New Look Testosterone Therapy

In recent years, testosterone replacement therapy (TRT) has become increasingly sought after by multitudes of aging men. These individuals gravitate toward TRT to replenish hormone levels to possibly rekindle vitality and libido.

However, the use of TRT is shrouded in debate due to the unclear extent of its advantages and the potential for adverse health consequences. Historical safety concerns have emerged, sparked by research indicating a potential link between TRT and a heightened risk of cardiovascular disease.

Dr. Frances Hayes, an expert in reproductive endocrinology at the Massachusetts General Hospital associated with Harvard, highlights that certain investigative studies come with their fair share of drawbacks.

She mentions, “For example, there was a study where the administered doses of Testosterone Replacement Therapy (TRT) were considerably higher than the standard prescription levels, and the individuals involved were typically weaker and faced additional health concerns.” Dr. Hayes also notes that “Other research in the field has found no conclusive evidence suggesting an elevated risk.”

THE LATEST FINDINGS

Recent findings lend support to this viewpoint. Researchers presented a study at the 2015 American Heart Association Scientific Sessions that observed 1,472 men between the ages of 52 to 63. These individuals all had lower-than-average levels of testosterone and no prior heart disease diagnosis. The data indicated that men in good health, who underwent Testosterone Replacement Therapy (TRT), were not at an increased risk for heart attacks, strokes, or mortality.

Additionally, research published in the August 2015 edition of the Mayo Clinic Proceedings found no association between TRT and venous blood clots, after reviewing cases of 30,000 men. Dr. Hayes notes, “As of now, there remains uncertainty surrounding the implications of TRT on heart disease.”

The connection between Testosterone Replacement Therapy (TRT) and various health conditions has always been complex. Previous assumptions pointed to an increased risk of prostate cancer associated with TRT use. However, research highlighted in the December 2015 edition of the Journal of Urology disputes this, indicating that five years of TRT does not correlate with a heightened risk of aggressive prostate cancer.

It’s important to recognize, though, that the long-term implications of TRT remain somewhat ambiguous. This uncertainty stems from the short duration of many studies on the subject. Despite this, TRT should not be discounted entirely; for certain men, it can be a therapeutic and beneficial choice.

WHO IS A CANDIDATE?

For a prescription of Testosterone Replacement Therapy (TRT), you must exhibit not only a deficiency in testosterone levels, lower than 300 nanograms per deciliter (ng/dL) but also multiple symptoms detailed on page 7. “Having low testosterone does not always align with experiencing symptoms,” Dr. Hayes notes. If key symptoms such as fatigue and sexual dysfunction—which are predominant—are absent, initiating TRT is not advisable due to uncertainties surrounding its long-term safety.

Testosterone levels are typically determined by a straightforward blood test, though it’s often necessary to perform multiple tests since these levels are subject to daily fluctuations and can be affected by factors like medication and diet. Dr. Hayes points out that “in about 30% of cases where initial testosterone readings are low, a subsequent test shows normal levels.”

Even in the case of low levels coupled with numerous symptoms, Testosterone Replacement Therapy (TRT) isn’t necessarily the default intervention. Dr. Hayes emphasizes that pinpointing and addressing the underlying causes of decreased levels can often naturally augment them.

Consider weight gain, which stands as the principal factor influencing a reduction in testosterone more so than the aging process itself. “As an individual’s weight increases, their testosterone often declines,” Dr. Hayes notes. To illustrate, a five-unit rise on the Body Mass Index (BMI) scale—such as climbing from a 30 to a 35 BMI—not only impacts weight but is akin to aging a decade about the effects on testosterone levels.

Dr. Hayes emphasizes that doctors must consider additional factors that could alter levels, such as medications or existing health conditions. In such cases, treating the root cause or adjusting medication or its dose might be necessary to avoid influencing testosterone levels.

Additionally, Dr. Hayes advises men to manage their expectations regarding Testosterone Replacement Therapy (TRT). Many regard it as an elixir of youth, but its effects may be more modest than anticipated.

Sexual health and vitality are frequently highlighted as positive outcomes of Testosterone Replacement Therapy (TRT). A rigorous double-blind study published in the February 18, 2016 edition of The New England Journal of Medicine scrutinized TRT’s impact on a group of 790 men aged 65 and older. Results from a year of TRT treatment (compared to a placebo group) indicated notable enhancements in sexual function — this included heightened activity, increased desire, and improved erectile function. On the other hand, only marginal improvements were observed in mood, with no significant changes in ambulatory agility, which was a proxy for assessing vitality through TRT.

USING TRT

Testosterone Replacement Therapy (TRT) can be administered via gel or injection. The gel requires a daily application, roughly the size of a standard ketchup packet, across both upper arms, shoulders, or thighs. In contrast, injections are usually administered biweekly directly into the gluteal muscles.

Each administration method comes with its own set of benefits. Gels offer the advantage of maintaining more consistent testosterone levels throughout treatment. “However, patients must exercise caution for several hours post-application to prevent inadvertent skin-to-skin transfer, particularly to women, as it could lead to unwanted side effects like acne or hirsutism,” advises Dr. Hayes.

Testosterone replacement therapy involves periodic injections that could significantly elevate testosterone levels for several days post-injection before gradually tapering off. This fluctuation often results in a ‘roller-coaster’ effect characterized by intermittent spells of heightened mood and energy, which eventually diminish.

Many individuals commence feeling symptomatic relief within four to six weeks of initiating treatment, though tangible changes, such as muscle mass increase, may require between three to six months to become evident.

However, the requirement for lifelong testosterone replacement therapy is not a foregone conclusion. Dr. Hayes advises, “In situations where the underlying cause of decreased testosterone levels is resolved, it’s advisable to discontinue the treatment temporarily for assessment. Subsequently, your physician should reevaluate to determine the necessity of continuing therapy.”