Testosterone and the myths of TRT

by | Aug 26, 2021

imageWhat do you know about TRT? It seems that there are so many sources out there touting both pros and cons of the treatments, so what to believe? Let’s see if we can dispel some of the more common myths.

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Testosterone Replacement Therapy, or TRT, is the process of literally replacing testosterone levels to normal, healthy levels. The aim of TRT is to improve symptoms of testosterone deficiency such as decreased libido, erectile dysfunction, depression, anemia, and loss of muscle and bone mass. Unfortunately, we know that a man’s testosterone steadily declines after the age of 30 and low testosterone is becoming more common than ever before according to a study in the Journal of Clinical Endocrinology and Metabolism. This study showed that testosterone levels in men have rapidly declined in the last 20 years meaning an average testosterone level in a 60 year old male in 1989 was higher than that on average of a 60 year old male in 1995. This showed to be the same over a range of ages.

#1 One common myth is that since it is “natural” for testosterone to decline with age there is no reason to treat it.

It’s true! We do know that levels decrease with aging. But it is also true that a low testosterone level can increase your risk for diabetes, abdominal obesity, sexual dysfunction, depression, and heart disease. Not addressing a low testosterone level just because it is natural for it to decrease over time would be like not regularly checking and changing the oil on your car. With time and use, oil in a car breaks down and becomes less effective and can cause decreased effectiveness of your car. Same with testosterone. Lower levels can lead to a number of physical problems not only in sexual function with decreased libido and erectile dysfunction, but also increased body fat, reduced muscle mass, back pain, fatigue and loss of energy. TRT can reverse these symptoms and keep your engine running effectively for years to come!

#2 Another myth is that TRT will make the patient become overly aggressive and angry.

It should be known that many of the early studies on testosterone were done in prisons…an environment where concerns of violent behavior and aggression exists anyways. Many studies have been performed, since those done in the 1970s, to see if levels of testosterone can be associated with male “typical” behaviors. More recent studies are consistently showing that therapeutic ranges of testosterone used for clinical purposes are not associated with changes in anger or aggressive behavior. While behavior changes may be present with those abusing medications that will enhance testosterone levels without medical supervision, it is clear with recent studies that men being treated for hypogonadism, or low testosterone levels, actually report and present with increases in their well-being and mood.

#3 If I start testosterone replacement therapy, I won’t ever be able to stop.

There are many factors and considerations made when deciding to treat each patient. Usually, men are seeking treatment due to symptoms. If TRT is improving those symptoms, it’s likely the patient will WANT to continue treatment as they are feeling better and their symptoms are alleviated or improved. Should you opt to discontinue treatment, that can be done at any time. That decision will be discussed with your provider and it is preferred to taper off the treatment over a few weeks. As you taper, your body will restart its natural production of testosterone. With that said, when a patient opts to discontinue treatment, it is important to remember that your testosterone will return to the levels that were present pre-treatment and the symptoms that accompany a low testosterone level will return. Continuing treatment will prevent those undesirable symptoms from occurring.

#4 Taking testosterone will give me breasts or make me lose my hair.

Generally, male pattern baldness is a genetic condition and affects approximately 80% of the male population. This pattern of baldness is usually due to the actions of DHT, which is similar to testosterone but more powerful. DHT occurs from the breakdown of testosterone. With that said, in a man predisposed to male pattern baldness TRT may accelerate the process as it may increase the level of DHT. Conversely, TRT has shown to increase growth of facial and body hair. In men who are showing signs of hair loss, there are medications that can slow the male pattern baldness progression.

There are many medications as well as alcohol and marijuana use that can result in increased male breast tissue. Basically enlarged breast tissue, or gynecomastia, is mediated by estrogen. Those on TRT may have an increase in their estradiol levels by the process of aromatization which can lead to gynecomastia. Patients who present with this condition can be placed on either over-the-counter or prescription aromatase inhibitors which will reduce the condition and/or prevent it from occurring. Careful monitoring of hormone levels can often prevent this condition.