Rejuvenate Blog

Why Testosterone Replacement Therapy For Men?

Low testosterone (low T) or hypogonadism is a common condition in older men.  Testosterone levels are at their peak during the teens and 20’s and then sometime after the age of 30 the levels begin to decline at a rate of about 1-2% per year.  There are exceptions with the occasional young man experiencing hypogonadism and some older men maintaining adequate production.  But in general, as a man ages he can expect his T levels on average to be going in only one direction, and it isn’t up.

Treating a low testosterone condition can lead to many potential health benefits including the prevention of several serious health conditions.  Lower levels of testosterone are correlated with a higher incidence of diabetes, insulin resistance, metabolic syndrome, cardiovascular disease and dementia, among others.  As with all the positive benefits mentioned in the box above it is about quality of life and maintaining optimal functioning, mentally and physically, for as long as possible, whatever one’s length of life.  After a short time on testosterone replacement therapy (TRT) it is common to hear patients report an overall greater sense of well-being.  It plays a critical role in helping one to achieve a more ideal body composition, essentially less fat and more lean muscle, which is associated with an overall healthier state.

Sounds good so far?  But maybe you’ve heard negative press on TRT, that testosterone can have many side effects and maybe even be dangerous! Possibly you’ve even been told this by your own doctor.

It’s true that many doctors are reluctant to treat low testosterone let alone even test for it. This is primarily due to being reliant on old, outdated assumptions and outright misinformation. What little research and studies done in the past were very limited and poorly designed. As can often occur in the world of medicine much that is professed as fact year after year may be mostly based on “leaps of logic” rather than actual human studies.  An example of this was the standard recommendation by medical doctors that if you have high cholesterol then you must avoid eating eggs.  This seems logical due to eggs containing cholesterol but after decades of this supposed obvious truth the actual human studies on the subject did not validate this assumption.  Eating cholesterol does not typically raise blood cholesterol levels because most of the cholesterol in our bodies is produced by our liver and when taken in through food it just means the liver doesn’t have to make as much in order to maintain the same level of cholesterol in the blood.  Or how about, for decades, condemning the use of butter and recommending instead to replace it with margarine.  Was that based on science?  Well, in the end apparently not!  Margarine is loaded with trans fats which are a well-established risk factor in heart disease. There could be example after example of medical dogma that eventually meets its demise after finally being scrutinized and put to the test with objective well designed scientific studies. 

Now, back to testosterone.  Firstly, we must acknowledge that testosterone is a natural human hormone produced by the body for beneficial purposes.  In other words, it’s there for a reason.  Also, that the human body seems to work much more efficiently when at a younger age with optimal hormone levels vs when older with lower hormone levels.  We also must understand that hormones are extremely powerful substances having a profound impact on human (or any living creature’s) physiology.  So, why would it provide so many health benefits to the younger human body and not to the older? 

Regarding the tendency for most medical doctors to either ignore the subject of testosterone replacement or to strongly discourage its use can typically be related to the side effects that have been associated with TRT.  As with any powerful substance there can be side effects if not used correctly.  The confusion lies in the fact that many doctors believe these potential side effects are the direct result of testosterone when most often they are indirect effects and as a result of poorly managed treatment, whether through patient error or doctor mismanagement.  When TRT is done correctly and appropriately through an experienced physician in hormone replacement then most potential side effects need not occur. 

Certainly, the overuse of testosterone or other anabolic hormones by body builders and some athletes have not helped its reputation. You may also hear warnings that testosterone could cause prostate cancer or contribute to heart disease.  Thus far, studies do not find a correlation with testosterone use, let alone naturally high levels of testosterone and prostate cancer.  In fact, there is a slight tendency to a higher prevalence of prostate cancer in those with the lowest levels of testosterone.  Consider this; why is it that young virulent men at the peak of their testosterone production do not tend to come down with prostate cancer and yet older men with much lower testosterone are the ones with the increased risk?  As I tell my patients, aside from making sure that the testosterone is within the safe and healthy range there are two primary factors that must be monitored and managed for effective and safe testosterone replacement.  These are monitoring and controlling estrogen levels and monitoring and controlling red blood cell count or something called hematocrit which is the measure of the thickness of the blood (primarily due to the number of RBC’s or solids in the blood).  While we’re on the subject, this is why it is so critical that anyone in need of testosterone replacement must search out a physician very experienced in this area.  It is not brain surgery, but it does need to be done right and when managed correctly one should expect to experience the health benefits without the side effects.  Regarding the heart disease concern, this is most likely only due to the RBC count mentioned above.  Testosterone is one of many substances involved in the production of red blood cells and when one’s T levels are higher there is a tendency for increased red blood cell production and therefore higher blood counts.  The majority of men do not experience much increase but regardless, this is why it is crucial that red blood cell-counts and hematocrit be checked on a regular basis, typically every 3-4 months.  Why this is of concern is because the thicker the blood the more tendency to clot along with the higher risk of stroke.  As long as the hematocrit is kept within the reference range there should be no concern of any additional cardiovascular risk.  In fact, testosterone has been shown to play an important role in heart health and the prevention of heart disease.  Consider this fun fact; the heart is a muscle; testosterone strengthens muscle and the heart has more receptor sites for testosterone than any other organ in the body.  It was designed to need testosterone.

What about estrogen?  This is the other of the two critical factors that need to be monitored and controlled with TRT.  First off, yes guys you do have some estrogen, just as women have some testosterone.  The amounts and ratios are what makes the difference.   Of course, as men we do not want too much of the female hormone (or am I being presumptuous?).  Why would higher testosterone levels be associated with higher estrogen levels?  Simple, the only source of estrogen in the male body is through the conversion of testosterone to estrogen (more specifically estradiol).  The more testosterone in your body the more raw material it has to make estrogen out of.  This varies individual to individual but those experienced in TRT know the importance for testing and for preventing the overproduction of estrogen.  Through the years when I have new patients coming in who have already been prescribed testosterone by their family physician I always ask if they are being monitored for their estrogen level (and hematocrit) and more often than not they do not recall any mention of the subject.  I am pleased that their doctor recognized the patient’s need for TRT and willingness to prescribe testosterone but still concerned about the poor management of their therapy.  There is much more that can be discussed regarding testosterone and all the specifics related to successful use of this hormone.  Once hypogonadism is detected via blood testing then everything is clearly explained and all questions answered before any treatment begins.  The decision to initiate TRT is based primarily on the blood test results but also along with the signs and symptoms of testosterone deficiency being experienced.  The ultimate decision is then made by both the doctor and patient together.