Poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy. Paracelsus
As with any medical intervention, the benefits of Low T therapy must be weighed against the potential risk of adverse reactions or side effects of testosterone replacement therapy. Just as Paracelsus says in the quote above, whether testosterone replacement creates a poisonous or beneficial environment is largely dependent upon how the medication is delivered and dosed.
Those who abuse testosterone and other androgens may experience significant and even life threatening side effects. Somewhat similarly, if treatment of Low T is mismanaged or not carefully monitored, patients will experience a higher rate and increased severity of adverse reactions or possibly a complete lack of meaningful results.
For the most part, this discussion will deal with the side effects of testosterone replacement therapy (TRT) in general, but some attention will be given to particular differences in the variety of methods utilized for treatment of Low T. You can also watch the video below to hear from one of our founding partners, Augie Galindo, PA-C about the side effects of testosterone replacement therapy.
Some side effects seen with TRT are the direct result of the use of exogenous testosterone (testosterone not made naturally in the body). Pharmaceutical grade testosterone is bio-identical, that is, it is constructed, recognized, and utilized in the same manner as the hormone produced by your body. Many adverse effects occur only in the presence of higher testosterone levels, and still others are simply the consequences of the bodys normal metabolism of testosterone. This metabolism, or breakdown of testosterone, occurs in the same manner for both exogenous and endogenous testosterone (naturally produced testosterone), but because of an increased abundance of testosterone this may lead to higher than normal levels of these metabolites.
Normal metabolism of testosterone results in its conversion into two primary metabolites, dihydrotestosterone (DHT) and estradiol (E2, a form of estrogen). Elevated levels of DHT can cause benign growth of the prostate, increased oiliness of the skin and acne, as well as male pattern balding. Abnormal increases in estradiol can lead to mood swings, breast tissue changes, and fluid retention that may cause swelling or increases in blood pressure. Furthermore, abnormal estradiol levels have been linked to lower testosterone levels, erectile dysfunction, and a decrease in free testosterone.
According to the 2010 update to Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline, the conversion rate and subsequent ratio of testosterone to estradiol and DHT does not change when treating Low T via injection of testosterone cypionate. These ratios may be negatively affected with other Low T treatments (gels, patches, pellets, etc.).
While prostate changes can occur with testosterone replacement, a study published in The Journal of Clinical Endocrinology & Metabolism in June of 2010, which looked closely at the adverse reactions reported in 51 other studies, found there to be no increased risk of the development of prostate cancer, prostate related urinary symptoms, or elevated PSA (prostate specific antigen). Basically, prostate cancer is NOT one of the side effects of testosterone replacement therapy. That aside, because PSA is essentially a tumor marker for prostate cancer, patients with a first-degree relative who has been diagnosed with prostate cancer and those with an elevated PSA level should proceed with caution and be monitored closely.
For men with a personal history of prostate cancer, treatment for Low T is considered contraindicated according to most sources. It is important to note that testosterone replacement does not give you prostate cancer, but certainly elevated testosterone levels (even to the normal range) can cause an otherwise unnoticed prostate lesion to grow more aggressively.
It is important to note that testosterone, in and of itself, is not a causative factor in the development of prostate cancer. That myth has finally been debunked through countless studies over several years while more recent data now indicate that low serum testosterone levels are a potential predictor of high-risk prostate cancer. The more interesting debate at this point is the potential consequence of increasing a mans testosterone level, even to a normal range, in the presence of an existing prostatic growth.
The findings of multiple studies over the years have ranged from testosterone appearing to be associated with promoting the transition of a common, low-grade lesion into one of a more aggressive nature, to testosterone actually contributing to cell death of the malignancy to no appreciable effect whatsoever. Obviously the current data is inconclusive, however, it is becoming more and more apparent that as we ponder the safest recommendations, while peering through the lens of risk/benefit analysis, living with testosterone deficiency may indeed be the more risky endeavor.
The production of testosterone and sperm both are controlled by what is referred to as the Hypolthalamus-Pituitary-Gonadal Axis. That is, the hypothalamus ( a portion of the forebrain responsible for the control of certain autonomic nervous system actions and pituitary gland activity) talks to the pituitary gland by mean of a chemical messenger (GnRH gonadotropin-releasing hormone).
The pituitary gland in turn will talk to the testicles (male gonads) also by means of different chemical messengers (LH luteinizing hormone and FSH follicular stimulating hormone).
Low T occurs when either this hormonal cycle fails to stimulate the testes to produce testosterone or more commonly when the testes themselves fail to respond to said stimulation.
When testosterone levels are normalized, either by natural means or through treatment of Low T, the brain reduces the stimulus to produce testosterone by secreting less GnRH. Since this singular hormone controls both FSH and LH, the natural suppression of GnRH that occurs can reduce fertility.
Additionally, it is this same process that is responsible for the potential reduction in size and/or change in firmness of the testicles.
