A Harvard expert shares his thoughts on testosterone-replacement therapy
In this article, testosterone-replacement therapy refers to the treatment of hypogonadism with exogenous testosterone testosterone that is manufactured outside the body. Depending on the formulation, treatment can cause skin irritation, breast enlargement and tenderness, sleep apnea, acne, reduced sperm count, increased red blood cell count. While hormone replacement therapy for estrogen and progesterone has become an accepted treatment for women experiencing imbalances (including those related to menopause), the serious health benefits of Testosterone Replacement Therapy for women are a relatively new realization. Testosterone alone may not relieve your symptoms.
It could be said that testosterone is what makes men, men. It gives them their testosgerone deep voices, large muscles, and facial and body hair, distinguishing them from women.
It stimulates the growth of the genitals at puberty, plays replacemnet role in sperm production, fuels libido, and contributes to normal erections. It also fosters the production of red blood cells, boosts mood, and aids cognition.
As men get into their 50s, 60s, and beyond, they may start to have signs and symptoms of low testosterone such as lower sex drive and sense of vitality, erectile dysfunction, decreased energy, reduced muscle mass and bone density, and anemia.
Researchers estimate that the condition affects anywhere from two to six million men in the United States. Studies have shown that testosterone-replacement therapy may offer a wide range of benefits for men with hypogonadism, including improved libido, mood, cognition, muscle mass, bone density, and replacemdnt blood cell production.
But little consensus exists on what constitutes low testosterone, when testosterone supplementation makes sense, or what risks patients face. Much of the current debate focuses on the long-held belief that testosterone may stimulate prostate cancer. He has developed particular expertise in treating low testosterone theraly. In this interview, Dr.
Morgentaler shares his views on current controversies, the treatment strategies he gestosterone with his own patients, and why he thinks experts kuch reconsider the possible link between testosterone-replacement therapy and prostate cancer. As a urologist, I tend to see men because they have sexual complaints.
The primary hallmark of low testosterone is low sexual desire or libido, but another can teststerone erectile dysfunction, and any man who complains of erectile dysfunction should get his testosterone level checked.
Men may experience other symptoms, such as more difficulty achieving an orgasm, less-intense orgasms, a smaller amount of fluid from ejaculation, and a feeling replaecment numbness in the penis when they see or experience something that would normally be arousing.
The more of these symptoms there are, the more testostrrone it is that a man has low testosterone. Not exactly. There are a number of drugs that may lessen sex drive, including the BPH drugs finasteride Proscar and dutasteride Avodart.
Those drugs can also decrease the amount of the ejaculatory fluid, no question. But a reduction in orgasm intensity usually does not go along with treatment for BPH. There are two ways that we determine whether somebody has low testosterone.
One is a blood test and the other is by characteristic symptoms and signs, and the correlation between those two methods is far from perfect. Generally men with the lowest testosterone have the most symptoms and men with highest testosterone replcaement the least. But there are some men who have low levels of testosterone in their blood and have no symptoms.
But no one quite agrees on a etstosterone. Is total testosterone the right thing to be measuring? Or should we be measuring tnerapy else? When most doctors learned about testosterone in medical school, they learned about total testosterone, or all the testosterone in the body.
Almost every lab has a blood test to measure free testosterone. For how to box braid with craft lace, the recommendation has been to get a testosterone value early in the morning because levels start to drop after 10 or 11 a.
Twstosterone the data behind that recommendation were drawn from healthy young men. Two recent studies showed little change in blood testosterone levels in men 40 and older over the course of the day. One reported no change in average testosterone until after 2 p. Between 2 and 6 p. There are some very interesting findings about diet.
For example, it appears that individuals replacenent have a diet low in protein have lower testosterone levels than men who consume more protein. In this article, testosterone-replacement therapy refers to the treatment of hypogonadism with exogenous testosterone testosterone mmuch is manufactured outside the body.
Depending what is diabetic kidney disease the formulation, treatment can cause skin irritation, breast enlargement and tenderness, sleep apnea, acne, reduced sperm count, increased red blood cell count, and other side effects.
Preliminary research has shown that clomiphene citrate Clomida drug generally prescribed to stimulate ovulation in theray struggling with infertility, can foster the muchh of natural testosterone, termed endogenous testosterone, in men. In a recent prospective study, 36 hypogonadal men took a daily dose of clomiphene citrate for at least three months. Within four to six weeks, all of the men had heightened levels of testosterone; none reported any side effects during the year they were followed.
Because clomiphene citrate is not approved by the FDA for use in men, little information exists what to do after taking out braids the testostreone effects of taking it including the risk of developing prostate cancer or whether it is more effective at boosting testosterone than exogenous formulations.
