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Why Men Should Think Twice About Testosterone Replacement Therapy

December 3, 2008 Research Archive 14 Comments Archive , Healthy Living , Men's Health

With all the controversies surrounding hormone replacement therapy (HRT) to address the health concerns of menopausal women, I’m sure there are some who might have the misconception that mid-life hormonal change is exclusively a women’s issue. But that’s not the case at all.

Today we’ll turn our attention to the men. Because men also face challenges to their health and well-being as they experience their own hormonal changes, sometimes known as andropause, or ‘male menopause.’

But much like we’ve seen in so many reports on female HRT, some disturbing questions were raised last month with the release of a new report that reviews the existing research on the safety and effectiveness of testosterone replacement therapy (TRT).

Strange changes

Here’s what we know about andropause: As men grow older, their testosterone levels drop a little more than one percent each year after the age of 40. This can trigger a variety of symptoms, such as moodiness, memory loss, a decline in sex drive, and a lack of energy, strength and endurance. Other less obvious problems include the decrease of lean muscle mass and bone mineral density in the spine. Taken together, these conditions sometimes cause men to experience a gradual passivity and disinterest in life.

For those men who choose to address the problem there are several therapies available, including exercise regimens, a variety of natural supplements that help your body raise its own testosterone levels, or testosterone replacement therapy.

There is also prescription-only testosterone replacement therapy for the treatment of low testosterone production called hypogonadism. Since then, many doctors have exercised the option of off-label usage to prescribe the therapy for other andropause symptoms. And they’ve had some help.

In a previous e-Alert I told you about a campaign to promote andropause as a condition requiring medical treatment. That campaign has been aggressively advanced by Unimed, makers of AndroGel, a testosterone replacement therapy formula that’s rubbed on the shoulders daily. AndroGel dominates the testosterone replacement therapy market of testosterone gels, creams and patches.

Not going long

Last month, a committee of the Institute of Medicine concluded a one-year review of existing testosterone replacement therapy research. They found only 3 trials that focused on older men. Most of those trials used less than 50 subjects, all but one lasted less than a year, and many were not placebo-controlled.

In light of the quickly growing testosterone replacement therapy market, the committee determined that the risks and benefits of testosterone replacement therapy have not been adequately tested, especially in older men. And because some studies have also shown that testosterone therapy may increase the risk of prostate cancer (especially in those men who are already in a high-risk group), committee members called for doctors to immediately take greater care in prescribing testosterone replacement therapy.

In addition, the committee recommended careful planning for upcoming trials in order to assess how testosterone replacement therapy may increase the prostate cancer risk in older men, while excluding potential subjects who are already at high risk. They also recommend that short-term studies should begin, specifically designed to determine benefits of the therapy. They suggest that long-term studies should follow only if the shorter studies reveal clear benefits of testosterone replacement therapy.

This strikes me as ‘short-term’ thinking. If researchers conclude that long-term studies aren’t needed, doctors will certainly continue to prescribe the therapy and men will continue to demand it. Meanwhile, one of the problems with testosterone replacement therapy right now is the fact that we don’t know exactly what problems may come with long-term usage.

What we do know is that some studies have already revealed certain unpleasant side effects, including testicular shrinkage, abnormal enlargement of the breasts and an elevation in circulating blood cell level, which can lead to stroke and heart failure. So short-term studies will likely benefit manufacturers while potentially causing problems for users down the road.

Don’t rush in

Apart from the existing research, there are many testimonials from men who have reported a boost in energy and libido while using testosterone replacement therapy. But the use of this therapy as an anti-ageing tool is scientifically unproven. In fact, committee chair Dr Dan G. Blazer, told WebMD Medical News that, ‘the evidence is almost nil.’ So in many ways, our knowledge of testosterone replacement therapy is similar to our knowledge of HRT a few years ago.

And if we knew then what we know now, the prudent advice to women would be the same as the Institute of Medicine committee’s advice with testosterone replacement therapy: Tread very carefully with this therapy.

As I mentioned above, there are alternatives, including supplements, which have been shown to help men cope with andropause symptoms. For instance, Tribulus terrestris Linn is a botanical used in India for centuries to treat sexual dysfunction and promote rejuvenation in men. Formulas containing this herb are available in health food stores and through Internet sources.

