The Pros and Cons of Testosterone Therapy
By Matt McMillen
Reviewed by Michael W. Smith, MD on February 04, 2020
“I do see some men who are more hesitant to take testosterone supplementation,” says Michael Eisenberg, MD, director of the Stanford Male Reproductive Medicine and Surgery Program at Stanford Health Care in Palo Alto, CA. “We talk about the risks, as that’s what we’ve gotten more information on in recent years.”In 2014, the FDA ordered that a warning label must accompany TRT prescriptions, alerting men to the possibility that TRT increases the chances of heart attack and stroke. More recently, a study linked TRT to higher chances of venous thromboembolism, a potentially fatal type of blood clot.And there are other concerns. Does TRT improve symptoms linked to low testosterone? In January of this year, the American College of Physicians released new practice guidelines that outlined the limited benefits men are likely to get from TRT. The doctors’ group found that TRT offered slight improvements to sexual and erectile function; they found no other benefits.Eisenberg says that studies of TRT’s benefits and risks have had mixed results and provide limited answers. Does it improve fatigue, for example? It’s unclear. “We counsel men that it’s not clear whether TRT will help,” Eisenberg says.
However, Eisenberg stresses that men with very low testosterone have a higher chance of developing heart disease, osteoporosis, and other problems if they go untreated.“There are health implications for very low levels,” he says. “It’s very important to have an open discussion about the benefits and the risks of HRT.”
Ask Your Doctor
Could something other than low testosterone explain my symptoms?Yes. Low libido and erectile dysfunction, for example, have many contributing factors to rule out, including heart disease and psychological issues.If I do start TRT, how long until I know it’s helping?Your doctor should confirm within 6 months or so whether TRT has improved your symptoms. If it hasn’t, discuss ending treatment.Will TRT affect my ability to father children? Yes. TRT decreases sperm production. Stop therapy, and fertility likely will return. In a small number of men, infertility is permanent.Can I do anything to elevate my testosterone naturally? If you are overweight or obese, weight loss and, perhaps especially, exercise may help boost your levels without medication.Find more articles, browse back issues, and read the current issue of WebMD Magazine.