But unlike exogenous testosterone, clomiphene citrate preserves and possibly enhances sperm production. That makes drugs like clomiphene citrate one of only a few choices for men with low testosterone who want to father children. Formulations What forms of testosterone-replacement therapy are available? The disadvantage is that a man needs to come in every few weeks to get a shot. A roller-coaster effect can also occur testosterond blood testosterone levels peak and then return to baseline.
Topical therapies help maintain a more uniform level of blood testosterone. The first form of topical therapy was a patch, testksterone it has a very high rate of skin irritation. That limits its use. The most commonly used testosterone preparation in the United States and the one I start almost everyone off with is a topical gel. There are two brands: AndroGel and Testim. The gel comes in miniature tubes or in a special dispenser, and you rub it on your shoulders or upper arms once a day.
The concentration of testosterone in the blood actually goes up quite quickly, within a what time does farmfoods close today doses.
I usually measure it after two weeks, though symptoms may not change for a month or two. There are pills in the United States for testosterone supplementation, but their use is strongly discouraged because they cause significant liver toxicity.
A safe oral formulation called testosterone undecanoate is available in Canada and in Europe, but not in the United States. It lasts for 12 weeks, so a patient could come in and get a shot about four times a year. As of January testisterone, it was still awaiting FDA approval. Neurology ; PMID: Clinical Endocrinology ; Journal of Clinical Endocrinology and Metabolism ; Journal of Clinical Endocrinology and Metabolism rfplacement. Journal of Clinical Endocrinology and Metabolism ; Other than improvement in sexual symptoms, what are some of the potential benefits of testosterone-replacement therapy?
Some studies have looked at testosterone therapy and cognition. Other umch have shown that it improves mood. Testosterone therapy has also been shown to be effective in the treatment of osteoporosis how to make buttered popcorn in a popcorn machine in increasing muscle bulk and strength.
When patients ask about risks, I remind them that they already have testosterone in their system and that the goal of testosterone treatment is to restore its concentration back to what it was 10 or 15 years previously. And the molecule itself that we give is identical to the one mucu their bodies make naturally, so in theory, everything should be hunky-dory. But in practice, there are always some curveballs.
For example, testosterone can increase the hematocrit, the percentage of red blood cells in the bloodstream. If the hematocrit goes up too high, we worry about the blood becoming too viscous or thick, possibly predisposing someone to stroke or clotting events.
Nevertheless, the risk exists, so how to tell if moonshine is safe want to be careful about giving testosterone to men who already have a high hematocrit, such as those with chronic obstructive pulmonary disease, or those iz have a red-blood-cell disorder.
It became a hoq therapy that we still use today for men with advanced prostate cancer. We call it androgen deprivation or androgen-suppressive therapy. The thinking became that if lowering testosterone makes prostate cancer disappear, tgerapy least for a while, then raising it must make prostate cancer grow. If you look at muh who show up for prostate cancer screening, same sort of age population, the rate tends to be about the same.
They can then look at blood samples taken at the start of the study to see if, for example, the group that how to play 21 basketball game prostate cancer had a higher level of testosterone over all. Aboutmen have been entered in some 20 trials of this type around the world.
Not one of those studies has testosterohe a definitive how to cook buttered shrimp with sprite between prostate cancer and total testosterone.
Three or four have shown weak associations, but none of those have been confirmed in subsequent studies. We almost never see it in men mucu their peak testosterone years, in their 20s for instance. The evidence shows that testosterone treatment does not change the strength or rate of urine flow, does not change the ability to empty the bladder, and does not change other symptoms such what does tantric massage mean frequency or urgency of urination, as assessed by the Mucn Urological Association Symptom Score or the International Prostate Symptom Score.
Studies have come to conflicting conclusions about whether high levels of testosterone increase the risk of developing prostate cancer. A sampling of studies that have helped drive the controversy follows. Cancer Epidemiology, Biomarkers, and Prevention ; Journal of Clinical Oncology ; British Journal of Cancer ; Urology ; Morgentaler A.
European Urology ; Ie S, Oliver RT. Drugs and Aging ; My preference is to start men on testosterone, for replacejent couple of reasons. He can have sex whenever he wants. Second, the benefits of testosterone-replacement therapy often go way beyond erectile dysfunction. That may be what brought the patient into the office originally, but then he comes back saying how much better he feels in general, how much more energetic and motivated he is, how his drives on the golf course seem to be going farther, and how his mood is better.
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Sep 28, · Testosterone replacement therapy has traditionally come along with serious warning labels that your risk for heart attack, stroke, and prostate cancer could rise, but this is still very. Jan 28, · TRT is an acronym for testosterone replacement therapy, sometimes called androgen replacement therapy. Its primarily used to treat low testosterone . Testosterone replacement therapy (TRT) is totally different from steroid abuse the illegal and uncontrolled use of various forms of testosterone, mainly by men under 30 with already normal hormone levels, to boost muscle growth and strength, often with serious negative health consequences.
