What Should You Know About Testosterone Replacement Therapy?

Testosterone levels decline gradually with advancing age due to a number of reasons. Depending upon the cause, testosterone levels respond to different type of therapies. In some men, testosterone can get back to normal levels by reducing extra pounds which can be done via healthier and physically active life style whereas some men will require testosterone replacement therapy. Sometimes, testosterone levels decline due to another underlying medical condition and treating that disease or problem can restore normal levels of testosterone. In United States, some doctors prescribe testosterone therapy (off-label) to treat low T related sexual problems in women.

Testosterone Replacement Therapy

Testosterone is administered in different ways, including:

• Daily application of gels or patches on skin
• After every few weeks Intra muscular injections are administered either by doctor or self-administration.
• 12 hourly application of buccal system (tablet shaped patch) in between lips and upper gums.
• A more advanced and new type of testosterone therapy is testosterone pellets which are placed beneath the buttocks skin and hormone is released for three or four months.

To find out how well a person is responding to the given therapy, regular blood examination is required.

Risks Associated With Testosterone Therapy

Testosterone replacement therapy is less likely to produce any adverse effects when given to treat male hypogonadism – a condition in which problems in pituitary gland or testicles restricts the body from secreting enough testosterone.

But, when given to boys with delayed puberty, it can stop the growth of bones and cause premature fusion which results in dwarfism. Therefore, adolescents must be examined after every 6 months for bone development.

Sometimes low T is due to the old age factor. In such case testosterone replacement therapy, can induce a number of side effects such as:

• Promote growth of existing prostate cancer
• Benign prostatic hyperplasia
• Decreased production of sperms
• Breast enlargement
• Skin problems like acne
• High risk for deep vein thrombosis, heart attack and strokes
• Aggravated sleep apnea

FDA Safety Warning

A safety alert regarding the use of testosterone replacement therapy due to age related low T was issued by FDA in March, 2015. Evidence suggests that men who use testosterone containing drugs have much higher risk of developing strokes, heart attacks and even death. Since there is much hype about testosterone replacement therapy and it is being used extensively without any appropriate reason, FDA recommends healthcare professionals to prescribe these drugs only when there is a medical condition leading to low T and it is confirmed via laboratorial tests.

If men experience symptoms such as shortness of breath, pain in chest, slurred speech or weakness on one side or part of body they should immediately seek medical help.

Risks To Women And Children

The testosterone therapy associated risks in women are not known much clearly however, it is thought to be linked with breast cancer (no decisive evidence). Getting in contact with towels, clothes or skin of a men using testosterone gels can harm women and children. Children if exposed to testosterone drugs may develop male secondary sexual characteristics i.e. enlargement of genitals, hair growth in pubic area, aggression and increased libido. While women when exposed to these drugs may get acne, irregular periods, body hair growth, male pattern baldness or other manly features. Its use is not safe during pregnancy or lactation. Since it is associated with birth defects, pregnant ladies should stay away from such products as much as possible and if they have contacted such preparations accidently, skin should be washed thoroughly with soapy water.

Contraindications

Testosterone replacement therapy is prohibited in following conditions:

• Existing or suspected prostate cancer
• Breast cancer
• Liver or kidney disease
• Heart disease

References

• Hackett, G., Cole, N., Bhartia, M., Kennedy, D., Raju, J., & Wilkinson, P. (2013). Testosterone replacement therapy with long‐acting testosterone undecanoate improves sexual function and quality‐of‐life parameters vs. placebo in a population of men with type 2 diabetes. The journal of sexual medicine, 10(6), 1612-1627.
• Pastuszak, A. W., Pearlman, A. M., Lai, W. S., Godoy, G., Sathyamoorthy, K., Liu, J. S., … & Khera, M. (2013). Testosterone replacement therapy in patients with prostate cancer after radical prostatectomy. The Journal of urology, 190(2), 639-644.