Is Testosterone Replacement Safe?
Have you heard about the latest craze of using testosterone replacement in aging men to revitalize energy, strength, and sexual prowess?
Conversely, we've all heard about the dangers of taking steroids, and testosterone is, quite frankly, a steroid. So is testosterone replacement safe?
And yes, to answer the question I most often get on the topic, we are basically talking about medically-prescribed steroids.
Well, it turns out that this fountain of youth does not yet have the support of scientists.
To put it bluntly: long-term testosterone replacement is controversial because only a few large clinical trials have shown any effectiveness in combating age-related physical decline, and none have looked at long-term risks, including a potential increased incidence of prostate cancer and/or cardiovascular disease (3).
Besides, lifestyle changes have been shown to positively impact many complaints of aging, moods, fatigue, and libido, as well as reduce risks for cardiovascular disease... without any adverse side-effects.
Testosterone replacement therapy has been used predominately for
but recently has garnered the interest of physicians and patients also looking to
treat declining physical attributes with age,
cardiovascular disease, and even depression and fatigue.
Learn More About How to Increase Testosterone Naturally
Testosterone is one of the naturally occurring steroid hormones. Although both men and women produce testosterone, it is found in higher quantities in men, and is associated with typically male traits such as hair growth, a deep voice, muscle mass, and strength. It is also associated with male virility and sexual performance.
“Steroid” hormone, in biochemical terms, means that it is derived from cholesterol. It should be no surprise, then that cholesterol-lowering drugs, like statins, can interfere with testosterone production (7). Some glucose-lowering prescriptions can affect testosterone levels, too (7).
Testosterone naturally declines with age. There is a clinical diagnosis of “testosterone deficiency” which indicates significantly lower testosterone levels than what is expected with normal age-related decline.
The clinical diagnosis of testosterone deficiency is associated with negative moods,
fatigue, reduced libido, impaired cognition and memory, as well as
changes in strength, muscle mass
and weight management (7).
Clinically low testosterone levels in men are also associated with a general increased risk of illness and death (1,3). However, scientists note that it is unclear whether testosterone deficiency is the cause of diseases, or if low testosterone is just an additional symptom in a bigger picture of ill-health (1).
But beware! While physicians can run standard tests to determine testosterone levels, there is no accepted standard for diagnosing testosterone deficiency, and the diagnosis is often at the discretion of the physician based on symptoms and lab results.
In fact, there is even controversy over the best tests to use, and the reliability of testing.
So What About Testosterone Replacement Therapy?
Testosterone therapy was once reserved for men who had sexual performance complaints such as reduced libido, failure to hit puberty, or erectile dysfunction.
Recently, however, testosterone therapy has gained the interest of even middle-aged men who suffer from any of the typical aging symptoms associated with declining testosterone, especially changes in physical fitness, energy levels, and mood.
The potential benefits are many, and very appealing, meaning that all that's left to ask is: Is Testosterone Replacement Safe?
Before we answer that question, let's look at the appeal of testosterone replacement...
Preliminary research suggests that testosterone therapy may be useful in addressing many of the standard complaints of aging men who long for the energy and physique that they knew in younger years.
Research also suggests that testosterone therapy may also be useful in treating more serious health complaints such as cardiovascular disease risk.
The most common and promising uses of testosterone replacement are discussed in more detail in the provided links. Here are the basics…
Testosterone replacement therapy in men has been associated with:
- Reduced fat mass (2,3,4)
- Increased lean mass, or muscle mass, and increased strength (2,3,4)
- Improved waist circumference (7)
- Positive effects on lipid profiles (cholesterol tests) (2,7)
- Improved bone density (2)
- Fewer symptoms of depression (2)
- Reduced erectile dysfunction (2)
- Improved fasting plasma glucose (7)
Now on to the big question: Is testosterone replacement safe...
Before you get too excited, EVERY recent review cautions that additional research is required to assess whether testosterone replacement safe and effective over long-term use.
The consensus is that the medical prescription of hormones to address declining muscle mass and cardiovascular risk cannot yet be scientifically justified (2,3,4,5).
