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Testosterone replacement therapy (TRT) can help improve the symptoms of low testosterone due to male hypogonadism. "When we treat men with testosterone replacement therapy, our testosterone level goal is 450 to 600. While there are no hard and fast rules about what testosterone levels should be, they should not be above 1,000 ng/dL, says Dubin. Half of the platforms that offered him testosterone said that their goal was to get his testosterone levels up to or above 1,000 ng/dL.
If your levels are OK you'll stay on your current dose. They are inexpensive compared to other treatments. These patches are convenient but can cause irritation or gum disease. A nasal gel is now available that eliminates the risk of exposure to others.
"One of the biggest risks that most men don’t understand is that testosterone therapy causes infertility," explains Dubin. In the studies that enrolled men who had low testosterone, "there was a positive effect of testosterone therapy on mood and vitality," says Anawalt. "The Testosterone Trials looked at older men who had low testosterone levels and had symptoms of testosterone deficiency," says Anawalt. Over the past decade or so, four landmark trials looking at a total of roughly 7,300 men have tested the benefits and risks of testosterone replacement therapy for at least a year in middle-aged and older men. In an analysis of 10 studies, losing roughly 10 percent of body weight through diet changes was linked to a roughly 80 ng/dL rise in testosterone levels. In one analysis of 13 studies of roughly 4,300 men with obesity, 43 percent had blood levels of testosterone under 300 ng/dL.
Here is how to take a cautious approach to testosterone therapy. Although this new information is somewhat reassuring, men and their doctors should still weigh these issues before committing to long term testosterone therapy. Doctors also watch out for high red blood cell counts, which could increase the risk of clotting. If a man's testosterone is below the normal range, it's best to repeat it once more to be sure before starting testosterone therapy - often staying on it indefinitely. Just being tired isn't enough to seek testosterone replacement therapy. "Although some men believe they feel younger and more vigorous if they take testosterone medications, there's little evidence to support the use of testosterone in otherwise healthy men," the Mayo Clinic says. And while it is approved by the Food and Drug Administration for some conditions, and is widely marketed as a way to improve health and stay young, data on long-term effects is limited.
Studies looking at the occurrence of polycythemia as a negative side-effect in men on testosterone therapy are rare. For men with untreated prostate cancer on active surveillance, TRT remains controversial. TRT does not appear to increase cancer recurrence in hypogonadal men following radical prostatectomy. Recently, there has been a paradigm shift whereby TRT usage has increased despite this potential risk. While the beneficial effects of testosterone are rarely disputed and widely publicized, there is a paucity of the literature on the risks of testosterone use. The benefits seen with TRT, such as increased libido and energy level, beneficial effects on bone density, strength and muscle as well as cardioprotective effects, have been well-documented. But Eisenberg stresses that men with very low testosterone have a higher chance of developing heart disease, osteoporosis, and other problems if they go untreated.
If you choose to pursue testosterone replacement therapy, it’s important to understand the common side effects you may experience. Because it involves a potent hormone, testosterone therapy carries a handful of risk factors. The FDA has approved testosterone as replacement therapy only for men who have low testosterone levels from disorders that cause hypogonadism.
You can stay on testosterone replacement therapy for as long as it’s benefiting your symptoms and not causing health issues. To allow the therapy to take full effect, healthcare providers typically wait 30 days after you start TRT to check your testosterone levels. Certain existing health conditions make it unsafe, like prostate cancer and heart failure. "Achieve your peak testosterone levels," says the website of the direct-to-consumer company Maximus, which offers testosterone replacement therapy for roughly $100 to $150 a month.
To monitor the risk, "we check their blood every six months." Using non-injectable forms (like gels or oral testosterone) or reducing the dosage can lower the risk of excess red blood cells. That may increase the risk of blood clots, though the data are mixed. "So if a patient is interested in future fertility, I will not offer them testosterone replacement therapy.
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