Whether or not andropause should be accepted as a normal part of ageing or regarded as a medical condition that requires treatment is a question that can only be answered individually by each man experiencing the symptoms of these changes. If you’re a 40-something or older man who’s noticed changes in energy levels, sexual desires, or moods, share your concerns with your doctor.

But most importantly, weigh your options carefully before deciding which course to take.

Disclaimer: This article is part of the Daily Health's extensive research archive. The research and information contained in this article was accurate at the the time of publication but may have been updated since the date of publication. Consult our most recent articles for the latest research on alternative health and natural breakthroughs.

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  • I’m 43 & have been on TRT for over a year now. Was diagnosed with hypogonadism. I Have very bad headaches with nausea at times, memory loss, weird thoughts, very moody often, tired feeling most of the time, ringing in ears, and joint pain. I’m socially awkward now, my mind wanders, hate the weird thoughts, & stressed out all the time. Am I alone or are there other men out there that have my symptoms. Please let me know! I feel like I’m loosing my mind…!…

  • I have a testosterone level of 266 and was told that it is low. I am 53 years old and have battled with Erectile Dysfunction for several years as well as premature ejaculation. I am taking Cialis daily and and chlomimpramine for the premature ejaculation with some success. I am considering using testosterone but am a bit fearful of the side effects of growing breasts, shrinking testicles, prostate and liver issues? I would appreciate it if anyone has any feedback to share. I have a loss of energy, feel tired often, libido is present but not as strong as it once was, sex life is OK but could be better. I do not want to try something that will effect my health negatively if I am relatively healthy. Please give me some feedback.

  • Hello Everyone.
    Ok don’t think i am coming on this board trying to start problems or be smart anything like that, but i just have a question?. It is 2011, the medical field has advanced so much and Thank god there is Testosterone Replacement Therapy but dont you all think that scientist and researchers should work on better treatments for Hypogandism such as Allogeneic Testicle Transplant?. I mean i totally understand that if this is done it will be a ethical issues and you would have to take anti rejection pills, but it would be a lot better and less expensive than having to buy cream, gels or injections every month or so because it will replace hormones on a daily level like the ones before. I mean think about it, there are millions probably billions of men who suffer from hypogandism or there are men who suffer from chronic testicle pain/testicluar cancer and have to get them removed. Which totally sucks because not everyone responds well to trt. So you tell me this why has it not been done yet because Allegeneic Testicle transplantation are possible . it has been done before, and they are currently researching and working on it with Testicular cancer patients (which is Great). Scientist/Reseachers out there if you are reading this, please please put more effort into this field, it will help alot of men, with their libido, hormonal levels etc. There was a face transplant done which was successful, a hand transplant done, a penile transplant done, a tongue transplant done which were all successful. Lets start doing more research on Allogeneic Testicle transplants!!!!!.

  • can a man without testicles produce any testosterone via natural supplements? what is the likelyhood of having a normal sex life? should a wife expect that sex is over with this man? thank you.

  • I was, like Gil,also born with Klinefelters Syndrome, I did not however get offered any treatment until 2003 due to a GP failing to include my condition on his notes and so for more than 25 years I was vainly protesting against the misdiagnosis of Asthma when in fact it is highly likely I had mild Anaemia caused occasionally by low testosterone. For 3 years my TRT was infrequent and insufficient in strength and this period was a bad time for me, because while I largely felt better I also felt, at times, worse than I had before taking it. I now inject myself in the thigh every nine days and on the evening of the ninth day with Sustanon 250. Yes it is a painful experience but personally very worth it in my opinion. Tests carried out by the hospital show that my body processes testosterone very quickly and here I must add my blood is being tested to ensure that I do not produce too many red blood cells. I am 55 years old and fully aware of the recommendations that men who have been receiving TRT since they were 14 should at my age be receiving lower doses. However I have only been receiving it for 4 years and as my body processes it quickly contest the notion of a one size fits all mentality that some doctors seem to be endorsing. I am not a musclar freak by any stretch of the imagination and I do agree the points raised by Will.

