When Is Testosterone Replacement Therapy a Good Idea?

Testosterone replacement therapy is a popular topic today, as millions of American men are turning to it to replace what they perceive as low levels of a hormone that makes them characteristically male. Late-night television commercials promise that TRT will make men feel more energetic, alert, mentally sharp and sexually functional, and many of the men who hear these claims think these products might be the answer to their health woes. Unfortunately, the potential risks and safety concerns that come along with testosterone therapy aren’t as widely discussed.

So how do you know when you might actually need TRT and when it could hurt more than help? First, consultation and advice from your trusted physician are in order. It’s also important to understand the potential risks of testosterone replacement therapy so you’re fully informed before you dive in.

Testosterone is the hormone responsible for the production of sperm and the development of male characteristics and features. Generally, as men age, their testosterone levels decrease and can contribute to symptoms such as fatigue, low sex drive, erectile dysfunction, difficulty concentrating, increased body fat and depression. The first thing that’s important to understand is that there are also many other conditions that can cause these symptoms — the symptoms themselves aren’t always due to low testosterone. Symptoms by themselves are not enough to begin a course of TRT, and a low blood testosterone level without symptoms doesn’t automatically require treatment either. Due to the potential side effects and unknown long-term risks and benefits, TRT should be reserved for men with both low blood levels and symptoms that are significantly affecting their daily lives.

[See: The Scary Side Effects of Testosterone Replacement Therapy.]

What Are the Risks of Testosterone Replacement Therapy?

A small number of men experience immediate side effects like the development of a rash and itching at the injection site, acne, breast swelling, trouble breathing or high red blood cell counts that could increase unnecessary clotting. Men on long-term therapy appear to have a higher risk for cardiovascular events such as heart attacks, strokes and complications from heart disease. There is also a concern that ongoing therapy could actually stimulate the growth of prostate cancer cells.

For men with deficient blood testosterone levels, the benefits of hormone replacement therapy usually outweigh the potential risks. There are a few specific conditions that will most likely benefit from supplementing testosterone as well. If you suffer from Klinefelter syndrome — a congenital disease in which a man is born with an extra X chromosome — or have had your testicles harmed or removed from a different health condition, like cancer, TRT may be a beneficial option for you. On the other hand, there are a few health conditions doctors believe TRT can actually make worse:

Enlarged prostate. The prostate grows under the stimulation of testosterone normally, and as men age, the prostate tends to become larger and can eventually put pressure on the urethra and impede the flow of urine. More testosterone can cause the prostate to grow larger and can worsen this problem.

[See: The Real Sperm Killers.]

Prostate cancer. As mentioned above, it’s a concern that long-term TRT could stimulate prostate cancer cells to grow. Men who have an elevated PSA or have already been diagnosed with prostate cancer should avoid TRT, and every man is encouraged to be screened for prostate cancer before beginning any kind of testosterone replacement therapy. Doctors tend to avoid prescribing testosterone to men who are at an increased prostate cancer risk.

Sleep apnea. Disturbed breathing during sleep is another side effect of testosterone therapy, so men with sleep apnea who already have trouble breathing should avoid compounding the problem. A sleep study that monitors your breathing overnight can confirm the diagnosis of sleep apnea.

Blood clots and heart disease. The Food and Drug Administration has announced that for some men using testosterone products, there is a heightened risk of heart disease and stroke. An increase in red blood cells can lead to dangerous clotting in vessels. When this occurs, heart attack, stroke, deep vein thrombosis and pulmonary embolism (a life-threatening event where blood clots travel to the lungs) can follow. The risk of heart disease and other cardiovascular events, such as heart attack, are increased with higher testosterone levels. Generally, men who achieve a higher-than-normal range of testosterone levels with testosterone replacement therapy also have a higher chance of experiencing a cardiovascular event. It’s preferable to keep testosterone levels in the middle range. If you’re already dealing with cardiovascular issues, testosterone therapy carries a risk of making them worse. Every man should be checked for heart problems before starting testosterone therapy, plus intermittently during treatment.

[See: What Only Your Partner Knows About Your Health.]

For men with significant and life-altering side effects from low testosterone levels, the benefits of testosterone replacement therapy may outweigh the possible risks. However, for those certain preexisting health conditions, the side effects may be too risky. For all men, it’s about making an educated decision with your physician on what’s best for your body and mind. Get an accurate assessment, be mindful of the risks and have realistic expectations to make the healthiest decision for yourself.

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When Is Testosterone Replacement Therapy a Good Idea? originally appeared on usnews.com