TRT: Separating Fact from Fiction

Doctors may choose to prescribe testosterone replacement therapy as a remedy for men with low testosterone levels. There are potential benefits and drawbacks to this therapeutic intervention, with safety considerations being paramount, particularly for those with certain health conditions.

What Is TRT?

Testosterone replacement therapy (TRT), also known as androgen replacement therapy, is a medical intervention used primarily to treat low levels of testosterone (T) in individuals. Such a decline in testosterone levels can occur due to ageing or underlying medical conditions. However, TRT has also become increasingly popular for non-medical purposes, including efforts to improve sexual performance, boost energy levels and increase muscle mass for bodybuilding. While some studies suggest that TRT may offer benefits in achieving these goals, it is imperative to acknowledge certain caveats. In particular, it is important to understand the natural fluctuations in testosterone levels with age and to realistically assess the potential benefits and limitations of TR.

Why Does T Decrease With Age?

The decline in testosterone (T) levels with age is a natural biological phenomenon. According to an article in the American Family Physician, the average man experiences a decrease in T production of about 1 to 2 percent per year. This natural process typically begins in the late 20s or early 30s and is characterised by several sequential physiological events:

1. Testicular production of testosterone decreases with age
2. Decreased testicular testosterone levels lead to a reduction in the secretion of gonadotropin-releasing hormone (GnRH) by the hypothalamus
3. The decrease in GnRH leads to decreased synthesis of luteinising hormone (LH) by the pituitary gland
4. Consequently, the reduced LH levels contribute to an overall reduction in testosterone production

While this gradual decline in testosterone levels can often be asymptomatic, a more significant decline can manifest itself with a variety of symptoms, including:

• Reduced libido or sex drive
• Reduced frequency of spontaneous erections
• Erectile dysfunction
• Decreased sperm count or semen volume
• Sleep disturbances
• Noticeable loss of muscle or bone density
• Unexplained weight gain

How Do I Know If I Have Low T?

To find out if you have low testosterone (T) levels, you will need to see a healthcare professional for a testosterone assessment. This involves a simple blood test, which is usually required by most healthcare providers before testosterone replacement therapy (TRT) is considered. Repeated testing may be necessary as T levels can be affected by a number of factors, including diet, physical fitness, timing of the test and the use of certain medications such as anticonvulsants and steroids. Below are the typical ranges of testosterone levels in adult men from the age of 20: Age (in years) T levels in nanograms per millilitre (ng/ml)

• 20-25: 5.25-20.7
• 25-30: 5.05-19.8
• 30-35: 4.85-19.0
• 35-40: 4.65-18.1
• 40-45: 4.46-17.1
• 45-50: 4.26-16.4
• 50-55: 4.06-15.6
• 55-60: 3.87-14.7
• 60-65: 3.67-13.9
• 65-70: 3.47-13.0
• 70-75: 3.28-12.2
• 75-80: 3.08-11.3
• 80-85: 2.88-10.5
• 85-90: 2.69-9.61
• 90-95: 2.49-8.76
• 95-100+: 2.29-7.91

If your testosterone levels are only slightly below the expected range for your age, TRT may not be warranted. However, if the deficiency is significant, your doctor may carry out further diagnostic tests before considering TRT as a treatment option.

What Are The Symptoms Of Low Testosterone?

When a man’s body lacks testosterone, he may not feel very ill at first. The symptoms are diffuse and often dismissed as harmless. In addition, the symptoms of testosterone deficiency rarely occur at the same time. The condition often starts slowly and develops over time. Typical symptoms of testosterone deficiency include

• Lack of energy, fatigue and tiredness
• Hot flushes
• Less or no desire for sex
• Concentration and memory problems
• Loss of muscle mass and strength
• Increase in body fat, especially around the abdomen

How Is TRT Administered?

Testosterone Replacement Therapy (TRT) offers a range of administration methods, each designed to meet individual medical requirements and lifestyle preferences. The frequency of administration ranges from daily to monthly, depending on the method chosen. TRT modalities include:

• Oral medication
• Intramuscular injections
• Transdermal patches
• Topical creams

There is also a variant of TRT in which testosterone is applied to the gums twice a day.

How Is TRT Used Medically?

Testosterone replacement therapy (TRT) is the conventional treatment for hypogonadism, a condition characterised by insufficient production of testosterone by the testes (gonads). There are two forms of hypogonadism:

• Primary hypogonadism: Low testosterone results from a malfunction within the gonads, where they receive signals from the brain to produce testosterone, but are unable to do so.
• Central (secondary) hypogonadism: Low testosterone is caused by dysfunction in the hypothalamus or pituitary gland, which regulate testosterone production. TRT aims to compensate for the lack of testosterone produced by the testes.

For people who have been diagnosed with true hypogonadism, TRT can:

• Improve sexual function
• Increase sperm count and semen volume
• Increase levels of other hormones that interact with testosterone, such as prolactin

In addition, TRT can help correct abnormal testosterone levels caused by:

• Autoimmune conditions
• Genetic disorders
• Infections that damage the reproductive organs
• Undescended testicles
• Radiation therapy for cancer
• Surgery on the reproductive organs

What Are The Non-Medical Uses Of TRT?