  • Until 2 1/2 years ago, everyone including my doctor knew I naturally produced a lot of testosterone. After a blood test for a physical, it was discovered that I also produced well beyond the normal range of human growth hormone. Being a rather large, muscular man and having fathered 10 children (with the same wife, by the way) and able to bench press 300+ lbs at 46 years old, it was a total surprise that my testicles suddenly stopped producing testosterone. (Now its thought a virus invaded my testicles.) I really thought I was going to die. Couldn’t walk up a flight of stairs without severe joint pain, major muscle loss and pain, major migraines, etc. TRT has literally saved my life. Though my testicles are 1/5th their original size and produce only a few good sperm now, I otherwise feel much, much better. And my sex drive returned much to our delight.

    Don’t knock TRT. It’s been around since the 1940s and millions of men have benefitted without problems. However, I do strongly suggest to men who aren’t hypogonadal, do not start TRT. Testosterone is not a designer drug. I suspect it will adversely affect otherwise healthy men. Take it from me, you can’t feel like you’re a beefed-up stud again and you won’t no matter how much testosterone you inject. TRT does have side effects. Getting older is not bad particularly if you are already healthy.

  • Replying to Neil 03/05/2010. Your lumps are almost certainly cysts on the epididymis. They go away without treatment in a couple of weeks, if they don’t then get a scan.

  • I was tested and was at the low range of normal for testosterone levels and took an injection that was to be part of a low-level TRT. About 2 wks later I developed a few pea-sized bumps in and near my scrotum/ Is it possible that there’s a connection? It seems like maybe testicular cancer- I’m in a developing country & a little uneasy about the quality of medical care here… off to the urologist, but he may not know much about TRT… Thanks

  • The problem is how can we know if any of these supplements work? I have tried a couple in the past and they did nothing. I remain open minded. I suppose one could have a blood testosterone check prior to commencing a supplement course and then another after a month or two. I was prescribed andro patches a few years ago and the result was nil so I was taken off them. I didn’t fancy the alternatives which was an injection every few weeks or an implant every few months.

  • I am pushing 95 (age). I had lost a lot of
    muscle, but had develop women like breasts, due to Estrogen dominance. After checking PSA, I started TR therapy
    Now I have regained my muscles, also
    Heart muscles. I’ll check my PSA.

  • The problem with prostate cancer is not with testesterone. It lies with oestrogen dominance. It is important to keep track of oestrogen levels when taking testosterone replacement if the test aromatases to cause elevated oestrogen then an antiaromatase medication should be used.
    These are not new findings but those recently published are often done so by doctors who are fed up watching their patients live with poor health and even dying because of false FDA/AMA guidelines.

  • Hi

    I am wondering if you have any idea what i can take as far as natural supplements for low testosterone. I was born with klinefelter’s syndrome. I am XXY male and 48 yrs old. I took testosterone injections for 2 years when I was 14, but stopped when I learned that it could cause cancer as well as liver problems. I am a strong believer in natural products which I would rather take @ anytime rather than prescription form. I believe most pills cause cancer and liver problems as well as other ailments. If you know anything that works for this condition, can you please share it with me?
    Thanks!
    Gil

  • I am 69 1/2 years old. In 1984 I was diagnosed with a 50 mm pituitary tumour. A neuro-surgeon removed it with the pituitary gland. I was put onto replacement hormones: Thyroxine, Cortisone Acetate and Testosterone intermuscular Injections (fortnightly). Unfortunately 12 months later the tumour was back to the same size and I had to have a second neuro-surgery followed by radio-therapy. 1990 the Endocrineologist suggested Testosterone Pellet Implants for a better delivery over 6 months. All went well till 2002. My PSA went up to 11.3 – I had a biopsy – 6 out of 10 were positive. I was supposed to have had a total prostactomy followed by maximum radio therapy. However the decision I made with my wife was to wait and see and not have anymore Testosterone Replacement. Today my PSA is down to 0.04 undetectable. The side effects of this however are muscle wastage and loss of strength. I am thinking about taking small amounts of Testosterone in tablet form. What would be your opinion about this?
    Thank you for your time it is much appreciated.

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