Low T Therapy: Finding the Safest Option

Testosterone is a male sex hormone that is involved in various bodily functions, including muscle growth, bone density, sex drive, and mood regulation. When testosterone levels decline, it can lead to a range of symptoms, often referred to as "low T":

• Fatigue and low energy
• Mood changes
• Reduced muscle mass and increased body fat
• Erectile dysfuction
• Decreased bone density

Testosterone Replacement Therapy (TRT)

TRT is a medical treatment to restore healthy testosterone levels in men with confirmed low testosterone (hypogodanism). There are several forms of TRT, each with its method of delivery and possible side effects.

Injections

One of the most common options is injections. These are given either into the muscle (intramuscular), or just beneath the skin (subcutaneous). They administer testosterone directly into the bloodstream.

• Aveed (testosterone undecanoate): First two injections a month apart, then an injection every 10 weeks
• Xyosted (testosterone enanthate): Once a week

While injections are effective, some patients may experience side effects, such as soreness at the injection site, mood swings between doses, or changes in red blood cell levels.

Gels

Testosterone gels, including AndroGel, are applied daily to your skin, where the hormone is absorbed into the bloodstream. These provide convenience for those who prefer avoiding needles. However, patients must be cautious about accidental transfer to others through direct skin contact. Common side effects include mild skin irritation or acne.

Nasal Gel

Nasal testosterone therapy, such as Natesto, involves using a gel that is applied inside the nostrils. This method is less common but allows for quick absorption without injections or skin application. It requires multiple daily doses, and some patients may experience nasal discomfort or irritation.

Patches

Transdermal patches, such as Androderm, are another option worn on the skin to release testosterone steadily over 24 hours. They may be convenient and provide consistent levels but can sometimes cause skin irritation when the patch is applied.

Pills

Testosterone can also be administered through oral pills, including Kyzatrex (testosterone undecanoate).

Pellets

For those looking for longer-lasting solutions, implanted pellets are an option. These small pellets are placed under the skin during a minor procedure and gradually release testosterone over several months. They may be convenient for those who prefer fewer treatments but may also cause soreness or a slight risk of infection at the site of implantation.

Risks of TRT

Testosterone replacement therapy can help manage symptoms of low testosterone, but it’s important to understand the risks that may come with treatment.

While TRT is generally considered safe for most patients when used appropriately, certain side effects and complications are possible, depending on your health factors and the method of administration.

Increased Red Blood Cells

One common risk of TRT is an increase in red blood cell count, a condition called polycythemia. This can thicken the blood, increasing your likelihood of developing blood clots, strokes, or heart attacks.

Cardiovascular Risks

Cardiovascular health has been a topic of concern regarding TRT, particularly in men with underlying conditions.

In 2013, a study revealed that certain men undergoing TRT had a 30% higher risk of heart attack, stroke, or death compared to those not using TRT.

In 2015, the FDA issued a statement recommending that TRT should only be used by patients with low testosterone levels caused by hypogonadism, a condition where the body produces insufficient testosterone due to dysfunction in the pituitary gland, brain, or testicles.

The FDA also cautioned that men taking TRT for age-related declines in testosterone levels may face an elevated risk of heart-related problems, such as heart attack, stroke, and various types of blood clots.

More recently, research has brought additional clarity to the concern. A 2022 study published in The New England Journal of Medicine found no significant increase in major cardiovascular events among men using TRT compared to those receiving a placebo.

Prostate Health

TRT can also affect prostate health. Testosterone can stimulate the prostate, potentially worsening conditions such as benign prostatic hyperplasia (BPH), or increasing your risk of developing prostate cancer in men predisposed to it.

Sleep Apnea

Some patients may experience sleep apnea or fluid retention, which can lead to swelling in your legs or feet.

As mentioned, the safety of TRT depends on factors such as age, health history, and how the treatment is administered. Speaking with your doctor and regular monitoring can help minimize risks and maximize the benefits of treatment.

Who Should Avoid Testosterone Therapy?

TRT is not recommended for everyone, as certain medical conditions and situations can make it unsafe. In these cases, TRT may worsen existing health problems or introduce new risks, making it important to recognize when therapy is not appropriate.

• Prostate or Breast Cancer: Testosterone can stimulate cancer growth in hormone-sensitive tissues.
• Severe Heart Conditions: For those with uncontrolled heart failure or a history of serious heart problems, TRT may increase fluid retention and place additional strain on the heart, exacerbating symptoms or increasing cardiovascular risk.
• Sleep Apnea: TRT can worsen this sleep disorder by relaxing airway muscles, leading to more frequent interruptions in breathing.
• Polycythemia: This rare condition, which may require lowering or discontinuation of therapy, causes excessive red blood cell production, and TRT can make it worse by stimulating even higher red blood cell counts. This increases your risk of blood clots, stroke, or other complications.
• Liver Disease: In patients with liver failure or advanced liver disease, the risks often outweigh the potential benefits of TRT.
• Planning for Conception: TRT can suppress your body’s natural testosterone production, which is important for sperm production. Men actively trying to conceive may find that TRT negatively affects fertility and should explore alternative options for managing low testosterone.

It is important to weigh the potential risks and benefits with your doctor. Regular monitoring, including blood work and symptom assessments, is crucial for safe and effective management of low testosterone, especially in patients with medical histories.

Speak with Your Doctor

Testosterone replacement therapy can be a safe and effective option when carefully managed under medical supervision. However, it’s important to remember that TRT may have potential risks and side effects, which can vary from person to person.

Talking with your doctor is important before starting any treatment. They will consider your symptoms, medical history, and overall health to determine if TRT is the right choice for you.

If it’s not an appropriate option, your doctor can discuss alternatives or suggest adjustments to help manage your symptoms in a way that aligns with your health goals. With the right guidance and regular follow-ups, you can make informed decisions that prioritize your safety and quality of life.