A New Look Testosterone Therapy

Testosterone replacement therapy (TRT) has surged in popularity over the past decade. Millions of older men have turned to TRT to restore hormone levels in hopes of refueling energy and reigniting their sex drive. Yet TRT remains controversial because of its uncertain benefits and potential health risks. Safety concerns were raised years ago when studies showed a possible association between TRT and an increased risk of cardiovascular disease.

07 Aug 2024

5 min read

Over the past decade, testosterone replacement therapy (TRT) has become a popular choice among older men in Media. They are choosing this therapy to restore their hormone levels, hoping to increase their energy and revive their sexual desire.

Despite its frequent use, TRT remains a controversial issue due to its uncertain benefits and potential health risks. Studies conducted years ago suggested a possible connection between TRT and increased cardiovascular disease risk, sparking safety concerns.

Recognizing limitations in certain studies, Dr. Frances Hayes, a Reproductive Endocrinologist at Harvard-affiliated Massachusetts General Hospital, shares her insights.

“For instance, in one study, TRT doses were much higher than what would usually be prescribed, and the subjects tended to be more frail, with other health problems,” she says. “Other studies showed no evidence of increased risk.”

THE LATEST FINDINGS

New studies confirm this position. At the 2015 American Heart Association Scientific Sessions, a study on 1,472 men aged 52 to 63 with low testosterone levels and no cardiovascular disease history revealed that TRT did not heighten the risk of heart attack, stroke, or death in healthy men.

More evidence from the August 2015 Mayo Clinic Proceedings indicated no connection between TRT and blood clots in veins among 30,000 men. “Right now, the jury is still out about TRT’s influence on cardiovascular disease,” says Dr. Hayes.

TRT’s connection to other health issues remains inconclusive. Although earlier studies linked TRT to a higher risk of prostate cancer, a December 2015 Journal of Urology study found no increased risk of aggressive prostate cancer with five years of TRT exposure. This challenges conventional wisdom and calls for further investigation into TRT’s long-term effects.

Due to limited follow-up in many studies, TRT’s long-term risks remain unclear. Still, individuals should not overlook TRT as a potential solution, as it may be suitable for certain cases.

Who Is a Candidate For TRT In Media?

For TRT prescription in Media, two requirements must be met: low testosterone levels (below 300 nanograms per deciliter (ng/dL)) and experiencing several symptoms (refer to page 7). Dr. Hayes emphasizes, “While it’s conceivable to have low levels without symptoms, if crucial symptoms like fatigue and sexual dysfunction aren’t present, initiating TRT isn’t advisable due to current uncertainties surrounding its long-term safety.”

A standard blood test is generally used to measure testosterone levels. Considering daily fluctuations and the impact of medication and diet, multiple tests are needed. Dr. Hayes explains, “In around 30% of cases where the initial testosterone test indicates low levels, subsequent tests show normal levels.”

Low testosterone levels and various symptoms don’t always necessitate immediate testosterone replacement therapy (TRT). Dr. Hayes suggests, “By understanding the underlying cause of declining levels, we can address it and naturally enhance low levels.”

For example, improvements in sexual well-being and vitality are commonly cited as advantages of TRT. A study published in the February 18, 2016 edition of The New England Journal of Medicine involved 790 men aged 65 and older to examine TRT’s effects. Men who received TRT for one year, compared to those on a placebo, experienced enhancements in sexual function, including activity, desire, and erectile function. However, the group saw only slight improvements in mood and noticed no changes in walking speed, a gauge of TRT’s effect on vitality.

“Your doctor should also consider any additional factors that could influence levels, such as medication or medical conditions,” recommends Dr. Hayes. In such scenarios, your doctor could address the underlying issue or adjust your medication or dosage to avoid impacting testosterone levels.

It’s crucial for men to acknowledge the limitations of TRT, frequently perceived as a quick fix. “Its outcomes are typically not as astounding as men expect,” Dr. Hayes observes.

An example of this is the frequent emphasis on sexual health and vitality as benefits of testosterone replacement therapy (TRT). A study published in the February 18, 2016 release of The New England Journal of Medicine investigated the effects of TRT on 790 men aged 65 and older. Participants who received TRT for one year, compared to those on a placebo, observed improvements in sexual function, including activity, desire, and erectile function. However, the group only experienced a marginal improvement in mood and detected no changes in walking speed, a measure of TRT’s effect on vitality.

Using TRT

TRT can be administered through gel application or injections. Gel application requires spreading the daily dose, approximately the size of a ketchup packet, across both upper arms, shoulders, or thighs. Injections are typically given into the buttocks every two weeks.

Both methods provide distinct advantages, especially gels for maintaining stable testosterone levels. “However, you should be careful to avoid close skin contact for a few hours, especially with women, as testosterone could cause acne or hair growth,” Dr. Hayes advises.

Following an injection, testosterone levels may briefly peak before tapering down, causing mood swings and energy fluctuations akin to a roller-coaster.

In Media, most men typically see symptom improvement within four to six weeks, although changes in muscle mass might take three to six months.

TRT is not necessarily a lifelong commitment. “If the factor that caused your testosterone drop is resolved, you should try stopping the treatment and be re-evaluated by your doctor,” says Dr. Hayes.

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