Many countries, including the United States, have restrictions that prohibit the purchase of testosterone supplements for non-medical purposes without a prescription. Despite regulatory restrictions, individuals seek testosterone replacement therapy (TRT) for a number of non-medical reasons, including:

• Weight loss
• Increasing energy levels
• Increasing sexual drive or performance
• Improving endurance for sporting activities
• Building additional muscle mass for bodybuilding endeavours

Research suggests that TRT can achieve some of these desired results. For example, recent studies have concluded that TRT is effective in increasing muscle strength in middle-aged and older men. However, the effectiveness of TRT for individuals, particularly younger men, with normal or elevated testosterone levels remains uncertain, while potential risks may outweigh the benefits. A small study conducted in 2014 found an association between high testosterone levels and reduced sperm production. Furthermore, the use of TRT to gain a competitive advantage in sport is widely considered ‘doping’ by professional organisations and often results in disqualification from participation. Instead, it may be wise to explore alternative methods of boosting testosterone levels.

How Much Does TRT Cost?

The cost of Testosterone Replacement Therapy (TRT) varies depending on the specific type prescribed. If TRT is needed to treat a medical condition and you have medical insurance, the cost will usually be lower. However, out-of-pocket costs can also be influenced by geographical location and the availability of generic alternatives. In general, the monthly cost of TRT can range from $20 to $1,000. The exact amount will depend on a number of factors, including

• Geographical location
• Type of medication prescribed
• Method of administration
• Availability of generic versions

It’s important to remember that while TRT is effective in increasing testosterone levels, it doesn’t treat the underlying cause of low testosterone. As a result, lifelong treatment may be required, which requires an ongoing financial commitment.

Keep It Legal (And Safe)

It’s important to follow legal and safe practices when taking testosterone (T) supplements. In most countries, obtaining T without a valid prescription is illegal and could result in serious legal consequences if you are caught. In addition, T obtained from sources outside of regulated pharmacies lacks oversight and quality control. This increases the risk of unknowingly consuming T contaminated with undisclosed substances or allergens, which can lead to serious health risks or life-threatening complications, especially if allergic reactions occur.

Are There Any Risks Associated With TRT?

There are potential risks and side effects associated with testosterone replacement therapy (TRT), although these are still being fully researched and understood by experts. In particular, many studies investigating TRT have inherent limitations, such as small sample sizes or the use of higher-than-usual doses of testosterone. As a result, there is ongoing debate about the benefits and risks of TRT. For example, there is conflicting evidence about its effect on the risk of certain cancers. An article published in 2016 in the journal Therapeutic Advances in Urology suggests that some of these conflicting perspectives stem from sensationalised media coverage, particularly in the United States. Before starting TRT, it is important to have a thorough discussion with a healthcare provider about all potential side effects and risks. These may include:

• Chest pain
• Difficulty breathing
• Speech problems
• Decreased sperm count
• Polycythemia vera
• Reduced levels of HDL (‘good’) cholesterol
• Risk of heart attack
• Oedema in the hands or legs
• Stroke
• Benign prostatic hyperplasia (enlarged prostate)
• Sleep apnoea
• Acne or similar skin problems
• Deep vein thrombosis
• Pulmonary embolism

People who are at risk of any of the above conditions should not undergo TRT

Frequently Asked Questions

Is TRT safe for long term use?

TRT can be safe for long-term use when monitored by a qualified healthcare professional. Studies suggest that when used correctly and under supervision, TRT doesn’t significantly increase the risk of cardiovascular events or prostate cancer. However, regular monitoring of testosterone levels, blood counts and prostate health is essential to reduce any potential risks.

Does TRT cause infertility?

TRT can suppress sperm production, which can lead to temporary infertility in some men. However, this effect is reversible when therapy is stopped. Men who are concerned about their fertility may wish to consider alternative treatments such as selective estrogen receptor modulators (SERMs), which can help preserve fertility while treating the symptoms of low testosterone.

Are mood changes a common side effect of TRT?

Mood swings are not a typical side effect of TRT when administered appropriately. In fact, many people report improved mood, energy levels and general wellbeing with TRT. However, as with any medical treatment, individual responses can vary. It’s important for patients to report any changes in mood or emotional well-being to their doctor so that treatment can be adjusted appropriately.

Can TRT increase the risk of blood clots?

There’s some evidence that TRT may slightly increase the risk of blood clots, particularly in older men or those with pre-existing cardiovascular problems. However, the overall risk appears to be small. It’s important for anyone considering TRT to have a thorough cardiovascular assessment before starting treatment. Lifestyle changes such as regular exercise and stopping smoking may also help to reduce this potential risk.

Is TRT only for older men?

Although TRT is often associated with ageing and age-related testosterone decline, it’s not exclusively for older men. Testosterone deficiency can occur at any age due to a number of factors including genetic conditions, injury to the testicles or certain medical treatments. TRT can be prescribed to men of any age who are experiencing symptoms of low testosterone, such as fatigue, low libido or erectile dysfunction, following thorough assessment and diagnosis by a healthcare professional.

Conclusion

In summary, while Testosterone Replacement Therapy (TRT) has traditionally served as a treatment option for individuals with hypogonadism or related conditions characterised by reduced testosterone production, its efficacy for those without an underlying medical condition remains ambiguous amidst widespread attention. It is important to consult a healthcare professional before starting any testosterone supplement or medication. They will be able to advise you on the safety and feasibility of your goals with TRT. In addition, undergoing TRT requires careful monitoring by a healthcare professional. This allows for the early identification and management of any adverse symptoms or side effects that may occur during the course of treatment.

Sources

• National Center for Biotechnology Information. “Decreased Testosterone in the Aging Male.” PubMed Central, PMC1502317. Click for details.
• National Center for Biotechnology Information. “Review of health risks of low testosterone and testosterone administration.” PubMed Central, PMC4391003. Click for details.
• Evolutionary Biology. “Male facial attractiveness and masculinity may provide sex- and culture-independent cues to semen quality.” Wiley Online Library. Click for details.
• Mayo Clinic. “Testosterone therapy: Potential benefits and risks as you age.” Click for details.