A New Way to Approach Testosterone Replacement Therapy (TRT)

As men age, it’s common for their testosterone levels to decrease, prompting many to explore testosterone replacement therapy (TRT) as a means to reclaim vitality and sexual drive. However, the discussion around TRT is multifaceted, with ongoing debates about its benefits and potential risks. While some studies have raised concerns about TRT’s association with cardiovascular problems, more recent research has provided conflicting evidence, suggesting that TRT may not pose the same risks as previously thought. This is results in confusion and frustration for so many people suffering with symptoms related to low testosterone.

Despite these evolving findings, the decision to pursue TRT should be carefully considered, weighing the potential benefits against the uncertainties regarding its long-term effects. Although TRT has been linked to a higher incidence of prostate cancer in the past, recent studies have not found a significant correlation, providing some reassurance to potential candidates. Similarly, the supposed cardiovascular risks have not been found to be causally linked to TRT definitively.  Is there risk? Yes, probably for some. Do we know what the risk actually is? Not really.  Especially when we are dealing with patients who have no chronic medical conditions, the risk actually appears to be low to none. The most important factor is the provider managing the TRT.  Wide variability in the management of TRT among clinicians is cause for concern for many men.  It is imperative to find an experienced TRT provider who will closely monitor the patients biomarkers and symptoms.

Determining eligibility for TRT involves assessing testosterone levels, typically below 300 ng/dL, along with the presence of symptoms such as fatigue and sexual dysfunction. Does this mean that a man with a total testosterone level of 500 shouldn’t receive TRT, even if he has symptoms of low testosterone? Testosterone deficiency is way more nuanced that just a total testosterone level.  A more thorough look at the sex hormones, including sex hormone binding globulin (SHBG), free testosterone, and estrodiol are important.  Many men will have a middle range total testosterone level with a really low free testosterone, which is the testosterone that is actually bioavailable.  These patients are extremely common and deserve a deep evaluation, rather than a quick total testosterone check. However, it’s essential to recognize that TRT is not always the immediate solution. Addressing underlying factors contributing to low testosterone, such as sleep, diet, obesity or medication side effects, may offer alternative strategies to naturally boost testosterone levels.

While TRT has shown promise in improving sexual function, its impact on overall vitality may be more nuanced. Research suggests that while TRT may enhance certain aspects of sexual health, its effects on mood and energy levels may be modest. This underscores the importance of managing expectations and considering other lifestyle modifications in conjunction with TRT.

Practical considerations also come into play when deciding on TRT, including the mode of administration—whether through gels or injections—and the potential side effects associated with each method. We could write an entire article dedicated to the various methods to deliver testosterone with associated positives and negatives.  Suffice it to say that there are numerous ways to achieve good testosterone levels, each with their own high points and low points.

Despite the potential risks and benefits of TRT, it’s crucial to approach treatment with caution and to be aware of the need for ongoing monitoring and evaluation. It is important to choose a provider who has extensive experience in prescribing and managing TRT.  Your provider should discuss your individual situation and obtain a thorough blood evaluation to determine a good path forward.  Not every patient is a good candidate for TRT and given the lifelong nature of treatment, it should not be jumped into lightly.  TRT takes a lot of personal ownership as well as partnership with an expert TRT provider.

In summary, while TRT offers a potential great solution for age-related declines in testosterone levels, it’s essential to weigh the benefits against the uncertainties and to explore alternative strategies for managing symptoms. Ultimately, the decision to pursue TRT should be made in consultation with a healthcare provider, considering individual health needs and preferences.