Other side effects of testosterone replacement therapy that are not part of normal functioning are increased red blood cell counts (erythrocytosis), potential decreases in good cholesterol or high-density lipoproteins (HDL), and increases in diastolic blood pressure (the lower of the two numbers reported in blood pressure readings). The effects of high blood pressure are well known and the reasons for avoiding hypertension during TRT are no different from standard recommendations. Increased number of red blood cells on the other hand, can lead to significant risk if not managed appropriately.
Think of red blood cells (RBCs) as the solid portion of the solution that is whole blood, and your hematocrit (HCT) the percentage of blood volume made up of RBCs. If you add more solid to any solution without proportionately increasing the volume of the liquid it is suspended within, the result is a thicker solution. Thickening of the blood then, is the end result of an increase in the number of RBCs.
Hematocrit values greater than 54.0% increase a patients risk factors for abnormal clotting, spleen enlargement, heart failure and other serious conditions. If erythrocytosis does occur, it is typically rather easy to address. However if its assessment is overlooked, as is far too often the case, it can lead to potentially serious problems.
Certain side effects of testosterone replacement therapy are preparation specific. Gels, creams, and other topical agents can cause skin irritation and secondary exposure to women and children who come into contact with the medication via direct transfer. Some untoward consequences of use of topicals is the wonderful odor (or fragrance, to steal Big Pharmas term) that is associated with it. Failure rates are much, much higher for this type of medication owing to the inability of 30-40% of men to even absorb enough to improve their testosterone levels.
Virtually every medical treatment can cause adverse reactions. All things considered, the side effects of testosterone replacement therapy are quite manageable. We know what to look for and how to intervene. With careful monitoring, it is entirely possible to treat and/or prevent significant problems these side effects may pose.
Ultimately it comes down to balance. Can we approach Low T treatment in such a way that allows for minimization of side effects while allowing for optimization of results? Absolutely!
What is necessary to achieve this is having providers who are open and honest about the benefits AND the risks associated with TRT. If you have questions, we would love the opportunity to talk with you and answer them. Please Contact Us to schedule a no-obligation consultation in our clinic. If you are suffering from Low T and are ready to improve the quality of your life but are concerned about the side effects of testosterone replacement therapy (TRT), the dedicated providers at Testosterone Centers of Texas are ready to help you.
See the rest here:
- Behavioral and Health Changes Decrease Levels of Testosterone - April 21st, 2019
- Ensuring The Safety of Testosterone Replacement Therapy for Men - September 6th, 2018
- Testosterone Creams for Low Testosterone Treatment and Andropause - August 1st, 2018
- Safety of Testosterone Replacement Therapy | The Medical ... - June 29th, 2016
- Testosterone Replacement Therapy Resources - Fabulously ... - June 15th, 2016
- Testosterone Replacement Therapy - cpt.sagepub.com - May 14th, 2016
- Prostate cancer: Testosterone therapy 'does not increase aggressive ... - May 11th, 2016
- Testosterone Replacement Therapy | Low Testosterone | Low T - April 28th, 2016
- Low Testosterone, Low T, E.D. | Andrologix.com - April 21st, 2016
- Low Testosterone Treatments - Testosterone Replacement Therapy - April 21st, 2016
- Testosterone Therapy Side Effects - DrugWatch - April 10th, 2016
- Testosterone Replacement Therapy: Myths and Facts - April 5th, 2016
- Testosterone Replacement Therapy - Bottar Leone, PLLC - February 8th, 2016
- Heart Attack Risk from Testosterone Replacement Therapy - February 8th, 2016
- Book - What You Need to Know About Low Testosterone - February 8th, 2016
- Testosterone Replacement Therapy in Torrance, CA - November 2nd, 2015
- Male Hormone Replacement | Low Testosterone Treatment - August 19th, 2015
- Hormone & Testosterone Replacement Therapy - August 15th, 2015
- testosterone replacement therapy cost , low testosterone therapy , buy testosterone online - Video - May 5th, 2015
- natural testosterone supplement , natural testosterone , natural testosterone replacement therapy - Video - May 3rd, 2015
- Greater Than 40 Fitness Testosterone Replacement Therapy Update - Video - April 17th, 2015
- Testosterone therapy: Potential benefits and risks as you ... - April 13th, 2015
- Testosterone Replacement Therapy - Risk Myths - Video - April 11th, 2015
- Does Testosterone Replacement Therapy Increase the Risk of Prostate Cancer? - Video - April 11th, 2015
- ALC - Testosterone Replacement Therapy - Video - April 11th, 2015
