercise will help you lose weight, decrease stress, and sleep better. Along with a well- balanced diet, you may be on your way to a natural boost in your testosterone.

Summary

Testosterone is the male sex hormone that is naturally produced in the

body. The production peaks in your late teens before it begins to decrease.

Testosterone can be low at any age because of underlying medical reasons or simple lifestyle choices. Testosterone replacement therapy has benefits and negative side effects, like any medication. So, where does that leave us? If you take away anything from this post, remember it is important to discuss any treatment considerations with your provider.

References

Grossmann, M., Anawalt, B. D., & Yeap, B. B. (2024). Testosterone therapy in older men: Clinical implications of recent landmark trials. European Journal of Endocrinology, 191(1). https://doi.org/10.1093/ejendo/lvae071 

Hudson, J., Cruickshank, M., Quinton, R., Aucott, L., Wu, F., Grossmann, M., Bhasin, S., Snyder, P. J., Ellenberg, S. S., Travison, T. G., Brock, G. B., Gianatti, E. J., van der Schouw, Y. T., Emmelot-Vonk, M. H., Giltay, E. J., Hackett, G., Ramachandran, S., Svartberg, J., Hildreth, K. L., … Jayasena, C. N. (2023). Symptomatic benefits of testosterone treatment in patient subgroups: A systematic review, individual participant data meta-analysis, and aggregate data meta-analysis. The Lancet Healthy Longevity, 4(10). https://doi.org/10.1016/s2666-7568(23)00169-1 

Lincoff, A. M., Bhasin, S., Flevaris, P., Mitchell, L. M., Basaria, S., Boden, W. E., Cunningham, G. R., Granger, C. B., Khera, M., Thompson, I. M., Wang, Q., Wolski, K., Davey, D., Kalahasti, V., Khan, N., Miller, M. G., Snabes, M. C., Chan, A., Dubcenco, E., … Nissen, S. E. (2023). Cardiovascular safety of testosterone-replacement therapy. New England Journal of Medicine, 389(2), 107–117. https://doi.org/10.1056/nejmoa2215025