What Are The Risks of Testosterone Replacement Therapy?

The deluge of ads and infomercials pushing testosterone replacement therapy for men with low T or symptoms associated with it have convinced many consumers that testosterone replacement therapy is the answer to their concerns, even though very few men actually meet the medical criteria for needing this form of treatment. One question all men who are considering this approach should ask themselves is if the risks of testosterone replacement therapy are worth the potential and demonstrated health problems the hormone therapy may cause.

Risks of testosterone replacement therapy

What risks are we talking about? Let’s begin with the findings of a new US multicenter study that involved 700 men age 65 or older. All of the participants had moderately low testosterone without any obvious medical cause for their levels. Half of the men used testosterone gel while the other half were given a placebo gel. After being monitored for one year, here’s what the investigators found.

On the positive side, men who used testosterone replacement therapy showed an increase in bone density, which lowered their risk of experiencing bone fractures and osteoporosis. More specifically, they showed an increase in trabecular bone mineral density of the lumbar spine and better bone strength when compared with placebo.

It’s been shown that older men with a testosterone deficiency often have low hemoglobin levels and sometimes mild anemia. Researchers found that testosterone replacement therapy was associated with an improvement in hemoglobin levels among men who had mild anemia when they entered the study. This benefit held true even among men who had a coexisting cause of anemia.

On the negative side, use of testosterone was linked to an accumulation of a significant amount of noncalcified coronary artery plaque in the heart’s blood vessels when compared with men in the placebo group. This suggests an increased risk of heart disease, but the authors emphasized that larger clinical trials are needed to better understand these findings.

Another negative finding was a lack of any significant change in memory or cognition. Some previous studies have suggested that testosterone replacement therapy may lead to improved cognition, but this latest effort did not find this to be true. Compared with men who took placebo, those who used testosterone gel showed no significant improvement in memory or other cognitive functions.

Based on all of these findings, a spokesperson for the UK Society for Endocrinology noted that “The message here is to select the correct patients who will benefit from testosterone therapy, but not treat it as a wonder drug,” which is often how it is portrayed by the media. In fact, the best way to tackle low testosterone is by lifestyle methods, including diet, exercise, stress reduction, adequate sleep, avoidance of alcohol, and other measures. The European Association of Urology, for example, recommends treating other causes of low testosterone, such as obesity or poor nutrition, before considering testosterone replacement therapy.

Other possible risks of testosterone replacement therapy

Some of the other possible risks and side effects of testosterone replacement therapy include development of acne or oily skin, fluid retention, possibility of increased urinary symptoms (e.g., urinary urgency or frequency), aggressiveness and mood swings, worsening of sleep apnea, reduction in testicular size, breast enlargement, and increased risk of blood clots. Men who are thinking about trying testosterone replacement therapy should be sure they understand all of the possible risks.


Budoff MJ et al. Testosterone treatment and coronary artery plaque volume in older men with low testosterone. JAMA 2017; 1317(7): 708-16

Resnick SM et al. Testosterone treatment and cognitive function in older men with low testosterone and age-associated memory impairment. JAMA 2017; 317(7): 717-27

Roy CN et al. Association of testosterone levels with anemia in older men: a controlled clinical trial. JAMA Internal Medicine 2017 Feb 21

Snyder PJ et al. Effect of testosterone treatment on volumetric bone density and strength in older men with low testosterone: a controlled clinical trial. JAMA Internal Medicine 2017 Feb 21

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