The Pros and Cons of Testosterone Therapy

The number of men who take testosterone has dropped dramatically in the past few years, in part because of growing awareness of the risks that may accompany it. Should you avoid it?

Testosterone, a hormone, helps men maintain muscle, bone health, libido, and the ability to perform in the bedroom. But beginning in their mid-30s, men lose an average of just under 2% per year. Eventually, that drop could lead to hypogonadism, or low testosterone. This happens to 1 in 5 men in their 60s, and the likelihood rises as men get older. Testosterone replacement treatment (TRT) aims to boost those low levels back up.

But TRT has had its ups and downs in the past 2 decades. From 2001 to 2013, prescriptions rose by 300% following marketing efforts that proclaimed it could restore energy, alertness, mental focus, and sexual function. Then, over the next 3 years, the number of men taking it dropped by half as studies revealed potential risks, particularly to heart health.

“I do see some men who are more hesitant to take testosterone supplementation,” says Michael Eisenberg, MD, director of the Stanford Male Reproductive Medicine and Surgery Program at Stanford Health Care in Palo Alto, CA. “We talk about the risks, as that’s what we’ve gotten more information on in recent years.”

In 2014, the FDA ordered that a warning label must accompany TRT prescriptions, alerting men to the possibility that TRT increases the chances of heart attack and stroke. More recently, a study linked TRT to higher chances of venous thromboembolism, a potentially fatal type of blood clot.

And there are other concerns. Does TRT improve symptoms linked to low testosterone? In January of this year, the American College of Physicians released new practice guidelines that outlined the limited benefits men are likely to get from TRT. The doctors’ group found that TRT offered slight improvements to sexual and erectile function; they found no other benefits.

Eisenberg says that studies of TRT’s benefits and risks have had mixed results and provide limited answers. Does it improve fatigue, for example? It’s unclear. “We counsel men that it’s not clear whether TRT will help,” Eisenberg says.

However, Eisenberg stresses that men with very low testosterone have a higher chance of developing heart disease, osteoporosis, and other problems if they go untreated.

“There are health implications for very low levels,” he says. “It’s very important to have an open discussion about the benefits and the risks of HRT.”