The People's Perspective on Medicine

What Are the Pros and Cons of Testosterone Therapy?

Is testosterone therapy a boon or a boondoggle for men with low T? Many people remember the HRT disaster for women. What is the story on TRT for men?

Hormone replacement therapy (HRT) has been one of the most controversial and contentious treatments in medicine for decades. Now, TRT (testosterone replacement therapy) is following a similar trajectory. What’s the straight scoop on male hormone research?

New Data Support TRT:

The world of testosterone therapy has been turned upside down because of research published in the New England Journal of Medicine (Feb. 18, 2016). The Testosterone Trials concluded that that men with low testosterone levels “…had a moderate benefit with respect to sexual function and some benefit with respect to mood and depressive symptoms…” after using AndroGel for a year.

FDA Unprepared for Positive Results:

The idea that testosterone therapy might have benefits without scary side effects runs counter to the FDA’s recommendations on testosterone therapy. The agency specifically cautions against treating “low T” in otherwise healthy men. Only those who have a diagnosed medical condition (hypogonadism) are considered eligible for testosterone treatment.

According to the agency, this male hormone is appropriate only for treating disorders of the testicles, pituitary gland or brain that result in failure to produce testosterone. It is not considered appropriate for treating men whose low testosterone levels are caused by aging.

What Are Men to Make of Testosterone Therapy?

Not surprisingly, the new research puts millions of men in a quandary. Those who are suffering symptoms of low testosterone but do not have a clearly defined medical condition, such as a pituitary gland problem, are told that TRT is not for them.

One reader reported this experience:

“About eight years ago I entered into a study for replacement testosterone (trying to reduce erectile dysfunction). Prior to starting the study I was very lethargic and depressed. I had erectile dysfunction, no libido worth talking about, liver spots all over my hands and arms and graying hair. I had basically lost interest in my life and my family and had a really hard time just getting motivated.

“Now, eight years later at age 69, I still take testosterone. I work out at our local gym an hour each day. I have no depression (I don’t take antidepressants of any kind), am full of life and energy and my blotchy liver spots have almost disappeared.

“My libido is the same as when I was in my forties and my ED is pretty much a thing of the past. Through regular blood tests my doctor manages my testosterone levels to where they would be if I was 30 years old.

“About two years ago my doctor thought it would be a good idea to have a heart scan. The results showed that my heart was that of a much younger man with no sign of weakness in the walls or arteries. Many people I meet can’t believe that I am 69 and say that I could easily pass for 50.”

Physicians and patients now have research to support their contention that testosterone therapy can be helpful. Men with low hormone levels (below 275 ng per deciliter) and symptoms of hypogonadism like low libido and depressed mood appear to benefit moderately.

Of course any physician who prescribes testosterone for such a man would be challenging the FDA’s party line that otherwise healthy men with low T should not be allowed access to testosterone therapy.

What About Heart Attacks and Strokes?

The FDA warns that extra testosterone might increase the risk of heart attacks, stroke or death. That’s a scary message and one that would reasonably deter most men from even asked their doctors about TRT.

But research conflicts with the FDA’s stance. A review of the scientific literature in the journal Expert Opinion on Drug Safety (Oct. 2014) concluded that testosterone supplementation did not increase the risk of cardiovascular complications. A study in the European Heart Journal (Oct. 21, 2015) found that normalizing testosterone levels actually reduced heart attacks, strokes and the risk of death in male veterans.

Testosterone is no fountain of youth. And there are still concerns about the possibility that prostate cancer could be accelerated by hormone supplementation. Nevertheless, the new research may force the FDA to reconsider its stance on the role of hormone therapy for men with low testosterone levels.

What’s your Experience With Testosterone Therapy?

We would love to hear from men who have tried TRT. Has it been beneficial or problematic? Share your own experiences in the comment section below.

William in Toronto, Canada offered this:

“I had my testosterone level checked, and found that for my age, 76, I was quite deficient in testosterone. I had suspected this, as I had some symptoms of low T.

I asked my doctor for a trial period with testosterone gel, and he reluctantly agreed. He said the jury was still out as to any detrimental side effects. I have been using the gel for one month now, and have noticed an improvement in my health. I no longer have those days when I have no energy to do anything except lie down, my walking has improved, and my interest in sex as well. I have also experienced an improvement in my general mood and well being.

“In conclusion, my life has improved considerably.”

