Should You Get Testosterone Replacement Therapy?

Everyone's getting TRT. But Is It Safe or Necessary?

You may have come across ads for TRT promising renewed vigor, youthlike virility and muscle gains like you’ve never seen. 

TRT or testosterone replacement therapy is a treatment typically prescribed for men with testosterone deficiency, or what’s called adult-onset hypogonadism in medical circles.

But a lot of these ads from men’s health clinics say that any man can benefit from TRT. Feeling a little fatigued these days? Come on over. Feel like your libido has been on a downward trend? You need TRT ASAP. Want to feel like a MAN? TRT is the answer.

But is that true really? 

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Aging ≠ Testosterone Deficiency

TRT is only recommended for men with diagnosed testosterone deficiency. 

Testosterone deficiency is defined as T levels below 300 nanograms per deciliter (ng/dL) accompanied by symptoms of low T such as low libido, fatigue, depression and delayed ejaculation among others.

Some experts recommend turning to TRT only when levels are below 230 ng/dL. 

T levels go down naturally as we age and lifestyle factors like diet, body fat content, smoking and exercise can further influence our T levels. 

But a majority of men do not have low enough T levels to warrant TRT. Changing your lifestyle is usually enough to boost T levels and maintain them at a healthy range. Things like more strength training, getting good sleep and eating T-boosting foods.

Just because you are feeling more tired than usual or your performance in bed has been unsatisfactory doesn't mean that you should go on testosterone replacement therapy. This is part of normal aging and doesn't always indicate hypogonadism. 

If you are worried about your T levels, first get a testosterone test. You can get it done at a clinic or you can order an at-home testosterone test kit. 

Do at least two tests early in the morning. This is when T levels are highest. Based on your test results plus your symptoms, your doctor may prescribe TRT.

They may also opt against TRT and instead recommend specific lifestyle adjustments for a period to see if there are any improvements. 

Risks of TRT

TRT has huge benefits for men with low testosterone. It boosts moods, increases energy levels, helps with focus and concentration and allows men to enjoy higher sexual satisfaction. 

So why not get every dude to try a testosterone shot, patch or gel? Shouldn’t we all enjoy these benefits, especially as we age?

There are two reasons doctors are cautious about recommending TRT. 

One, there isn’t any evidence that TRT offers any benefits to men with normal T levels. In other words, increasing your testosterone beyond normal levels does not confer any additional benefits. You will not get extra-energetic or become super strong. 

Two, TRT comes with potential risks that are not worth it if you do not need the treatment. 

Granted, TRT is not as dangerous as some older studies suggested. There were claims that it increased the risk of heart attack and stroke, and could allow prostate cancer cells to grow. 

Newer studies have found these risks not to be as high as suggested. But we still do not fully know what long term health risks TRT carries. If you have cardiovascular disease risk factors such as diabetes, family history and smoking, discuss it with your doctor before using TRT. 

The same is true if you’ve been diagnosed with prostate cancer or have recovered from it.  

TRT and Male Fertility

What we know for sure is that TRT is bad for male fertility, which is ironic considering it’s used to improve sexual function. 

Essentially, TRT acts as male contraception through a negative feedback mechanism.

Adding TRT to your body triggers a switch in your brain (in the hypothalamus, to be specific) that reduces the production of gonadotropin releasing hormone (GnRH). Lower GnRH, in turn, causes lower production of luteinizing hormone (LH) and follicle stimulating hormone (FSH). 

LH and FSH are essential hormones in the production of sperm in the testicles. With less of these hormones being produced, your sperm count goes down. 

If you are planning to achieve pregnancy soon, avoid TRT or stop it if you’ve already started. It can take up to a year and sometimes two years for your sperm count to fully recover after stopping TRT. 

TRT and Low Testosterone

Along with reduced sperm count, TRT also affects the body’s ability to produce its own testosterone. That’s why men with hypogonadism typically have to stay on TRT for life. 

If your T levels are normal and you take TRT, your natural testosterone drops and stays low for some time after you stop treatment. It takes a while for your natural testosterone to bounce back. So you may feel worse after stopping TRT than before you went on it. 

Takeaways

• Common issues that come with aging don’t always mean you have testosterone deficiency. Do not start TRT before you are tested. Definitely do not go for off the shelf TRT treatments. Get a prescription. 

• Experts are uncertain about the long term health risks of TRT. So if you don’t really need it, don’t use it. 

• For a lot of men experiencing symptoms of low T, lifestyle changes such as diet, exercise and sleep are enough to bring their T levels back up without any of the risks and side effects associated with TRT. 

• If you have diagnosed testosterone deficiency, then TRT is a great way to reverse the effects of low T.