As men age, testosterone levels may decline leading to a host of symptoms such as sexual dysfunction, lack of energy, and depression. Low testosterone levels can even alter overall body composition by contributing to loss of muscle mass and increased weight gain. When testosterone supplements are given to men with documented testosterone deficiency, the effects can be gratifying. There is an immediate improvement in mood and general outlook as well as a substantial boost in energy level. While these positive benefits are certainly desirable, is supplementation really safe? What are the risks of testosterone replacement therapy?
Testosterone replacement therapy was once regarded with scrutiny because of the fear that giving testosterone supplements could increase the risk of prostate cancer; but recent studies have shown this fear to be unfounded. Giving testosterone supplements for low testosterone levels doesn’t appear to significantly alter the risk of prostate cancer. In fact, testosterone replacement may actually lower the risk of some diseases. Low testosterone levels are frequently seen in men with diabetes and heart disease, although this doesn’t prove that low testosterone causes these conditions, the association is intriguing.
Testosterone deficiency in men also increases the risk of osteoporosis, a disease that affects six out of every hundred males. Even more compelling is a study that shows that men with low testosterone levels may actually live shorter life spans. Of course, there are other issues such as sexual function and overall sense of well being which are improved with testosterone supplements.
What about the risks of testosterone replacement therapy? Although testosterone supplementation doesn’t appear to increase the risk of prostate cancer, it can cause enlargement of the prostate, a condition known as benign prostatic hypertrophy or BPH. In some cases giving testosterone replacement therapy might cause an undiagnosed prostate cancer to become apparent by stimulating prostate growth. In rare cases, men taking testosterone can develop enlarged breast tissue or changes in mood. Testosterone supplements can also cause an elevation in the red blood cell count, a finding that usually isn’t significant.
All in all, the risks of testosterone replacement therapy are small compared to the benefits it could give a man experiencing depression, lack of energy, and sexual dysfunction related to a low testosterone level. Keep in mind that this applies only to men who have a low testosterone level (less than 200 ng/dl) confirmed by a blood test. Testosterone should never be used in men who have normal hormone levels.
Are the risks of testosterone replacement therapy worth it? It may be for some men, particularly now that prostate cancer risk appears to be less of an issue. The bottom line? Talk to your doctor if you’re experiencing symptoms of testosterone deficiency and have a blood level checked. If it’s low, you and your doctor can explore the possibility of supplementation.
Clinical Geriatrics. July 2009. pages 22-27