The number of men taking testosterone has dropped dramatically in recent years, in part due to growing awareness of the risks that can accompany it. Should it be avoided?
The hormone testosterone helps men maintain muscle, bone health, libido, and the ability to perform in the bedroom. But starting in their mid-thirties, men lose on average just under 2% per year. Eventually, this decline could lead to hypogonadism or low testosterone levels. It happens to 1 in 5 men in their 60s, and the likelihood increases as men get older. Testosterone replacement therapy (TRT) aims to increase these low levels.
But TRT has had its ups and downs over the past 2 decades. From 2001 to 2013, prescriptions increased by 300% following marketing efforts that claimed it could restore energy, alertness, mental focus and sexual function. Then, over the next 3 years, the number of men taking it halved as studies revealed potential risks, including to heart health.
“I see some men who are more hesitant to take testosterone supplements,” says Michael Eisenberg, MD, director of Stanford’s Male Reproductive Medicine and Surgery Program at Stanford Health Care in Palo Alto, Calif. “We talk about the risks, because that’s what we’ve gotten more information about in recent years.”
In 2014, the FDA ordered that a warning label accompany TRT prescriptions, alerting men to the possibility that TRT increases the risk of heart attack and stroke. More recently, a study linked TRT to higher risks of venous thromboembolism, a potentially fatal type of blood clot.
And there are other concerns. Does TRT improve symptoms related to low testosterone? In January of this year, the American College of Physicians released new practice guidelines outlining the limited benefits men are likely to derive from TRT. The group of doctors found that TRT offered slight improvements in sexual and erectile function; they found no other benefit.
Eisenberg says studies of the benefits and risks of TRT have had mixed results and provide limited answers. Does it improve fatigue, for example? It’s unclear. “We advise men that it’s not clear if TRT will help,” Eisenberg says.
However, Eisenberg points out that men with very low testosterone levels have a higher risk of developing heart disease, osteoporosis and other problems if left untreated.
“There are health implications at very low levels,” he says. “Having an open discussion about the benefits and risks of HRT is very important.”
Ask your doctor
Could something other than low testosterone explain my symptoms?
Yes. Low libido and erectile dysfunction, for example, have many contributing factors to rule out, including heart disease and psychological issues.
If I start TRT, how long until I know it helps?
Your doctor should confirm within about 6 months whether TRT has improved your symptoms. If not, discuss ending treatment.
Will TRT affect my ability to father children?
Yes. TRT decreases sperm production. Stop treatment and fertility will likely return. In a small number of men, infertility is permanent.
Can I do anything to raise my testosterone naturally?
If you are overweight or obese, weight loss and, perhaps most importantly, exercise can help boost your levels without medication.
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