Risk and Benefits of Testosterone Replacement Therapy
efore delving into new forms of treatment to boost your testosterone, it is important to understand the complex risk and benefits that come with replacement therapy. A quick fix sounds appealing to prevent aging quickly, but there are a lot of myths surrounding the subject that can be misleading for men. To understand testosterone replacement therapy it is first key to understand what testosterone even is in the first place.
What is testosterone anyway?
Many men conceptualize testosterone as a magical manly elixir that pumps through veins. Testosterone is actually a steroid hormone, or androgen, produced in the testicles that stimulate male secondary sexual characteristics. Testosterone has many functions in the body like maintaining: bone density, fat distribution, muscle mass, hair follicles, red blood cell production, sperm production, and sex drive. It is a common misconception that exclusively men produce testosterone, but it is produced in the female ovaries as well, only to a lesser degree, about a tenth to a twentieth of men’s levels.
The brain’s hypothalamus and pituitary gland act as the control center over testosterone production. The hypothalamus lets the pituitary gland know how much testosterone is adequate to produce for the body, and the pituitary gland tells the testes. Chemicals in the bloodstream help to communicate these messages in the body.
Low Testosterone Causes and Symptoms
As men get older testosterone naturally decreases over an elongated period of time. So what is the marker for low testosterone or hypogonadism? Testosterone levels are exceptionally difficult to capture accurately. Levels can vary with huge differences throughout the course of the day. Testosterone levels tend to be lower in the evenings, which makes measurement complicated. Here are some symptoms that might indicate low testosterone without a numerical diagnosis:
- Low sex drive
- Erectile dysfunction
- Lowered sperm count
- Shrunken testes
- Hot flashes
- Enlarged breasts
- Depression and fogginess
- Irritability and moodiness
- Loss of muscle mass or hair
- Weakened bones
There three different kinds of hypogonadism: primary, secondary, and mixed. Underactive testes that do not produce enough testosterone for the body cause primary hypogonadism. Under activity can be caused by hereditary circumstances like having undescended testicles, a condition where the testicles never descend prior to birth, they remain in the abdomen. Hemochromatosis is another condition that falls under primary hypogonadism. Too much iron in the blood causes testicular failure or pituitary damage, which in turn results in low-T. Klinefelter’s syndrome is a genetic birth condition where a man is born with three sex chromosomes: X, X, and Y.
Secondary hypogonadism is from direct damage to the pituitary gland and/or hypothalamaus. If these centers are not functioning, the testes will not receive messages to produce the proper amount of hormones. Different pituitary disorders and inflammatory diseases can have negative impact on the pituitary gland and hypothalamus, effecting testosterone production. Kallmann syndrome is specific to hypothalamus function and is a condition that causes abnormality in this part of the brain. Non-acute circumstances that can lead to secondary hypogonadism are normal aging after thirty, obesity, and opioid usage.
Testing for Low Testosterone
Doctors typically to treat men for hypogonadism if they have symptoms of low testosterone and their testosterone levels are below 300 nanograms per deciliter. Levels can be checked with an routine blood test. If testosterone production has lowered noticeably artificial testosterone is offered as a solution, one that comes with risks and benefits.
Testing is complex, as previously mentioned; there is a wide window for what doctors consider healthy levels of testosterone. “Normal” is anywhere between 300 and 1,000 ng/dL. Unusually low rates can be caused by either primary or secondary conditions. Be sure to talk to your doctor about testing, especially if you are experiencing common symptoms of low-T. Also keep in mind that accuracy is difficult to achieve when testing for testosterone levels, though a blood test is the only way to truly confirm low testosterone.
Testing should be conducted between 7-10 am in the morning and then tested again on a different day to confirm the reading.
Benefits of Testosterone Therapy
Once diagnosed with having low testosterone, replacement therapy is sometimes the next step. Treating sexual symptoms is usually at the for front of the discomfort so some men, but brining low-T back up can help in many areas of health.
- Reduced fat
- Improved muscle mass
- Increased concentration
- Better sleep
- Maintain bone density/strength
- Increase strength and energy
- Improved mood
- Improve insulin sensitivity
- Restored erectile function
- Overall sense of vitality
These benefits do not occur over night though; it often takes up to 4 or 6 weeks into replacement therapy to start seeing and feeling results.
Risks of Testosterone Therapy
While the laundry list of benefits that one can reap from replacement therapy are enticing, it is important to know the risks.
- Decreased testicular size.
- Decreased sperm count/ infertility
- Changes in cholesterol and lipid levels.
- Increased risk for prostate cancer
- Stroke and blood clots
- Heart attacks
- Sleep apnea
- Hormonal imbalance
- Polycythemia (high red blood cell count)
Heart attack survivors or those diagnosed with heart disease are especially at risk when choosing testosterone replacement therapy. Those with urinary symptoms should be especially cautious when deciding whether or not to participant in this type of therapy.
Testosterone therapy is not a fountain of youth. There is no proof that it will restore you to the level of physical fitness or sexual function of your youth, make you live longer, prevent heart disease or prostate cancer, or improve your memory or mental sharpness. Try to manage expectations for what this therapy can and cannot do for your health before deciding to incur these major health risks. Get a second opinion on testing and take a trip to the endocrinologist.
If erectile dysfunction is the main reason for wanting to get replacement therapy, be sure to remember that testosterone therapy may not even fix erectile problems. What can happen though, is that your libido will increase and your ability to perform may remain the same. This can create even more frustration. You may need different supplements or lifestyle changes to get and maintain strong erections.