Risks of Testosterone Therapy
Medically reviewed by Dr. Larry Lipshultz M.D
Taking testosterone replacement therapy presents a clear health risk to your cardiovascular, reproductive, and endocrine systems. If you have a medical condition that warrants the use of prescription testosterone replacement therapy (TRT), then you should know about the possible side effects and complications associated with this form of treatment. Because TRT is a relatively new phenomenon and there are few studies of its long-term consequences, more research is needed in this area to help clear up the controversies and inconsistencies surrounding the risks of testosterone therapy.
What Are the Short-Term Side Effects of Testosterone Replacement Therapy?
People mistakenly think that prescription T is natural and therefore good for you. Some of the claims sound great, but when you look closer there are some side effects that don’t sound so good. Men taking TRT may experience one or more of the following side effects:
- Acne or oily skin
- Breast enlargement
- Fluid retention
- Urinary symptoms, such as decreased frequency or stream
- Worsening sleep apnea
- Testicle shrinkage
- Hair loss
- Increase in red blood cell count
- Mood swings and increased aggression and irritability
- Changes in cholesterol and lipid levels
- Reduction in sperm count, which can affect fertility
Under a doctor’s scrupulous care, the side effects of T can be at least managed. Somewhat. But let’s be clear: T is a serious, system-altering drug, and more and more frequently, some doctors are voicing concerns about how little research exists about its long-term effects.
The worst reports suggest that prescription T can potentially do serious, long-term, irreversible damage to your cardiovascular, reproductive, and endocrine systems.
What Are the Long-Term Consequences of Testosterone Replacement Therapy?
For now, research into the long-term effects of this treatment course is scarce. However, already there is some evidence that testosterone replacement therapy can increase the risk of stroke and heart attack.
A 2013 study in the Journal of the American Medical Association reported that men taking the hormone had a 30 percent higher risk of death, heart attack, or stroke compared with men not taking the hormone replacement. Although some studies have challenged this finding, it did not stop the Food and Drug Administration from subsequently issuing a warning requiring manufacturers of prescription testosterone “to add information to the labeling about a possible increased risk of heart attacks and strokes in patients taking testosterone.” Other long-term risks include:
- blood clots
- liver problems
- breast growth
- increased risk of heart disease
- worsening of urinary symptoms
You also need to protect your family members from your T therapy as the warning label suggests, “Women and children should avoid skin contact with treated areas, as accidental transfer may cause unwanted hair growth.”
In addition, about 40 percent of men who take T develop polycythemia, or high blood cell count, which causes a thickening of the blood—which in turn, can increase the risk of blood clots, stroke, and heart attack. A study published in 2010, found that older men taking T had nearly five times the risk of cardiovascular problems as men taking a placebo. Another study from 2013 concluded that cardiovascular risk went up for men over sixty-five who took the drug. In 2014, with these findings in mind, the FDA launched an initiative to reassess the safety of prescription T.
One side effect that many doctors and advertisers do mention, is that T therapy causes your testicles to shrink, and your own natural hormone production to shut down temporarily—or in some cases permanently (depending on how long you’re on the drugs, and how much you take). It can mean that once you start, you’re on prescription T for the rest of your life.
This is part of what makes anti-aging clinics such a safe business proposition: unlike Viagra, which you may be able to take or leave, T can skew your system so that, now and forever, your body will need supplemental T.
The latest warning from the FDA concerning testosterone replacement therapy came on October 25, 2016, when the agency issued a statement saying that all testosterone products must have a label pointing out the possibility of abuse and dependence associated with its use. The FDA noted that “Abuse of testosterone, usually at doses higher than those typically prescribed and usually in conjunction with other AAS [anabolic androgenic steroids] is associated with serious safety risks affecting the heart, brain, liver, mental health, and endocrine system.”
Among the reported serious side effects that may result from abuse include the following:
- heart failure
- myocardial infarction
- male infertility
Withdrawal symptoms have been reported and can include fatigue, depression, irritability, loss of appetite, insomnia, and reduced libido, ironically many of the same symptoms associated with low T.
Some experts worry that testosterone replacement therapy may follow the same route as hormone replacement therapy did for women. You may remember reports on how after decades of women taking hormone replacement therapy for symptoms of menopause, researchers discovered that the treatment presented a higher risk of stroke, heart attack, blood clots, dementia, lung cancer, breast cancer, colorectal cancer, and urinary incontinence. Could similar long-term side effects be found to be associated with testosterone replacement someday? Some health professionals fear they may, as the FDA has pointed out.
Does T Therapy Cause Prostate Cancer and Infertility?
Even though current evidence shows that testosterone therapy doesn’t cause prostate cancer, research indicates that it may make an existing prostate cancer worse, or hasten its growth. That’s worrisome, especially given the mounting evidence that many of us over forty are walking around with slow-growing prostate cancer that probably won’t affect us during our lifetime—unless, of course, some external factor causes its growth to accelerate.
Another great irony is that by reducing and sometimes shutting down your body’s natural T production, supplemental T also decreases fertility. Adding testosterone to the body spurs a process that impedes sperm production—in some cases, perhaps even permanently. In one 2013 study, thirty-four men who had been seeking treatment for infertility agreed to stop taking the supplemental T they had been prescribed as part of their treatment. The result? Sperm count jumped from 1.8 million to 34 million per milliliter in most of the subjects. In six of them, it didn’t bounce back at all. T has even been studied as a possible method of birth control— because a reported 90 percent of men can drop their sperm count to zero while on it. The take-home lesson: if you think you might want more biological kids—ever—don’t touch T.
Finally, because T hasn’t been researched long-term, there really is no telling what the side effects of the drug will ultimately be—and, indeed, whether supplemental T for more-or-less healthy men eventually goes down in history as a huge mistake that we could have avoided.
What’s The Bottom Line?
Here’s the bottom line on all this: For men with clinical hypogonadism (low T count and symptoms), supplemental T can be a godsend. For the rest of us, it’s a huge mistake. Although many ethical physicians prescribe T judiciously (only after a patient has complained of symptoms and a test reveals unquestionably low T), an increasing number of doctors have started prescribing T without even so much as a blood test, and only upon hearing of the vaguest symptoms (“low energy,” or “just not as excited about sex anymore”). Though state regulations dictate what constitutes low T, the sizable window for “normal” levels allows doctors to top off a patient right to the upper limit of 1,000 ng/dL—a sky-high T level that could represent four times the patient’s natural production.
Before beginning a potentially dangerous and addicting prescription T habit, at least consider trying some of the natural T treatments or the 30-Day Natural T-Boost Program to increase your own body’s testosterone production first.
References for Risks of Testosterone Therapy:
Food and Drug Administration. FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. 2016 Mar 3
Food and Drug Administration. FDA Drug Safety Communication: FDA approves new changes to testosterone labeling regarding the risks associated with abuse and dependence of testosterone and other anabolic androgenic steroids (AAS). 2016 Oct 25
Vigen R et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA 2013 Nov 6; 310(17): 1829-36