When to Seriously Consider Testosterone Therapy?
Testosterone replacement therapy is best discussed with a physician (or a couple physicians, since there is no standard for diagnosis). It may be a valuable option for men who have not begun puberty by the late teen years, or in men who have a disease affecting the glands that modulate testosterone levels (3).
In addition, men with clinically low levels of testosterone that are significantly impacting quality of life may be good candidates for testosterone therapy – such as those with levels significantly lower than what would be considered normal age-related decline, and who experience debilitating depression, or fatigue.
Again, a physician should be consulted to make the determination of who falls into these categories. Be sure to assess the risks (many of which may be unknown at this point since large-scale clinical trials are still needed) versus the benefits. Feel free to ask your physician whether they believe that testosterone replacement is safe for long-term use.
Testosterone replacement therapy typically is not prescribed in pill form. The options for testosterone prescription in the US include injections, a patch, a topical gel, or a pellet surgically implanted under the skin for 3-6 months (7). Each method has its drawbacks, so discuss the options with a physician.
The effects of testosterone treatment will typically take 3 weeks to 6 months to set-in, depending on the condition being treated (6).
Common adverse side-effects with testosterone treatment are: acne, breast enlargement, swelling, and changes in red blood cell concentration (7).
Less well established but possible adverse reactions include: sleep apnea, worsening of urinary voiding symptoms, and prostate cancer (7).
Widespread use of testosterone for men who are lamenting the loss of lean body mass, or strength as they age is not scientifically supported at this time (4).
Even men who have chronic diseases associated with low testosterone levels such as cardiovascular disease, are cautioned of the risk:benefit ratio for hormone replacement (1,3).
Afterall, long-term testosterone replacement is controversial because only a few large clinical trials have shown any effectiveness in combating age-related physical decline, and none have looked at long-term risks, including a potential increased incidence of prostate cancer and/or cardiovascular disease (3).
Consider the possibility of declining testosterone levels as a result of using statin and glucose-lowering prescriptions if you are currently taking those medications (7).
More importantly, consider whether low testosterone is a symptom of a larger picture of ill-health, in which case lifestyle changes that improve vitality and health may also address complaints of aging, energy, libido, and moods. Lifestyle changes can also have a positive impact on the risks of cardiovascular disease.
Despite the concerns, no study thus far has reported any increases in prostate cancer or prostate-related ailments with testosterone therapy (2,7).
Read More About
Low Testosterone Symptoms: ED & Reduced Libido,
Low Testosterone and Physical Fitness,
or How to Increase Testosterone Naturally.
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Is Testosterone Replacement Safe?
1) Corona G, G Rastrelli, L Vignozzi, E Mannucci, M Maggi. “Testosterone, cardiovascular disease and the metabolic syndrome.” Best Prac Res Clin Endocrinol Metab. 2011; 25:337-53.
2) Corona G, G Rastrelli, G Forti, M Maggi. “Update in testosterone therapy for men.” J Sex Med. 2011 Mar; 8(3):639-54.
3) Cunningham GR, SM Toma. “Clinical Review: Why is androgen replacement in males controversial?” J Clin Endocrinol Metab. 2011 Jan; 96(1):38-52.
4) Giannoulis MG, FC Martin, KS Nair, AM Umpleby, P Sonksen. “Hormone replacement therapy and physical function in healthy older men. Time to talk hormones?” Endocr Rev. 20 Mar 2012 [Epub ahead of print].
5) Nguyen CT, A Aaronson, RP Morrissey, M Agarwal, RD Willix, ER Schwarz. “Myths and truths of growth hormone and testosterone therapy in heart failure.” Expert Rev Cardiovasc Ther. 2011 Jun; 9(6):711-20.
6) Saad F, A Aversa, AM Isidori, L Zafalon, M Zitzmann, L Gooren. “Onset and effects of testosterone treatment and time span until maximum effects are achieved.” Euro J Endocrinol. 2011; 165:675-85.
7) Traish AM, MM Miner, A Morgentaler, M Zitzmann. “Testosterone deficiency.” Am J Medicine. 2011; 124:578-87.