Testosterone Therapy To Keep You Younger Risks

Testosterone is a naturally occurring powerful hormone that has amazing effects on the rejuvenation and revitalization of biological tissues. There has been claims that testosterone therapy can also reverse the physiological signs of aging, which probably explains why a lot of people today consider exogenous testosterone replacement therapy to feel younger and more exuberant.

Classic benefits of testosterone replacement therapy are:

Improvement in sexual vigor and stamina
Positive changes in the energy levels and libido
Improvement in bone density, body composition and muscle mass

Testosterone therapy also improves mood, cognition, intellectual capacity and synthesis of red blood cells (also known as erythropoiesis). Several other research studies also suggested that testosterone therapy improves the quality of life and overall life expectancy in hypo-gonadal males.

Indications Of Testosterone Therapy

Due to extensive popularity of testosterone therapy as an anti-aging hormonal agent, many males (and some females as well) choose testosterone replacement therapy. Some classic indications of testosterone therapy are:

Low or sub-normal levels of testosterone levels due to physiological aging.
Hypogonadism (due to an organic condition of pituitary, hypothalamus or testicles). According to latest estimates, approximately 2 to 4 million males in United States are currently living with hypogonadism. However, according to a study reported in New England Journal of Medicine (1) only 5% males suffering from hypogonadism consider testosterone replacement therapy.
Symptomatic andropause (such as hot flashes, mood swings, negative changes in libido)

Risks Associated With Testosterone Therapy

Despite all the positive hype and potential benefits on physical and physiological health, several clinical studies suggests that exogenous supplementation of testosterone carries several risks. Most statistically significant adverse effects of testosterone therapy are:

Cardiovascular dysfunction: There has been scientific evidence that testosterone replacement therapy can aggravate the risk of developing cardiovascular disorders in otherwise healthy males over the age of 65 years. According to another study reported in the Journal of American Medical Association (2) investigators suggested that the risk of death due to a coronary event is higher in heart patients who are on testosterone therapy. According to another study, testosterone replacement increases the risk of sudden death due to stroke or myocardial infarction in middle-aged to elderly males with preexisting cardiac condition.
Sleep apnea: This potentially serious sleep disorder is characterized by sleep disordered breathing that is marked by sudden cessation of breathing during deeper stages of sleep. The affected person experiences intermittent cerebral hypoxia (poor oxygen saturation of brain tissue). Data suggests that testosterone therapy can cause sleep apnea in high risk group.
Stimulation of noncancerous growth of prostate gland and high risk of prostate cancer: There has been reports that testosterone replacement can promote cancer growth in high risk group. Although the evidence is somewhat conflictive, yet experts recommend strict cancer surveillance in males receiving the therapy (4).
Formation of blood clots in the veins: Testosterone supplementation may have a profound effect on erythropoiesis (production of red blood cells), which may contribute to deep vein thrombosis in susceptible subjects; however, according to a new study reported in the Journal of the American College of Cardiology (5), scientists provided statistical evidence that very low-dose testosterone therapy does not seems to increase the risk of DVT in males.

Other common risks associated with testosterone therapy include enlargement of male breasts and compromised production of sperms. Study reported in the Journal of Urology (4) suggested that intramuscular injection therapy with human chorionic gonadotropin can reduce the negative effects on spermatogenesis caused by testosterone therapy.

Despite the controversies surrounding the use of testosterone therapy, there has been a 500% increase in the prescription of testosterone in males since 1993 (1).

Should I Consider Testosterone Therapy?

Due to potential risk of adverse effects, the US Endocrine Society and the American Association of Clinical Endocrinologists is strictly against the use of testosterone supplementation in males with no clinical deficiency or requirement of testosterone. If you are considering testosterone therapy; here is what you should do:

Evaluate if you really need testosterone therapy to live a normal life.
Weigh potential pros against cons after discussing your case thoroughly with your primary care provider
Make sure your symptoms (such as poor libido, lethargy, lack of energy) are not due to other health reasons such as obesity, diabetes, stress, medications or illicit drugs.

Some tips to reduce the risk of adverse effects are:

Keep up with your regular follow up appointments to make sure you are not developing any signs of cardiac dysfunction or other complications.
Consider bioidentical hormone replacement therapy.
Avoid other drugs/ hormonal analogues that may cross-react with your therapy.
Choose low-dose local therapy; such as gels or patches over oral formulations.

US Food and Drug Administration is further investigating the risk and benefit profile of testosterone replacement therapy in susceptible males.

References:

1. Rhoden, E. L., & Morgentaler, A. (2004). Risks of testosterone-replacement therapy and recommendations for monitoring. New England Journal of Medicine, 350(5), 482-492.

2. Vigen, R., O’Donnell, C. I., Barón, A. E., Grunwald, G. K., Maddox, T. M., Bradley, S. M., … & Rumsfeld, J. S. (2013). Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. Jama, 310(17), 1829-1836.

3. Surampudi, P. N., Wang, C., & Swerdloff, R. (2012). Hypogonadism in the aging male diagnosis, potential benefits, and risks of testosterone replacement therapy. International journal of endocrinology, 2012.

4. Hsieh, T. C., Pastuszak, A. W., Hwang, K., & Lipshultz, L. I. (2013). Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. The Journal of urology, 189(2), 647-650.

5. Sharma, R., Oni, O., Barua, R., Sharma, M., Sharma, R., Chen, G., & Gupta, K. (2015). EFFECT OF TESTOSTERONE REPLACEMENT THERAPY ON INCIDENCE OF DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM. Journal of the American College of Cardiology, 65(10_S).