Are you considering testosterone therapy to help you feel younger and stronger as you age? Know the risks before making a decision. Earlier observational studies suggested that long-term use of testosterone could increase the risk of cardiovascular disease. Testosterone is also known to stimulate the growth of prostate cancer in men who have been diagnosed with this condition. Recent clinical trials, which provide more accurate information compared to observational studies, have provided some peace of mind regarding the risk of heart and prostate cancer.
For men who are clearly deficient in testosterone, there is no apparent increased risk of heart attack or stroke or a greater chance of developing a new prostate cancer from testosterone replacement therapy. Heart attacks and strokes related to the use of this medication have been reported. Get emergency help if you have signs or symptoms of a heart attack or stroke. Talk to your healthcare team about the risks and benefits of this medication. A known risk is that testosterone can cause blood to become too thick, also known as a high hematocrit count, which can lead to a stroke, heart attack, or other conditions.
This can be a particular problem if you are taking a dose that is too high for the body's metabolism. This can be prevented by maintaining an appropriate dose and performing blood tests to monitor blood and hormone levels. Another side effect that many associate with excess testosterone is hair loss or male pattern baldness. While there are links to hair loss and DHT levels, it's a common misconception that increased testosterone levels are a direct cause of hair loss (read our article on testosterone and baldness here).
The estimated likelihood of long-term adverse effects of TRT remains virtually unknown, as high-quality evidence to discourage its use in most men with this condition is generally lacking. The prominent studies discussed in this article can be used to guide doctors on how to best monitor patients receiving TRT, especially those with the comorbid conditions listed below. In addition to analyzing the onset of the effects of testosterone treatment in hypogonadal men, it would also be possible to analyze the onset of symptoms of testosterone deficiency in patients receiving androgen deprivation therapy (ADT), the standard treatment for men with advanced prostate cancer. If you are going to have prolonged skin-to-skin contact of someone who doesn't have testosterone in their body, such as a child or a woman, or you're going to have intense skin-to-skin contact, for example, during sexual intercourse, the gel may transfer a small amount of testosterone to the other person.
Regularly monitor and treat new-onset hypertension or exacerbations of pre-existing hypertension and reevaluate if the benefits of testosterone undecanoate outweigh its risks in patients who develop cardiovascular risk factors or cardiovascular disease during treatment. Since the clinical manifestations of testosterone deficiency do not occur at a definitive threshold value of circulating testosterone, but vary depending on the target organ, associated symptoms and underlying conditions, it is even more complicated to establish a time course, since the reversion of these deficiency symptoms does not only depend on the return of serum testosterone to normal. Because of this risk, use testosterone undecanoate only to treat men with hypogonadal conditions associated with structural or genetic etiologies. Before starting treatment with testosterone undecanoate, consider the patient's baseline cardiovascular risk and ensure that blood pressure is adequately controlled.
Excess testosterone can cause mood symptoms or irritability, bloating, pelvic cramps, or even the recurrence of menstruation. Fatigue and general malaise have many other causes, and when most men have a blood test, the result is a normal level of testosterone. Treating physicians can prepare their patients for intermediate periods before they can experience the effects of testosterone. While some men believe they feel younger and more vigorous if they take testosterone medications, there is little evidence to support the use of testosterone in otherwise healthy men.
Some studies measure the effects of testosterone only after 3 months (3) and, in particular, the effects on libido and erections have occurred long before this period (14, 6). Approaches to controlling hair loss in trans men are the same as in cisgender men; treatments may include the partial testosterone blocker finasteride, minoxidil, also known as rogaine, applied to the scalp and hair transplant. Millions of American men use a prescription testosterone injection or gel as a form of testosterone replacement therapy (often referred to as TRT therapy) to restore normal levels of the male hormone. Excess free testosterone in the body can cause the hormone, which is so abundant, to be converted to estrogen.
Studies that investigate the effects of testosterone should take this time course into account to design the duration of the studies in order to have quantifiable measurements. Although the available data is limited, it does not appear that testosterone increases the risk of uterine, ovarian, or breasts.
