Testosterone Replacement Therapy (TRT) has become an increasingly popular treatment for addressing the symptoms of low testosterone levels, such as fatigue, decreased libido, and loss of muscle mass. However, the decision of when to initiate this therapy is critical, as starting TRT too early can have a host of implications. In this article, we will discuss the scientifically proven advantages and potential dangers of early TRT initiation.
Advantages
Improvement in Mood and Energy Levels:
One of the primary benefits of TRT is the improvement in mood and energy levels. Men with low testosterone levels often report feeling fatigued and depressed. A study conducted in 2012 showed that TRT could significantly improve the mood and reduce symptoms of depression in hypogonadal men (1). Hypogonadal simply means the testes don’t produce enough testosterone; however, we know that men who seek TRT aren’t always clinically “low.”
Men often seek TRT as they age because their testosterone levels are lower ( which is a natural part of aging ) and want that “pep” back. This will help with strength and endurance improvements in the gym returning to one’s former glory. Any introduction of substances that increase your testosterone will improve mood and energy, but lower testosterone doesn’t mean that your systems aren’t functioning properly. You have to speak to your doctor about tracking trends and seek these improvements with TRT when medically necessary.
Increased Muscle Mass and Bone Density:
TRT has been shown to have a positive impact on muscle mass and bone density. This is particularly beneficial for individuals with conditions that cause muscle wasting or osteoporosis. A 2017 review highlighted that TRT effectively increased lean body mass and had a positive effect on bone mineral density in men with low testosterone levels (2). Keep in mind that advantages from TRT studies are often caveated with a sample segment that isn’t always you. If your levels aren’t particularly low then the benefits mentioned won’t impact you in the same way. Medicine, as always, is a mixture of science and art. Some doctors will prescribe TRT before others would. An endocrinologist would likely follow medical norms whereas those doctors you see labeled with “anabolic” or a “cage” may choose some liberties based on research they support. That is not to suggest that what you or your doctor is doing is unsafe. It simply means that medicine is a broad spectrum and the benefits you may see from muscle mass and bone density will vary depending on your prescription.
Enhanced Sexual Function:
Low testosterone levels are associated with a decrease in libido and erectile dysfunction. TRT has been found to improve sexual desire and function. A study conducted in 2016 concluded that TRT significantly improved all aspects of sexual function in men with low testosterone levels (3).
Dangers
Fertility Complications:
One of the major concerns associated with initiating TRT too early is its potential impact on fertility. Testosterone therapy can suppress the production of sperm. A study conducted in 2013 revealed that men who started TRT experienced a significant decrease in sperm count, which in some cases led to infertility (4). With that said, while there are conflicting studies you have to ask yourself, “would this matter?” If you are considering TRT you are likely closer to 45 than 20, in which case child rearing is less and less likely. While recent trends for people having children later in life, this may become more of a factor but you have to self assess if this risk is worth not going on TRT. There are drawbacks with not going on TRT for some.
Cardiovascular Risks and Cancer risks.
There has been debate and conflicting evidence concerning the association between TRT and cardiovascular risks. Some studies suggest that TRT might be associated with an increased risk of cardiovascular events, especially in the first few months of treatment. A 2014 study showed that there was a two-fold increase in the risk of heart attack among men aged 65 years and older within the first 90 days of TRT (5). This is perhaps the most scary. It’s virtually impossible to know how your body will respond. Some studies have shown low testosterone to be a factor of negative cardiovascular health while elevated levels show the same. Being careful means being informed. Thus you can’t ignore the potential for risks.
As discussed earlier if you are considering TRT you are probably closer to mid-life, but there are people who are younger who seek TRT due to naturally low testosterone levels or the perception that a prescription for TRT mitigates legal risk. This goes back to the point about medicine being a broad spectrum of beliefs. If a doctor prescribes TRT it does reduce or eliminate legal ramifications, but the cardiovascular risk remains. These studies mentioned do not typically test younger men going on TRT.
