November 16th, 2015
Testosterone replacement therapy can improve mood, energy levels, and libido in men who have low testosterone. However, therapy for replacement of testosterone is associated with side effects and the risks over the long term are not well understood. Men may have low testosterone levels without symptoms, simply as a result of the aging process. Current medical guidelines do not recommend treatment of low testosterone that is unaccompanied by symptoms. Testosterone supplements are not recommended for treatment of men who have normal age-related declines in testosterone.
Different forms of testosterone replacement include a transdermal, or skin, patch. This patch is usually applied to the upper body or arm once a day. There are also clear testosterone gels that are applied to the skin, allowing direct absorption of the testosterone through the skin. One gel, Natesto, is applied to the inside of the nose and testosterone is then absorbed through the mucus membrane of the nasal cavity. A mouth patch can also be used to replace testosterone. It is a small tablet that adheres to the area of the gums above the incisors and it is applied twice daily, allowing absorption of testosterone across the oral mucous membrane. Intramuscular injections are often used for testosterone replacement, and there are implantable pellets that allow slow release of testosterone into the bloodstream. Oral testosterone may be riskier, as there is some evidence it can cause liver damage. By avoiding the gastrointestinal tract, the testosterone can be directly absorbed by patches or injections to by pass the liver.
Local reactions at the site of application of testosterone gel or patches include rashes, itching, and irritation. Although long clinical trials have not been done to determine the long-term risks and benefits of testosterone replacement therapy, there is some evidence that the risk of stroke or heart attack may be increased with the treatment.
There are several health conditions that may be exacerbated by treatment with testosterone replacement therapy. These include prostate cancer and benign prostatic hypertrophy. Benign prostatic hypertrophy refers to the enlargement of the prostate that often occurs with aging. As the prostate enlarges, the urethra (the tube that carries the urine from the bladder to outside the body) can become compressed. This will result in difficulty with urination and can even result in complete obstruction. The prostate gland is responsive to testosterone, so testosterone replacement therapy can make this problem worse.
Prostate cancer often grows in response to testosterone; so many men with prostate cancer undergo therapy with hormones to counteract testosterone production. Prostate cancer is very common as men age, so men who are considering testosterone replacement therapy should undergo screening for prostate cancer before they begin treatment with testosterone. Men who have elevated prostate specific antigen should not begin testosterone replacement treatment.
Other conditions that can become worse with testosterone replacement therapy are blood clots, congestive heart failure, and sleep apnea. Before considering testosterone therapy, discuss these risks with your doctor.
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