As with any medical intervention, the benefits of Low T therapy must be weighed against the potential risks of adverse reactions or “side effects.” As Paracelsus indicated, whether testosterone replacement creates a beneficial or harmful environment is largely dependent on how the treatment is delivered and dosed.
When abused, testosterone and other androgens can lead to significant, even life-threatening side effects. Similarly, if Low T treatment is mismanaged or not carefully monitored, individuals may experience an increased rate and severity of adverse reactions or a lack of meaningful results.
This discussion primarily focuses on the side effects associated with testosterone replacement therapy (TRT) in general but also addresses some differences in treatment methods for Low T.
Why Side Effects Occur with Low T Treatment
Some side effects of TRT are directly related to the use of exogenous testosterone (testosterone not naturally produced in the body). Many side effects occur only when testosterone levels are elevated, and others are simply the results of the body’s normal metabolism of testosterone. This breakdown happens in the same way for both exogenous and endogenous testosterone (naturally produced testosterone), but increased testosterone levels can lead to higher-than-normal levels of certain metabolites.
TRT Side Effects: DHT and Estradiol
Testosterone metabolism results in its conversion into two primary metabolites: dihydrotestosterone (DHT) and estradiol (E2, a form of estrogen). Elevated DHT levels can cause benign prostate growth, increased oiliness of the skin, acne, and male pattern balding. Abnormal increases in estradiol may lead to mood swings, breast tissue changes, and fluid retention, potentially causing swelling or high blood pressure. Additionally, abnormal estradiol levels have been linked to lower testosterone levels, erectile dysfunction, and a decrease in free testosterone.
TRT Side Effects: Prostate Changes
Prostate changes can occur with testosterone therapy, but a study published in The Journal of Clinical Endocrinology & Metabolism in June 2010 found no increased risk of developing prostate cancer, prostate-related urinary symptoms, or elevated PSA (prostate-specific antigen). However, because PSA is a tumor marker for prostate cancer, individuals with a family history of prostate cancer or elevated PSA levels should proceed with caution and be monitored closely.
For men with a personal history of prostate cancer, Low T treatment is considered contraindicated. It is important to note that testosterone replacement does not “cause” prostate cancer but may lead to more aggressive growth of existing prostate lesions.
TRT Side Effects: Suppression of Fertility
The production of testosterone and sperm is controlled by the Hypothalamic-Pituitary-Gonadal Axis. When testosterone levels are normalized, whether naturally or through treatment, the brain reduces the stimulus to produce testosterone by secreting less GnRH (gonadotropin-releasing hormone). This reduction can suppress fertility, as GnRH controls the secretion of FSH and LH, which are necessary for sperm production. This process can also lead to a reduction in testicle size and/or firmness.
TRT Side Effects: “Blood Thickening” and Other Effects
Other side effects include increased red blood cell counts (erythrocytosis), potential decreases in HDL (good cholesterol), and increased diastolic blood pressure. The effects of high blood pressure are well-known, and erythrocytosis can increase the risk of abnormal clotting, spleen enlargement, and heart failure.
Erythrocytosis occurs when there is an increase in the number of red blood cells without a proportionate increase in blood volume, leading to thicker blood. Hematocrit values greater than 52% increase the risk of serious conditions like clotting, heart failure, and spleen enlargement. While erythrocytosis can typically be managed, it must be monitored closely.
Other Side Effects
Some side effects are specific to the preparation used. Gels, creams, and other topical agents can cause skin irritation and secondary exposure to others, including women and children. Additionally, many men may struggle with absorption, leading to less effective treatment outcomes with topical forms.
What Can Be Done About It?
Every medical treatment carries the potential for adverse reactions. However, the side effects of testosterone replacement therapy are manageable. With careful monitoring, significant problems can be prevented or treated.
Ultimately, the key is balance. It is possible to approach Low T treatment in a way that minimizes side effects while optimizing results. Open and honest communication about both the benefits and risks of testosterone replacement is essential to achieving this balance.