There is also concern about the potential link between TRT and prostate cancer. Some studies have suggested that TRT might increase the risk of developing prostate cancer, although this link is still debated. A 2016 review suggested that men undergoing TRT may have a higher risk of being diagnosed with prostate cancer (6). These studies are interesting because it’s very difficult to manage all variables. Some research shows that protein intake can have a correlation to prostate cancer, so it leads us to question the TRT related research given that was not a variable mentioned (7). Can men who go on TRT be considered health conscious and thus more likely to take additional protein? Are these correlations flimsy or do they support the question on whether prostate cancer is a real risk? We think the truth is that health risks with TRT must be assessed personally. As with anything if you arrive at a bad scenario while taking TRT would that outweigh any benefits you have seen previously? It’s a hypothetical, but as with all risk, you need to own the decision you make — but do so by being informed that the potential for risks do exist. These studies aren’t suggesting you may or may not see bad outcomes — instead they suggest that bad outcomes occur to men while on TRT and that TRT could have been an important variable in the cause.
The last word
While Testosterone Replacement Therapy can be beneficial for individuals suffering from low testosterone levels, it is imperative to approach the therapy judiciously, especially when considering early initiation. The potential benefits such as improved mood, increased muscle mass, and enhanced sexual function should be weighed against the risks including fertility complications, cardiovascular events, and a possible increase in prostate cancer risk. Consulting a healthcare professional and considering personalized factors is essential in making an informed decision regarding TRT. But you also must look at the risks in comparison to the benefits. For some men the weight loss benefits can help reduce the other risks to their health. This is why we can’t look at any part of health from a one sided lens. The real science informs us of risks and benefits, but the bro-science minimizes the risks and shows us outweighed benefits. The truth is often in the middle. If you are overweight, sedentary, and or struggling to improve your health and TRT can help, it’s a benefit; however, you must know of the risks. Prostate cancer isn’t a given but some research is needed to see if there is an elevated risk for you.
Depending on how early you are considering TRT can have a big impact on your risk profile. When you approach your doctor know that not all doctors have the same risk profile as other doctors. That is why some doctors won’t touch TRT for a certain age range. Have an honest conversation with your doctor, know the risks, and try to keep an open mind while seeking your desired outcome.
References
- Shores, M. M., Kivlahan, D. R., Sadak, T. I., Li, E. J., & Matsumoto, A. M. (2012). A randomized, double-blind, placebo-controlled study of testosterone treatment in hypogonadal older men with subthreshold depression (dysthymia or minor depression). The Journal of Clinical Psychiatry, 73(7), 959-965.
- Traish, A. M., Haider, A., Haider, K. S., Doros, G., & Saad, F. (2017). Long-term testosterone therapy improves cardiometabolic function and reduces risk of cardiovascular disease in men with hypogonadism. The Journal of Cardiovascular Pharmacology and Therapeutics, 22(5), 414-433.
- Corona, G., Rastrelli, G., Morgentaler, A., Sforza, A., Mannucci, E., & Maggi, M. (2016). Meta-analysis of Results of Testosterone Therapy on Sexual Function Based on International Index of Erectile Function Scores. European Urology, 72(6), 1000-1011.
- Kohn, T. P., Louis, M. R., Pickett, S. M., Lindgren, M. C., Kohn, J. R., Pastuszak, A. W., & Lipshultz, L. I. (2017). Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy. Fertility and Sterility, 107(2), 351-357.
- Finkle, W. D., Greenland, S., Ridgeway, G. K., Adams, J. L., Frasco, M. A., Cook, M. B., … & Derby, C. A. (2014). Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One, 9(1), e85805.
- Kaplan, A. L., & Hu, J. C. (2016). Use of testosterone replacement therapy in the United States and its effect on subsequent prostate cancer outcomes. Urology, 94, 42-48.
- Ye Mao, Yan Tie, and Jing Du Association between dietary protein intake and prostate cancer risk: evidence from a meta-analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6058353/
Disclaimer: This article is intended for informational purposes only and is not meant to serve as professional medical or fitness advice. The information provided should not be used for diagnosing or treating a health problem or disease. It is not a substitute for professional care or consultation with qualified healthcare or fitness professionals. If you have concerns about your health or fitness, please consult with a healthcare or fitness professional before making any changes to your training, nutrition, or lifestyle. The author and publisher disclaim any liability or responsibility for any loss, damage, or injury that may occur as a result of following the information provided in this article.
