A Fresh Perspective on Testosterone Therapy
A decrease in testosterone levels is an expected part of the aging process. However, if you’re thinking about replacement hormone therapy, there are some things to consider.
Over the past ten years, there has been a dramatic upsurge in the acceptance of testosterone replacement therapy, also known as TRT. As we know, testosterone levels decrease with age, and there has been a dramatic rise in the number of males over the age of 50 who have received TRT to re-establish an average testosterone level, expecting newfound energy and a resurgence in their sexual stamina.
However, TRT is still considered a contentious therapy; its outcomes are varied and unpredictable and there are risks to overall health for the TRT recipient. Some years ago, study results presented a correlation between a heightened possibility of cardiovascular disease and receiving testosterone replacement therapy.
Harvard-based reproductive endocrinologist, Dr. Frances Hayes, specifies that, while safety concerns do exist, such studies have limitations. She added an example of a particular study where the TRT dose level was significantly higher than the dose that would normally be prescribed to a patient. She also said that study subjects were generally more fragile and had additional health issues. Hayes declared that “Other studies showed no evidence of increased risk.”
Recent outcomes for testosterone replacement therapy
Recent findings corroborate this declaration. Research completed in 2015 by the American Heart Association Scientific Sessions involved nearly 1,500 men between the ages of 52 and 63 who were diagnosed with testosterone levels below average. None of the participants had heart disease in their history. Once the participants received TRT, researchers continued assessing their health and found no increased instances of heart attacks or strokes leading to death.
The consensus on the risk for several other health issues developing among those receiving testosterone replacement therapy is up for debate. For example, TRT has been linked to a higher potential for prostate cancer. Even so, the results of a study reported in a 2015 issue of the Journal of Urology stated that having testosterone replacement therapy for up to five years did not appear to have any relationship with a heightened risk of prostate cancer.
The researchers emphasised that the potential for long-term health risks is uncertain because of limited follow-ups with study participants. However, they indicated that this does not mean that those considering TRT should not proceed and that, indeed, TRT could be a practical choice for a designated subgroup of males.
Who are potential TRT recipients?
To be considered a potentially successful recipient for TRT, a person needs to meet the following criteria: testosterone levels need to be present at less than 300 nanograms per decilitre and a doctor must have prescribed TRT for the individual to address certain symptoms. Dr. Hayes stresses that many males have testosterone levels below 300 nanograms but do not have symptoms of chronic fatigue or sexual dysfunction, the most common indications of testosterone issues. Hayes emphasizes that she would not recommend that a person receives TRT if they do not have overt symptoms as there are potential health risks associated with it.
A preliminary blood test gives a testosterone level. However, before TRT can occur, several more tests are mandatory since testosterone levels in males vacillate every day based on, for instance, a person’s diet and prescribed medication. Dr. Hayes notes that these tests are imperative because for at least 30% of males who have a low testosterone result, the follow-up tests show an average level.
It is essential to keep all options in mind as TRT is not necessarily the only alternative when testosterone levels test low. “If you can identify the source,” according to Dr. Hayes, “you can address the problem…naturally.”
One of the most significant factors for testosterone is excessive weight gain, which can have more of an impact than aging on testosterone levels in males. Dr. Hayes explains that a rise in body mass index from 30 to 35 has an impact on testosterone levels equal to aging ten years.
Dr. Hayes notes that doctors should be diligent and should consider other factors that could potentially cause testosterone levels to fluctuate, like prescription medication or medical conditions that have low testosterone levels as a symptom. Hayes warns that TRT is not a cure-all and indeed does not reverse aging.
This is reflected in the results of a 2016 double-blind study published in The New England Journal of Medicine in which males over the age of 65 either received TRT for 12 months or a placebo. The TRT recipients saw improvements in their sexual functioning and drive, yet they did not have marked improvements in their agility and walking pace.
Testosterone replacement therapy can be administered either through a gel or by injection. The gel is applied daily to the upper arms, thighs, and shoulders from small ketchup-size packets, while the injection is administered bi-weekly in the backside region.
Each method has its merits. The gel tends to give more consistency to testosterone levels. However, the recipient must be careful to avoid contact with the applied area for several hours as it can cause women to grow hair or develop acne if the gel comes in contact with their skin. The injections can result in much higher testosterone levels initially, but they then gradually decrease after several days, causing mood swings and an artificial boost in energy that could drop significantly.
The majority of males will see their symptoms diminish within four to six weeks after TRT, but profound changes in muscle density may take up to six months to occur.