If you have low testosterone,
increasing your testosterone levels to the normal range can improve low-T symptoms, resulting in:
- improved sex drive
- enhanced mood and energy levels
- improved sexual function
- increased red blood cell production
- decreased body fat
- higher bone mineral density
- improved cognition
Improvements in sex drive and mood typically occur soon after beginning TRT. You’ll likely experience
a decrease in body fat and increased bone mineral density within 6 months of starting
treatment. You may continue to see benefits after a longer period of TRT.
If your symptoms don’t show improvement after 3 months of TRT, your
doctor will likely reevaluate the potential causes behind your condition.
There’s limited
evidence about the potential side effects of testosterone replacement therapy, especially when used
long-term. The following are possible issues:
- liver damage
- erythrocytosis (excessively high production of red blood cells)
- infertility (for this reason, you may consider sperm freezing before TRT)
- enlarged prostate
- trouble sleeping
- blood clots
Testosterone replacement therapy may have additional side effects, but more research is needed to
confirm them. These include possible increased risks of heart attack and cancer.
Using TRT comes with a potential
increased risk of heart attack, stroke, and myocarditis (inflammation of the heart). As research has
particularly linked this issue to older men, it’s an important factor to take into account for TRT
patients over the age of 55, who are already at increased risk.
A large 2014 study
found an increased risk of heart attack in men aged 65 and above as well as in younger men with
heart disease after taking TRT. The study noted that taking testosterone may increase blood clotting
and blood pressure, which may contribute to heart attacks.
Another study also showed a higher chance of
negative cardiovascular events among older men who were using testosterone gel. Many of these men
also had other chronic diseases.
On the other hand, some recent research
has suggested that TRT may reduce cardiovascular risks in men with very low testosterone levels.
Compared to participants who did not receive treatment, men younger than 55 who used TRT had a 25%
lower chance of heart attack and stroke, while men over 60 on TRT had a 15% lower risk. The men
using TRT also had health improvements in other areas.
In another study,
testosterone was even used as a treatment for cardiovascular issues, improving exercise capacity in
men with heart failure. Only 24% of participants had low testosterone levels when they began the
study.
More research is needed to evaluate the risk of TRT on heart conditions. For the moment, the FDA
requires that prescription testosterone product labels include warnings of the potential higher
chance of strokes and heart attacks. It’s important to seek immediate medical care if you experience
any of the following, particularly while taking testosterone:
- difficulty breathing
- pain in your chest
- slurring while speaking
- weakness in one area of your body
There’s some concern
that TRT may heighten the risk of prostate cancer because testosterone promotes the growth of prostate
cancer cells. However, little, if any,
research supports this. While more research should be done in this area, multiple studies and
analyses indicate that TRT does not impact prostate cancer risk.
A recent study of over 12,000
men with late-onset hypogonadism found that using TRT was not linked to a higher chance of prostate
cancer. All of the men were at least 45 years old with no history of prostate cancer, and many had a
follow-up period of multiple years.
Research from 2017 also found no
elevated risk of prostate cancer, even after participants received TRT for a longer period. In fact,
those who took TRT had a lower chance of aggressive prostate cancer.
Similarly, a meta-analysis indicated that
using TRT did not cause an increase in prostate cancer compared to controls. It also found no
increase in prostate-specific antigen (a marker that tends to be elevated when prostate cancer is
present) related to TRT, except for a slight increase with testosterone injections.
More research is needed to confirm the link, or lack thereof, between TRT and cancer. It’s currently
recommended that individuals receiving
TRT undergo regular checks for prostate cancer. Additionally, you shouldn’t use TRT if you already
have prostate cancer.