A New Look at Testosterone Replacement Therapy (TRT)

The decline of testosterone is a natural part of aging, but is testosterone replacement therapy (or TRT for short) right for you? Over the past decade, replacement therapy for testosterone is becoming increasingly popular. Millions of older men use TRT to refuel their energy and sex drive by replenishing hormone levels.

The full benefits of TRT are uncertain, yet it is a controversial therapy due to potential health risks. TRT was linked to cardiovascular disease years ago when studies on the subject suggested raising safety concerns. Below is some information you should know in A New Look at Testosterone Replacement Therapy (TRT). 

Dr. Frances Hayes, an endocrinologist specializing in reproductive health at Massachusetts General, notes that studies were limited. She notes that the TRT dose was much higher than would normally be prescribed and that the subjects in the study were frailer and had other health problems, whereas other studies found no increased risk.

Findings from the Latest Study

This position has been supported by recent research. One thousand four hundred seventy-two men between the ages of 52 and 63 with no history of heart disease and lower levels of testosterone took part in a study presented at the scientific sessions at the American Heart Association in 2015. Study results found TRT did not increase the risk of heart attacks, strokes, or death for healthy men.

In addition, a Mayo Clinic Proceedings study in August 2015 found that TRT did not increase the risk of blood clots in veins. However, “TRT’s impact on cardiovascular disease is still an open question,” says Dr. Hayes.

In addition to TRT, there are other health problems that it may affect. For example, the Journal of Urology published a study showing that TRT does not directly contribute to an increased risk of prostate cancer, as previously associated with TRT.

Due to the limited follow-up of many of these studies, the TRT and suspected long term risks remain unknown. TRT should not be avoided because of that. The therapy is certainly viable for certain groups of men.

Who are the Candidates for Testosterone Replacement Therapy?

A prescription for TRT cannot be obtained unless both low testosterone levels and other symptoms are present. Despite having low levels, Dr. Hayes says it is possible not to feel any symptoms. However, there is uncertainty regarding terms of the long-term safety of TRT, so it is not recommended for you to proceed if there are no well-defined symptoms, like sexual dysfunction and chronic fatigue.

It is possible to perform tests to assess your testosterone. However, as levels fluctuate daily and are influenced by medications and diet, multiple tests are required. “In 30% of the cases where testosterone levels are low on the first test, they will return to normal on the second test,” explains Dr. Hayes.

It is not the first course of treatment to give TRT to patients with low levels and several symptoms. However, often, when you can figure out what is causing low levels, you can improve them naturally by addressing the cause, explains Dr. Hayes.

As an example, weight gain is the most important factor contributing to falling levels. The higher your weight, the lower your testosterone levels,” says Dr. Kim. If you are 35 years-old, a five-point increase in body mass index equals a ten-year increase in testosterone levels – as an example, going from 30 to 35.

Dr. Hayes advises that you also discuss medications or medical conditions with your doctor. As well as evaluating testosterone levels, your doctor may address the underlying condition or alter your medication to one that will not cause problems with testosterone levels.

Men should realize that there are limits with TRT since many people imagine it to be a miracle that turns back the clock. “Their impact is far smaller than most men understand,” says Dr. Hayes.

A study in the New England Journal examined how TRT affected 790 men aged 65 and older regarding their sexual health and vitality. One year of TRT versus a placebo improved sexual function, including erectile capacity, activity, and desire. A measure of TRT’s impact on vitality and walking speed was not affected by the TRT treatment, but the mood of participants improved slightly.

Utilizing TRT

Gel application or injection is the most common method for TRT. You spread a ketchup packet-sized amount of gel daily over the upper arms, shoulders, and thighs. Injections are usually administered every two weeks via the buttocks.

Both methods have their advantages. Using gel reduces the variability of testosterone levels. According to Dr. Hayes, men should avoid close skin contact with women before and after the testosterone treatment because testosterone can cause hair growth and acne.

When testosterone is injected, its levels may be elevated for a few days and gradually fall afterward. Roller-coaster effects can occur, in which energy and mood levels spike and then plateau.

Symptoms usually take between four and six weeks to improve in men, although muscle strength and tone may increase between three and six months after symptoms start improving.

It is not always necessary to take TRT for life. As a result, you should try a different treatment and have a revaluation with your physician if the issue that lowered your testosterone levels in the first place resolves, advises Dr. Hayes.

As always, with any prescribed treatment or therapy, you should always consult with a physician-supervised TRT service.

Hormones Associated with Masculinity

The hormone, testosterone, is responsible for giving men their masculinity. The testicles produce testosterone, contributing to characteristics that are inherently male, like facial hair. Additionally, testosterone increases bone density and red blood cell production. By early adulthood, levels peak, then drop by 2% annually after 40. A healthy level ranges from 300 to 1,000 ng/dL. In addition to the following symptoms, low testosterone can also lead to:

  • Lack of sexual desire or impotence
  • Anxiety or depression
  • Tendency to energy-conservation instead of willingness to expend it
  • Muscle mass reduction
  • Weight gain
  • Lack of iron
  • Hot flashes

We hope this article gives you a clearer idea as to whether you might need TRT. Are you taking it? What changes have you noted? Let us know in the comments below, and join in the conversation on FacebookTwitter & Instagram!

1 Comment
  1. Interesting article. As far as I understand, testosterone therapy is provided to men with officially diagnosed hypogonadism (or low T).
    With careful dosing you can get improved muscular strength, mass, as well as just more energy and drive in life.

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