For men who worry about the potential negative consequences of long-term testosterone therapy, we suggest listening to our interview with John La Puma, MD. Our one-hour radio show, “Boosting Testosterone Naturally” offers alternative approaches for achieving a positive outcome.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I have not yet used TR yet but since i am recently been diagnosed with type11 diabetics ,it it a search for a remedy for this adult onset diabetics that set me on the path to TR and i am enticed . It seems that the idea about being a cause for prostate enlargement to emendate for the conclusive study that estrogen replacement therapy to be culprit in women’s ovarian cancer and so if that is true about women perhaps the corollary is true about men.

A wrong comparison perhaps between a reproductive hormone relating to a reproductive organ of women to that of a men. If my layman’s intuition is correct and the assumption is made as linearly as i assumed, the assumption couldn’t be more wrong for the following reasons. !) the woman’s ovaries are heavily taxed organs due to monthly reproductive cycles and even heavier tax is levied on them during pregnancies that no wonder their active duty years are limited not to last for the entire life of a woman; while the prostate is a do no good evolutionary relic with limited or no roll at all and the testicles organs commissioned to last the entire life of men.

As such, not replenishing testosterone when and if needed may be dealing with an anomaly unlike it is for estrogen which may mean a design limit override which naturally mean a systemic breakdown.

This was quite an interesting read, I had heard about testosterone therapy before, but never actually knew that much about it. I suppose that, like with a lot of other things, your benefits come down to just how healthy you are normally. After all, whether or not your body accepts the new testosterone is really down to how well taken care of it is.

I’m 60 years old and started TRT about 6 years ago. At first, I did Androgel for about 4 years with little positive results. I then tried some other topical treatments and had the same low results. About a year ago, I started to take weekly T injections from a male clinic. There has been a considerable difference in my energy, libido and general well being. I feel so much better than I did. It has helped draw my wife and I closer then ever!

My doctors continually monitor my PSA and testosterone levels by drawing blood every six weeks or so. At this point, I have not experienced any side effects. I would recommend this therapy to anyone who has not gotten good results with topical treatments.

I have been taking AndroGel for 18 years. Now, at age 80, I take Viagra twice a week with satisfactory results, the same low dose of Cozar for mildly high blood pressure as I started on 25 years ago. My cholesterol levels are excellent as they have been all along, my risk of heart problems low. My PSA remains under 2 mg/dl (4.0 is the high normal range) I am physically active, splitting and handling all the firewood we need to heat our old farmhouse easily, and exercise as well.

I am glad I started the AndroGel when I did, and am sure that my active sexual and physical life would cease without it. And, at my age, I see no reason to stop taking it. I had to convince my doctor, a man my own age to start me on it….he was reluctant. He has since died and I have had to move on to a new doctor, who fortunately did not challenge the existing prescription.

For the past 50 years we have eaten no meat at all, and choose the saturated fats that get into our diet with care. Most of the food we eat is organic, and a great deal of that is from our own garden. Our regime includes meditation, yoga, and mindful work.

I started bioidentical testosterone replacement 3 yrs ago after my test level dropped to 240 ng because of a compromised hPA due to benzo use. The effects have ben good w colesterol being under control w/o meds. it is import to realize that extra test can be converted to estriadiol, ahormone that has been known to potentially cause strokes. I take 200mg a day of I 3 Carbinol to help decrease this conversion and my estriadiol levels are in the moderate level. I dont have depression on test and feel good. I started the treatment in my early 50’s-now 55 and plan to cont. It is import to take supplement when on test. The drs that often prescribe this compounf , test, dont emphasize the need to take a supplement to help decrease the potential conversion and this may increase the chance for stroke! Also, donating blood helps to regulate any increae in red blood count. w/o test, i would ahve metabolic panel of an early teenager

Further to my previous comments on this matter, shown above, I have now been using the Androgel 1% for 10 months, and am happy to report that a recent blood test showed the following: Cholesterol – optimum, Blood pressure – normal, ALT(liver test) – normal, PSA – normal. All of the readings were in the mid-range or lower. In other words, no negative results of the testosterone supplement. I’m 77 years old, and feel like I’m 50. My testosterone level was in the low normal range, so my doctor suggested I use a little more gel with each application every morning.