- TRT - 6 Week Update / Beware Arimidex! (Testosterone Replacement Therapy) - Video - April 9th, 2015
- TRT - 1 Month Bloodwork Results / Protocol Adjustment (Testosterone Replacement Therapy) - Video - March 29th, 2015
- Testosterone Replacement Therapy Final - Video - March 21st, 2015
- Testosterone Replacement Therapy - Dr. G - Video - March 19th, 2015
- Living Well: Testosterone therapy good idea or not? - March 14th, 2015
- New studies fail to find cardiovascular risk with testosterone therapy - March 10th, 2015
- Testosterone Replacement Therapy for Men | AAG Health Gains - March 9th, 2015
- AM I HIDING SOMETHING? Where's My Blood work? | TRT Update - Video - March 6th, 2015
- Andropause and Testosterone Replacement Therapy - Video - March 5th, 2015
- Treat Low T Symptoms w/ Testosterone Replacement Therapy - February 23rd, 2015
- The LIFE*MOD Podcast With Dr. Gonzalez - Testosterone Replacement Therapy Part 1 - Video - February 12th, 2015
- Is testosterone replacement therapy safe? Take a look at ... - February 7th, 2015
- testosterone replacement therapy online | Find a testosterone replacement therapy online - Video - February 1st, 2015
- testosterone replacement therapy clinics | Find a testosterone replacement therapy clinics - Video - February 1st, 2015
- Introduction to Testosterone Replacement Therapy (TRT) - Video - February 1st, 2015
- what is testosterone replacement therapy | Find what is testosterone replacement therapy - Video - January 31st, 2015
- From Wellness and Prevention to Testosterone Replacement Therapy - Video - January 31st, 2015
- Testicular cancer - Testosterone replacement therapy - yourprivates.org.uk - Video - January 31st, 2015
- Testosterone Replacement Therapy testimonial - Dr. Retzler Portland Oregon - Video - December 25th, 2014
- Dr. Allens Device Boost Mens Wellbeing by Treating Enlarged Prostate & Chronic Prostatitis, While Testosterone ... - December 10th, 2014
- Carey Danis & Lowe Weighs in on Testosterone Gel Safety - November 26th, 2014
- Testosterone Replacement Therapy (TRT) - Danger & Play - November 7th, 2014
- Testosterone Replacement Therapy for Women | eHow - November 4th, 2014
- Testosterone Replacement Therapy For Young Men - Thumotic - October 30th, 2014
- Lipocine Announces Positive Top-line Results From Phase 2a Study Of LPCN 1111 - October 13th, 2014
- Cleveland Clinic: Testosterone Replacement Therapy - October 1st, 2014
- Strict Limitations May Be Coming for Low Testosterone Treatment - October 1st, 2014
- Testosterone Replacement Therapy (TRT) Update - New Test Results - Video - September 28th, 2014
- Testosterone Replacement Therapy | Dr. Richard Gaines - Video - September 20th, 2014
- It's Time To Cross The T's... - September 19th, 2014
- Endocrine Society Tells FDA Testosterone Therapy Should Only Be for Men with Hypogonadism - September 18th, 2014
- Testosterone Replacement Therapy | AAG HealthGAINS - Video - September 12th, 2014
- Warning over risks associated with testosterone replacement therapy - August 15th, 2014
- Is testosterone replacement therapy right for you? | Fox News - August 7th, 2014
- Do you need low T therapy? - August 7th, 2014
- Testosterone replacement therapy |Mens Medical New York PC ... - July 9th, 2014
- Low sex drive - or erectile dysfunction? - June 25th, 2014
- 1513 Hormone Replacement Therapy for Men - Video - June 13th, 2014
- Seen At 11: Testosterone Replacement Therapy Could Come With Serious Side Effects - Video - May 11th, 2014
- Are Low-T Drugs Putting Patients At High Risk? - May 10th, 2014
- Seen At 11: Experts Urge Caution When Using Popular Hormone Replacement Therapy - May 10th, 2014
- Viewer Mail - Testosterone Replacement Therapy/TRT Not Natty, Balls Busted, etc. - Video - May 4th, 2014
- NJ-Based Law Firm Exploring Potential Legal Claims from Side Effects of Testosterone Replacement Therapy - May 1st, 2014
- Testosterone Replacement Therapy in Men - myVMC - April 30th, 2014
- Acrux falls 15% on sales warning - April 28th, 2014
- Testosterone Replacement Therapy | Total T Clinic | 858-519-5509 - Video - April 26th, 2014
- Low Testosterone Claims: Options in a Growing Class Action Suit - Video - April 26th, 2014
- Reclaim Your Energy and Sex Drive | Testosterone ... - April 14th, 2014
- Testosterone Replacement Therapy - Video - April 12th, 2014
- FGSW - Weekly Weigh In & Update 15: Still Working On Mobility 03.31.14 - Video - April 7th, 2014
- FGSW Weekly Weigh In & Update 15 Still Working On Mobility 03 31 14 - Video - April 5th, 2014
- Discover the risk of prostate cancer with testosterone replacement therapy - Video - April 5th, 2014
- FGSW - Testosterone Replacement Therapy Update 03.27.14: An Improvement?? - Video - April 2nd, 2014
- Drug Recall Attorney at Herrera Law Firm, Inc., Comments on Reported Link Between Testosterone Drugs and Heart Attack ... - April 2nd, 2014
- FGSW - Week 14 Weigh-In & Update: Going Back To The Endocrinologist - Video - March 29th, 2014
Word Count: 1448