To hear and see the advertisements on TV, radio, the internet, and in print, you’d think that testosterone replacement therapy is the aging man’s answer to just about everything: better sex, more energy, enhanced libido, improved muscle strength and tone, youthful athletic performance. Who wouldn’t want to sign up for it given the hype! However, the question remains: is testosterone replacement therapy safe and effective?
As with many things, the cart was pushed way ahead of the horse, so to speak, and now the scientific research is trying to catch up with the claims that have been made for years about testosterone replacement. One reality experts are facing is that many men who are being prescribed TRT don’t have abnormally low levels of testosterone, a medical condition known as hypogonadism or androgen deficiency. This is the medical reason for which the treatment is supposed to be ordered.
In fact, untold numbers of men who are taking TRT have not even had their testosterone levels checked. They are exposing themselves to health risks with no scientific proof of beneficial return.
Is testosterone replacement therapy safe and effective?
To answer this question, we can turn to the results of the Testosterone Trials, which consisted of seven controlled, randomized clinical trials. The findings of three trials were published in The New England Journal of Medicine in February 2016 while those of the other four appeared online in early 2017 by the Journal of the American Medical Association and JAMA Internal Medicine.
All 705 men who completed the studies were aged 65 or older and had low testosterone levels (275 ng/dL or lower) and symptoms typically associated with low T. The low hormone levels were attributed to age and not hypogonadism.
In each trial, the men were randomly assigned to use either a 1 percent testosterone gel or a placebo gel applied daily to the skin for one year. The men were then follow-up for one year after the active period. Investigators wanted to identify whether testosterone was safe and effective regarding a number of factors. Their findings were as follows:
- Sex drive. A modest improvement in sex drive was seen, but it tended to decline over a year. The authors commented that testosterone replacement therapy did not seem to be as effective as oral drugs taken for erectile dysfunction.
- Erections. Again, a modest improvement in erectile function was experienced, but the gains were not sustained over the year. Improvements also were not as significant as those reported by men who take oral ED drugs.
- Energy levels. Researchers did not see any changes in energy or vitality levels between the testosterone and placebo groups.
- Physical function. The men’s walking speed was measured for this factor, and no difference was seen between the two groups.
- Heart health. Scans showed that men in the testosterone group had more accumulation of plaque in their arteries than did men in the placebo group, which places them at greater risk of heart attack or stroke. This finding is consistent with those in earlier studies.
- Bone health. Men in the testosterone group who had normal bone density at the beginning of the trial showed a significant gain in bone mineral density and strength after one year when compared with the placebo group. Because the study lasted only one year, it’s uncertain whether this improvement in bone density will translate into a reduction in fractures.
- Brain health. Use of testosterone did not result in any memory or cognition benefits. There were, however, some small and significant improvements in mood and depression.
- Anemia. The development of anemia (abnormally low red blood cell numbers) in some aging men has been puzzling to experts. In a subgroup of men (126) in this study who had anemia of known and unknown causes, it was shown that testosterone treatment significantly increased their hemoglobin levels.
Testosterone replacement therapy risks
The results from these seven trials show that testosterone replacement therapy does not appear to be effective and is even not safe when it comes to heart health. Other risks associated with TRT from past studies include breast augmentation, unwanted hair growth, infertility, acne, an enlarged prostate, and an abnormal rise in red blood cells levels (erthrocytosis). Men with sleep apnea, prostate cancer, heart failure, or an enlarged prostate should avoid TRT because it may worsen their condition.
Alternatives to testosterone replacement therapy
Lifestyle modifications have been shown to help relieve symptoms associated with low testosterone. Such changes, which can include alterations to diet, regular exercise, stress management, social interactions, and weight loss can provide benefits for overall health as well as address symptoms of low testosterone.
Related: The 30 Day Natural Testosterone Boosting Program That Guarantees Results
Read more in our Low T Health Center.
Budoff MJ et al. Testosterone treatment and coronary artery plaque volume in older men with low testosterone. JAMA 2017 Feb 21; 317(7): 708-16
Snyder PJ et al. Effects of testosterone treatment in older men. New England Journal of Medicine 2016; 374:611-24