Signs You Shouldn't Take Testosterone Therapy
Easy ways to get low T therapy, like patches and gels, make treating low testosterone seem deceptively simple. Yet it's far from risk-free.
“There is big money pushing men to use testosterone as an energy boost," said Bruce Gilbert, MD, an adjunct clinical professor of urology and reproductive medicine at Weill Cornell Medical College in New York City. "Some men can benefit and will feel better on testosterone, but the risks of testosterone therapy can outweigh the benefits if you are not careful about who gets treated." Dr. Gilbert is also a professor of urology at the North Shore-LIJ School of Medicine and director of reproductive and sexual medicine at the Smith Institute for Urology at the North Shore-LIJ Health System in Great Neck, N.Y.
In fact, a 2013 study published in the American Medical Association’s journal JAMA added to concerns about the risks of testosterone therapy for men. The study followed more than 1,000 men who had low testosterone, went through coronary angiography (a test to evaluate coronary heart disease), and were treated with testosterone therapy. The researchers found that, subsequently, the men had a
significantly higher rate of stroke and heart attack than a similar group of men with low testosterone and coronary angiography who were not treated with testosterone.
“Men may think that testosterone replacement therapy is the answer to feeling tired or having a tired sex life," said Richard Harris, MD, chief of urology at Gottlieb Memorial Hospital in Melrose Park, Ill. "In most cases, those symptoms are a normal part of aging and a normal part of life. Testosterone therapy is not the fountain of youth."
When Testosterone Is Not the Answer
Testosterone therapy comes with risks, and it's not appropriate for all men. Certain situations and certain health conditions make testosterone therapy less than a good idea and worthy of a talk with your doctor. These include:
If you have low T only. A man’s testosterone level starts to fall naturally after age 40. There's a difference between a natural decline, which often accelerates after age 60, and actual low T. “We measure testosterone with a blood test," said Dr. Gilbert. Still, having a low number without symptoms is not enough reason to treat low testosterone, he added.
If you have symptoms only. Symptoms of low testosterone may include low energy, low mood, loss of your sex drive, and poor erections. “About 25 percent of men take testosterone without ever having a blood test," Dr. Harris said. "Symptoms alone tell you nothing. You need to have low testosterone proved by blood tests along with symptoms to benefit from treatment."
If you have prostate cancer. “Testosterone therapy does not cause prostate cancer, but it can make prostate cancer grow," said Gilbert. "It might be like adding flame to the fire." According to guidelines from the Endocrine Society, you should not take testosterone if you have prostate cancer. If you have been successfully treated, you may be able to take testosterone, but you need to talk with your doctor. Although rare in men, breast cancer is another reason not to take testosterone.
If you have benign prostate disease. The Endocrine Society also warns against taking testosterone if you have severe urinary tract symptoms caused by an enlarged prostate or if your doctor finds a lump on your prostate gland during a digital rectal exam. Testosterone makes your prostate grow, which can increase symptoms of benign prostate disease. This is not an absolute red light for testosterone therapy, but you need discuss this risk with your doctor.
If you want to have children. “A younger man who may want to have children needs to know that taking testosterone can lower his sperm count and decrease his fertility," Gilbert warned. "
When you take testosterone, your brain shuts down natural testosterone production by your testicles. You may get bigger muscles but smaller testicles." Loss of sperm occurs after about 10 weeks of testosterone therapy.
If you have polycythemia. This is a condition in which you have too many red blood cells. Testosterone therapy can make polycythemia worse because testosterone stimulates the production of red blood cells. Polycythemia can also be a side effect of testosterone therapy. And, it makes your blood thicker, which increases your risk for a heart attack or stroke. If you've been diagnosed with this condition, you should not take testosterone.
If you have sleep apnea. “Untreated sleep apnea may get worse with testosterone therapy,” Gilbert said. Sleep apnea involves brief but frequent periods of interrupted breathing while sleeping, often accompanied by loud snoring. If you have symptoms of sleep apnea, you should have a sleep study done to get formally diagnosed and try treatment with continuous positive airway pressure (CPAP). If this treatment doesn't work, you should not take testosterone.
If you're seriously overweight. “Men who are 30 to 40 pounds overweight often have low testosterone," Harris said. "But this is not a reason to take testosterone therapy. Losing weight is a much healthier and effective solution."
Side Effects of Testosterone Therapy
Risks and side effects of testosterone therapy may be reasons not to have the treatment or be reasons to stop if you've started. Make sure to ask your doctor about them. They include breast enlargement, acne, and skin reactions related to the testosterone gels, patches, and injections.
If you can get by the risks and side effects of testosterone therapy, your doctor will still need to make sure you are safe on testosterone. “Most men can tolerate treatment well, and many men do get benefits, but you need to keep watch,” Gilbert said.
Monitoring and screening should include periodic blood tests to monitor your testosterone levels, digital rectal exams to check your prostate, testing your blood for prostate-specific antigen to check for prostate cancer, and blood tests to check your red blood cell level, called a hemoglobin and hematocrit.
“Finally, even if you do everything right, testosterone just does not work for some men," Harris said. "If you don’t feel any better after a trial of testosterone therapy, that’s another reason not to take it.”
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Originally Posted by Sister Miriam Godwinson
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