I went on TRT about 10 yrs ago when I was 65. One of my testes had shrunk and gave me low-T. It affected my libido and caused my wife to talk to me about it. I started with Androgel and for $$$ reasons soon went to shots (a huge savings as my Urologist’s nurse taught my wife to give me the shots).
Now my libido is good and my weight dropped from 266 lbs down to a stable 200 over the 1st 5 years of using TRT. (I’m 6′-5″ so 200 is good).
Now 75, I still walk 3 miles/day and we have a “date night” about twice a week. We schedule these and plan our days activities around it. Otherwise it is so hard to find both of us septuagenarians “in the mood” at the same time.

I have benefited from T gel for several years now. Without the treatment,
I was not able to function well. When I had the usual yearly battle to
get the T Rx refiled , I was with out treatment for a month. It was terrible.
Very low energy, lots of joint pain, very depressed. Back on minimal
treatment and all’s well enough. I do need to donate whole blood several
times a year.
There was nearly a decade of hassle to even get treatment. I very much regret
not getting treatment much earlier as it would have made my life much
more productive . At 76, I’m able to function at a reasonable level.
with T supplementation.

I had low testosterone as measured in physicals from age 33 (below 200), but this has not seemed to had effects on my energy or libido (I am now 48). I tried Androgel for a period of 4 months around the age of 37 and it boosted my levels to above 700 but then they dropped after 4 weeks to low 400s. The stoppage too all your natural testosterone generation and the consequent shrinkage of the testicles was unpleasant. After 3 months, I also found that I could hardly get out of my car as both knees were in such pain. After two more weeks I ceased the Androgel and my knees returned to normal after about 6-8 weeks. My next physical at 40 showed me back at a level of around 190 but I just live with it.

I wonder about benefits for women. At age 49, 29 years ago, I had a total hysterectomy because of fibroids. At that time it was standard to get a T shot once or twice a year. I was also on HRT, vivelle dots. After the injections I would have a boost of energy that lasted for weeks. My mood was also lifted and my desire for sex, which had basically died with the surgery, was revived. Then my gyn began discouraging them and I stopped. Since I was a high energy person anyway, it was OK to go without that boost. Boy, at 78, I would love to have it now! I have fibro, have tried many things to overcome the terrible fatigue and lassitude to no avail; perhaps I will discuss this with my pcp next week.

Helen M, I sure hope you look at testosterone pellets. That has been amazing for me.

I do find that injecting testosterone improves my libido and outlook. To be candid about it, the older I become the less I care about possible effects like heart attacks, stroke, and cancer (I’ve had some of that, already). You’re going to die of something and after one’s sixties no amount of jogging is going to help one live forever or even improve one’s life. I think it’s a matter of being happy until one goes.

Well, I don’t know about men, but I’d like to hear more about testosterone supplementation for women. I recently had a number of hormones tested to see if we could figure out what was going on with some perimenopausal issues, and my testosterone came out kind of borderline. Still in the normal range, but not in the optimal range. I DO feel less motivation and just “umph” in my life now than I used to, and this made me wonder if it’s the cause. I also read that a low or marginal testosterone could make your body less able to build bone, so now I’m wondering if it would be worth supplementing just a TINY amount (NOT the levels that guys use — would have to be just 2 mg or something). There are very negative consequences if you get it wrong, though, and I’m not sure it’s on very many doctors’ radar screens as something to do, so it might be hard to get good advice about it. It doesn’t seem like it’s an area that’s well researched, but geez, if it’s crucial to bone development and osteoporosis is a common problem, it really should be.

Please look into bio-identicals. I went and had my hormones tested. Testosterone was on the low side. Everything else fine. Had a pellet inserted, and that was it. Changed everything for me! I wish I had done it sooner.

and then there’s the yet to be determined (?) connection between testosterone-therapy and prostate cancer — would like to see future comments from readers. Thanks.

Several years After prostate cancer surgery 17 years ago, I developed ” male menopause”, night swears and hot flashes.
After many tests for many scary things, low T was the issue.
I feel great. I hit the gym 4 times a week, and lead a very active life at 73.
The ED caused by the cancer surgery, was not helped by AndroGel, but other ED drugs work very well

I have been receiving TRT for about seven years, gradually moving from the gel to injections. I started because of very low testosterone and low interest in sex, and it does benefit that. However I was pleasantly surprised to find that it helped my overall energy level and mood, and is a major factor enabling this 72 year old man to live a healthy and active lifestyle. I am very thankful for it – and for studies reducing concerns about adverse side effects!

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