About Us

Testosterone therapy: Potential benefits and risks as you age

Testosterone Replacement Therapy TRT: What to Know

AUA urges strict compliance with all government regulations and protocols for prescription and use of these substances. The physician is encouraged to carefully follow all available prescribing information about indications, contraindications, precautions and warnings. These guidelines and best practice statements are not in-tended to provide legal advice about use and misuse of these substances. Although guidelines are intended to encourage best practices and potentially encompass available technologies with sufficient data as of close of the literature review, they are necessarily time-limited.

And about 30 percent of men who have low testosterone according to one measurement will have normal testosterone on the next. In the studies that enrolled men who had low testosterone, “there was a positive effect of testosterone therapy on mood and vitality,” says Anawalt. “They felt better, like they had more energy.” But in the studies that enrolled men who had testosterone on the lower end of the normal range, taking testosterone didn’t make a difference. Dr. Lipshultz can help you better understand your symptoms and provide testosterone therapy to restore your body’s hormonal and reproductive function. Contact Dr. Lipshultz today to learn more about low testosterone treatments, or to schedule a consultation. If you are experiencing symptoms of low testosterone, Dr. Lipshultz will ask you to fill out a questionnaire and describe your symptoms. If your answers indicate low testosterone, he will conduct a physical exam, assessing the reproductive organs and conducting a rectal exam.

Some testosterone supplements have been shown to cause health conditions such as erectile dysfunction and kidney failure. So, before you call that low-T clinic or click on an outlandish ad for testosterone-boosting supplements, find out what’s at stake for your health. There are safer, more cost-effective options to restore youthful energy – and potentially reverse fertility loss from previous testosterone products. Pharmacists should verify dosing, check for potential interactions, and provide thorough counseling for drug administration, which will vary depending on the treatment modality and formulation chosen. Hyperestrogenism can be an adverse effect of replacement therapy because testosterone undergoes aromatization to estrogen.[24] Aromatase inhibitors may be necessary.

In contrast to topical agents where a percentage of men have difficulty achieving therapeutic levels within standard dosing ranges, injectable testosterone preparations are able to achieve therapeutic levels in almost any clinical scenario. However, compared to other agents, short-acting injections can result in longer times in the supra-therapeutic and sub-therapeutic ranges, which may impact overall efficacy and rates of adverse events. The Panel explicitly uses the term testosterone therapy rather than testosterone replacement therapy or testosterone supplementation to be in keeping with the beliefs of the current thought leaders in the field. The five observational studies and the Xu meta-analysis were discussed at a joint meeting of the Bone, Reproductive and Urologic Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee on September 17, 2014. Based on these findings, the advisory committee members were in general agreement that the signal of cardiovascular risk is weak and that only a prospective, well-controlled clinical trial could determine whether testosterone causes cardiovascular harm. The Corona study was recently published and could not be reviewed in time to be presented at the Advisory Committee meeting; however, we have reviewed the study and factored its findings into our overall assessment. Regaining fertility is not guaranteed, but it is possible for some patients depending on their age and duration of testosterone use.

If you wonder whether testosterone therapy might be right for you, talk with your doctor about the risks and benefits. Most prostate cancers eventually stop responding to hormone therapy and become castration (or castrate) resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable.

The concern, says Dr. Deibert, is overprescribing testosterone therapies for men that may not actually need therapy or prescribing additional therapies like estrogen blockers or human chorionic gonadotropin (hCG). “At most, just 5% of men who need testosterone therapy, will actually need these additional therapies,” Dr. Deibert says. Testosterone deficiency is defined as testosterone blood levels less than 300 nanograms per deciliter (ng/dL). Study design is one of the most important aspects of any investigation because it defines the reliability of outcomes and the extent to which they may be extrapolated to other groups. Meta-analyses of RCTs and cohort studies provide the highest levels of evidence and reliability, followed by individual RCTs, prospective cohorts, retrospective cohorts, and observational studies. Clinicians should understand that of these agents, only hCG has been approved by the FDA for use in males, specifically to treat males with hypogonadotropic hypogonadism.

Beginning around age 30 to 40, testosterone levels may start to slowly decrease. The Cleveland Clinic adds that TRT is also unsafe if you have certain existing health conditions like prostate cancer, breast cancer or heart failure. While it’s normal for estrogen to increase when taking testosterone medications, explains Dr. Deibert, most men won’t see an increase in estrogen at high enough levels to develop any new symptoms that warrant estrogen blockers. Patients who are on long-acting SQ pellets require two separate assessments of testosterone to determine the dose and frequency required. The first testosterone measurement should be obtained two to four weeks after initial implant to determine if the number of inserted pellets needs to be increased or decreased to achieve the appropriate therapeutic level. For example, there are several testosterone gels available in 1%, 1.62%, and 2% formulations, each marketed under a different brand or generic name. Within this modality family alone, there are three different application sites, including upper body, thigh, and axilla, with four different dosing ranges for each gel.

In the event these practices fail to raise a patient’s testosterone levels naturally, Dr. Muthigi says he then introduces the idea of external testosterone supplementation, or testosterone replacement therapy (TRT). Lots of things can affect testosterone levels, including lifestyle factors like diet, sleep, stress and weight. Age can too, as the glands responsible for regulating testosterone decline over time, along with certain medical conditions like diabetes and genetic disorders. Although TRT offers benefits to people with low testosterone levels, it can cause many short-term side effects. Past research found a correlation between TRT and lower urinary tract symptoms (LUTS) due to testosterone’s growth-promoting effects on the prostate. This is common among aging men who developed hypogonadism late in their life. Recent clinical trials support this theory, concluding that although TRT may help in reducing prostate inflammation, it does not lower urinary tract symptoms and may even make these symptoms worse in the long term.

Where gaps in the evidence existed, the Panel provides guidance in the form of Clinical Principles or Expert Opinion with consensus achieved using a modified Delphi technique if differences of opinion emerged. A Clinical Principle is a statement about a component of clinical care that is widely agreed upon by urologists or other clinicians for which there may or may not be evidence in the medical literature. Expert Opinion refers to a statement, achieved by consensus of the Panel, that is based on members’ clinical training, experience, knowledge, and judgment for which there is no evidence. A large, 2010 meta-analysis of 51 studies looked at the safety of trt san francisco (bigteam.es). The report concluded that safety analysis of TRT is of low quality and fails to inform the public about potential long-term effects. Still think testosterone therapy turns guys into roid-raging gym rats?