As with any treatment or medication, there is a certain risk of side effects. However, with testosterone, the amount that is taken, the frequency that it is taken, and additional supportive therapies can, in most cases, prevent side effects. Let’s break down each misconception and potential side effect piece by piece:
- First, let’s address the misconception that testosterone replacement increases your risk of cardiovascular disease, in which the heart is not healthy or functioning well. Initially, it was claimed that high levels of testosterone were associated with heart disease.Previous studies on this subject were flawed, however, because the test subjects had pre-existing heart and mobility issues, making them predisposed to heart disease. More recent research, however, has shown that low testosterone can actually lead to an increased risk of disease. When dosed and maintained at optimal levels, cardiovascular disease risk can actually be reduced (1). To date, there is no evidence to support that TOT causes increased risk of heart and stroke in any man under 65. In a meta-analysis of randomized placebo-controlled trials, it was found that TOT does not increase cardiovascular disease, heart attack, or stroke (2). A 2017 study found that there currently is no evidence that testosterone therapy increases cardiovascular risk and substantial evidence that it in fact does not (1). So, as long as you do not have a known history of cardiovascular disease, starting testosterone will be safe.
- Next, let’s talk about the misconception that testosterone causes prostate cancer. When initially starting testosterone, especially transdermal applications, there may be an increase to your Prostate Specific Antigen or PSA. At first, providers ascribed to the “Androgen Hypothesis” that asserts that prostate cancer is driven by androgens or male hormones, and so TOT could potentially drive cancer growth. More recently, however, research has shown that there is no increase in prostate cancer incidence among men on TOT. Furthermore, there has been no discernable increase in disease progression in patients with pre-existing prostate cancer while on TOT (3). A 2006 study showed that in aging men with late-onset hypogonadism (LOH), six months of TOT normalizes serum androgen levels, but appears to have little effect on prostate tissue androgen levels and cellular functions(4). In 2009, a study found that the incidence of prostate cancer among men with LOH on TOT is no greater than that in the general population(5). We will always monitor your PSA at Regenics as recommended, but recent studies have shown that there is not an increased risk of prostate cancer growth.
- Finally, let’s discuss the issue of testicular shrinkage and infertility when on testosterone. Taking testosterone by injection is referred to as exogenous, meaning it comes from outside the body. We also produce our own testosterone, which is called endogenous, meaning it comes from inside the body. When there is more exogenous testosterone from injections, the body must signal to the brain that we do not need to make more of our own endogenous testosterone. This occurs by a negative feedback loop that results in a decrease of luteinising hormone (LH) and follicle stimulating hormone (FSH). These are two hormones released from the pituitary gland and are sent to the testicles to produce sperm and testosterone. When the negative feedback loop reduces LH and FSH, the testicles will produce less sperm and testosterone. Overtime, this may result in a non-harmful decrease in the size of the testicles. For many men, this is not a problem, but if fertility and testicle size want to be maintained, there are additional medications that we can use to achieve this, typically through Human Chorionic Gonadotropin (hCG).
- Now, let’s talk about specific side effects that testosterone can cause. One of the frequently discussed side effects is that testosterone replacement may cause mood issues, especially increased anger or aggression. Keep in mind, testosterone is a hormone that dictates male sex characteristics, including behavior and mood. Using exogenous testosterone, specifically in excess, may lead to increased emotions such as anger or aggression. When testosterone is optimized and within normal limits, however, this effect is greatly reduced. Additionally, if estrogen levels increase, a person may experience more moodiness, including sadness or depression. Estrogen may increase especially if testosterone is excessively high, as this increases the aromatization or conversion of testosterone to estrogen. Again, if testosterone dosing and blood levels are optimized, this effect is significantly reduced.
- Another frequently discussed potential side effect of testosterone therapy is gynecomastia. Gynecomastia is the over-development of the male breast. This can occur when estrogen levels increase. Estrogen can increase as a result of obesity because fat tissue causes more conversion of testosterone to estrogen. Additionally, having too much testosterone may lead to a higher rate of aromatization, or the conversion of testosterone to estrogen. If testosterone is dosed and managed well, gynecomastia can be prevented. If needed, there are medications to prevent the conversion of testosterone to estrogen, in the case that dosing changes are insufficient.
- Finally, let’s address issues with hair loss and acne. Male pattern baldness (MPB) is driven by your genetic makeup and using testosterone can speed up this process, if you are already genetically prone to this. This is because as testosterone increases in the body, there is more dihydrotestosterone (DHT), which is a modified, more active form of testosterone. DHT can shrink the hair follicles as well as shorten the hair replacement cycle, causing hair to grow out looking thinner and more brittle, as well as fall out faster. DHT also increases oil production in the skin’s sebaceous glands, which can lead to an increase in acne. Just as with baldness, if you are genetically inclined to have acne or had acne as a teen, then there is a higher likelihood that acne will occur. There are, however, effective treatments for acne as well as dietary changes that can be greatly beneficial. While DHT may cause hair loss or increased acne and medications exist to reduce DHT production, it is still important for it to remain in the body because it is essential for proper brain chemistry and sexual function.
Ultimately, like any medication or treatment, there is a certain degree of risk of side effects. However, as discussed, most of the issues with testosterone arise when the hormone is used in excess, at which point the body is overloaded and issues can occur. At Regenics, it is always our goal to use as little testosterone as needed to restore youthful levels of hormone and minimize side effects.