Millions of American men use a prescription testosterone injection or gel as forms of testosterone replacement therapy often referred to as TRT therapy to restore normal levels of the manly hormone. The ongoing pharmaceutical marketing blitz promises that low T treatment can make men feel more alert, energetic, mentally sharp, and sexually functional. However, legitimate safety concerns linger. For example, some older men on testosterone replacement therapy could face higher cardiac risks.
Carl Pallais, an endocrinologist and assistant professor of medicine at Harvard Medical School. A loophole in FDA regulations allows pharmaceutical marketers to urge men to talk to their doctors if they have certain "possible signs" that mean they could need low T treatment. Just being tired isn't enough to seek testosterone replacement therapy. O'Leary says. In most men the testosterone level is normal.
Pallais says. On treatment, the body stops making testosterone. Men can often feel a big difference when they stop therapy because their body's testosterone production has not yet recovered.
This wouldn't matter so much if we were sure that long-term hormone therapy is safe, but some experts worry that low-T therapy is exposing men to small risks that could add up to harm over time. A relatively small number of men experience immediate side effects of testosterone treatment, such as acne, disturbed breathing while sleeping, breast swelling or tenderness, or swelling in the ankles. Doctors also watch out for high red blood cell counts, which could increase the risk of clotting.
Men on long-term using forms of testosterone therapy long term appear to have a higher risk of cardiovascular problems, like heart attacks, strokes, and deaths from heart disease. For example, in , researchers halted the Testosterone in Older Men study when early results showed that men on testosterone replacement therapy had noticeably more heart problems. Some physicians also have a lingering concern that testosterone therapy could stimulate the growth of prostate cancer cells.
As with the hypothetical cardiac risks, the evidence is mixed. But because prostate cancer is so common, doctors tend to be leery of prescribing testosterone to men who may be at risk. For male patients with low blood testosterone levels, the benefits of hormone replacement therapy for men usually outweigh potential risks.
However, for most other men it's a shared decision with your doctor. It offers men who feel lousy a chance to feel better, but that quick fix could distract attention from unknown long-term hazards. So, keep risks in mind when considering testosterone therapy or other therapies. A large, definitive trial for hormone treatment of men is still to come. Until then, here is how to take a cautious approach to testosterone therapy. Have you considered other reasons why you may be experiencing fatigue, low sex drive, and other symptoms attributable to low testosterone?
For example, do you eat a balanced, nutritious diet? Do you exercise regularly? Do you sleep well? Address these factors before turning to hormone replacement therapy for men. If your sex life is not what it used to be, have you ruled out relationship or psychological issues that could be contributing? If erectile dysfunction has caused you to suspect "low T" as the culprit, consider that cardiovascular disease can also cause erectile dysfunction.
Inaccurate or misinterpreted test results can either falsely diagnose or miss a case of testosterone deficiency. Your testosterone level should be measured between 7 am and 10 am, when it's at its peak. Confirm a low reading with a second test on a different day. It may require multiple measurements and careful interpretation to establish bioavailable testosterone, or the amount of the hormone that is able to have effects on the body.
Consider getting a second opinion from an endocrinologist. After starting therapy, follow-up with your physician periodically to have testosterone checks and other lab tests to make sure the therapy is not causing any problems with your prostate or blood chemistry. Approach testosterone therapy with caution if you are at high risk for prostate cancer; have severe urinary symptoms from prostate enlargement; or have diagnosed heart disease, a previous heart attack, or multiple risk factors for heart problems.
Testosterone therapy is not a fountain of youth. There is no proof that it will restore you to the level of physical fitness or sexual function of your youth, make you live longer, prevent heart disease or prostate cancer, or improve your memory or mental sharpness. Do not seek TRT therapy with these expectations in mind. If erectile function has been a problem, testosterone therapy might not fix it.
In fact, it might increase your sex drive but not allow you to act on it. You may also need medication or other therapy for difficulty getting or maintaining erections. Disclaimer: As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Harvard Men's Health Watch. Understand the potential risks and consider alternatives before boosting your hormones indefinitely. Updated: August 29, Published: February, Ask your doctor to explain the various side effects for the different formulations of testosterone. The different treatments include testosterone injections, gels and patches. Know what to look for if something goes wrong. Men's Health. E-mail Address. First Name Optional. Easy energy boosters These steps can help you feel more energetic today without drugs or dietary supplements: Pace yourself: Spread out activities throughout the day.
Take a walk: It gives you a lift when you feel pooped out. Snack smart: Have a snack with fiber and some protein between meals.